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  • 1995-1999  (13)
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Material
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Year
  • 1
    Electronic Resource
    Electronic Resource
    A multicentre evaluation of the guidelines for the use of cyclosporin A in severe psoriasis (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of the European Academy of Dermatology and Venereology 7 (1996), S. 0 
    Details
    ISSN: 1468-3083
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    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).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1468-3083.1996.tb00556.x
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  • 2
    Electronic Resource
    Electronic Resource
    The effectiveness of cyclosporine and photochemotherapy in the treatment of psoriasis: a retrospective study (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of the European Academy of Dermatology and Venereology 9 (1997), S. 0 
    Details
    ISSN: 1468-3083
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective In this retrospective study, the effectiveness of cyclosporine A (CsA) and photochemotherapy (PUVA) in inducing and maintaining remission has been evaluated for a 1 year period in 50 patients.Methods CsA was administered for induction of remission and continued as maintenance therapy. PUVA was given as a single course. Patients were classified into two groups: moderate psoriasis and severe psoriasis.Results Efficacy parameters showed a remission of 93% following one course of PUVA therapy versus 80% in the CsA group (P 〈 0.01) in moderate psoriasis. In severe psoriasis no differences were detectable. The mean induction of remission period with CsA was 12.5 weeks and with PUVA 13.5 weeks. Nine of 25 CsA treated patients and five of 25 PUVA treated patients failed to reach a remission within a period of 16 weeks. The mean maintenance of remission was 39 weeks in the CsA group and 33 weeks in the PUVA group.Conclusion These results indicate a preferential position of PUVA therapy to treat both moderate and severe psoriasis that does not respond to topical treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1468-3083.1997.tb00508.x
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  • 3
    Electronic Resource
    Electronic Resource
    Atopic dermatitis (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of the European Academy of Dermatology and Venereology 7 (1996), S. 0 
    Details
    ISSN: 1468-3083
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: General description Atopic dermatitis is a common disease with a genetic background known as atopic syndrome. New findings as to possible genes involved are in accordance with a suspected pathogenesis of immune dysregulation. A preferential outgrowth of IL-4 secreting Th2 cells upon stimulation with relevant allergens results in B cell stimulation and the production of allergen-specific IgE. Non-specific and specific immunological and inflammatory processes form the pathological basis of the clinical condition eczema. Therapeutical options include general measures such as allergen avoidance, prescription of emollients, and the use of (sedating) antihistamines. Specific topical agents are tar preparations, corticosteroids and possibly topical non-steroidal anti-inflammatory drugs. Systemic therapy is sometimes required and corticosteroids and cyclosporin are available for that purpose. Photo(chemo)therapy is another modality and long-wave UVA seems to be promising in that respect. Learning objective The reader will have knowledge of new developments in the genetics and immunopathology of atopy and atopic dermatitis. Knowledge of the imniunodiagnosis and management of atopic dermatitis as well as its complications will be reviewed and updated with insights in new therapeutic modalities as well as in the changes of how the existing modalities should be used.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1468-3083.1996.tb00605.x
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  • 4
    Electronic Resource
    Electronic Resource
    A multicentre evaluation of the guidelines for the use of cyclosporin A in severe psoriasis [J. Eur. Acad. Dermatol. Venereol. 7 (1996) 49–58] (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of the European Academy of Dermatology and Venereology 8 (1997), S. 0 
    Details
    ISSN: 1468-3083
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1468-3083.1997.tb00477.x
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  • 5
    Electronic Resource
    Electronic Resource
    A systematic review of five systemic treatments for severe psoriasis (1997)
    Oxford, UK : Blackwell Publishing Ltd
    British journal of dermatology 137 (1997), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We systematically reviewed the evidence concerning the ability of five systemic treatments to induce remission in patients with severe psoriasis: ultraviolet B (UVB), photochemotherapy (PUVA), methotrexate (MTX), retinoids (RET) and cyclosporin A (CYA). An elaborate literature search was performed, the validity of studies was assessed, and data were analysed. In total, 89, 193, 101, 155 and 127 studies (n=665) concerning UVB, PUVA, MTX, RET and CYA were found. The exclusion rate was high, mainly because of concomitant antipsoriatic therapy, outdated dosages or inadequate documentation. No study on MTX could be included. A total of 129 patient series was included in the analysis, reporting on 13,677 patients, Study size-weighted averages of the proportions of patients with clearance and good, moderate and poor response (defined, respectively, as 95–100%, 75–100% and 50–75% and 〈50% reduction in the outcome measurements as compared with baseline) were calculated. PUVA therapy was associated with the highest average proportion of patients with clearance (70%) and the highest proportion of patients with good response (83%), followed by UVB (68%) and CYA (64%). Incidence of side-effects per week was highest in the RET group and lowest in the phototherapy groups. This review may provide a basis for the development of guidelines for the treatment of psoriasis. Trials comparing oral modalities applied according to currently accepted standards should also be carried out.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2133.1997.19902071.x
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  • 6
    Electronic Resource
    Electronic Resource
    Effect of calcitriol on the production of T-cell-derived cytokines in psoriasis (1997)
    Oxford, UK : Blackwell Publishing Ltd
    British journal of dermatology 136 (1997), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Although the use of vitamin D analogues in the treatment of psoriasis has been an important new development, the mechanisms of action of these drugs are not fully understood. Psoriasis results from hyperproliferation of keratinocytes, and various studies attribute a crucial role to the locally infiltrating T lymphocytes. In an attempt to add to the understanding of the mechanisms of calcitriol therapy, we determined the effect of this drug on T cells by studying its effect on proliferation and on the production of various cytokines by T-cell clones prepared from psoriatic skin after non-specific activation with the combination of phytohaemagglutinin (PHA) and phorbol myristate acetate (PMA). The addition of increasing doses (10-9–10-5mol/1) of caleitriol to these T cells resulted in a dose-dependent inhibition in lymphocyte proliferation and in production of the type 1 cytokines IFN- γ and IL-2. the type 2 cytokines IL-4 and IL-5. The general cytokines TNF-α and GM-CSF were not significantly inhibited. These data suggest that calcitriol is involved in the treatment of psoriasis via inhibition of the expansion, and cytokine production, of skin-infiltrating T lymphocytes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2133.1997.d01-1231.x
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  • 7
    Electronic Resource
    Electronic Resource
    The long-term safety and efficacy of cyclosporin in severe refractory atopic dermatitis: a comparison of two dosage regimens (1996)
    Oxford, UK : Blackwell Publishing Ltd
    British journal of dermatology 135 (1996), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: An open, randomized trial was performed to determine the optimal dosage schedule with regard to the efficacy and safety of cyclosporin in severe atopic dermatitis. The study also provided clinical experience with regard to the efficacy and safety of long-term cyclosporin treatment. During a 2-month dose-finding period. 78 patients with severe, long-standing atopic dermatitis received cyclosporin at a dose of either 5 mg/kg per day, decreasing to 3 mg/kg per day (Group A), or 3 mg/kg per day, increasing to 5 mg/kg per day (Group B). Patients were maintained on their optimal dose for a further 10 months. Patients in Group A showed a significantly greater improvement in efficacy parameters over the first 2 weeks than with patients in Group B, but as the dose was decreased in Group A and increased in Group B, these differences were minimized. After 1 year, cyclosporin showed an efficacy of 59.8% in Group A and 51.7% in Group B, assessed by a severity score. Assessed in terms of an area score, these figures were 48.7% and 40%, respectively. Cyclosporin demonstrated a good safety profile during long-term treatment and was generally well tolerated. The lower starting dosage was not associated with higher dropout rates. This study showed no differences in efficacy or adverse events between the two dosage schedules in long-term treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2133.1996.tb00704.x
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  • 8
    Electronic Resource
    Electronic Resource
    A new psoralen-containing gel for topical PUVA therapy: development, and treatment results in patients with palmoplantar and plaque-type psoriasis, and hyperkeratotic eczema (1995)
    Oxford, UK : Blackwell Publishing Ltd
    British journal of dermatology 132 (1995), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary Topical photochemotherapy with psoralen and its derivatives 4.5′,8-trimethylpsoralen (TMP) and 8-methoxypsoralen (8-MOP), with UVA irradiation, was evaluated with regard to minimum phototoxic dose, concentration, timing of UVA irradiation and systemic and local side-effects, in healthy volunteers. Psoralen (0.005%) in aqueous gel was found to be superior to TMP and 8-MOP in aqueous gel. No hyperpigmentation was seen after topical PUVA treatment with psoralen in aqueous gel. Patients with plaque-type psoriasis (n = 7), palmoplantar psoriasis (n = 7) and hyperkeratotic eczema (n = 2) were treated. Topical PUVA therapy was effective in most psoriasis patients, without the occurrence of local or systemic side-effects. Moreover, hyperkeratotic eczema patients who did not respond to conventional therapy showed partial remission. These results indicate that topical PUVA therapy with psoralen in aqueous gel is a useful therapeutic modality for treatment of psoriasis patients, and patients with recalcitrant dermatoses such as palmoplantar psoriasis and hyperkeratotic eczema.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2133.1995.tb16956.x
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  • 9
    Electronic Resource
    Electronic Resource
    Demodicidosis or rosacea: what did we treat? (1995)
    Oxford, UK : Blackwell Publishing Ltd
    British journal of dermatology 133 (1995), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We report a 75-year-old man with a fulminant rosacea-like eruption, suggestive of demodicidosis. Multiple Demodex folliculorum mites were found in facial scales and pustules and, on histological examination, in the infundibulum of pilosebaceous follicles and in the dermis. Intradermal mites were surrounded either by polymorphonuclear granulocytes and histiocytes, or by a granulomatous infiltrate containing foreign-body giant cells, which had phagocytosed the parasites. Complete recovery, with disappearance official mites, was achieved by treatment with a combination of oral and topical metronidazole, although this drug is not known to be miticidal.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2133.1995.tb02632.x
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  • 10
    Electronic Resource
    Electronic Resource
    Photoisomerization spectrum of urocanic acid in human skin and in vitro: effects of simulated solar and artificial ultraviolet radiation (1995)
    Oxford, UK : Blackwell Publishing Ltd
    British journal of dermatology 132 (1995), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary Ultraviolet (UV) irradiation of trans-urocanic acid (UCA), a major UV absorbing component of the epidermis, leads to the formation of cis-UCA, which mediates immunosuppressive effects. In this study, the net yield of cis-UCA was measured after the photoisomerization of urocanic acid by narrow UV wavebands (spectral range 295–405 nm), with the irradiation doses related to solar irradiance at sea level. The formation of cis-UCA in Caucasian skin (in vivo), as well as in aqueous solution (in vitro), was determined by HPLC analysis. The same irradiation conditions were met in both components of the study. The in vivo experiments showed high efficiency of cis-UCA formation in the spectral region of 305–341 nm, whereas high efficiency in vitro was found at 305 and 326 nm. At 350 and 363 nm, cis-UCA was formed in vivo, but not in vitro. At longer test wavelengths up to 405 nm. no significant formation of cis-UCA was detectable. The established partition between UVB and UVA at 320 nm is not relevant for the isomerization pattern of UCA. Additional studies revealed substantial cis-UCA formation in human skin by UVA phototherapy lamps. Furthermore, raised levels of 295 nm irradiation doses, a possible effect of stratospheric ozone depletion, were found to increase the cis-UCA yield. Our results demonstrate that the formation of cis-UCA in the skin with common exposures takes place over a broad spectrum range of UVB and UVA, up to at least 363 nm. These findings emphasize the potency of UVA to isomerize UCA, and they may contribute to further elucidation of the effects of phototherapy and sunbathing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2133.1995.tb16943.x
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