On the treatment of psoriasis

Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5% to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, surveys have shown that patients still do not received optimal treatments. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologi sche Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. They were first published in 2006 and updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate and severe plaque-type psoriasis in adults including systemic therapy, UV therapy and topical therapies. The therapeutic recommendations were developed based on the results of a systematic literature search and were finalized during a consensus meeting using structured consensus methods (nominal group process).

S3 – Guidelines on the treatment of psoriasis vulgaris (English version). Update

http://www.jbc.org/content/286/45/39497.full.pdf

CD105 protein depletion enhances human adipose-derived stromal cell osteogenesis through reduction of transforming growth factor β1 (TGF-β1) signaling.

Summary

Background Several cross-sectional studies have shown that different cytokines and growth factors are enhanced in psoriasis



Objectives  We aimed to understand the role/relation of interleukin (IL)-22, IL-17, IL-23, IL-8, vascular endothelial growth factor (VEGF) and tumour necrosis factor (TNF)-α in psoriasis vulgaris, addressing their levels and changes before, during and after psoralen–ultraviolet A (PUVA) and narrowband ultraviolet B (NB-UVB) treatment



Methods  A cross-sectional and a longitudinal study (n = 34) – before (T0) and at 3 (T3), 6 (T6) and 12 (T12) weeks of NB-UVB and PUVA therapy – were performed; 17 patients started NB-UVB and 17 PUVA, and IL-22, IL-17, IL-23, IL-8, TNF-α and VEGF levels were evaluated



Results  At T0, compared with controls (n = 20), all the parameters were significantly higher in patients, except for TNF-α Both NB-UVB and PUVA treatment gave, at T3, a significant decrease in TNF-α and IL-23; IL-22 and IL-17 decreased significantly at T6; all parameters and Psoriasis Area and Severity Index decreased significantly at T12 However, in both groups, at T12, VEGF was still significantly higher than control



Conclusions  Psoriasis seems to be a complex disease in which the cytokine network is disturbed, namely in levels of IL-22, IL-17, IL-23, IL-8, TNF-α and VEGF NB-UVB and PUVA follow-up studies suggested that the reduction in the IL-23/Th17 axis might be important in the pathogenic mechanisms of psoriasis Further follow-up studies of patients with psoriasis treated with these and other therapies could be very helpful for the understanding of the disturbance in the cytokine network in psoriasis and indirectly in its pathogenesis

Interleukin (IL)-22, IL-17, IL-23, IL-8, vascular endothelial growth factor and tumour necrosis factor-α levels in patients with psoriasis before, during and after psoralen-ultraviolet A and narrowband ultraviolet B therapy.

Alexander Nast, Wolf-Henning Boehncke, Ulrich Mrowietz, Hans-Michael Ockenfels, Sandra Philipp, Kristian Reich, Thomas Rosenbach, Adel Sammain, Martin Schlaeger, Michael Sebastian, Wolfram Sterry, Volker Streit, Matthias Augustin, Ricardo Erdmann, Joachim Klaus, Joachim Koza, Siegrid Müller, Hans-Dieter Orzechowski, Stefanie Rosumeck, Gerhard Schmid-Ott, Tobias Weberschock, Berthold Rzany (1) Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Vene-rologie und Allergologie, Charité – Universitätsmedizin Berlin, Germany (2) Zentrum der Dermatologie und Venerologie, Klinikum der Johann Wolfgang Goethe Universität, Frankfurt/Main, Germany (3) Klinik für Dermatologie, Venerologie, Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany (4) Hautu. Allergieklinik, Klinikum Hanau, Germany (5) Psoriasisstudienzentrum, Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin, Germany (6) Dermatologikum Hamburg, Germany (7) Dermatologist in private practice, Osnabrück, Germany (8) Dermatologist in private practice, Oldenburg, Germany (9) Dermatologist in private practice, Mahlow, Germany (10) Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin, Germany (11) Niedergelassener Dermatologe, Buchholz, Germany (12) Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Dermatologie und Venerologie, Hamburg, Germany (13) Deutscher Psoriasis Bund e.V., Germany (14) Nursing care representative, Ravenstein, Germany (15) Institut für Klinische Pharmakologie und Toxikologie, Charité – Universitätsmedizin Berlin, Germany (16) Berolina Klinik, Löhne, Germany

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1610-0379.2011.07680.supp.x

S3‐Leitlinie zur Therapie der Psoriasis vulgaris Update 2011

Goeckerman's therapy (GT) of psoriasis is based on daily application of pharmacy grade coal tar on affected skin with subsequent exposure to UV light. Goeckerman's therapy is still the first line therapy of psoriasis in the Czech Republic because of its low cost and long-term efficacy. Disturbances in angiogenic activity are characteristic for the immunopathogenesis of psoriasis. An abnormal spectrum of cytokines, growth factors and proangiogenic mediators is produced by keratinocytes and inflammatory cells in patients suffering from the disease. The aim of this study was to evaluate the influence of GT of psoriasis on angiogenic activities by comparing serum levels of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in 44 patients with psoriasis in peripheral blood samples collected before and after therapy. Forty otherwise healthy blood donors serve as a control group. The efficacy of GT was delineated by psoriasis area and severity index (PASI). The disease activity was significantly diminished by GT (P < 0.001). The serum levels of both VEGF and bFGF were statistically significantly correlated to PASI value in patients before the treatment by GT. The serum levels of VEGF (329.4 +/- 125.5 microg/ml) and bFGF (10.2 +/- 5.04 pg/ml) in patients before GT were significantly higher than those measured in healthy blood donors (VEGF 236.4 +/- 55.9 pg/ml, bFGF 7.3 +/- 3.7 pg/ ml). The serum levels of both VEGF and bFGF were significantly diminished by GT. The level of VEGF dropped from 329.4 +/- 125.5 pg/ml before GT to 278.5 +/- 109.9 pg/ml after GT (P = 0.0042) and the level of bFGF fell from 10.2 +/- 5.04 to 7.78 +/- 4.5 pg/ml (P = 0.019). Comparing to healthy controls, the serum level of bFGF in psoriasis patients was normalised (P = 0.5723) after GT. In contrast, the serum level of VEGF remained significantly increased in psoriasis patients after GT in comparison with healthy blood donors (P = 0.0319). In conclusion, we found that the angiogenic potential which is abnormally increased in patients with psoriasis is significantly alleviated by GT.

Angiogenic activity in patients with psoriasis is significantly decreased by Goeckerman’s therapy

Goeckerman's therapy (GT) of psoriasis is based on daily application of pharmacy grade coal tar on affected skin with subsequent exposure to UV light. The aim of this study was to evaluate the influence of Goeckerman's therapy of psoriasis on the levels of proangiogenic chemokines ENA-78 (CXCL5, Epithelial Cell Derived Neutrophil Attractant-78), GRO alpha (CXCL1, Growth-Related Oncogene), IL-8 (CXCL8, Interleukin-8), MCP-1 (CCL2, Monocyte Chemotactic (Chemoattractant) Protein 1) and RANTES (CCL5, Regulated on Activation of Normal T Cell Expressed and Secreted) in peripheral blood of 22 children's patients with psoriasis. 22 otherwise healthy children serve as a control group. The serum levels of chemokines were determined by commercial membrane protein array technique (RayBiotech, USA). Efficacy of Goeckerman's therapy was delineated by PASI score. Disease activity was significantly diminished by Goeckerman's therapy (p < 0.001). Serum levels of GRO alpha and MCP-1 in patients before GT were significantly higher than those measured in healthy blood donors (GRO alpha: p = 0.0128 and MCP-1: p = 0.0003). Serum levels of GRO alpha, MCP-1 and RANTES were significantly diminished by GT (GRO alpha: p = 0.002, MCP-1: p = 0.048 and RANTES: p = 0.0131). Compared to the healthy controls, serum level of MCP-1 remained significantly increased in psoriasis patients after GT (p < 0.0001). In conclusion, we found that the GT of psoriasis influenced the serum levels of proinflammatory and proangiogenic chemokines, especially GRO alpha, MCP-1 and RANTES. It could be the cause for decreased proangiogenic activity which is described after GT of psoriasis.

/pdf/cc-and-cxc-chemokines-patterns-in-psoriasis-determined-by-2w1zmno055.pdf

CC and CXC chemokines patterns in psoriasis determined by protein array method were influenced by Goeckerman's therapy.

Summary: Background. Goeckerman’s therapy (GT) of psoriasis is based on daily application of pharmacy grade coal tar on affected skin with subsequent exposure to UV light. Disturbances in angiogenic activity are characteristic for the immunopathogenesis of psoriasis. The aim of study was to evaluate the influence of GT of psoriasis on proinflammatory and angiogenic activities expressed as changes in levels of endoglin (CD105). Methods. Serum levels of a soluble form of endoglin were measured in peripheral blood samples of 38 patients with psoriasis before and after therapy. Sixty three otherwise healthy blood donors serve as a control group. The efficacy of GT was expressed as changes in Psoriasis Area and Severity Index (PASI). Results. PASI score was significantly diminished by GT (p<0.001). Serum levels of soluble CD105 were significantly diminished after GT. The serum level of soluble CD105 dropped from 7.85 ± 2.26 ng/ml before therapy to 7.01 ± 1.71 ng/ml after therapy (p= 0.0002). Compared to serum levels of soluble CD105 in healthy blood donors, serum levels of soluble CD105 in patients before GT were significantly higher (p<0.001) and remained elevated after therapy (p<0.001). Angiogenic activity expressed as serum endoglin is diminished in patients with psoriasis treated by GT.

/pdf/serum-level-of-a-soluble-form-of-endoglin-cd105-is-decreased-4a9htr481p.pdf

David Pohl

Papers

Angiogenic activity in patients with psoriasis is significantly decreased by Goeckerman’s therapy

CC and CXC chemokines patterns in psoriasis determined by protein array method were influenced by Goeckerman's therapy.

Serum level of a soluble form of endoglin (CD105) is decreased after Goeckerman's therapy of psoriasis.