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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
Aliskiren: Preclinical evidence for the treatment of hyperproliferative skin disorders.
Biomed. Pharmacother..
2018 Aug , 104:151-157.
Psoriasis is a complex inflammatory and hyperproliferative skin disease. The pathogenesis and mechanisms involved are not completely understood, which makes treatment a difficult issue. Angiotensin II, the most active peptide of the renin-angiotensin system, seems to be involved in processes related to psoriasis pathogenesis, such as inflammation and cell proliferation. The aim of this study was to investigate the influence of renin inhibition on inflammation parameters and keratinocyte (...)
see on pubmed
Association between Psoriasis and haplotypes of the IgH 3' Regulatory Region 1.
D'Addabbo P et al.
Association between Psoriasis and haplotypes of the IgH 3' Regulatory Region 1.
Gene.
2018 Aug 30, 669:47-51.
The association studies of several immune-diseases with the 3' Regulatory Region 1 (3'RR1) increased interest on the role that the region plays in the immune-regulation. The 3'RR1 is a polymorphic region on human chromosome 14q32, acting as a cis-regulative element on the Immunoglobulin constant-gene locus recently considered as super-enhancer. The human 3'RR1 share large sequences with its paralogous 3'RR2, at high level of similarity. Thus, a focused investigation was necessary to (...)
see on pubmed
Proanthocyanidins: novel treatment for psoriasis that reduces oxidative stress and modulates Th17 and Treg cells.
Redox Rep..
2018 Dec , 23, (1):130-135.
Psoriasis is a common, chronic, inflammatory skin disease that affects 2%-4% of the global population. Recent studies have shown that increased oxidative stress (OS) and T-cell abnormalities are central to the pathogenesis of this disease. The resulting reactive oxygen species (ROS) induces proliferation and differentiation of Th17/Th1/Th22 cells and inhibits the anti-inflammatory activities of regulatory T lymphocytes (Treg). Subsequent secretions of inflammatory cytokines, such as (...)
see on pubmed
on Atopic Dermatitis
Anti-inflammatory and immune response regulation of Si-Ni-San in 2,4-dinitrochlorobenzene-induced atopic dermatitis-like skin dysfunction.
J Ethnopharmacol.
2018 Aug 10, 222:1-10.
Si-Ni-San (SNS) is a well-known decoction in traditional Chinese medicine. Although studies have indicated that the anti-inflammatory and anti-allergic properties of SNS and its components can account for their therapeutic effects, the role and mechanism of SNS in treating skin dysfunction remain unclear.
see on pubmed
Identification of pyruvate kinase as a novel allergen in whiteleg shrimp (Litopenaeus vannamei) by specific-IgE present in patients with shrimp allergy.
Food Chem.
2018 Aug 30, 258:359-365.
Food allergy is one of the most important health issues worldwide. In Taiwan, current literature suggests shrimps and crabs are the most common causes of food allergy, and are frequently associated with acute allergic reactions such as urticaria, atopic dermatitis, and asthma. However, knowledge regarding the shrimp allergens remains limited. Thus, there is an urgent need to establish comprehensive information for elucidating underlying triggers for food allergy. In this study, whiteleg (...)
see on pubmed
Environmental factors associated with allergic rhinitis symptoms in Japanese university students: A cross-sectional study.
Auris Nasus Larynx.
2018 Oct , 45, (5):1006-1013.
Numerous studies have reported that various environmental factors during early life are key determinants for developing allergic disease. Herein, we aimed to investigate the impact of environmental factors on allergic rhinitis.
see on pubmed
