Psoriasis serum

OiFFerential effects of and etretinate on serum cytokine levels in patients with psoriasis... 

Cyclosporine demonstrates immunosuppressive activity by inhibiting the first phase of T-cell activation. It also inhibits release of inflammatory mediators from mast cells, basophils, and polymorphonuclear cells. It is used in the treatment of both cutaneous and arthritis manifestations of severe psoriasis. The usual dose is between 2.5 and 5 mg/kg/day given in two divided doses. Adverse effects include nephrotoxicity, hypertension, hypomagnesemia, hyperkalemia, alterations in liver function tests, elevations of serum lipids, GI intolerance, paresthesias, hypertrichosis, and gingival hyperplasia. Cumulative treatment for more than 2 years may increase the risk of malignancy, including skin cancers and lymphoproliferative disorders. 

Dogan, P., Soyuer, U., Tanrikulu, G. (1989). Superoxide dismutase and myeloperoxidase activity in polymorphonuclear leukocytes, and serum ceruloplasmin and copper levels, in psoriasis. Brit. J. Dermatol. 120,239-44. 

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. 

A patient with psoriasis developed hypercalcemia and hypercalciuria after 28 days of treatment with tacalcitol (1208). He had been taking long-term thiazide therapy for his hypertension. When he used topical tacalcitol ointment his serum calcium concentration and urinary calcium excretion gradually increased to 3.55 mmol/1 and 0.475 g/day respectively. Within 7 days of withdrawal of tacalcitol, the serum calcium concentration had normalized. 

Stiller MJ, Pak GH, Kenny C, Jondreau L, Davis I, Wachsman S, Shupack JL. Elevation of fasting serum lipids in patients treated with low-dose cyclosporine for severe plaque-type psoriasis. An assessment of clinical significance when viewed as a risk factor for cardiovascular disease. J Am Acad Dermatol 1992 27(3) 434-8. 

The population PK/PD of efalizumab were recently evaluated in patients with moderate to severe plaque psoriasis following SC administration of 1.0 and 2.0 mg/kg for 12 weeks [81-83]. Steady-state serum concentrations were achieved by four to eight weeks following administration of 1 and 2 mg/kg doses, respectively. At both doses, CDlla expression on T lymphocytes was reported to be maximally down-modulated. In addition, at doses of 1 and 2 mg/kg, >95 % of CDlla binding-sites were reported to be saturated at steady-state serum trough concentrations of 9 and 24 pg/mL, respectively. The improvement in PAS I scores was observed quickly, and efalizumab administration was reported to result in 60-70% improvement in PASI scores when compared to baseline after 12 weeks of treatment. The current recommended dose for efalizumab is a single 0.7 mg SC conditioning dose which is followed by weekly SC doses of 1 mg/kg. 

Squamometry X corresponds to the analytical evaluation of xerosis using SACD samplings.6,7,14 31 A linear correlation exists between the amount of harvested orthokeratotic SC and SQMI. Data are also influenced by the presence of parakeratotic cells and serum deposits as found in spongiotic dermatoses such as atopic dermatitis, irritant or allergic contact dermatitis, seborrheic dermatitis and psoriasis.32,36... 

The efficacy, safety, and tolerability of twice-daily calcitriol ointment 3 micrograms/g (n — 60) has been investigated and compared with 0.25-2% dithranol cream (once daily for 30 minutes n = 54) in an 8-week prospective, randomized, open, parallel-group trial in 114 patients with plaque psoriasis (53). Skin irritation was reported by three patients who used calcitriol and by 39% of those who used dithranol. Three patients who used calcitriol and four who used dithranol reported adverse effects on the skin (pruritus, erythema, rash, dry skin, eczema). One patient with 75% skin involvement used 3.38 mg of calcitriol over 56 days (about 140 g of ointment per week without any effect on serum calcium). 

Zachheim, H. S., Wolf, P., Serum Copper in Psoriasis and Other Derma-... 

After administration Assess skin for irritation, erythema, worsening of psoriasis. If irritation of lesions or surrounding uninvolved skin develops or if serum calcium level increases outside normal range, medication should be discontinued. 

Positive correlations were found by Wendt for blood group M and serum factor Gm (2). If confirmed by further studies this association would lead to another area of investigation of the hereditary factors responsible for psoriasis. 

In accordance with the findings on serum lipoproteins are those on serum cholesterol. As would be expected in Tickner and Mier s (T8) study on 86 psoriatics, the serum cholesterol tended to follow changes in the serum /8-lipoproteins and was elevated in only 20% of the subjects with psoriasis. In the North Carolina study by Abele et al. (Al) of a large kindred with psoriasis there was no significant elevation of cholesterol or any correlation with the presence or absence of disease in the 258 members examined for cholesterol and who were over 21 years of age. 

In most studies no significant increase in serum uric acid values have been found (Al, T8, Wl), but in some an increase has been reported (B8, S24). The work of Eisen and Seegmiller (E3) is the only report concerned with the metabolic formation of uric acid using radioactive glycine. They did show an increase in the formation of uric acid in extensive psoriasis and a reduction to normal levels with treatment. In addition, the excretion of pseudouridine and uracil was increased in extensive psoriasis (E2) (Table 13). There was a direct correlation in the above studies between the serum uric acid level versus the extent of skin involvement, the excretion of pseudouridine versus the extent of skin involvement, and also the excretion of pseudouridine versus the uric acid excretion (E = 0.81). These findings imply increased nucleic acid synthesis and increased nucleic acid breakdown in the skin, access of the purine breakdown products to the blood stream and from there to the liver ( ) for transformation into uric acid and finally to the kidney for excretion. 

Serum Glucose-6-Phosphate Dehydrogenase and 6-Phosphogluconate Dehydrogenase in Psoriasis... 

Shuster et al. (Sll) measured B12 levels in the sera of 20 patients with psoriasis and found normal levels in all but one. Folic acid levels were decreased below normal in 21 out of 28 patients, urinary FIGLU excretion was elevated in 19 of 30, and in 5 of 9 patients sternal marrow puncture revealed megaloblastic erythropoiesis, thereby implying a true folate deficiency. Neither serum iron deficiency nor lack of absorption of folate could be implicated as a cause of the folate deficiency, and presumably it is related to the skin lesions. 

T8. Tiokner, A., and Mier, P. D., Serum cholesterol, uric acid, and protein in psoriasis. Brit. J. Dermatol. 72, 131 (1960). 

W13. Wendt, G. G., Blood groups, serum factors and psoriasis vulgaris. Dermatologica 136, 1-10 (1968). 

This disease is of considerable interest in relation to oxypurine metabolism, although a wide variety of potential metabolic abnormalities have been said to be associated with it. In a review in 1961 Tickner (T4) asserted that there was evidence to support the postulate that psoriasis was associated with alterations in lipid, protein, carbohydrate, and mineral metabolism as well as in serum protein level. Investigators have since supported a myriad of hypotheses. Note has been taken of variations in carbohydrate metabolism (R16), and of changes in the synthesis of hyaluronic acid with resultant alterations in transport mechanisms (CIO). Changes in fatty acid levels and metabolism (C8), alterations of aldolase activity (C6), increased proteolytic activity (S33), and alterations in the composition of proteins in psoriatic scales (L20) have been suggested. Changes in serum copper content in psoriatic patients have been observed (L18). 

There were early reports that in patients with psoriasis there was a greater output of urinary uric acid (Bll) and increases in serum uric acid levels (E2). Eisen and Weissman showed that the increase in uric acid excreted was proportional to the amount of skin involved in the disease. This increase in uric acid may be partially the result of increased turnover of the diseased cells and release of their nucleic acid to the purine catabolic pool. There are other alterations in nucleic acids related to cellular metabolism in psoriasis. The ribonucleic acid concentration of psoriatic tissues is approximately 3 times that of normal skin, and the DNA can be as much as 13-14 times greater than in normal tissues (H8, W5). A fundamental change in the nature of psoriatic deoxyribonucleic acid was suggested by Steigleder et al. (S36), who isolated DNA s from psoriatic skin and from normal skin and... 

L18. Lipkin, G., Herrmann, F., and Mandol, L., Studies of senun copper. I. The copper content of blood serum in patients with psoriasis. J. Invest. Dermatol. 39, 543-546 (1962). 

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