4.1. Pustular psoriasis (photo 100)
Pustular psoriasis of the Zumbusch type responds remarkably to retinoids at doses approaching 1 mg/kg/j, the retinoids having a resolvent effect on attacks in seven to ten days at this dose.
In women in child-bearing age, Soriatane® is replaced with Roaccutane® in order to avoid the restrictions imposed by overly lengthy contraception. After 7 to 10 days the daily dose of retinoids must be reduced to 10 or 20 mg in order to avoid side effects.
Zumbusch-type pustulosis resistant to retinoids presents difficult therapeutic problems. Methotrexate and cyclosporine can be of help.
Anti-TNF?drugs are very effective.
4.2. Erythrodermic psoriasis
Like any erythroderma, psoriatic erythroderma is a metabolic emergency that can jeopardize the life of fragile subjects. Cardiac flow increase by two- or threefold, the calorific loss associated with vasodilation involves intense protein catabolism, trans epidermal water loss is severe - involving a risk of dehydration - and the accelerated rate of skin turnover increases moreover the protein catabolism.
Hydration is necessary. Strength 4 topical steroids must be used whenever there is a metabolic emergency, bearing in mind that a long-term treatment needs to be started simultaneously in order to avoid ending up in a situation of cortico-dependence or, even worse, rebound.
The long-term treatments may be:
- retinoids, never exceeding 20 mg/j as higher doses run the risk of producing particularly serious weeping erythroderma;
- methotrexate in small doses, taking into consideration frequent hypoalbuminemia and generally starting treatment at 10 mg/week intramuscularly;
- cyclosporine has not been assessed in psoriatic erythroderma. Metabolic disturbances and the frequent reduction in renal perfusion caused by dehydration should dictate caution, starting off at weak doses in the order of 2 or 2.5 mg/kg/j;
- Phototherapy is contraindicated in erythroderma because it is practically always poorly tolerated and a source of aggravation.
Substantial improvements have been sometimes observed in psoriatic erythroderma after taking vitamin D, but the results are very fickle and remain to be assessed.
Anti-TNF?are very effective.
[|4.1 Pustular Psoriasis and 4.2 Erythrodermic Psoriasis - Response to infliximab, in both these forms of psoriasis, is frequently more dramatic than even ciclosporin. |auteur215]
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Recent publications on Psoriasis and Atopic Dermatitis
on Psoriasis
Adherence and resource use among psoriasis patients treated with biologics.
Aleshaki JS et al.
Adherence and resource use among psoriasis patients treated with biologics.
Expert Rev Pharmacoecon Outcomes Res.
2018 Dec , 18, (6):609-617.
The emergence of immune-modulating drugs such as biologics has altered the treatment landscape for psoriasis. However, their use presents high financial costs to patients and healthcare systems. Patient demographic and socioeconomic status may influence adherence to biologic medications and usage of healthcare resources. Areas covered: We performed a systematic literature review to summarize the available evidence pertaining to biologic medication adherence and resource use. PubMed was (...)
see on pubmed
Genetic deficiency of the tumor suppressor protein p53 influences erythrocyte survival.
Apoptosis.
2018 Dec , 23, (11-12):641-650.
The transcription factor p53 suppresses tumor growth by inducing nucleated cell apoptosis and cycle arrest. Because of its influence on primitive erythroid cell differentiation and survival, p53 is an important determinant of erythropoiesis. However, the impact of p53 on the fate of erythrocytes, cells lacking nucleus and mitochondria, during their post-maturation phase in the circulation remained elusive. Erythrocyte survival may be compromised by suicidal erythrocyte death or eryptosis, (...)
see on pubmed
Therapeutic applications of zebrafish (Danio rerio) miRNAs linked with human diseases: A prospective review.
Gene.
2018 Dec 30, 679:202-211.
MicroRNAs (miRNAs) are the class of small, non-coding RNAs that are produced from precursor transcripts by subsequent processing steps mediated by members of the RNaseIII family, Dicer and Drosha protein within cell. The importance of zebrafish miRNAs in regulation of normal cellular development and support to various kinds of metabolism process. Although the zebrafish model provides a fundamental platform for the study of developmental biology but recent work with zebrafish model has (...)
see on pubmed
on Atopic Dermatitis
Associations of Eczema Severity and Parent Knowledge With Child Quality of Life in a Pediatric Primary Care Population.
Clin Pediatr (Phila).
2018 Nov , 57, (13):1506-1514.
We investigated factors associated with quality of life (QOL) in children with eczema. We conducted a cross-sectional analysis of survey data from 224 parents of children with eczema attending a large, hospital-based pediatric clinic. Parents completed a validated eczema severity scale (Patient-Oriented Eczema Measure), a QOL scale (Infants' Dermatitis QOL Index or Children's Dermatology Life Quality Index), and a knowledge and understanding questionnaire. In adjusted multivariate analyses, (...)
see on pubmed
Probiotics as a Potential Immunomodulating Pharmabiotics in Allergic Diseases: Current Status and Future Prospects.
Allergy Asthma Immunol Res.
2018 Nov , 10, (6):575-590.
The prevalence of allergic disorders has dramatically increased over the past decade, particularly in developed countries. Apart from gastrointestinal disorders, neoplasia, genital and dermatological diseases , dysregulation of gut microbiota (dysbiosis) has also been found to be associated with increased risk of allergies. Probiotics are increasingly being employed to correct dysbiosis and, in turn, to modulate allergic diseases. However, several factors like strain variations and effector (...)
see on pubmed
A novel pH-responsive hydrogel based on carboxymethyl cellulose/2-hydroxyethyl acrylate for transdermal delivery of naringenin.
Carbohydr Polym.
2018 Nov 15, 200:341-352.
In this study, a pH-responsive hydrogel (cl-CMC-g-pHEA), based on carboxymethyl cellulose/2-hydroxyethyl acrylate, was prepared. Its physicochemical properties and applicability as a transdermal delivery system for naringenin (NRG) were investigated. The hydrogel was synthesized via radical polymerization; its structure was analyzed by FT-IR and H NMR. The water loss amount was measured by using thermogravimetric analysis; a porous 3D network structure was confirmed by SEM. All hydrogels (...)
see on pubmed