Library

Notes: Background Controversy still exists as lo whether a dosage scheme for the treatment of severe psoriasis with cyclosporin A (CsA) should start with low dosages (3 mg/kg/day) or rather with high dosages (5 mg/kg/day).Aims In this open prospective multi-centre trial guidelines for the use of CsA in psoriasis beginning with low dosages were evaluated. A secondary aim of the study was to elucidate factors predicting efficacy of CsA treatment.Methods Efficacy and tolerability of CsA were evaluated monthly during 16 weeks in 86 patients (56 males, 30 females, mean age 43,0 ± 14,9 years) suffering from chronic severe plaque-type psoriasis, not responding to topical therapy (mean PASI 18.0 ± 8.1). All patients started with 3 mg/kg/day. Patients were defined as responders with a PASI reduction 〉 25% at month 1, ≥ 25% at month 1, ≥ 60% at month 3 and ≥ 70% at month 4. When a patient was a failure, the dose was increased by 1 mg/kg/day lo a maximum of 5 mg/kg/day.Results A gradual mean PASI reduction of 38%. 59%, 72% to 76% was reached with a mean CsA dose of 3.0, 3.2, 3.5, and 3.6 mg/kg/day at weeks 4, 8, 12 and 16. respectively. At the end of the study period, 39 patients were still on 3, 24 patients were on 4 and 15 patients were on 5 mg/kg/day. Due to subjective side-effects 6 patients dropped out on 3 mg/kg/day and 2 on 4 mg/kg/day. Diastolic and systolic blood pressure and creatinine levels were stable. Overall, CsA was relatively well tolerated. Absence of previous therapies, low baseline PASI and failure at week 4 were predictive for higher drop-out and failure rate and lower PASI at the end of study.Conclusions This study shows that a significant proportion of severe psoriasis patients can be treated with 3 mg/kg/day CsA with good tolerability and excellent clinical results. It is concluded that a treatment scheme with an optimal risk-benefit ratio should start with low dosages of CsA (3 mg/kg/day).

Notes: Objectives To evaluate the efficacy of treatment of plaque-type psoriasis with a moderate and a strong corticosteroid under continuous hydrocolloid occlusion, with weekly change of dressing, compared with treatment with the same corticosteroids alone, and the acceptance by the patients of his type of treatment.Setting Dermatological Departments of two University Hospitals and four General Hospitals.Design Open parallel study divided in two parts depending on the two different corticosteroid preparations applied. Each part was an intrasubject half-side study with left-right comparison.Subjects Fifty five patients with symmetrical, stable psoriasis plaques on elbows or knees.Methods Twenty nine patients were treated with clobetason butyrate cream (EmovatcR) twice daily as well as once weekly covered with a hydrocolloid dressing (ContreetR) for four weeks. Twenty six patients were treated with clobetasol propionate cream (DermovateR) twice daily as well as once weekly covered by the hydrocolloid dressing for 2 weeks. Induration, erythema and scaling were assessed using a four-point scale. Plaque size was measured by multiplying the largest and the smallest diameter. Healing was defined as score 0 for scaling and induration and score 0 or 1 for erythema. Acceptance was evaluated by questions related to the wearing of the dressings: comfort of wearing, pain, itching, adhesiveness and sticking to clothing, and the performance of daily activities.Statistics analysis Sign test for the score values, parametric paired Student t-test for plaque size, chi-square test for healing.Results With occlusion a statistically significant increased reduction of severity was obtained compared to treatment without occlusion; this effect was more pronounced with the application of the strong corticosteroid. The questions related to the wearing of the dressing were answered positively by the majority of the patients.Conclusions Treatment of psoriasis plaques with, especially strong, corticosteroid creams under occlusion with a hydrocolloid dressing with a high adherence is rapid and effective. The acceptance of this type of treatment by the patients is high, and it permits normal daily activities.