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Monthly Archives: June 2020
This Is The Evolution Of The Honda Civic Type R | HotCars – HotCars
Posted: June 17, 2020 at 2:00 am
The Honda Civic Type R just keeps getting faster with age, but no matter which year you opt for, this performance Civic will give you a thrilling ride
The talented engineer Honda Soichiro founded the Honda Technical Research Institute in 1946 to produce small engines. The Honda C-100, a small-engine bike, was introduced 7 years later and by 1959 was the best selling motorcycle in the world. While the company is a leading motorcycle manufacturer, the bulk of its sales come from automobiles, which Honda started producing in 1963. Among its fuel-efficient cars have been the Civic and Accord.
The Honda Civic Type R is one of the hottest hatches in the world. Its red badge has been a symbol of Japanese engineering marvel and performance. It comes in a lightweight body and features upgraded chassis and brakes. The car had been a forbidden fruit in the US ever since the introduction in 1997. But in 2017, the US could finally get its hands on the Type R. This is why we love the Honda Civic Type R.
The 1997 EK9 was the first Civic to get the Type R nameplate. Under the hood sat a B16B engine boasting the highest power output per liter of all time for a naturally-aspirated unit. It delivered 182 hp at 8.200 rpm. For the first time the company used seam welded monocoque chassis.
In 2001, Honda unveiled the EP3 to the UK market, which was a hot 3-door hatchback. It featured a 197-hp 2.0L engine and a unique treatment of upgraded brakes and seam welding. Thanks to these enhancements, the EP3 could hit 60 mph in 5.8 seconds and get to a top speed of 141 mph.
In 2003, Honda decided to celebrate 30 years of the Civic by offering a unique Civic Type R. These models were available in silver, black, and red. Only 300 units were made, 100 in each color. Under the hood sat the same 2.0L engine that pushed the car to 100 mph in 15.1 seconds.
RELATED:New Civic Type R Limited Edition To Conquer the 'Ring
In 2005, Honda released the final Premier Edition EP3 Type R with tinted rear windows and enhanced interior materials. The car left the factory with one of the Honda's best engines, the K20 2.0-liter naturally-aspirated four-cylinder unit that was good for 212 hp. Today, these models are starting to fetch good money.
For the first time, the Civic Type R was sold as a four-door saloon. The engine generated 222 horsepower at 8.000 rpm and 159 lb. ft. of torque at 6.100 rpm. According to Honda, the chassis was 50% more rigid than those in previous Type Rs. Aluminum was extensively used to save weight.
The 2007 FN2 was offered only in Europe as a three-door hatchback and used unique chassis and internal layout. The car offered 198 horsepower at 7.800 rpm and 142 lb. ft. of torque at 5.600 rpm. Thanks to aluminum body panels, its curb weight was only 2.910 lbs. It rode on 19-inch Rage alloys.
The 2015 FK2 was powered by the Direct Fuel Injection 1,996 cc turbocharged inline-four engine with a power output of 306 hp and maximum torque of 295 lb. ft. The engine was mated to a six-speed manual transmission. According to Honda, the car could hit 62 mph in 5.7 seconds.
RELATED:Hondata Unveils Hardcore Civic Type R Tuning Packages
The 2016 Honda Civic Type-R was a real deal - a raw and aggressive hatch. It was the second time the Japanese company turbocharged the Civic, taking everyone's favorite car to a new level. To match its racer looks, the Type-R packed a 2.0L VTEC engine delivering 228 kW and 400 Nm.
The 2016 Mugen Type R was an aerodynamic package for the Civic. It included unique front canards and side skirts, an upgraded rear diffuser, and a new front lip spoiler. All parts were made of carbon fiber with a carbon fiber hood as an option. A new exhaust system featured a monstrous pipe.
The 2017 Civic Type-R was an entirely different car American enthusiasts lusted for. The turbocharged 2.0L engine was at its core to break from the old-style performance. The unit cranked out 306 horsepower and 295 lb. ft. of torque. Honda said there were 3.117 pounds to pull around, and the engine did it without a hiccup.
The 2017 FK8 got the same turbocharged engine as its predecessor but the power was increased to 316 hp. The engine was paired with a six-speed manual transmission to continue the tradition of previous Type Rs. With a top speed of 169 mph, it was the fastest Civic Type R to date.
RELATED:2020 Honda Civic Type R Receives Performance, Styling Updates
In 2017, the Type-R achieved a lap time of 7:43.80 on the Nrburgring and set a record for the fastest front-wheel-drive car. It also won many awards. It was voted "International Editors Choice and overall Car of the Year 2017." What Car also awarded the Type R its Hot Hatch of the Year award.
The 2018 Civic Type-R featured a massaged version of the tried and tested 2.0L turbocharged engine good for 306 hp and 295 lb. ft. of torque. According to drivers who've tested the car, the torque came on nicely and resulted in ample hustle. With the exhaust pipes the size of cannons, the noise wasn't overpowering.
In 2019, Honda finally perfected the performance of the Civic Type R by prioritizing chassis tuning. The powertrain is a six-speed manual transmission paired with a turbocharged four-cylinder engine. This setup delivers 306 horsepower, which is more than enough to fill your stomach with butterflies. The hatchback gets to 60 mph in 4.9 seconds.
The 2020 Honda Civic Type-R features an exclusive turbocharged four-cylinder engine that makes 306 hp and 295 lb. ft. of torque. The most notable upgrades include new brake rotors to "inhibit fade during hard braking" and revised front suspension to improve steering feel. As a bonus, the 2020 model gets lots of driver-assist features.
NEXT:The Evolution Of The Honda Civic In Pictures
Next 14 European Sports Sedans We Can't Get Enough Of (1 That Sucks)
Chris is a proficient reader and writer. He has written for many publications including TheRichest, TheClever, TheQuiz, and ListVerse. Cars are his passion.
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‘A watershed moment in the evolution of Irish politics’ – RTE.ie
Posted: at 2:00 am
"Coalitions do not work, are not satisfactory and have a kind of political paralysis."
These were the words of the then taoiseach, CharlesHaughey, when he spoke to RT on the second day of the count following the general election of 1989.
Just three weeks later, havinglooked intothe abyss of another election campaign and, presumably, not liking what he saw, he signed up to acoalitiondeal with the Progressive Democrats led by Des O'Malley.
It was a watershed moment, marking the end of Fianna Fil's long-standing aversion tocoalitions.
Before then, dating to the five party plus government of 1948, coalitions had been a case of Fianna Fil versus the rest.
While itsdominance continued long afterwards, 1989 was a marker that Fianna Fil too would have to go fishing for partners like everybody else.
Coalitions of Chaos
The reputation that coalitions had for instability lasted well before and after those comments byHaughey.
Butin more recent history, coalitions shook off theirassociation withparalysis and chaos, and became more of a political fact of life.
TwoFianna Fil-PD coalitions ran for full terms between1997 to 2007,led by Bertie Ahern.
While these coalitions spanned the era of tribunals examining corruption,theyalso oversaw a period of unprecedented economic growth, the NorthernPeace Process and Ireland'sPresidency of theEuropeanCouncil.
When the public financesdisimproved, so too did their reputation for stability. The Green Party-Fianna Filcoalition formed in 2007,which had lasted four years, ended intears after the arrival of the bailout Troika.
TheLabourand Fine Gael governmentlasted from the post-crash years of 2011 to 2016. It was a term during which Ireland exited the bailout and the public finances were restored. It also oversaw the successful marriage equality referendum, which was a big policy objective of Labour.
But ultimately, the smaller party got savaged by the electorate, who blamedLabourfor its role in the implementation ofausterity measures thatwere completely at odds with their pre-election, pre-coalition promises.
The price of power
Labour, like the Green Party before it, learned the hard way that power comes with a price. In the last ten years, both went from their best ever to worst ever electoral performances after serving as a junior partner.
It seems to be the political law of gravity that the smaller party gets punished (although this has not always been the case, the PDs doubled theirseats in 2002 after serving in coalition).
The backdrop to the coalition currently being proposed means the stakes are even higher. There is a far greater number of parties and groupings, a far more fragmented Dil and therefore a more competitive playing field.
There is also the factor that the coalition proposed this time is far wider and mixed,meaning that the smaller party may not necessarily play the role of mudguard. Fianna Fil and Fine Gael could well end up doing that for each other.
While it is usually the role of the smaller party to try to preserve their "brand identity" while in coalition,by ensuring their policies are implemented,this time all three parties will be striving for status.
Put together, this means political competition both external and internal will be intense.
The new normal
While coalitions of the past have managed to reshape and remould politics, none has ever had the potential to recast politics so dramatically as the one that is currently on the cards.
It would mark not just the end of the historic Fianna Fil - Fine Gael dichotomy that has been a defining feature of our politicalhistory.
It would also mark the start of a multi/party government system that is likely to be here to stay. The coalition that will now be voted on by party members might be hard to get our heads around.
But a multi-party government isthe more organic outcome of the proportionate representation voting system which in other countries where it is practised has long since resulted in a wider number of smaller parties and multi-party governments, where policies are formed by cross-party alliances and consensus.
This trend was commented on by Michel Martin at the launch of 'How Ireland Voted'in December 2016.
At a speech to a gathering in Trinity College, he described how Irish politics is in transition, "moving away from the Westminster model of parliament" to becoming "solidly European in terms of numbers of parties and complexity of government".
If, as now seems likely, he becomes Taoiseach in the coming days it will be as a result of the process that he foresaw in the early days of the confidence and supply deal.
It will be another watershed moment in the evolution of Irish politics.
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Harry Styles’ Fashion Evolution: His 10 Best Looks Over the Years – Showbiz Cheat Sheet
Posted: at 2:00 am
Harry Styles is one of the most popular recording artists in the world. After leaving One Direction in 2016, hes found a successful solo career and has become one of the music industrys biggest fashion icons. From his early boy band days to his androgynous Met Gala appearances, heres are 10 of Styles best looks over the years.
Styles burst on to the music scene in 2010 when he auditioned for Britains version of The X Factor. He was initially eliminated and then brought back to form a band with other contestants, including Zayn Malik and Liam Payne. Styles suggested the bands name, One Direction, and although they didnt win the season, they went on to become a chart-topping musical sensation.
He was only 16-years-old and had come to London for the first time from his small hometown Redditch, England. With his cool scarf and flowing hair, Styles looked ready for stardom from the get-go.
RELATED: Rumor Has It Adele and Harry Styles Are About to Drop a Song Together and Fans Are Freaking out Again
As a member of One Direction, Styles often coordinated with the rest of the band. But his personal look was always just a little more polished than the others. In many appearances with the band, Styles would don a blazer when the rest were in jackets or sweaters.
In 2012, Styles was spotted attending fashion shows in and around London. And his fashion choices started becoming a little more sophisticated. In this look from the 2012 Brit Awards, the popstar is weathering a grey three-piece suit, with a statement black bowtie.
During his very first X Factor audition, Styles wore a skinny scarf and pulled it off effortlessly. In 2013, when attending the Brit Fashion Awards, the singer revisited the style. He wore a black blazer, black pants, and shirt, with a skinny black and white polka-dot scarf looped around his neck.
By 2014, Styles was attending fashion shows regularly, and his own style choices began getting bolder. At the 2014 Brit Fashion Awards, he wore a black and red pin-striped double-breasted suit. It was a fierce fashion choice, and he carried it off perfectly.
At the 2015 American Music Awards, Styles wore a white and grey floral printed bell-bottom suit. With his long hair and tie-front velvet shirt, this look was more androgynous than his previous red carpet looks. And it was when he seemed to really be breaking from the bands uniform style choices.
By 2017, Styles was comfortable experimenting with color and prints. While in New York City for the Today show, the singer wore a bright pink double-breasted suit with a black shirt, and wowed the crowd with his performance of Carolina.
In 2019, Styles attended the Met Gala with one of his most amazing looks yet. The theme for the night was Camp: Notes Fashion, and the singer wore a sheer, peasant sleeve, ruffle neck black Gucci blouse with a dangling pearl earring. He also wore rainbow-colored nail polish, which he still does from time to time.
Styles appeared on Saturday Night Live as a host and musical guest in November 2019. In his monologue and his performances, the pop star wore bright and bold colored suits. He also wore numerous rings and displayed his brightly colored nails throughout the night.
In 2020, the singer was seen at multiple events wearing a string of pearls. At the Brit Awards in February, he wore his pearls with a maroon double-breasted suit, a lavender sweater with a scalloped peter pan collar, and Mary Jane flats.
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Marijuana Market Evolution of Key Players That Will Change Industry: Cara Therapeutics, Cannabis Sativa, CannaGrow Holdings – Owned
Posted: at 2:00 am
Marijuana Market Research Report provides customers with a complete analytical study that provides all the details of key players such as company profile, product portfolio, capacity, price, cost and revenue during the forecast period from 2020 to 2027. A Marijuana market that includes Future Trends, Current Growth Factors, Meticulous Opinions, Facts, Historical Data and Statistically Supported And Industry-Validated Market Data.
This Marijuana market research provides a clear explanation of how this market will make a growth impression during the mentioned period. This study report scanned specific data for specific characteristics such as Type, Size, Application and End User. There are basic segments included in the segmentation analysis that are the result of SWOT analysis and PESTEL analysis.
RequestSample PDF of Marijuana Market Report https://www.worldwidemarketreports.com/sample/126865
Cara Therapeutics, Cannabis Sativa, CannaGrow Holdings, United Cannabis, Growblox Sciences, GreenGro Technologies, GW Pharmaceuticals, Lexaria Corp, MMJ America, Medicine Man, Canopy Growth, Aphria, Aurora Cannabis Inc., mCig Inc are some of the major organizations dominating the global market.
(*Note: Other Players Can be Added per Request)
Key players in the Marijuana market were identified through a second survey, and market share was determined through a first and second survey. All measurement sharing, splitting and analysis were solved using a secondary source and a validated primary source. The Marijuana market report starts with a basic overview of the Industry Life Cycle, Definitions, Classifications, Applications, and Industry Chain Structure. The combination of these two factors will help key players meet the market reach and help to understand offered characteristics and customer needs.
The report also makes some important suggestions for the new Marijuana market project before evaluating its feasibility. Overall, this report covers Marijuana market Sales, Price, Sales, Gross Profit, Historical Growth and Future Prospects. It provides facts related to mergers, acquisitions, partnerships and joint venture activities prevalent in the market.
This report includes market size estimates of value (million US $) and volume (K MT). The top-down and bottom-up approaches are used to estimate and validate the market size of the Marijuana market, estimating the size of various other submarkets in the overall market. Major players in the market were identified through secondary studies, and market share was determined through primary and secondary studies. All ratio sharing, splitting and analysis were determined using the secondary source and the identified primary source.
What Marijuana Market report offers:
Regions Covered in This Report
Complete knowledge of the Marijuana market is based on the latest industry news, opportunities and trends in the expected region. The Marijuana market research report provides clear insights into the influential factors expected to change the global market in the near future.
Remarkable Attributes of Marijuana Market Report:
About WMR
Worldwide Market Reports is your one-stop repository of detailed and in-depth market research reports compiled by an extensive list of publishers from across the globe. We offer reports across virtually all domains and an exhaustive list of sub-domains under the sun. The in-depth market analysis by some of the most vastly experienced analysts provide our diverse range of clients from across all industries with vital decision making insights to plan and align their market strategies in line with current market trends.
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The latest evolution of the Huawei AppGallery is ecosystem-focused – htxt.africa
Posted: at 2:00 am
As Huawei pushes forward with its mobile plans sans access to Google applications and the Play Store, the Huawei AppGallery will become increasingly important. Not only as a platform to download new mobile applications, but also a tool for developers wanting to gain access to a new audience.
While the AppGallery has existed on older Huawei phones that ran Google Mobile Services, if were completely honest about our experiences, it was often pushed to side in favour of the Play Store. As such, like many of the duplicated apps that could not be deleted at the time, the AppGallery felt a bit like bloatware.
Thats changed today though, with Huawei Mobile Services now core to the mobile experience on new devices launched this year, such as the P40 series, and the AppGallery playing the crucial complementary role to this.
To gain a better understanding of how the app marketplace has evolved to its current state, as well as how Huawei goes about selecting or porting apps to the store, along with what developers stand to gain from joining it, we spoke with Huawei Mobile South Africa CTO, Akhram Mohamed.
Heres what he had to say about the AppGallery, and why it forms part of a larger ecosystem that Huawei is quickly aiming to bring to fruition.
As mentioned earlier, the AppGallery has been around for a few years now, but is now front and centre to the Huawei mobile experience. As such, for many users the functionality available will be foreign, but as Mohamed explains, it has been there for some time.
I think historically, because we were running the core services on GMS, it (AppGallery) was an app repository, just like any other. It didnt drive our agenda as we did not have a specific need to create tools for the entire ecosystem, says Mohamed.
Now that we have shifted to HMS it means that we will be owning the entire ecosystem. It therefore becomes crucial that we dont just simply have a place where apps are downloaded, and now were focusing on how to improve the entire experience, he notes.
The CTO adds that the companys hand being forced as far as developing its own mobile ecosystem goes, has also proved beneficial for the AppGallery, particularly when it comes to porting apps over to the new store.
This, as the previous scenario saw the AppGallery being ignored for the most part, with the Play Store being favoured most of time.
The current landscape then, has seen Huawei engage more intimately with developers.
By going the HMS route, we have a vast number of new users across the globe and in South Africa too. This creates a great case for developers to say that I can now monetise this and reach these consumers, according to Mohamed.
Sticking with the idea of porting apps and growing the AppGallery library, the CTO tells us that Huaweis plan as far as getting the most popular global and local apps in its store has been a success to date.
He estimates that the list, which Huawei created for the apps it deemed crucial to having in its store, is currently sitting at around 95 percent completion. He also notes that this list is in a constant state of evolution, as Huawei continues to learn what its users are wanting in terms of app availability.
We had to go an do extensive research. That was through third-party paid research, to find out what are the most popular apps and what do South African consumers want. At the same time we looked at global trends and data, Mohamed explains.
He points out that usability played a bit part in selecting the priority apps for the AppGallery, as the number of downloads only paint part of the picture.
Looking at some of the strides that Huawei has been making of late, the CTO highlights partnerships and collaboration a key focus moving forward, with the companys recent work alongside Capitec serving as an example.
That said he does stress that Huawei is taking a different approach to partnerships than what you may typically think they would involve.
Its important for me to clarify what partnership means. Partnerships are not just marketing. For us, partnerships is about looking at value and how we can be different, he says.
Having a number of different banking applications to match that of another app store is not what were after, as it does not make us better. What were looking for is how to make the partnership and porting of the application part of the native Huawei experience. In our partnerships we are looking for deep integration, he continues.
Shifting to the consumer and developer response around HMS and the AppGallery, Mohamed is truly pleased with the numbers he has seen to date, which he says is all the more impressive given the short period of time that HMS-powered Huawei phones have been on the market.
While the COVID-19 pandemic and national lockdown posed significant challenges for Huawei, as it did most of the consumer technology industry, the CTO notes that Huawei has been able to garner substantial customer satisfaction and sales despite several hurdles.
To that end he notes that customer satisfaction since HMS devices launched in the country is sitting at 97 percent, with much of this down to the fact that Huawei had its digital channels in place before lockdown began, along with a 24/7 customer care platform for local users being up and running.
Added to this is a rather bold prediction too.
In terms of volumes, our total sales percentage of HMS devices in South Africa within the next two months will exceed the total sales of GMS in the same period compared to last year, the CTO says.
When we asked for more insight into the prediction, he explained that this year-on-year projection, which started with a slight slump in March due to the lockdown, but recovered steadily since then.
We need to see the likes of GfK and other market analysts confirming the sales figures, but if it the projection does hold true, it seems like the Huawei brand is far stronger than we originally estimated, and the lack of Google on devices is not as big a purchasing decision as we thought it would be.
It would also go a long way to affirming that Huawei Mobile Services and the AppGallery has a burgeoning user and developer community, with the latter being an area that Mohamed says the company is still determined to nurture despite not being able to host in-person dev days, as its done previously.
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Orthopedic Splints and Casts Market Evolution By Recent Trends, Regional Growth, Revenue and Opportunities Till 2026 – Cole of Duty
Posted: at 2:00 am
Orthopedic Splints and Casts Market Overview
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Superior Skin Clearance Observed With Risankizumab in Head-to-Head Psoriasis Study – Monthly Prescribing Reference
Posted: at 1:58 am
New data from a head-to-head study comparing risankizumab-rzaa to secukinumab in patients with moderate to severe plaque psoriasis were recently presented online at the American Academy of Dermatology virtual annual meeting.
In this 52-week, phase 3b, open-label, active-comparator study, patients were randomized to receive risankizumab 150mg subcutaneously (n=164) at baseline, week 4, then every 12 weeks thereafter, or secukinumab 300mg subcutaneously at baseline, weeks 1, 2, 3, and 4, then every 4 weeks thereafter. The co-primary end points were the proportion of patients with a 90% reduction in the Psoriasis Area and Severity Index score (PASI 90 response) at week 16 (noninferiority) and at week 52 (superiority) from baseline.
Results showed that the study met both primary end points of noninferiority and superiority. A greater proportion of patients treated with risankizumab achieved a PASI 90 response at week 16 (74% vs 66%) and at week 52 (87% vs 57%; P <.001) compared with secukinumab.
Risankizumab also met key secondary end points including a superior rate of complete skin clearance (PASI 100 response) at week 52 compared with secukinumab (66% vs 40%; P <.001). Moreover, 88% of patients treated with risankizumab achieved a static Physician Global Assessment (sPGA) score of clear (0) or almost clear (1) at week 52 compared with 58% of patients treated with secukinumab (P <.001).
Risankizumab and secukinumab demonstrated comparable rates of adverse reactions. The most common were nasopharyngitis, upper respiratory tract infection, headache, arthralgia and diarrhea.
Risankizumab, an interleukin-23 antagonist, is marketed under the trade name Skyrizi and is indicated for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy.
Secukinumab, an interleukin-17A antagonist, is marketed under the trade name Cosentyx and is indicated for the treatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy. It is also approved for the treatment of active psoriatic arthritis or ankylosing spondylitis in adults.
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Superior Skin Clearance Observed With Risankizumab in Head-to-Head Psoriasis Study - Monthly Prescribing Reference
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What Are the Medication Options for Psoriasis? – HealthCentral.com
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Theres no cure for psoriasis, but there are a lot of medications that can treat the chronic skin condition. Whether youre newly diagnosed or still searching for the right treatment (yup, sometimes theres a little trial and error), the number of choices can seem daunting. There are topicals, oral medications, and biologic drugs. While they all have the same overall goalclear your skinthey do it in different ways. Some medications soothe and calm an outbreak, while others prevent future flares. The treatment plan you end up on is often determined by your type of psoriasis, its severity and location, and your overall healthy history. Here, well walk you through all your options.
Psoriasis is a chronic condition that causes red, stinging patches or bumps on your arms, legs, and even your scalp. When you have this disease, your skin cells turn over faster than they should, leading to a buildup of cells on your body's surface that turn into those inflamed, scaly spots.
At first glance, it looks like a skin issue. And while thats true, experts say it starts on a deeper levelin your immune system. An overactive immune system, along with a genetic predisposition for psoriasis, and at least one other factor such as infection, obesity, or smoking are thought to be the driving forces behind the condition.
As we mentioned, there are several different types of psoriasis: plaque psoriasis (the most common type), scalp psoriasis, guttate, pustular, inverse, erythrodermic, and even psoriatic arthritis, which is a combo of psoriasis and arthritis. The medication youre prescribed is often determined by your type, and may include topical treatments, drugs taken orally, and injections. Let's start by taking a look at topical medications for psoriasis.
These creams, ointments, foams, shampoos, and lotions are applied directly to the affected areas, and are often prescribed for mild to moderate casespsoriasis that covers 1% to 10% of your body. Topical treatments can be used alone, or in combination with another treatment prescribed by your doctor. For example, you may use a cream along with an oral medication and/or light therapy. Topicals are used for these types of psoriasis:
The most common types of topical treatments prescribed for psoriasis include:
Corticosteroids work by reducing inflammation and redness. Theyre often prescribed to clear a current flare but wont necessarily stop your psoriasis from coming back in the future. There are various forms, including liquids, foams, and creams that come in various strengths. Examples include:
Side effects include:
These creams, liquids, and foams are believed to stop the overgrowth of skin cells, which may help prevent future psoriasis flares. They also help clear current patches by sloughing off scaly skin and flattening plaques so they are less noticeable.
Dovonex (calcipotriene) is a synthetic form of vitamin D that comes in a cream or a liquid for scalp psoriasis. You apply it twice a day for up to eight weeks.
Vectical (calcitriol) is a natural form of vitamin D that comes in an ointment formulation to use twice daily. While most topicals are okay to use during pregnancy, Vectical is not.
Enstilar (calcipotriene and betamethasone dipropionate) is a foam thats a combination of a synthetic form of vitamin D and a steroid. Its approved for adults only and used once a day for up to a month.
Taclonex (calcipotriene and betamethasone dipropionate) is a liquid vitamin D-steroid combo thats approved for use in children ages 12 and up. Use it once a day for up to a month.
Research has shown that using a vitamin D analogue with a corticosteroid may not only be more effective than using either one alone, but the combo can even reduce the side effects that can come with strong steroid use. But side effects can include:
Yes, the vitamin A derivatives that smooth wrinkles and clear acne can also help with psoriasis. Topical retinoids help alleviate redness, scaling, and inflammation, and regulate the high-speed skin-cell growth associated with the condition. Because of their risk of birth defects, retinoids should be avoided if youre pregnant or planning to become pregnant.
Tazorac (tazarotene), available as a gel or cream, is approved for adults and comes in two strengths. It is used once a day and can be applied daily for up to a year.
Duobril (halobetasol propionate and tazarotene) is one of the newest topical medications. This combo product contains a vitamin A derivative (called tazarotene) with an anti-inflammatory cream. You use it daily as needed.
Side effects include:
Anthralin is a man-made version of goa powder, a natural substance that comes from the araroba tree. Like many of the other topicals, this helps halt the excessive growth of skin cells and is approved for adults. It comes in a variety of formulations including a cream, ointment, and paste which can be used once a day on the skin. It also comes in a shampoo which can be used on the scalp. Anthralin-containing products include:
Side effects include:
Taken by mouth, oral medications target your overactive immune system (or parts of it) to reduce inflammation and/or slow down skin cell production. With so many choices, your doctor can help you find the best oral option for you to take alone or in combination with other forms of treatment like topicals, phototherapy, or biologics. Oral medications are most often prescribed for the following psoriasis types:
The most commonly prescribed oral options include:
Trexall and Rheumatrex (methotrexate) work by targeting and slowing the growth of skin cells. They come with a risk of toxicity, so theyre only taken once or twice a week, and not prescribed for long-term use. Methotrexate isnt safe to take if youre pregnant or nursing or have any blood issues like low white blood cell count or anemia.
Side effects include:
Gengraf (cyclosporine) was initially used as a medication to ward off organ rejection. It works on severe psoriasis by slowing an overactive immune system. The drug is taken daily either in pill form or a liquid that you dilute in juice.
Side effects: Cyclosporine can cause decreased kidney function, flu-like symptoms, high blood pressure, and cholesterol. This is another medication thats not safe while pregnant or nursing, and shouldnt be taken for longer than a year. Avoid cyclosporine if you take anti-cancer, anti-fungal, anti-convulsants, or anti-inflammatory medications, as well as antibiotics, aspirin, or ibuprofen.
Xeljanz (tofacitinib), one of the newer oral medications, inhibits a family of intracellular nonreceptors called Janus kinase, a.k.a. a JAK inhibitor. In doing so, it decreases cytokines, proteins that cause inflammation. By lowering inflammation in those with psoriasis, you get less symptoms.
Side effects include:
Soriatane (acitretin) is a form of vitamin A (a.k.a. a retinoid) that helps regulate those out-of-control skin cells. Its taken orally daily. If youre pregnant or planning to start a family within the next three years or have experienced sensitivity to retinoids in the past, this medication isnt an option for you.
Side effects include:
Otezla (apremilast) is one of the newest oral treatments. It works by reducing inflammation. Less inflammation may mean less outbreaks, or at least less severe ones. This cant be taken with some other medications such as phenobarbital and rifampin.
Side effects include:
Prednisone and Medrol (methylprednisone). Sometimes prescribed as pills or injections, these meds work by reducing inflammation and slowing cell growth. They help calm a flare-up but arent recommended for long-term use.
Side effects include:
These drugs are commonly prescribed (alone or along with other meds) for moderate-to-severe psoriasis because theyre so effectiveespecially the newer kids on the block like Skyrizi, Cimzia, and Ilumya.
Biologics are known as systemic treatments because they spread throughout the body and do their work from the inside out, but unlike other drugs that affect your entire immune system, these zero in on very specific partsvarious proteins or white blood cells that contribute to psoriasis such as tumor necrosis factor (TNF), interleukin 17, interleukin 23, and T-cells. By blocking these proteins and cells, the drugs can stop a psoriasis flare.
Interestingly, psoriasis biologics may help with other inflammatory issues such as heart disease. A recent study in JAMA Cardiology found that those who took biologics for psoriasis had a significant reduction in coronary inflammation, too.
Biologics are made from living cells of animals, humans, or bacteria and are given through an intravenous drip (IV) or injected in your thigh, upper arm, stomach, or butt either by a health care provider, caregiver, or yourself. (Dont worry, your M.D. will make sure you know exactly how to do this before sending you off to self-inject.)
Theyre used to treat these types of psoriasis:
There are several types of biologics:
Stelara (ustekinumab) is injected into your body to block a protein called IL-23. This helps ease the inflammation that can cause symptoms of both moderate to severe psoriasis and psoriatic arthritis. The drug requires two starter injections four weeks apart followed by four doses done 12 weeks apart.
Ilumya (tidrakizumab-asmn) and Skyrizi (risankizumab-rzaa) require two initial doses, four weeks apart, to block the IL-23 protein. This is followed by four doses per year, every 12 weeks.
Tremfya (guselkumab) also targets IL-23 with two starter doses four weeks apart and then every eight weeks.
Side effects include:
One cause of plaque psoriasis (which accounts for 80% of all psoriasis cases) is the excess production of a protein called tumor necrosis factor (TNF) which tells your skin cells to grow at an accelerated rate. These medications, which block TNF so that your skin cells grow more slowly, need to be taken over a long period of time to clear your skin.
Unlike some psoriasis medications, TNF inhibitors can be taken while pregnant or nursing (but of course, not without talking to your OB/GYN). However, youll want to avoid this category of biologics if you have multiple sclerosis (MS) or have an immediate relative with MS. Anti-TNF therapy has been associated with the demyelinating disease.
Cimzia (certolizumab pegol) can either be injected by yourself or you can have it injected at your doctors offices with two doses the first time, then two doses two weeks later, followed by two doses two weeks after that. Following these initial shots, you have one every other week.
Enbrel (etanercept) is unique because it is also approved for use in children. Although dosage can vary, you typically inject yourself with Enbrel twice a week for the first three months and then once a week for three months after that.
Humira (adalimumab) starts with two doses on day one and continues with one dose every other week. Cyltezo and Amjevita are approved biosimilars to Humira.
Remicade (infliximab) is given as an IV infusion that takes about two hours at your health care providers office. You begin with three starter doses administered during a six-week period, and then get one infusion every eight weeks. Inflectra and Renflexis are biosimilar.
Side effects include:
These biologics contain a human antibody that blocks a protein called interleukin 17 (IL 17), which causes inflammation and an immune response. Before prescribing these biologics, your M.D. will make sure you dont have latent tuberculosis, meaning you carry the tuberculosis bacteria but dont have an active disease. IL 17 inhibitors can trigger a case.
Cosentyx (secukinumab) is self-injected; two doses a week for four weeks and then once a month.
Siliq (brodalumab) targets four of the IL-17 proteins (others target just one). You take one dose weekly for three weeks and then one dose every two weeks. (Siliq carries a warning about suicidal behavior and thoughts.
Taltz (ixekizumab) is self-injected; two doses on the first day and then one injection every two weeks for three months. After that, you do it just once per month.
Side effects include:
These medications target T-cells, a type of white blood cell that causes inflammation.
Orencia (abatacept) is prescribed as a once-a-week shot for psoriatic arthritis, but it doesnt help with skin psoriasis.
Side effects include:
In some cases, your physician may prescribe a biologic along with another medication such as a topical treatment or oral medication. Some people develop anti-drug antibodies (ADAs) to biologics, making them less effective after a while. A review in the British Journal of Dermatology found that combining a biologic with the systemic oral medication methotrexate may help prevent ADAs.
Some medications are safe to take while pregnant or breastfeeding, while others, such as methotrexate, should be avoided. Discuss your options with your doctor so you can create a customized treatment plan.
You may be desperate to try anything to soothe your skin, but skip the fad diets, tanning beds, and Vicks VapoRubtheres little to no research verifying their efficacy, and they can irritate or dry out your skin.
Yes. Many of the medications are approved for both conditions, including the Cimzia, Enbrel, Humira, Stelara, Remicade, Cosentyx, methotrexate, Otezla, and systemic steroids.
Some people notice their biologic doesnt work as well over time. Experts say your body may have outsmarted the drug by creating antibodies against it. If your psoriasis is no longer responding to a certain drug, your doctor will likely switch you to something else.
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What Is the Impact of Psoriasis on Patients’ Mental Health? – AJMC.com Managed Markets Network
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Patients with psoriasis often have other physical diseases, and these somatic comorbidities can have a bigger effect on the patients mental health than the skin symptoms from their psoriasis, according to a study published in JAMA Dermatology.
Researchers in Sweden used a population-based registry data from Swedish patients in routine clinical care. Patients with psoriasis were matched with control participants without psoriasis by age, sex, and municipality. All participants in the study were free of existing psychiatric illness (PI).
Little is known about the independent risks imparted by skin psoriasis compared with somatic comorbidity on the development of PI or whether they have additive or synergistic associations, the authors explained.
A total of 93,239 patients with skin psoriasis and 1,387,495 control participants were enrolled between January 2005 and December 2010. Patients with psoriasis had their first diagnosis during the study period. For the study, PI was a composite measure of depression, anxiety, and suicidality, which was composed of suicidal ideation, suicide attempt, and completed suicide. The Elixhauser Comorbidity Index (ECI) and the Charlson Comorbidity Index (CCI) were used to calculate comorbidity profiles for each patient in the year before baseline.
The authors found that the interaction between skin psoriasis and ECI and between skin psoriasis and CCI were not statistically significant, which indicated skin psoriasis and somatic comorbidities do not act synergistically. The authors noted that both skin psoriasis and somatic comorbidity are independent risk factors for PI onset.
Patients who were sicker (with both skin psoriasis and somatic comorbidity) had the highest rate of incident PI. However, patients with skin psoriasis but no somatic comorbidity actually had a lower rate of PI onset compared with the control participants who had somatic comorbidity.
The authors speculated that the somatic comorbidities in the ECI and CCI may be considered severe compared with skin psoriasis, which explains why they may contribute more to PI onset. They also noted that since somatic comorbidity is broadly defined, patients may have multiple diseases compared with the patients with skin psoriasis and no somatic comorbidity who only had 1 recorded disease.
They recommended that future research understand the interaction of clinical severity with somatic comorbidity and PI in patients with psoriasis. They also noted that the findings support use of holistic patient management.
"I would be delighted if our study could support the trend towards a more holistic view on psoriasis care," coauthor Marcus Schmitt-Egenolf, MD, PhD, dermatologist and professor at Ume University, said in a statement. At the doctor's office, lifestyle factors should be discussed in the awareness that individual responsibility may be limited by available personal and community resources. Such an approach may improve the complete triad of psoriasisskin symptoms, somatic and mental health alike.
Reference
Geale K, Henriksson M, Jokinen J, Schmitt-Egenolf M. Association of skin psoriasis and somatic comorbidity with the development of psychiatric illness in a nationwide Swedish study.JAMA Dermatol.Published online June 3, 2020.doi:10.1001/jamadermatol.2020.1398
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Management Strategies for Unforeseen Events of Psoriasis Biotech Therapies – Dermatology Advisor
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Unforeseen adverse events associated with biotechnological medications for the treatment of psoriasis are not uncommon. Investigators from the University of Bologna in Italy have published evidence-based recommendations on the management of unforeseen events in patients with psoriasis who are treated with these therapies in Dermatologic Therapy.
According to the authors of the paper, the use of biotechnological medications for psoriasis should be avoided during pregnancy and lactation as there is currently a lack of robust data on the safety of these therapies during these times. Based on current evidence, some monoclonal antibodies may cross the placenta after the first trimester. New anti-IL23 and IL1-17 therapies should be avoided because of these concerns.
The authors suggest clinicians should speak with women with psoriasis who have become pregnant about the safety risks associated with biotechnological therapies and should evaluate whether or not to discontinue therapy. Etanercept and certolizumab are cited as agents that may not cross the placental barrier to the embryo and are suggested as safer therapeutic options for moderate-to-severe psoriasis. Few safety data on the use of biotechnologic agents during lactation exist, suggesting clinicians may wish to practice caution when considering these therapies in women who are considering breastfeeding.
The authors recommend clinicians screen patients with psoriasis for latent tuberculosis prior to and during anti-TNF- treatment. Biologic therapies anti-TNF- or anti-IL12/23 may be initiated 1 month following prophylactic therapy for latent tuberculosis, according to guidelines in the US. For patients with psoriasis who have HIV, the authors cited recent expert opinion statements that supported the consideration of anti-TNF-, ustekinumab, and apremilast for patients who have close monitoring and control of HIV load and CD4 count.
In terms of surgical procedures, the authors stated that no interruption of biologic therapy is needed for patients with psoriasis who are set to undergo low-risk interventions. For moderate- and high-risk surgeries, the authors suggest the administration of biologic agents should be stopped 3 to 4 times the half-lives of the therapy prior to intervention. Biologic therapy could be restarted 1 to 2 weeks after surgery if the patient is free from complications.
The authors wrote that any clinician who treats psoriasis with biotechnologic therapy may experience 1 unexpected events, stating that it should be good practice to know how to manage them. Further study is needed to form a consensus-based guideline on how to manage these events in this patient population.
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Reference
Sacchelli L, Magnano M, Loi C, Patrizi A, Bardazzi F. The unforeseen during biotechnological therapy for moderatetosevere psoriasis: How to manage pregnancy and breastfeeding, infections from Mycobacterium tuberculosis, hepatitis B virus, hepatitis C virus, and HIV, surgery, vaccinations, diagnosis of malignancy, and dose tapering [published online April 14, 2020]. Dermatol Ther. doi:10.1111/dth.13411
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