Showing papers on "Psoriasis published in 1984"

Randomized, Double‐Blind, Placebo Controlled Trial of Low‐Dose Pulse Methotrexate in Psoriatic Arthritis

Abstract: Thirty-seven patients with psoriatic arthritis were entered into a 12-week prospective, controlled, double-blind multicenter trial comparing placebo and oral pulse methotrexate therapy. Methotrexate was given in a dose of 2.5-5.0 mg every 12 hours in 3 consecutive doses per week. A stable background medication program with nonsteroidal antiinflammatory drugs was allowed. Methotrexate was superior to placebo only in physician assessment of arthritis activity and in improvement of the amount of skin surface area with psoriasis. A small but statistically significant rise of serum total bilirubin occurred in the methotrexate-treated patients. No patients were withdrawn from the study for adverse drug effects.

T‐cell subpopulations in the blood and skin of patients with psoriasis

Abstract: SUMMARY Monoclonal antibodies were used to determine, simultaneously, the proportions of T-cell populations in the peripheral blood and in the skin lesions of fifty-one patients with psoriasis. The results were analysed in relation to the extent, age and clinical type of the skin lesions. In the group of patients with extensive lesions, a significant reduction in the number of total T (TT) and T helper/inducer-cells, (TH), but not in T suppressor/cytotoxic cells (Ts) was observed in the peripheral blood. Furthermore, the skin TH/TS ratio was greater in late guttate and in chronic plaque lesions than the corresponding ratio in the blood. These findings suggest that there is an active selective recruitment of TH cells into established psoriatic lesions. In contrast, the TH/TS ratio in early guttate lesions was the same as in the blood, and significantly lower than in the plaque lesions. An additional finding was a decrease of TS, and a corresponding increase of null cells in the blood of patients with chronic plaque psoriasis. These observations provide further evidence for the participation of T cells in the pathogenesis of psoriasis.

Psoriatic arthritis in psoriatic patients

Abstract: One hundred and eighty patients with psoriasis have been studied in the Neapolitan area to find the prevalence of arthritis in psoriasis. Wright and Moll's criteria for the diagnosis of arthritis were applied. Of 180 psoriatic patients, 62 exhibited arthritis (34.4% of total cases) According to Moll and Wright's five broad clinical forms of arthritis, the following distribution was found: polyarticular in 38.7% of arthritic patients, mono-oligoarticular in 16.1%, distal interphalangeal in 7.5%, deforming or mutilans in 2.3% and spondylitic and/or sacro-iliitic in 20.9%. In 14.5% of arthritic patients an overlap of the spondylitic form and peripheral involvement was also found. Stratification by age of patient populations shows that cutaneous pathology has a homogeneous distribution in the various age decades, while joint symptoms are seen maximally in the sixth decade and are absent in the first two decades. The relationship between the onset of skin lesions and joint pathology demonstrates that skin lesions preceded arthritis in 64.5% of the cases, whilst arthritis antedated psoriasis in only 19.35%. In 16.1% of cases psoriasis and arthritis began almost simultaneously. Nail changes were present in 63% of arthritic patients and in 37% of psoriatic subjects without arthritis. Furthermore, in 88% of arthritic patients in whom arthritis preceded skin lesions, nail changes antedated the onset of clinically apparent psoriasis. Extra-articular features were not found. This absence might be associated with the usual seronegativity for rheumatoid factor in psoriatic arthritis, also confirmed in this survey.

Skin typing for assessment of skin cancer risk and acute response to UV-B and oral methoxsalen photochemotherapy

Abstract: Skin typing is a clinical classification system based on a patient's historical reporting of the acute skin response to sunlight. It is advocated as a means of determining an individual's relative risk of skin tumors and has been used to determine the initial therapeutic dose of UV radiation for UV-B phototherapy or oral methoxsalen photochemotherapy (PUVA) for psoriasis. Among PUVA-treated patients, the relative risk of cutaneous carcinoma was significantly higher among patients with skin types I and II compared with patients with skin type IV (3.2 and 2.3, respectively). Skin type was a better predictor of this risk than eye or hair color. The minimal erythemal dose ( MErD ) and minimal phototoxic dose (MPD) increased with increasing skin type number, but within a given skin type each varied as much as sixfold. Skin type was a good clinical predictor of skin cancer risk, but lacked specificity as a predictor of an individual's MErD or MPD.

Two patterns of skin ulceration induced by methotrexate in patients with psoriasis

Abstract: Two patterns of skin ulceration occurred in patients receiving weekly methotrexate for psoriasis. In type I ulceration, psoriatic plaques became painful and eroded shortly after starting methotrexate (MTX) (median, 10 days). Type II ulcers occurred in clinically uninvolved skin affected by other pathology—stasis dermatitis in two and adjacent to an anal fistula in one and had a variable relationship to the duration of methotrexate treatment. Type I ulcers developed at methotrexate doses between 12.5 and 25 (median, 20) tng/wk and healed rapidly (median, 10 days) after dose reduction or withdrawal. Type II ulcers developed at methotrexate doses of 7.5 to 20 (median, 10) mg/wk and took a median of 9 weeks to heal. Type I ulceration may be confused with an exacerbation of psoriasis, and the MTX dose mistakenly increased rather than reduced. Type II ulcers can mimic stasis ulcers and may be overlooked as evidence of MTX toxicity.

Synthetic Retinoids in Dermatology

Abstract: Publisher Summary This chapter discusses synthetic retinoids in dermatology. Synthetic retinoids are beneficial in a variety of cutaneous disorders. Synthetic retinoids are of value in the treatment and prevention of skin cancer. Isotretinoin is the drug of choice for severe cystic acne. The development of optimum dosage schedules for acne of varying severity and for facial and truncal locations is continuing. The use of etretinate either alone or in combination with currently available therapies for psoriasis is very effective, especially for the typically treatment-resistant pustular and erythrodermic varieties. Unlike isotretinoin in acne, maintenance therapy with etretinate is necessary for most psoriatic patients. Synthetic retinoids is the most effective treatment for Darier's disease and certain other disorders of keratinization. The use of synthetic retinoids in cancer prevention and therapy for both cutaneous and internal tumors is potentially the most significant clinical use of these drugs. Chronic maintenance therapy is needed for successful chemoprevention of cancer with retinoids.

Treatment of Sebopsoriasis

Abstract: 1% Bifonazole cream and gel were used for the local therapy of sebopsoriasis and psoriasis in a pilot study with 20 patients. 3 of the 9 patients with psoriasis and 9 of the 11 patients with sebopsoriasis had improved markedly. The mechanisms of the effectiveness of this therapy will be discussed together with the results of some provocation tests with bacterial antigens.

Hypocalcemia-Induced Pustular Psoriasis of von Zumbusch: New Experience with an Old Syndrome

Abstract: Hypocalcemia occurs in patients with psoriasis vulgaris, pustular psoriasis of von Zumbusch, and impetigo herpetiformis. In most cases hypocalcemia is caused by accompanying hypoalbuminemia, yet reductions in ionized serum calcium concentrations due to hypoparathyroidism or malabsorption have been reported. We report the case of a patient with surgical hypoparathyroidism in whom hypocalcemia precipitated typical pustular psoriasis of von Zumbusch. The psoriasis rapidly cleared on two occasions when the patient's serum calcium was corrected by therapy with oral calcium and vitamin D or its analogues, and reappeared when treatment was discontinued. The patient's psoriasis cleared on a third occasion when her serum calcium level returned to normal with a calcium infusion. Hypocalcemia can precipitate pustular psoriasis of von Zumbusch in susceptible persons. These psoriatic flares are due not to abnormal circulating levels of parathyroid hormone or vitamin D metabolites but to hypocalcemia.

Psoriasis and arthritis. I. A population study.

Abstract: In a population survey of 3659 persons aged 20 years or older, no association was found between psoriasis and rheumatoid arthritis. Inflammatory, degenerative and soft tissue rheumatic diseases occurred in 59% of the psoriatics and 46% of the controls. However, the mean number of rheumatological diagnoses in the psoriatics was 1.1 and in the controls 1.3. Features of psoriasis were found in 41 individuals (1.1%). Features of inflammatory arthritis (RA + past-polyarthritis) were established in 5% and 2.2% of the psoriatics and the controls respectively, but this difference is not significant. Because patients with psoriasis have complaints associated with the locomotor system more frequently than non-psoriatic people, it seems likely that the referral rate of the former to special clinics is higher.

Study of the oral mucosa in 200 consecutive patients with psoriasis.

Abstract: The oral cavities of 200 consecutive psoriasis patients, most of them with widespread disease on the skin, were examined (man/woman ratio 1.63:1, mean age of the patients 43.7 yr). The average duration of the disease at time of examination was 15.8 yr. When questioned, 16% of the patients reported changes in the joints, which, according to them, had been verified by radiography. 72.5% of the patients reported on nail involvement at some time during their disease. Fissured tongue was present in 9.5% of the patients, and geographic tongue and smooth tongue each in 1% of the patients. Angular cheilitis was found in 3.5% of the patients. In 20 out of 200 cases, the oral mucosa showed changes and biopsy was taken. Four out of 20 patients showed histologic features typical of psoriasis, including accumulations of leukocytes in the upper layers of the epithelium, all with widespread psoriasis skin involvement. Areas of oral mucosa were most often deep red in color, the buccal mucosa and tongue being the two most common sites. Two out of these four patients had a fissured tongue and one had a geographic tongue.

Australian Aborigines and psoriasis.

Abstract: SUMMARY Psoriasis among full-blood Australian Aborigines appears to be rare or absent. After examination of some three thousand of these people in central, northern, and southern Australia, I have not seen psoriasis. Other medical and nursing observers have also not seen psoriasis in these people. Two references in the literature to psoriasis in Abotigines are reviewed briegly. The author has seen only one, male, part-Aborigine (more Causcasian than Aborigine), with in a female Aborigine whose father was said to be “not tribal”. A third was recently reported to me. Other conditions common among Aborigines, which should not be confused with psoriasis, are outlined, Certain aspects of the apparent absence of psoriasis in full-blood Australian Aborigines are discussed. Previous research about the essential causes of psoriasis has not been particularly rewarding. An important question must, therefore, be asked. Should some research projects in future be directed to reasons why some human groups seem not to get psoriasis rather than to why others do?

Method of treating psoriasis

Abstract: A method of treating psoriasis in a patient which comprises administering to said patient an effective amount of a vitamin D compound which is capable of stimulating the differentiation of cultured tumor cells or normal rodent or human fibroblasts or keratinocytes in vitro.

Cutaneous carcinoma in psoriatic patients treated with PUVA

Abstract: SUMMARY Eight of 216 psoriatic patients treated at The London Hospital with photochemotherapy (PUVA) have developed a total of twenty-five skin carcinomata. The type and site of tumour are discussed with special reference to the importance of PUVA compared with other risk factors. We suggest that a history of previous skin carcinoma, arsenic therapy or radiotherapy are relative contra-indications to PUVA therapy for psoriasis.

Ophthalmological manifestations in patients with psoriasis.

Abstract: 101 patients suffering from psoriasis have been examined ophthalmologically, in order to determine the incidence of the eye symptoms. The most important finding was iridocyclitis (uveitis) which was present in 3 out of 7 patients suffering from psoriatic arthritis.

Neutral proteinases and other neutrophil enzymes in psoriasis, and their relation to disease activity

Abstract: The activities of elastase, cathepsin G, lysozyme and myeloperoxidase of polymorphonuclear leukocytes were determined by spectrophotometry in thirty-six patients with psoriatic lesions, twelve symptom-free patients with psoriasis and fifteen normal controls. The mean activities of cathepsin G, elastase and lysozyme were found to be increased by 55 to 70% in patients with actively spreading plaque lesions compared with healthy controls (P less than 0.01). Most patients with guttate lesions had total enzyme activities within the normal range. Those with stationary plaque psoriasis had activities of both neutral proteinases (cathepsin G and elastase) which were about 40% lower than normal controls (P less than 0.05). In the lesion-free psoriatics, the activities of neutral proteinases were about 70% of control values. Our findings emphasize the importance of assessment of disease activity in this sort of investigation. The present data may help to resolve much of the confusion regarding PMN function in psoriasis.

The coexistence of systemic lupus erythematosus and psoriasis

Abstract: Systemic and discoid lupus erythernatosus (LE) have both been reported in association with psoriasis. Four additional patients who had systemic LE are reported. All of them had a high titer of antinuclear antibodies (ANAs) and were SS-A(Ro)-negative. Only one patient exhibited photosensitivity. SS-A(Ro) antibodies do not appear to be specific markers for the coexistence of LE and psoriasis, and screening for them in all psoriatics prior to ultraviolet B phototherapy is not recommended. Pitfalls in the management of patients with systemic LE and psoriasis are discussed. (J Am ACAD DERMATOL 10:619–622, 1984.)

Comparison of Phototherapy (UV-B) and Photochemotherapy (PUVA) for Clearing and Maintenance Therapy of Psoriasis

Abstract: • One hundred eighty-three patients with psoriasis were treated with UV-B irradiation or oral methoxsalen plus longwave UV light (PUVA). Patients treated with PUVA, in the initial and maintenance period, achieved in general a higher therapeutic score (95% to 100% clearance) than those receiving UV-B therapy. However, taking 80% to 100% improvement as criterion, no difference was found between initial UV-B and PUVA therapy, if less than 50% of the skin surface was affected by psoriasis. If more than 50% of the skin was involved, PUVA was better than UV-B therapy. The maintenance treatment frequency for the UV-B—treated patients for more than a year seemed to be higher than for PUVA-treated patients. A positive correlation was found between response to sunbathing (questionnaire survey) and the response to UV-B phototherapy. An extra UV-B treatment to the leg lesions appeared useless. ( Arch Dermatol 1984;120:52-57)

Psoriasis and arthritis.

Abstract: In a group of patients with seronegative polyarthritis and psoriasis, the radiological features and the incidence of histocompatibility antigens were compared with those of a group of patients with seronegative polyarthritis but not psoriasis. No radiological criteria proved to be characteristic of psoriatic arthritis. In the group of patients with seronegative polyarthritis and psoriasis, erosions of the distal interphalangeal (DIP) joints were seen more frequently and were more severe than in the group of patients with seronegative arthritis without psoriasis. For the group of patients with seronegative polyarthritis and psoriasis, correlation was found between psoriatic nail lesions and erosions of the DIP joints, but this correlation was not found between the nail involvement and erosion of the adjacent DIP joint. No significant differences were found for the incidence of histocompatibility antigens between patients with seronegative polyarthritis with or without psoriasis. However, differences were found between these two groups and either the seropositive polyarthritis group or blood bank donors.

Long-term safety of trioxsalen bath PUVA treatment: an 8-year follow-up of 149 psoriasis patients.

Abstract: A thorough clinical follow-up study with regard to the occurrence of degenerative skin changes and cutaneous carcinomas was undertaken in 1982 in 149 patients with moderate to severe psoriasis treated with PUVA baths (trioxsalen + UVA). The PUVA treatment had been commenced between 1974 and 1978. With trioxsalen baths a high sensitivity to UVA is obtained. The initial UVA dosage is therefore as low as 0.04-0.08 J/cm2 and in the majority of the patients the maximum daily dose was about 1.0 J/cm2. The accumulated UVA dosage was low. Thus 89% of the patients had received less than 50 J/cm2 in 5-8 years of bath PUVA treatment. No degenerative skin changes were found on PUVA-exposed skin that were not also seen on the facial skin not exposed to PUVA. Two patients showed mild mottling of exposed skin. Otherwise no PUVA-related degenerative changes were observed. No carcinomas were found on bath PUVA-treated skin.

Confirmation of raised phospholipase A2 activity in the uninvolved skin of psoriasis

Abstract: SUMMARY Phospholipase A2 has been measured in the lesions and the ‘uninvolved’ skin of patiens with psoriasis. We confirm a previous report that there is a generalized increase in the activity of this enzyme in psoriatic skin.

Skin blood flow in psoriasis during Goeckerman or beech tar therapy.

Abstract: Skin blood flow (SBF) was measured by the laser Doppler technique in lesional and clinically normal skin of 8 patients with psoriasis vulgaris during Goeckerman or beech tar therapy. The SBF measurements were performed before therapy and 1, 2, and 3-4 weeks after treatment was initiated. The results were compared to a clinical psoriasis index based on the objective assessment of infiltration, erythema, and scaling of the psoriatic plaques. The pre-treatment value of SBF in lesional skin was about 9 times higher than that of clinically normal skin. During therapy SBF of involved skin decreased rapidly approaching that of uninvolved skin after 3-4 weeks. Furthermore, there was a significant linear correlation between the SBF values and the clinical psoriasis index. It is concluded that SBF in psoriatic lesions decreases significantly during Goeckerman or beech tar therapy, and that this variable might be used to obtain a quantitative measure of the disease activity.