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
Integrated analysis of gene expression profiles identifies transcription factors potentially involved in psoriasis pathogenesis.
J. Cell. Biochem.. 2019 Aug , 120, (8):12582-12594.
Psoriasis is a common inflammatory skin disease mediated by cells and molecules in both the innate and adaptive immune systems. Recently, gene expression profile analysis revealed a large set of immune-related differentially expressed genes (DEGs) in psoriasis. However, the associations between these DEGs and their transcriptional regulation mechanisms have not been completely elucidated. In this study, several psoriasis Gene Expression Omnibus data sets were systematically analyzed using (...)see on pubmed
Models of human psoriasis: Zebrafish the newly appointed player.
Dev. Comp. Immunol.. 2019 Aug , 97:76-87.
Psoriasis is a human chronic, immune disease with severe cutaneous and systemic manifestations. Its prevalence, among the world population, highly varies with ethnicity and geography, but not sex from remarkable low levels in Asia to 2.3% in Spain, or an impressive 11.5% in Norway. The pathogenesis of psoriasis derives from complex genetic and environmental interactions, which creates aberrant crosstalk between keratinocytes and variated immune cell, resulting in open amplified inflammatory (...)see on pubmed
A vivid cytokines interaction model on psoriasis with the effect of impulse biologic (TNF-α inhibitor) therapy.
J. Theor. Biol.. 2019 Aug 07, 474:63-77.
Psoriasis is a chronic skin condition that produces plaques of condensed, scaling skin due to excessively rapid proliferation of keratinocytes. During the disease progression, keratinocyte proliferation is influenced by many immune cells and cytokines. This article deals with a five dimensional deterministic model, which has been derived using quasi-steady-state approximation for describing the dynamics of psoriasis in various cytokines environment. Equilibrium analysis of the system shows (...)see on pubmed
Synthesis of chitosan derivatives with organoselenium and organosulfur compounds: Characterization, antimicrobial properties and application as biomaterials.
Carbohydr Polym. 2019 Sep 01, 219:240-250.
In this study, Schiff bases of chitosan (CS) were synthesized using citronellal, citral, and their derivatives containing selenium and sulfur. Organoselenium and organosulfur compounds show attractive biological and pharmaceutical activities, which can be beneficial to CS-based materials. From the characterization analyses, it was found that the CS-derivatives containing organoselenium and organosulfur compounds exhibited the highest conversion degrees (23 and 28%). Biological assays were (...)see on pubmed
Skin inflammation induced by ambient particulate matter in China.
Sci. Total Environ.. 2019 Sep 10, 682:364-373.
Most published studies on particulate matter (PM) concerning PM and PM have focused on PM-induced effects on the respiratory system (particularly lung) and cardiovascular system effects. However, epidemiological and mechanistic studies suggest that PM and PM also affects the skin, which is a key health issue. In this study, we first reviewed the current status of PM and PM in China, including relevant regulations, concentration levels, chemical components, and emission sources. Next, we (...)see on pubmed
Effect of cinnamamides on atopic dermatitis through regulation of IL-4 in CD4 cells.
J Enzyme Inhib Med Chem. 2019 Dec , 34, (1):613-619.
This study aimed to evaluate the effects of cinnamamides on atopic dermatitis (AD) and the mechanisms underlying these effects. To this end, the actions of two cinnamamides, (E)-3-(4-hydroxyphenyl)-N-phenylethyl acrylamide (NCT) and N-trans-coumaroyltyramine (NCPA), were determined on AD by orally administering them to mice. Oral administration of the cinnamamides ameliorated the increase in epidermal and dermal thickness as well as mast cell infiltration. Cinnamamides suppressed serum (...)see on pubmed