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PubMed1961

Variations in the natural history of psoriasis.

Latent psoriasis is a state which exists before the development of clinical psoriasis and wherein probably some as yet undiscovered defect exists. Investigation concerning a group of persons with latent psoriasis might disclose basic aberrations. The natural course of psoriasis may be altered by therapy. Folic acid antagonists and intradermal corticosteroids may at times eclipse psoriatic lesions. Oral adrenal corticosteroids may prove morbidistatic but on discontinuance a rebound flare may occur which is both protracted and recalcitrant. Antimalarial agents when employed as therapy for coexistent arthridites may cause psoriasis to become more severe. The Goeckerman regimen which employs topical tar and ultraviolet light therapy produces in some 75 per cent of patients a prolonged remission. As it is safe and repeatable it is favored for the usual severe case of psoriasis. Psoriasis therapy is better assessed by considering its effect on the natural evolution of the disease.

Adrenal Cortex Hormones↗
PubMed1993

An approach to the treatment of moderate to severe psoriasis with rotational therapy.

BACKGROUND: There are four standard approaches for treating moderate to severe psoriasis: UVB plus tar, PUVA, methotrexate, and etretinate. Although patients with psoriasis receive these therapies for many years, there is no commonly accepted approach for the initial and subsequent selection of the alternatives. OBJECTIVE: Our purpose was to develop a theoretical and practical basis for using these treatments that will minimize the risks of their long-term toxicities and prolong their safe long-term use. METHODS: A review of the published side effects of the treatments and cumulative clinical experience are used to develop an approach for the treatment of severe psoriasis. RESULTS: It is proposed that patients receive each form of therapy for 1 to 2 years and then switch to the next form of treatment. By rotating each of the three or four treatments at these time intervals, it may well be 4 or 5 years before needing to return to the first therapy, thereby minimizing cumulative toxicity by long periods off each treatment. CONCLUSION: Rotation of available therapies for moderate to severe psoriasis may minimize long-term toxicity and allow effective treatments to be maintained for many years.

Combined Modality Therapy↗
PubMed2005

[Consensus document on phototherapy: PUVA therapy and narrow-band UVB therapy].

It is essential to develop a consensus document on phototherapy in order to adapt this procedure to the specific characteristics, needs and reality of our milieu. Using a review of existing literature on the subject and the experience of its own members as a reference, the Spanish Photobiology Group (GEF) of the Spanish Academy of Dermatology and Venereology (AEDV) has developed some therapeutic guidelines for the most widely used modes of phototherapy: PUVA therapy and narrow-band UVB (NBUVB) therapy. These guidelines deal with generalities about the equipment, calibration and regulation in phototherapy booths, and the concept and indications for these forms of treatment are reviewed. Recommendations are also proposed regarding patient selection, therapeutic procedures, associated pharmacological agents of interest and the prevention and management of adverse effects. The consensus document is designed as a flexible and practical instrument intended for use in daily clinical practice, aimed at optimizing the possibilities of phototherapy while reducing risks for patients and therapists.

Humans↗
PubMed2004

Comparison of localized high-dose UVA1 irradiation versus topical cream psoralen-UVA for treatment of chronic vesicular dyshidrotic eczema.

BACKGROUND: Vesicular dyshidrotic palmoplantar eczema is a common disorder but treatment is difficult. Localized photochemotherapy (cream psoralen-UVA [PUVA]) has widely been used for therapy. Although the efficacy of cream PUVA therapy is well known, potential side effects may occur. Therefore, a more standardized safe and effective UV therapy should be carried out. OBJECTIVE: This study compared the effects of localized high-dose UVA1 irradiation versus topical cream PUVA for treatment of chronic vesicular dyshidrotic eczema. METHODS: On the basis of the assessment of the Dyshidrotic Area and Severity Index, the decrease of score points on the UVA1-treated side was compared with the decrease on the cream PUVA-treated side in 27 patients. In addition, analysis of serum markers was performed. RESULTS: Of 27 patients, 24 showed a good response to localized UVA1 irradiation or cream PUVA. Dyshidrotic Area and Severity Index scores significantly decreased on both sides and were reduced to half of the pretreatment values. No statistically significant differences between localized UVA1 irradiation or cream PUVA could be detected. CONCLUSION: This study demonstrates that localized UVA1 phototherapy is easy to perform and appears to be an effective and safe treatment for vesicular dyshidrotic eczema.

Administration, Topical↗
PubMed1982

International studies of the efficacy of etretinate in the treatment of psoriasis.

International studies evaluating the efficacy of etretinate (Ro 10-9359) in psoriatic patients are reviewed. Double-blind, placebo controlled studies uniformly have demonstrated the therapeutic effect of the retinoid. Both single therapy and combination therapy studies confirm the efficacy of this new form of treatment, especially in patients with the rarer and more severe forms of psoriasis.

Anthralin↗
PubMed1984

White paper on hospitalization for psoriasis care.

Psoriasis is a common, chronic skin disorder that is conservatively estimated to affect between 1% and 2% of the population in the United States, not including mild cases. Despite the fact that psoriasis is one of the more common skin conditions requiring medical attention, it is poorly understood by the general public. This lack of information or misinformation on the part of health care administrators and insurers can affect the medical treatment of psoriasis and concomitant reimbursement in a manner that may be inappropriate and/or inadvertently deleterious to the patient's health care. The Committee on Psoriasis of the American Academy of Dermatology has sought to address this void. The Committee on Psoriasis is comprised of several dermatologists from the major academic medical centers in the United States. The combined expertise of this group reflects decades of experience in research, diagnosis, and treatment of psoriasis, as well as other skin diseases. This group has approved the "White Paper on Hospitalization for Psoriasis Care" as a straightforward, accurate, and well-documented source of information on psoriasis and psoriasis care. The purpose of this document is to explore the relevant medical aspects of the disease, its treatment modalities and their associated risks, and the outcomes of care.

Adolescent↗