Homocysteine, vitamin B12 and folic acid levels in psoriasis patients

Background  Hyperhomocysteinaemia is a risk factor for atherosclerotic cardiovascular disease, stroke, peripheral arterial occlusive disease and venous thrombosis. An association between psoriasis and cardiovascular diseases has been reported.
Aim  The aim of our study was to examine serum homocysteine, folic acid and vitamin B₁₂ levels in psoriasis patients.
Material and methods  We performed a cross-sectional study in 70 consecutive outpatients with chronic plaque psoriasis and 70 age- and gender-matched controls. Serum levels of homocysteine, vitamin B₁₂ and folic acid levels were measured in both groups.
Results  Serum homocysteine, folic acid and vitamin B₁₂ levels did not differ between patient and control groups. In psoriasis patients, homocysteine levels correlated directly with psoriasis severity as measured by psoriasis area and severity index. Serum homocysteine level inversely correlated with serum folic acid levels in the patient group.
Discussion  Homocysteine levels correlated with psoriasis area and severity index in the patient group, which shows the disease severity. The increase in cardiovascular mortality with the severity of psoriasis might be also due to the effects of homocysteine.

Conflicts of interest

None declared     

Association between methylenetetrahydrofolate reductase C677T polymorphism and psoriasis: A meta‐analysis

Several studies have evaluated the associations between methylenetetrahydrofolate reductase (MTHFR) C677T and psoriasis. However, the results remain inconclusive. The objective of the present study was to conduct a qualitative and quantitative meta‐analysis investigating the associations between MTHFR C677T and psoriasis. A published work search of PubMed, Embase, Web of Science and Chinese National Knowledge Infrastructure database were conducted to identify all publications concerning MTHFR C677T polymorphism and psoriasis on 1 October 2014. The principal outcome measure for evaluating the strength of the association was crude odds ratios along with their corresponding 95% confidence intervals. Data were extracted and statistical analyses were implemented using STATA version 12.0 software. A total of 1179 psoriatic cases and 937 controls from five case–control studies concentrating on the association between MTHFR C677T polymorphism and psoriasis were included in this qualitative meta‐analysis. Pooled analysis revealed that there is no association between this polymorphism and susceptibility to psoriasis in dominant, recessive, allele and additive models under a random‐effect model. However, a marginal significant association was found in the overdominant model under fixed‐effect model. Subgroup analysis of ethnicity demonstrated that there is no association between MTHFR C677T polymorphism and either Asian or European psoriatic patients. In conclusion, MTHFR C677T polymorphism, qualitatively, is not a genetic factor for the pathogenesis of psoriasis but could quantitatively reflect the severity of psoriasis to some extent.     

Patients' perspective of pruritus in chronic plaque psoriasis: a questionnaire-based study

Background  Pruritus in psoriasis patients has not been regarded as a major symptom.
Objective  To study the pattern of pruritus in chronic plaque psoriasis.
Methods  A questionnaire was sent out to 109 patients with a diagnosis of chronic plaque psoriasis, who attended our outpatient departments during the period of January 2006 to January 2007.
Results  Out of 109 patients, 80 patients (74%) answered the questionnaire. Pruritus was found in 80% of the patients, with an intensity of 5.2 ± 2.6 (±SD) using a visual analogue scale (0–10). The frequency and intensity of pruritus were higher in women. Lower leg and scalp were reported to be the most commonly affected sites. Major aggravating factors for pruritus were stress and dryness of skin. Sun, sleep and vacation could relieve pruritus. The most common antipruritic treatments used by the patients were topical steroids, topical vitamin D, emollients and ultraviolet light therapy, whereas antihistamines were used by a small number of patients. Mood, concentration and sleep were negatively affected by pruritus.
Conclusion  Pruritus is a common symptom in patients with chronic plaque psoriasis.     

系统性红斑狼疮与亚甲基四氢叶酸还原酶基因多态性的相关性

目的 探讨亚甲基四氢叶酸还原酶(MTHFR)基因第四外显子第677位C→T突变与系统性红斑狼疮(SLE)的相关性。方法 检测40例SLE患者和20例正常人对照组血浆同型半胱氨酸水平,用聚合酶链反应(PCR)-限制性片段长度多态性法作MTHFR基因分型。结果 SLE患者组血浆同型半胱氨酸水平明显高于正常人对照组.而活动期SLE患者与非活动期SLE患者之间血浆同型半胱氨酸水平差异无统计学意义。SLE患者组MTHFR基因TT型占62.5%,明显高于其他两种基因型和正常人对照组(15%)。MTHFR基因677位发生C→T突变可导致血浆同型半胱氨酸水平明显升高,且TT型的效应要明显强于CT型的效应。结论 MTHFR基因多态性是影响SLE患者同型半胱氨酸水平的主要因素之一。MTHFR基因第677位TT型是SLE的易感基因或与易感基因紧密连锁。     

Vitamin D production in psoriasis patients increases less with narrowband than with broadband ultraviolet B phototherapy

Background: Phototherapy of psoriasis is an effective treatment. In addition to standard broadband ultraviolet radiation B (UVB), (280–320 nm), narrowband phototherapy (NBUVB) (monochromatic UV between 311 and 312 nm) has become an important treatment for psoriasis. The same wavelength range of UVB (290–315 nm) induces synthesis of vitamin D. The aim was to compare the effect of broadband with NBUVB therapy on vitamin D synthesis in patients with psoriasis.
Methods: Sixty-eight Caucasian patients (17 women and 51 men) mean age 54.1 ± 16.0 years, with active plaque psoriasis, were treated with broadband UVB ( n =26) or NBUVB ( n =42) two to three times/week for 8–12 weeks. The serum concentrations of 25-hydroxyvitamin D (25(OH)D3), 1,25-dihydroxyvitamin D (1,25(OH)₂D3), intact parathyroid hormone (PTH), calcium and creatinine were measured before the first exposure and after the last dose of radiation.
Results: In broadband UVB treated patients, 25(OH)D3 increased from 37.9 ± 16.9 to 69.4 ± 19.7 ng/ml ( P <0.0001) and in patients treated with NBUVB from 34.8 ± 11.9 to 55.3 ± 17.6 ng/ml ( P <0.0001) and P =0.008 between the treatment groups. PTH decreased on broadband UVB ( P <0.05). The serum concentrations of 1,25(OH)₂D3, calcium or creatinine remained unaltered.
Conclusion: Serum 25(OH)D3 in psoriasis patients increased less with NBUVB than with broadband UVB phototherapy. Psoriasis improved on both regimens.     

The role of psychological factors and serum zinc, folate and vitamin B12 levels in the aetiology of trichodynia: a case–control study

Background.  Cutaneous dysaesthesia syndromes are characterized by chronic cutaneous symptoms without objective findings, and their aetiologies are obscure. Trichodynia describes pain and a stinging sensation of the scalp related to diffuse alopecia.
Aims.  To determine the prevalence rate of trichodynia in patients with diffuse alopecia; to assess the serum zinc, folate and vitamin B₁₂ levels; and to investigate the significance of psychological disorders in these patients.
Methods.  The study comprised 91 patients with a diagnosis of diffuse hair loss and 74 healthy controls. Patients were questioned about the presence of trichodynia, and their serum zinc, folate and vitamin B₁₂ levels were assessed. They were also evaluated using the Beck Depression Inventory (BDI), the Beck Anxiety Inventory, and the Somatoform Dissociation Questionnaire (SDQ).
Results.  The rates of androgenetic alopecia and telogen effluvium were 26.4% and 73.6%, respectively, Trichodynia was found in 30 patients (33%), and was more common in the telogen effluvium group than in the androgenetic alopecia group ( P  = 0.5). There was no significant difference between the patients with alopecia and controls for zinc, folate and vitamin B₁₂ levels, or for psychological test scores. However, the BDI and SDQ scores were significantly higher ( P  = 0.03 and P  = 0.01, respectively) in patients with than those in without trichodynia.
Conclusions.  Trichodynia is a commonly encountered symptom in patients with diffuse alopecia, and depression and somatoform dissociation disorders may play an important role in its aetiology. Our data provide no evidence that serum levels of zinc, folate or vitamin B₁₂ are involved in the pathogenesis of trichodynia.     

Common polymorphisms in the interleukin-22 gene are not associated with chronic plaque psoriasis

Background:  Psoriasis is a chronic inflammatory skin disease. Among other cytokines, interleukin 22 (IL-22) has been implicated in the pathogenesis of chronic plaque psoriasis. The purpose of this study was to investigate a hypothesized association between common IL-22 gene polymorphisms and chronic plaque psoriasis.
Methods:  Genotypes of 10 common polymorphisms of the IL-22 gene were determined by fluorogenic 5' exonuclease assays (TaqMan) in 475 patients with chronic plaque psoriasis and 252 controls.
Results:  Two blocks of high linkage disequilibrium, formed by eight polymorphisms upstream of exon 5 (rs2227485, rs2227491, rs2046068, rs1179251, rs1012356, rs2227501, rs2227503, rs976748) and two polymorphisms in the 3' near gene region (rs1182844, rs1179246), were observed within the IL-22 gene. Neither single polymorphisms nor haplotypes were significantly associated with the presence or clinical features of chronic plaque psoriasis ( P  > 0.05).
Conclusions:  Our data suggest that the investigated IL-22 gene polymorphisms are unlikely major risk factors for chronic plaque psoriasis.     

Plasma homocysteine and folate levels in patients with chronic plaque psoriasis

Background Hyperhomocysteinaemia is a well‐known risk factor for cardiovascular diseases. Patients with severe chronic plaque psoriasis have a higher risk of death due to arterial and/or venous thrombosis. Objectives To investigate the relationship among plasma homocysteine and folate levels and severity of chronic plaque psoriasis in a selected cohort of patients with psoriasis without known risk factors for acquired hyperhomocysteinaemia. Methods We performed a case–control study in 40 patients with chronic plaque psoriasis and 30 age‐ and sex‐matched healthy controls. Cases and controls were selected excluding individuals with conditions or diseases associated with acquired hyperhomocysteinaemia, and were also asked to stop alcohol and coffee consumption for 1 week before blood sampling. The plasma levels of homocysteine and folic acid were measured and were correlated with the severity of psoriasis (Psoriasis Area and Severity Index, PASI). Results Patients with psoriasis had plasma homocysteine levels higher than controls (mean ± SD 16·0 ± 5·6 vs. 10·4 ± 4·7 μmol L^?1; P < 0·001). Conversely, folic acid levels were lower in patients with psoriasis compared with controls (mean ± SD 3·6 ± 1·7 vs. 6·5 ± 1·7 nmol L^?1; P < 0·001). Plasma homocysteine levels in patients with psoriasis correlated directly with disease severity (PASI) and inversely with folic acid levels. Plasma folic acid levels were inversely correlated with the PASI. No abnormalities of plasma vitamin B₆ and B₁₂ were found. Conclusions Patients with psoriasis may have a tendency to hyperhomocysteinaemia, which may predispose to higher cardiovascular risk. Dietary modification of this risk factor appears relevant to the global management of patients with moderate to severe psoriasis.     

Clinical effectiveness and safety experience with alefacept in the treatment of patients with moderate-to-severe chronic plaque psoriasis in Taiwan: results of an open-label, single-arm, multicentre pilot study

Background  The effectiveness and safety of alefacept for the treatment of moderate-to-severe chronic plaque psoriasis has been established in several clinical trials conducted in the United States and Europe. No clinical trial of alefacept has been conducted in Asia.
Objective  To determine the effectiveness and safety of alefacept in the treatment of psoriasis in Chinese population.
Design and methods  This was an open-label, single-arm, multicentre pilot study conducted at three centres. Patients with a body surface area ≥ 10% and psoriasis area and severity Index (PASI) ≥ 12 were given 15 mg alefacept intramuscularly once a week for 12 weeks and were then followed up for a further 12 weeks.
Results  A total of 46 patients was enrolled. Only one subject (2%) achieved a ≥ 75% improvement in PASI at week 14. The median improvement in PASI at week 14 after the 12-week treatment was 39%. At any time during the 6-month course, 3 subjects (7%) achieved a Physician Global Assessment (PGA) of 'almost clear', and a ≥ 50% and ≥ 75% improvement in PASI was seen in 46% and 9%, respectively. There is a trend for decreased counts of CD4⁺ and CD8⁺ cells after alefacept treatment, but subjects who achieved PASI50 showed a lesser degree of decrease in CD4⁺ and CD8⁺ counts compared with those in patients who did not achieve PASI50.
Conclusions  This small pilot study indicated that intramuscular alefacept was effective and safe in psoriasis in Chinese patients over 12 weeks of treatment. Further studies are needed to clarify the reason for low PASI 75 effectiveness and the paradoxical lesser decline of CD4⁺ and CD8⁺ T cells in those who responded.     

The angiotensin-converting enzyme insertion/deletion and the endothelin -134 3A/4A gene polymorphisms in patients with chronic plaque psoriasis

BACKGROUND: Psoriasis is a common chronic inflammatory skin disease. Vasoactive peptides such as endothelin-1 (ET-1) and bradykinin have previously been implicated in the pathogenesis of chronic plaque psoriasis. The angiotensin-converting enzyme (ACE) gene carries a 287-base pair insertion/deletion (I/D) gene polymorphism, which is associated with plasma concentrations of bradykinin-degrading ACE. A functional polymorphism (EDN1 -134 3A/4A) in the gene encoding ET-1 has been shown to affect ET-1 expression. The purpose of the present study was thus to investigate a hypothesized association between these gene polymorphisms and the presence of chronic plaque psoriasis. METHODS: The present case-control study comprised 207 patients with chronic plaque psoriasis (136 with early onset and 71 with late onset disease) and 182 control subjects. Genotypes of EDN1 and ACE were determined by a 5' exonuclease assay (Taqman). RESULTS: The prevalence of the homozygous ACE II genotype was significantly higher in patients with early-onset psoriasis than among control subjects (30.9% vs 19.2%, P = 0.016), yielding an odds ratio of 1.88 [95% confidence interval (CI): 1.12-3.15] for early-onset disease. For late-onset psoriasis, presence of the ACE II genotype was associated with a non-significant odds ratio 1.54 (95% CI: 0.81-2.92). As for the EDN1 -134 3A/4A gene polymorphism, no significant differences in genotype distributions were found between patients with either early- or late-onset psoriasis and control subjects (EDN1 -134 4A/4A: 9.6% in early-onset and 5.6% late-onset psoriasis vs 7.7% in controls; P > 0.05). CONCLUSIONS: Our data suggest that homozygosity for the ACE I allele may affect susceptibility to early-onset psoriasis.     

Vascular endothelial growth factor in psoriasis: an indicator of disease severity and control

Background  Psoriasis is a chronic disease characterized by abnormal epidermal proliferation, inflammation and angiogenesis. It has been reported that vascular endothelial growth factor (VEGF) is overexpressed in lesional psoriatic skin and its serum levels are significantly elevated in patients with moderate to severe disease.
Objective  This study aims to evaluate the possible role of VEGF in the pathogenesis of psoriasis, and its significance as an indicator of disease severity and control.
Methods  Thirty patients with moderate to severe psoriasis and 10 healthy controls were subjected to baseline evaluation of VEGF. Patients were divided into three groups according to the received treatment: psoralen plus ultraviolet A (PUVA) thrice weekly (group 1), acitretin 50 mg daily (group 2), and combined PUVA twice weekly and acitretin 25 mg daily (group 3).Treatment continued for 16 weeks or up to clinical cure. Every patient was subjected to severity evaluation by Psoriasis Area and Severity Index (PASI) and measurement of serum VEGF before and after treatment.
Results  Mean serum levels of VEGF were significantly elevated in patients (327 ± 66.2 pg/mL) than control subjects (178 ± 83.4 pg/mL). A highly significant correlation was found between VEGF and PASI score, but not with other variables. The best clinical response, the least side-effects and the highest reduction of VEGF serum levels were achieved by the combined therapy.
Conclusion  The present study supported the proposed role of VEGF in the pathogenesis of psoriasis, and suggested that it could serve as a good indicator of disease severity and control.     

Balneotherapy for chronic plaque psoriasis at Comano spa in Trentino, Italy

ABSTRACT:  Thermal therapy is used worldwide in the treatment of psoriasis but few controlled studies have evaluated its efficacy and safety. We studied the efficacy and safety of balneotherapy compared to photobalneotherapy performed at Comano spa in Trentino, Italy, in chronic plaque psoriasis in a prospective, nonrandomized, open study. Three hundred adult patients with mild to severe chronic plaque psoriasis were assigned to either balneotherapy or photobalneotherapy with daily narrow-band ultraviolet B for a mean period of 1 or 2 weeks, reflecting the times that most patients can dedicate to thermal therapy. Patients were evaluated at baseline and end of treatment for psoriasis area and severity index (PASI) and body surface area; self-administered PASI (SAPASI) and Skindex-29 were evaluated at the same times, and also at 4 months by a mailed questionnaire. One-week balneotherapy or photobalneotherapy resulted in a significant reduction in PASI score (11.54% ± 2.76 and 12.76% ± 3.79, respectively; mean ± standard deviation; p  < 0.001). Two-week therapy induced a greater response with photobalneotherapy than with balneotherapy alone, with PASI reduction of 19.8% ± 24.5 and 13.5% ± 23.1 ( p <  0.005), respectively. These results were confirmed by SAPASI and Skindex-29 evaluation. The therapy was well tolerated. Skin improvement was mostly lost after 4 months. Short-term balneotherapy and photobalneotherapy could thus be offered to patients willing to temporarily discontinue pharmacologic therapy or as adjuvant therapy.     

Economic evaluation of etanercept in the management of chronic plaque psoriasis

Background  The National Institute for Health and Clinical Excellence has recommended that etanercept 25 mg twice weekly (biw) be used in adults with severe plaque psoriasis. However, its economic model did not consider the alternative licensed regimen of etanercept 50 mg biw.
Objectives  To assess the cost-effectiveness of etanercept 50 mg biw for the treatment of chronic plaque psoriasis, and to explore characteristics of patients who benefited most from 50 mg dosing.
Methods  An economic model was constructed to estimate the incremental cost per quality-adjusted life year (QALY) gained. The model considered patients with chronic plaque psoriasis who had both Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) of 10 or higher who were unable to take standard systemic therapies. Quality of life gain was estimated from the DLQI responses of patients enrolled in three clinical studies. The model considered expenditure on drugs, monitoring visits, adverse events and inpatient stays. Costs were estimated from the perspective of the U.K. National Health Service over a time period of 10 years.
Results  The incremental cost per QALY for etanercept 50 mg biw compared with no systemic therapy was found to be £6217 (95% confidence interval £5396–7486). The cost-effectiveness of 50 mg dosing was more attractive in patients with baseline PASI ≥ 20 (£5163) or baseline DLQI ≥ 20 (£4599).
Conclusions  This model found the licensed dose regimen of etanercept 50 mg biw to be cost effective in the U.K. This regimen was particularly appropriate for patients with severe disease or poor quality of life at baseline.     

Relationship of MTHFR gene polymorphisms with renal and cardiac disease

AIM: To investigate the effects of different methylenetetrahydrofolate reductase(MTHFR) 677CT gene polymorphism and hyperhomocysteinemia for the development of renal failure and cardiovascular events, which are controversial.METHODS: We challenged the relationship, if any, of MTHFR 677CT and MTHFR 1298AC polymorphisms with renal and heart function. The present article is a reappraisal of these concepts, investigating within a larger population, and including a subgroup of dialysis patients, if the two most common MTHFR polymorphisms, C677 T and A1298 C, as homozygous, heterozygous or with a compound heterozygous state, show different association with chronic renal failure requiring hemodialysis. MTHFR polymorphism could be a favorable evolutionary factor, i.e., a protective factor for many ominous conditions, like cancer and renal failure. A similar finding was reported in fatty liver disease in which it is suggested that MTHFR polymorphisms could have maintained and maintain their persistence by an heterozygosis advantage mechanism. We studied a total of 630 Italian Caucasian subject aged 54.60 ± 16.35 years, addressing to the increased hazard of hemodialysis, if any, according to the studied MTHFR genetic polymorphisms. RESULTS: A favorable association with normal renal function of MTHFR polymorphisms, and notably of MTHFR C677 T is present independently of the negative effects of left ventricular hypertrophy, increased IntraRenal arterial Resistance and hyperparathyroidism. CONCLUSION: MTHFR gene polymorphisms could have a protective role on renal function as suggested by their lower frequency among our dialysis patients in end-stage renal failure; differently, the association with left ventricular hypertrophy and reduced left ventricular relaxation suggest some type of indirect, or concurrent mechanism.     

银屑病亚甲基四氢叶酸还原酶基因多态性与甲氨蝶呤疗效及不良反应的关系

目的:探讨银屑病患者亚甲基四氢叶酸还原酶(MTHFR)基因C677C/T多态性及其与长期小剂量甲氨蝶呤(MTX)方案治疗的疗效和不良反应的相关性。方法:运用聚合酶链反应和限制性片段长度多态性分析(PCR-RFLP)的方法检测120例寻常型银屑病患者及100名健康对照组的MTHFRC677C/T多态性,比较两组间基因型及等位基因频率分布。在MTX治疗用药前,治疗后1、2、4、12周定期检查实验室指标,评价疗效及不良反应。结果:银屑病组MTHFR基因CC、CT、TT基因型分布分别为54.17%、32.50%、13.33%,与健康对照组(分别为43.00%、45.00%、12.00%)比较,差异无统计学意义(2=3.70,P0.05)。有105例银屑病患者纳入疗效评估,各基因型间的疗效比较差异无统计学意义(2=1.45,P0.05)。35.00%(42/120)患者出现不良反应,将有、无不良反应的两组基因型进行比较,差异有统计学意义(2=17.26,P0.05),CT+TT基因型占不良反应组的71.43%,与无不良反应组(32.05%)比较差异有统计学意义(2=17.05,P0.05)。29.17%(35/120)出现肝毒反应,将肝毒性组和无不良反应两组基因型分布比较差异有统计学意义(2=10.02,P0.05),肝毒性组T等位基因出现频率较无不良反应组高,差异有统计学意义(2=7.52,P0.05)。结论:MTHFR基因C677C/T多态性与银屑病的发病和MTX疗效无关,但与MTX治疗后的不良反应和肝毒性有关,T突变基因是不良反应的高危因素。     

Folic acid in general medicine and dermatology

Folic acid is a vitamin B essential for the integrity and function of DNA. Relative deficiency of folic acid may occur in conditions such as pregnancy and hyperproliferative or chronic inflammatory disorders. Folic acid supplementation has been proven to be beneficial in the prevention of neural tube defects and in limiting methotrexate side effects, and may reduce the risk of colorectal cancer. Folate is a critical vitamin in determining plasma homocysteine levels, which in turn is a major risk factor for cardiovascular diseases. The results of large clinical trials with dietary supplementation of folic acid, vitamin B12 and vitamin B6 have shown that this homocysteine-lowering therapy is effective in the secondary prevention of non-fatal strokes, but had no effect in the prevention of fatal cardiovascular diseases. Hyperhomocysteinemia has also been reported in age-related neurological conditions with cognitive impairment (e.g. dementia), and psychiatric disorders such as depression. Elevated homocysteine levels are frequent in patients with chronic immune-mediated disorders including rheumatoid arthritis, systemic lupus erythematosus, chronic plaque psoriasis and psoriatic arthritis, which have in common a tendency to an accelerated atherosclerosis leading to increased deaths from cardiovascular events. Folic acid supplementation appears as a reasonable therapeutic option in patients affected by chronic inflammatory skin diseases, such as moderate to severe psoriasis; in particular, those with concomitant hyperhomocysteinemia, low plasma folate and additional cardiovascular risk factors.     

DEFICIENT FOLATE ACTIVITY DURING TREATMENT OF PSORIASIS WITH METHOTREXATE DIAGNOSED BY DETERMINATION OF SERINE SYNTHESIS IN LYMPHOCYTES

Summary.— Deficient folate activity was diagnosed in all of 7 patients treated for psoriasis with methotrexate (Mtx) by applying a new method (Ellegaard and Esmann, 1972a) of assaying folate activity which utilizes the folate-dependent incorporation of ¹⁴C-formate into serine of lymphocytes during incubation under standardized conditions. The arithmetical mean of this folate activity was 4–8%± 0.6 (SEM) of added ¹⁴C-activity per 10⁹ lymphocytes per 4 hours, as compared to 9.2%± 0.4 in 24 normals. The ¹⁴C-formate incorporation into RNA was severely depressed in each case. Mtx added to lymphocytes in vitro had no effect on the folate activity.
In addition, the new observation was made that patients under treatment with Mtx develop decreasing serum concentrations of B₁₂, possibly due to an impaired B₁₂-absorption.     

Adalimumab treatment for severe recalcitrant chronic plaque psoriasis

Aim.  To assess the efficacy and safety profile of adalimumab in patients with severe, recalcitrant chronic plaque psoriasis, and to assess short-term overlapping of other systemic treatment with adalimumab to prevent flaring of disease.
Methods.  This was a retrospective study comprising 39 patients with chronic plaque psoriasis treated with adalimumab between October 2005 and January 2008. All had failed treatment with other systemic agents, including biological therapies in 59% of patients. Patients were started on adalimumab 40 mg weekly or fortnightly, as clinically indicated. Severity of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI). Therapeutic response was assessed by 75% improvement on PASI (PASI 75). All adverse events were recorded.
Results.  Results were analysed separately for those treated with adalimumab only and those on combination treatment. PASI 75 was achieved in 38% (8 of 21 patients at week 16), 62% (13 of 21 patients) at week 24, 69% (9 of 13 patients) at week 48% and 71% (5 of 7 patients) at week 72 in the adalimumab-only group, compared with 56% (5 of 9 patients) at week 16, 50% (4 of 8 patients) at week 24, 80% (4 of 5 patients) at week 48% and 67% (2 of 3 patients) at week 72 in the combined group. Of the 39 patients, 15 (38%) achieved a PASI of 0 at some point in their treatment. Adalimumab was well tolerated; 38% of patients experienced side-effects, which were generally mild.
Conclusion.  Adalimumab was effective in a group of patients with psoriasis refractory to other systemic therapies, including biological treatments, and was well tolerated.     

Failure of short-term psoralen and ultraviolet A light maintenance treatment to prevent early relapse in patients with chronic recurring plaque-type psoriasis

Background: Photochemotherapy using psoralen and ultraviolet A light (PUVA) is a highly effective treatment option for patients with severe psoriasis. Maintenance treatment has been advocated to provide for sustained remission. However, only a few studies have been conducted to assess the efficacy of maintenance treatment and these have provided inconsistent results.
Methods: We performed a prospective intrapatient left–right comparison study in 34 patients with chronic relapsing plaque psoriasis. PUVA treatment for clearing was given four times weekly. After complete or near-complete clearing, all patients were placed on a halfside maintenance schedule with irradiation twice weekly and then once weekly for 4 weeks each. The psoriasis area and severity index score was determined at baseline, end of the clearing phase and at 2-monthly intervals after discontinuation of treatment.
Results: Using a short-term maintenance protocol, a moderate delay in relapse of psoriasis was observed in only three patients (8.8%; 95% CI: 1.8–23.6%). In the remaining patients (91.2%), maintenance treatment had no effect on the length of remission. The mean time interval until relapse without and with maintenance irradiation was 4.5 ± 3.4 and 4.6 ± 3.4 months, respectively.
Conclusion: Our data indicate that short-term maintenance treatment is not effective in preventing early relapse of psoriasis and should be avoided.