Journal of Dermatological Treatment

Segaert, Siegfried; Duvold, Laëtitia Bouérat

doi: 10.1080/09546630600999219pmid: 17853305

Published data are reviewed on the pharmacology, efficacy, tolerability, and pleasantness of the vitamin D3 analogue calcipotriol in a cream formulation (Daivonex®/Dovonex® cream; LEO Pharma AS, Denmark) in the treatment of psoriasis. Calcipotriol cream monotherapy is more effective than placebo, and as effective as betamethasone valerate cream and coal tar in psoriasis. A regimen of morning‐cream and evening‐ointment is equally effective as twice‐daily calcipotriol ointment and is preferred by patients. Calcipotriol cream is also a highly efficacious maintenance treatment used alone or in an alternating regimen with calcipotriol/betamethasone dipropionate ointment. Short‐ and long‐term trials have demonstrated that calcipotriol cream is well tolerated by patients with psoriasis. Irritation is observed less frequently than with calcipotriol ointment, making the cream very suitable for children and thin or sensitive areas, such as flexures or (off‐label use) the face. Calcipotriol cream is generally preferred to the ointment formulation, as shown by preference testing, and leads to improved patient compliance. In conclusion, calcipotriol cream is not only an effective treatment for psoriasis but is pleasant to use and well tolerated even in sensitive areas. Therefore, calcipotriol cream is particularly useful for the maintenance treatment of psoriasis, after induction therapy with a fast‐acting vitamin D/steroid two‐compound product.

Şendur, Neslihan; Karaman, Göksun; Saniç, Nagehan; Şavk, Ekin

doi: 10.1080/09546630601028711pmid: 17853306

Objectives: The purpose of this study was to assess the efficacy of pimecrolimus cream 1% in vitiligo and to evaluate the effects of age of the patients, age of onset and duration of disease on response rate. Materials and methods: Twenty‐three patients with vitiligo were enrolled in our study; 19 patients (seven male, 12 female) completed the 6‐month study period. Patients were treated with topical pimecrolimus 1% cream once daily. The response was evaluated as excellent (76–100%), moderate (51–75%), mild (26–50%), minimal (1–25%), or no response. Results: The mean age of the 19 patients was 29.3±16.6 (range 7–62 years) and the mean duration of vitiligo was 68.4±81.3 months. Three patients demonstrated an excellent response to the therapy. Four patients had moderate, six patients had mild and five patients had minimal responses; one patient had no response to the treatment. Side effects were noted as a burning and stinging sensation in only three patients. The correlations between response rate and duration of the disease (r = 0.02, p = 0.95), onset age (r = −0.17, p = 0.48), and age of the patients (r = −0.16, p = 0.53) were not significant. Conclusions: Pimecrolimus has a mild therapeutic effect on vitiligo without significant side effects and can be an alternative therapy agent.

Myers, Wendy A.; Najarian, David; Gottlieb, Alice B.

doi: 10.1080/09546630600967406pmid: 17853308

Efalizumab is a humanized anti‐CD11a monoclonal IgG1 antibody approved for the treatment of moderate‐to‐severe plaque psoriasis. This case report describes two cases of new‐onset debilitating psoriatic arthritis in patients with plaque psoriasis on long‐standing efalizumab therapy, despite the fact that their skin disease was in remission. Although during the clinical trials, involving over 2700 study subjects, arthralgia was seen only at a rate of 1–2% higher than in those subjects receiving placebo, the cases presented here are interesting in that it appears that efalizumab treatment ‘uncoupled’ the psoriatic arthritic component from the cutaneous disease. It can be speculated that a possible mechanism for efalizumab‐induced psoriatic arthritis is related to the blockade of regulatory T cells from joint tissue.

De Felice, Catia; Mazzotta, Annamaria; Esposito, Maria; Bianchi, Luca; Chimenti, Sergio

doi: 10.1080/09546630601028703pmid: 17853309

Background: Etanercept is a human recombinant protein that functions as a competitive inhibitor of tumour necrosis factor‐alpha (TNF‐α), a pro‐inflammatory molecule exerting a key role in the pathogenesis of psoriatic arthritis (PsA). Methods: Seventy‐one patients affected by PsA with variable skin involvement, refractory to conventional anti‐rheumatic drugs, were treated with 50 mg etanercept subcutaneous injections twice‐weekly for 12 weeks, followed by a maintenance dose regimen of 25 mg twice‐weekly for an additional 12 weeks. Efficacy and safety were assessed at 12–24 weeks. Efficacy criteria was the global assessment of a patient's joint symptoms expressed by the Ritchie index (RI), while skin symptoms were assessed by the psoriasis area and severity index (PASI). The impact of etanercept on patients' quality of life (QoL) was measured by four validated QoL instruments. Results: At week 12, all patients showed a reduction of symptoms with improvement of mean RI (mRI) of 66.1% from baseline and a reduction of mean PASI (mPASI) from 8.8 to 3.2. At week 24, there was a mRI reduction of 78.4% as well as a mPASI reduction to 1.7. Psoriasis‐specific QoL measures improved throughout therapy. Conclusions: A high‐dose regimen of etanercept is a highly effective and tolerable treatment for PsA with variable skin involvement, although a larger study population group and a longer trial would be needed to draw strong conclusions about the safety of the higher dose.

Simpson, Gregory L.; Yelverton, Christopher B.; Rittenberg, Sheila; Feldman, Steven R.

doi: 10.1080/09546630601028786pmid: 17853310

The use of phototherapy for psoriasis has declined because of inconvenience, managed care disincentives, and poor reimbursements. However, phototherapy is safer than other options, and the efficacy rates for different methods of phototherapy are among the highest of all available treatment options. Phototherapy is also one of the least costly treatments for moderate‐to‐severe psoriasis. We hypothesize that utilization management controls on phototherapy shift patients to more expensive and risky systemic treatments. Reducing disincentives on phototherapy will benefit both patients and payors, while increasing physicians' ability to manage this debilitating disease.

Langewouters, Annechien M. G.; Van Erp, Piet E. J.; De Jong, Elke M. G. J.; Van De Kerkhof, Peter C. M.

doi: 10.1080/09546630601028794pmid: 17853311

Objective: Alefacept is a biologic treatment for psoriasis, with a selective effect on memory effector T cells. Few data are available on the combination of alefacept with either topical or systemic anti‐psoriatics. We studied the effect of alefacept combination treatment on clinical disease severity scores and on circulating T‐cell subsets. Methods: Twelve patients with moderate‐to‐severe psoriasis were included and treated with alefacept for a period of 12 weeks. Patients were allowed to continue the anti‐psoriatic therapies they used prior to the study. Severity of disease and expression of T‐cell markers CD4, CD8, CD45RA, CD45RO, CD94, CD161, CD25, and CLA were assessed at baseline and after treatment. Results: Seven of 12 included patients used a concomitant systemic therapy: either methotrexate (n = 4), acitretin (n = 2) or cyclosporine (n = 1). PASI reductions in this group after 12 and 24 weeks were 40% and 55%, respectively. Several lymphocyte subsets showed a reduction in circulating numbers. These decreases were independent of the use of an additional systemic psoriasis therapy. Conclusions: The concomitant use of systemic anti‐psoriatic medication in combination with alefacept has a noteworthy impact on efficacy results. No differences in circulating psoriasis‐relevant T‐cell populations between patients with or without an additional systemic treatment were seen.

Marzano, Angelo V.; Dassoni, Federica; Caputo, Ruggero

doi: 10.1080/09546630600964999pmid: 17853312

Background: Immunosuppressive drugs are used as steroid‐sparing agents in the management of blistering autoimmune diseases. Mycophenolic acid (MPA) is a relatively new adjuvant drug that selectively inhibits T and B lymphocyte proliferation by suppressing de novo purine synthesis. Objective: To evaluate the efficacy of MPA in refractory blistering autoimmune diseases and the safety profile of a recent formulation, enteric‐coated mycophenolate sodium (EC‐MPS), in comparison with mycophenolate mofetil (MMF). Patients and methods: Twelve patients with various bullous dermatoses (three pemphigus vulgaris, one pemphigus herpetiformis, three bullous pemphigoid (BP), two cicatricial pemphigoid (CP) and three epidermolysis bullosa acquisita (EBA)) were enrolled in the study. In 10 cases, MPA was administered in combination with systemic corticosteroids, while in two patients with severe diabetes mellitus MPA was employed as monotherapy. The total time on MPA varied from 2 to 8 months. Four patients were given MMF (2000 mg daily), seven received EC‐MPS (1440 mg daily) and one received both sequentially. Results: Complete remission, lasting for a mean time of 6.1 months, was achieved in 10 patients. Partial remission was obtained in two patients with disseminated CP and EBA. Both MMF and EC‐MPS were well tolerated, but the latter was better in terms of gastrointestinal adverse effects. Conclusions: MPA may be proposed as a first‐line adjuvant agent for pemphigus as well as for refractory BP and CP. MPA monotherapy has to be considered in selected cases of BP and pemphigus. The highly promising results obtained in EBA suggest a future key role for MPA in the management of this disease.

Castiñeiras, Iria; Almagro, Manuel; Rodríguez‐Lozano, Jesús; Fernández‐Jorge, Beatriz; Paradela, Sabela; Del Pozo, Jesús; Fonseca, Eduardo

doi: 10.1080/09546630600919993pmid: 17853313

Pegylated liposomal doxorubicin (PLD) is usually used in disseminated HIV‐related Kaposi's sarcoma (KS). It is the first‐line treatment or second‐line therapy in patients who do not tolerate or do not respond to polychemotherapy since 1995, when it was approved by the FDA. We report two cases of disseminated classic KS not associated with immunosuppression in which HHV‐8 infection was demonstrated. They showed an excellent response to PLD, with good tolerance and an absence of side effects.

Bovenschen, Jorn H.; Kop, Else N.; Van De Kerkhof, Peter C. M.; Seyger, Marieke M. B.

doi: 10.1080/09546630600967174pmid: 17853314

We describe a patient with severe psoriasis who was treated with 25 mg subcutaneous etanercept, twice weekly, after several traditional topical and systemic treatments had failed. Our patient initially responded well to etanercept, but after 5 weeks she developed remarkable purple, sharply demarcated, erythematosquamous plaques on the dorsa of both hands, wrists and proximal fingers. Histology showed apoptotic cells and basal vacuolization in addition to a histological picture consistent with moderately active psoriasis. Discontinuation of the drug resulted in a slow regression of the eruption. It is important to realize that a lichenoid reaction pattern may occur during anti‐TNFα agent treatment.