Acute psoriasis

Contraindications Acute psoriasis where inflammation is present, erythroderma, hypersensitivity to anthralin... 

MTX is part of curative therapeutic schedules for acute lymphoblastic leukemias (ALL), Burkitt s lymphoma, and choriocarcinoma. It was also used in adjuvant therapy of breast cancer. High dose MTX with leucovorin rescue can induce about 30% remissions in patients with metastatic osteogenic sarcoma. MTX is one of the few antineoplastic drugs that can be safely administered intrathecally for the treatment of meningeal metastases and leukemic infiltrations (routine prophylaxis in ALL). In addition, MTX can be used as an immunosuppressive agent for the treatment of severe rheumatoid arthritis and psoriasis. 

Pustular psoriasis may be localized or generalized and may be an acute emergency requiring systemic therapy. Generalized pustular psoriasis is characterized by disseminated deep-red erythematous areas and pustules, which may merge to become "lakes of pus."... 

Topical corticosteroids may be used for short-term treatment of acute flare-ups (see Table 16-1 in Chap. 16 on Psoriasis). Most corticosteroids are applied once or twice daily. High-potency agents are used for less than 3 weeks for flare-ups or for lichenified (thickened) lesions. Moderate-potency steroids may be used for more chronic conditions, and low-... 

Others Osteoporosis, asthma, cystic fibrosis, acute myocardial infarction, severe sepsis, psoriasis, non-Hodgkin s lymphoma Forteo, Xolair, Puhnozyme, Activase/TNKase, Xigris, Raptiva, Zevahn... 

Th-17 cells appear to be involved in protection against bacterial pathogens. In addition, Th-17 cells may also be crucial in the pathogenesis of various chronic inflammatory diseases that were formerly categorized as Th-1-mediated disorders. Whereas IL-17 may play an important role in the pathogenesis of psoriasis and contact hypersensitivity, its role in atopic dermatitis is still unclear [36]. In skin biopsy specimens recovered from acute and chronic skin lesions from patients with atopic dermatitis, IL-17 was preferentially associated with acute lesions [37]. 

Furanocoumarlns have a number of scientifically interesting and even economically and medicinally Important actions. They are effectively used in human medicine in the treatment of vitiligo (skin depigmentation, leukoderma) ( ) and psoriasis (10,11), and have shown promise against certain other human maladies (12-15). Plants that contain furanocoumarlns are known to cause acute photosensltlzatlon (phytophotodermatltls) in man (2,16). 

Uses Psoriasis Action Keratolytic Dose Apply daily Caution [C, ] Contra Acutely inflamed psoriatic eruptions, erythroderma Disp Cream SE Irritation hair/fingemails/skin discoloration Interactions T Tox if used immediately after long-term topical corticosteroid therapy EMS None OD Unlikely... 

Clinical applications include childhood acute lymphoblastic leukemia, choriocarcinoma, osteosar-com, non-Hodgkin s lymphoma and Burkitt s lymphoma. However methotrexate is also frequently used as an immunosuppressant in diseases such as psoriasis, rheumatoid arthritis and others. 

Although 6-thioguanine is chiefly used in chemotherapy for acute myelocytic leukemia and other marrow-based malignancies, lower doses are very effective for moderate to severe psoriasis, particularly in... 

Hydroxychloroquine (Plaquenil), like chloroquine, is a 4-aminoquinoline derivative used for the suppressive and acute treatment of malaria. It also has been used for rheumatoid arthritis and discoid and systemic lupus erythematosus. Hydroxychloroquine has not been proved to be more effective than chloroquine. Adverse reactions associated with its use are similar to those described for chloroquine. The drug should not be used in patients with psoriasis or porphyria, since it may exacerbate these conditions. 

Methotrexate is one of the few anticancer drugs that can be safely administered intrathecally for the treatment of meningeal metastases. Its routine use as prophylactic intrathecal chemotherapy in acute lymphoblastic leukemia has greatly reduced the incidence of recurrences in the CNS and has contributed to the cure rate in this disease. Daily oral doses of methotrexate are used for severe cases of the nonneoplastic skin disease psoriasis (see Chapter 41), and methotrexate has been used as an immunosuppressive agent in severe rheumatoid arthritis. 

Tar preparations are used mainly in the treatment of psoriasis, dermatitis, and lichen simplex chronicus. The phenolic constituents endow these compounds with antipruritic properties, making them particularly valuable in the treatment of chronic lichenified dermatitis. Acute dermatitis with vesiculation and oozing may be irritated by even weak tar preparations, which should be avoided. However, in the subacute and chronic stages of dermatitis and psoriasis, these preparations are quite useful and offer an alternative to the use of topical corticosteroids. 

Modest but significant improvement has been observed in patients with chronic hepatitis C, Crohn s disease, psoriasis and rheumatoid arthritis after subcutaneous administration of IL-10 in human clinical trials. The systemic administration of IL-10 produces general immune suppression, inhibition of macrophage and T-cell infiltration, less secretion of IL-12 and TNF-a by monocytes and suppression of nuclear factor (NF)-kB induction. In patients with acute myelogenous leukemia, IL-10 increases the serum levels of TNF-a and IL-1 (3. The use of IL-10 for human cancer therapy is under investigation and despite its immunosuppressive effects it may serve a role as a facilitator in preconditioning tumors to be recognized by immune effector cells. 

S100A12 is associated with several pathological states including psoriasis (together with S100A7), inflammation, Mooren s ulcer, an autoimmune disease of the human cornea, and Kawasaki s disease, an acute multisystem vasculitits, occurring in children usually under 5 years of age (Table 2). 

Nitric oxide has a role in both acute and chronic inflammation. NOS-3 is involved in the vasodilation associated with acute inflammation. In experimental models of acute inflammation, inhibitors of NOS-3 have a dose-dependent protective effect, suggesting that nitric oxide promotes edema and vascular permeability. Nitric oxide has a detrimental effect in chronic models of arthritis dietary L-arginine supplementation exacerbates arthritis whereas protection is seen with NOS-2 inhibitors. Psoriasis lesions, airway epithelium in asthma, and inflammatory bowel lesions in humans all demonstrate elevated levels of nitric oxide and NOS-2. Synovial fluid from patients with arthritis contains increased oxidation products of nitric oxide, particularly peroxynitrite. 

The first therapeutic antibody approved (Orthoclone OKT-3 or Muromonab CD3, 1986) was indicated not for cancer treatment, but for controlling acute rejection of transplanted organs (kidney, heart, and liver). Nowadays, other clinical indications such as asthma, rheumatoid arthritis, psoriasis, and Crohn s disease are treated with mAbs (see Chapter 17) (Antibody Engineering and Manufacture, 2005 Monoclonal Antibodies and Therapies, 2004 Hot Drugs, 2004 Walsh, 2004). 

The major risk resulting from topical treatment of psoriasis with salicylic acid is the potential chronic or acute systemic intoxication with the symptoms of burning of oral mucosa, frontal headache, CNS symptoms, pH deviation (metabolic acidosis), tinnitus, nausea, vomiting, and gastric symptoms.28-30 These symptoms may occur in topical treatment of large body surfaces, especially in children.31-33 Even lethal cases have been reported.34,35 Therefore, a concentration higher than 10%, and an application on larger surfaces especially in children are not suitable. Salicylic acid should not be applied to more than 20% of the body surface area.13 It should be noted that some topical treatments of psoriasis such as calcipotriol are inactivated by salicylic acid.36... 

Tracy Gamier and Gary Moss Case study level 1 - Cold sores 294 Case study level 2 -Severe acne 295 Case study level 3 - Acute cellulitis 297 Case study level Ma - Atopic eczema 298 Case study level Mb - Psoriasis 301... 

Desferrioxamine and several related iron chelators have been demonstrated to inhibit the proliferation of a variety of malignant cell lines [148,149] as well proving inhibitory in acute neonatal leukaemia [150]. In addition desferrioxamine also exhibits in vivo anti-malarial activity in both humans and rats [151,152], Iron chelators have also been used to treat the inflammatory skin disorder, psoriasis, where there is hyperproliferation of keratinocytes and T-lymphocytes [153,154], A general problem still to be overcome with a number of powerful iron chelators is their lack of cell specificity and thus general toxicity for example to bone marrow function [144],... 

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