Genotoxic effect of Goeckerman regimen of psoriasis

Goeckerman regimen (GR) of psoriasis includes daily dermal application of crude coal tar (CCT) and dermal exposure to UV-A and UV-B radiation. Observed group consisted of 23 patients with psoriasis treated by GR. Therapeutic ointment contained 5% of CCT. The level of psoriasis area and severity index was significantly decreased after GR (P < 0.001) and confirms high efficiency of GR. High levels of selected metabolites of pyrene and phenanthrene indicated high level of dermal penetration. We found significantly increased urinary mutagenicity in samples collected in the middle and in the end of GR (TA98+S9, P < 0.01; YG1041-S9, P < 0.001; YG1041+S9, P < 0.001). Significant increasing of chromosomal aberrations in peripheral lymphocytes (CA) in blood samples collected in the end of GR (P < 0.001) and consecutive decreasing of CA in 78th day after the end of GR has been observed. Almost all results indicated that the patients could be endangered by a peak genotoxic exposure. Nevertheless, the genotoxic effect does not seem to be long lasting. Despite conflicting results from cancer epidemiological studies, it is evident that single GR can contribute to the total load of environmental mutagens in a group of treated patients.     

The Goeckerman regimen in two psoriasis day care centers

Three hundred patients with severe psoriasis were treated with the Goeckerman regimen in two different day care centers. Each patient was personally evaluated and followed by us for a period of 1 year or longer in an effort to determine accurately clearing of the skin, side effects, and length of remission. The average duration of treatment to produce over 90% clearing of the skin was 18 days. Ninety percent of the patients remained clear for a minimum of 8 months, and 73% were clear for 1 year or longer. The average total body dosage of ultraviolet B (UVB) needed to clearing was 1.96 joules/cm². Side effects were minimal, and there was no increase in skin cancer. The cost-effectiveness of the regimen in a day care center is comparable to psoralens and ultraviolet A (PUVA) therapy.     

The effect of severe psoriasis on the quality of life of 369 patients

The aim of this survey was to quantify the level of handicap experienced by patients with severe psoriasis, and to assess the value that patients place on their disease using various questionnaire techniques. Dermatologists throughout the U.K. each gave a questionnaire to up to five psoriasis patients, who were either being admitted for in-patient care or were starting systemic therapy. Three hundred and sixty-nine questionnaires were completed. Of the 150 patients currently working, 59·3% had lost a mean of 26 days (SD 21·9) from work during the preceding year because of their psoriasis, and of the 180 not working 33·9% attributed not working to their psoriasis. The mean Psoriasis Disability Index (PDI) score was 38·2% (SD 23·3, n= 248), with the mean sub-scores of the ‘daily activities’ and ‘treatment’ sections being greater than those of the other three sections. Despite having severe psoriasis, the majority of patients felt that it would be worse to have diabetes, asthma or bronchitis than to have psoriasis. Forty-six, 42 and 32% considered it would be either ‘better’ or ‘the same’ to have diabetes, asthma or bronchitis, respectively. However, in those patients who also had the comparative disease, 87, 80 and 77% considered it would be ‘better’, or ‘the same’ to have the comparative disease. Forty-nine per cent of patients (n= 362) stated they would be prepared to spend 2 or 3 h each day on treatment if this might result in normal skin for the rest of the day. Three hundred and sixty-four (98·9%) of patients stated they would prefer to have a complete cure of their psoriasis rather than be given £1000 cash. Seventy-one per cent (n=336) of patients said they would be prepared to pay £1000 or more, and 38% (n=336) said they would pay £10,000, for a cure for their psoriasis. There was a substantial correlation (0·48) between the PDI score and the amount a patient indicated they would pay for a cure. This survey of patients with severe psoriasis reveals major handicap caused by the disease, and illustrates the extent to which patients would value effective therapy.     

阿维A治疗斑块状银屑病临床疗效观察

目的:观察阿维A治疗中、重度斑块状银屑病的疗效.方法:将中、重度斑块状银屑病患者随机分成两组,分别给予阿维A和海棠合剂治疗,疗程均为8周,以银屑病面积和严重度指数(PASI)和皮肤病生活质量指数(DLQI)作为观察指标,比较两种药物的疗效.结果:治疗后,两组患者的PASI评分和DLQI评分与治疗前比较均显著下降(P＜0.01),但PASI改善率和DLQI改善率两组间比较差异无统计学意义,PASI50和PASI75有效率亦无统计学意义(P＞0.05).结论:阿维A治疗中、重度斑块状银屑病有效.     

Effect of a family history of psoriasis and age on comorbidities and quality of life in patients with moderate to severe psoriasis: Results from the ARIZONA study

Psoriasis is a chronic inflammatory skin disease whose clinical characteristics vary from patient to patient. We aimed to analyze how comorbidities and quality of life (QoL, as per the Dermatology Life Quality Index [DLQI]) may be affected by a family history of psoriasis and by age. The ARIZONA study was a multicenter, cross‐sectional study in 1022 adult patients diagnosed with moderate to severe psoriasis at least 6 months prior to inclusion. The severity of psoriasis and the proportion of patients with comorbidities were not affected by the presence of a family history. The regression analysis revealed that the presence of a family history of psoriasis was associated with the effect on the patient's QoL (P = 0.002), regardless of disease severity. The mean DLQI total score varied significantly across age groups (5.1 ± 5.3 for the 18–30‐year group, 5.7 ± 6.5 for the 31–60‐year group and 3.8 ± 5.1 for the >60‐year group; P = 0.001). In conclusion, the presence of a family history of psoriasis appears to disrupt QoL in patients with moderate to severe psoriasis, but it hardly affected the prevalence of comorbid conditions. The effect of age on QoL was particularly noticeable in younger patients, highlighting its negative impact. As expected, older patients appeared to be burdened with a higher number of comorbidities than their younger counterparts.     

The effect of treatment on quality of life in psoriasis patients

Psoriasis is a chronic skin disease with substantial impact on patients' social and relational ways of living and subsequently on their quality of life. The aim of this study was to evaluate the health-related quality of life (HRQoL) of patients with moderate to severe psoriasis treated with short contact dithranol treatment, UVB phototherapy or inpatient dithranol treatment. HRQoL was evaluated in an open randomized multicentre study by appliance of the Dutch short form of the Sickness Impact Profile and the Psoriasis Disability Index; 250 patients were included. Successful short contact dithranol treatment and UVB phototherapy both led to a comparable improvement in HRQoL immediately after treatment until the end of the follow-up (maximum 1 year). Inpatients experienced a more impaired HRQoL and showed no significant improvement in HRQoL directly following treatment. At the end of the study HRQoL became comparable for all treatment groups.All three treatments led to substantial improvement in HRQoL; however, patients treated by short contact treatment or UVB showed a better HRQoL than inpatients.     

Plasma levels of p53 protein and chromosomal aberrations in patients with psoriasis treated with the Goeckerman regimen

The Goeckerman regimen (GR) is one of the oldest effective treatments for psoriasis. It involves daily dermal application of crude coal tar with dermal exposure to ultraviolet (UV) radiation. A study was carried out to evaluate the genotoxic risk of GR by comparing p53 protein plasma level and chromosomal aberrations (CA) in peripheral lymphocytes in 33 patients with psoriasis, before and after GR. Psoriasis Area and Severity Index (PASI) was used to evaluate the efficacy of GR. PASI significantly decreased after GR (P < 0.001), confirming the excellent efficacy of the treatment, However, significant increases in level of p53 protein (P < 0.05) and CA (P < 0.001) after treatment indicates that this method carries an increased genotoxic risk in patients with psoriasis.     

中重度银屑病的维持治疗

银屑病目前尚是一种不可治愈的疾病,大部分患者不能实现长期的临床缓解,因此需要维持治疗以达到长期缓解的目的。然而,国外研究指出,接受传统治疗及光疗的中重度银屑病患者中约20%不能坚持为期1年的治疗［１］,接受生物制剂治疗的银屑病患者中10% ~ 15%在第1年就中断治疗［2-3］,而中重度银屑病患者中断治疗后多数在2 ~ 6个月内复发,影响疗效且增加经济负担,因此强调中重度银屑病的维持治疗很有必要。银屑病维持治疗的定义尚未明确,Mrowietz等［4］提到,中重度斑块型银屑病的治疗分为两个阶段,即诱导阶段和维持阶段。诱导阶段定义为16周,可根据情况适当延长到24周,维持阶段即为诱导阶段之后的时间段。本文提出的维持治疗概念指的是皮损基本消退之后的治疗……     

Age, gender, quality of life and psychological distress in patients hospitalized with psoriasis

BACKGROUND: Psoriasis has a great impact on the quality of life of patients, and the ageing population is an important public health issue. OBJECTIVES: To investigate whether older patients with psoriasis have a different impairment in quality of life compared with younger patients, considering level of severity, duration of disease, gender and psychological distress. METHODS: The study was performed between February 2000 and February 2002 at the inpatient wards of the Dermatological Institute IDI-IRCCS, Rome, Italy, in the framework of a large project on clinical, epidemiological, emotional and quality of life aspects of psoriasis (IMPROVE study). This is a hospital-based cross-sectional study, with measures of quality of life (Skindex-29, Dermatology Life Quality Index and Psoriasis Disability Index) and of psychological distress, generic (12-item General Health Questionnaire) and psoriasis-related (Psoriasis Life Stress Inventory), all self-assessed by patients. We compared the mean scores of each quality of life instrument in patients aged < 65 years and >/= 65 years, in subsets of patients based on clinical and sociodemographic characteristics. RESULTS: We analysed 936 patients hospitalized at IDI-IRCCS with a diagnosis of psoriasis. Quality of life was significantly more impaired in the older group for all the Skindex-29 scales, and psychological distress was higher in older patients. In particular, older women suffering from anxiety or depression had the greatest impairment in quality of life. The results were somewhat different using the other quality of life instruments. CONCLUSIONS: These results should alert dermatologists that similar levels of clinical severity in psoriasis may be associated with different levels of quality of life and psychological distress of patients. Particular attention should be devoted to older patients, and especially to older women.     

Quantifying the harmful effect of psoriasis on health-related quality of life

BACKGROUND: Psoriasis affects 7 million people in the United States, causing substantial cost, social stigma, and disability. OBJECTIVE: The purpose of this study was to evaluate the health effects of skin disease by comparing psoriasis to other primary medical disorders using 3 different scales of health-related quality of life. METHODS: A self-administered questionnaire consisting of 3 health-related quality of life measures was given sequentially to 35 eligible patients with psoriasis presenting to the Dermatology Branch of the National Cancer Institute (NCI) for an investigational therapeutic protocol. RESULTS: All patients (100%) agreed to participate. The median Psoriasis Area and Severity Index (PASI) score was 13.0. Overall, 82.9% at least often felt the need to hide their psoriasis, and 74.3% claimed their self-confidence was at least often affected by their psoriasis. The median EQ-5D health state utility score was 13.0% less than healthy individuals (P <.001). On the SF-36, the mean general health score was 13.2% less (P =.005) and the median social functioning score 18.7% less (P =.005) than that of patients with no chronic conditions. CONCLUSION: Individuals with psoriasis are significantly affected in their health state utility, perception of general health, and social functioning when compared with individuals without chronic disease and those with certain primary medical conditions.     

Diflorasone diacetate ointment 0.05 percent in conjunction with UVB and tar in a modified outpatient Goeckerman regimen

Nineteen patients with psoriasis were treated with a modified Goeckerman regimen tailored to enhance patient compliance. Treatment consisted of daily coal tar emulsion baths at bedtime, followed by the application of 0.05 percent diflorasone diacetate ointment. Patients received increasing suberythemal dosages of short ultraviolet radiation (UVB) three times weekly at our outpatient phototherapy center. The duration of therapy ranged from three to twenty-eight weeks. The average number of phototherapy treatments was twenty-nine. Eight patients had total clearing of their lesions. Of the remainder, seven had at least 75 percent clearing and one had less than 25 percent clearing of psoriasis. One patient with psoriatic erythroderma experienced no improvement. Two patients did not complete the study. There were no side effects encountered during treatment other than periodic excessive erythema. If the two patients who did not complete the study are excluded from the results, 88 percent (fifteen of the remaining seventeen) had 75 percent or greater resolution of their psoriatic eruption and 47 percent (eight of seventeen) had total clearing. This outpatient modification of the Goeckerman regimen eliminates the use of cosmetically unacceptable topical agents during working hours, promotes patient compliance, and presumably contributes to enhanced therapeutic efficacy.