Plaque-type Psoriasis Vulgaris Research Articles

The relationship between TNF-α, IL-1, IL-12, IL-17, IL-23, IL-36 expression and treatment response in psoriasis histopathologically and immunohistochemically

Aim There is no marker that can predict whether there is resistance to treatment in patients with psoriasis. In this study, we investigated the relationship between the staining rates of TNF-α, IL-1, IL-12, IL-17, IL-23, and IL-36 markers immunohistochemically from cutaneous biopsy and the treatment success. Methods The patients who were followed up in the dermatology clinic with the diagnosis of plaque-type psoriasis vulgaris and received biological treatment and previously had cutaneous biopsy were included in the study. The cutaneous biopsies of the cases that met the conditions were re-sectioned and subjected to immunohistochemical examination for TNF-α, IL-1, IL-12, IL-17, IL-23, and IL-36. Results Comparing the staining scores with psoriasis area severity index (PASI); A statistically significant positive correlation was found between PASI and TNF-α staining score (p = 0.034). A statistically significant positive correlation was found between PASI and IL-17 staining score (p = 0.004). When the staining scores and PASI response rates of psoriasis treatment were evaluated in terms of correlation; there was a positive correlation between TNF-α, IL-17, and IL-23 immunohistochemical staining rates and PASI response rates. Conclusions In line with the data obtained from our study, we think that making immunohistochemical scoring before the biological treatment decision in psoriasis patients will be beneficial in treatment selection. In this respect, our study may open a new era in the selection of biological treatments for psoriasis.

The correlation between patient satisfaction treatment of narrowband ultraviolet B phototherapy and the improvement of psoriasis severity index

Background: Psoriasis is a chronic inflammatory disease of the skin affecting patients of all ages, both males and females. Currently, the psoriasis area and severity index (PASI) method is the gold standard in assessing the severity of psoriasis. Phototherapy narrowband ultraviolet B (NBUVB) is one of the modalities of psoriasis therapy which is relatively safe and effective for repairing psoriasis lesions. Patient satisfaction with phototherapy, which can be assessed using a questionnaire, serves to determine the patient's motivation in carrying out routine therapy. 
 Objective: This study was designed to determine the correlation between the level of NBUVB phototherapy satisfaction with PASI improvement.
 Method: The study subjects were 22 plaque-type psoriasis vulgaris patients who underwent NBUVB phototherapy from May 2018 to October 2018 in the dermatovenereology outpatient clinic of Dr. Moewardi Hospital Surakarta. Subjects filled in the Treatment Satisfaction Questionnaire for Medication (TSQM) included questions about satisfaction with NBUVB phototherapy, and PASI scores were measured before and after NBUVB phototherapy. 
 Results: The data were analyzed with the Pearson correlation test with a significance value of p <0.05. There are significant differences between PASI before and after giving 24 times phototherapy with a value of p<0.05. 
 Conclusion: There was a significant correlation between the degree of PASI improvement and the global patient satisfaction with NBUVB phototherapy

The correlation between patient satisfaction treatment of narrowband ultraviolet B phototherapy and the improvement of psoriasis severity index

Background: Psoriasis is a chronic inflammatory disease of the skin affecting patients of all ages, both males and females. Currently, the psoriasis area and severity index (PASI) method is the gold standard in assessing the severity of psoriasis. Phototherapy narrowband ultraviolet B (NBUVB) is one of the modalities of psoriasis therapy which is relatively safe and effective for repairing psoriasis lesions. Patient satisfaction with phototherapy, which can be assessed using a questionnaire, serves to determine the patient's motivation in carrying out routine therapy.Objective: This study was designed to determine the correlation between the level of NBUVB phototherapy satisfaction with PASI improvement.Method: The study subjects were 22 plaque-type psoriasis vulgaris patients who underwent NBUVB phototherapy from May 2018 to October 2018 in the dermatovenereology outpatient clinic of Dr. Moewardi Hospital Surakarta. Subjects filled in the Treatment Satisfaction Questionnaire for Medication (TSQM) included questions about satisfaction with NBUVB phototherapy, and PASI scores were measured before and after NBUVB phototherapy.Results: The data were analyzed with the Pearson correlation test with a significance value of p <0.05. There are significant differences between PASI before and after giving 24 times phototherapy with a value of p<0.05.Conclusion: There was a significant correlation between the degree of PASI improvement and the global patient satisfaction with NBUVB phototherapy.

Clinical Features and Genetic Polymorphism in Chinese Patients with Erythrodermic Psoriasis in a Single Dermatologic Clinic.

Erythrodermic psoriasis (EP) is a rare variant of psoriasis that involves more complications and poorer biologic drug survival than plaque-type psoriasis vulgaris (PV). No prior study has explored human leukocyte antigen (HLA) or other genetic polymorphisms in patients with EP. Our objective was to describe the clinical features, comorbidities, and HLA polymorphisms among Chinese patients with EP. We enrolled consecutive patients with EP from our clinic, with EP defined as generalized confluent erythematous thin plaques covering at least 80% body surface area. Patients were categorized as having primary or secondary EP. Aggravating factors, comorbidities including psoriatic arthritis, family history of psoriasis, age of onset, and treatment history were also identified. Genetic studies were performed for HLA-C and HLA-DRB1, and the results were compared with those from a healthy population and patients with PV. Of the 63 included patients, the male to female ratio was 2.71:1. Five (7.9%) patients had primary EP, and 58 (92.1%) had secondary EP. Genotyping of HLA-C and HLA-DRB1 was available in 61 and 58 subjects, respectively. HLA-C*0102 was the most frequent HLA-C allele (34.4%), followed by HLA-C*0702 (18.0%). The frequency of HLA-C*0602 allele (4.1%) was lower than in patients with plaque-type psoriasis (4.1 vs. 16.3%, corrected p value [Pc] = 0.02) and similar to that in the healthy population in Taiwan. The most frequent HLA-DRB1 allele was HLA-DRB1*0901 (20.7%), followed by HLA-DRB1*0803 (13.8%). An increased prevalence of psoriatic arthritis (61.9%) and higher male predominance were also noted in comparison with PV. There are HLA differences in Chinese patients with EP compared with patients with PV. The incidence of psoriatic arthritis is also higher. The implications of the above findings await further investigation.

Effect of epigallocatechin gallate on Th1/Th2 immune balance in patients with plaque-type psoriasis

Objective To evaluate the effect of epigallocatechin gallate (EGCG) on T helper cell 1 (Th1) and Th2 in psoriasis patients. Methods A total of 33 patients with plaque-type psoriasis vulgaris were enrolled, and peripheral blood mononuclear cells (PBMC) were isolated and cultured. The appropriate concentration of EGCG was determined by methyl thiazol tetrazolium (MTT) assay. PBMC at exponential growth phase were divided into 2 groups to be treated with EGCG (EGCG group) or not (control group) for 24 hours. Flow cytometry was performed to determine proportions of Th1 and Th2 cells, enzyme-linked immunosorbent assay (ELISA) to detect levels of Th1 (interleukin[IL]-2, interferon[IFN]-γ) and Th2 cytokines (IL-4, IL-10) in the cell culture supernatant, and real-time quantitative RCR (qRT-PCR) to determine the mRNA expression of T-bet (a Th1 transcription factor) and GATA3 (a Th2 transcription factor) . Statistical analysis was carried out by using t test. Results According to the MTT assay results, EGCG at a non-toxic concentration of 60 μmol/L was chosen for subsequent experiments. Compared with the control group, the EGCG group showed significantly decreased number of Th1 cells (t = 3.43, P = 0.026) , increased number of Th2 cells (t = 6.68, P = 0.026) , and decreased Th1/Th2 ratio (P < 0.05) . The levels of IL-2 and IFN-γ in the culture supernatant of PBMC were both significantly lower in the EGCG group (824.45 ± 101.21 ng/L, 1 623.62 ± 185.56 ng/L respectively) than in the control group (1 568.32 ± 196.45 ng/L, 3 287.63 ± 235.54 ng/L respectively) , while the levels of IL-4 and IL-10 were significantly higher in the EGCG group (389.48 ± 46.63 ng/L, 285.95 ± 53.28 ng/L respectively) than in the control group (225.38 ± 26.92 ng/L, 165.46 ± 32.25 ng/L respectively) . Compared with the control group, the EGCG group showed significantly decreased T-bet mRNA expression (t = 11.99, P < 0.001) , but increased GATA3 mRNA expression (t = 18.62, P < 0.001) . Conclusion EGCG can reduce the number of Th1 cells, inhibit the production of Th1 cytokines and transcription factors, and increase the number of Th2 cells and the production of Th2 cytokines and transcription factors, followed by the modulation of Th1/Th2 immune imbalance. Key words: Psoriasis; Th1 cells; Th2 cells; Interferon-gamma; Interleukins; Transcription factor; Epigallocatechin gallate

A hospital based assessment of the effects of various topical agents in chronic plaque type psoriasis

Aim: To determine the effect of various topical agents in chronic plaque type psoriasis.Materials and Methods: The study was carried out on patients having chronic plaque type psoriasis vulgaris came to the Department of Dermatology, Chandulal Chandrakar Memorial Medical College, Durg, Chhattisgarh, India. Total 300 patients were enrolled and were divided into three groups comprising of 100 patients in each group. Group A patients were asked to apply ammonium lactate twice a day, Group B patients were asked to apply ammonium lactate in morning and clobetasol propionate in evening, Group C patients were asked to apply topical ammonium lactate in morning and calcipotriol in evening.Results: Physician global assessment scale shows that in Group A, 39% patients had excellent response, 15% patients had good response, and 21% patients had fair response whereas 25% patients had poor response. In group B, 35% patients had excellent response, 29% patients had good response, and 17% patients had fair response whereas 19% patients had poor response. In group C, 31% patients had excellent response, 28% patients had good response, and 22% patients had fair response whereas 19% patients had poor response.Conclusion: Combination therapy is effective, well tolerated with minimal side effects and better compliance was seen with patients. Ammonium lactate 12% can also be considered as one of the topical option as a monotherapy and also as a maintenance therapy.

Epidermal barrier and oxidative stress parameters improve during in 311 nm narrow band UVB phototherapy of plaque type psoriasis

BackgroundPsoriasis is a multi-systemic inflammatory disease that results from dysregulation between epidermal keratinocyte homeostasis and both innate and acquired immunity. Epidermal barrier defect has been described in psoriatic lesions. Furthermore an imbalance between pro-oxidative stress and antioxidant defense mechanisms are known in psoriasis patients. AimThe aim of this study was to address the link between disease activity, epidermal barrier and systemic oxidative stress in the course of 311 nm narrow band ultraviolet B (NB-UVB) therapy of psoriasis. The dynamic of systemic oxidative stress parameters as well as local transepidermal water loss (TEWL) and stratum corneum hydration (SCH) was characterized before and after 311 nm NB-UVB therapy on the plaques of psoriasis vulgaris in comparison to untreated non-affected volar forearm sites of the same patients. Material and methods22 patients with plaque type psoriasis vulgaris and 25 gender- and age-matched healthy controls were enrolled. We assessed the psoriasis area and severity index (PASI) and the dermatology life quality index (DLQI) for monitoring disease activity, severity and self-perceived DLQI impact as patient related outcome parameter. We measured non-invasively TEWL (Tewameter TM 300) and SCH (Corneometer CM 825) and the end product of lipid peroxidation – malondialdehyde (MDA), Reactive oxygen species (ROS), ascorbyl radicals (Asc) and detoxifying activity of catalase (CAT) were measured in the peripheral blood with spectrophotometric and EPR spectroscopy methods. ResultsDisease activity improved in all patients compared to baseline witnessed by significant decrease in PASI; (from 14.1 to 10.4; p < 0.0001) and DLQI (from 11.7 to 8.1; p < 0.0001). At baseline TEWL-values were significantly (p < 0.0001) higher on psoriatic plaques (16.8 g/h/m2) in comparison to uninvolved skin (5.3 g/h/m2); with a decrease at both sites after NB-UVB phototherapy. SCH was significantly lower at psoriatic plaque s (4.7AU) compared to uninvolved sskin (42.4AU) and increased after treatment (8.6AU) (p < 0.0001). Interestingly, SCH decrease slightly during therapy at uninvolved skin (40.6AU). ROS and Asc declined during therapy in parallel to a decrease in MDA. A mild decrease in the antioxidative enzyme CAT activity which did not reach the significance was observed. ConclusionThe presented data is shows that a clinical improvement of psoriatic plaques under NB-UVB therapy, shown in with a decreased PASI and reflected by an increase in quality of life has beneficial effects on epidermal barrier function, SCH and improvement of systemic oxidative stress parameters (ROS, MDA and Asc). We assume that the general improvement in the oxidative stress parameters along with epidermal barrier parameters reflects mainly the improvement of disease activity which overwrites the possible negative pro-oxidative effects of the UV treatment.

A Case of Verrucous Psoriasis

ABSTRACT Psoriasis is a common, complex immune-mediated disease that may present with several clinical variants. Some of these variants include plaque-type psoriasis vulgaris and pustular, erythrodermic, and guttate psoriasis. We are presenting a case of the verrucous variant, a rare atypical presentation of psoriasis.

The role of irisin in the relationship between psoriasis and insulin resistance.

Irisin, a hormone like myokine, is identified to the relation with insulin resistance and metabolic syndrome recently. In the literature to date, there are no studies evaluating serum irisin levels in psoriasis patients. We aimed to elucidate the pathogenesis of insulin resistance in psoriasis patients by evaluating serum irisin levels and metabolic parameters associated with insulin resistance in patients with plaque-type psoriasis vulgaris. The study included 40 patients with moderate-to-severe chronic plaque-type psoriasis vulgaris and 37 healthy subjects. Body Mass Index (BMI) and waist circumference were measured, and serum irisin, fasting blood glucose (FBG), lipid profile, high-sensitivity CRP (hs-CRP) and insulin levels were assessed. To evaluate insulin resistance, the Homeostasis Model Assessment (HOMA-IR) and triglyceride/HDL (TG/HDL) ratio were used. Serum irisin and HDL levels were significantly lower in patients than the control group (P<0.001, P=0.024). Within the patient group, there was a significant negative correlation between serum irisin and serum TG, LDL, and TG/HDL levels (P=0.041, P=0.022, P=0.025), and a positive correlation with HDL levels (P=0.036). The PASI scores and serum irisin levels were significantly positively correlated. In conclusion, we observed that serum irisin levels were significantly lower in patients with psoriasis, and associated with serum lipid levels and disease activity in our study. These results can be interpreted that irisin is involved in the disease pathogenesis of patients with psoriasis in relation to metabolic dysregulation.

The evaluation of the clinical effect of topical St Johns wort (Hypericum perforatum L.) in plaque type psoriasis vulgaris: A pilot study

In this case series, ten patients with plaque-type psoriasis were treated with Hypericum perforatum ointment. The hypericum ointment was applied to one side of each patient's body and the vehicle to the opposite side twice daily for 4 weeks in a single blinded manner. Modified psoriasis area severity index (PASI) scores were significantly lowered where the formulated ointment had been applied. In determining PASI scores, three factors, erythema, scaling and thickness, were evaluated; all were significantly lower where the formulated ointment had been applied (P = 0.01, P = 0.004, P = 0.04). Hypericum perforatum ointment applied twice daily may be effective in reducing PASI scores in mild plaque-type psoriasis, however, further larger studies need be conducted to achieve a more conclusive result.

A phase II placebo-controlled study of photodynamic therapy with topical hypericin and visible light irradiation in the treatment of cutaneous T-cell lymphoma and psoriasis

Hypericin is a known photodynamic agent that has been demonstrated to induce apoptosis in normal and malignant B and T lymphocytes, and has potential to treat benign and malignant disorders of the skin, including psoriasis and cutaneous T-cell lymphoma. We wished to test whether topical hypericin was an effective, safe, and well-tolerated therapy for patch or plaque phase mycosis fungoides and for plaque psoriasis. We conducted a phase II placebo-controlled clinical study in patients who had either patch or plaque phase mycosis fungoides or plaque type psoriasis vulgaris. Representative lesions were treated twice weekly for 6 weeks with topically applied hypericin or placebo followed 24 hours later by exposure to visible light at 8 to 20 J/cm(2). After 6 weeks of twice-weekly therapy, several concentrations of hypericin resulted in the significant improvement of treated skin lesions among the majority of patients with cutaneous T-cell lymphoma and psoriasis whereas the placebo vehicle was ineffective. The clinical trial involved a small number of patients. Overall, the data from this study support the conclusion that topical hypericin/visible light photodynamic therapy is an effective and well-tolerated alternative to standard psoralen plus ultraviolet A treatment of these disorders.

The Role of Etanercept on the Expression of Markers of T Helper 17 Cells and Their Precursors in Skin Lesions of Patients with Psoriasis Vulgaris

Very recently, it has been demonstrated that CD161, retinoic acid-related orphan receptor gamma-t (RORgamma-t) and CC-chemokin receptor 6 (CCR6) can be considered good surface markers to detect T helper 17 cells and their precursors, T cell populations that are considered to play an important role in the pathogenesis of psoriasis. In the present study, we evaluate the clinical involvement by calculating the PASI score and the number of CD4+, CD161+, RORgammat+ and CCR6+ cells before and after a 12-week course with etanercept or acitretin in patients with moderate-to-severe, plaque-type psoriasis vulgaris. Ten patients were given etanercept 50 mg twice weekly and 10 patients acitretin 0.4 mg/kg per day, both for 12 weeks. At the baseline and at the end of the treatment PASI was calculated, and skin biopsies were taken to evaluate the expression of CD4, CD161, RORgammat and CCR6 by immunohistochemistry. As controls, 10 patients with atopic dermatitis (AD) were included in the study. After 12 weeks, PASI was significantly lower than at the baseline for both groups. However, etanercept-treated patients showed lower PASI than acitretin-treated ones. While CD4+ cell numbers were similar in both diseases, all the other markers, that are considered more specific for Th17 cells and their precursors, were more expressed in psoriasis than in AD. Furthermore, only etanercept, but not acitretin, was able to significantly reduce CD161+, RORgammat+ and CCR6+ cells in skin lesions of patients with psoriasis. Our study provides further evidence of the role of Th17 pathway in the pathogenesis of psoriasis. Furthermore, our findings suggest that etanercept is able to downregulate the expression of the recently recognized markers of Th17 cells and their precursors CD161, RORgammat and CCR6, while acitretin is not. This activity on the Th17 lineage may contribute to the efficacy of etanercept in the treatment of psoriasis.

Tumor necrosis factor-α-converting enzyme as a potential mediator of the influence of smoking on the response to treatment with narrowband ultraviolet B in psoriasis patients

The aim of the study was to analyze the relationship between smoking and the treatment with narrowband ultraviolet B (NB-UVB) in psoriasis patients and to examine the role of the soluble tumor necrosis factor-alpha receptor type one (sTNF-R1) in plasma and that of TNF-alpha-converting enzyme (TACE) released from peripheral blood mononuclear cells (PBMC) in this relationship. The study has been conducted among 45 inpatients with plaque-type psoriasis vulgaris and 36 inpatients with other chronic inflammatory skin disorders from similar social background (controls). Taking into account the number of cigarettes smoked daily and the duration of smoking, subjects were classified as mild, moderate and heavy smokers. The severity of psoriasis was assessed using psoriasis area and severity index (PASI) score, concentrations of sTNF-R1 and TACE (expressed in ng/ml)--with quantitative sandwich enzyme immunoassays before (T(0)) and after 20 NB-UVB irradiations (T(20)). The pretreatment concentration of sTNF-R1 was 2.55+/-0.17 in patients and 1.79+/-0.13 in controls (P<0.05) and that of TACE - 2.62+/-0.34 and 1.29+/-0.25, P<0.05, respectively. PASI score correlated with sTNF-R1 and with TACE concentrations (R=0.40 and R=0.38, P<0.05, respectively). PASI score, sTNF-R1 and TACE concentrations were similar in mild, moderate and in heavy smokers. PASI score and TACE concentration declined significantly after treatment in three groups; the lowest TACE concentration at T(20) was noticed in mild smokers, the highest in heavy smokers (0.86+/-0.26 and 1.91+/-0.20, P<0.05, respectively). The post-treatment PASI score correlated with the intensity of smoking and with TACE concentration (R=0.50 and R=0.47, P<0.05, respectively). The strong correlation between the pretreatment TACE concentration and the treatment outcome was observed in heavy smokers (R=0.63, P<0.05). The baseline TACE concentration in PBMC may be of value in predicting the response to the treatment with NB-UVB in smoking psoriasis patients. Smoking may adversely influence this treatment and TACE may be one of mediators in this influence.

308nm excimer laser phototherapy of psoriasis: Monotherapy versus combination with Calcipotriol therapy

Abstract Objective Aim of the present investigation was to prove whether a combination therapy using 308 nm excimer laser phototherapy and topical Calcipotriol application is more effective than a monotherapy to treat stable plaque psoriasis. Material and methods In a one center open trial, 36 patients (21 men, 15 women) with stable, moderate to severe, plaque-type psoriasis vulgaris received 308 nm UVB dose of 200–1200 mJ/cm 2 to affected areas, delivered by an 308 nm XTRAC™ XeCl excimer laser (PhotoMedex, Radnor, PA, USA). One side of either, back, leg or arm was additionally treated with Calcipotriol ointment twice daily, starting 0–7 days before the treatment with the 308 nm laser. The other side was treated with the 308 nm laser and Vaseline only. To evaluate the efficiency of both therapy concepts, a modified Psoriasis Area and Severity Index (PASI) score was calculated, which was initially found to be 31 per side on average. Results Clearing of infiltration, erythema and scales was achieved at 25% after 2 sessions for the excimer laser treated side without Calcipotriol, and 40% in the Calcipotriol plus excimer laser treated side. Discussion With the 308 nm excimer laser (FDA approved), higher doses of UVB can be administered to the psoriatic plaques while sparing the non-affected skin. Plaques clear faster in fewer sessions at a lower cumulative dose. The combination of 308 nm excimer laser phototherapy with Calcipotriol improves the reduction of infiltration and scales of psoriatic plaques considerably. Compared to narrow-band UVB monotherapy, the narrow-band UVB plus Calcipotriol treatment needed fewer sessions of excimer laser treatment, fewer days to achieve a reduction of the PASI parameter and a lower cumulative dosage.

Tumour necrosis factor α (TNF‐α)‐converting enzyme (TACE) and soluble TNF‐α receptor type 1 in psoriasis patients treated with narrowband ultraviolet B

The aim of the study was to examine the tumour necrosis factor alpha (TNF-alpha)-converting enzyme (TACE) concentration in peripheral blood mononuclear cells (PBMC) and its relationship with plasma concentration of soluble TNF-alpha receptor type 1 (sTNF-R1) and with the disease severity in psoriasis patients treated with narrowband ultraviolet B (NB-UVB). The study has been conducted among 40 patients with plaque-type psoriasis vulgaris: 23 had only skin lesions (PV) and 17 had co-existing, inactive, psoriatic arthritis (PsA). Control blood samples were obtained from 20 healthy subjects. The assessment of the severity of skin lesions (using Psoriasis Area and Severity Index - PASI), TACE and sTNF-R1 concentrations (using quantitative sandwich enzyme immunoassays) have been performed at baseline (T 0) and after 20 NB-UVB irradiations (T 20). The baseline sTNF-R1 and TACE concentrations in all patients was higher than that in controls (2.55 +/- 1.67 vs. 1.70 +/- 0.15 ng/ml, P<0.001, respectively, and 2.62 +/- 0.32 vs. 1.31 +/- 0.30 ng/ml, P<0.001, respectively). The sTNF-R1 and TACE concentrations were lower in PV than in PsA patients (2.47 +/- 0.16 vs. 2.65 +/- 0.13 ng/ml, and 2.52 +/- 0.22 vs. 2.76 +/- 0.39 ng/ml, P<0.05, respectively). The baseline PASI correlated with sTNF-R1 and to TACE concentrations (R=0.48 and 0.39, P<0.05, respectively). The sTNF-R1 correlated to TACE concentration (R=0.52, P<0.05). The significant decline in sTNF-R1 and TACE concentrations at T 20 was noticed, TACE reached control values (1.20 +/- 0.44 ng/ml in PV patients and 1.16 +/- 0.48 ng/ml in PsA patients, respectively). TACE from PBMC can contribute to up-regulation of sTNF-R1 in patients with active psoriasis vulgaris and with psoriatic arthritis. It also can serve as a sensitive marker of the disease severity.

Caspase 9 is decreased in psoriatic epidermis

Psoriasis is a proliferative and inflammatory disease of the skin. Caspase 9 is responsible for initiating the caspase activation cascade during apoptosis. Apoptosis is a physiological mechanism of homeostasis and development, and caspases are the executioners of apoptosis. This study reports the immunohistochemical localisation of caspase 9 in psoriatic skin and compares it with that seen in normal, healthy control skin. Skin biopsy specimens of lesions were obtained from 15 patients with plaque type psoriasis vulgaris. The specimens were labelled immunohistochemically for binding of an anti-caspase 9 primary antibody. Biopsies of healthy skin from 10 age-matched and sex-matched healthy control individuals were also analysed. The caspase 9 positive cell fraction was calculated for both epidermal and dermal cells in psoriatic lesions and healthy control skin. Counts of caspase 9 positive cells from the epidermis of psoriatic skin lesions were significantly lower than those seen in healthy skin (p<0.05). The caspase 9 immunolabelled perivascular cell counts in the dermis were not statistically significantly different in psoriatic lesions versus normal skin (p>0.05). Psoriatic epidermis contains little of the apoptotic marker, caspase 9. The results of this study are indicative of decreased apoptosis in psoriatic epidermis, and no change in the perivascular area in psoriatic lesions. These findings support the idea that decreased apoptosis is seen in psoriatic epidermal cells. Greater understanding of the nature of the disease may open new avenues for further therapeutic modalities.

Psoriasis am behaarten Kopf

Der behaarte Kopf ist der häufigste Manifestationsort einer Psoriasis vulgaris. Während leichte und mittelschwere Formen hauptsächlich kosmetische Probleme bereiten und häufig mit Juckreiz einhergehen, kann ein schwerer Befall der Kopfhaut zu vorübergehendem, selten auch zu bleibendem Haarverlust führen. Bei der Therapie der Psoriasis am behaarten Kopf müssen die Besonderheiten der Kopfhaut und der verwendeten Medikamente berücksichtigt werden. Neben lokaltherapeutischen Maßnahmen muss im Einzelfall auch eine systemische Therapie erwogen werden. Der Artikel gibt einen Überblick über die wichtigsten Aspekte der Therapie der Psoriasis am behaarten Kopf.

Pustular and Erythrodermic Psoriasis

Pustular psoriasis and erythrodermic psoriasis are generally less stable, more challenging to treat, and more severe for the patient than classical plaque-type psoriasis vulgaris. The risk for systemic infection and overwhelming sepsis in these forms of psoriasis emphasizes the potential life-threatening impact of psoriasis. Careful attention to management strategies enables the astute clinician to help the patient improve, despite the challenges these difficult forms of psoriasis present.

Topical Corticosteroids

Topical corticosterioids represent a frequently prescribed form of treatment for plaque-type psoriasis vulgaris. Topical corticosteroids have immunosuppressive, antimitotic, and anti-inflammatory actions that can contribute to the temporary alleviation of psoriasis. Protracted topical steroid-induced remissions are possible if psoriasis plaques can be cleared or almost cleared and then treated in an intermittent fashion, thereby limiting exposure and reducing the possibility of adverse experiences.

Calcipotriol: A New Topical Antipsoriatic

Calcipotriol is a synthetic vitamin D analogue. In vitro it can regulate cell differentiation and proliferation and suppress lymphocyte activities. These actions of calcipotriol at the cellular level are very similar to those of the natural hormone 1,25-(OH)2-D3. In contrast, the systemic effects on calcium and bone metabolism are at least 100 to 200 times less than those of 1,25-(OH)2-D3. Because of this unique pharmacologic profile, calcipotriol has been evaluated for the topical treatment of psoriasis. In well-designed and properly conducted studies involving more than 3000 patients, calcipotriol ointment, 50 micrograms/g, has been shown to be effective and safe for the short- and long-term treatment of psoriasis vulgaris. Calcipotriol ointment should be applied twice daily in amounts up to 100 g/week (Table 1). Used according to these guidelines, calcipotriol treatment does not affect calcium or bone metabolism. Calcipotriol is indicated for the treatment of plaque-type psoriasis vulgaris and has already been approved in several countries. It should be considered a first-line drug for the topical treatment of psoriasis.