27.) Combined
topical
calcipotriene
ointment
0.005% and
various
systemic
therapies in
the treatment
of plaque-type
psoriasis
vulgaris:
Review of the
literature and
results of a
survey sent to
100
dermatologists
28.) The
genetics of
psoriasis
29.) The use of
topical
calcipotriene/calcipotriol
in conditions
other than
plaque-type
psoriasis
30.) Tazarotene:
The first
receptor-selective
topical retinoid
for the
treatment of
psoriasis
31.) The effects
of topical
calcipotriol on
systemic calcium
homeostasis in
patients with
chronic plaque
psoriasis
32.)
Cyclosporine
consensus
conference: With
emphasis on the
treatment of
psoriasis
33.) Tazarotene
0.1% gel plus
corticosteroid
cream in the
treatment of
plaque
psoriasis
34.) The
pathogenesis of
psoriasis and
the mechanism of
action of
tazarotene
35.)
Bath-5-methoxypsoralen-UVA
therapy for
psoriasis
36.) -3 Fatty
acid–based lipid
infusion in
patients with
chronic plaque
psoriasis:
Results of a
double-blind,
randomized,
placebo-controlled
multicenter
trial
37.)
Immunopathogenesis
of
Psoriasis
38.)
Epstein-Barr
Virus-Associated
Lymphoproliferative
Disease During
Methotrexate
Therapy for
Psoriasis
39.) Long-term
Safety of
Cyclosporine in
the Treatment of
Psoriasis
40.) Acitretin
Therapy Is
Effective for
Psoriasis
Associated With
Human
Immunodeficiency
Virus
Infection
41.)
Methotrexate
Osteopathy in
Long-term,
Low-Dose
Methotrexate
Treatment
for Psoriasis
and Rheumatoid
Arthritis
42.) Commercial
tanning bed
treatment is an
effective
psoriasis
treatment:
results from an
uncontrolled
clinical
trial.
43.) Transfer of
autoimmune
thyroiditis and
resolution of
palmoplantar
pustular
psoriasis
following
allogeneic bone
marrow
transplantation.
44.) Demographic
evaluation of
successful
antipsoriatic
climatotherapy
at the Dead
Sea
45.) Topical
calcipotriene in
combination with
UVB phototherapy
for
psoriasis.
46.) A
controlled trial
of acupuncture
in psoriasis: no
convincing
effect.
47.) Psoriatic
erythroderma: a
histopathologic
study of
forty-five
patients.
48.) [The
immunological
and
morphological
aspects of
hemoperfusion
with pig donor
spleen in
treating
psoriasis
patients]
49.) Clearance
of recalcitrant
psoriasis after
tonsillectomy.
50.) Psoriasis
treatment:
bathing in a
thermal lagoon
combined with
UVB, versus UVB
treatment
only.
51.) Alternative
therapies
commonly used
within a
population of
patients with
psoriasis.
52.) Using
aromatherapy in
the management
of psoriasis.
1.) What
patients with
psoriasis
believe about
their
condition
=====================================================================
=====================================================================
1.) What
patients with
psoriasis
believe about
their
condition
=====================================================================
Donal G.
Fortune, BSca,b
Helen L.
Richards, Clin
Psy Db
Chris J. Main,
PhDb,
Christopher E.
M. Griffiths,
MDa
Manchester,
United
Kingdom
Abstract
Background:
Patients’
beliefs about
their disease
have been shown
to be of
fundamental
importance in
adjustment to
their
condition.
Objective: We
investigated
patients’
beliefs about
their psoriasis
and
examined the
relationship
between these
beliefs and
clinical
severity,
symptom report,
and other
clinical and
demographic
variables.
Methods: A total
of 162 patients
with psoriasis
(84 male, 78
female)
completed the
illness
perception
questionnaire
that provides a
standardized
assessment of
beliefs about
causes,
consequences,
chronicity or
recurrence,
controllability,
and symptoms of
the
condition.
Results: The
most commonly
reported agents
of causation
were stress
(60.1%)
and genetic
factors
(55.5%)—the
latter group
being
significantly
more
likely to have a
family history
of psoriasis (P
= .0001).
Forty-six
percent of
patients
believed that
their behavior
could improve or
worsen
their
psoriasis,
whereas 32%
believed that
treatment would
be
curative.
Desquamation and
pruritus were
experienced
"frequently" or
"all the
time" by
80% and 76% of
patients
respectively.
Overall clinical
severity was
not
associated with
any of the
beliefs held by
patients or with
symptom
report.
Conclusion: The
beliefs held and
symptoms
experienced by
patients
with
psoriasis are
not governed by
overall clinical
severity of the
disease.
(J Am Acad
Dermatol
1998;39:196-201.)
=====================================================================
2.) Terbinafine
therapy may be
associated with
the development
of
psoriasis
de novo or its
exacerbation:
Four case
reports and a
review of
drug-induced
psoriasis
=====================================================================
Aditya K. Gupta,
MD, FRCPCa R.
Gary Sibbald,
MD, FRCPCb
Sandra R.
Knowles, BSc,
Phmc Charles W.
Lynde, MD,
FRCPCd
Neil H. Shear,
MD, FRCPCa,c
Ontario and
Toronto,
Canada
Abstract
Adverse effects
may occur in
10.4% of
patients
receiving
terbinafine
therapy, with
cutaneous
reactions in
2.7%. We
describe the
development
of
psoriasis in
four patients
who took oral
terbinafine. Two
patients
had
plaque-type
psoriasis that
flared 12 and 17
days,
respectively,
after
starting
terbinafine.
Another patient
developed
pustular-type
psoriasis
de novo
after 27 days of
terbinafine
therapy.
The fourth
patient was
a
psoriatic with
stable plaque
disease who
experienced a
pustular flare
after
taking
terbinafine for
21 days. We are
aware of only
one report in
the
literature in
which a patient
developed
pustular
psoriasis de
novo after
5 days of
terbinafine
therapy. In all
patients the
psoriasis
cleared or
lessened after
discontinuation
of terbinafine
and institution
of
antipsoriatic
therapy. (J Am
Acad Dermatol
1997;36:858-62.)
=====================================================================
3.) Topical
calcipotriol in
childhood
psoriasis
=====================================================================
Arnold P.
Oranjea,
Danielle
Marcouxb, Åke
Svenssonc
Julie
Prendivilled,
Bernice
Krafchike, J
Toolef
Donald
Rosenthalg,
Flora B. de
Waard-van der
Speka Lars
Molinh, Mads
Axelseni
Rotterdam, The
Netherlands;
Montreal,
Vancouver,
Toronto,
Winnipeg,
and
Hamilton,
Canada;
Kristianstad and
Orebro, Sweden;
and Ballerup,
Denmark
Abstract
Background: The
use of topical
calcipotriol in
adults with
psoriasis
is safe
and
effective.
Objective:Our
purpose was to
study the
efficacy and
safety of
calcipotriol
in
children.
Methods: A
multicenter,
prospective,
8-week,
double-blind,
parallel
group
study was
conducted in 77
children.
Response to
treatment was
assessed
by means
of the Psoriasis
Area and
Severity Index
(PASI) in that
the
intensity
of redness,
thickness, and
scaliness as
well as the area
involved
are
scored. The
children were 2
to 14 years of
age and had
stable
psoriasis,
involving less
than 30% of the
body surface.
Forty-three
children
were
assigned to
receive
calcipotriol
ointment and 34
to receive
placebo.
Nine
children dropped
out of the
study, six in
the
calcipotriol-treated
group and
three in the
placebo-treated
group.
Results: Both
treatment groups
(calcipotriol
and placebo)
showed
significant
improvement in
PASI from
baseline to the
end of
treatment,
and the
difference was
not
statistically
significant. No
serious side
effects,
in particular
including those
relating to
calcium and bone
metabolism,
were
recorded.
Conclusion:
Calcipotriol
ointment was
statistically
significantly
more
effective than
its vehicle in
terms of the
investigator’s
overall
assessment and
reduction in
redness and
scaliness but
not in terms of
PASI
score. (J Am
Acad Dermatol
1997;36:203-8.)
=====================================================================
4.) Is the
efficacy of
topical
corticosteroid
therapy for
psoriasis
vulgaris
enhanced by
concurrent
moclobemide
therapy? A
double-blind,
placebo
controlled
study
=====================================================================
Erkan Alpsoy,
MDa Erhan Özcan,
MDb Lütfiye
Çetin, MDa Oya
Özgur, MDb
Hanife Er, MDa
Ertan Yilmaz,
MDa Taha
Karaman,
MDb
Antalya,
Turkey
Abstract
Background:
Psychosocial
factors have
been implicated
in the onset
and
exacerbation of
psoriasis.
Objective: We
conducted a
randomized,
placebo-controlled,
double-blind
study to
investigate the
effect of an
antidepressant
agent,
moclobemide,
on the
course of
psoriasis
vulgaris.
Methods: Sixty
subjects were
enrolled in the
study. Patients
were
randomly
assigned to
treatment
groups. Patients
received
moclobemide 450
mg/day or
placebo and a
topical
corticosteroid
ointment
(diflucortolone
valerate)
for 6
weeks. Patients
were examined at
the beginning of
the study and at
2-week
intervals. At
each visit, the
severity of
psoriasis and
psychologic
status
were evaluated
with the
Psoriasis Area
Severity Index
(PASI),
Beck
Depression
Inventory (BDI),
Hamilton Rating
Scale for
Anxiety
(HAM-A),
Hamilton Rating
Scale for
Depression
(HRS-D-17) and
State-Trait
Anxiety
Inventory
including state
(STAI-1) and
trait anxiety
(STAI-2).
Results:
Treatment
efficacy was
able to be
evaluated in 22
patients in
the
moclobemide-treated
group and in 20
in the
placebo-treated
group. The
improvement
rates in PASI,
BDI, STAI-1, and
HAM-A scores
were
significantly
higher in the
moclobemide
treatment group.
The level of
state anxiety
was
diminished in
the moclobemide
group.
Correlation was
positive
between
improvement
rates of the
psoriatic
lesions and
state anxiety in
all
patients.
Conclusion: Our
results suggest
that an
antidepressant
drug is useful
in the
treatment of
psoriasis. (J Am
Acad Dermatol
1998;38:197-200.)
=====================================================================
5.)
Administration
of DAB389IL-2 to
patients with
recalcitrant
psoriasis:
A
double-blind,
phase II
multicenter
trial
=====================================================================
Jerry Bagel, MDa
W. Thomas
Garland, MDb
Debra Breneman,
MDc Michael
Holick,
MDd T. W.
Littlejohn, MDe
David Crosby,
MDf Holly Faust,
MDg David
Fivenson, MDh
Jean Nichols,
PhDi
East Windsor and
Lawrenceville,
New Jersey;
Cincinnati,
Ohio; Boston
and
Hopkinton,
Massachusetts;
Winston-Salem,
North Carolina;
Milwaukee,
Wisconsin;
Indianapolis,
Indiana; and
Detroit,
Michigan
Abstract
Background:
Current
therapies for
recalcitrant
psoriasis focus
on
immunoregulation
and targeting of
activated
T-lymphocytes
rather
than
keratinocytes.
Previous studies
with low doses
of the
lymphocyte-selective
fusion protein
DAB389IL-2 have
shown benefit to
patients with
psoriasis.
Objective: We
examined the
safety and
efficacy of
DAB389IL-2 in
41
volunteers
receiving more
frequent and
higher doses
than in a
previous
trial.
Methods:
Patients were
randomized to
receive either
placebo or 5,
10, or 15
µg/kg
daily of
DAB389IL-2
intravenously
for 3
consecutive days
each week
for 4
consecutive
weeks with a
subsequent
4-week
observation
period.
Results: Of the
placebo group,
17% (2 of 12)
exhibited at
least 50%
improvement from
baseline
Psoriasis Area
and Severity
Index scores at
the end of
the study,
whereas 24% of
all treated
patients (7 of
29) showed
the same
improvement.
Overall, 3 of 12
(25%) patients
given placebo as
opposed to
12 of 29 (41%)
patients treated
with DAB389IL-2
improved to this
same
extent at some
point during the
study. The rate
of improvement
for
treated
patients was
significantly
greater than for
placebo patients
(p = 0.04;
repeated
measures ANOVA).
Among treated
patients,
decreases in
Psoriasis
Area and
Severity Index
scores were
paralleled by
changes in
the
Physician’s
Global
Assessment and
the Dermatology
Life Quality
Index.
Treatment in ten
patients was
discontinued
because of
adverse
events.
Flu-like
symptoms were
the most common
with severity
increasing at
the two
higher doses.
Only one serious
adverse event
was reported.
This occurred
in a
patient
receiving 5
µg/kg
daily who
experienced
vasospasm and
a
coagulopathy
resulting in
arterial
thrombosis.
Conclusion: Our
findings are
consistent with
the potential
antipsoriatic
activity of
DAB389IL-2
demonstrated in
an earlier
study.
However,
DAB389IL-2 was
less well
tolerated at
this dosing
regimen,
particularly
at the
highest dose,
and it was too
toxic at these
doses and
schedules to
be
considered in
the routine
treatment of
psoriasis. (J Am
Acad
Dermatol
1998;38:938-44.)
=====================================================================
6.)
Suberythemogenic
narrow-band UVB
is markedly more
effective
than
conventional UVB
in treatment of
psoriasis
vulgaris
=====================================================================
Ian B. Walters,
MD Lauren
H. Burack,
MD Todd R.
Coven, MD
Patricia
Gilleaudeau, RN,
BSN James
G. Krueger, MD,
PhD New
York, New
York
Abstract
Background:
Narrow-band UVB
(NB-UVB) is a
new phototherapy
option for
psoriasis.
Action spectrum
studies
previously done
with different
UVB
wavelengths
suggest that
suberythemogenic
doses of NB-UVB
could be
highly
effective in
treating
psoriasis
vulgaris. Even
so, no
comparative
studies
with
suberythemogenic
doses of NB
versus
conventional UVB
have been
performed
previously.
Objective: Our
purpose was to
compare
conventional
broad-band UVB
(BB-UVB)
with NB-UVB at
suberythemogenic
doses for the
treatment of
psoriasis
vulgaris.
Methods: Eleven
patients were
treated using a
split-body
approach for
6 weeks on
a
three-times-a-week
basis. Outcomes
were evaluated
by means
of
Psoriasis
Severity Index
scores and
quantitative
histologic
measures.
Results: We were
able to induce
clinical
clearing in
81.8% of
patients
after NB-UVB,
but in only 9.1%
of patients
after BB-UVB (P
< .01).
Biopsy
specimens
obtained at the
end of treatment
revealed that
keratin 16
staining was
absent in 75% of
patients on the
NB side compared
with none
on the BB
side, suggesting
a reversal of
regenerative
epidermal
hyperplasia
by
NB-UVB.
Conclusion:
NB-UVB is
superior to
UVB-BB in
reversing
psoriasis
at
suberythemogenic
doses when given
three times per
week. This
schedule
was well
tolerated by all
patients.(J Am
Acad Dermatol
1999;40:893-900.)
=====================================================================
7.) Cyclosporine
as maintenance
therapy in
patients with
severe
psoriasis
=====================================================================
Jerome Shupack,
MDa Elizabeth
Abel, MDb Eugene
Bauer, MDb Marc
Brown, MDc
Lynn Drake, MDd
Ruth Freinkel,
MDe Cynthia
Guzzo, MDf John
Koo, MDg
Norman
Levine, MDh
Nicholas Lowe,
MDi Charles
McDonald,
MDjDavid
Margolis,
MDf
Matthew Stiller,
MDaBruce
Wintroub, MDg
Carol
Bainbridge, MDk
Sndra
Evansk
Susan Hilssk
William
Mietlowski,
PhDk
Christine
Winslow,
PhDk Jay
E. Birnbaum,
PhDk
New York and
Rochester, New
York; Stanford,
San Francisco,
and Santa
Monica,
California;
Boston,
Massachusetts;
Evanston,
Illinois;
Philadelphia,
Pennsylvania;
Tucson, Arizona;
Providence,
Rhode Island;
and East
Hanover, New
Jersey
Abstract
Background:
Low-dose
cyclosporine
therapy for
severe plaque
psoriasis
is
effective. Most
side effects can
be controlled by
patient
monitoring,
with
appropriate dose
adjustment or
pharmacologic
intervention, or
both, if
indicated.
Prevention or
reversibility of
laboratory and
chemical
abnormalities
may be achieved
by
discontinuation
of therapy after
the
induction of
clearing.
However, relapse
occurs rapidly
on
discontinuation.
Maintenance
therapy with
cyclosporine
after induction
has not been
fully
evaluated.
Objective: Our
purpose was to
compare a
regimen of 3.0
mg/kg per day
of oral
cyclosporine
with placebo in
maintaining
remission or
improvement
in
patients with
psoriasis.
Methods: After a
16-week
unblinded
induction phase
in which 181
patients
received
cyclosporine,
5.0 mg/kg per
day (an increase
up to 6.0 mg/kg
per day
and a decrease
to 3.0 mg/kg per
day were
allowed, if
required,
to achieve
efficacy or
tolerability,
respectively),
those patients
showing a
70% decrease or
more in involved
body surface
area (BSA)
entered
the
24-week
maintenance
phase and were
randomly
assigned to
either
placebo,
cyclosporine,
1.5 mg/kg per
day, or
cyclosporine,
3.0 mg/kg per
day.
Patients were
considered to
have had a
relapse when BSA
returned to 50%
or more of
the prestudy
baseline value.
Clinical
efficacy,
adverse
effects,
and laboratory
values were
monitored
regularly
throughout both
study
phases.
Results: During
induction,
cyclosporine at
approximately
5.0 mg/kg per
day
produced a
reduction in BSA
of 70% or more
in 86% of the
patients.
During
maintenance, the
median time to
relapse was 6
weeks in both
the placebo
and
cyclosporine 1.5
mg/kg per day
groups, but was
longer than the
24-week
maintenance
period in the
3.0 mg/kg per
day group (p
<0.001 vs
placebo).
By the end
of the
maintenance
period, 42% of
the patients in
the 3.0 mg/kg
per day
cyclosporine
group had a
relapse compared
with 84% in the
placebo
group. Changes
in laboratory
values
associated with
the higher
induction
dosage generally
exhibited
partial or
complete return
toward mean
prestudy
baseline values
during the
maintenance
phase, with the
greatest degree
of
normalization in
the placebo
group.
Conclusion:
Cyclosporine,
3.0 mg/kg per
day, adequately
and safely
maintained 58%
of patients with
psoriasis for a
6-month period
after
clearing of
their psoriasis
with doses of
approximately
5.0 mg/kg per
day. (J Am
Acad Dermatol
1997;36:423-32.)
=====================================================================
8.) Tazarotene
gel, a new
retinoid, for
topical therapy
of
psoriasis:
Vehicle-controlled
study of safety,
efficacy, and
duration of
therapeutic
effect
=====================================================================
Gerald D.
Weinstein, MDa
Gerald G.
Krueger, MDb
Nicholas J.
Lowe, MDc
Madeleine Duvic,
MDd David J.
Friedman, MDe
Brian V.
Jegasothy,
MDf Joseph
L. Jorizzo, MDg
Edward Shmunes,
MDh Eduardo H.
Tschen,
MDi
Deborah A.
Lew-Kaya,
PharmDj John C.
Lue, MSj John
Sefton,
PhDj John
R. Gibson, MDj
Roshantha A. S.
Chandraratna,
PhDj
Irvine and Santa
Monica,
California; Salt
Lake City, Utah;
Houston,
Texas;
Providence,
Rhode Island;
Pittsburgh,
Pennsylvania;
Winston-Salem,
North
Carolina;
Columbia, South
Carolina; and
Albuquerque, New
Mexico
Abstract
Background:
Topical therapy
providing
initial
improvement and
maintenance
of effect after
treatment of the
large majority
of patients with
limited,
mild to moderate
psoriasis is not
presently
available.
Previous
topical
retinoids have
generally been
either
ineffective or
too irritating
for
therapy of
psoriasis.
Objective: Our
purpose was to
evaluate a new
topical
retinoid,
tazarotene,
in the treatment
of stable plaque
psoriasis during
treatment
and
posttreatment
periods.
Methods: In a
double-blind
manner, 324
patients were
randomly
selected
to receive
tazarotene 0.1%
or 0.05% gel, or
vehicle control,
once daily for
12 weeks
and were then
followed up for
12 weeks after
treatment.
Results: Of the
total, 318
patients could
be evaluated.
Tazarotene
gels were
superior (p <
0.05) to
vehicle, often
as early as
treatment week
1, in all
efficacy
measures: plaque
elevation,
scaling, and
erythema;
treatment
response;
percentage
treatment
success
(patients with
50%
improvement);
and time
to initial
success.
Efficacy was
equivalent on
target lesion
sites
(trunk or limbs
and knees or
elbows) and
overall. A
sustained
therapeutic
effect was
observed for 12
weeks after
treatment.
Tazarotene gel
was
cosmetically
acceptable.
There was low
systemic
absorption,
limiting
toxicity to
local
irritation.
Conclusion:
Once-daily
tazarotene was
effective and
safe as a
topical
monotherapy for
plaque
psoriasis,
providing rapid
reduction of
signs and
symptoms. (J Am
Acad Dermatol
1997;37:85-92.)
=====================================================================
9.) Management
of psoriasis
with
calcipotriol
used as
monotherapy
=====================================================================
Colin A. Ramsay,
MD, FRCP, FRCP
(C)
Toronto,
Ontario,
Canada
Abstract
Background: The
vitamin D analog
calcipotriene/calcipotriol
(Dovonex/Daivonex)
offers
advantages over
other forms of
topical therapy
in some
patients with
psoriasis.
Objective: We
review the
studies of the
use of
calcipotriol
alone in
the
management of
psoriasis.
Methods: The
literature
concerning
topical
calcipotriol
therapy was
reviewed.
Results:
Calcipotriol
compares well
with other
standard forms
of topical
therapy for
psoriasis.
Irritation of
the skin may
occur but is
generally
mild. Treatment
can often be
restarted after
the irritation
has
cleared.
Conclusion:
Treatment with
calcipotriol
ointment, cream,
or solution
is
effective and
safe in many
patients with
psoriasis. (J Am
Acad
Dermatol
1997;37:S53-S54.)
=====================================================================
10.) Individual
pharmacodynamics
assessed by
antilymphocyte
action
predicts
clinical
cyclosporine
efficacy in
psoriasis
=====================================================================
Toshihiko
Hirano, PhD
Kitaro Oka, PhD
Yoshinori
Umezawa,
MD
Masako Hirata,
MD Tsunao Oh-i,
MD Michiyuki
Koga, MD
Tokyo,
Japan
Abstract
Background:
Cyclosporine
(INN,
ciclosporin) use
for psoriasis
has been
proposed and
clinically
examined.
However,
individual
variation
in
cyclosporine
efficacy is
currently
observed. To
evaluate
individual
therapeutic
potency of
cyclosporine,
pharmacodynamic
approaches
were
performed with
use of
peripheral blood
mononuclear
cells (PBMCs)
from
patients with
psoriasis.
Methods:
Cyclosporine
effects on
PBMC-blastogenesis
were examined in
33
patients with
psoriasis. The
drug
concentration
that gave 50%
inhibition
of
mitogen-stimulated
PBMC
proliferation in
vitro (IC50, in
nanograms
per
milliliter) was
evaluated in
each patient.
Cyclosporine was
administered
at an
initial dose of
5 mg/kg/day, and
the dose was
tapered for 16
weeks to 3
mg/kg/day. The
recovery rate in
the psoriasis
area and the
severity
index
(PASI) 16 weeks
after
cyclosporine
therapy began
was
measured.
Results:
Cyclosporine
IC50 values in
33 patients
deviated widely,
from 0.1
to 120.6 ng/ml.
We classified
these patients
into two groups
on the
basis of
their PBMC
sensitivity to
cyclosporine
with use of the
median
cyclosporine
IC50 (3.0 ng/ml)
of these
patients as the
cutoff point.
The PASI
recovery rate
after
cyclosporine
therapy in the
patients with
high
sensitivity was
significantly
higher than that
in the patients
with low
sensitivity (p
< 0.0007).
Moreover, a
significant
negative
correlation
between the IC50
and the PASI
recovery rate
was observed in
these 33
patients (r =
-0.73; p <
0.0001). Blood
trough levels
and side effects
of
cyclosporine
were not
significantly
different
between the two
patient
groups.
Conclusions: The
results showed
that we could
use PBMCs
to
pharmacodynamically
predict the
patients with a
poor response
to
cyclosporine
therapy. These
patients may
require larger
doses of
cyclosporine or
alternative
approaches to
treatment. The
patients
with PBMCs
sensitive to
cyclosporine
should be
evaluated for
treatment
with
smaller doses of
the drug to
avoid serious
side effects.
(Clin
Pharmacol
Ther
1998;63:465-70.)
=====================================================================
11.)
Calcipotriene
ointment and
halobetasol
ointment in the
long-term
treatment of
psoriasis:
Effects on the
duration of
improvement
=====================================================================
Mark Lebwohl, MD
Ayelet Yoles, BS
Kathleen
Lombardi,
BS Wendy
Lou, PhD
New York, New
York
Abstract
Background:
Weekend therapy
with superpotent
topical
corticosteroids
has been
used for the
long-term
treatment of
psoriasis.
Recently,
calcipotriene
ointment has
been added to
this regimen for
use on weekdays,
but there
are no
long-term
studies of that
combination.
Objective: The
purpose of this
study was to
determine
whether the
addition
of weekday
calcipotriene to
a pulse therapy
regimen of
weekend
superpotent
corticosteroids
results in a
longer duration
of remission of
plaque
psoriasis.
Subjects: This
was a
double-blind,
placebo-controlled,
parallel-group
study.
Forty-four
patients with
mild to moderate
psoriasis were
treated
with
calcipotriene
ointment in the
morning and
halobetasol
ointment in
the
evening for 2
weeks.
Thereafter, 40
patients who
were at least
moderately
(50% or greater)
improved were
randomized to 2
treatment
groups. After
2 weeks of
treatment with
calcipotriene
ointment in the
morning
and
halobetasol
ointment in the
evening, 20
patients were
randomized to
receive
halobetasol
ointment twice
daily on
weekends and
calcipotriene
ointment
twice daily on
weekdays, and 20
patients were
randomized to
receive
halobetasol
ointment twice
daily on
weekends and
placebo ointment
twice
daily on
weekdays.
Results:
Seventy-six
percent of
patients
applying
halobetasol
ointments
on
weekends and
calcipotriene
ointment on
weekdays were
able to
maintain
remission for 6
months compared
with 40% of
patients
applying
halobetasol
ointment on
weekends only
with the vehicle
on
weekdays.
Conclusion: The
addition of
calcipotriene
ointment applied
on weekdays to
a weekend
pulse therapy
regimen of
superpotent
corticosteroids
can
increase
the duration of
remission of
psoriasis. (J Am
Acad Dermatol
1998;39:447-50.)
=====================================================================
12.) The
epidermal
phenotype during
initiation of
the psoriatic
lesion in
the symptomless
margin of
relapsing
psoriasis
=====================================================================
Fransje A. C. M.
Castelijns, MD
Marie-Jeanne P.
Gerritsen, MD,
PhD Ivonne
M. J. J. van
Vlijmen-Willems,
Ing Piet E. J.
van Erp, Ing,
PhD Peter
C. M. van de
Kerkhof, MD, PhD
Nijmegen, The
Netherlands
Abstract
TOP
Background: The
mature psoriatic
lesion does not
necessarily
demonstrate
changes relevant
to early phases
of the
lesion.
Objective: In a
model for
relapsing
psoriasis we
examined the
epidermal
phenotype by
means of a panel
of
immunohistochemical
parameters:
keratins
14 and 16,
epidermal growth
factor receptor
(EGFR), Ki-67
antigen,
and
Tdt-mediated
Unscheduled Nick
End Labeling to
detect
apoptosis.
Methods: In 9
patients, we
cleared
psoriatic
plaques by
topical
treatment
with
clobetasol-17-propionate
under
hydrocolloid
occlusion.
Relapse
(defined as a
clinical sum
score 6) was
awaited. Biopsy
specimens of
the
psoriatic
lesion, the
cleared skin,
the relapsed
plaque, and its
clinically
normal margin
were
assessed.
Results:
Psoriasis
recurred after
19 ±
6 weeks (mean
±
SEM).
During
treatment all
parameters
improved
considerably;
however, the
number of
apoptotic cells
was not
affected.Ki-67
values decreased
well below
the normal
range. At
initial relapse,
the symptomless
skin adjacent to
the
relapsing lesion
(margin) showed
a marked
expression of
keratin 16
and EGFR.
Ki-67 expression
was increasing
in the margin
but was below
values of
the mature
lesion. The
localization of
cycling cells in
the first
suprabasal
layers was a
remarkable
feature. Keratin
14 expression
was
increased in the
recurrent lesion
itself, but not
in the
symptomless
margin.
Conclusion:
Keratin 16 and
EGFR expression
are early
phenomena in
the
evolution of the
lesion, and they
anticipate
epidermal
proliferation.
The
expression of
keratin 14
follows overt
epidermal
hyperproliferation.
The
present
observation in
incipient
psoriasis lends
support to the
hypothesis
that the basal
cell compartment
does not have a
primary
involvement in
the
initiation of
epidermal
abnormalities in
psoriasis, but
that a
coordinated
sequence of
events involving
proliferation
and
differentiation
markers in
the first
suprabasal
layers of the
epidermis could
be the key to
the
pathogenesis of
this puzzling
disease. (J Am
Acad Dermatol
1999;40:901-9.)
=====================================================================
13.) The
economic impact
of psoriasis
increases with
psoriasis
severity
=====================================================================
Steven R.
Feldman, MD,
PhDa,b Alan B.
Fleischer, Jr.,
MDa David
M.
Reboussin, PhDc
Stephen R. Rapp,
PhDc,d Douglas
D. Bradham,
DrPHc M.
Lyn Exumc, Adele
R. Clark, PA-Ca,
Winston-Salem,
North
Carolina
Abstract
Background:
Psoriasis
treatments are
known to be
costly, but
little is
known about the
financial impact
of psoriasis and
the way in which
it relates
to the severity
of the
disease.
Objective: This
study was
performed to
obtain an
estimate of the
treatment
costs faced by
patients with
psoriasis.
Methods: A total
of 578 anonymous
mail surveys
were distributed
to
patients
with psoriasis;
318 surveys were
returned (55%).
Psoriasis
severity
was
assessed with
the previously
validated
Self-Administered
Psoriasis
Area
Severity Index
(SAPASI).
Results: The
total and
out-of-pocket
expenses to care
for psoriasis
were
correlated with
psoriasis
severity (r =
0.26, p =
0.0001). There
were no
sex (p = 0.9) or
racial (p = 0.4)
differences in
total
expenditures.
Severity was
correlated with
how bothersome
to the patient
was the cost
of
treatment (r =
0.30, p =
0.0001), the
time required
for treatment (r
= 0.38, p
= 0.0001), and
the time lost
from work (r =
0.23, p =
0.0001).
Lower quality of
life at work and
in money matters
also correlated
with
severity of
psoriasis.
Higher family
income was
associated with
less time
spent caring for
psoriasis and
less
interference
with work around
the home.
Conclusion: As
expected, the
expenses caring
for psoriasis
are greater
for
patients with
more severe
disease. These
costs and other
financial
implications are
associated with
lower quality of
life for
patients
with more
severe
psoriasis. (J Am
Acad Dermatol
1997;37:564-9.)
=====================================================================
14.) The impact
of psoriasis on
the quality of
life of patients
from the
16-center PUVA
follow-up
cohort
=====================================================================
K. E. McKenna,
MRCP, R. S.
Stern, MD
Abstract
Background: The
impact of
psoriasis on the
quality of life
of patients
is likely
to be
principally
related to
alterations in
individual
appearance
and consequent
psychosocial
disability.
Quantifying the
impact of
psoriasis
and related
changes from
therapy would
help in the
selection of
optimal
management.
Objective: Our
purpose was to
evaluate the
impact of
psoriasis on
patients
with severe
disease who have
had
photochemotherapy
(PUVA).
Methods: In 1979
we interviewed
877 of 988 still
participating
patients
who were
enrolled in 15
of 16 centers in
the PUVA
Follow-up Study.
We
determined the
impact of
psoriasis on
quality of life
with a
questionnaire
that had been
modified to
incorporate
measures of
impairment that
are likely
to be affected
by cutaneous
disease.
Results:
Psoriasis had
substantial
impact on the
quality of life.
Women were
more likely than
men to report
impairment in
quality of
life
dimensions. The
impact of
disease
decreased with
increasing age.
Moderate
to high relative
impact on total
quality of life
was more often
reported
by
patients who had
recently used
UVB phototherapy
than by those
using PUVA
or
methotrexate.
Conclusion:
Psoriasis has a
substantial
impact on the
quality of life.
This
impact seems to
decrease with
increasing age.
Use of specific
treatments
are also
associated with
the extent to
which psoriasis
affects quality
of life.
(J Am Acad
Dermatol
1997;36:388-94.)
=====================================================================
15.)
Immunosuppressant
pharmacodynamics
on lymphocytes
from
healthy
subjects and
patients with
chronic renal
failure,
nephrosis, and
psoriasis:
Possible
implications for
individual
therapeutic
efficacy
=====================================================================
Toshihiko
Hirano, PhD
Kitaro Oka, PhD
Hironori
Takeuchi,
BS Koichi
Kozaki, MD,
Naoto Matsuno,
MD Yakeshi
Nagao, MD,
Masami Kozaki,
MD Makiko
Ichikawa, MD
Masaharu
Yoshida, MD
Yoshinori
Umezawa, MD
Masako
Hirata, MD
Tsunao Oh-i, MD,
Michiyuki Koga,
MD Tokyo,
Japan
Abstract
Background: In
organ
transplantation,
patients with
peripheral
blood
mononuclear
cells (PBMCs)
that exhibit
resistance to
cyclosporine
(INN,
ciclosporin) or
glucocorticoids
in vitro are
refractory to
therapy based
on these
drugs in vivo.
However,
detection or
distribution of
the
resistant
patients with
immunologic
disorders
remains to be
documented.
Methods: Drug
sensitivity
tests were
performed with
PBMCs from four
subject
groups: 69
healthy
subjects, 100
patients with
chronic renal
failure,
38
patients with
nephrosis, and
51 patients with
psoriasis. The
values for
the
concentration
that produces
50%
lymphocyte-mitosis
inhibition
(IC50) of
the drugs
on PBMC
blastogenesis
were estimated,
and individual
variations
or group
differences in
the IC50 values
were
examined
Results: The
median
cyclosporine
IC50 values of
the four subject
groups
were similar,
but large
individual
deviations in
the IC50 values
were
observed.
Individual
differences in
prednisolone
IC50 values were
spread
from 1 to 3500
ng/ml. When
compared with
healthy
subjects, a
significantly
large number of
the patients
with chronic
renal failure
group exhibited
low
responses to
prednisolone (p
< 0.04). In
contrast, no
significant
difference in
the
methylprednisolone
IC50 was
observed among
the
groups.
Normal upper
thresholds for
IC50 values of
these drugs were
estimated
from the
mean + 2
standard
deviations (SD)
of the IC50
values of
healthy
PBMCs, and
the patients
with IC50 values
above these
levels were
considered to
be
resistant. The
incidence of
resistant
patients with
nephrosis or
psoriasis
was similar to
that of healthy
subjects;
however, the
incidence
of
cyclosporine- or
prednisolone-resistant
subjects with
chronic renal
failure
was
significantly
higher (p <
0.04).
Significant
correlations
between
PBMC
sensitivity to
cyclosporine in
vitro and
clinical
efficacy of the
drug in
vivo were
observed in
renal transplant
recipients and
in patients
with
psoriasis.
Conclusions: A
large subset of
patients with
chronic renal
failure
showed
PBMC resistance
to cyclosporine
and
prednisolone.
Hyperresistant
patients
have a high risk
of being
refractory to
immunosuppressive
therapy with
one of
these drugs.
Alternative
treatment should
be considered
according to
the
individual
drug-sensitivity
data. (Clin
Pharmacol Ther
1997;62:652-64.)
=====================================================================
16.) Oral
mucositis with
features of
psoriasis,
Report of a case
and review
of the
literature
=====================================================================
Fariba Simhai
Younai, DDSa,
Joan Andersen
Phelan,
DDSb New
York and
Northport,
N.Y.
NEW YORK
UNIVERSITY
COLLEGE OF
DENTISTRY AND
STATE UNIVERSITY
OF NEW
YORK AT
STONY
BROOK
Abstract
An unusual case
of oral
mucositis with
features of
psoriasis is
reported
along with a
review of the
cases of oral
psoriasis in the
literature.
The case
reported
involved a
crusted lesion
on the upper lip
and
erythematous
lesions on the
labial mucosa,
buccal mucosa,
and
denture-bearing
palatal
mucosa. In
addition,
lesions
resembling
geographic
tongue and
ectopic
geographic
tongue were
present. All
lesions
exhibited
multiple
small
pustules.
The review of
the literature
compares the
distribution
and
clinical
appearance of
previously
reported cases
of oral
psoriasis.(Oral
Surg Oral Med
Oral Pathol Oral
Radiol Endod
1997;84:61-7)
=====================================================================
17.) Molecular
mechanisms of
tazarotene
action in
psoriasis
=====================================================================
Madeleine Duvic,
MDa, Sunil
Nagpal,
PhDb Arisa
T. Asano, MDa
Roshantha A.S.
Chandraratna
Houston, Texas
and
Irvine,
California
Abstract
Psoriasis is a
chronic
immune-mediated
disease that is
characterized by
the
hyperproliferation
and abnormal
differentiation
of keratinocytes
and by
inflammation.
The epidermal
changes
associated with
psoriasis may be
due to the
infiltration of
inflammatory T
lymphocytes and
the release of
cytokines
in response to
antigenic
stimulation.
Tazarotene is a
retinoic
acid
receptor-specific
retinoid with
demonstrated
efficacy in the
topical
treatment of
psoriasis.
Tazarotene
downregulates
markers of
keratinocyte
differentiation,
keratinocyte
proliferation,
and
inflammation.
The drug
also upregulates
three novel
genes TIG-1
(tazarotene-induced
gene-1),
TIG-2, and
TIG-3, which may
mediate an
antiproliferative
effect. The
effect of
tazarotene on
these markers is
probably a
direct effect on
gene
expression
rather than an
indirect effect
associated with
disease
improvement. (J
Am Acad Dermatol
1997;37:S18-S24.)
=====================================================================
18.) Tazarotene
gel: Efficacy
and safety in
plaque
psoriasis
=====================================================================
Gerald D.
Weinstein,
MD Irvine,
California
Abstract
Tazarotene is
the first of a
new generation
of acetylenic
retinoids
developed for
the topical
treatment of
mild-to-moderate
plaque
psoriasis.
Controlled
clinical trials
have
demonstrated
that once-daily
tazarotene
0.05% and 0.1%
gels are
effective in
improving and
reducing
clinical
signs and
symptoms of
psoriasis on
trunk and limb
lesions and
difficult-to-treat
elbow and knee
plaques.
Tazarotene has a
rapid onset of
action indicated
by
significant
improvements as
early as the
first week of
treatment.
Sustained
beneficial
effects have
been observed in
some patients
for up to 12
weeks
after the
cessation of
therapy.
Compared with
twice-daily
fluocinonide
0.05% cream,
once-daily
tazarotene
0.05%, and 0.1%
gels were
similarly
effective in
reducing plaque
elevation.
Once-daily
tazarotene 0.05%
and 0.1%
gels
demonstrated a
more prolonged
therapeutic
effect
after
discontinuation
than twice-daily
fluocinonide
cream.
Tazarotene
is
generally well
tolerated, with
adverse events
limited to local
irritation.
Tazarotene
appears to be an
effective
addition to the
currently
available
treatments for
plaque
psoriasis. (J Am
Acad Dermatol
1997;
37:S33-S38.)
=====================================================================
19.) Once-daily
tazarotene gel
versus
twice-daily
fluocinonide
cream in
the
treatment of
plaque
psoriasis
=====================================================================
Mark Lebwohl,
MDa, Ernest Ast,
MDb Jeffrey P.
Callen, MDc,
Stanley I.
Cullen, MDd
Steven R. Hong,
MDe,Carol L.
Kulp-Shorten,
MDc,
Nicholas J.
Lowe, MDf Tania
J. Phillips, MDg
Theodore Rosen,
MDh David
I. Wolf, MDi,
Janine M. Quell,
BSj John Sefton,
PhDj John
C. Lue, MSj,
John R. Gibson,
MDj
Roshantha A. S.
Chandraratna,
PhDj
New York and
Great Neck, New
York;
Louisville,
Kentucky;
Gainesville,
Florida;
Boulder,
Colorado;
Boston,
Massachusetts;
Houston, Texas;
and Santa
Monica, Vista,
and Irvine,
California
Abstract
Background: A
new class of
topical
receptor-selective
acetylenic
retinoids,
the first of
which is
tazarotene, has
been
developed.
Objective: Our
purpose was to
compare the
safety,
efficacy, and
duration
of
therapeutic
effect of 12
weeks of
once-daily
tazarotene 0.1%
and 0.05%
gel with
that of
twice-daily
fluocinonide
0.05% cream in
the treatment
of
patients with
plaque
psoriasis.
Methods: Three
hundred
forty-eight
patients with
plaque psoriasis
were
enrolled and 275
patients
completed a
multicenter,
investigator-masked,
randomized,
parallel-group
clinical
trial.
Results: Both
tazarotene gels
were as
effective as
fluocinonide in
reducing
plaque elevation
after 1 week of
treatment, and
tazarotene 0.1%
gel was
similar to
fluocinonide in
reducing scaling
of trunk/limb
lesions at
all study
weeks except
week 4.
Tazarotene 0.1%
gel was similar
to
fluocinonide
in reducing
scaling of
knee/elbow
lesions at weeks
8 and 12.
Fluocinonide
had a
significantly
greater effect
on erythema than
tazarotene at
weeks 2
through 8.
However,
treatments were
not
significantly
different at
week 12,
and tazarotene
demonstrated
significantly
better
maintenance of
therapeutic
effect after
cessation of
therapy.
Conclusion:
Tazarotene 0.1%
and 0.05% gels
were safe and
effective in
the
treatment of
mild-to-moderate
plaque
psoriasis. (J Am
Acad
Dermatol
1998;38:705-11.)
=====================================================================
20.) Clinical
safety of
tazarotene in
the treatment of
plaque
psoriasis
=====================================================================
Ronald Marks,
FRCP, FRCPath,
Cardiff,
Wales
Abstract
Oral retinoids
are effective in
the treatment of
psoriasis, but
their use
is limited by
concerns for
teratogenic
potential and
systemic side
effects.
Tazarotene is a
novel acetylenic
retinoid
undergoing
clinical trials
for the
topical
treatment of
mild-to-moderate
plaque
psoriasis. The
safety and
tolerability of
tazarotene 0.1%
and 0.05% gels
were examined in
a series
of
preclinical and
clinical trials.
In preclinical
studies
topically
applied
tazarotene gel
was
nonmutagenic,
noncarcinogenic,
and
nonteratogenic.
Tazarotene gel
was not
sensitizing,
phototoxic, or
photosensitizing
in a
series of
studies in human
volunteers.
Treatment-related
systemic
adverse
effects were not
observed in
clinical trials
involving
approximately
2000
patients treated
with tazarotene
0.1% or 0.05%
gel for periods
of up to 1
year. Adverse
effects appear
limited to
manageable,
mainly
mild-to-moderate
local skin
irritation. (J
Am Acad Dermatol
1997;37:S25-S32.)
=====================================================================
21.)
Methotrexate-induced
toxic epidermal
necrolysis in a
patient
with
psoriasis
=====================================================================
Edward J. Primka
III, MD, Charles
Camisa, MD
Cleveland,
Ohio
Abstract
We describe a
fatal case of
low-dose
methotrexate
(MTX) toxicity
in a
patient with
psoriasis,
emphasizing the
factors that
exacerbate
MTX
toxicity and
presenting
rescue
techniques. The
patient had a
toxic
epidermal
necrolysis-like
condition. MTX
cutaneous
reactions
ranging
from toxic
epidermal
necrolysis to
specific
ulcerations have
been described.
The use of
granulocyte
colony
stimulating
factor for
leukopenia
associated
with MTX
toxicity is
discussed. (J Am
Acad Dermatol
1997;36:815-8.)
=====================================================================
22.) Comparative
efficacy of
once-daily
flurandrenolide
tape
versus
twice-daily
diflorasone
diacetate
ointment in the
treatment of
psoriasis
=====================================================================
Gerald G.
Krueger, MDa
Margretta A.
O’Reilly, MDa,
Melissa Weidner,
BSNa,
Sydney H.
Dromgoole, PhDb,
Frank P. Killey,
PhDb Salt
Lake City, Utah,
and San Rafael,
California
Abstract
Background:
Flurandrenolide
tape has
recently been
listed as a
group I
topical
cortico-steroid.
There are no
studies that
compare this
product to
group I
ointments in the
treatment of
steroid-responsive
dermatoses.
Objective: Our
purpose was to
determine the
relative
efficacy
of
flurandrenolide
(4
µg/cm2)
tape versus
0.05%
diflorasone
diacetate
ointment
in plaque
psoriasis.
Methods: Thirty
patients
participated in
an
investigator-blinded,
randomized,
bilateral
paired-comparison
study of
flurandrenolide
tape
applied to
lesions of one
side of the body
once daily for
up to 16
hours
versus
diflorasone
diacetate
ointment applied
contralaterally
twice
daily.
Lesions were
assessed at
baseline, then
reevaluated at 2
and 4
weeks.
Results:
Flurandrenolide
tape–treated
plaques showed
consistently
greater
clearing in
terms of
erythema,
scaling,
induration, and
treatment
success
for all plaques,
as well as the
subset of knee
and elbow
plaques,
when
compared with
the lesions
receiving
diflorasone
diacetate
ointment.
Conclusion: The
efficacy of
flurandrenolide
tape in the
treatment
of
psoriatic
plaques
surpasses that
of diflorasone
diacetate
ointment. (J
Am Acad
Dermatol
1998;38:186-90.)
=====================================================================
23.) Alterations
in HIV
expression in
AIDS patients
with psoriasis
or
pruritus treated
with
phototherapy
=====================================================================
Joan
Breuer-McHam,
MSca,d Gailen
Marshall, MD,
PhDc Ahmed
Adu-Oppong,
MScf
Michelle Goller,
MDa Steven Mays,
MDa Tim Berger,
MDe Dorothy E.
Lewis,
PhDf Madeleine
Duvic,
MDa,b,d
Houston, Texas,
and San
Francisco,
California
Abstract
Background:
Ultraviolet
light (UVL)
upregulates HIV
transcription in
vitro and
in transgenic
mice.
AIDS-associated
psoriasis and
pruritus respond
to
phototherapy.
Objective: Our
goal was to
determine the
effect of
phototherapy on
viral load
and immunologic
parameters in
HIV-positive
patients.
Methods: T cell
subsets, p24,
plasma
cytokines, serum
or plasma
HIV-RNA,
dosage, and
antivirals were
assessed in
HIV-positive
patients and
negative
controls
receiving 6
weeks of
phototherapy
with UVB and in
untreated
controls.
Results:
Phototherapy
improved skin
conditions
without
significantly
affecting T cell
numbers. Plasma
p24 increased
2-fold (P =
.055) and
HIV-RNA levels
4-fold (P =
.022) 6 weeks
from baseline in
patients
who
entered the
trial before
March 1995.
Later patients
who were
mostly
receiving
combination
antiviral
therapy showed a
4-fold reduction
in serum
HIV-RNA (P =
.012) at 2
weeks. The
effect of UVB on
viral load at 6
weeks was
dependent on the
baseline level
(P = .006).
IL-10 increased
and was
inversely
related to
HIV-RNA levels
(P =
.0267).
Conclusion:
Phototherapy is
associated with
HIV load
alterations,
depending
on patients’
initial HIV-RNA,
antiviral
therapy, skin
type, and UVL
dosage. (J
Am Acad Dermatol
1999;40:48-60.)
=====================================================================
24.) Cancer
incidence among
Finnish
psoriasis
patients treated
with
8-methoxypsoralen
bath PUVA
=====================================================================
Anna
Hannuksela-Svahn,
MDa Eero
Pukkala, PhDb
Leena Koulu, MD,
PhDc
Christer T.
Jansén, MD, PhDc
Jaakko Karvonen,
MD, PhDaOulu,
Helsinki,
Turku,
Finland
Abstract
Background:
Long-term oral
8-methoxypsoralen
(8-MOP) and UVA
(PUVA)
therapy
increases the
risk of
nonmelanoma skin
cancer and
possibly also
of
cutaneous
malignant
melanoma.
Topical
application of
8-MOP PUVA
induces
malignant tumors
in rodent skin,
but little is
known about
its
carcinogenicity
in human
skin.
Objective: Our
purpose was to
investigate the
carcinogenicity
of 8-MOP
bath PUVA
in humans.
Methods: This
was a cohort
study of 158
patients with
psoriasis, for
whom 8-MOP
bath PUVA had
been initiated
during 1979 to
1992. The
average
number of
8-MOP bath PUVA
treatments was
36 (range, 6 to
204) and the
mean
cumulative UVA
dose was 92
J/cm2 (range, 3
to 884 J/cm2) by
the end of
1995.
The patients
were not treated
with any other
forms of PUVA.
Cancer
incidence
subsequent to
8-MOP bath PUVA
up to the end of
1995 was
determined by
linking the
cohort with the
records of the
Finnish
Cancer
Registry. The
standardized
incidence ratios
(SIR) were
calculated for
skin
cancer and some
common internal
cancers, using
the expected
numbers of
cases based on
the regional
cancer incidence
rates.
Results: There
was one case of
basal cell
carcinoma, but
no cases of
other
types of skin
cancer. A total
of 6
noncutaneous
cancers were
observed
(SIR, 1.3;
95% confidence
interval, 0.5 to
2.8).
Conclusion: No
association
between
cutaneous cancer
and 8-MOP bath
PUVA was
found, but the
statistical
power of this
study alone is
not adequate
to warrant
definite
conclusions. The
results can be
used in a
meta-analysis
as soon as
other studies on
the
carcinogenicity
of 8-MOP bath
PUVA are
published.(J Am
Acad Dermatol
1999;40:694-6.)
=====================================================================
25.) Comparison
of psoralen-UVB
and psoralen-UVA
photochemotherapy
in the
treatment of
psoriasis
=====================================================================
D. A. R. de
Berker, MRCPa A.
Sakuntabhai, MDa
B. L. Diffey,
PhDb J. N.
S. Matthews,
PhDc P. M. Farr,
MDa
Newcastle upon
Tyne and Durham,
United
Kingdom
Abstract
Background: PUVA
treatment of
psoriasis is
usually given
with
broad-band
fluorescent UVA
lamps.
Narrow-band UVB
exposure after
oral methoxsalen
has been
shown to achieve
a greater
therapeutic
response in
psoriasis
than
identical UVB
exposure given
without
psoralen.
Objective: The
purpose of this
study was to
compare
conventional
PUVA with
psoralen-UVB
therapy in
psoriasis.
Methods: We
studied 100
patients with
plaque-type
psoriasis who
were
randomly
selected to
receive either
conventional
psoralen-UVA
or
psoralen-UVB
treatment.
Results: No
significant
difference was
found between
the two
treatments
in the
proportion of
patients whose
skin cleared
during treatment
or in the
number of
exposures
required for
clearance of
psoriasis. As
expected,
the
cumulative UV
dose for
clearance was
smaller in the
group treated
with UVB
compared with
those receiving
UVA. Side
effects and
disease status
at 3
months after the
end of treatment
were similar for
the two
groups.
Conclusion:
Psoralen-UVB
treatment of
psoriasis is as
effective
as
conventional
PUVA. The
mechanism of
psoralen-311 nm
UVB action on
psoriasis
requires study
to predict the
long-term safety
of this
treatment. (J
Am Acad
Dermatol
1997;36:577-81.)
=====================================================================
26.)Ranitidine
does not affect
psoriasis: A
multicenter,
double-blind,
placebo-controlled
study
=====================================================================
I. M. Zonneveld,
MDa M. M. H. M.
Meinardi, MDa T.
Karlsmark,
MDb
U. Broby
Johansen, MDb G.
R. R. Kuiters,
MDc
L. Hamminga, MDc
B. Staberg, MDd
A. J. van’t
van’t Veen,
MDe
P. M. M.
Bossuyt, PhDf J.
C. G. van Niel,
PhDg J. D. Bos,
MDa
Amsterdam,
Zwolle, and
Rotterdam, The
Netherlands, and
Copenhagen
and
Rødovre,
Denmark
Abstract
Background: Data
from open
studies suggest
that ranitidine
has a
beneficial
effect on
psoriasis and is
well
tolerated.
Objective: Our
purpose was to
determine the
effectiveness of
ranitidine
in a
24-week,
multicenter,
double-blind,
placebo-controlled,
dose-comparing
study of 201
patients with
psoriasis.
Methods:
Patients with
moderate to
severe psoriasis
who had
stopped
systemic
antipsoriatic
therapy,
including PUVA
and UVB, for at
least 10
weeks were
included. After
a washout period
of 2 weeks,
patients
were
randomly
allocated to use
either
ranitidine, 150
mg twice a
day;
ranitidine, 300
mg twice a day;
or placebo for
up to 24 weeks.
Assessment
with the
Psoriasis Area
and Severity
Index was
performed at
weeks 3, 6,
9, 12, 18,
and 24 after
randomization.
Reduction of the
Psoriasis Area
and
Severity Index
score by 70% at
the completion
of the study was
considered
a
treatment
success.
Results: The
success rates at
week 24 in the
300 mg, 600 mg,
and
placebo
groups were 11%,
5%, and 12%,
respectively. No
significant
differences
were
observed between
the three
treatment groups
at any stage of
the study.
Conclusion: This
study provides
strong evidence
that ranitidine
does not
affect the skin
disease in
patients with
psoriasis. (J Am
Acad
Dermatol
1997;36:932-4.)
=====================================================================
27.) Combined
topical
calcipotriene
ointment 0.005%
and various
systemic
therapies in the
treatment of
plaque-type
psoriasis
vulgaris: Review
of the
literature and
results of a
survey sent to
100
dermatologists
=====================================================================
H. Irving Katz,
MD, Fridley,
Minnesota
Abstract
Background:
Plaque-type
psoriasis may at
times require
systemic
therapy.
There are
limited data as
to whether
topical
calcipotriene
ointment
0.005% can
be used to
increase the
efficacy and
improve the
risk/benefit
ratio of
concurrent
systemic
antipsoriatic
therapy.
Objective: We
attempt to
answer this
question by
means of a
literature
review and
results of a
written survey
that was sent to
100
international
psoriasis
treatment
experts.
Methods: The
survey was sent
to academic and
psoriasis
treatment
center–based
dermatologists
who treat
approximately
3000 to 4000
patients
with psoriasis
per month. The
survey requested
that
dermatologists
relate
their experience
regarding the
safety and
efficacy of
topical,
systemic,
and combined
topical/systemic
agents in
psoriasis after
8 weeks of
therapy.
Results: The
results of the
survey support
the experience
in the
literature
regarding the
favorable use of
calcipotriene
ointment
combined
with
systemic therapy
for the
treatment of
psoriasis.
Conclusion:Combination
therapy with
calcipotriene
ointment
and
acitretin/etretinate,
cyclosporine,
methotrexate, or
phototherapy
usually
enhances
efficacy while
improving the
risk/benefit
ratio by
decreasing
exposure to the
potentially
hazardous
systemic agent.
(J Am Acad
Dermatol
1997;37:S62-S68.)
=====================================================================
28.) The
genetics of
psoriasis
=====================================================================
Tilo Henseler,
MD, PhD
Kiel,
Germany
Abstract
The analysis of
population-specific
human leukocyte
antigen
(HLA)
haplotypes has
provided
evidence that
susceptibility
to psoriasis is
linked to
the class I and
II major
histocompatibility
complex on human
chromosome
6. In addition,
these studies
show that
psoriasis
consists of two
distinct
disease subtypes
(type I and type
II), which
differ in age of
onset and
in the
frequency of
HLA. In type I
(early-onset)
psoriasis, Cw6,
B57, and
DR7 are
strongly
increased,
whereas in type
II (late-onset)
psoriasis,
HLA-Cw2 is
overrepresented.
It has
also been
proposed that
HLA haplotypes
extended
by class III
play a role in
the genetics of
this disease.
Moreover,
studies of
affected
families
indicate that
other disease
susceptibility
loci may
also be
involved. Likely
candidates for
additional
susceptibility
genes are
located at
chromosomes 1,
6, and 17, and
microsatellite
markers over
the whole
genome have been
used to identify
susceptibility
genes. Two years
ago
linkage to the
distal part of
chromosome 17
was published.
However,
this
linkage could
not be confirmed
by other groups
with comparable
or
enlarged
numbers of
psoriatic family
members
investigated.
Recently,
an
investigation
presenting an
area of
chromosome 4 as
a susceptibility
locus for
psoriasis was
published.
According to our
knowledge today,
psoriasis
is a
polygenetically
inherited
disease.
Furthermore from
twin studies it
is known
that
environmental
factors play a
significant role
in the onset
or
recurrence of
the disease. (J
Am Acad Dermatol
1997;37:S1-S11.)
=====================================================================
29.) The use of
topical
calcipotriene/calcipotriol
in conditions
other than
plaque-type
psoriasis
=====================================================================
Bruce H. Thiers,
MD
Charleston,
South
Carolina
Abstract
Background:
Topical
calcipotriene
ointment has
been approved
for the
treatment of
plaque-type
psoriasis.
Objective:
This article
explores the
possible use of
topical
calcipotriene
ointment in the
treatment of
nail and
intertriginous
psoriasis,
palmoplantar and
pustular
psoriasis,
Reiter’s
syndrome,
pityriasis
rubra
pilaris, and
disorders of
keratinization.
Methods: The
recent
literature is
reviewed.
Results: Recent
reports suggest
that certain
ichthyoses
(particularly
the
hyperproliferative
variants) and
keratodermas may
respond to
topical
calcipotriene
ointment. The
activity of
calcipotriene
relates to
a
dose-dependent
decrease in
proliferation
and an increase
in
terminal
differentiation
of
keratinocytes.
Conclusion:
Patients with
other disorders
characterized by
epidermal
hyperproliferation
may also be
candidates for
treatment. The
use of
calcipotriene in
treating
congenital
hyperproliferative
disorders
is limited
by the
theoretical risk
of hypercalcemia
from absorption
of the
drug after
application to
extensive areas
of skin. (J Am
Acad
Dermatol
1997;37:S69-S71.)
=====================================================================
30.) Tazarotene:
The first
receptor-selective
topical retinoid
for the
treatment of
psoriasis
=====================================================================
Roshantha A. S.
Chandraratna,
PhD
Irvine,
California
Abstract
Tazarotene
belongs to a
novel,
nonisomerizable
class of
retinoic
acid
receptor
(RAR)-specific
retinoids, the
acetylenic
retinoids, and
is the
first topical
retinoid
developed for
the treatment of
psoriasis.
Tazarotene
targets the
keratinocyte and
modulates the
major causes of
psoriasis.
Tazarotene is
rapidly
metabolized by
esterase to the
active free
acid
tazarotenic
acid, which is
rapidly
eliminated in
animal species.
Tazarotene
selectively
transactivates
RAR and RAR
subtypes and is
inactive at
retinoid X
receptors
(RXRs). This
receptor
selectivity
could contribute
to an
optimized
therapeutic
index.
Tazarotene has
low systemic
absorption
after
topical
administration.
In preclinical
toxicity
studies, high
topical
doses
produced
reversible
topical
irritation, and
lower doses were
well
tolerated.
Topical doses
were neither
teratogenic nor
carcinogenic and
were not
sensitizing,
phototoxic, or
photosensitizing.
The topical
delivery
of
tazarotene and
limited systemic
exposure
apparently
result in a very
low
potential for
systemic
effects. (J Am
Acad Dermatol
1997;37:S12-S17.)
=====================================================================
31.) The effects
of topical
calcipotriol on
systemic calcium
homeostasis
in
patients with
chronic plaque
psoriasis
=====================================================================
J. F. Bourkea,
R. Mumforda, P.
Whittakerb, S.
J. Iqbalb
L. W. Le Vand,
A. Trevellyanc,
P. E.
Hutchinsona,
Leicester,
United Kingdom,
and Madison,
Wisconsin
Abstract
Background:
Calcipotriol is
an effective
treatment of
chronic
plaque
psoriasis. We
have previously
demonstrated
that it has a
small effect
on
systemic calcium
homeostasis even
at recommended
doses.
Objective: We
attempted to
determine the
mechanism of the
effect of
calcipotriol on
sytemic calcium
homeostasis so
we could assess
the
possible
consequences of
long-term
use.
Methods: Sixteen
patients with
extensive
chronic plaque
psoriasis
were
hospitalized and
treated with
high-dose
topical
calcipotriol. Up
to 360 gm
of calcipotriol
(50
µg/gm)
ointment was
applied per week
for 2 weeks
under
controlled
conditions.
Results: There
was a
dose-dependent
rise in
intestinal
absorption
of
calcium. No
effect on bone
turnover was
demonstrated
over this
short
period. Five
patients became
hypercalcemic,
and there was a
dose-dependent
rise in serum
total adjusted
calcium, serum
ionized calcium,
serum
phosphate, urine
calcium, and
urine phosphate.
There was a
dose-dependent
fall in serum
parathyroid
hormone and
serum 1,25
dihydroxyvitamin
D3.
Conclusion:
Calcipotriol
exerts its
effects on
systemic calcium
homeostasis
by increasing
intestinal
absorption of
calcium and
probably
phosphate.
This
results in
suppression of
parathyroid
hormone and 1,25
dihydroxyvitamin
D3. (J Am
Acad Dermatol
1997;37:929-34.)
=====================================================================
32.)
Cyclosporine
consensus
conference: With
emphasis on the
treatment
of
psoriasis
=====================================================================
Mark Lebwohl,
MDa, Charles
Ellis, MDb,
Alice Gottlieb,
MD, PhDc John
Koo,
MDd Gerald
Krueger, MDe,
Kenneth Linden,
MDg, Jerome
Shupack, MDf,
Gerald
Weinstein,
MDg
New York, New
York; Ann Arbor,
Michigan;
Newark, New
Jersey; San
Francisco
and Irvine,
California; and
Salt Lake City,
Utah
Abstract
Cyclosporine has
been in
worldwide use
for 15 years for
patients who
have
undergone
transplantation
operations and
is now being
used to
control
inflammatory
reactions in
other organs
(eg, joints,
bowel, and
skin).
Neoral, a more
consistently
absorbed form of
cyclosporine,
has
recently
been approved by
the Food and
Drug
Administration
for the
treatment
of
psoriasis.
This report
outlines the
indications,
contraindications,
dosage
recommendations,
monitoring
requirements,
adverse events,
drug
interactions,
interactions
with other
psoriasis
treatments, and
suggestions
for
cyclosporine’s
use in
rotational
therapy.(J Am
Acad
Dermatol
1998;39:464-75.)
=====================================================================
33.) Tazarotene
0.1% gel plus
corticosteroid
cream in the
treatment
of plaque
psoriasis
=====================================================================
Mark G. Lebwohl,
MDa Debra L.
Breneman, MDb
Bernard S.
Goffe, MDc
Jay R. Grossman,
MDd Mark R.
Ling, MD, PhDe
James Milbauer,
MDf
Stephanie H.
Pincus, MDg R.
Gary Sibbald,
MDh Leonard J.
Swinyer,
MDi Gerald
D. Weinstein,
MDj Deborah A.
Lew-Kaya,
PharmDk John C.
Lue, MSk
John R. Gibson,
MDk John Sefton,
PhDk
New York and
Buffalo, New
York;
Cincinnati,
Ohio; Seattle,
Washington;
Vista and
Irvine,
California;
Atlanta,
Georgia;
Hackensack, New
Jersey;
Mississauga,
Ontario, Canada;
and Salt Lake
City, Utah
Abstract
Background:
Topical
corticosteroids
are often used
in the treatment
of
psoriasis, but
long-term use
may be
associated with
serious adverse
events
such as
tachyphylaxis or
atrophy of the
skin.
Tazarotene, a
new
topical
retinoid, has
demonstrated
significant
clinical
benefits but can
cause mild
to moderate
local
irritation.
Objective: We
evaluate whether
a combination
treatment of
topical
tazarotene and a
topical
corticosteroid
would increase
efficacy
while
reducing the
incidence of
local adverse
events
associated with
a topical
retinoid.
Methods: Three
hundred patients
enrolled in an
investigator-masked
study were
randomly
assigned to 1 of
4 treatment
groups:
tazarotene 0.1%
gel in
combination with
placebo cream,
or with a low-,
mid-, or
high-potency
corticosteroid
cream, for 12
weeks of
treatment and a
posttreatment
follow-up at
week 16.
Results:
Tazarotene 0.1%
gel in
combination with
a mid- or
high-potency
corticosteroid,
when compared
with tazarotene
plus placebo
cream,
achieved
significantly
greater
reductions in
scaling,
erythema, and
overall
lesional
severity, and a
decreased
incidence of
adverse
events.
Conclusion: All
tazarotene
combinations
(including
tazarotene plus
placebo)
were highly
effective in
rapidly reducing
the severity of
psoriasis.
Combining
tazarotene with
a topical
corticosteroid
increased
efficacy
while
reducing the
incidence of
local adverse
events. (J Am
Acad
Dermatol
1998;39:590-6.)
=====================================================================
34.) The
pathogenesis of
psoriasis and
the mechanism of
action of
tazarotene
=====================================================================
Madeleine Duvic,
MD Arisa T.
Asano, MD Carina
Hager, MD
Steven Mays,
MD
Houston,
Texas
Abstract
The 3 major
features of
psoriasis—abnormal
differentiation
of
keratinocytes,
hyperproliferation
of
keratinocytes,
and infiltration
of
inflammatory
components into
the skin—can be
quantified by
measuring
levels of
certain
biochemical
markers.
Psoriasis is
associated with
upregulation
or
downregulation
of several of
these markers.
Tazarotene helps
to
normalize the
levels of the
markers, thereby
bringing about
clinical
improvement. (J
Am Acad Dermatol
1998;39:S129-33.)
=====================================================================
35.)
Bath-5-methoxypsoralen-UVA
therapy for
psoriasis
=====================================================================
Pier Giacomo
Calzavara-Pinton,
MD
Cristina Zane,
MD Anna Carlino,
MD Giuseppe De
Panfilis,
MD
Brescia,
Italy
Abstract
Background:
After oral
intake,
5-methoxypsoralen
(5-MOP) is as
effective
as 8-MOP
for PUVA therapy
for psoriasis,
with a lower
incidence of
acute
cutaneous side
effects.
Objective: We
compared
bath-water
delivery of
5-MOP and 8-MOP
for
photochemotherapy
of
psoriasis.
Methods:
Twenty-two
patients
underwent
phototesting
with 0.0003%
5-MOP or
8-MOP aqueous
solutions.
Twelve patients
with palmar
psoriasis were
studied
with a
side-to-side
comparison, and
10 patients with
recurrent
plaque-type
psoriasis were
treated with one
therapy or the
other.
Results: Minimal
phototoxic dose
(MPD) values
were 2.8
± 1.2
J/cm2 with
8-MOP and 2.0
± 1.2
J/cm2 with 5-MOP
(p < 0.01).
Both therapies
cleared
palmar lesions
but 8-MOP
required more
UVA irradiation
(46.3
±
21.0 J/cm2
vs 30.2
±
21.5 J/cm2; p
< 0.01) and
more exposures
(21.0
± 6.0
vs 17.0
±
5.0; p = 0.02).
Bath-5-MOP-UVA
was also more
effective in the
treatment
of
plaque-type
psoriasis
(cumulative UVA
doses, 56.8
±
39.2 vs 59.1
±
27.9
J/cm2; number of
exposures, 20.0
± 5.7
vs 21.6
±
4.7), but
these
differences were
not significant
(p = NS).
Patients
developed an
intense
tan
significantly
earlier with
5-MOP than with
8-MOP (3.5
± 0.5
weeks vs
4.4 ±
0.5 weeks; p
<
0.01).
Conclusion:
Bath-5-MOP-UVA
was more
phototoxic than
bath-8-MOP-UVA.
It was
more effective
in the treatment
of palmar
psoriasis,
whereas its
greater
pigmentogenic
activity
appeared to have
an adverse
effect on
therapeutic
effectiveness in
the treatment of
plaque-type
psoriasis. (J Am
Acad
Dermatol
1997;36:945-9.)
=====================================================================
36.) -3 Fatty
acid–based lipid
infusion in
patients with
chronic
plaque
psoriasis:
Results of a
double-blind,
randomized,
placebo-controlled,
multicenter
trial
=====================================================================
Peter Mayser,
MDa Ulrich
Mrowietz, MDb
Peter
Arenberger,
MDc Pavel
Bartak, MDd
Jozef Buchvald,
MD, PhDe Enno
Christophers,
MDb
Stefania
Jablonska, MDf
Werner
Salmhofer, MDg
Wolf-Bernhard
Schill,
MDa
Hans-Joachim
Krämer, PhDh
Ewald Schlotzer,
PhDi Konstantin
Mayer, MDh
Werner Seeger,
MDh Friedrich
Grimminger, MD,
PhDh
Giessen, Kiel,
and Oberursel,
Germany; Prague,
Czech Republic;
Bratislava,
Slovak Republic:
Warsaw, Poland;
and Graz,
Austria
Abstract
Background:
Profound changes
in the
metabolism of
eicosanoids
with
increased
concentrations
of free
arachidonic acid
(AA) and
its
proinflammatory
metabolites have
been observed in
psoriatic
lesions.
Free
eicosapentaenoic
acid (EPA) may
compete with
liberated AA and
result in
an
antiinflammatory
effect.
Objective: Our
purpose was to
assess the
efficacy and
safety of
intravenously
administered
fish-oil–derived
lipid emulsion
on chronic
plaque-type
psoriasis.
Methods: A
double-blind,
randomized,
parallel group
study was
performed
in eight
European
centers.
Eighty-three
patients
hospitalized for
chronic
plaque-type
psoriasis with a
severity score
of at least 15
according to
the
Psoriasis Area
and Severity
Index (PASI)
participated in
a 14-day
trial.
They were
randomly
allocated to
receive daily
infusions with
either a
-3 fatty
acid–based lipid
emulsion
(Omegavenous;
200 ml/day with
4.2 gm of
both EPA and
docosahexaenoic
acid (DHA); 43
patients) or a
conventional
-6-lipid
emulsion
(Lipovenous;
EPA+DHA < 0.1
gm/100 ml; 40
patients).
The groups
were well
matched with
respect to
demographic data
and
psoriasis-specific
medical history.
Efficacy of
therapy was
evaluated
by changes
in PASI, in an
overall
assessment of
psoriasis by the
investigator,
and a
self-assessment
by the patient.
In one center
neutrophil 4-
versus
5-series
leukotriene (LT)
generation and
platelet 2-
versus 3-
thromboxane
generation were
investigated and
plasma-free
fatty acids were
determined.
Results: The
total PASI score
decreased by
11.2
± 9.8
in the -3 group
and by 7.5
± 8.8
in the -6 group
(p = 0.048). In
addition, the -3
group was
superior to the
-6 group with
respect to
change in
severity of
psoriasis
per body area,
change in
overall
erythema,
overall scaling
and
overall
infiltration, as
well as change
in overall
assessment by
the
investigator
and
self-assessment
by the patient.
Response
(defined as
decrease in
total PASI
of at least 50%
between
admission and
last value) was
seen in 16 of
43
patients (37%)
receiving the -3
emulsion and 9
of 40 patients
(23%)
receiving -6
fatty acid–based
lipid emulsion.
No serious side
effects
were
observed. Within
the first few
days of -3 lipid
administration,
but not in
the -6
supplemented
patients, a
manifold
increase in
plasma-free
EPA
concentration,
neutrophil
leukotriene B5
and platelet
thromboxane
B3
generation
occurred.
Conclusion:
Intravenous
-3-fatty acid
administration
is effective in
the
treatment of
chronic
plaque-type
psoriasis. This
effect may be
related to
changes in
inflammatory
eicosanoid
generation. (J
Am Acad
Dermatol
1998;38:539-47.)
=====================================================================
37.)
Immunopathogenesis
of
Psoriasis
=====================================================================
Alice Bendix
Gottlieb, MD,
PhD Chief of
Dermatology and
Associate
Professor
University of
Medicine and
Dentistry of New
Jersey Robert
Wood
Johnson
Medical
School
Clinical
Academic
Building 125
Paterson
St New
Brunswick, NJ
08901
Archives of
Dermatology
Editorial - June
1997
The Road From
Bench to Bedside
is a 2-Way
Street In
this age of
genetic
engineering and
transgenic and
knockout mice,
it is
sobering to
realize that the
immunopathogenesis
of psoriasis was
discovered
largely through
clinical
research in
patients with
psoriasis.
Before the
mid-1980s, the
keratinocyte was
the focus of
scientific
research
in
psoriasis
because both the
clinical and
histologic
phenotypes of
this
disease are
dominated by the
results of
abnormal
keratinocyte
proliferation
and
differentiation.[1-6]
However, the
results of
research since
then have
demonstrated
that if one
eliminates the
activated T
lymphocyte in
psoriatic
plaques,
keratinocyte
proliferation
and
differentiation
return to
normal
both clinically
and
histologically.[7-10]
Thus, the
abnormalities in
the
keratinocytes
are reversible.
Clinically,
psoriatic
plaques are
described
as red,
elevated, and
scaly. Both the
elevation and
scale are
direct
results of the
same altered
keratinocyte
proliferation
and
differentiation
that have been
observed in
acute and
chronic
cutaneous
wounds.
This
alternate
pathway of
keratinocyte
differentiation
has been
termed
regenerative
maturation.[1]
It is
characterized by
increased
proliferation
in both basal
and suprabasal
keratinocytes,
K-16 keratin
expression in
the viable
suprabasal
keratinocyte
layers, and
patchy to absent
expression
of
filaggrin.[1,3,7-9,11]
In the
mid-1980s,
activated T
lymphocytes
(high-affinity
interleukin-2
receptor-bearing
T lymphocytes)
and
interferon
gamma-induced
proteins on the
surfaces of
keratinocytes
were detected
in
psoriatic
plaques,[12-20]
and the first
reports of
clinical
efficacy of
the
immunosuppressant
cyclosporine
were
published.[17,21,22]
The research
began to
focus on the T
lymphocyte.
However, the
clinical
response
to
cyclosporine
treatment was
not definitive
pathogenic proof
since
cyclosporine is
demonstrated to
affect both
keratinocyte and
lymphocyte
function at
concentrations
detected in skin
samples of
patients
with
psoriasis who
were treated
with
cyclosporine.[19,23,24]
Therefore, it
was not a
clean reagent to
use as a
therapeutic
probe into the
pathogenic
origin of
psoriasis. The
clinical
availability of
an
interleukin-2-diphtheria
toxin fusion
protein, which
was specific
for
activated T
lymphocytes
bearing
high-affinity
interleukin-2
receptors
and did
not react with
keratinocytes,
provided the
ideal reagent
for
testing
which cell
drives the
psoriatic
plaque--the T
lymphocyte or
the
keratinocyte.
As a single
therapeutic
agent, the
treatment of
patients
with
psoriasis using
the
interleukin-2-diphtheria
toxin fusion
protein
resolved
the psoriatic
plaques both
clinically and
histologically.[8]
Therefore,
the T
lymphocyte, and
not the
keratinocyte,
drives the
psoriatic
plaque.
Further reports
have
demonstrated
that remittive
psoriatic
treatments
(ie, those
that result in
prolonged
clearance of
psoriatic
lesions in
the
absence of
continuous
treatment), such
as treating
inpatients with
UV-B and
topical tar or
oral psoralen
with UV-A,
induced
apoptosis in T
cells with
cell death in
vitro. Activated
T lymphocytes
were more
sensitive to
these
effects than
keratinocytes.[7,9]
In contrast,
suppressive
treatments
(ie, those
that require
continual
treatment to
maintain the
clearance
of
lesions), such
as cyclosporine
or etretinate,
merely
suppressed
T-cell
function or
proliferation
and did not
induce apoptosis
in
vitro.[23,25,26]
OLIGOCLONAL
EXPRESSION OF
T-CELL RECEPTOR
Vbeta SUBGROUPS
IN PSORIATIC,
LESIONAL
EPIDERMAL CD8+ T
LYMPHOCYTES
The accumulated
work by Chang et
al and
others[27,28]
has resulted
in
clinical trials
in patients with
psoriasis, with
therapeutic
vaccines
made of
T-cell receptor
Vbeta peptides,
only 1 year
after the
original
publication by
Chang et al[27]
in 1995.
Chang et al
cloned activated
T
lymphocytes from
psoriatic
plaques. Their
results
demonstrated
the
oligoclonal
expression of
Vbeta T-cell
receptor
subgroups Vbeta3
and
Vbeta13.1 in
only the CD8+ T
cells cloned
from psoriatic
lesional
epidermis.
The results did
not demonstrate
oligoclonal
expression in
CD8+ T
cells from
psoriatic
lesional dermis,
from any
psoriatic CD4+ T
cells, and
in any T cells
similarly cloned
from lesions of
patients with
atopic
dermatitis.
Using different
technologies,
Menssen and
coworkers[28]
looked at
Vbeta
restrictions in
punch biopsy
specimens, which
included
both
epidermis and
dermis, and
found Vbeta2 and
Vbeta6
overexpression
in the
results.
Other
investigators,[29]
again using
different
technologies,
could not
find the
clonality of
Vbeta T-cell
receptor
expression. The
possibility
was brought up
that by using
technology based
on polymerase
chain
reaction
Chang et al had
merely
demonstrated a
small population
of T cells,
which
could express
messenger RNA at
exceedingly high
rates, and not a
key
subpopulation,
which could
potentially be
the pathogenic T
cells in
psoriasis. In
the article
entitled
"Persistence of
T-Cell Clones
in
Psoriatic
Lesions,"
published in
this issue of
the ARCHIVES,
Chang et
al[30] sorted
CD8+ T cells and
assessed
clonality at the
message level.
To
demonstrate that
the message
level reflected
the proportion
of T cells
bearing that
specific Vbeta
T-cell receptor
and that the
clonal
dominance
originally
detected was not
due to an
overabundance of
messenger
RNA
expressed by
only a few
cells, they
sorted the
Vbeta13.1+ cells
directly
from psoriatic
lesional
epidermis.
In that
way, the authors
could
determine
whether the
clonality
observed by
assessing the
T-cell receptor
messenger
RNA accurately
reflected the
clonality in the
T-cell
population.
Vbeta13.1+
T lymphocytes,
sorted directly
from the skin
biopsy specimens
of
psoriatic
plaques, again
exhibited clonal
dominance.
The dominant
Vbeta13.1 clone,
as
detected by
sequence
analysis, was
the same as that
detected in the
same
patients in the
original
publication by
these
investigators.[27]
Additionally, in
8 of the 9 new
patients
examined, the
results
again
demonstrated the
preferential use
of Vbeta3 and/or
Vbeta13.1 genes
by
lesional CD8+ T
lymphocytes.
Thus, the
clonality
detected in
Vbeta
messages
of CD8+ T cells
sorted from
psoriatic
plaques
accurately
reflected
clonal
dominance. In
addition, the
same clone
persisted for as
long as 15
months.
The
demonstration of
the same
overrepresentation
of Vbeta3 and
Vbeta13.1
in CD8+ T
cells from
psoriatic
plaques in a new
population of
patients
confirmed the
original
suggestion that
these T cells
may play a
pathogenic role
in
psoriasis.
NOVEL
IMMUNOTHERAPIES
FOR PSORIASIS
ARE NOW IN THE
CLINIC
These studies
started in the
clinic and now
have returned to
the clinic
in the
form of a
recently
completed
double-blind,
phase 2,
adjuvant-controlled
study of a
therapeutic
vaccine
consisting of
Vbeta3 and
Vbeta13.1
peptides
in patients with
moderate to
severe
psoriasis.
At a recent
meeting
dedicated to the
basic and
clinical
research of
psoriasis, a
number of
pharmaceutical
companies
presented their
work, which
targets the
T
lymphocyte.
Targets include
accessory
molecules of
T-cell
activation
(B7/CD28), the
interleukin-2-diphtheria
toxin fusion
protein, a
purine-nucleoside
phosphorylase
inhibitor, and
T-cell receptor
peptide
vaccines.
Many
investigators in
both industry
and academics
use
psoriasis
as the paradigm
of a
TH1-mediated
immune disease.
These studies
have shown
that
collaboration
between the
pharmaceutical
industry and
academics
yields
good science.
Research in
psoriasis has
demonstrated the
power of
clinical
research in
determining the
mechanism of
disease (ie, the
road from
bench to
bedside is a
2-way
street).
This work was
funded by a
grant from the
Foundation of
the University
of
Medicine and
Dentistry of New
Jersey, New
Brunswick, to
support
dermatology
research in the
Division of
Dermatology at
the University
of Medicine
and
Dentistry of New
Jersey-Robert
Wood Johnson
Medical
School.
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use T-cell
receptor V beta
3 and/or V beta
13.1 genes. Proc
Natl Acad Sci U
S A.
1995;91:9282-9286.
28. Menssen A,
Rommler P,
Vollmer S.
Evidence for an
antigen-specific
cellular immune
response in skin
lesions of
patients with
psoriasis
vulgaris. J
Immunol.
1995;155:4078-4083.
29.
Schmitt-Egenolf
M, Boehncke W,
Christophers E,
Stander M,
Sterry W. Type I
and type II
psoriasis show a
similar usage of
T-cell receptor
variable
regions. J
Invest Dermatol.
1991;97:1053-1056.
30. Chang JCC,
Smith LR,
Froning KJ, et
al. Persistence
of T-cell clones
in psoriatic
lesions. Arch
Dermatol.
1997;133:703-708.
(Arch Dermatol.
1997;133:781-782)
=====================================================================
38.)
Epstein-Barr
Virus-Associated
Lymphoproliferative
Disease
During
Methotrexate
Therapy for
Psoriasis
=====================================================================
Carle Paul, MD;
Agnés Le
Tourneau, MD;
Jean Michel
Cayuela, PhD;
Alain
Devidas, MD;
Caroline Robert,
MD; Vincent
Molinié, MD;
Louis Dubertret,
MD
Background:
Epstein-Barr
virus
(EBV)-associated
lymphoproliferative
disorders have
recently been
observed during
treatment of
rheumatoid
arthritis and
dermatomyositis
with low-dose
methotrexate.
Observation: A
patient with
psoriasis
developed a
B-cell
lymphoproliferative
disorder during
long-term
treatment with
low-dose
methotrexate.
The lymphoid
cells expressed
EBV latent
membrane protein
1, and the
EBV viral genome
was present as
demonstrated by
in situ
hybridization.
Evaluation for
EBV clonality
showed that the
lymph node
contained clonal
EBV DNA.
Polymerase chain
reaction studies
confirmed
that the
B-cell
lymphoproliferative
disorder was
mainly
monoclonal,
suggesting
that the
disorder arose
from a single
EBV-infected
B-cell
clone.
Conclusions:
Lymphoproliferative
disorders
associated with
Epstein-Barr
virus in which
the
clinicopathological
presentation is
similar to
those
occurring in
patients after
transplantation
may be observed
in
patients
with psoriasis
treated with
methotrexate.
While it is
impossible to
rule out a
fortuitous
occurrence of an
EBV-associated
lymphoproliferative
disorder and
psoriasis
treated with
methotrexate in
the same
patient,
EBV
appears to be
critical in the
pathogenesis of
the
lymphoproliferative
disorder in this
patient.
Arch Dermatol.
1997;133:867-871
=====================================================================
39.) Long-term
Safety of
Cyclosporine in
the Treatment of
Psoriasis
=====================================================================
Rachel M.
Grossman, MD;
Sylvie Chevret,
MD, PhD; Johnny
Abi-Rached,
MD;
Francoise
Blanchet, MD;
Louis Dubertret,
MD
Background and
Design:
Cyclosporine has
proved to be
highly effective
in the
treatment of
psoriasis.
However,
cyclosporine is
potentially
toxic.
Side effects
include renal
toxic effects,
hypertension,
and an
increased
risk of
malignant
neoplasm.
The toxicity of
cyclosporine is
dose-related,
yet the safe
duration of
treatment is
undefined. We
studied the
hospital
records of all
patients with
psoriasis
treated with
cyclosporine at
Saint
Louis Hospital,
Paris, France,
between January
1, 1987, and
December
31, 1993.
In total, 122
patients treated
for 3 to 76
months were
evaluated.
Results: The
percentage of
patients who
discontinued
treatment
because of
side effects
rose from a
mean+/-SD of
14%+/-2.4% at 12
months to
41%+/-6.7%
at 48 months. An
increase in
serum creatinine
levels to more
than 30%
above the
baseline value
occurred in 53
patients after a
median treatment
time of 23
months.
Hypertension
developed in 29
patients after a
median
treatment
time of 53
months. Three
initial patient
characteristics--age
older than
50 years
(P=.04), initial
diastolic
pressure higher
than 75 mm Hg
(P=.05),
and serum
creatinine
levels more than
100 micromol/L
(1.1 mg/dL)
(P=.02,
log rank
test)--predicted
discontinuation
of cyclosporine
because of
side
effects.
Conclusions: The
risk of
cyclosporine-induced
toxic effects
increases
with age
of the patient
and with
preexisting
hypertension or
high serum
creatinine
levels. The data
suggest that the
incidence of
side
effects
increases with
time. Thus,
cyclosporine is
not an
acceptable
long-term
monotherapy for
psoriasis.
(Arch Dermatol.
1996;132:623-629)
=====================================================================
40.) Acitretin
Therapy Is
Effective for
Psoriasis
Associated With
Human
Immunodeficiency
Virus
Infection
=====================================================================
Laura Buccheri,
MD; Bradford R.
Katchen, MD;
Andrew J.
Karter, PhD;
Steven
R. Cohen,
MD
Objective: To
determine the
safety,
tolerability,
and
effectiveness of
a newer
retinoid,
acitretin, as
monotherapy for
psoriasis
associated
with human
immunodeficiency
virus infection
(PS-HIV).
Design: Pilot
investigation.
Setting: An
academic medical
center.
Patients: Eleven
patients
selected from
volunteers with
PS-HIV
were
enrolled in a
20-week
treatment
protocol. Two
patients
discontinued
participation in
the study
because of
worsening
psoriasis; a
third
patient
was unable to
continue
treatment after
having a
myocardial
infarction,
presumably
unrelated to
acitretin
therapy.
Intervention:
Each patient
received an
optimized dose
of acitretin
during the
period of
observation.
Clinical and
laboratory
assessments
were
performed every
2 weeks during
the trial.
Main Outcome
Measures: The
Psoriasis Area
and Severity
Index was used
to assess
the clinical
response to
treatment. To
monitor for
toxic drug
effects, a panel
of laboratory
parameters,
including
complete blood
cell
count,
biochemistry
profile,
urinalysis, HLA
typing, skin
biopsy for
histological
examination, and
T-cell counts,
was
performed.
Results: Six
(54%) of 11
patients with
PS-HIV achieved
good to
excellent
responses using
acitretin
monotherapy.
Four patients
(36%)
achieved
complete
clearing. There
was no evidence
of a correlation
between
the
pretreatment
measures of
immunosuppression
and the
therapeutic
response.
Parameters of
immunosuppression
were not
exacerbated by
acitretin
therapy.
Conclusions:
Acitretin is a
safe and
effective
treatment for
PS-HIV.
Both skin
and joint
manifestations
of PS-HIV
responded to
acitretin
therapy in
most patients.
Optimal results
were achieved
with a dose of
75 mg/d.
The
adverse effects
were moderate
and well
tolerated.
Acitretin does
not appear
to have
immunosuppressive
properties. A
formal
randomized
clinical trial
is
warranted.
Arch Dermatol.
1997;133:711-715
=====================================================================
41.)
Methotrexate
Osteopathy in
Long-term,
Low-Dose
Methotrexate
Treatment
for Psoriasis
and Rheumatoid
Arthritis
=====================================================================
Ingrid M.
Zonneveld, MD;
Wiepke K.
Bakker, MD; Piet
F. Dijkstra, MD,
PhD; Jan
D. Bos, MD, PhD;
Renee M. van
Soesbergen, MD,
PhD; Huib J.
Dinant,
MD,
PhD
Background: In
dermatology and
rheumatology,
methotrexate is
frequently
prescribed in
low dosages per
week; in
oncology, high
dosages per week
are
prescribed.
Methotrexate
osteopathy was
first reported
in children
with
leukemia treated
with high doses
of methotrexate.
In animal
studies,
low doses
of methotrexate
proved to have
an adverse
effect on bone
metabolism,
especially on
osteoblast
activity.
Observations:
Methotrexate
osteopathy is a
relatively
unknown
complication
of low-dose
methotrexate
treatment. We
describe three
patients treated
with
low-dose oral
methotrexate in
whom signs and
symptoms were
present
that were
similar to those
found in
children treated
with high doses
of
methotrexate.
All three
patients had a
triad of severe
pain localized
in the
distal tibiae,
osteoporosis,
and compression
fractures of the
distal
tibia, which
could be
identified with
radiographs,
technetium Tc
99m
scanning, and
magnetic
resonance
imaging.
Conclusions:
Methotrexate
osteopathy can
occur in
patients treated
with low
doses of
methotrexate,
even over a
short period of
time. As pain
is
localized in the
distal tibia, it
is easily
misdiagnosed as
psoriatic
arthritis of the
ankle, but the
diagnosis can be
correctly made
by careful
investigation
and use of
imaging
techniques.
The only therapy
is
withdrawal
of methotrexate.
It is important
that more
physicians
become aware of
this side
effect of
methotrexate
therapy, which
can occur along
with
arthritic
symptoms. (Arch
Dermatol.
1996;132:184-187)
=====================================================================
42.) Commercial
tanning bed
treatment is an
effective
psoriasis
treatment:
results
from an
uncontrolled
clinical
trial.
=====================================================================
Fleischer AB Jr;
Clark AR; Rapp
SR; Reboussin
DM; Feldman
SR
Department of
Dermatology,
Bowman Gray
School of
Medicine of Wake
Forest
University,
Winston-Salem,
North Carolina,
U.S.A.
J Invest
Dermatol (UNITED
STATES) Aug 1997
109 (2) p170-4
ISSN:
0022-202X
Language:
ENGLISH
Document Type:
CLINICAL TRIAL;
JOURNAL
ARTICLE
Journal
Announcement:
9710
Subfile: INDEX
MEDICUS
Phototherapy is
highly effective
in the therapy
of psoriasis,
but patient
access to
phototherapeutic
facilities is
not universal.
Commercial
tanning
facilities
are
universal, but
their efficacy
in psoriasis
treatment is
unestablished.
Our
purpose
was to conduct a
study to assess
the effect of a
commercial
tanning unit
outfitted
with
nonprescription
lamps on
psoriasis.
We conducted a
6-wk open study
of 20
adult
patients with
stable psoriasis
vulgaris.
Clinical
response was
defined as a
decrease
in the Psoriasis
Area Severity
Index (PASI) or
the
Self-Administered
PASI (SAPASI)
by > or
= 10%.
There were 16
men and 4 women
who participated
with a mean
(+/-SD)
age of
43.0 +/- 14.8 y.
Initial and
final
health-related
quality of life
information
collected
included the
following
instruments: the
Brief Symptom
Inventory (BSI),
the
Psoriasis-Related
Stressor Scale
(PRSS), and the
Psoriasis
Disability Scale
(PDS).
Side effects of
tanning therapy
were closely
monitored.
Fifteen subjects
completed
the entire 6-wk
trial, and exit
data on all
subjects were
used for
analysis.
The mean
number of
tanning sessions
was 19 +/- 7.6
with a median of
19 and range of
3 to 29.
Analysis of all
20 enrolled
subjects found
that 16 (80%)
showed
clinical
response as
measured by
PASI, whereas 17
(85%) showed
SAPASI response.
Initial
and final
PASI scores
decreased (p =
0.0001) from
7.96 +/- 1.77 to
5.04 +/- 2.5,
and SAPASI
scores also
decreased (p =
0.02) from 11.8
+/- 4.4 to 7.9
+/- 7.7.
When
controlled for
age and sex, a
dose-response
relationship was
demonstrated
with the
PASI and SAPASI
(p < 0.02).
Decreases in the
mean BSI and
PRSS scales
were
demonstrated (p
< 0.02),
confirming the
clinical
significance of
the reductions
in disease
severity scores.
Episodes of mild
burning occurred
in 7 of 20
(35%)
participants.
Three subjects
reported itching
after one or two
tanning
sessions.
This study
showed that a
tested
commercial
nonprescription
tanning unit
improved
both
psoriasis
severity and
health-related
quality of life.
Commercial
tanning
bed
treatments may
be a useful
approach in
patients unable
to obtain
office-based
ultraviolet
treatments.
=====================================================================
43.) Transfer of
autoimmune
thyroiditis and
resolution of
palmoplantar
pustular
psoriasis
following
allogeneic bone
marrow
transplantation.
=====================================================================
Kishimoto Y;
Yamamoto Y; Ito
T; Matsumoto N;
Ichiyoshi H;
Katsurada T;
Date M;
Ohga
S; Kitajima H;
Ikehara S;
Fukuhara S
First Department
of Internal
Medicine, Kansai
Medical
University,
Moriguchi,
Osaka,
Japan.
Bone Marrow
Transplant
(ENGLAND) May
1997 19 (10)
p1041-3 ISSN:
0268-3369
Language:
ENGLISH
Document Type:
JOURNAL
ARTICLE
Journal
Announcement:
9710
Subfile: INDEX
MEDICUS
We report an
unusual case of
a patient who
was cured of one
autoimmune
disease
(palmoplantar
pustular
psoriasis (PPP))
but developed
another
autoimmune
disease
(autoimmune
thyroiditis)
after allogeneic
BMT. A
40-year-old man
suffering from
AML with
PPP underwent
allogeneic BMT
from his
HLA-identical
sister for the
treatment
of AML.
The patient
experienced
complete
clearance of the
cutaneous PPP
despite
the
cessation of
immunosuppressive
therapy for over
2 years.
However, he
developed
hyperthyroidism
with
anti-thyroglobulin
antibodies 5
months after
BMT, although
he had
showed normal
thyroid
functions
without
anti-thyroglobulin
antibodies
before
BMT. The
donor had no
history of
thyroid diseases
and showed
normal thyroid
functions
but was
positive for
anti-thyroglobulin
antibodies.
Thus, even when
the donor is in
a
subclinical
state,
autoimmune
thyroiditis may
be transferred
from donors
to
recipients by
BMT.
=====================================================================
44.) Demographic
evaluation of
successful
antipsoriatic
climatotherapy
at the Dead
Sea
=====================================================================
(Israel) DMZ
Clinic.
Harari M; Shani
J
German Medical
Centre (DMZ
Clinic),
Ein-Bokek,
Israel.
Int J Dermatol
(UNITED STATES)
Apr 1997 36 (4)
p304-8 ISSN:
0011-9059
Language:
ENGLISH
Document Type:
JOURNAL
ARTICLE
Journal
Announcement:
9709
Subfile: INDEX
MEDICUS
BACKGROUND:
Natural
balneologic
properties,
thermomineral
springs and
unequivocal
success in
improving
psoriasis,
attract an
ever-growing
number of
psoriatics to
the DMZ
Clinic on the
shores of the
Dead Sea in
Israel.
METHODS: This
paper analyses
the rate
of success of
this
balneotherapy in
740 psoriatics
who flew in from
Germany
specifically for
this treatment,
during 1995, as
a function of
sex, family
history of
the disease,
number of
previous
treatments at
the Dead Sea,
skin type,
skin
involvement,
joint
involvement,
duration of
treatment,
sun-exposure
schedule,
remission
length, and
psychologic
supervision.
RESULTS: After 4
weeks, 70% of
the
patients were
completely
cleared, this
improvement
being about the
same across
both
sexes. Family
history of the
disease, skin
type, and
psychologic
support did
not affect
the rate of
success. On the
other hand,
previous
treatments at
the Dead
Sea,
moderate to
severe skin
surface
involvement, and
participation of
arthritis,
improved
the chance of
better clearing
of the psoriatic
condition.
Similar
improvement
was
obtained by a
longer
sun-exposure
schedule and a
complete-4-week
treatment.
CONCLUSION:
These results
indicate that
the medical
improvement in
the
psoriatic
condition after
a 4-week stay at
the Dead Sea can
be better
enhanced and
its
remission
prolonged if
additional
demographic and
anamnestic
factors are
carefully
taken into
account.
=====================================================================
45.) Topical
calcipotriene in
combination with
UVB phototherapy
for
psoriasis.
=====================================================================
Hecker D;
Lebwohl M
Department of
Dermatology,
Mount Sinai
School of
Medicine, New
York, USA.
Int J Dermatol
(UNITED STATES)
Apr 1997 36 (4)
p302-3 ISSN:
0011-9059
Language:
ENGLISH
Document Type:
CLINICAL TRIAL;
JOURNAL ARTICLE;
RANDOMIZED
CONTROLLED
TRIAL
Journal
Announcement:
9709
Subfile: INDEX
MEDICUS
A total of 20
patients with
symmetric
plaque-type
psoriasis were
recruited for
a
controlled,
investigator-blinded,
right-left
study. None of
the patients had
used any
therapy other
than emollients
for 2 months
prior to
starting in the
trial. All
patients had a
negative
antinuclear
antibody.
By
history, all
patients
had
previously
improved upon
exposure to
sunlight or
ultraviolet
light. Two
symmetrical
sites of equal
severity were
selected as
target areas.
Each patient was
treated on
one side with
mineral oil
twice daily and
on the opposite
side with
calcipotriene
0.005% ointment
twice daily. The
investigator was
blinded as to
which site
received
which topical
treatment.
Both sides were
treated with
equal doses of
ultraviolet
B (UVB)
three times
weekly in
graduated
suberythemogenic
doses.
Ultraviolet
B
radiation was
emitted by a
group of 6-ft
fluorescent
bulbs (Light
Sources FS72
T12 UVB
HO) in a
standard
phototherapy
unit.
The above
regimen was
continued for a
total of
12 weeks. The
severity of
psoriasis in the
target sites was
rated by the
examiner
at baseline and
at weekly
intervals for
the 12 weeks of
study. Target
sites were
rated by
severity of
erythema,
scaling, plaque
elevation, and
pruritus, with
each of
these parameters
being assigned a
score on a
four-point
scale: 0, clear;
1, mild;
2,
moderate; 3,
severe. The four
scores were
added together
to arrive at a
total
severity score
for each of the
target sites.
Statistical
analysis was
performed
using the paired
t test, P values
less than 0.05
were considered
statistically
significant.
Eleven of the 20
patients (55%)
showed a greater
decrease in
the
severity of
their psoriasis
with UVB plus
calcipotriene
compared with
UVB plus
mineral oil. The
difference in
severity scores
between the two
groups was
statistically
significant as
early as week 1
(P < 0.05).
The difference
between
the UVB
and
calcipotriene
group versus the
UVB and mineral
oil group peaked
between
weeks 3
and 6. The
differences then
decreased but
remained
statistically
significant
through to week
12 (Fig. 1).
There were no
instances of
local cutaneous
irritation,
but mild
photosensitivity
occurred
symmetrically on
both sides in
three
patients.
=====================================================================
46.) A
controlled trial
of acupuncture
in psoriasis: no
convincing
effect.
=====================================================================
Jerner B; Skogh
M; Vahlquist
A
Department of
Dermatology,
Linkoping
University,
Sweden.
Acta Derm
Venereol
(NORWAY) Mar
1997 77 (2)
p154-6 ISSN:
0001-5555
Language:
ENGLISH
Document Type:
CLINICAL TRIAL;
JOURNAL ARTICLE;
RANDOMIZED
CONTROLLED
TRIAL
Journal
Announcement:
9708
Subfile: INDEX
MEDICUS
Several
uncontrolled
studies have
suggested that
acupuncture is
an
effective
treatment for
psoriasis. To
test this
hypothesis, 56
patients
suffering from
long-
standing plaque
psoriasis were
randomized to
receive either
active
treatment
(electrostimulation
by needles
placed
intramuscularly,
plus
ear-acupuncture)
or placebo
(sham, 'minimal
acupuncture')
twice weekly for
10 weeks.
The severity of
the skin
lesions was
scored (PASI)
before, during,
and 3 months
after therapy.
After 10
weeks of
treatment the
PASI mean value
had decreased
from 9.6 to 8.3
in the
'active'
group and from
9.2 to 6.9 in
the placebo
group (p <
0.05 for both
groups).
These
effects are less
than the usual
placebo effect
of about 30%.
There were
no
statistically
significant
differences
between the
outcomes in the
two groups
during or
3 months after
therapy. The
patient's own
opinion about
the results
showed no
preference for
'active'
therapy. It was
also clear from
the answers that
the
blinded
nature of the
study had not
been discovered
by the patients.
In
conclusion,
classical
acupuncture is
not superior to
sham (placebo)
'minimal
acupuncture' in
the
treatment of
psoriasis.
=====================================================================
47.) Psoriatic
erythroderma: a
histopathologic
study of
forty-five
patients.
=====================================================================
Tomasini C; Aloi
F; Solaroli C;
Pippione M
Department of
Dermatology,
University of
Turin,
Italy.
Dermatology
(SWITZERLAND)
1997 194 (2)
p102-6 ISSN:
1018-8665
Language:
ENGLISH
Document Type:
JOURNAL
ARTICLE
Journal
Announcement:
9708
Subfile: INDEX
MEDICUS
BACKGROUND:
There are
conflicting
opinions about
the diagnostic
value of
skin
biopsy in
erythrodermic
psoriasis.
OBJECTIVE: The
purpose of the
present study
was to
establish the
specificity of
the
histopathologic
changes of
psoriatic
erythroderma.
METHODS: We
reviewed 52 skin
biopsies from 45
erythrodermic
patients having
a final
diagnosis of
psoriasis on the
basis of
combined
clinical and
laboratory data,
in
addition to
response to
therapy and
follow-up. In 5
patients,
erythroderma was
the
presenting sign
of psoriasis. A
control group of
nonpsoriatic
erythrodermic
patients
was also
included in the
study.
RESULTS: Among
the group of
patients with
a
discharge
diagnosis of
psoriatic
erythroderma,
the
histopathologic
changes
were
specific for
psoriasis in 40
cases (88%). The
changes of early
macular and
squamous
lesions of
psoriasis were
more often found
in the biopsy
specimens of our
series
than those
of fully
developed or
late lesions of
psoriasis.
They included
mainly
slight
epidermal
hyperplasia,
focal
disappearance of
the granular
layer, mounds
of
parakeratosis
and extravasated
erythrocytes
within edematous
dermal
papillae
associated with
perivascular and
interstitial
infiltration of
lymphocytes
and
histiocytes.
CONCLUSION: When
features of
early lesions of
psoriasis are
found
during the
evaluation of a
biopsy specimen
from a patient
with a
clinically
nonspecific
erythroderma,
the
dermatopathologist
should be aware
that this
patient
could have
psoriasis and a
renewed
anamnesis and a
close follow-up
should be
made.
=====================================================================
48.) [The
immunological
and
morphological
aspects of
hemoperfusion
with pig donor
spleen in
treating
psoriasis
patients]
Immunologic
Heskey i
morfologiche
skye aspekty
gemoperfuzii
donorskoi
selezenki
svin'i pri
lechenii
bol'nykh
psoriazom.
=====================================================================
Korol' VN;
Koliadenko VG;
Zhmin'ko PG;
Terman AK; Iakub
AA; Iankevich
MV Lik
Sprava (UKRAINE)
Oct-Dec 1996
(10-12) p138-42
ISSN:
1019-5297
Language:
RUSSIAN Summary
Language:
ENGLISH
Document
Type:
JOURNAL ARTICLE
English
Abstract
Journal
Announcement:
9707
Subfile: INDEX
MEDICUS
The present
paper focuses on
the
immunological
and
morphological
aspects of
extracorporal
joining up of
donor porcine
spleen in the
treatment of
psoriasis.
It has
been ascertained
that
extracorporal
joining up of
donor porcine in
the
treatment
of psoriasis
makes for
normalization of
bodily
immunologic
reactivity
leading to
regression of
psoriatic
eruptions.
=====================================================================
49.) Clearance
of recalcitrant
psoriasis after
tonsillectomy.
=====================================================================
Hone SW;
Donnelly MJ;
Powell F;
Blayney AW
Department of
Otolaryngology/Head
and Neck
Surgery, Mater
Misericordiae
Hospital,
Dublin,
Ireland.
Clin Otolaryngol
(ENGLAND) Dec
1996 21 (6)
p546-7 ISSN:
0307-7772
Language:
ENGLISH
Document Type:
JOURNAL
ARTICLE
Journal
Announcement:
9706
Subfile: INDEX
MEDICUS
Infection is a
well-recognized
triggering
factor for both
guttate and
chronic
plaque
psoriasis. We
investigated
prospectively 13
patients with
recalcitrant
psoriasis
exacerbated by
recurrent
tonsillitis, who
underwent
tonsillectomy
between
1990 and 1993.
There were 12
female patients
and one male,
with a mean age
of 17 yr
(range 6-28).
Six patients had
guttate
psoriasis
resistant to
standard
treatments
and seven
patients had
chronic plaque
psoriasis
exacerbated by
tonsillitis that
was severe
enough to
warrant at least
one admission to
hospital.
Patients were
followed
by chart review
and postal
questionnaire.
Psoriasis was
cleared
completely
after
tonsillectomy in
five out of the
six patients
(83%) with
guttate
psoriasis and
was
improved in one
patient. Two out
of seven
patients with
plaque psoriasis
(29%) were
cleared, two
(29%) were
improved and
three (42%) were
unchanged.
We conclude
that
tonsillectomy
may be a
successful
treatment
modality in
selected
patients
with
recalcitrant
guttate or
chronic plaque
psoriasis.
=====================================================================
50.) Psoriasis
treatment:
bathing in a
thermal lagoon
combined with
UVB, versus
UVB
treatment
only.
=====================================================================
Olafsson JH;
Sigurgeirsson B;
Palsdottir
R
Department of
Dermatology,
University of
Iceland,
Reykjavik,
Iceland.
Acta Derm
Venereol
(NORWAY) May
1996 76 (3)
p228-30 ISSN:
0001-5555
Language:
ENGLISH
Document Type:
JOURNAL
ARTICLE
Journal
Announcement:
9706
Subfile: INDEX
MEDICUS
We have compared
bathing in a
thermal lagoon
in Iceland,
combined with
UVB
treatment, to
UVB treatment
only in an open
comparative
study.
Twenty-three
psoriasis
patients bathed
3 times daily
and were treated
with UVB 5 times
a week for
4 weeks.
The control
group was only
treated with UVB
5 times a week
for 4
weeks.
Psoriasis Area
and Severity
Index (PSAI) was
used to estimate
the severity of
the
disease. The
mean PASI score
in the bathing
group decreased
from 20.8 to 2.8
(p <
0.01). In the
control UVB
group, the PASI
score decreased
from 16. 7 to
6.9. The
percentage
difference
between the
groups was
significant
after 1, 2, 2
and 4
weeks.
Bathing in the
lagoon combined
with UVB was
found to be a
very effective
treatment
and better than
UVB treatment in
our control
group.
=====================================================================
51.) Alternative
therapies
commonly used
within a
population of
patients with
psoriasis.
=====================================================================
Fleischer AB Jr;
Feldman SR; Rapp
SR; Reboussin
DM; Exum ML;
Clark AR
Department of
Dermatology,
Bowman Gray
School of
Medicine of Wake
Forest
University,
Winston-Salem,
North Carolina,
USA.
Cutis (UNITED
STATES) Sep 1996
58 (3) p216-20
ISSN:
0011-4162
Contract/Grant
No.:
MH51552--MH--NIMH
Language:
ENGLISH
Document Type:
JOURNAL
ARTICLE
Journal
Announcement:
9704
Subfile: INDEX
MEDICUS
Alternative
therapies are
known to be
employed by
dermatology
patients. This
study
investigates the
use of
alternative
medical
treatments for
psoriasis and
the
sociodemographic
variables,
conventional
medical
treatment, and
psoriasis
disease
severity.
Our study
population
consisted of 578
university
dermatology
clinic
patients with
psoriasis and
data was
analyzed from
317 (55 percent)
questionnaire
respondents.
The majority of
our sample were
women (57
percent) and
nonwhites
represented 8
percent of our
sample.
Psoriasis
severity was
measured using
the
validated
Self-Administered
Psoriasis Area
and Severity
Index.
Alternative
medicine
was used by 62
percent of
respondents.
Excluding
sunlight and
nonprescription
tanning
equipment, 51
percent used one
or more of the
remaining
alternative
therapeutic
modalities.
The psoriasis
severity was
worse in those
who had
tried
herbal remedies,
vitamin therapy,
and dietary
manipulation.
With the
exception
of vitamin
therapy, we
observed no
association
between the
intensity of
conventional
medical
treatment and
alternative
treatment.
The present or
prior use of
herbal
remedies was
correlated with
the use of
vitamin therapy
and sunbathing,
and
dietary
interventions
were
significantly
correlated with
vitamin therapy.
Of the 113
(36
percent) who had
used
nonprescription
tanning
equipment for
their psoriasis,
68 percent
believed this
modality was
effective. We
found that
alternative
medical
therapies were
widely utilized
by subjects
participating in
this study.
Clinicians
need to continue
to be aware of
nonallopathic
remedies
employed by
their patients
to
discover useful
information
about future
therapies and to
monitor for
adverse
effects.
=====================================================================
52.) Using
aromatherapy in
the management
of
psoriasis.
=====================================================================
Walsh D
Homerton School
of Health
Studies,
Cambridge.
Nurs Stand
(ENGLAND) Dec 18
1996 11 (13-15)
p53-6 ISSN:
0029-6570
Language:
ENGLISH
Document Type:
JOURNAL
ARTICLE
Journal
Announcement:
9704
Subfile: ;
NURSING
Psoriasis is an
uncomfortable,
inflammatory
skin disease for
which there is
no cure
but which can be
managed at an
acceptable level
for the
individual. This
article
explores the use
of aromatherapy
as an
alternative
management
approach. The
author
describes a
range of
treatment
outcomes, which
show both
physiological
and
psychological
benefits.
====================================================================
DATA-MÉDICOS/DERMAGIC-EXPRESS
No (61)
07/07/99 DR.
JOSÉ LAPENTA
R.
UPDATED 11 JUNE 2025
====================================================================
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