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Psoriasis

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15361. Defective cyclic guanosine monophosphate-gated calcium channels and the pathogenesis of psoriasis. Full Text available with Trip Pro

Defective cyclic guanosine monophosphate-gated calcium channels and the pathogenesis of psoriasis. A positive association between intake of calcium channel blockers and psoriasis has been observed recently. Intake of blockers of voltage-gated calcium ion channels is associated with outbreaks of psoriasis after a latent period in patients with and without a previous family history of psoriasis. This suggests that interfering with calcium influx may trigger psoriasis. Calcium influx also occurs

2003 Acta Dermato-Venereologica

15362. Gluten-free diet in psoriasis patients with antibodies to gliadin results in decreased expression of tissue transglutaminase and fewer Ki67+ cells in the dermis. Full Text available with Trip Pro

Gluten-free diet in psoriasis patients with antibodies to gliadin results in decreased expression of tissue transglutaminase and fewer Ki67+ cells in the dermis. Previous studies have shown that 16% of patients with psoriasis vulgaris have IgA and/or IgG antibodies to gliadin, but few have antibodies to endomysium. The increase in duodenal intraepithelial lymphocytes was mild. Still, highly significant clinical improvement was observed after 3 months on a gluten-free diet. This study surveys (...) certain immunohistological aspects of involved and non-involved skin in 28 AGA-positive psoriasis patients before and after 3 months of a gluten-free diet. Staining was performed for CD4+ T lymphocytes, Langerhans' cells, endothelium, proliferating (Ki67) cells and tissue transglutaminase. In the entire group of patients, as well as in those on a gluten-free diet as the only treatment, Ki67 + cells in involved dermis were highly significantly decreased after the diet. There was a significant decrease

2003 Acta Dermato-Venereologica

15363. Calcitriol vs. dithranol in combination with narrow-band ultraviolet B (311 nm) in psoriasis. (Abstract)

Calcitriol vs. dithranol in combination with narrow-band ultraviolet B (311 nm) in psoriasis. Narrow-band ultraviolet (UV) B (311 nm) phototherapy is an effective treatment for psoriasis. In order to reduce cumulative UV doses and to enhance clearance of psoriasis plaques, combination therapies with topical agents such as dithranol and calcipotriol have been established.To compare the clinical efficacy, in a half-side manner, of UVB (311 nm) in combination with either calcitriol (...) or dithranol.Ten patients with symmetrical stable plaque psoriasis were treated with narrow-band UVB (311 nm) five times a week. In addition, topical calcitriol was applied twice daily to one arm, whereas the other arm and the rest of the body were treated once daily with dithranol. The follow-up period was at least 4 weeks. Efficacy was assessed separately for both arms prior to treatment and once weekly thereafter by a modified Psoriasis Area and Severity Index (PASI) score. The cumulative irradiation dose

2003 British Journal of Dermatology

15364. The effects of ultraviolet B treatment on the expression of adhesion molecules by circulating T lymphocytes in psoriasis. (Abstract)

The effects of ultraviolet B treatment on the expression of adhesion molecules by circulating T lymphocytes in psoriasis. T lymphocytes are believed to play a role in the pathogenesis of psoriasis; > 80% of T lymphocytes that infiltrate psoriatic lesions express the surface glycoprotein cutaneous lymphocyte-associated antigen (CLA), compared with < 20% in the blood. Exposure to ultraviolet (UV) B is an effective treatment for psoriasis.To compare the effects of UVB treatment of psoriasis (...) on the expression of CLA and several other surface markers expressed by circulating T lymphocytes.Peripheral blood mononuclear cells from psoriatic patients were stained for adhesion molecules and stimulated with streptococcal antigens before and once weekly during 3 weeks of UVB treatment.A marked and progressive decrease was observed during the treatment in expression of the CLA and the very late antigen-4alpha by T cells; this decrease correlated closely with clinical improvement (Psoriasis Area and Severity

2003 British Journal of Dermatology

15365. Psoriasis: response to high-dose intravenous immunoglobulin in three patients. (Abstract)

Psoriasis: response to high-dose intravenous immunoglobulin in three patients. Treatment of recalcitrant psoriasis and psoriatic arthritis can be challenging, with treatment options limited by drug intolerance or poor efficacy. High-dose intravenous immunoglobulin (hdIVIg) has been used successfully in Kawasaki's disease and idiopathic thrombocytopenic purpura, where it has become the standard treatment. The literature also suggests its positive effect in the treatment of dermatological (...) conditions, such as autoimmune chronic urticaria, atopic dermatitis, scleromyxoedema, dermatomyositis and autoimmune bullous disorders. We report three patients with treatment-resistant psoriasis and psoriatic arthritis who improved with hdIVIg.

2002 British Journal of Dermatology

15366. Downregulation and altered spatial pattern of caveolin-1 in chronic plaque psoriasis. (Abstract)

Downregulation and altered spatial pattern of caveolin-1 in chronic plaque psoriasis. Caveolin-1 is a key structural and functional protein for plasmalemmal invaginations termed caveolae. Caveolin-1 is known to modulate multiple signal-transducing pathways involved in cell differentiation and proliferation. Psoriasis is viewed as a multifactorial pathology characterized by keratinocyte hyperproliferation and abnormal cell maturation. We hypothesized that loss of caveolin-1 within epidermal (...) keratinocytes may contribute to the development and/or progression of the psoriatic phenotype.To examine the expression and spatial distribution of caveolin-1 in skin biopsies from normal subjects and in patients with psoriasis.Using immunohistochemical methods caveolin-1 protein expression was assayed in two independent patient groups. Firstly, a retrospective analysis was conducted on archival skin samples obtained from nine normal subjects and from involved tissue of 12 patients with psoriasis. Following

2002 British Journal of Dermatology

15367. Circulating natural killer cells in psoriasis. (Abstract)

Circulating natural killer cells in psoriasis. Psoriasis is an immunologically mediated, probably autoimmune, disease in which T-helper type 1 cytokines play an important role. Established autoimmune diseases, with similar mechanistic characteristics to psoriasis, include multiple sclerosis, rheumatoid arthritis, type 1 diabetes mellitus and systemic lupus erythematosus. Natural killer (NK) and natural killer-T (NK-T) cells are considered key to the pathogenesis of these conditions, which (...) are characterized by reduced numbers of NK cells in peripheral blood. NK and NK-T cells have been implicated in the pathogenesis of psoriasis and are present in plaques of psoriasis.To investigate whether levels of NK and NK-T cells are reduced in the peripheral blood of patients with psoriasis.Fourteen patients with untreated psoriasis, mean +/- SD age 46 +/- 13 years, and 13 healthy volunteers, mean +/- SD age 34 +/- 9 years, were venesected and peripheral blood mononuclear cells isolated, labelled

2003 British Journal of Dermatology

15368. CD30+ T-cell lymphoma in a patient with psoriasis treated with ciclosporin and infliximab. (Abstract)

CD30+ T-cell lymphoma in a patient with psoriasis treated with ciclosporin and infliximab. There is a known relationship between the use of immunosuppressive therapies and the development of lymphoproliferative malignancies. These lymphomas are mainly B-cell nonHodgkin's lymphomas associated with Epstein-Barr virus. Most cases concern classical immunosuppressive treatments including ciclosporin and methotrexate. A relationship between the new antitumour necrosis factor (TNF)-alpha agents (...) and lymphoproliferative malignancies is debated. Patients with psoriasis on immunosuppressive therapies, mainly ciclosporin, are considered to have a low risk of developing lymphoid proliferation. We report a patient with erythrodermic psoriasis treated with ciclosporin and infliximab who developed a CD30+ T-cell lymphoma. This lymphoma regressed after stopping these treatments. In this case, the anti-TNF-alpha agent may have played a role in association with ciclosporin in the development of the lymphoproliferative

2003 British Journal of Dermatology

15369. Reciprocal altered expression of T-cadherin and P-cadherin in psoriasis vulgaris. (Abstract)

Reciprocal altered expression of T-cadherin and P-cadherin in psoriasis vulgaris. The most characteristic change in psoriasis vulgaris is markedly increased, persistent keratinocyte proliferation. The underlying mechanism of excessive epidermal growth is controversial. We previously found and reported that T-cadherin was expressed in keratinocytes and confined to the basal layer of mouse and human skin. Invasive cutaneous squamous cell carcinoma showed a loss of T-cadherin expression. Another (...) study showed that T-cadherin was a negative growth regulator of epidermal growth factor in T-cadherin transfectant neuroblastoma cells.To obtain insight into the role of T-cadherin in keratinocyte proliferation and to investigate further the pathogenesis of psoriasis vulgaris, we examined the expression of T-cadherin, as well as E- and P-cadherin, in psoriasis vulgaris.Four untreated active psoriatic skin samples from psoriasis vulgaris patients and four normal human skin samples from plastic

2003 British Journal of Dermatology

15370. Sensitivity of the Dermatology Life Quality Index to clinical change in patients with psoriasis. (Abstract)

Sensitivity of the Dermatology Life Quality Index to clinical change in patients with psoriasis. Quality of life is increasingly recognized as an important outcome measure in dermatology. The Dermatology Life Quality Index (DLQI) is a self-administered questionnaire designed to measure the impact of skin diseases on patients' quality of life.To assess the responsiveness of the DLQI to variations in clinical status as measured by the Self-Administered Psoriasis Area and Severity Index (SAPASI (...) ) in a large sample of in-patients with psoriasis.The SAPASI and the DLQI were completed by 359 in-patients with psoriasis at hospital admission and 4 weeks after discharge. Changes in SAPASI scores were used to categorize patients as improved, unchanged or worsened. Next, these groups were compared with one another with regard to the change in DLQI scores.Four weeks after discharge, both mean SAPASI scores and mean DLQI scores were significantly lower than at admission (P < 0.001). In improved patients

2003 British Journal of Dermatology

15371. Development of the PSORIQoL, a psoriasis-specific measure of quality of life designed for use in clinical practice and trials. (Abstract)

Development of the PSORIQoL, a psoriasis-specific measure of quality of life designed for use in clinical practice and trials. Patients with psoriasis have significant impairment in their quality of life (QoL). Several patient-completed instruments are available to measure outcome in dermatological conditions but these primarily focus on severity of disease rather than on QoL.To develop a new instrument specifically designed to measure QoL in psoriasis-the Psoriasis Index of Quality of Life (...) (PSORIQoL).The content of the instrument was derived from qualitative interviews with 62 psoriasis patients in the U.K., Italy and the Netherlands. Content analysis of the interview transcripts from the three countries identified potential items for the questionnaire. All further stages of the project were conducted in the U.K. only. Face and content validity were determined by means of a focus group held with seven psoriasis patients and face-to-face interviews with a further 21 patients. A new draft

2003 British Journal of Dermatology

15372. Expression of the T-helper 2-specific chemokine receptor CCR4 on CCR10-positive lymphocytes in atopic dermatitis skin but not in psoriasis skin. (Abstract)

Expression of the T-helper 2-specific chemokine receptor CCR4 on CCR10-positive lymphocytes in atopic dermatitis skin but not in psoriasis skin. Atopic dermatitis (AD) and psoriasis are inflammatory skin diseases. AD is generally perceived as a T-helper (Th) 2-dominated disease whereas psoriasis is a Th1-dominated disease. The chemokine cutaneous T-cell attracting chemokine (CTACK) and its receptor CCR10 attract skin-homing lymphocytes to inflamed skin, suggesting that CCR10+ cells in AD (...) and psoriasis should be of Th2 and Th1 type, respectively. The chemokine receptor CCR4 is expressed selectively on Th2 lymphocytes and its ligand thymus and activation-regulated chemokine (TARC) is upregulated in AD lesions, suggesting that the CCR10+ cells in AD lesions should also express CCR4.To examine the coexpression of CCR10 and CCR4 on skin-invading lymphocytes in AD and psoriasis lesions as well as the Th1/Th2 cytokine expression of the CCR10+ lymphocytes.Skin biopsies from AD and psoriasis

2003 British Journal of Dermatology

15373. Streptococcal throat infections and exacerbation of chronic plaque psoriasis: a prospective study. (Abstract)

Streptococcal throat infections and exacerbation of chronic plaque psoriasis: a prospective study. Guttate psoriasis has a well-known association with streptococcal throat infections but the effects of these infections in patients with chronic psoriasis remains to be evaluated in a prospective study.To determine whether streptococcal throat infections are more common in and can cause exacerbation in patients with chronic psoriasis.Two hundred and eight patients with chronic plaque psoriasis (...) and 116 unrelated age-matched household controls were followed for 1 year. At recruitment all patients were examined, their disease severity scored and throat swabs taken. Patients and corresponding controls were then re-examined and tested for streptococcal colonization whenever they reported sore throat or exacerbation of their psoriasis during the study period.The psoriasis patients reported sore throat significantly more often than controls (61 of 208 vs. three of 116, P < 0.0001), and beta

2003 British Journal of Dermatology

15374. Pruritogenic mediators in psoriasis vulgaris: comparative evaluation of itch-associated cutaneous factors. (Abstract)

Pruritogenic mediators in psoriasis vulgaris: comparative evaluation of itch-associated cutaneous factors. Although some patients with psoriasis vulgaris also complain of severe pruritus, the data available regarding pruritus in psoriasis are sparse.To clarify the mechanism and mediators involved in the pruritus of psoriasis vulgaris, we compared itch-associated factors in lesional skin from psoriatic patients vs. skin without pruritus quantitatively using a panel of histological (...) and immunohistological parameters.Biopsied specimens were obtained from 38 patients with psoriasis vulgaris who were divided into two groups according to the presence or absence of pruritus.When compared with psoriatic patients devoid of pruritus, lesional skin from patients with pruritus showed the following characteristic features: (i) a rich innervation both in the epidermis and in the papillary dermis; (ii) an increase in neuropeptide substance P-containing nerve fibres in perivascular areas; (iii) decreased

2003 British Journal of Dermatology

15375. High frequency of detection of human papillomaviruses associated with epidermodysplasia verruciformis in children with psoriasis. (Abstract)

High frequency of detection of human papillomaviruses associated with epidermodysplasia verruciformis in children with psoriasis. Psoriasis is a T-cell-mediated immunological disease characterized by epidermal proliferation. The nature of the antigen(s) responsible for T-cell activation is still unknown. It has been suggested that the human papillomaviruses (HPVs) associated with epidermodysplasia verruciformis (EV), including the oncogenic HPV5, may contribute to the pathogenesis (...) of psoriasis.To determine whether EV-HPVs may play a role early in the disease, we searched for these viruses in children with psoriasis. The influence of clinical data on EV-HPV infection was investigated.We studied scrapings of involved skin from 26 children aged 1.5-13 years with psoriasis. As controls, we analysed scrapings from 28 adults with psoriasis and 15 children with atopic dermatitis, as well as scrapings from normal skin of 28 adults with no known history of HPV infection. We searched for EV-HPV

2003 British Journal of Dermatology

15376. Long-term safety aspects of systemic therapy with fumaric acid esters in severe psoriasis. (Abstract)

Long-term safety aspects of systemic therapy with fumaric acid esters in severe psoriasis. Therapy with fumaric acid esters (FAE) has been shown to be safe and effective in patients with severe psoriasis in several clinical studies with limited follow-up periods. In view of the chronic character of psoriasis, long-term safety aspects are of major importance in determining the suitability of a drug during prolonged periods of treatment.To investigate adverse events of therapy with systemic FAE (...) (14%), tiredness (14%) and stomach complaints (12%). A relative lymphocytopenia was observed in 76% of patients during therapy with FAE, resulting in a permanent discontinuation of therapy with FAE in four patients. A transient eosinophilia and moderate liver enzyme elevations were observed in 14% and 25% of patients, respectively.The present study indicates that FAE can be considered as a safe long-term treatment in patients with severe psoriasis.

2003 British Journal of Dermatology

15377. Interleukin-10 promoter polymorphism IL10.G and familial early onset psoriasis. (Abstract)

Interleukin-10 promoter polymorphism IL10.G and familial early onset psoriasis. The anti-inflammatory cytokine interleukin (IL)-10 is considered to play a major role in the pathophysiology of psoriasis, which is characterized by an IL-10 deficiency. Systemic administration of IL-10 has been shown to be an effective therapy for psoriasis. The IL-10 promoter region contains a highly polymorphic microsatellite (IL10.G) and in a recent case-control study the IL10.G13 (144 bp) allele was found (...) to be associated with familial early onset psoriasis (type 1 psoriasis) having a susceptible effect.As it is essential in multifactorial diseases to replicate findings before definite conclusions can be drawn, we decided to perform a follow-up study and to follow a genetic approach analysing allele transmission in families with a positive family history of psoriasis.We studied 137 nuclear families (trio-design) comprising 456 individuals and genotyped the IL10.G marker. For comparison we also genotyped

2003 British Journal of Dermatology

15378. Psoriasis: to cut or not to cut, what say you? (Abstract)

Psoriasis: to cut or not to cut, what say you? A common problem facing patients suffering from psoriasis is the need for surgery that requires incision through active psoriatic skin. Many patients have been denied surgery because of the fear of an increased risk of infection, decreased wound healing ability, and worsening of the psoriatic lesions.To assess the practices and beliefs of dermatologists and surgeons (orthopedic and plastic surgeons) faced with the decision of whether to operate (...) through active psoriatic skin.Dermatologists, orthopedic surgeons, and plastic surgeons selected from various professional membership lists from five representative cities were sent a survey to ascertain their opinions on operating on active psoriatic skin. Psoriatic patients were also given forms asking about the severity of their psoriasis and whether they had ever been denied surgery.Dermatologists are more likely to condone surgery in active psoriatic skin and to believe that there is not a risk

2003 Dermatologic Surgery

15379. Calcium homeostasis remains unaffected after 12 weeks' therapy with calcitriol 3 microg/g ointment; no correlation with extent of psoriasis. (Abstract)

Calcium homeostasis remains unaffected after 12 weeks' therapy with calcitriol 3 microg/g ointment; no correlation with extent of psoriasis. To assess the systemic safety of calcitriol 3 microg/g ointment (Silkis) ointment) in relation to body surface area (BSA) affected by chronic plaque psoriasis.In this open-label, multicentre study, patients were divided into three parallel groups: 5% to <15% (n=23), 15% to <25% (n=18), 25% to 35% (n=18) based on BSA involvement. Ointment was applied (...) topically twice daily for 12 weeks; patients were followed up for a further 8 weeks.There was no alteration of calcium homeostasis: the mean values of albumin-adjusted serum total calcium, as well as 24-hour urinary calcium and serum calcitriol levels, remained within normal ranges throughout treatment. No changes in calcium or phosphate homeostasis related to the area of psoriasis being treated with calcitriol ointment were detected.Reductions in the global severity score and BSA involvement, as well

2003 Journal of Dermatological Treatment

15380. Cyclosporin in childhood psoriasis. (Abstract)

Cyclosporin in childhood psoriasis. Cyclosporin is known to be highly effective in the treatment of psoriasis in adults. It has also proved effective and well tolerated in the treatment of severe childhood atopic dermatitis. Psoriasis in childhood is relatively unusual but by no means rare and on occasions the disease can be very difficult to control in this age group. The use of cyclosporin for psoriasis in childhood has received scarcely any attention and in the few cases that have been (...) reported the results have been inconsistent. Three children aged from 7 to 11 years with severe psoriasis resistant to topical agents were treated with cyclosporin. The highest dose required was 3.5 mg/kg per day. The duration of treatment ranged from 6 weeks to 4 months. Cyclosporin was effective and generally well tolerated. Treatment was interrupted in one case due to nausea and diarrhoea. None of the patients developed hypertension or renal impairment. The potential role of cyclosporin in severe

2003 Journal of Dermatological Treatment

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