Psoriatic lesion

TOPICAL ANTIPSORIATICS. The nurse may be responsible for applying the product and inspecting the areas of application. Care is exercised so that the product is applied only to the psoriatic lesions and not to surrounding skin. The nurse brings signs of excessive irritation to tlie attention of the primary health care provider. 

We have already stressed the potential importance of lipid-rich membranes in the skin as potential targets for ROS-induced damage and ageing of human skin is morphologically identical to changes found by peroxidative processes (Serri et al., 1977). The involvement of AA metabolites in skin disease, and in particular psoriasis, has been the subject of much recent interest. Studies have included topical and intradermal administrations of AA metabolites, and assay of such products in clinical specimens. Results show that concentration of AA, 12-hydroxy-eicosatetraenoic acid (12-HETE), PG and leu-kotrienes are increased in psoriatic lesions (Hammarstrom etal., 1975 Camp etal., 1983 Brain etal., 1984 Duell et al., 1988) and also that full-thickness epidermis from normal and diseased skin has the enzymatic capacity to convert AA to some of the same metabolites (Hammarstrom etal., 1975, 1979 Camp etal., 1983 Brain etal., 1984 Ziboh et al., 1984 DueU et al., 1988). The biological effect of both 12-HETE and leukotrienes was confirmed by both topical application and intradermal injection, which caused epidermal inflammation and... 

Fogh, K., Herlin, T. and Kr balle, K. (1989). Eicosanoids in acute and chronic psoriatic lesions leukotriene B4, but not 12-hydroxyeicosatetraenoic acid is present in biologically active amounts in acute lesions. J. Invest. Dermatol. 92, 837-841. 

WooUard, P.M. (1986). Stereochemical differences between 12-hydroxy-5,8,10,14-eicosatetraenoic acid in platelets and psoriatic lesions. Biochem. Biophys. Res. Commun. 136, 169-176. 

Koebner phenomenon The occurrence of psoriatic lesions due to skin trauma. 

Psoriatic lesions are relatively asymptomatic, but about 25% of patients complain of pruritus. 

Psoriatic arthritis is a distinct clinical entity in which both psoriatic lesions and inflammatory arthritis-like symptoms occur. Distal interphalangeal joints and adjacent nails are most commonly involved, but knees, elbows, wrists, and ankles may also be affected. 

Very high potency products may be used for thick, chronic psoriatic lesions but for only short periods of time and on relatively small surface areas. 

Although ciclosporin and tacrolimus applied systemically improve psoriatic lesions, they are clearly less active when applied topically. Therefore, liposomal preparations have been developed. Indeed, ciclosporin penetrates deeper strata of rodent and human cadaver skin more efficiently when incorporated into liposomes [51], Moreover, tacrolimus concentrations in murine skin have increased ninefold, and skin graft survival prolonged, if the drug is liposome encapsulated [52]. This indicates that topical psoriasis therapy with tacrolimus may become possible. At present, topical tacrolimus is confined to the less recalcitrant forms of mild eczema. 

A 50-year-old woman developed contact dermatitis on her legs after she applied hydrocortisone aceponate cream (Efficort) to psoriatic lesions on her lower back (177). Similar lesions also occurred on her legs after she... 

These properties could provide additional preventive/therapeutic effects toward psoriatic lesions. Thus, the potential use of green tea constituents as an alternative nontoxic preventive agent or therapeutic component to treat psoriasis and other skin disorders needs to be explored. 

Not surprisingly, the cutaneous microbiome has been studied for its potential role in dermatologic conditions such as psoriasis, atopic dermatitis, and acne. Psoriasis, a chronic idiopathic inflammatory disease of the skin (170), has been associated with an overrepresentation of Firmicutes and underrepresentation of Actinobacteria when compared to both the unaffected skin of psoriatic patients and the skin of normal controls (171). Additionally, Pro-teobacteria were detected less frequently in psoriatic lesions compared to skin of healthy controls (171). Subsequent studies using pyrosequencing techniques confirmed that Actinobacteria were more abundant in controls compared to patients with psoriasis however, Proteobacteria were significantly higher in trunk skin samples from psoriatic patients compared to controls (172). 

Psoriasis is universal in occurrence. It is a disease of the skin characterized by variable clinical features. The cutaneous lesions are usually so distinct that a clinical diagnosis is easy to make. Psoriatic lesions are classified as erythrosquamous, which indicates that both the vasculature and the epidermis are involved.1... 

Psoriasis is a chronic disease with hyperproliferation of the epidermis and inflammatory reactions of the dermis and epidermis. Psoriasis is characterized by an elevated turnover rate of keratinocytes. The duration of the cell cycle is shortened. Inflammation is characterized by the release of cytokines and an expression of CD4+ cells in psoriatic lesions of affected patients. Scaling marks the clinical feature associated with hyperkeratosis, pruritus, inflammation, and stratum corneum dryness. 

In an own controlled study we treated 12 psoriatic patients with a glycolic acid lotion 15% versus a 0.05% betamethasone valerate cream.63 TEWL (Evaporimeter EP1, ServoMed, Sweden), Laser Doppler (Perimed-Periflux, Sweden), and skin color (Chroma Meter CR-200, Minolta, Japan) were taken at baseline and on day 5-10-15 on psoriatic lesions. Erythema a value was used for monitoring. The results of the study showed that ... 

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). 

The intense staining for HA in psoriatic lesions may in part be due to partially degraded HA, and may be the mechanism for the marked capillary proliferation and inflammation that characterizes these lesions.53,57-59 Attempts to stimulate HA deposition for purposes of promoting skin hydration must use caution that the HA deposited remain high molecular weight, by preventing free radical-catalyzed chain breaks and by carefully restricting the catabolic reactions of the hyaluronidases. 

Arnold, W.P., Glade, C.P., Mier, P.D., and van de Kerkhof, P.C., Effects of sphingosine, isoquinoline and tannic acid on the human tape-stripping model and the psoriatic lesion, Skin Pharmacol., 6, 193,... 

The first reports of psoriasis in cancer patients treated with high-dose interferon alfa were followed by a controversial debate (295,296). However, numerous cases have confirmed that interferon alfa can either induce typical psoriasis or worsen pre-existing psoriasis (SED-13,1095) (297), an observation that is compatible with interferon aHa-induced imbalance toward an increased Thl response. This was particularly exemplified by the reversibility of the lesions after withdrawal of treatment and the prompt recurrence of symptoms after interferon aha readministration. Exacerbation of psoriasis usuaUy occurred within the first month, whereas a minimum of 2-3 months of treatment was required in patients without a past history of psoriasis (297). Psoriatic lesions at the sites of injection were suggested to be potential indicators for further generalization of psoriasis. In more severe cases, there was concomitant development of monoarticular or polyarticular joint symptoms (SED-13, 1095) (SEDA-21, 372). Pustular psoriasis with balanitis and erosive monoarthritis, suggesting incomplete Reiter s sjmdrome, was also reported in one patient with HLA-B27 (298). 

Other reports include exacerbation of quiescent psoriasis or induction of psoriatic lesions at the injection sites (SED-13, 1099) (SEDA-20, 332), and the development or exacerbation of lichen planus (SEDA-21, 375). 

Induction of psoriatic lesions at the injection site has been observed in 10 of 42 patients treated with interferon gamma for psoriatic arthritis, while the joint sjmptoms were improved (17). 

Our measurements indicate that the cyclic AMP/cyclic GMP ratio in psoriatic lesions is reduced.1 The level of cyclic GMP is consistently increasedl whereas depending on the study, the level of cyclic AMP is either slightly increased,19 normal 9 or modestly reduced.1 Perhaps the most important observation is that whereas most metabolic parameters in psoriasis are unequivocally elevated20,21 as the case with any acti-... 

Said differently, the normal lesional cyclic AMP content or even a 25% elevation may be insufficient to stimulate the lesional cyclic AMP system to a level of activity which is capable of restoring normalcy to the lesion. This view in pharmacological terms means that if we use drugs or hormones to generate more cyclic AMP in the psoriatic lesion, a therapeutic result may be achieved. 

Cyclic AMP phosphodiesterase inhibitors, with or without an appropriate agonist are also candidates for clinical experimentation. In preliminary work, which requires confirmation, we have reported greater low Km cyclic AMP phosphodiesterase activity in psoriatic lesions than in normal appearing areas in six patients. If this is the case in an in vivo lesion and is not an artifact of tissue preparation for biochemical analysis, a cyclic AMP phosphodiesterase inhibitor may be an excellent choice. We have shown that epidermal cyclic AMP phosphodiesterase is inhibited by caffeine, theophylline, diazepam, papaverine and R020-1724. The methyl xanthines are poor inhibitors, whereas papaverine and R020-1724 are potent... 

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