Psoriasis Vulgaris

For the topical treatment of some chronic inflammatory skin diseases (like atopic dermatitis) immunosuppressive macrolides (like TRL and pimecrolimus) that permeate the inflamed epidermis are of benefit for patients. Severe side effects comparable to those after systemic application of TRL in transplanted patients (see above) have not been observed so far. For the treatment of psoriasis vulgaris these drugs are less effective. The CD2 antagonist alefacept may be a suitable alternative to allergic reactions. 

Illig et al.35 treated nineteen patients suffering from psoriasis vulgaris once or twice with 50 g of 0.005Z H in petrolatum. They concluded that whole-body inunction with H presents a low carcinogenic risk. That is likely to be erroneous, in view of the low dose and brief treatment used. 

It is a synthetic vitamin derivative effective in the treatment of plaque type psoriasis vulgaris. Adverse effects include itching and mild irritation. 

A number of clinical implications of drug reservoir formation in the upper skin layers by delivery from liposomes have been reported [4-6,13], From these studies it appears that the efficiency of liposomal-incorporated drugs was superior to other formulations in the treatment of disorders, which do not affect the deep layers of the skin. For example, in a doubleblind, randomized paired study on patients suffering from atopic eczema or psoriasis vulgaris, a liposomal betamethasone dipropionate was more efficient than a nonliposomal preparation in eczematous but not in psoriatic patients [6],... 

Korting, H.C., et al. 1990. Liposome encapsulation improves efficacy of betamethasone dipropionate in atopic eczema but not in psoriasis vulgaris. Eur J Clin Pharmacol 39 349. 

Schopf, E., J.M. Mueller, and T. Ostermann, Value of adjuvant basic therapy in chronic recurrent skin diseases. Neurodermatitis atopica/psoriasis vulgaris. Hautarzt, 1995, 46 451-4. 

Dubertet, L., Wallach, D., Souteyrand, P. et al. Efficacy and safety of calcipotriol (MC903) ointment in psoriasis vulgaris. A randomized, bouble-blind, right/left comparative, vehicle-controlled study. J. Am. 

Different types of evidence exist for the clinical efficacy of 10% urea in the treatment of psoriasis (Table 19.1). Early clinical data from a clinical study on various types of hyperkeratosis showed no superior effects on from 10% urea cream compared to ordinary aqueous cream BP in the treatment of psoriasis.10 However, five psoriatic patients with chronic therapy-resistant lesions obtained soft and pliable skin after treatment with 10% urea, but no effect on erythema was observed.17 Psoriatic lesions on the extremities (at least 5 cm in diameter in size) also showed clinical improvement after two weeks of treatment with an ointment containing 10% urea (Basodexan S ointment) in a placebo-controlled study on ten patients.26 Higher values of skin capacitance (suggested to reflect skin hydration) were also noted on urea-treated areas. Increased hygroscopicity and water content were also obtained after treatment with 10% urea ointment in patients with psoriasis vulgaris.27 Moreover, urea treatment reduced epidermal proliferation, measured as an altered expression of involucrin and cytokeratins.26 Treatment of psoriasis vulgaris with 10% urea-formulations support clinical efficacy at evidence-level lb (cf. Figure 19.1). 

Treatment of Psoriasis Vulgaris with Urea-Formulations... 

Topical vitamin D analogs as calcipotriol, and tacalcitol are well established, effective and safe preparations for the treatment of psoriasis vulgaris due to their antiproliferative and prodifferentiating effects on keratinocytes.110 They can be used either as monotherapy or in combination with other treatment modalities.111 The main side effect is the increasing risk ofhypercalcaemia with increasing amounts of vitamin D analogs applied to the skin. 

Vitamin D analogs seem to be limited in dermatology to the topical treatment of psoriasis vulgaris, which is not least because of their overall effects on calcium and phosphorus homoostasis. 

Fischer, M., The topical application of vitamin D3-analogues in psoriasis vulgaris, i n Trends inDerma-topharmacy, Trends Clin. Exp. Dermatol., vol. 1, Wohlrab, J., Neubert, R., and Marsch, W., Eds.,... 

Gudjonsson JE, Karason A, Antonsdottir AA et al. (2002) HLA-Cw6-positive and HLA-Cw6-negative patients with psoriasis vulgaris have distinct clinical features. Journal of Investigative Dermatology 118 362-365. 

Illig, L., Paul, E., Eyer, P., Weger, N., Bom, W. (1979). Treatment of psoriasis vulgaris with external sulfur mustard gas with particular reference to its potential carcinogenic risk. III. Clinical and experimental studies on the extent of percutaneous and inhalational uptake of sulfur mustard gas. Z Hautkr. 54 941-51. 

Skov L, Kragballe K, Zachariae C, Obitz ER, Holm EA, Jemec GB, Solvsten H, Ibsen HH, Knudsen L, Jensen P, Petersen JH, Menne T, Baadsgaard O. HuMax-CD4 a fully human monoclonal anti-CD4 antibody for the treatment of psoriasis vulgaris. Arch Dermatol 2003 139(ll) 1433-9. 

Topical calcipotriol (a vitamin D analogue) is an effective and safe treatment for mild to moderate psoriasis vulgaris. Its mode of action is identical to that of 1,25-dihydroxycolecalciferol (calcitriol). 

Calcipotriol can occasionally convert psoriasis vulgaris into pustular psoriasis (SEDA-19,165). 

In 83 patients with severe psoriasis vulgaris, the fumaric acid ester formulations Fumaderm initial and Fumaderm caused adverse effects in 62%, mainly flushing and gastrointestinal complaints, which decreased in frequency during the course of the study (6). 

Dubiel W, Happle R. Behandlungsversuch mit Fumarsaure monoathylester bei Psoriasis vulgaris. [Experimental treatment with fumaric acid monoethylester in psoriasis vulgaris.] Z Haut Geschlechtskr 1972 47(13) 545-50. 

Lew W, Bowcock AM, Krueger JG. Psoriasis vulgaris cutaneous lymphoid tissue supports T-cell activation and Type T inflammatory gene expression. Trends Immunol 2004 25 295-305. 

B29. Braun-Falco, O., Zum Problem der Psoriasis Vulgaris. Japanese Journal of Dermatology, Series B 78, 558-588 (1968). 

B30. Braun-Falco, O., and Petzoldt, D., Zur Histotopie von Enzymen des ener-gieliefemden Stoffwechsels in der Epidermis bei Psoriasis vulgaris. Arch. Klin. Exp. Dermatol. 230, 223-236 (1967). 

B35. Brody, I., The ultrastructure of the epidermis in psoriasis vulgaris as revealed by electron microscopy. 1. The dermo-epidermal junction and the stratum basale in parakeratosis without keratohyalin. J. Ulirastrucl. Res. 6, 304-323 (1962). 

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