A novelliposomal formulation of dithranol for psoriasis: preliminary results

We have prepared a novel, aqueous gel-based, liposome-entrapped formulation of dithranol. Herein, we report preliminary observations on its efficacy, tolerability, and cosmetic acceptability in treating stable plaque psoriasis. Nineteen plaques of psoriasis in nine adult patients were treated for six weeks in a prospective, open-label trial. In five patients, there was total clearance of lesions, with more than 50% subsidence in a further two patients. Significantly, there were no reports of lesional or perilesional irritation, and only one patient showed faint brown staining of the skin, which was completely and rapidly reversible. These preliminary results indicate that our liposomal dithranol gel has potential advantages over presently available preparations of dithranol; these may translate into enhanced acceptance of this useful drug by patients and physicians.     

Treatment of nail psoriasis with efalizumab: a preliminary study

Nail involvement is common in psoriasis, affecting 50% to 80% of all patients with the disorder. Pain may accompany nail involvement, restricting daily living activities, and therapy is limited by issues of efficacy and safety. The cases of 4 participants who had been enrolled in a 3-year study of efalizumab for the treatment of chronic moderate to severe plaque psoriasis are presented in this preliminary study. In addition to the diagnosis of moderate to severe plaque psoriasis, each participant discussed in this report presented with nail involvement. These participants achieved clearance of their nail psoriasis within 19 to 33 weeks of efalizumab therapy. None of the participants demonstrated adverse effects during efalizumab therapy. Our experience with these participants suggests that efalizumab may help to improve psoriasis affecting the nails when used for the treatment of chronic moderate to severe plaque psoriasis.     

Oral lesions in patients with psoriasis: a controlled study.

Stomatitis areata migrans was found in 5.4 percent of patients with psoriasis compared to 1 percent of control patients, while benign migratory glossitis was identified in 10.3 percent of patients with psoriasis and 2.5 percent of control patients. The association of these disorders with psoriasis indicates that they may be manifestations of psoriasis of the oral mucosa.     

Tongue lesions in psoriasis: a controlled study

Background

Our objective was to study tongue lesions and their significance in psoriatic patients.

Methods

The oral mucosa was examined in 200 psoriatic patients presenting to Razi Hospital in Tehran, Iran, and 200 matched controls.

Results

Fissured tongue (FT) and benign migratory glossitis (BMG) were the two most frequent findings. FT was seen more frequently in psoriatic patients (n = 66, 33%) than the control group (n = 19, 9.5%) [odds ratio (OR): 4.69; 95% confidence interval (CI): 2.61–8.52] (p-value < 0.0001). BMG, too, was significantly more frequent in psoriatic patients (28 cases, 14%) than the control group (12 cases, 6%) (OR: 2.55; 95% CI: 1.20–5.50) (p-value < 0.012). In 11 patients (5.5%), FT and BMG coexisted.FT was more frequent in pustular psoriasis (7 cases, 53.8%) than erythemato-squamous types (56 cases, 30.4%). On the other hand, the frequency of BMG increased with the severity of psoriasis in plaque-type psoriasis assessed by psoriasis area and severity index (PASI) score.

Conclusions

Nonspecific tongue lesions are frequently observed in psoriasis. Further studies are recommended to substantiate the clinical significance of these seemingly nonspecific findings in suspected psoriatic cases.

     

Targeted UVB phototherapy for psoriasis: a preliminary study

Excimer laser treatment for psoriasis has been associated with good results at a lower cumulative dose than narrowband ultraviolet (UV)B protocols. To examine the clinical performance of a new targeted UVB lamp (290-320 nm; BClear) in the treatment of plaque-type psoriasis, 28 consecutive patients attending a dermatology service were treated twice weekly with the UVB lamp for 6-18 sessions (median 10). UV doses were based on multiples of a predetermined minimal erythema dose (MED). MEDs ranged from 150 to 350 mJ/cm2; maximal dose was 8 MED. Mean cumulative fluence until remission was 12.63 J/cm2. The Psoriasis Severity Index (PSI) was measured every 2 weeks for 16 weeks. Mean PSI improvement during treatment peaked at 73% after 6 weeks, and declined to 63% at 16 weeks. At that point, 36% of the patients had a > 75% improvement in PSI, and 21% showed complete clearance. Targeted radiation with the UVB lamp is effective for the treatment of plaque-type psoriasis, requiring as few as six sessions and achieving moderately long remission. As treatment is selectively directed toward lesioned skin, normal surrounding skin is spared unnecessary radiation exposure.     

生存素在寻常型银屑病皮损中的表达

目的：探讨生存素（survivin）在银屑病皮损中的表达及意义。方法：应用免疫组织化学技术（IHC）检测38例寻常型银屑病患者皮损与14例正常人皮肤中生存素的表达。结果：36例银屑病皮损中可检测到生存素,而正常皮肤无生存素表达,生存素在进行期皮损中的表达高于稳定期。结论：生存素可能参与了银屑病的发病过程。     

Microbiology of infected pustular psoriasis lesions

BACKGROUND: Bacterial infections can occur in lesions of pustular psoriasis (PP). The objective of this study was to establish the aerobic and anaerobic microbiology of secondarily infected PP. METHODS: A retrospective 10-year review was carried out of clinical and microbiology laboratory records from patients with secondarily infected PP lesions, whose specimens of infected sites were processed for the presence of aerobic and anaerobic bacteria. RESULTS: Bacterial growth was noted in 23 specimens. Aerobic or facultative anaerobic bacteria only were present in 12 patients (52%), anaerobic bacteria only in four (17%), and mixed anaerobic-aerobic flora was present in seven (30%). Thirty-six isolates were recovered (1.6 per specimen), 23 aerobic or facultative bacteria and 13 strict anaerobes. The predominant aerobic and facultative bacteria were Staphylococcus aureus (15 isolates), Group D Enterococcus (two isolates), and Escherichia coli (two isolates). The predominant anaerobes were Peptostreptococcus spp. (six isolates) and Bacteroides fragilis group, Propionibacterium acnes, and pigmented Prevotella spp. in two each. Single bacterial isolates were recovered in 14 patients (61%), 11 of which were S. aureus. Nineteen of the organisms isolated from 18 patients (78%) produced the enzyme beta-lactamase. S. aureus was isolated from all body sites. Organisms that resided in the mucous membranes close to the lesions predominated in these infections. Enteric Gram-negative rods and Bacteroides fragilis group predominated in lesions on the legs and buttocks. Group A beta-hemolytic streptococci, pigmented Prevotella, and Fusobacterium spp. were most frequently recovered in lesions of the hand. CONCLUSIONS: The polymicrobial etiology of secondarily infected PP lesions and the association of bacterial flora with the anatomic site of the lesions were demonstrated.     

Effects of psychologic intervention on psoriasis: A preliminary report

Background: Case reports have indicated that psychologic treatments may have a beneficial effect on psoriasis activity.Objective: Our purpose was to further investigate the hypothesis that psychologic intervention has a beneficial effect on psoriasis activity in a blinded, controlled manner.Methods: Fifty-one patients with psoriasis vulgaris were randomly assigned to a treatment or a control group. Patients in the treatment group participated in seven individual psychotherapy sessions in 12 weeks. Intervention techniques included stress management, guided imagery, and relaxation. The Psoriasis Area Severity Index (PASI), Total Sign Score (TSS), and Laser Doppler Skin Blood Flow (LDBF) of a selected reference plaque was measured in a blinded fashion at baseline (week 0), week 4, week 8, and after treatment (week 12).Results: Slight, but significant, changes in TSS and LDBF were found in the treatment group but not in the control group. When analyses were performed for both groups separately, the treatment group displayed significant reductions for all three psoriasis activity measures, whereas no changes were seen in the control group.Conclusion: Our preliminary results suggest that psychologic intervention may have a moderate beneficial effect on psoriasis activity.     

华法令治疗银屑病52例的初步报告

华法令治疗病期在一年以内的寻常型银屑病患者52例取得了一定疗效,其有效率为84.62%.显效率为63.46%.临床痊愈率为36.54%.并和白血宁、安慰剂治疗组进行了对照比较,表明华法令治疗银屑病具有副作用少(1.92%).治疗后缓解期长,复发率低的特点.作用机制可能是通过改善机体的微循环功能而起到治疗作用的.     

Switching of biologics in psoriasis: Reasons and results

Efficacy and safety profiles of biologics have been established for moderate to severe psoriasis. However, inefficacy or adverse events sometimes require changing the treatment to other biologics. Here, we examine the effectiveness of this strategy. We retrospectively investigated cases requiring switching biologics. We enrolled 275 psoriatic patients treated with biologics between January 2010 and December 2014 in our hospital. Of these, 51 required a switch to another biologic. First‐line therapies were infliximab (IFX, n = 26), adalimumab (ADA, n = 18) and ustekinumab (UST, n = 7), and second‐line therapies were IFX (n = 5), ADA (n = 21) and UST (n = 25). Reasons for switching were inefficacy (n = 38), adverse events (n = 11) and others (n = 2). The details were primary failure (n = 15), secondary failure (n = 23) and infusion reactions (n = 8). In 49 patients who switched biologics due to inefficacy and adverse events, the mean Psoriasis Area and Severity Index (PASI) score at week 16 was 4.3 for first‐line therapies and 2.9 for second‐line therapies (P < 0.05). Switching to a second biologic therapy to address the first's inefficacy or adverse events often results in significant improvement in moderate to severe psoriasis.     

Palmoplantar lesions in psoriasis: a study of 3065 patients

Although palmoplantar psoriasis can be severely disabling, there are very few large clinico-epidemiological studies on this condition. Our purpose was to study the morphology and pattern of lesions in Indian patients with palmoplantar psoriasis and to elucidate the role of occupation in the incidence/localization of these lesions. All patients attending our Psoriasis Clinic from 1993 to 2000 were screened for palmoplantar lesions and their demographic characteristics, occupation and the exact localization of the lesions were noted. Out of 3,065 patients screened, 532 had palm and/or sole involvement. Plantar lesions were seen in 91.9% and palmar lesions in 55.6% of these patients. Four distinct patterns of lesion localization were noted on the palms and 5 patterns on the soles. Almost half of the men involved in regular manual labor had palmar lesions restricted to areas exposed to pressure, whereas only a quarter of other men had this type of lesion pattern. All patients with unilateral palmar lesions had them on their dominant hand and these patients were involved in regular manual labor. In our patients, the prevalence of plantar lesions was much higher than that of palmar lesions. The possible role of occupational trauma in lesion localization in Indian patients with palmoplantar psoriasis is discussed.