Stable Psoriasis Vulgaris Research Articles

Clinical efficacy of ozonated oil in the treatment of psoriasis vulgaris

To compare the efficacy and safety between ozonated oil and compound flumethasone ointment in the treatment of psoriasis vulgaris. Methods: A left/right self-controlled, parallel group study was conducted. Forty patients with stable psoriasis vulgaris were enrolled in the study, whose lesions were symmetrical and involvement areas were <30% body surface. The patients were divided into 2 groups. Patients with left lesions served as a test group were treated daily for ozonated oil twice, and patients with right lesions served as a control group were treated daily for compound flumetasone ointment twice. The patients in the 2 groups were treated for 4 weeks. The clinical efficacy and safety were observed at 1, 2 and 4 weeks after the treatment. Results: After 1 week treatment, the effective rates of the test group and the control group were 60.58% and 72.28%, respectively, with significant difference between them (P<0.05). At 2 weeks and 4 weeks after the treatment, the efficacy in the test group was similar to that in the control group. The effective rates in the test group and the control group were 69.84% and 70.25% after 2 weeks, respectively, 70.88% and 71.23% after 4 weeks, respectively. There was no significant difference between the 2 groups (P<0.05). In addition, the reflectance confocal microscope results in both the test group and the control group after 4 weeks showed that the epidermis was approximately normal. There were few inflammatory cells infiltration in the dermal papilla, and the inflammatory cells infiltration was significantly reduced after treatment. Conclusion: Ozonated oil treatment for stable psoriasis is safe and effective, and its efficacy is equivalent to the effect of glucocorticoid topical preparations.

Cellular features of psoriatic skin: Imaging and quantification using in vivo reflectance confocal microscopy

In vivo reflectance confocal microscopy (RCM) is a novel, exciting imaging technique. It provides images of cell-and tissue structures and dynamics in situ, in real time, without the need for ex vivo tissue samples. RCM visualizes the superficial part of human skin up to a depth of 250 μm. In psoriasis, an erythematosquamous skin disease, we evaluated well known histological features of stable psoriasis vulgaris (PP) with RCM. RCM images were correlated to morphological and cell biological findings in routine HE and immunohistochemical stained histology with CD3 and antifilaggrin antibodies. Lesional and nonlesional skin of eight patients with PP were evaluated with RCM, after which 4-mm punch biopsies were taken and cut vertically in two equal parts. One part was processed in the conventional vertical way, the other horizontally (en face) for optimal correlation to RCM images. We evaluated and quantificated nine histopathological features of psoriasis: parakeratosis, epidermal and dermal inflammatory infiltrate, diminished or absent stratum granulosum, epidermal thickening, thinning of the suprapapillary epidermal plate, increased height of the papillary dermis, increase in number of dermal papillae and increase in number and volume of papillary capillaries. Quantification and evaluation of cell biological and histological features of PP with RCM correlated highly to evaluation in HE, CD3 and filaggrin-stained histology. RCM is a novel technique which can be used for real time, cytometric evaluation and quantification of PP features. RCM might be suited equally for cytometric evaluation of other superficial tissues.

Calcipotriol betamethasone ointment in the treatment of psoriasis vulgaris: a randomized, double-blind, active-controlled, parallel group study.

Objective To assess the clinical efficacy and safety of calcipotriol betamethasone ointment （Daivobet ） in Chinese patients with stable psoriasis vulgaris. Methods In this double-blind, active-controlled, parallel group study, 320 patients were recruited from 4 clinical centers, and randomly divided into two groups to receive either calcipotriol betamethasone ointment once daily in the evening and placebo once daily in the morning or calcipotriol ointment twice daily. The safety and efficacy of the two regimens were evaluated on week 1, 2 and 4 after the first dosage. Results After 1 and 4 weeks of treatment, calcipotriol betamethasone-treated patients experienced a greater decrease in psoriasis area and severity index （PASI） compared with calcipotriol-treated patients （41.47%±18.21% vs 33.74% ± 16.94%, 79.23%±17.82% vs 70.43%±20.76%, respectively, both P 〈 0.001）. After 4 weeks of treatment, a 75 percent decrease in PASI was observed in 111 （73.03%） patients receiving combination therapy and 72 （48.32%） patients receiving monotherapy with significant difference between the two groups （P 〈 0.01 ）. A greater improvement was also seen in the individual score of redness, thickness, scaliness as well as area percentage of lesions at the end of week 1, 2 and 4 in patients receiving combination therapy than in patients receiving monotherapy （P 〈 0.05 or 0.01 ）. Of the 320 subjects, 58 （18.1%） reported adverse events and 42 （13.1%） reported drug-related adverse events. No statistical difference was observed in the incidence of adverse events （15.6% vs 20.6%, P 〉 0.05 ） or drug-related events （10.6% vs 15.6%, P 〉 0.05） between the two groups. Drug-related adverse events mainly included mild to moderate skin reactions, such as pruritus, folliculitis, erythema, etc. Conclusions Once daily calcipotriol betamethasone ointment is an effective, safe, convenient treatment with a rapid onset of action for stable psoriasis vulgaris in Chinese patients. Key words: Psoriasis; Calcipotriol; Betamethasone; Randomized controlled trials

Bath PUVA and Saltwater Baths Followed by UV-B Phototherapy as Treatments for Psoriasis

To evaluate the efficacy of psoralens dissolved in a warm-water bath followed by exposure to UV-A irradiation (bath PUVA) or saltwater phototherapy (SW UV-B) compared with tap-water phototherapy (TW UV-B) or UV-B irradiation alone in psoriasis. Multisite, prospective, randomized, controlled trial with 4 parallel groups. Total of 102 dermatologic outpatient clinics. Total of 1241 patients with stable psoriasis vulgaris and a Psoriasis Area and Severity Index score of 7 or greater. Four-times-weekly UV-B, TW UV-B, SW UV-B, or bath-PUVA with baths preceding UV irradiation over a maximum of 8 weeks. The UV dose was adapted to erythemal response. Incidence of therapeutic success, defined as a reduction of the Psoriasis Area and Severity Index or affected body surface area of 50% or more. Patients who received TW UV-B had a significantly higher incidence of therapeutic success than did patients treated with UV-B alone (60.7% vs 43.3%; P<.001; number needed to treat, 5.8; 95% confidence interval [CI], 3.9-10.9). Patients who received SW UV-B or bath PUVA had a significantly higher incidence of therapeutic success than did patients treated with TW UV-B (74.9% vs 60.7%; P<.001; number needed to treat, 7.0; 95% CI, 4.6-14.9; and 78.4% vs 60.7%; P<.001; number needed to treat, 5.7; 95% CI, 4.0-9.7, respectively). Bath PUVA was not superior to SW UV-B (78.4% vs 74.9%; P = .34). Bath PUVA and SW UV-B are comparably effective treatments in psoriasis and superior to UV-B and TW UV-B.

Treatment of Psoriasis Vulgaris with??the Two-Compound Product Calcipotriol/Betamethasone Dipropionate followed by Different Formulations of Calcipotriol

A calcipotriol (calcipotriene)/betamethasone dipropionate two-compound product has been shown to be efficacious for the treatment of psoriasis vulgaris. It is usually administered once daily for up to 4 weeks followed by treatment with corticosteroid-free conventional products (e.g. calcipotriol). The aim of this study was to evaluate the efficacy and tolerability of a 4-week treatment with the two-compound product in psoriasis vulgaris and the effects of sequential 8-week maintenance treatment with different calcipotriol formulations. After an initial 4-week phase with the once-daily calcipotriol/betamethasone dipropionate two-compound product, adult patients with stable psoriasis vulgaris entered an 8-week maintenance phase and were allocated to one of the following treatments: calcipotriol ointment twice daily, calcipotriol cream twice daily, or calcipotriol cream once daily in the morning and calcipotriol ointment once daily in the evening. Clinical assessment was performed at baseline, after 4 weeks and after 12 weeks, and employed evaluation of the severity of pruritus using a scale from zero to four and the Psoriasis Area and Severity Index (PASI). After 4 weeks' treatment with the calcipotriol/betamethasone dipropionate two-compound product, a significant improvement in the severity of psoriasis was observed in all groups, with a mean reduction in the PASI of 71.3% (p < 0.001 vs baseline). A significant improvement in pruritus was also obtained after 4 weeks. These results were maintained after 8 weeks of treatment with calcipotriol, regardless of the formulation used. Treatment was very well tolerated and accepted by patients. On a scale ranging from poor to excellent, more patients treated with calcipotriol cream (49%) rated the acceptability of the treatment as excellent when compared with patients treated with the calcipotriol ointment (33%) or both calcipotriol formulations (36%). This study shows that the calcipotriol/betamethasone dipropionate two-compound product causes a rapid and marked improvement in both psoriasis lesions and pruritus. Our preliminary results suggest that the three calcipo- triol-based regimens are equally effective in maintaining the therapeutic results obtained with the calcipotriol/betamethasone dipropionate two-compound product and that the use of calcipotriol cream was the best accepted maintenance treatment.

Efficacy of Treatment with Calcipotriol/Betamethasone Dipropionate Followed by Calcipotriol Alone Compared with Tacalcitol for the Treatment of Psoriasis vulgaris: A Randomised, Double-Blind Trial

Background: A two-compound product containing calcipotriol 50 µg/g and betamethasone dipropionate 0.5 mg/g (Daivobet^®, Dovobet^®) has been demonstrated to be an effective, once daily, treatment for psoriasis vulgaris. Objective: To compare the efficacy and safety of treatment with the two-compound product for 4 weeks followed by calcipotriol for 4 weeks, with that of tacalcitol for 8 weeks in patients with stable psoriasis vulgaris. Methods: 501 patients were randomised to double-blind treatment with the two-compound product followed by calcipotriol 50 µg/g once daily, or to tacalcitol 4 µg/g once daily. Results: Treatment with the two-compound product/calcipotriol was significantly more effective than tacalcitol in terms of mean percentage PASI reduction (65.0 vs. 33.3% at week 4 and 59.0 vs. 38.4% at week 8; p < 0.001 for both). Conclusion: A treatment regimen comprising calcipotriol/betamethasone ointment (Daivobet) for 4 weeks followed by calcipotriol for 4 weeks is superior to tacalcitol ointment for 8 weeks in patients with psoriasis vulgaris.

Exazerbation einer Psoriasis vulgaris zu einer generalisierten Psoriasis pustulosa mit psychiatrischen Komplikationen als erstes Symptom eines primären Hypoparathyreoidismus

Die Manifestation eines primären Hypoparathyreoidismus ist ein seltenes Ereignis mit vielfältiger Symptomatik, welche oft die Diagnosestellung verzögert. Wir berichten über einen 55-jährigen männlichen Patienten, bei dem seit über 25 Jahren eine chronisch stationäre Psoriasis vulgaris bekannt war. Innerhalb von zwei Wochen kam es zur massiven Exazerbation der Hauterscheinungen mit Pustelbildung. Im Verlauf entwickelte sich eine depressive Verstimmung mit Wesensveränderung, intermittierenden Sprachstörungen und asthmoiden Symptomen. Unter der Annahme einer endogenen Depression wurde bei dem Patienten deshalb bereits eine ambulante Psychotherapie eingeleitet und eine antidepressive Medikation verordnet. Der Patient wurde mit dem Bild einer Psoriasis pustulosa generalisata notfallmäßig stationär aufgenommen. Die Bestimmung des Serumkalziums und die nachfolgenden Untersuchungen deckten einen primären Hypoparathyreoidismus als Trigger der akuten Symptomatik auf. Das Aufdecken derartiger überlagerter Krankheitsbilder ist für eine spezifische Therapie von Bedeutung.

Combination Therapy with Low‐Dose Etretinate and Eicosapentaenoic Acid for Psoriasis Vulgaris

A randomized open study was undertaken to compare the therapeutic effects between low-dose etretinate alone and low-dose etretinate combined with eicosapentaenoic acid in 40 patients with chronic, stable psoriasis vulgaris. Better and more rapid improvement was obtained with the combination therapy for 12 weeks than with low-dose etretinate monotherapy. Eicosapentaenoic acid was safe, and adverse reactions due to low-dose etretinate were mild or tolerable. The combination regimen, therefore, has a satisfactory effect on psoriasis without marked adverse reactions.

Commercial Tanning Bed Treatment Is an Effective Psoriasis Treatment: Results from an Uncontrolled Clinical Trial

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.

Generalized Pustular Psoriasis Precipitated by Lithium Carbonate

Precipitation of generalized pustular psoriasis was manifested in a patient with previously stable psoriasis vulgaris following lithium carbonate therapy for manic-depressive psychosis. Methotrexate toxicity was observed during the acute stage of the illness, and photochemotherapy was the successful treatment. Further pustulation occurred when lithium carbonate therapy was reintroduced.