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
Immunological and clinical effects of low-dose interleukin-2 across 11 autoimmune diseases in a single, open clinical trial.
Ann. Rheum. Dis..
2019 Feb , 78, (2):209-217.
Regulatory T cells (Tregs) prevent autoimmunity and control inflammation. Consequently, any autoimmune or inflammatory disease reveals a Treg insufficiency. As low-dose interleukin-2 (ld-IL2) expands and activates Tregs, it has a broad therapeutic potential.
see on pubmed
A Chinese cross-sectional study on depression and anxiety symptoms in patients with psoriasis vulgaris.
Psychol Health Med.
2019 Mar , 24, (3):269-280.
Previous studies have reported a higher incidence of depression and anxiety in psoriasis patients compared to the general population, which has important implications for assessment and treatment. In this study, we determined the frequency of depression and anxiety in Chinese patients with psoriasis and its relationship with disease severity and other demographic variables. The study included 208 Chinese patients with psoriasis vulgaris. The Patient Health Questionnaire (PHQ-9) and (...)
see on pubmed
Downregulated miR-187 contributes to the keratinocytes hyperproliferation in psoriasis.
Tang L et al.
Downregulated miR-187 contributes to the keratinocytes hyperproliferation in psoriasis.
J. Cell. Physiol..
2019 Apr , 234, (4):3661-3674.
Psoriasis is a common chronic skin disease characterized by epidermal hyperplasia and inflammation. However, the pathogenesis of psoriasis is multifactorial and is not fully understood. MicroRNAs (miRNAs) represent a promising class of small, noncoding RNA molecules that have a large impact on cellular functions by regulating gene expression. Here we reported that microRNA-187 (miR-187), which is one of the most dynamic microRNAs identified in the deep screening miRNAs profile, is (...)
see on pubmed
on Atopic Dermatitis
Interleukin-4/interleukin-13 versus interleukin-5: a comparison of molecular targets in biologic therapy for the treatment of severe asthma.
Curr Opin Allergy Clin Immunol.
2019 Feb , 19, (1):30-37.
Asthma is a chronic, inflammatory disorder of the airways caused by a complex interplay of various biologic mechanisms. Several monoclonal antibody therapies targeting interleukin (IL)-4/IL-13 and IL-5 cytokine pathways have been developed for the treatment of severe eosinophilic asthma. As individuals can display biomarkers and clinical features characteristic of several asthma phenotypes, selection of anoptimal biologic can be (...)
see on pubmed
A tale of 2 poles.
Bach RO et al.
A tale of 2 poles.
Contact Derm..
2019 Feb , 80, (2):131-132.
Neopterin Levels and Indoleamine 2,3-Dioxygenase Activity as Biomarkers of Immune System Activation and Childhood Allergic Diseases.
Ann Lab Med.
2019 May , 39, (3):284-290.
Although Th2 immune activation is predominant in allergic diseases, neopterinlevels and indoleamine 2,3-dioxygenase (IDO)-1 activity (kynurenine:tryptophan ratio), which reflect Th1 immune activity, increase with interferon-gamma (IFN-γ) stimulation. We investigated neopterin, tryptophan, and kynurenine levels as biomarkersof the Th1 immune system activation and changes in IDO-1 activityin children with asthma, allergic rhinitis, and atopic dermatitis, as well as the relationship between (...)
see on pubmed