CONVENTIONAL THERAPIES FOR PSORIASIS

Conventional treatments of psoriasis include topical and systemic drugs. For sake of brevity, the presentation will deal only with systemic therapy. Three drugs are presently available in Italy: methotrexate, acitretin and cyclosporin A. Their efficacy is almost identical, all of them achieving PASI 75 in about 60% of cases in 12 weeks The indications (which, in Italy, do not include psoriasis for methotrexate), the contraindications, the interactions, the adverse effects and the precautions in their use will be discussed. Methotrexate side effects account for more than 10% of cases and include nausea and vomiting and chiefly increase of blood levels of liver enzymes. Acitretin side effects are numerous and varied, the most severe being increase of liver enzymes and blood lipids, renal impairment, and teratogenicity. Cyclosporin side effects are chiefly hypertension and renal failure. The Author concludes that cylosporin is the drug with the best efficacy/side effect ratio, though it should be used in selected cases. Key words: Psoriasis, methotrexate, cyclosporine A, acitreti

candida and psoriasis

Sir, I was not surprised that Dr Flytstrom and co-workers failed to cultivate Candida in the intertriginous areas of psoriatics (1). As I showed, over 30 years ago, Candida acts as a primer and disappears when Gram-negative bacteria come along to replace it (2). This does not mean that the yeast is unable to do harm to the skin. Once applied on the folding skin where occlusion is provided, it produces a pustular dermatitis that heals spontaneously when left to dry, but, when humidity is high enough, it is replaced by Gram-negatives that work as perpetuators of the dermatitis. This has been shown in the interdigital spaces, but it is likely to occur in all intertriginous folds. Nowonder therefore that cultures do not yieldCandida in the intertriginous areas of psoriatics. The yeast is no longer there, but its kobnerizing effect has already taken place

Hydroxychloroquine in psoriasis: is it really harmful?

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Serum antioxidant capacity in polymorphic light eruption.

Polymorphic light eruption is one of the few dermatological diseases in which some antioxidants have been said to be reduced in both the epidermis and the blood. This study measured the hydrosoluble antioxidant capacity in the serum of patients with polymorphic light eruption, using a commercially available kit. All patients were tested in winter, in order to avoid the influence of exposure to ultraviolet light. The results showed that a hydrosoluble antioxidant capacity was significantly decreased (by 29%) in patients with polymorphic light eruption, and b) that females (both patients and controls) has less hydrosoluble antioxidant capacity (by 27%) than males. In addition, the hydrosoluble antioxidant capacity values for females with polymorphic light eruption increased significantly with age, possibly accounting for the well-known propensity of young women to polymorphic light eruption. These last observations have not been reported previously

occlusive medication with imiquimod in bowen s disease

Sir, Both basal and squamous cell carcinomas respond satisfactorily to imiquimod medication (1). Squamous cell carcinoma in situ, or Bowen's disease, has been successfully treated as well. It is reported, however, that it takes several weeks for treatment to achieve clinical and histological cure. To shorten the duration of treatment, we tried an occlusive imiquimod medication instead. The study was open and uncontrolled and involved three patients with biopsy proven Bowen's disease. The patients were two women 74 (no. 1) and 75 (no. 2) years of age, and a 70-year-old man (no. 3). Their neoplasms were about 364 cm in size and located on the leg, thorax and thigh, respectively. Imiquimod 5% cream was applied under an occlusive dressing, without interruption, and medication was changed every 3 days. Biopsy samples were taken before and at the end of the treatment – in each case at the periphery of the lesion. In addition, three biopsy specimens were taken from patient no. 1 on day 423. The mean duration of treatment was 66.7 days (range 60 – 75 days). The course of the treatment followed several steps, including intense erythema and abundant exudation that persisted for 3 days, and was followed by erosions and bleeding. There was a clinical and histological clearance in all patients after treatment (see Fig. 1 for examples). Histology after treatment showed ortho-hyperkeratosis with epidermal atrophy. There were no apparent keratinocyte atypias. In the papillary dermis, neoangiogenesis was observed with moderate lymphocytic infiltrate and signs of actinic elastosis. The patients were followed up to 267, 303 and 423 days, respectively, and found clinically and histologically free of disease (see Fig. 1c and f). Systemic adverse effects were observed, including fever, flu-like symptoms and, in two patients, psychic depression apparently independently of the size of the neoplasm and of the duration of treatment. Our report is the eighth successful one using imiquimod 5% cream in Bowen's disease (2 – 9). A total of 33 patients have been successfully treated to date, with only one failure (Table I). In 6 cases

Failure of gluten-free diet in celiac disease-associated alopecia areata.

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anorectal involvement is frequent in limited systemic sclerosis

The gastrointestinal tract, particularly the oesophagus, is affected in about half of all patients with systemic sclerosis. Only a few studies so far have dealt with the anorectal tract. We studied the anal function using anorectal manometry in 12 patients with limited systemic sclerosis. We also studied the oesophageal function. For the oesophagus, we measured the difference between intragastric and oesophageal pressure, while for the anorectal tract we investigated the maximum resting pressure, the maximum voluntary squeeze effort and the rectoanal inhibitory reflex. Maximum resting pressure and maximum voluntary squeeze effort were found to be decreased in all patients. The rectoanal inhibitory reflex was abnormal in four patients. Statistical analysis showed a significant correlation between maximum resting pressure and maximum voluntary squeeze effort. No correlation was found between oesophageal and anorectal involvement. Anorectal dysfunction is common in patients with limited systemic sclerosis. We suggest that these patients should have an evaluation of their anorectal function including anorectal manometry