Skin disorders, treatment Psoriasis

A potentially interesting application of (acyloxy)methyl ester prodrugs can be found in delivery through skin of antibacterial agents. Nalidixic acid (8.53, R = H), a topoisomerase II inhibitor, showed promising activity in the treatment of antiproliferative skin disorders, notably psoriasis. To improve the... 

Daily administration of colchicine is useful for the prevention of attacks of familial Mediterranean fever (familial paroxysmal polyserositis) and for prevention and treatment of amyloidosis in such patients. Colchicine appears to benefit patients with primary biliary cirrhosis in terms of improvement of liver function tests and perhaps of survival. Colchicine also has been employed to treat a variety of skin disorders, including psoriasis and Behcet s syndrome. 

Phototherapy is the generic term covering therapies which use light either with or without a sensitiser. Those that do not require a sensitiser use the natural chromophores within the tissue to perform this function e.g. treatment of vitamin D deficiency in rickets, and neonatal jaundice). Those that do use an added sensitiser include photochemotherapy (largely psoriasis and skin disorders) and photodynamic therapy (currently mainly cancer). Photodynamic therapy is differentiated from photochemotherapy by its additional requirement for the presence of oxygen at molecular or ambient levels.In this text we will deal only with photodynamic therapy since, at the present time, this is the main driving force in phototherapy. ° ... 

For dermatological treatment the main focus has been on vitamins A and D. Retinoids have been used systemically and topically for the treatment of acne and a variety of hyperkeratotic disorders including psoriasis, ichthyoses, and lichenoid dermatoses as well as skin cancer.1 Vitamin D-analogs are of great importance for the topical treatment in psoriasis. 

Fumaric acid is also used as a food additive at concentrations up to 3600 ppm, and as a therapeutic agent in the treatment of psoriasis and other skin disorders. ... 

Fumaric acid is used in oral pharmaceutical formulations and food products and is generally regarded as a relatively nontoxic and nonirritant material. However, acute renal failure and other adverse reactions have occurred following the topical and systemic therapeutic use of fumaric acid and fumaric acid derivatives in the treatment of psoriasis or other skin disorders. Other adverse effects of oral therapy have included disturbances of liver function, gastrointestinal effects, and flushing. ... 

The primary use of coke is a fuel reductant and support for other raw materials in iron-making blast furnaces. Coke is also used to synthesize calcium carbide and to manufacture graphite and electrodes, and coke-oven gas is used as a fuel. Coal tar, a by-product of the production of coke from coal, is used in the clinical treatment of skin disorders such as eczema, dermatitis, and psoriasis. 

Direct access to target or diseased site, e.g. treatment of skin disorders such as psoriasis, eczema and fungal infections [14]... 

Common disorders of the skin include eczema, psoriasis and infections with viruses, bacteria and fungi. Treatment of skin conditions is usually topical because the skin is uniquely accessible to this mode of administration. However, systemic treatment is sometimes necessary. 

Gold drugs have been used to treat a variety of other rheumatic diseases including psoriatic arthritis , a form of arthritis associated with psoriasis, juvenile arthritis, palindromic rheumatism and discoid lupus erythematosus . Gold therapy has also been investigated as a treatment for various inflammatory skin disorders such as psoriasis, pemphigus and urticaria. ... 

Topical antipsoriatics are drugs used in the treatment of psoriasis (a chronic skin disease manifested by bright red patches covered with silvery scales or plaques). These drug help remove tiie plaques associated with this disorder. Examples of antipsoriatics include antiiralin (Anthra-Derm) and calcipotriene (Dovonex). 

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. 

The past twenty years have witnessed considerable progress in the synthesis and use of other retinoid-like molecules related to vitamin A. The aromatic retinoid etretin (8.54) and its ester etretinate (8.55) had some effectiveness in the treatment of psoriasis, a disorder of skin. 13-cA-Retinoic acid (isotretinoin) produces sebaceous gland atrophy and could prove useful in the treatment of severe acne vulgaris. Although these compounds have toxic side effects and are not in regular use, they have opened up new therapeutic possibilities. Retinoic acid (tretinoin, 8.56) has been employed in the treatment of acne. 

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],... 

In 1990, etretinate (Tigason) was replaced by acitretin (Neo-Tigason), an aromatic retinoid, a carboxylic acid metabolite of etretinate (15). It is effective in pustular psoriasis and psoriatic palmoplantar keratoderma and in combination with PUVA or topical therapy (calci-potriol or glucocorticoids) in the treatment of other forms of psoriasis. It has also been used to treat disorders of keratinization (ichthyosis, palmoplantar keratoderma, Darier s disease) and severe cutaneous forms of lichen planus. It prevents new skin carcinomas in patients with xeroderma pigmentosum and those who are immunosuppressed. The main advantage of acitretin is its short half-life of 50 hours, compared with over 80 days for etretinate (16). 

Isotretinoin is approved for use in the treatment of severe recalcitrant nodular acne and psoriasis, and is also used to treat keratinization disorders and some skin cancers. 

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