Combination phototherapy of psoriasis with tazarotene and UVB

The addition of oral retinoids to phototherapy has shown to enhance both the efficacy and rapidity of psoriatic lesion clearance when compared to phototherapy alone. Tazarotene is the first available topical retinoid developed for the treatment of psoriasis. In the present study, a total of 20 patients with plaque psoriasis were randomly assigned to one of the two treatment groups: tazarotene 0.1% gel plus UVB phototherapy or UVB phototherapy alone. During the two months of the study only 10 patients applied a thin film of tazarotene gel 0.1% to all psoriatic lesions once daily, in the evening. All patients were exposed to UVB three times weekly. Patients were evaluated for tolerability and global response to treatment using the Psoriasis Area and Severity Index (PASI) at days 0, 10, 20, 30, 40, 50, 60. At baseline the mean PASI in the tazarotene plus UVB group was 8.6, while in the other group it was 8.3. At the end of the study the mean PASI in the tazarotene plus UVB group was 4.6, while in the other group it was 5.4. All treatments were generally well tolerated and the incidence of undesired side effects was low

Abnormalities of pigmentation following UVB exposure and incorrect application of calcipotriol ointment and tazarotene gel for psoriasis

We present two cases where an incorrect application of the topical therapy in association with UVB phototherapy caused hyper- or hypopigmented skin lesions. CASE 1. A 48-year-old man with plaque psoriasis treated with calcipotriol ointment plus UVB phototherapy. Although correctly instructed, on one occasion he applied the calcipotriol ointment a few minutes before the UVB exposure. Some hours later he presented numerous irregular hypopigmented areas around the psoriatic lesions. The calcipotriol therapy plus UVB phototherapy was continued and the hypopigmentation areas gradually cleared in about a month. CASE 2. A 48-year-old man with plaque psoriasis treated with tazarotene 0.1% gel plus UVB phototherapy. Although correctly instructed, he applied tazarotene gel one hour before the UVB exposure. The results was the sudden appearance of numerous dark-brown hyperpigmentation in the form of asymptomatic round or oval patches on the site of psoriatic lesions involving his trunk and limbs. The treatment was discontinued and the hyperpigmentated patches lasted for a further 6 months

Successful treatment of rare dermatologic diseases with oral cyclosporine

Cyclosporine A has been shown to be a very versatile drug able to act on different diseases of immune pathogenesis. We present four cases of different drug-resistant dermatoses that showed no response to any of the previous treatments and that, because of the seriousness and extent of their clinical pictures, prompted us to use cyclosporine A. The dermatoses were the following: ulcerative lichen ruber planus, necrobiosis lipoidica, pyoderma gangrenosum and persistent light reaction. In all of the four cases the average attack dose was 4.5 mg/kg/day, which was gradually reduced. The treatment was then protracted for several months. The result was reepithelization of the ulcers and maintenance of the result after treatment suspension in necrobiosis lipoidica and in pyoderma gangrenosum. In the patients with erosive lichen ruber planus and persistent light reaction, cyclosporine A therapy provided a dramatic, although only temporary, improvement of the lesions. In all four patients, cyclosporine A proved to be an efficacious and manageable drug