Data-Medicos 
Dermagic/Express No. 64 
07 Julio 1.999. 07 July 1.999. 

~ PSORIASIS ~ 


EDITORIAL ESPANOL 
================= 
Hola amigos DERMAGICOS del mundo, el tema de hoy la PSORIASIS, enfermedad ancestral, todavia hoy sin un tratamiento 100% curativo, todo un reto para cualquier dermatologo. Estas 52 referencias nos hablan de las ultimas tendencias en cuanto a etiologia, evolucion y tratamiento. Espero que les gusten. 
La referencia 37 contiene 30 referencias más "cerradas", Espero que les guste el nuevo formato hecho con Netscape. 

Bienvenidos a DERMAGIC Dr. Grimalt (España), Dr. Borges (Venezuela), Dr. Pinzon (Miami) 

Saludos a todos !!! 

Dr. Jose Lapenta R.,,, 

EDITORIAL ENGLISH 
================= 
Hello friends DERMAGIC of the world, today's topic the PSORIASIS, ancestral illness, still today without a treatment 100 healing%, an entire challenge for any dermatologist. These 52 references speak to us the new tendencies as for etiology, evolution and treatment. I hope enjoy it.. 
The reference 37 contains 30 more "closed" references. I hope you like the new format made with Netscape. 

Welcome to DERMAGIC Dr. Grimalt (España), Dr. Borges (venezuela), Dr. Pinzon (Miami) 

Greetings to ALL, !! 
Dr. Jose Lapenta R.,,, 
==================================================================== 
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES 
==================================================================== 
1.) What patients with psoriasis believe about their condition 
2.) Terbinafine therapy may be associated with the development of psoriasis de novo or its exacerbation: Four case reports and a review of drug-induced psoriasis 
3.) Topical calcipotriol in childhood psoriasis 
4.) Is the efficacy of topical corticosteroid therapy for psoriasis vulgaris enhanced by concurrent moclobemide therapy? A double-blind, placebo controlled study 
5.) Administration of DAB389IL-2 to patients with recalcitrant psoriasis: A double-blind, phase II multicenter trial 
6.) Suberythemogenic narrow-band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris 
7.) Cyclosporine as maintenance therapy in patients with severe psoriasis 
8.) Tazarotene gel, a new retinoid, for topical therapy of psoriasis: Vehicle-controlled study of safety, efficacy, and duration of therapeutic effect 
9.) Management of psoriasis with calcipotriol used as monotherapy 
10.) Individual pharmacodynamics assessed by antilymphocyte action predicts clinical cyclosporine efficacy in psoriasis 
11.) Calcipotriene ointment and halobetasol ointment in the long-term treatment of psoriasis: Effects on the duration of improvement 
12.) The epidermal phenotype during initiation of the psoriatic lesion in the symptomless margin of relapsing psoriasis 
13.) The economic impact of psoriasis increases with psoriasis severity 
14.) The impact of psoriasis on the quality of life of patients from the 16-center PUVA follow-up cohort 
15.) Immunosuppressant pharmacodynamics on lymphocytes from healthy subjects and patients with chronic renal failure, nephrosis, and psoriasis: Possible implications for individual therapeutic efficacy 
16.) Oral mucositis with features of psoriasis, Report of a case and review 
of the literature 
17.) Molecular mechanisms of tazarotene action in psoriasis 
18.) Tazarotene gel: Efficacy and safety in plaque psoriasis 
19.) Once-daily tazarotene gel versus twice-daily fluocinonide cream in the treatment of plaque psoriasis 
20.) Clinical safety of tazarotene in the treatment of plaque psoriasis 
21.) Methotrexate-induced toxic epidermal necrolysis in a patient with psoriasis 
22.) Comparative efficacy of once-daily flurandrenolide tape versus twice-daily diflorasone diacetate ointment in the treatment of psoriasis 
23.) Alterations in HIV expression in AIDS patients with psoriasis or pruritus treated with phototherapy 
24.) Cancer incidence among Finnish psoriasis patients treated with 8-methoxypsoralen bath PUVA 
25.) Comparison of psoralen-UVB and psoralen-UVA photochemotherapy in the treatment of psoriasis 
26.)Ranitidine does not affect psoriasis: A multicenter, double-blind, placebo-controlled study 
27.) Combined topical calcipotriene ointment 0.005% and various systemic therapies in the treatment of plaque-type psoriasis vulgaris: Review of the literature and results of a survey sent to 100 dermatologists 
28.) The genetics of psoriasis 
29.) The use of topical calcipotriene/calcipotriol in conditions other than plaque-type psoriasis 
30.) Tazarotene: The first receptor-selective topical retinoid for the treatment of psoriasis 
31.) The effects of topical calcipotriol on systemic calcium homeostasis in patients with chronic plaque psoriasis 
32.) Cyclosporine consensus conference: With emphasis on the treatment of psoriasis 
33.) Tazarotene 0.1% gel plus corticosteroid cream in the treatment of plaque psoriasis 
34.) The pathogenesis of psoriasis and the mechanism of action of tazarotene 
35.) Bath-5-methoxypsoralen-UVA therapy for psoriasis 
36.) -3 Fatty acid–based lipid infusion in patients with chronic plaque psoriasis: Results of a double-blind, randomized, placebo-controlled multicenter trial 
37.) Immunopathogenesis of Psoriasis 
38.) Epstein-Barr Virus-Associated Lymphoproliferative Disease During Methotrexate Therapy for Psoriasis 
39.) Long-term Safety of Cyclosporine in the Treatment of Psoriasis 
40.) Acitretin Therapy Is Effective for Psoriasis Associated With Human Immunodeficiency Virus Infection 
41.) Methotrexate Osteopathy in Long-term, Low-Dose Methotrexate Treatment 
for Psoriasis and Rheumatoid Arthritis 
42.) Commercial tanning bed treatment is an effective psoriasis treatment: results from an uncontrolled clinical trial. 
43.) Transfer of autoimmune thyroiditis and resolution of palmoplantar pustular psoriasis following allogeneic bone marrow transplantation. 
44.) Demographic evaluation of successful antipsoriatic climatotherapy at the Dead Sea 
45.) Topical calcipotriene in combination with UVB phototherapy for psoriasis. 
46.) A controlled trial of acupuncture in psoriasis: no convincing effect. 
47.) Psoriatic erythroderma: a histopathologic study of forty-five patients. 
48.) [The immunological and morphological aspects of hemoperfusion with pig donor spleen in treating psoriasis patients] 
49.) Clearance of recalcitrant psoriasis after tonsillectomy. 
50.) Psoriasis treatment: bathing in a thermal lagoon combined with UVB, versus UVB treatment only. 
51.) Alternative therapies commonly used within a population of patients with psoriasis. 
52.) Using aromatherapy in the management of psoriasis. 
===================================================================== 
===================================================================== 
1.) What patients with psoriasis believe about their condition 
===================================================================== 
Donal G. Fortune, BSca,b Helen L. Richards, Clin Psy Db 
Chris J. Main, PhDb, Christopher E. M. Griffiths, MDa 
Manchester, United Kingdom 

Abstract 
Background: Patients’ beliefs about their disease have been shown to be of 
fundamental importance in adjustment to their condition. 
Objective: We investigated patients’ beliefs about their psoriasis and 
examined the relationship between these beliefs and clinical severity, 
symptom report, and other clinical and demographic variables. 
Methods: A total of 162 patients with psoriasis (84 male, 78 female) 
completed the illness perception questionnaire that provides a standardized 
assessment of beliefs about causes, consequences, chronicity or recurrence, 
controllability, and symptoms of the condition. 
Results: The most commonly reported agents of causation were stress (60.1%) 
and genetic factors (55.5%)—the latter group being significantly more 
likely to have a family history of psoriasis (P = .0001). Forty-six percent 
of patients believed that their behavior could improve or worsen their 
psoriasis, whereas 32% believed that treatment would be curative. 
Desquamation and pruritus were experienced "frequently" or "all the time" 
by 80% and 76% of patients respectively. Overall clinical severity was not 
associated with any of the beliefs held by patients or with symptom report. 
Conclusion: The beliefs held and symptoms experienced by patients with 
psoriasis are not governed by overall clinical severity of the disease. (J 
Am Acad Dermatol 1998;39:196-201.) 

===================================================================== 
2.) Terbinafine therapy may be associated with the development of psoriasis 
de novo or its exacerbation: Four case reports and a review of drug-induced 
psoriasis 
===================================================================== 
Aditya K. Gupta, MD, FRCPCa R. Gary Sibbald, MD, FRCPCb 
Sandra R. Knowles, BSc, Phmc Charles W. Lynde, MD, FRCPCd 
Neil H. Shear, MD, FRCPCa,c Ontario and Toronto, Canada 

Abstract 
Adverse effects may occur in 10.4% of patients receiving terbinafine 
therapy, with cutaneous reactions in 2.7%. We describe the development of 
psoriasis in four patients who took oral terbinafine. Two patients had 
plaque-type psoriasis that flared 12 and 17 days, respectively, after 
starting terbinafine. Another patient developed pustular-type psoriasis de 
novo after 27 days of terbinafine therapy. The fourth patient was a 
psoriatic with stable plaque disease who experienced a pustular flare after 
taking terbinafine for 21 days. We are aware of only one report in the 
literature in which a patient developed pustular psoriasis de novo after 5 
days of terbinafine therapy. In all patients the psoriasis cleared or 
lessened after discontinuation of terbinafine and institution of 
antipsoriatic therapy. (J Am Acad Dermatol 1997;36:858-62.) 

===================================================================== 
3.) Topical calcipotriol in childhood psoriasis 
===================================================================== 
Arnold P. Oranjea, Danielle Marcouxb, Åke Svenssonc 
Julie Prendivilled, Bernice Krafchike, J Toolef 
Donald Rosenthalg, Flora B. de Waard-van der Speka Lars 
Molinh, Mads Axelseni 
Rotterdam, The Netherlands; Montreal, Vancouver, Toronto, Winnipeg, and 
Hamilton, Canada; Kristianstad and Orebro, Sweden; and Ballerup, Denmark 

Abstract 
Background: The use of topical calcipotriol in adults with psoriasis is 
safe and effective. 
Objective:Our purpose was to study the efficacy and safety of calcipotriol 
in children. 
Methods: A multicenter, prospective, 8-week, double-blind, parallel group 
study was conducted in 77 children. Response to treatment was assessed by 
means of the Psoriasis Area and Severity Index (PASI) in that the intensity 
of redness, thickness, and scaliness as well as the area involved are 
scored. The children were 2 to 14 years of age and had stable psoriasis, 
involving less than 30% of the body surface. Forty-three children were 
assigned to receive calcipotriol ointment and 34 to receive placebo. Nine 
children dropped out of the study, six in the calcipotriol-treated group 
and three in the placebo-treated group. 
Results: Both treatment groups (calcipotriol and placebo) showed 
significant improvement in PASI from baseline to the end of treatment, and 
the difference was not statistically significant. No serious side effects, 
in particular including those relating to calcium and bone metabolism, were 
recorded. 
Conclusion: Calcipotriol ointment was statistically significantly more 
effective than its vehicle in terms of the investigator’s overall 
assessment and reduction in redness and scaliness but not in terms of PASI 
score. (J Am Acad Dermatol 1997;36:203-8.) 

===================================================================== 
4.) Is the efficacy of topical corticosteroid therapy for psoriasis 
vulgaris enhanced by concurrent moclobemide therapy? 
A double-blind, placebo controlled study 
===================================================================== 
Erkan Alpsoy, MDa Erhan Özcan, MDb Lütfiye Çetin, MDa Oya Özgur, MDb 
Hanife Er, MDa Ertan Yilmaz, MDa Taha Karaman, MDb 
Antalya, Turkey 

Abstract 
Background: Psychosocial factors have been implicated in the onset and 
exacerbation of psoriasis. 
Objective: We conducted a randomized, placebo-controlled, double-blind 
study to investigate the effect of an antidepressant agent, moclobemide, on 
the course of psoriasis vulgaris. 
Methods: Sixty subjects were enrolled in the study. Patients were randomly 
assigned to treatment groups. Patients received moclobemide 450 mg/day or 
placebo and a topical corticosteroid ointment (diflucortolone valerate) for 
6 weeks. Patients were examined at the beginning of the study and at 2-week 
intervals. At each visit, the severity of psoriasis and psychologic status 
were evaluated with the Psoriasis Area Severity Index (PASI), Beck 
Depression Inventory (BDI), Hamilton Rating Scale for Anxiety (HAM-A), 
Hamilton Rating Scale for Depression (HRS-D-17) and State-Trait Anxiety 
Inventory including state (STAI-1) and trait anxiety (STAI-2). 
Results: Treatment efficacy was able to be evaluated in 22 patients in the 
moclobemide-treated group and in 20 in the placebo-treated group. The 
improvement rates in PASI, BDI, STAI-1, and HAM-A scores were significantly 
higher in the moclobemide treatment group. The level of state anxiety was 
diminished in the moclobemide group. Correlation was positive between 
improvement rates of the psoriatic lesions and state anxiety in all patients. 
Conclusion: Our results suggest that an antidepressant drug is useful in 
the treatment of psoriasis. (J Am Acad Dermatol 1998;38:197-200.) 

===================================================================== 
5.) Administration of DAB389IL-2 to patients with recalcitrant psoriasis: A 
double-blind, phase II multicenter trial 
===================================================================== 
Jerry Bagel, MDa W. Thomas Garland, MDb Debra Breneman, MDc Michael Holick, 
MDd T. W. Littlejohn, MDe David Crosby, MDf Holly Faust, MDg David 
Fivenson, MDh Jean Nichols, PhDi 
East Windsor and Lawrenceville, New Jersey; Cincinnati, Ohio; Boston and 
Hopkinton, Massachusetts; Winston-Salem, North Carolina; Milwaukee, 
Wisconsin; Indianapolis, Indiana; and Detroit, Michigan 

Abstract 
Background: Current therapies for recalcitrant psoriasis focus on 
immunoregulation and targeting of activated T-lymphocytes rather than 
keratinocytes. Previous studies with low doses of the lymphocyte-selective 
fusion protein DAB389IL-2 have shown benefit to patients with psoriasis. 
Objective: We examined the safety and efficacy of DAB389IL-2 in 41 
volunteers receiving more frequent and higher doses than in a previous trial. 
Methods: Patients were randomized to receive either placebo or 5, 10, or 15 
µg/kg daily of DAB389IL-2 intravenously for 3 consecutive days each week 
for 4 consecutive weeks with a subsequent 4-week observation period. 
Results: Of the placebo group, 17% (2 of 12) exhibited at least 50% 
improvement from baseline Psoriasis Area and Severity Index scores at the 
end of the study, whereas 24% of all treated patients (7 of 29) showed the 
same improvement. Overall, 3 of 12 (25%) patients given placebo as opposed 
to 12 of 29 (41%) patients treated with DAB389IL-2 improved to this same 
extent at some point during the study. The rate of improvement for treated 
patients was significantly greater than for placebo patients (p = 0.04; 
repeated measures ANOVA). Among treated patients, decreases in Psoriasis 
Area and Severity Index scores were paralleled by changes in the 
Physician’s Global Assessment and the Dermatology Life Quality Index. 
Treatment in ten patients was discontinued because of adverse events. 
Flu-like symptoms were the most common with severity increasing at the two 
higher doses. Only one serious adverse event was reported. This occurred in 
a patient receiving 5 µg/kg daily who experienced vasospasm and a 
coagulopathy resulting in arterial thrombosis. 
Conclusion: Our findings are consistent with the potential antipsoriatic 
activity of DAB389IL-2 demonstrated in an earlier study. However, 
DAB389IL-2 was less well tolerated at this dosing regimen, particularly at 
the highest dose, and it was too toxic at these doses and schedules to be 
considered in the routine treatment of psoriasis. (J Am Acad Dermatol 
1998;38:938-44.) 

===================================================================== 
6.) Suberythemogenic narrow-band UVB is markedly more effective than 
conventional UVB in treatment of psoriasis vulgaris 
===================================================================== 

Ian B. Walters, MD 
Lauren H. Burack, MD 
Todd R. Coven, MD 
Patricia Gilleaudeau, RN, BSN 
James G. Krueger, MD, PhD 
New York, New York 
Abstract 
Background: Narrow-band UVB (NB-UVB) is a new phototherapy option for 
psoriasis. Action spectrum studies previously done with different UVB 
wavelengths suggest that suberythemogenic doses of NB-UVB could be highly 
effective in treating psoriasis vulgaris. Even so, no comparative studies 
with suberythemogenic doses of NB versus conventional UVB have been 
performed previously. 
Objective: Our purpose was to compare conventional broad-band UVB (BB-UVB) 
with NB-UVB at suberythemogenic doses for the treatment of psoriasis vulgaris. 
Methods: Eleven patients were treated using a split-body approach for 6 
weeks on a three-times-a-week basis. Outcomes were evaluated by means of 
Psoriasis Severity Index scores and quantitative histologic measures. 
Results: We were able to induce clinical clearing in 81.8% of patients 
after NB-UVB, but in only 9.1% of patients after BB-UVB (P < .01). Biopsy 
specimens obtained at the end of treatment revealed that keratin 16 
staining was absent in 75% of patients on the NB side compared with none on 
the BB side, suggesting a reversal of regenerative epidermal hyperplasia by 
NB-UVB. 
Conclusion: NB-UVB is superior to UVB-BB in reversing psoriasis at 
suberythemogenic doses when given three times per week. This schedule was 
well tolerated by all patients.(J Am Acad Dermatol 1999;40:893-900.) 

===================================================================== 
7.) Cyclosporine as maintenance therapy in patients with severe psoriasis 
===================================================================== 
Jerome Shupack, MDa Elizabeth Abel, MDb Eugene Bauer, MDb Marc Brown, MDc 
Lynn Drake, MDd Ruth Freinkel, MDe Cynthia Guzzo, MDf John Koo, MDg Norman 
Levine, MDh Nicholas Lowe, MDi Charles McDonald, MDjDavid Margolis, MDf 
Matthew Stiller, MDaBruce Wintroub, MDg Carol Bainbridge, MDk Sndra Evansk 
Susan Hilssk William Mietlowski, PhDk 
Christine Winslow, PhDk 
Jay E. Birnbaum, PhDk 
New York and Rochester, New York; Stanford, San Francisco, and Santa 
Monica, California; Boston, Massachusetts; Evanston, Illinois; 
Philadelphia, Pennsylvania; Tucson, Arizona; Providence, Rhode Island; and 
East Hanover, New Jersey 

Abstract 
Background: Low-dose cyclosporine therapy for severe plaque psoriasis is 
effective. Most side effects can be controlled by patient monitoring, with 
appropriate dose adjustment or pharmacologic intervention, or both, if 
indicated. Prevention or reversibility of laboratory and chemical 
abnormalities may be achieved by discontinuation of therapy after the 
induction of clearing. However, relapse occurs rapidly on discontinuation. 
Maintenance therapy with cyclosporine after induction has not been fully 
evaluated. 
Objective: Our purpose was to compare a regimen of 3.0 mg/kg per day of 
oral cyclosporine with placebo in maintaining remission or improvement in 
patients with psoriasis. 
Methods: After a 16-week unblinded induction phase in which 181 patients 
received cyclosporine, 5.0 mg/kg per day (an increase up to 6.0 mg/kg per 
day and a decrease to 3.0 mg/kg per day were allowed, if required, to 
achieve efficacy or tolerability, respectively), those patients showing a 
70% decrease or more in involved body surface area (BSA) entered the 
24-week maintenance phase and were randomly assigned to either placebo, 
cyclosporine, 1.5 mg/kg per day, or cyclosporine, 3.0 mg/kg per day. 
Patients were considered to have had a relapse when BSA returned to 50% or 
more of the prestudy baseline value. Clinical efficacy, adverse effects, 
and laboratory values were monitored regularly throughout both study phases. 
Results: During induction, cyclosporine at approximately 5.0 mg/kg per day 
produced a reduction in BSA of 70% or more in 86% of the patients. During 
maintenance, the median time to relapse was 6 weeks in both the placebo and 
cyclosporine 1.5 mg/kg per day groups, but was longer than the 24-week 
maintenance period in the 3.0 mg/kg per day group (p <0.001 vs placebo). By 
the end of the maintenance period, 42% of the patients in the 3.0 mg/kg per 
day cyclosporine group had a relapse compared with 84% in the placebo 
group. Changes in laboratory values associated with the higher induction 
dosage generally exhibited partial or complete return toward mean prestudy 
baseline values during the maintenance phase, with the greatest degree of 
normalization in the placebo group. 
Conclusion: Cyclosporine, 3.0 mg/kg per day, adequately and safely 
maintained 58% of patients with psoriasis for a 6-month period after 
clearing of their psoriasis with doses of approximately 5.0 mg/kg per day. 
(J Am Acad Dermatol 1997;36:423-32.) 

===================================================================== 
8.) Tazarotene gel, a new retinoid, for topical therapy of psoriasis: 
Vehicle-controlled study of safety, efficacy, and duration of therapeutic 
effect 
===================================================================== 
Gerald D. Weinstein, MDa Gerald G. Krueger, MDb Nicholas J. Lowe, MDc 
Madeleine Duvic, MDd David J. Friedman, MDe Brian V. Jegasothy, MDf 
Joseph L. Jorizzo, MDg Edward Shmunes, MDh Eduardo H. Tschen, MDi 
Deborah A. Lew-Kaya, PharmDj John C. Lue, MSj John Sefton, PhDj 
John R. Gibson, MDj Roshantha A. S. Chandraratna, PhDj 
Irvine and Santa Monica, California; Salt Lake City, Utah; Houston, Texas; 
Providence, Rhode Island; Pittsburgh, Pennsylvania; Winston-Salem, North 
Carolina; Columbia, South Carolina; and Albuquerque, New Mexico 

Abstract 
Background: Topical therapy providing initial improvement and maintenance 
of effect after treatment of the large majority of patients with limited, 
mild to moderate psoriasis is not presently available. Previous topical 
retinoids have generally been either ineffective or too irritating for 
therapy of psoriasis. 
Objective: Our purpose was to evaluate a new topical retinoid, tazarotene, 
in the treatment of stable plaque psoriasis during treatment and 
posttreatment periods. 
Methods: In a double-blind manner, 324 patients were randomly selected to 
receive tazarotene 0.1% or 0.05% gel, or vehicle control, once daily for 12 
weeks and were then followed up for 12 weeks after treatment. 
Results: Of the total, 318 patients could be evaluated. Tazarotene gels 
were superior (p < 0.05) to vehicle, often as early as treatment week 1, in 
all efficacy measures: plaque elevation, scaling, and erythema; treatment 
response; percentage treatment success (patients with 50% improvement); and 
time to initial success. Efficacy was equivalent on target lesion sites 
(trunk or limbs and knees or elbows) and overall. A sustained therapeutic 
effect was observed for 12 weeks after treatment. Tazarotene gel was 
cosmetically acceptable. There was low systemic absorption, limiting 
toxicity to local irritation. 
Conclusion: Once-daily tazarotene was effective and safe as a topical 
monotherapy for plaque psoriasis, providing rapid reduction of signs and 
symptoms. (J Am Acad Dermatol 1997;37:85-92.) 

===================================================================== 
9.) Management of psoriasis with calcipotriol used as monotherapy 
===================================================================== 
Colin A. Ramsay, MD, FRCP, FRCP (C) 
Toronto, Ontario, Canada 

Abstract 
Background: The vitamin D analog calcipotriene/calcipotriol 
(Dovonex/Daivonex) offers advantages over other forms of topical therapy in 
some patients with psoriasis. 
Objective: We review the studies of the use of calcipotriol alone in the 
management of psoriasis. 
Methods: The literature concerning topical calcipotriol therapy was reviewed. 
Results: Calcipotriol compares well with other standard forms of topical 
therapy for psoriasis. Irritation of the skin may occur but is generally 
mild. Treatment can often be restarted after the irritation has cleared. 
Conclusion: Treatment with calcipotriol ointment, cream, or solution is 
effective and safe in many patients with psoriasis. (J Am Acad Dermatol 
1997;37:S53-S54.) 

===================================================================== 
10.) Individual pharmacodynamics assessed by antilymphocyte action predicts 
clinical cyclosporine efficacy in psoriasis 
===================================================================== 
Toshihiko Hirano, PhD Kitaro Oka, PhD Yoshinori Umezawa, MD 
Masako Hirata, MD Tsunao Oh-i, MD Michiyuki Koga, MD 
Tokyo, Japan 

Abstract 
Background: Cyclosporine (INN, ciclosporin) use for psoriasis has been 
proposed and clinically examined. However, individual variation in 
cyclosporine efficacy is currently observed. To evaluate individual 
therapeutic potency of cyclosporine, pharmacodynamic approaches were 
performed with use of peripheral blood mononuclear cells (PBMCs) from 
patients with psoriasis. 
Methods: Cyclosporine effects on PBMC-blastogenesis were examined in 33 
patients with psoriasis. The drug concentration that gave 50% inhibition of 
mitogen-stimulated PBMC proliferation in vitro (IC50, in nanograms per 
milliliter) was evaluated in each patient. Cyclosporine was administered at 
an initial dose of 5 mg/kg/day, and the dose was tapered for 16 weeks to 3 
mg/kg/day. The recovery rate in the psoriasis area and the severity index 
(PASI) 16 weeks after cyclosporine therapy began was measured. 
Results: Cyclosporine IC50 values in 33 patients deviated widely, from 0.1 
to 120.6 ng/ml. We classified these patients into two groups on the basis 
of their PBMC sensitivity to cyclosporine with use of the median 
cyclosporine IC50 (3.0 ng/ml) of these patients as the cutoff point. The 
PASI recovery rate after cyclosporine therapy in the patients with high 
sensitivity was significantly higher than that in the patients with low 
sensitivity (p < 0.0007). Moreover, a significant negative correlation 
between the IC50 and the PASI recovery rate was observed in these 33 
patients (r = -0.73; p < 0.0001). Blood trough levels and side effects of 
cyclosporine were not significantly different between the two patient groups. 
Conclusions: The results showed that we could use PBMCs to 
pharmacodynamically predict the patients with a poor response to 
cyclosporine therapy. These patients may require larger doses of 
cyclosporine or alternative approaches to treatment. The patients with 
PBMCs sensitive to cyclosporine should be evaluated for treatment with 
smaller doses of the drug to avoid serious side effects. (Clin Pharmacol 
Ther 1998;63:465-70.) 

===================================================================== 
11.) Calcipotriene ointment and halobetasol ointment in the long-term 
treatment of psoriasis: Effects on the duration of improvement 
===================================================================== 
Mark Lebwohl, MD Ayelet Yoles, BS Kathleen Lombardi, BS 
Wendy Lou, PhD 
New York, New York 

Abstract 
Background: Weekend therapy with superpotent topical corticosteroids has 
been used for the long-term treatment of psoriasis. Recently, calcipotriene 
ointment has been added to this regimen for use on weekdays, but there are 
no long-term studies of that combination. 
Objective: The purpose of this study was to determine whether the addition 
of weekday calcipotriene to a pulse therapy regimen of weekend superpotent 
corticosteroids results in a longer duration of remission of plaque psoriasis. 
Subjects: This was a double-blind, placebo-controlled, parallel-group 
study. Forty-four patients with mild to moderate psoriasis were treated 
with calcipotriene ointment in the morning and halobetasol ointment in the 
evening for 2 weeks. Thereafter, 40 patients who were at least moderately 
(50% or greater) improved were randomized to 2 treatment groups. After 2 
weeks of treatment with calcipotriene ointment in the morning and 
halobetasol ointment in the evening, 20 patients were randomized to receive 
halobetasol ointment twice daily on weekends and calcipotriene ointment 
twice daily on weekdays, and 20 patients were randomized to receive 
halobetasol ointment twice daily on weekends and placebo ointment twice 
daily on weekdays. 
Results: Seventy-six percent of patients applying halobetasol ointments on 
weekends and calcipotriene ointment on weekdays were able to maintain 
remission for 6 months compared with 40% of patients applying halobetasol 
ointment on weekends only with the vehicle on weekdays. 
Conclusion: The addition of calcipotriene ointment applied on weekdays to a 
weekend pulse therapy regimen of superpotent corticosteroids can increase 
the duration of remission of psoriasis. (J Am Acad Dermatol 1998;39:447-50.) 

===================================================================== 
12.) The epidermal phenotype during initiation of the psoriatic lesion in 
the symptomless margin of relapsing psoriasis 
===================================================================== 
Fransje A. C. M. Castelijns, MD Marie-Jeanne P. Gerritsen, MD, PhD 
Ivonne M. J. J. van Vlijmen-Willems, Ing Piet E. J. van Erp, Ing, PhD 
Peter C. M. van de Kerkhof, MD, PhD Nijmegen, The Netherlands 

Abstract TOP 
Background: The mature psoriatic lesion does not necessarily demonstrate 
changes relevant to early phases of the lesion. 
Objective: In a model for relapsing psoriasis we examined the epidermal 
phenotype by means of a panel of immunohistochemical parameters: keratins 
14 and 16, epidermal growth factor receptor (EGFR), Ki-67 antigen, and 
Tdt-mediated Unscheduled Nick End Labeling to detect apoptosis. 
Methods: In 9 patients, we cleared psoriatic plaques by topical treatment 
with clobetasol-17-propionate under hydrocolloid occlusion. Relapse 
(defined as a clinical sum score 6) was awaited. Biopsy specimens of the 
psoriatic lesion, the cleared skin, the relapsed plaque, and its clinically 
normal margin were assessed. 
Results: Psoriasis recurred after 19 &plusmn; 6 weeks (mean &plusmn; SEM). During 
treatment all parameters improved considerably; however, the number of 
apoptotic cells was not affected.Ki-67 values decreased well below the 
normal range. At initial relapse, the symptomless skin adjacent to the 
relapsing lesion (margin) showed a marked expression of keratin 16 and 
EGFR. Ki-67 expression was increasing in the margin but was below values of 
the mature lesion. The localization of cycling cells in the first 
suprabasal layers was a remarkable feature. Keratin 14 expression was 
increased in the recurrent lesion itself, but not in the symptomless margin. 
Conclusion: Keratin 16 and EGFR expression are early phenomena in the 
evolution of the lesion, and they anticipate epidermal proliferation. The 
expression of keratin 14 follows overt epidermal hyperproliferation. The 
present observation in incipient psoriasis lends support to the hypothesis 
that the basal cell compartment does not have a primary involvement in the 
initiation of epidermal abnormalities in psoriasis, but that a coordinated 
sequence of events involving proliferation and differentiation markers in 
the first suprabasal layers of the epidermis could be the key to the 
pathogenesis of this puzzling disease. (J Am Acad Dermatol 1999;40:901-9.) 

===================================================================== 
13.) The economic impact of psoriasis increases with psoriasis severity 
===================================================================== 
Steven R. Feldman, MD, PhDa,b Alan B. Fleischer, Jr., MDa David M. 
Reboussin, PhDc Stephen R. Rapp, PhDc,d Douglas D. Bradham, DrPHc 
M. Lyn Exumc, Adele R. Clark, PA-Ca, Winston-Salem, North Carolina 

Abstract 
Background: Psoriasis treatments are known to be costly, but little is 
known about the financial impact of psoriasis and the way in which it 
relates to the severity of the disease. 
Objective: This study was performed to obtain an estimate of the treatment 
costs faced by patients with psoriasis. 
Methods: A total of 578 anonymous mail surveys were distributed to patients 
with psoriasis; 318 surveys were returned (55%). Psoriasis severity was 
assessed with the previously validated Self-Administered Psoriasis Area 
Severity Index (SAPASI). 
Results: The total and out-of-pocket expenses to care for psoriasis were 
correlated with psoriasis severity (r = 0.26, p = 0.0001). There were no 
sex (p = 0.9) or racial (p = 0.4) differences in total expenditures. 
Severity was correlated with how bothersome to the patient was the cost of 
treatment (r = 0.30, p = 0.0001), the time required for treatment (r = 
0.38, p = 0.0001), and the time lost from work (r = 0.23, p = 0.0001). 
Lower quality of life at work and in money matters also correlated with 
severity of psoriasis. Higher family income was associated with less time 
spent caring for psoriasis and less interference with work around the home. 
Conclusion: As expected, the expenses caring for psoriasis are greater for 
patients with more severe disease. These costs and other financial 
implications are associated with lower quality of life for patients with 
more severe psoriasis. (J Am Acad Dermatol 1997;37:564-9.) 

===================================================================== 
14.) The impact of psoriasis on the quality of life of patients from the 
16-center PUVA follow-up cohort 
===================================================================== 
K. E. McKenna, MRCP, R. S. Stern, MD 

Abstract 
Background: The impact of psoriasis on the quality of life of patients is 
likely to be principally related to alterations in individual appearance 
and consequent psychosocial disability. Quantifying the impact of psoriasis 
and related changes from therapy would help in the selection of optimal 
management. 
Objective: Our purpose was to evaluate the impact of psoriasis on patients 
with severe disease who have had photochemotherapy (PUVA). 
Methods: In 1979 we interviewed 877 of 988 still participating patients who 
were enrolled in 15 of 16 centers in the PUVA Follow-up Study. We 
determined the impact of psoriasis on quality of life with a questionnaire 
that had been modified to incorporate measures of impairment that are 
likely to be affected by cutaneous disease. 
Results: Psoriasis had substantial impact on the quality of life. Women 
were more likely than men to report impairment in quality of life 
dimensions. The impact of disease decreased with increasing age. Moderate 
to high relative impact on total quality of life was more often reported by 
patients who had recently used UVB phototherapy than by those using PUVA or 
methotrexate. 
Conclusion: Psoriasis has a substantial impact on the quality of life. This 
impact seems to decrease with increasing age. Use of specific treatments 
are also associated with the extent to which psoriasis affects quality of 
life. (J Am Acad Dermatol 1997;36:388-94.) 

===================================================================== 
15.) Immunosuppressant pharmacodynamics on lymphocytes from healthy 
subjects and patients with chronic renal failure, nephrosis, and psoriasis: 
Possible implications for individual therapeutic efficacy 
===================================================================== 
Toshihiko Hirano, PhD Kitaro Oka, PhD Hironori Takeuchi, BS 
Koichi Kozaki, MD, Naoto Matsuno, MD Yakeshi Nagao, MD, Masami Kozaki, MD 
Makiko Ichikawa, MD Masaharu Yoshida, MD Yoshinori Umezawa, MD Masako 
Hirata, MD Tsunao Oh-i, MD, Michiyuki Koga, MD 
Tokyo, Japan 

Abstract 
Background: In organ transplantation, patients with peripheral blood 
mononuclear cells (PBMCs) that exhibit resistance to cyclosporine (INN, 
ciclosporin) or glucocorticoids in vitro are refractory to therapy based on 
these drugs in vivo. However, detection or distribution of the resistant 
patients with immunologic disorders remains to be documented. 

Methods: Drug sensitivity tests were performed with PBMCs from four subject 
groups: 69 healthy subjects, 100 patients with chronic renal failure, 38 
patients with nephrosis, and 51 patients with psoriasis. The values for the 
concentration that produces 50% lymphocyte-mitosis inhibition (IC50) of the 
drugs on PBMC blastogenesis were estimated, and individual variations or 
group differences in the IC50 values were examined 

Results: The median cyclosporine IC50 values of the four subject groups 
were similar, but large individual deviations in the IC50 values were 
observed. Individual differences in prednisolone IC50 values were spread 
from 1 to 3500 ng/ml. When compared with healthy subjects, a significantly 
large number of the patients with chronic renal failure group exhibited low 
responses to prednisolone (p < 0.04). In contrast, no significant 
difference in the methylprednisolone IC50 was observed among the groups. 
Normal upper thresholds for IC50 values of these drugs were estimated from 
the mean + 2 standard deviations (SD) of the IC50 values of healthy PBMCs, 
and the patients with IC50 values above these levels were considered to be 
resistant. The incidence of resistant patients with nephrosis or psoriasis 
was similar to that of healthy subjects; however, the incidence of 
cyclosporine- or prednisolone-resistant subjects with chronic renal failure 
was significantly higher (p < 0.04). Significant correlations between PBMC 
sensitivity to cyclosporine in vitro and clinical efficacy of the drug in 
vivo were observed in renal transplant recipients and in patients with 
psoriasis. 

Conclusions: A large subset of patients with chronic renal failure showed 
PBMC resistance to cyclosporine and prednisolone. Hyperresistant patients 
have a high risk of being refractory to immunosuppressive therapy with one 
of these drugs. Alternative treatment should be considered according to the 
individual drug-sensitivity data. (Clin Pharmacol Ther 1997;62:652-64.) 

===================================================================== 
16.) Oral mucositis with features of psoriasis, Report of a case and review 
of the literature 
===================================================================== 
Fariba Simhai Younai, DDSa, Joan Andersen Phelan, DDSb 
New York and Northport, N.Y. 
NEW YORK UNIVERSITY COLLEGE OF DENTISTRY AND STATE UNIVERSITY OF NEW YORK 
AT STONY BROOK 

Abstract 
An unusual case of oral mucositis with features of psoriasis is reported 
along with a review of the cases of oral psoriasis in the literature. The 
case reported involved a crusted lesion on the upper lip and erythematous 
lesions on the labial mucosa, buccal mucosa, and denture-bearing palatal 
mucosa. In addition, lesions resembling geographic tongue and ectopic 
geographic tongue were present. All lesions exhibited multiple small 
pustules. The review of the literature compares the distribution and 
clinical appearance of previously reported cases of oral psoriasis.(Oral 
Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:61-7) 

===================================================================== 
17.) Molecular mechanisms of tazarotene action in psoriasis 
===================================================================== 
Madeleine Duvic, MDa, Sunil Nagpal, PhDb 
Arisa T. Asano, MDa Roshantha A.S. Chandraratna 
Houston, Texas and Irvine, 
California 

Abstract 
Psoriasis is a chronic immune-mediated disease that is characterized by the 
hyperproliferation and abnormal differentiation of keratinocytes and by 
inflammation. The epidermal changes associated with psoriasis may be due to 
the infiltration of inflammatory T lymphocytes and the release of cytokines 
in response to antigenic stimulation. Tazarotene is a retinoic acid 
receptor-specific retinoid with demonstrated efficacy in the topical 
treatment of psoriasis. Tazarotene downregulates markers of keratinocyte 
differentiation, keratinocyte proliferation, and inflammation. The drug 
also upregulates three novel genes TIG-1 (tazarotene-induced gene-1), 
TIG-2, and TIG-3, which may mediate an antiproliferative effect. The effect 
of tazarotene on these markers is probably a direct effect on gene 
expression rather than an indirect effect associated with disease 
improvement. (J Am Acad Dermatol 1997;37:S18-S24.) 

===================================================================== 
18.) Tazarotene gel: Efficacy and safety in plaque psoriasis 
===================================================================== 
Gerald D. Weinstein, MD 
Irvine, California 

Abstract 
Tazarotene is the first of a new generation of acetylenic retinoids 
developed for the topical treatment of mild-to-moderate plaque psoriasis. 
Controlled clinical trials have demonstrated that once-daily tazarotene 
0.05% and 0.1% gels are effective in improving and reducing clinical signs 
and symptoms of psoriasis on trunk and limb lesions and difficult-to-treat 
elbow and knee plaques. Tazarotene has a rapid onset of action indicated by 
significant improvements as early as the first week of treatment. Sustained 
beneficial effects have been observed in some patients for up to 12 weeks 
after the cessation of therapy. Compared with twice-daily fluocinonide 
0.05% cream, once-daily tazarotene 0.05%, and 0.1% gels were similarly 
effective in reducing plaque elevation. Once-daily tazarotene 0.05% and 
0.1% gels demonstrated a more prolonged therapeutic effect after 
discontinuation than twice-daily fluocinonide cream. Tazarotene is 
generally well tolerated, with adverse events limited to local irritation. 
Tazarotene appears to be an effective addition to the currently available 
treatments for plaque psoriasis. (J Am Acad Dermatol 1997; 37:S33-S38.) 

===================================================================== 
19.) Once-daily tazarotene gel versus twice-daily fluocinonide cream in the 
treatment of plaque psoriasis 
===================================================================== 
Mark Lebwohl, MDa, Ernest Ast, MDb Jeffrey P. Callen, MDc, Stanley I. 
Cullen, MDd Steven R. Hong, MDe,Carol L. Kulp-Shorten, MDc, 
Nicholas J. Lowe, MDf Tania J. Phillips, MDg Theodore Rosen, MDh 
David I. Wolf, MDi, Janine M. Quell, BSj John Sefton, PhDj 
John C. Lue, MSj, John R. Gibson, MDj 
Roshantha A. S. Chandraratna, PhDj 
New York and Great Neck, New York; Louisville, Kentucky; Gainesville, 
Florida; Boulder, Colorado; Boston, Massachusetts; Houston, Texas; and 
Santa Monica, Vista, and Irvine, California 

Abstract 
Background: A new class of topical receptor-selective acetylenic retinoids, 
the first of which is tazarotene, has been developed. 
Objective: Our purpose was to compare the safety, efficacy, and duration of 
therapeutic effect of 12 weeks of once-daily tazarotene 0.1% and 0.05% gel 
with that of twice-daily fluocinonide 0.05% cream in the treatment of 
patients with plaque psoriasis. 
Methods: Three hundred forty-eight patients with plaque psoriasis were 
enrolled and 275 patients completed a multicenter, investigator-masked, 
randomized, parallel-group clinical trial. 
Results: Both tazarotene gels were as effective as fluocinonide in reducing 
plaque elevation after 1 week of treatment, and tazarotene 0.1% gel was 
similar to fluocinonide in reducing scaling of trunk/limb lesions at all 
study weeks except week 4. Tazarotene 0.1% gel was similar to fluocinonide 
in reducing scaling of knee/elbow lesions at weeks 8 and 12. Fluocinonide 
had a significantly greater effect on erythema than tazarotene at weeks 2 
through 8. However, treatments were not significantly different at week 12, 
and tazarotene demonstrated significantly better maintenance of therapeutic 
effect after cessation of therapy. 
Conclusion: Tazarotene 0.1% and 0.05% gels were safe and effective in the 
treatment of mild-to-moderate plaque psoriasis. (J Am Acad Dermatol 
1998;38:705-11.) 

===================================================================== 
20.) Clinical safety of tazarotene in the treatment of plaque psoriasis 
===================================================================== 
Ronald Marks, FRCP, FRCPath, Cardiff, Wales 

Abstract 
Oral retinoids are effective in the treatment of psoriasis, but their use 
is limited by concerns for teratogenic potential and systemic side effects. 
Tazarotene is a novel acetylenic retinoid undergoing clinical trials for 
the topical treatment of mild-to-moderate plaque psoriasis. The safety and 
tolerability of tazarotene 0.1% and 0.05% gels were examined in a series of 
preclinical and clinical trials. In preclinical studies topically applied 
tazarotene gel was nonmutagenic, noncarcinogenic, and nonteratogenic. 
Tazarotene gel was not sensitizing, phototoxic, or photosensitizing in a 
series of studies in human volunteers. Treatment-related systemic adverse 
effects were not observed in clinical trials involving approximately 2000 
patients treated with tazarotene 0.1% or 0.05% gel for periods of up to 1 
year. Adverse effects appear limited to manageable, mainly mild-to-moderate 
local skin irritation. (J Am Acad Dermatol 1997;37:S25-S32.) 

===================================================================== 
21.) Methotrexate-induced toxic epidermal necrolysis in a patient with 
psoriasis 
===================================================================== 
Edward J. Primka III, MD, Charles Camisa, MD 
Cleveland, Ohio 

Abstract 
We describe a fatal case of low-dose methotrexate (MTX) toxicity in a 
patient with psoriasis, emphasizing the factors that exacerbate MTX 
toxicity and presenting rescue techniques. The patient had a toxic 
epidermal necrolysis-like condition. MTX cutaneous reactions ranging from 
toxic epidermal necrolysis to specific ulcerations have been described. The 
use of granulocyte colony stimulating factor for leukopenia associated with 
MTX toxicity is discussed. (J Am Acad Dermatol 1997;36:815-8.) 

===================================================================== 
22.) Comparative efficacy of once-daily flurandrenolide tape versus 
twice-daily diflorasone diacetate ointment in the treatment of psoriasis 
===================================================================== 
Gerald G. Krueger, MDa Margretta A. O’Reilly, MDa, Melissa Weidner, BSNa, 
Sydney H. Dromgoole, PhDb, Frank P. Killey, PhDb 
Salt Lake City, Utah, and San Rafael, California 

Abstract 
Background: Flurandrenolide tape has recently been listed as a group I 
topical cortico-steroid. There are no studies that compare this product to 
group I ointments in the treatment of steroid-responsive dermatoses. 
Objective: Our purpose was to determine the relative efficacy of 
flurandrenolide (4 &micro;g/cm2) tape versus 0.05% diflorasone diacetate ointment 
in plaque psoriasis. 
Methods: Thirty patients participated in an investigator-blinded, 
randomized, bilateral paired-comparison study of flurandrenolide tape 
applied to lesions of one side of the body once daily for up to 16 hours 
versus diflorasone diacetate ointment applied contralaterally twice daily. 
Lesions were assessed at baseline, then reevaluated at 2 and 4 weeks. 
Results: Flurandrenolide tape–treated plaques showed consistently greater 
clearing in terms of erythema, scaling, induration, and treatment success 
for all plaques, as well as the subset of knee and elbow plaques, when 
compared with the lesions receiving diflorasone diacetate ointment. 
Conclusion: The efficacy of flurandrenolide tape in the treatment of 
psoriatic plaques surpasses that of diflorasone diacetate ointment. (J Am 
Acad Dermatol 1998;38:186-90.) 

===================================================================== 
23.) Alterations in HIV expression in AIDS patients with psoriasis or 
pruritus treated with phototherapy 
===================================================================== 
Joan Breuer-McHam, MSca,d Gailen Marshall, MD, PhDc Ahmed Adu-Oppong, MScf 
Michelle Goller, MDa Steven Mays, MDa Tim Berger, MDe Dorothy E. Lewis, 
PhDf Madeleine Duvic, MDa,b,d 
Houston, Texas, and San Francisco, California 

Abstract 
Background: Ultraviolet light (UVL) upregulates HIV transcription in vitro 
and in transgenic mice. AIDS-associated psoriasis and pruritus respond to 
phototherapy. 
Objective: Our goal was to determine the effect of phototherapy on viral 
load and immunologic parameters in HIV-positive patients. 
Methods: T cell subsets, p24, plasma cytokines, serum or plasma HIV-RNA, 
dosage, and antivirals were assessed in HIV-positive patients and negative 
controls receiving 6 weeks of phototherapy with UVB and in untreated controls. 
Results: Phototherapy improved skin conditions without significantly 
affecting T cell numbers. Plasma p24 increased 2-fold (P = .055) and 
HIV-RNA levels 4-fold (P = .022) 6 weeks from baseline in patients who 
entered the trial before March 1995. Later patients who were mostly 
receiving combination antiviral therapy showed a 4-fold reduction in serum 
HIV-RNA (P = .012) at 2 weeks. The effect of UVB on viral load at 6 weeks 
was dependent on the baseline level (P = .006). IL-10 increased and was 
inversely related to HIV-RNA levels (P = .0267). 
Conclusion: Phototherapy is associated with HIV load alterations, depending 
on patients’ initial HIV-RNA, antiviral therapy, skin type, and UVL dosage. 
(J Am Acad Dermatol 1999;40:48-60.) 

===================================================================== 
24.) Cancer incidence among Finnish psoriasis patients treated with 
8-methoxypsoralen bath PUVA 
===================================================================== 
Anna Hannuksela-Svahn, MDa Eero Pukkala, PhDb Leena Koulu, MD, PhDc 
Christer T. Jansén, MD, PhDc Jaakko Karvonen, MD, PhDaOulu, Helsinki, 
Turku, Finland 

Abstract 
Background: Long-term oral 8-methoxypsoralen (8-MOP) and UVA (PUVA) therapy 
increases the risk of nonmelanoma skin cancer and possibly also of 
cutaneous malignant melanoma. Topical application of 8-MOP PUVA induces 
malignant tumors in rodent skin, but little is known about its 
carcinogenicity in human skin. 
Objective: Our purpose was to investigate the carcinogenicity of 8-MOP bath 
PUVA in humans. 
Methods: This was a cohort study of 158 patients with psoriasis, for whom 
8-MOP bath PUVA had been initiated during 1979 to 1992. The average number 
of 8-MOP bath PUVA treatments was 36 (range, 6 to 204) and the mean 
cumulative UVA dose was 92 J/cm2 (range, 3 to 884 J/cm2) by the end of 
1995. The patients were not treated with any other forms of PUVA. Cancer 
incidence subsequent to 8-MOP bath PUVA up to the end of 1995 was 
determined by linking the cohort with the records of the Finnish Cancer 
Registry. The standardized incidence ratios (SIR) were calculated for skin 
cancer and some common internal cancers, using the expected numbers of 
cases based on the regional cancer incidence rates. 
Results: There was one case of basal cell carcinoma, but no cases of other 
types of skin cancer. A total of 6 noncutaneous cancers were observed (SIR, 
1.3; 95% confidence interval, 0.5 to 2.8). 
Conclusion: No association between cutaneous cancer and 8-MOP bath PUVA was 
found, but the statistical power of this study alone is not adequate to 
warrant definite conclusions. The results can be used in a meta-analysis as 
soon as other studies on the carcinogenicity of 8-MOP bath PUVA are 
published.(J Am Acad Dermatol 1999;40:694-6.) 

===================================================================== 
25.) Comparison of psoralen-UVB and psoralen-UVA photochemotherapy in the 
treatment of psoriasis 
===================================================================== 
D. A. R. de Berker, MRCPa A. Sakuntabhai, MDa B. L. Diffey, PhDb 
J. N. S. Matthews, PhDc P. M. Farr, MDa 
Newcastle upon Tyne and Durham, United Kingdom 

Abstract 
Background: PUVA treatment of psoriasis is usually given with broad-band 
fluorescent UVA lamps. Narrow-band UVB exposure after oral methoxsalen has 
been shown to achieve a greater therapeutic response in psoriasis than 
identical UVB exposure given without psoralen. 
Objective: The purpose of this study was to compare conventional PUVA with 
psoralen-UVB therapy in psoriasis. 
Methods: We studied 100 patients with plaque-type psoriasis who were 
randomly selected to receive either conventional psoralen-UVA or 
psoralen-UVB treatment. 
Results: No significant difference was found between the two treatments in 
the proportion of patients whose skin cleared during treatment or in the 
number of exposures required for clearance of psoriasis. As expected, the 
cumulative UV dose for clearance was smaller in the group treated with UVB 
compared with those receiving UVA. Side effects and disease status at 3 
months after the end of treatment were similar for the two groups. 
Conclusion: Psoralen-UVB treatment of psoriasis is as effective as 
conventional PUVA. The mechanism of psoralen-311 nm UVB action on psoriasis 
requires study to predict the long-term safety of this treatment. (J Am 
Acad Dermatol 1997;36:577-81.) 

===================================================================== 
26.)Ranitidine does not affect psoriasis: A multicenter, double-blind, 
placebo-controlled study 
===================================================================== 
I. M. Zonneveld, MDa M. M. H. M. Meinardi, MDa T. Karlsmark, MDb 
U. Broby Johansen, MDb G. R. R. Kuiters, MDc 
L. Hamminga, MDc B. Staberg, MDd A. J. van’t van’t Veen, MDe 
P. M. M. Bossuyt, PhDf J. C. G. van Niel, PhDg J. D. Bos, MDa 
Amsterdam, Zwolle, and Rotterdam, The Netherlands, and Copenhagen and 
Rødovre, Denmark 

Abstract 
Background: Data from open studies suggest that ranitidine has a beneficial 
effect on psoriasis and is well tolerated. 
Objective: Our purpose was to determine the effectiveness of ranitidine in 
a 24-week, multicenter, double-blind, placebo-controlled, dose-comparing 
study of 201 patients with psoriasis. 
Methods: Patients with moderate to severe psoriasis who had stopped 
systemic antipsoriatic therapy, including PUVA and UVB, for at least 10 
weeks were included. After a washout period of 2 weeks, patients were 
randomly allocated to use either ranitidine, 150 mg twice a day; 
ranitidine, 300 mg twice a day; or placebo for up to 24 weeks. Assessment 
with the Psoriasis Area and Severity Index was performed at weeks 3, 6, 9, 
12, 18, and 24 after randomization. Reduction of the Psoriasis Area and 
Severity Index score by 70% at the completion of the study was considered a 
treatment success. 
Results: The success rates at week 24 in the 300 mg, 600 mg, and placebo 
groups were 11%, 5%, and 12%, respectively. No significant differences were 
observed between the three treatment groups at any stage of the study. 
Conclusion: This study provides strong evidence that ranitidine does not 
affect the skin disease in patients with psoriasis. (J Am Acad Dermatol 
1997;36:932-4.) 

===================================================================== 
27.) Combined topical calcipotriene ointment 0.005% and various systemic 
therapies in the treatment of plaque-type psoriasis vulgaris: Review of the 
literature and results of a survey sent to 100 dermatologists 
===================================================================== 
H. Irving Katz, MD, Fridley, Minnesota 

Abstract 
Background: Plaque-type psoriasis may at times require systemic therapy. 
There are limited data as to whether topical calcipotriene ointment 0.005% 
can be used to increase the efficacy and improve the risk/benefit ratio of 
concurrent systemic antipsoriatic therapy. 
Objective: We attempt to answer this question by means of a literature 
review and results of a written survey that was sent to 100 international 
psoriasis treatment experts. 
Methods: The survey was sent to academic and psoriasis treatment 
center–based dermatologists who treat approximately 3000 to 4000 patients 
with psoriasis per month. The survey requested that dermatologists relate 
their experience regarding the safety and efficacy of topical, systemic, 
and combined topical/systemic agents in psoriasis after 8 weeks of therapy. 
Results: The results of the survey support the experience in the literature 
regarding the favorable use of calcipotriene ointment combined with 
systemic therapy for the treatment of psoriasis. 
Conclusion:Combination therapy with calcipotriene ointment and 
acitretin/etretinate, cyclosporine, methotrexate, or phototherapy usually 
enhances efficacy while improving the risk/benefit ratio by decreasing 
exposure to the potentially hazardous systemic agent. (J Am Acad Dermatol 
1997;37:S62-S68.) 

===================================================================== 
28.) The genetics of psoriasis 
===================================================================== 
Tilo Henseler, MD, PhD 
Kiel, Germany 

Abstract 
The analysis of population-specific human leukocyte antigen (HLA) 
haplotypes has provided evidence that susceptibility to psoriasis is linked 
to the class I and II major histocompatibility complex on human chromosome 
6. In addition, these studies show that psoriasis consists of two distinct 
disease subtypes (type I and type II), which differ in age of onset and in 
the frequency of HLA. In type I (early-onset) psoriasis, Cw6, B57, and DR7 
are strongly increased, whereas in type II (late-onset) psoriasis, HLA-Cw2 
is overrepresented. It has also been proposed that HLA haplotypes extended 
by class III play a role in the genetics of this disease. Moreover, studies 
of affected families indicate that other disease susceptibility loci may 
also be involved. Likely candidates for additional susceptibility genes are 
located at chromosomes 1, 6, and 17, and microsatellite markers over the 
whole genome have been used to identify susceptibility genes. Two years ago 
linkage to the distal part of chromosome 17 was published. However, this 
linkage could not be confirmed by other groups with comparable or enlarged 
numbers of psoriatic family members investigated. Recently, an 
investigation presenting an area of chromosome 4 as a susceptibility locus 
for psoriasis was published. According to our knowledge today, psoriasis is 
a polygenetically inherited disease. Furthermore from twin studies it is 
known that environmental factors play a significant role in the onset or 
recurrence of the disease. (J Am Acad Dermatol 1997;37:S1-S11.) 

===================================================================== 
29.) The use of topical calcipotriene/calcipotriol in conditions other than 
plaque-type psoriasis 
===================================================================== 
Bruce H. Thiers, MD 
Charleston, South Carolina 

Abstract 
Background: Topical calcipotriene ointment has been approved for the 
treatment of plaque-type psoriasis. 
Objective: This article explores the possible use of topical calcipotriene 
ointment in the treatment of nail and intertriginous psoriasis, 
palmoplantar and pustular psoriasis, Reiter’s syndrome, pityriasis rubra 
pilaris, and disorders of keratinization. 
Methods: The recent literature is reviewed. 
Results: Recent reports suggest that certain ichthyoses (particularly the 
hyperproliferative variants) and keratodermas may respond to topical 
calcipotriene ointment. The activity of calcipotriene relates to a 
dose-dependent decrease in proliferation and an increase in terminal 
differentiation of keratinocytes. 
Conclusion:Patients with other disorders characterized by epidermal 
hyperproliferation may also be candidates for treatment. The use of 
calcipotriene in treating congenital hyperproliferative disorders is 
limited by the theoretical risk of hypercalcemia from absorption of the 
drug after application to extensive areas of skin. (J Am Acad Dermatol 
1997;37:S69-S71.) 

===================================================================== 
30.) Tazarotene: The first receptor-selective topical retinoid for the 
treatment of psoriasis 
===================================================================== 
Roshantha A. S. Chandraratna, PhD 
Irvine, California 

Abstract 
Tazarotene belongs to a novel, nonisomerizable class of retinoic acid 
receptor (RAR)-specific retinoids, the acetylenic retinoids, and is the 
first topical retinoid developed for the treatment of psoriasis. Tazarotene 
targets the keratinocyte and modulates the major causes of psoriasis. 
Tazarotene is rapidly metabolized by esterase to the active free acid 
tazarotenic acid, which is rapidly eliminated in animal species. Tazarotene 
selectively transactivates RAR and RAR subtypes and is inactive at retinoid 
X receptors (RXRs). This receptor selectivity could contribute to an 
optimized therapeutic index. Tazarotene has low systemic absorption after 
topical administration. In preclinical toxicity studies, high topical doses 
produced reversible topical irritation, and lower doses were well 
tolerated. Topical doses were neither teratogenic nor carcinogenic and were 
not sensitizing, phototoxic, or photosensitizing. The topical delivery of 
tazarotene and limited systemic exposure apparently result in a very low 
potential for systemic effects. (J Am Acad Dermatol 1997;37:S12-S17.) 

===================================================================== 
31.) The effects of topical calcipotriol on systemic calcium homeostasis in 
patients with chronic plaque psoriasis 
===================================================================== 
J. F. Bourkea, R. Mumforda, P. Whittakerb, S. J. Iqbalb 
L. W. Le Vand, A. Trevellyanc, P. E. Hutchinsona, Leicester, 
United Kingdom, and Madison, Wisconsin 

Abstract 
Background: Calcipotriol is an effective treatment of chronic plaque 
psoriasis. We have previously demonstrated that it has a small effect on 
systemic calcium homeostasis even at recommended doses. 
Objective: We attempted to determine the mechanism of the effect of 
calcipotriol on sytemic calcium homeostasis so we could assess the possible 
consequences of long-term use. 
Methods: Sixteen patients with extensive chronic plaque psoriasis were 
hospitalized and treated with high-dose topical calcipotriol. Up to 360 gm 
of calcipotriol (50 &micro;g/gm) ointment was applied per week for 2 weeks under 
controlled conditions. 
Results: There was a dose-dependent rise in intestinal absorption of 
calcium. No effect on bone turnover was demonstrated over this short 
period. Five patients became hypercalcemic, and there was a dose-dependent 
rise in serum total adjusted calcium, serum ionized calcium, serum 
phosphate, urine calcium, and urine phosphate. There was a dose-dependent 
fall in serum parathyroid hormone and serum 1,25 dihydroxyvitamin D3. 
Conclusion: Calcipotriol exerts its effects on systemic calcium homeostasis 
by increasing intestinal absorption of calcium and probably phosphate. This 
results in suppression of parathyroid hormone and 1,25 dihydroxyvitamin D3. 
(J Am Acad Dermatol 1997;37:929-34.) 

===================================================================== 
32.) Cyclosporine consensus conference: With emphasis on the treatment of 
psoriasis 
===================================================================== 
Mark Lebwohl, MDa, Charles Ellis, MDb, Alice Gottlieb, MD, PhDc John Koo, 
MDd Gerald Krueger, MDe, Kenneth Linden, MDg, Jerome Shupack, MDf, Gerald 
Weinstein, MDg 
New York, New York; Ann Arbor, Michigan; Newark, New Jersey; San Francisco 
and Irvine, California; and Salt Lake City, Utah 

Abstract 
Cyclosporine has been in worldwide use for 15 years for patients who have 
undergone transplantation operations and is now being used to control 
inflammatory reactions in other organs (eg, joints, bowel, and skin). 
Neoral, a more consistently absorbed form of cyclosporine, has recently 
been approved by the Food and Drug Administration for the treatment of 
psoriasis. This report outlines the indications, contraindications, dosage 
recommendations, monitoring requirements, adverse events, drug 
interactions, interactions with other psoriasis treatments, and suggestions 
for cyclosporine’s use in rotational therapy.(J Am Acad Dermatol 
1998;39:464-75.) 

===================================================================== 
33.) Tazarotene 0.1% gel plus corticosteroid cream in the treatment of 
plaque psoriasis 
===================================================================== 
Mark G. Lebwohl, MDa Debra L. Breneman, MDb Bernard S. Goffe, MDc 
Jay R. Grossman, MDd Mark R. Ling, MD, PhDe James Milbauer, MDf 
Stephanie H. Pincus, MDg R. Gary Sibbald, MDh Leonard J. Swinyer, MDi 
Gerald D. Weinstein, MDj Deborah A. Lew-Kaya, PharmDk John C. Lue, MSk 
John R. Gibson, MDk John Sefton, PhDk 
New York and Buffalo, New York; Cincinnati, Ohio; Seattle, Washington; 
Vista and Irvine, California; Atlanta, Georgia; Hackensack, New Jersey; 
Mississauga, Ontario, Canada; and Salt Lake City, Utah 

Abstract 
Background: Topical corticosteroids are often used in the treatment of 
psoriasis, but long-term use may be associated with serious adverse events 
such as tachyphylaxis or atrophy of the skin. Tazarotene, a new topical 
retinoid, has demonstrated significant clinical benefits but can cause mild 
to moderate local irritation. 
Objective: We evaluate whether a combination treatment of topical 
tazarotene and a topical corticosteroid would increase efficacy while 
reducing the incidence of local adverse events associated with a topical 
retinoid. 
Methods: Three hundred patients enrolled in an investigator-masked study 
were randomly assigned to 1 of 4 treatment groups: tazarotene 0.1% gel in 
combination with placebo cream, or with a low-, mid-, or high-potency 
corticosteroid cream, for 12 weeks of treatment and a posttreatment 
follow-up at week 16. 
Results: Tazarotene 0.1% gel in combination with a mid- or high-potency 
corticosteroid, when compared with tazarotene plus placebo cream, achieved 
significantly greater reductions in scaling, erythema, and overall lesional 
severity, and a decreased incidence of adverse events. 
Conclusion: All tazarotene combinations (including tazarotene plus placebo) 
were highly effective in rapidly reducing the severity of psoriasis. 
Combining tazarotene with a topical corticosteroid increased efficacy while 
reducing the incidence of local adverse events. (J Am Acad Dermatol 
1998;39:590-6.) 

===================================================================== 
34.) The pathogenesis of psoriasis and the mechanism of action of tazarotene 
===================================================================== 
Madeleine Duvic, MD Arisa T. Asano, MD Carina Hager, MD 
Steven Mays, MD 
Houston, Texas 

Abstract 
The 3 major features of psoriasis—abnormal differentiation of 
keratinocytes, hyperproliferation of keratinocytes, and infiltration of 
inflammatory components into the skin—can be quantified by measuring levels 
of certain biochemical markers. Psoriasis is associated with upregulation 
or downregulation of several of these markers. Tazarotene helps to 
normalize the levels of the markers, thereby bringing about clinical 
improvement. (J Am Acad Dermatol 1998;39:S129-33.) 

===================================================================== 
35.) Bath-5-methoxypsoralen-UVA therapy for psoriasis 
===================================================================== 
Pier Giacomo Calzavara-Pinton, MD 
Cristina Zane, MD Anna Carlino, MD Giuseppe De Panfilis, MD 
Brescia, Italy 

Abstract 
Background: After oral intake, 5-methoxypsoralen (5-MOP) is as effective as 
8-MOP for PUVA therapy for psoriasis, with a lower incidence of acute 
cutaneous side effects. 
Objective: We compared bath-water delivery of 5-MOP and 8-MOP for 
photochemotherapy of psoriasis. 
Methods: Twenty-two patients underwent phototesting with 0.0003% 5-MOP or 
8-MOP aqueous solutions. Twelve patients with palmar psoriasis were studied 
with a side-to-side comparison, and 10 patients with recurrent plaque-type 
psoriasis were treated with one therapy or the other. 
Results: Minimal phototoxic dose (MPD) values were 2.8 &plusmn; 1.2 J/cm2 with 
8-MOP and 2.0 &plusmn; 1.2 J/cm2 with 5-MOP (p < 0.01). Both therapies cleared 
palmar lesions but 8-MOP required more UVA irradiation (46.3 &plusmn; 21.0 J/cm2 
vs 30.2 &plusmn; 21.5 J/cm2; p < 0.01) and more exposures (21.0 &plusmn; 6.0 vs 17.0 &plusmn; 
5.0; p = 0.02). Bath-5-MOP-UVA was also more effective in the treatment of 
plaque-type psoriasis (cumulative UVA doses, 56.8 &plusmn; 39.2 vs 59.1 &plusmn; 27.9 
J/cm2; number of exposures, 20.0 &plusmn; 5.7 vs 21.6 &plusmn; 4.7), but these 
differences were not significant (p = NS). Patients developed an intense 
tan significantly earlier with 5-MOP than with 8-MOP (3.5 &plusmn; 0.5 weeks vs 
4.4 &plusmn; 0.5 weeks; p < 0.01). 
Conclusion: Bath-5-MOP-UVA was more phototoxic than bath-8-MOP-UVA. It was 
more effective in the treatment of palmar psoriasis, whereas its greater 
pigmentogenic activity appeared to have an adverse effect on therapeutic 
effectiveness in the treatment of plaque-type psoriasis. (J Am Acad 
Dermatol 1997;36:945-9.) 

===================================================================== 
36.) -3 Fatty acid–based lipid infusion in patients with chronic plaque 
psoriasis: Results of a double-blind, randomized, placebo-controlled, 
multicenter trial 
===================================================================== 
Peter Mayser, MDa Ulrich Mrowietz, MDb Peter Arenberger, MDc 
Pavel Bartak, MDd Jozef Buchvald, MD, PhDe Enno Christophers, MDb 
Stefania Jablonska, MDf Werner Salmhofer, MDg Wolf-Bernhard Schill, MDa 
Hans-Joachim Krämer, PhDh Ewald Schlotzer, PhDi Konstantin Mayer, MDh 
Werner Seeger, MDh Friedrich Grimminger, MD, PhDh 
Giessen, Kiel, and Oberursel, Germany; Prague, Czech Republic; Bratislava, 
Slovak Republic: Warsaw, Poland; and Graz, Austria 

Abstract 
Background: Profound changes in the metabolism of eicosanoids with 
increased concentrations of free arachidonic acid (AA) and its 
proinflammatory metabolites have been observed in psoriatic lesions. Free 
eicosapentaenoic acid (EPA) may compete with liberated AA and result in an 
antiinflammatory effect. 
Objective: Our purpose was to assess the efficacy and safety of 
intravenously administered fish-oil–derived lipid emulsion on chronic 
plaque-type psoriasis. 
Methods: A double-blind, randomized, parallel group study was performed in 
eight European centers. Eighty-three patients hospitalized for chronic 
plaque-type psoriasis with a severity score of at least 15 according to the 
Psoriasis Area and Severity Index (PASI) participated in a 14-day trial. 
They were randomly allocated to receive daily infusions with either a -3 
fatty acid–based lipid emulsion (Omegavenous; 200 ml/day with 4.2 gm of 
both EPA and docosahexaenoic acid (DHA); 43 patients) or a conventional 
-6-lipid emulsion (Lipovenous; EPA+DHA < 0.1 gm/100 ml; 40 patients). The 
groups were well matched with respect to demographic data and 
psoriasis-specific medical history. Efficacy of therapy was evaluated by 
changes in PASI, in an overall assessment of psoriasis by the investigator, 
and a self-assessment by the patient. In one center neutrophil 4- versus 
5-series leukotriene (LT) generation and platelet 2- versus 3- thromboxane 
generation were investigated and plasma-free fatty acids were determined. 
Results: The total PASI score decreased by 11.2 &plusmn; 9.8 in the -3 group and 
by 7.5 &plusmn; 8.8 in the -6 group (p = 0.048). In addition, the -3 group was 
superior to the -6 group with respect to change in severity of psoriasis 
per body area, change in overall erythema, overall scaling and overall 
infiltration, as well as change in overall assessment by the investigator 
and self-assessment by the patient. Response (defined as decrease in total 
PASI of at least 50% between admission and last value) was seen in 16 of 43 
patients (37%) receiving the -3 emulsion and 9 of 40 patients (23%) 
receiving -6 fatty acid–based lipid emulsion. No serious side effects were 
observed. Within the first few days of -3 lipid administration, but not in 
the -6 supplemented patients, a manifold increase in plasma-free EPA 
concentration, neutrophil leukotriene B5 and platelet thromboxane B3 
generation occurred. 
Conclusion: Intravenous -3-fatty acid administration is effective in the 
treatment of chronic plaque-type psoriasis. This effect may be related to 
changes in inflammatory eicosanoid generation. (J Am Acad Dermatol 
1998;38:539-47.) 

===================================================================== 
37.) Immunopathogenesis of Psoriasis 
===================================================================== 
Alice Bendix Gottlieb, MD, PhD Chief of Dermatology and Associate Professor 
University of Medicine and Dentistry of New Jersey Robert Wood Johnson 
Medical School 
Clinical Academic Building 125 Paterson St 
New Brunswick, NJ 08901 

Archives of Dermatology Editorial - June 1997 

The Road From Bench to Bedside is a 2-Way Street 
In this age of genetic engineering and transgenic and knockout mice, it is 
sobering to realize that the immunopathogenesis of psoriasis was discovered 
largely through clinical research in patients with psoriasis. Before the 
mid-1980s, the keratinocyte was the focus of scientific research in 
psoriasis because both the clinical and histologic phenotypes of this 
disease are dominated by the results of abnormal keratinocyte proliferation 
and differentiation.[1-6] However, the results of research since then have 
demonstrated that if one eliminates the activated T lymphocyte in psoriatic 
plaques, keratinocyte proliferation and differentiation return to normal 
both clinically and histologically.[7-10] Thus, the abnormalities in the 
keratinocytes are reversible. Clinically, psoriatic plaques are described 
as red, elevated, and scaly. Both the elevation and scale are direct 
results of the same altered keratinocyte proliferation and differentiation 
that have been observed in acute and chronic cutaneous wounds. This 
alternate pathway of keratinocyte differentiation has been termed 
regenerative maturation.[1] It is characterized by increased proliferation 
in both basal and suprabasal keratinocytes, K-16 keratin expression in the 
viable suprabasal keratinocyte layers, and patchy to absent expression of 
filaggrin.[1,3,7-9,11] In the mid-1980s, activated T lymphocytes 
(high-affinity interleukin-2 receptor-bearing T lymphocytes) and interferon 
gamma-induced proteins on the surfaces of keratinocytes were detected in 
psoriatic plaques,[12-20] and the first reports of clinical efficacy of the 
immunosuppressant cyclosporine were published.[17,21,22] The research began 
to focus on the T lymphocyte. However, the clinical response to 
cyclosporine treatment was not definitive pathogenic proof since 
cyclosporine is demonstrated to affect both keratinocyte and lymphocyte 
function at concentrations detected in skin samples of patients with 
psoriasis who were treated with cyclosporine.[19,23,24] Therefore, it was 
not a clean reagent to use as a therapeutic probe into the pathogenic 
origin of psoriasis. The clinical availability of an 
interleukin-2-diphtheria toxin fusion protein, which was specific for 
activated T lymphocytes bearing high-affinity interleukin-2 receptors and 
did not react with keratinocytes, provided the ideal reagent for testing 
which cell drives the psoriatic plaque--the T lymphocyte or the 
keratinocyte. As a single therapeutic agent, the treatment of patients with 
psoriasis using the interleukin-2-diphtheria toxin fusion protein resolved 
the psoriatic plaques both clinically and histologically.[8] Therefore, the 
T lymphocyte, and not the keratinocyte, drives the psoriatic plaque. 
Further reports have demonstrated that remittive psoriatic treatments (ie, 
those that result in prolonged clearance of psoriatic lesions in the 
absence of continuous treatment), such as treating inpatients with UV-B and 
topical tar or oral psoralen with UV-A, induced apoptosis in T cells with 
cell death in vitro. Activated T lymphocytes were more sensitive to these 
effects than keratinocytes.[7,9] In contrast, suppressive treatments (ie, 
those that require continual treatment to maintain the clearance of 
lesions), such as cyclosporine or etretinate, merely suppressed T-cell 
function or proliferation and did not induce apoptosis in vitro.[23,25,26] 

OLIGOCLONAL EXPRESSION OF T-CELL RECEPTOR Vbeta SUBGROUPS IN PSORIATIC, 
LESIONAL EPIDERMAL CD8+ T LYMPHOCYTES 
The accumulated work by Chang et al and others[27,28] has resulted in 
clinical trials in patients with psoriasis, with therapeutic vaccines made 
of T-cell receptor Vbeta peptides, only 1 year after the original 
publication by Chang et al[27] in 1995. Chang et al cloned activated T 
lymphocytes from psoriatic plaques. Their results demonstrated the 
oligoclonal expression of Vbeta T-cell receptor subgroups Vbeta3 and 
Vbeta13.1 in only the CD8+ T cells cloned from psoriatic lesional 
epidermis. The results did not demonstrate oligoclonal expression in CD8+ T 
cells from psoriatic lesional dermis, from any psoriatic CD4+ T cells, and 
in any T cells similarly cloned from lesions of patients with atopic 
dermatitis. Using different technologies, Menssen and coworkers[28] looked 
at Vbeta restrictions in punch biopsy specimens, which included both 
epidermis and dermis, and found Vbeta2 and Vbeta6 overexpression in the 
results. Other investigators,[29] again using different technologies, could 
not find the clonality of Vbeta T-cell receptor expression. The possibility 
was brought up that by using technology based on polymerase chain reaction 
Chang et al had merely demonstrated a small population of T cells, which 
could express messenger RNA at exceedingly high rates, and not a key 
subpopulation, which could potentially be the pathogenic T cells in 
psoriasis. In the article entitled "Persistence of T-Cell Clones in 
Psoriatic Lesions," published in this issue of the ARCHIVES, Chang et 
al[30] sorted CD8+ T cells and assessed clonality at the message level. To 
demonstrate that the message level reflected the proportion of T cells 
bearing that specific Vbeta T-cell receptor and that the clonal dominance 
originally detected was not due to an overabundance of messenger RNA 
expressed by only a few cells, they sorted the Vbeta13.1+ cells directly 
from psoriatic lesional epidermis. In that way, the authors could determine 
whether the clonality observed by assessing the T-cell receptor messenger 
RNA accurately reflected the clonality in the T-cell population. Vbeta13.1+ 
T lymphocytes, sorted directly from the skin biopsy specimens of psoriatic 
plaques, again exhibited clonal dominance. The dominant Vbeta13.1 clone, as 
detected by sequence analysis, was the same as that detected in the same 
patients in the original publication by these investigators.[27] 
Additionally, in 8 of the 9 new patients examined, the results again 
demonstrated the preferential use of Vbeta3 and/or Vbeta13.1 genes by 
lesional CD8+ T lymphocytes. Thus, the clonality detected in Vbeta messages 
of CD8+ T cells sorted from psoriatic plaques accurately reflected clonal 
dominance. In addition, the same clone persisted for as long as 15 months. 
The demonstration of the same overrepresentation of Vbeta3 and Vbeta13.1 in 
CD8+ T cells from psoriatic plaques in a new population of patients 
confirmed the original suggestion that these T cells may play a pathogenic 
role in psoriasis. 

NOVEL IMMUNOTHERAPIES FOR PSORIASIS ARE NOW IN THE CLINIC 
These studies started in the clinic and now have returned to the clinic in 
the form of a recently completed double-blind, phase 2, adjuvant-controlled 
study of a therapeutic vaccine consisting of Vbeta3 and Vbeta13.1 peptides 
in patients with moderate to severe psoriasis. At a recent meeting 
dedicated to the basic and clinical research of psoriasis, a number of 
pharmaceutical companies presented their work, which targets the T 
lymphocyte. Targets include accessory molecules of T-cell activation 
(B7/CD28), the interleukin-2-diphtheria toxin fusion protein, a 
purine-nucleoside phosphorylase inhibitor, and T-cell receptor peptide 
vaccines. Many investigators in both industry and academics use psoriasis 
as the paradigm of a TH1-mediated immune disease. These studies have shown 
that collaboration between the pharmaceutical industry and academics yields 
good science. Research in psoriasis has demonstrated the power of clinical 
research in determining the mechanism of disease (ie, the road from bench 
to bedside is a 2-way street). 

This work was funded by a grant from the Foundation of the University of 
Medicine and Dentistry of New Jersey, New Brunswick, to support dermatology 
research in the Division of Dermatology at the University of Medicine and 
Dentistry of New Jersey-Robert Wood Johnson Medical School. 

References 
1. Mansbridge JN, Knapp AM. Changes in keratinocyte maturation during wound 
healing. J Invest Dermatol. 1987;89:253-263. 

2. Gottlieb AB, Chang CK, Posnett DN, Fanelli B, Tam JP. Detection of 
transforming growth factor alpha in normal, malignant, and 
hyperproliferative human keratinocytes. J Exp Med. 1988;167:670-675. 

3. Krueger JG, Krane JF, Carter DM, Gottlieb AB. Role of growth factors, 
cytokines, and their receptors in the pathogenesis of psoriasis. J Invest 
Dermatol. 1990;94(suppl):135S-140S. 

4. Krane JF, Gottlieb AB, Carter DM, Krueger JG. The insulin-like growth 
factor I receptor is overexpressed in psoriatic epidermis, but is 
differentially regulated from the epidermal growth factor receptor. J Exp 
Med. 1992;175:1081-1090. 

5. Nickoloff BJ. The cytokine network in psoriasis. Arch Dermatol. 
1991;127:871-884. 

6. Weinstein GD. Methotrexate: diagnosis and treatment drugs five years 
later. Ann Intern Med. 1977;86:199-204. 

7. Krueger JG, Wolfe JT, Nabeya RT, et al. Successful ultraviolet B 
treatment of psoriasis is accompanied by a reversal of keratinocyte 
pathology and by selective depletion of intraepidermal T cells. J Exp Med. 
1995;182:2057-2068. 

8. Gottlieb SL, Gilleaudeau P, Johnson R, et al. Response of psoriasis to a 
lymphocyte-selective toxin (DAB389IL-2) suggests a primary immune, but not 
keratinocyte, pathogenic basis. Nat Med. 1995;1:442-447. 

9. Vallat VP, Gilleaudeau P, Battat L, et al. PUVA bath therapy strongly 
suppresses immunological and epidermal activation in psoriasis: a possible 
cellular basis for remittive therapy. J Exp Med. 1994;180:283-296. 

10. Krueger JG, Gottlieb AB. Cellular signalling in psoriasis: growth 
factors, cytokines and eicosanoids. In: Dubertret L, ed. Psoriasis. 
Brescie, Italy: ISED Press; 1994:18-28. 

11. Gerritsen MJP, Boezeman JBM, van Vlijmen-Willems IMJJ, Van de Kerkhof 
PCM. The effect of tacalcitol (1,24(OH)2D3) on cutaneous inflammation, 
epidermal proliferation and keratinization in psoriasis: a 
placebo-controlled, double-blind study. Br J Dermatol. 1994;131:57-63. 

12. Gottlieb AB, Lifshitz B, Fu SM, Staiano-Coico L, Wang CY, Carter DM. 
Expression of HLA-DR molecules by keratinocytes and presence of Langerhans 
cells in the dermal infiltrate of active psoriatic plaques. J Exp Med. 
1986;164:1013-1028. 

13. Gottlieb AB. Immunologic mechanisms in psoriasis. J Am Acad Dermatol. 
1988;18:1376-1380. 

14. Gottlieb AB, Luster AD, Posnett DN, Carter DM. Detection of a 
gamma-interferon-induced protein (IP-10) in psoriatic plaques. J Exp Med. 
1988;168:941-948. 

15. Gottlieb AB, Krueger JG. HLA region genes and immune activation in the 
pathogenesis of psoriasis. Arch Dermatol. 1990;126:1083-1086. 

16. Gottlieb AB, Krueger JG. The role of activated T lymphocytes in the 
pathogenesis of psoriasis. In: Dubertret L, ed. Psoriasis. Brescie, Italy: 
ISED Press; 1994:63-71. 

17. Baker BS, Griffiths CEM, Lambert S, et al. The effects of cyclosporin A 
on T lymphocyte and dendritic cell sub-populations in psoriasis. Br J 
Dermatol. 1987;116:503-510. 

18. Livden JK, Nilsen R, Bjerke JR, Matre R. In situ localization of 
interferons in psoriatic lesions. Arch Dermatol Res. 1989;281:392-397. 

19. Cooper KD. Psoriasis: leukocytes and cytokines. Dermatol Clin. 
1990;8:737-745. 

20. Nickoloff BJ, Kunkel SL, Burdick M, Strieter RM. Severe combined 
immunodeficiency mouse and human psoriatic skin chimeras: validation of a 
new animal model. Am J Pathol. 1995;146:580-588. 

21. Ellis CN, Fradin MS, Messana JM, et al. Cyclosporine for plaque-type 
psoriasis: results of a multidose, double-blind trial. N Engl J Med. 
1991;324:277-284. 

22. Bos JD, VanJoost T, Powles AV, Meinardi MMHM, Fry L. Use of cyclosporin 
in psoriasis. Lancet. 1989;23:1500-1989. 

23. Gottlieb AB, Grossman RM, Khandke L, et al. Studies of the effect of 
cyclosporine in psoriasis in vivo: combined effects on activated T 
lymphocytes and epidermal regenerative maturation. J Invest Dermatol. 
1992;98:302-309. 

24. Khandke L, Ashinoff R, Krueger JG, et al. Effect of cyclosporin A on 
the regulation of signal transduction mechanisms in cultured keratinocytes. 
J Invest Dermatol. 1990;94:541. Abstract. 

25. Lu I, Gilleaudeau P, McLane JA, et al. Modulation of epidermal 
differentiation, tissue inflammation, and T-lymphocyte infiltration in 
psoriatic plaques by topical calcitriol. J Cutan Pathol. 1996;23:419-430. 

26. Gottlieb SL, Hayes E, Gilleaudeau P, Cardinale I, Gottlieb AB, Krueger 
JG. Etretinate promotes keratinocyte terminal differentiation and reduces 
T-cell infiltration in psoriatic epidermis. J Cutan Pathol. 1996;23:404-418. 

27. Chang JC, Smith LR, Froning KJ, et al. CD8+ T cells in psoriatic 
lesions preferentially use T-cell receptor V beta 3 and/or V beta 13.1 
genes. Proc Natl Acad Sci U S A. 1995;91:9282-9286. 

28. Menssen A, Rommler P, Vollmer S. Evidence for an antigen-specific 
cellular immune response in skin lesions of patients with psoriasis 
vulgaris. J Immunol. 1995;155:4078-4083. 

29. Schmitt-Egenolf M, Boehncke W, Christophers E, Stander M, Sterry W. 
Type I and type II psoriasis show a similar usage of T-cell receptor 
variable regions. J Invest Dermatol. 1991;97:1053-1056. 

30. Chang JCC, Smith LR, Froning KJ, et al. Persistence of T-cell clones in 
psoriatic lesions. Arch Dermatol. 1997;133:703-708. 

(Arch Dermatol. 1997;133:781-782) 

===================================================================== 
38.) Epstein-Barr Virus-Associated Lymphoproliferative Disease During 
Methotrexate Therapy for Psoriasis 
===================================================================== 
Carle Paul, MD; Agnés Le Tourneau, MD; Jean Michel Cayuela, PhD; Alain 
Devidas, MD; Caroline Robert, MD; Vincent Molinié, MD; Louis Dubertret, MD 

Background: Epstein-Barr virus (EBV)-associated lymphoproliferative 
disorders have recently been observed during treatment of rheumatoid 
arthritis and dermatomyositis with low-dose methotrexate. 

Observation: A patient with psoriasis developed a B-cell 
lymphoproliferative disorder during long-term treatment with low-dose 
methotrexate. The lymphoid cells expressed EBV latent membrane protein 1, 
and the EBV viral genome was present as demonstrated by in situ 
hybridization. Evaluation for EBV clonality showed that the lymph node 
contained clonal EBV DNA. Polymerase chain reaction studies confirmed that 
the B-cell lymphoproliferative disorder was mainly monoclonal, suggesting 
that the disorder arose from a single EBV-infected B-cell clone. 

Conclusions: Lymphoproliferative disorders associated with Epstein-Barr 
virus in which the clinicopathological presentation is similar to those 
occurring in patients after transplantation may be observed in patients 
with psoriasis treated with methotrexate. While it is impossible to rule 
out a fortuitous occurrence of an EBV-associated lymphoproliferative 
disorder and psoriasis treated with methotrexate in the same patient, EBV 
appears to be critical in the pathogenesis of the lymphoproliferative 
disorder in this patient. 

Arch Dermatol. 1997;133:867-871 

===================================================================== 
39.) Long-term Safety of Cyclosporine in the Treatment of Psoriasis 
===================================================================== 
Rachel M. Grossman, MD; Sylvie Chevret, MD, PhD; Johnny Abi-Rached, MD; 
Francoise Blanchet, MD; Louis Dubertret, MD 

Background and Design: Cyclosporine has proved to be highly effective in 
the treatment of psoriasis. However, cyclosporine is potentially toxic. 
Side effects include renal toxic effects, hypertension, and an increased 
risk of malignant neoplasm. The toxicity of cyclosporine is dose-related, 
yet the safe duration of treatment is undefined. We studied the hospital 
records of all patients with psoriasis treated with cyclosporine at Saint 
Louis Hospital, Paris, France, between January 1, 1987, and December 31, 
1993. In total, 122 patients treated for 3 to 76 months were evaluated. 

Results: The percentage of patients who discontinued treatment because of 
side effects rose from a mean+/-SD of 14%+/-2.4% at 12 months to 41%+/-6.7% 
at 48 months. An increase in serum creatinine levels to more than 30% above 
the baseline value occurred in 53 patients after a median treatment time of 
23 months. Hypertension developed in 29 patients after a median treatment 
time of 53 months. Three initial patient characteristics--age older than 50 
years (P=.04), initial diastolic pressure higher than 75 mm Hg (P=.05), and 
serum creatinine levels more than 100 micromol/L (1.1 mg/dL) (P=.02, log 
rank test)--predicted discontinuation of cyclosporine because of side 
effects. 

Conclusions: The risk of cyclosporine-induced toxic effects increases with 
age of the patient and with preexisting hypertension or high serum 
creatinine levels. The data suggest that the incidence of side effects 
increases with time. Thus, cyclosporine is not an acceptable long-term 
monotherapy for psoriasis. 

(Arch Dermatol. 1996;132:623-629) 


===================================================================== 
40.) Acitretin Therapy Is Effective for Psoriasis Associated With Human 
Immunodeficiency Virus Infection 
===================================================================== 
Laura Buccheri, MD; Bradford R. Katchen, MD; Andrew J. Karter, PhD; Steven 
R. Cohen, MD 

Objective: To determine the safety, tolerability, and effectiveness of a 
newer retinoid, acitretin, as monotherapy for psoriasis associated with 
human immunodeficiency virus infection (PS-HIV). 

Design: Pilot investigation. 

Setting: An academic medical center. 

Patients: Eleven patients selected from volunteers with PS-HIV were 
enrolled in a 20-week treatment protocol. Two patients discontinued 
participation in the study because of worsening psoriasis; a third patient 
was unable to continue treatment after having a myocardial infarction, 
presumably unrelated to acitretin therapy. 

Intervention: Each patient received an optimized dose of acitretin during 
the period of observation. Clinical and laboratory assessments were 
performed every 2 weeks during the trial. 

Main Outcome Measures: The Psoriasis Area and Severity Index was used to 
assess the clinical response to treatment. To monitor for toxic drug 
effects, a panel of laboratory parameters, including complete blood cell 
count, biochemistry profile, urinalysis, HLA typing, skin biopsy for 
histological examination, and T-cell counts, was performed. 

Results: Six (54%) of 11 patients with PS-HIV achieved good to excellent 
responses using acitretin monotherapy. Four patients (36%) achieved 
complete clearing. There was no evidence of a correlation between the 
pretreatment measures of immunosuppression and the therapeutic response. 
Parameters of immunosuppression were not exacerbated by acitretin therapy. 

Conclusions: Acitretin is a safe and effective treatment for PS-HIV. Both 
skin and joint manifestations of PS-HIV responded to acitretin therapy in 
most patients. Optimal results were achieved with a dose of 75 mg/d. The 
adverse effects were moderate and well tolerated. Acitretin does not appear 
to have immunosuppressive properties. A formal randomized clinical trial is 
warranted. 

Arch Dermatol. 1997;133:711-715 

===================================================================== 
41.) Methotrexate Osteopathy in Long-term, Low-Dose Methotrexate Treatment 
for Psoriasis and Rheumatoid Arthritis 
===================================================================== 
Ingrid M. Zonneveld, MD; Wiepke K. Bakker, MD; Piet F. Dijkstra, MD, PhD; 
Jan D. Bos, MD, PhD; Renee M. van Soesbergen, MD, PhD; Huib J. Dinant, MD, 
PhD 

Background: In dermatology and rheumatology, methotrexate is frequently 
prescribed in low dosages per week; in oncology, high dosages per week are 
prescribed. Methotrexate osteopathy was first reported in children with 
leukemia treated with high doses of methotrexate. In animal studies, low 
doses of methotrexate proved to have an adverse effect on bone metabolism, 
especially on osteoblast activity. 

Observations: Methotrexate osteopathy is a relatively unknown complication 
of low-dose methotrexate treatment. We describe three patients treated with 
low-dose oral methotrexate in whom signs and symptoms were present that 
were similar to those found in children treated with high doses of 
methotrexate. All three patients had a triad of severe pain localized in 
the distal tibiae, osteoporosis, and compression fractures of the distal 
tibia, which could be identified with radiographs, technetium Tc 99m 
scanning, and magnetic resonance imaging. 

Conclusions: Methotrexate osteopathy can occur in patients treated with low 
doses of methotrexate, even over a short period of time. As pain is 
localized in the distal tibia, it is easily misdiagnosed as psoriatic 
arthritis of the ankle, but the diagnosis can be correctly made by careful 
investigation and use of imaging techniques. The only therapy is withdrawal 
of methotrexate. It is important that more physicians become aware of this 
side effect of methotrexate therapy, which can occur along with arthritic 
symptoms. (Arch Dermatol. 1996;132:184-187) 

===================================================================== 
42.)Commercial tanning bed treatment is an effective psoriasis treatment: results from 
an uncontrolled clinical trial. 
===================================================================== 
Fleischer AB Jr; Clark AR; Rapp SR; Reboussin DM; Feldman SR 
Department of Dermatology, Bowman Gray School of Medicine of Wake Forest 
University, Winston-Salem, North Carolina, U.S.A. 
J Invest Dermatol (UNITED STATES) Aug 1997 109 (2) p170-4 ISSN: 0022-202X 
Language: ENGLISH 
Document Type: CLINICAL TRIAL; JOURNAL ARTICLE 
Journal Announcement: 9710 
Subfile: INDEX MEDICUS 
Phototherapy is highly effective in the therapy of psoriasis, but patient access to 
phototherapeutic facilities is not universal. Commercial tanning facilities are 
universal, but their efficacy in psoriasis treatment is unestablished. Our purpose 
was to conduct a study to assess the effect of a commercial tanning unit outfitted 
with nonprescription lamps on psoriasis. We conducted a 6-wk open study of 20 adult 
patients with stable psoriasis vulgaris. Clinical response was defined as a decrease 
in the Psoriasis Area Severity Index (PASI) or the Self-Administered PASI (SAPASI) by 
> or = 10%. There were 16 men and 4 women who participated with a mean (+/-SD) age 
of 43.0 +/- 14.8 y. Initial and final health-related quality of life information 
collected included the following instruments: the Brief Symptom Inventory (BSI), the 
Psoriasis-Related Stressor Scale (PRSS), and the Psoriasis Disability Scale (PDS). 
Side effects of tanning therapy were closely monitored. Fifteen subjects completed 
the entire 6-wk trial, and exit data on all subjects were used for analysis. The 
mean number of tanning sessions was 19 +/- 7.6 with a median of 19 and range of 3 to 
29. Analysis of all 20 enrolled subjects found that 16 (80%) showed clinical 
response as measured by PASI, whereas 17 (85%) showed SAPASI response. Initial and 
final PASI scores decreased (p = 0.0001) from 7.96 +/- 1.77 to 5.04 +/- 2.5, and 
SAPASI scores also decreased (p = 0.02) from 11.8 +/- 4.4 to 7.9 +/- 7.7. When 
controlled for age and sex, a dose-response relationship was demonstrated with the 
PASI and SAPASI (p < 0.02). Decreases in the mean BSI and PRSS scales were 
demonstrated (p < 0.02), confirming the clinical significance of the reductions in 
disease severity scores. Episodes of mild burning occurred in 7 of 20 (35%) 
participants. Three subjects reported itching after one or two tanning sessions. 
This study showed that a tested commercial nonprescription tanning unit improved both 
psoriasis severity and health-related quality of life. Commercial tanning bed 
treatments may be a useful approach in patients unable to obtain office-based 
ultraviolet treatments. 

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43.) Transfer of autoimmune thyroiditis and resolution of palmoplantar pustular 
psoriasis following allogeneic bone marrow transplantation. 
===================================================================== 
Kishimoto Y; Yamamoto Y; Ito T; Matsumoto N; Ichiyoshi H; Katsurada T; Date M; Ohga 
S; Kitajima H; Ikehara S; Fukuhara S 
First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka, 
Japan. 
Bone Marrow Transplant (ENGLAND) May 1997 19 (10) p1041-3 ISSN: 0268-3369 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9710 
Subfile: INDEX MEDICUS 
We report an unusual case of a patient who was cured of one autoimmune disease 
(palmoplantar pustular psoriasis (PPP)) but developed another autoimmune disease 
(autoimmune thyroiditis) after allogeneic BMT. A 40-year-old man suffering from AML 
with PPP underwent allogeneic BMT from his HLA-identical sister for the treatment of 
AML. The patient experienced complete clearance of the cutaneous PPP despite the 
cessation of immunosuppressive therapy for over 2 years. However, he developed 
hyperthyroidism with anti-thyroglobulin antibodies 5 months after BMT, although he 
had showed normal thyroid functions without anti-thyroglobulin antibodies before BMT. 
The donor had no history of thyroid diseases and showed normal thyroid functions but 
was positive for anti-thyroglobulin antibodies. Thus, even when the donor is in a 
subclinical state, autoimmune thyroiditis may be transferred from donors to 
recipients by BMT. 

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44.) Demographic evaluation of successful antipsoriatic climatotherapy at the Dead Sea 
===================================================================== 
(Israel) DMZ Clinic. 
Harari M; Shani J 
German Medical Centre (DMZ Clinic), Ein-Bokek, Israel. 
Int J Dermatol (UNITED STATES) Apr 1997 36 (4) p304-8 ISSN: 0011-9059 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9709 
Subfile: INDEX MEDICUS 
BACKGROUND: Natural balneologic properties, thermomineral springs and unequivocal 
success in improving psoriasis, attract an ever-growing number of psoriatics to the 
DMZ Clinic on the shores of the Dead Sea in Israel. METHODS: This paper analyses the 
rate of success of this balneotherapy in 740 psoriatics who flew in from Germany 
specifically for this treatment, during 1995, as a function of sex, family history of 
the disease, number of previous treatments at the Dead Sea, skin type, skin 
involvement, joint involvement, duration of treatment, sun-exposure schedule, 
remission length, and psychologic supervision. RESULTS: After 4 weeks, 70% of the 
patients were completely cleared, this improvement being about the same across both 
sexes. Family history of the disease, skin type, and psychologic support did not 
affect the rate of success. On the other hand, previous treatments at the Dead Sea, 
moderate to severe skin surface involvement, and participation of arthritis, improved 
the chance of better clearing of the psoriatic condition. Similar improvement was 
obtained by a longer sun-exposure schedule and a complete-4-week treatment. 
CONCLUSION: These results indicate that the medical improvement in the psoriatic 
condition after a 4-week stay at the Dead Sea can be better enhanced and its 
remission prolonged if additional demographic and anamnestic factors are carefully 
taken into account. 

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45.) Topical calcipotriene in combination with UVB phototherapy for psoriasis. 
===================================================================== 
Hecker D; Lebwohl M 
Department of Dermatology, Mount Sinai School of Medicine, New York, USA. 
Int J Dermatol (UNITED STATES) Apr 1997 36 (4) p302-3 ISSN: 0011-9059 
Language: ENGLISH 
Document Type: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL 
Journal Announcement: 9709 
Subfile: INDEX MEDICUS 
A total of 20 patients with symmetric plaque-type psoriasis were recruited for a 
controlled, investigator-blinded, right-left study. None of the patients had used 
any therapy other than emollients for 2 months prior to starting in the trial. All 
patients had a negative antinuclear antibody. By history, all patients had 
previously improved upon exposure to sunlight or ultraviolet light. Two symmetrical 
sites of equal severity were selected as target areas. Each patient was treated on 
one side with mineral oil twice daily and on the opposite side with calcipotriene 
0.005% ointment twice daily. The investigator was blinded as to which site received 
which topical treatment. Both sides were treated with equal doses of ultraviolet B 
(UVB) three times weekly in graduated suberythemogenic doses. Ultraviolet B 
radiation was emitted by a group of 6-ft fluorescent bulbs (Light Sources FS72 T12 
UVB HO) in a standard phototherapy unit. The above regimen was continued for a total 
of 12 weeks. The severity of psoriasis in the target sites was rated by the examiner 
at baseline and at weekly intervals for the 12 weeks of study. Target sites were 
rated by severity of erythema, scaling, plaque elevation, and pruritus, with each of 
these parameters being assigned a score on a four-point scale: 0, clear; 1, mild; 2, 
moderate; 3, severe. The four scores were added together to arrive at a total 
severity score for each of the target sites. Statistical analysis was performed 
using the paired t test, P values less than 0.05 were considered statistically 
significant. Eleven of the 20 patients (55%) showed a greater decrease in the 
severity of their psoriasis with UVB plus calcipotriene compared with UVB plus 
mineral oil. The difference in severity scores between the two groups was 
statistically significant as early as week 1 (P < 0.05). The difference between the 
UVB and calcipotriene group versus the UVB and mineral oil group peaked between weeks 
3 and 6. The differences then decreased but remained statistically significant 
through to week 12 (Fig. 1). There were no instances of local cutaneous irritation, 
but mild photosensitivity occurred symmetrically on both sides in three patients. 

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46.) A controlled trial of acupuncture in psoriasis: no convincing effect. 
===================================================================== 
Jerner B; Skogh M; Vahlquist A 
Department of Dermatology, Linkoping University, Sweden. 
Acta Derm Venereol (NORWAY) Mar 1997 77 (2) p154-6 ISSN: 0001-5555 
Language: ENGLISH 
Document Type: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL 
Journal Announcement: 9708 
Subfile: INDEX MEDICUS 
Several uncontrolled studies have suggested that acupuncture is an effective 
treatment for psoriasis. To test this hypothesis, 56 patients suffering from long- 
standing plaque psoriasis were randomized to receive either active treatment 
(electrostimulation by needles placed intramuscularly, plus ear-acupuncture) or 
placebo (sham, 'minimal acupuncture') twice weekly for 10 weeks. The severity of the 
skin lesions was scored (PASI) before, during, and 3 months after therapy. After 10 
weeks of treatment the PASI mean value had decreased from 9.6 to 8.3 in the 'active' 
group and from 9.2 to 6.9 in the placebo group (p < 0.05 for both groups). These 
effects are less than the usual placebo effect of about 30%. There were no 
statistically significant differences between the outcomes in the two groups during 
or 3 months after therapy. The patient's own opinion about the results showed no 
preference for 'active' therapy. It was also clear from the answers that the blinded 
nature of the study had not been discovered by the patients. In conclusion, 
classical acupuncture is not superior to sham (placebo) 'minimal acupuncture' in the 
treatment of psoriasis. 

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47.) Psoriatic erythroderma: a histopathologic study of forty-five patients. 
===================================================================== 
Tomasini C; Aloi F; Solaroli C; Pippione M 
Department of Dermatology, University of Turin, Italy. 
Dermatology (SWITZERLAND) 1997 194 (2) p102-6 ISSN: 1018-8665 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9708 
Subfile: INDEX MEDICUS 
BACKGROUND: There are conflicting opinions about the diagnostic value of skin 
biopsy in erythrodermic psoriasis. OBJECTIVE: The purpose of the present study was 
to establish the specificity of the histopathologic changes of psoriatic erythroderma. 
METHODS: We reviewed 52 skin biopsies from 45 erythrodermic patients having a final 
diagnosis of psoriasis on the basis of combined clinical and laboratory data, in 
addition to response to therapy and follow-up. In 5 patients, erythroderma was the 
presenting sign of psoriasis. A control group of nonpsoriatic erythrodermic patients 
was also included in the study. RESULTS: Among the group of patients with a 
discharge diagnosis of psoriatic erythroderma, the histopathologic changes were 
specific for psoriasis in 40 cases (88%). The changes of early macular and squamous 
lesions of psoriasis were more often found in the biopsy specimens of our series than 
those of fully developed or late lesions of psoriasis. They included mainly slight 
epidermal hyperplasia, focal disappearance of the granular layer, mounds of 
parakeratosis and extravasated erythrocytes within edematous dermal papillae 
associated with perivascular and interstitial infiltration of lymphocytes and 
histiocytes. CONCLUSION: When features of early lesions of psoriasis are found 
during the evaluation of a biopsy specimen from a patient with a clinically 
nonspecific erythroderma, the dermatopathologist should be aware that this patient 
could have psoriasis and a renewed anamnesis and a close follow-up should be made. 

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48.) [The immunological and morphological aspects of hemoperfusion with pig donor spleen 
in treating psoriasis patients] 
Immunologicheskie i morfologicheskie aspekty gemoperfuzii donorskoi selezenki 
svin'i pri lechenii bol'nykh psoriazom. 
===================================================================== 
Korol' VN; Koliadenko VG; Zhmin'ko PG; Terman AK; Iakub AA; Iankevich MV 
Lik Sprava (UKRAINE) Oct-Dec 1996 (10-12) p138-42 ISSN: 1019-5297 
Language: RUSSIAN Summary Language: ENGLISH 
Document Type: 
JOURNAL ARTICLE English Abstract 
Journal Announcement: 9707 
Subfile: INDEX MEDICUS 
The present paper focuses on the immunological and morphological aspects of 
extracorporal joining up of donor porcine spleen in the treatment of psoriasis. It 
has been ascertained that extracorporal joining up of donor porcine in the treatment 
of psoriasis makes for normalization of bodily immunologic reactivity leading to 
regression of psoriatic eruptions. 

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49.) Clearance of recalcitrant psoriasis after tonsillectomy. 
===================================================================== 
Hone SW; Donnelly MJ; Powell F; Blayney AW 
Department of Otolaryngology/Head and Neck Surgery, Mater Misericordiae Hospital, 
Dublin, Ireland. 
Clin Otolaryngol (ENGLAND) Dec 1996 21 (6) p546-7 ISSN: 0307-7772 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9706 
Subfile: INDEX MEDICUS 
Infection is a well-recognized triggering factor for both guttate and chronic 
plaque psoriasis. We investigated prospectively 13 patients with recalcitrant 
psoriasis exacerbated by recurrent tonsillitis, who underwent tonsillectomy between 
1990 and 1993. There were 12 female patients and one male, with a mean age of 17 yr 
(range 6-28). Six patients had guttate psoriasis resistant to standard treatments 
and seven patients had chronic plaque psoriasis exacerbated by tonsillitis that was 
severe enough to warrant at least one admission to hospital. Patients were followed 
by chart review and postal questionnaire. Psoriasis was cleared completely after 
tonsillectomy in five out of the six patients (83%) with guttate psoriasis and was 
improved in one patient. Two out of seven patients with plaque psoriasis (29%) were 
cleared, two (29%) were improved and three (42%) were unchanged. We conclude that 
tonsillectomy may be a successful treatment modality in selected patients with 
recalcitrant guttate or chronic plaque psoriasis. 

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50.) Psoriasis treatment: bathing in a thermal lagoon combined with UVB, versus UVB 
treatment only. 
===================================================================== 
Olafsson JH; Sigurgeirsson B; Palsdottir R 
Department of Dermatology, University of Iceland, Reykjavik, Iceland. 
Acta Derm Venereol (NORWAY) May 1996 76 (3) p228-30 ISSN: 0001-5555 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9706 
Subfile: INDEX MEDICUS 
We have compared bathing in a thermal lagoon in Iceland, combined with UVB 
treatment, to UVB treatment only in an open comparative study. Twenty-three 
psoriasis patients bathed 3 times daily and were treated with UVB 5 times a week for 
4 weeks. The control group was only treated with UVB 5 times a week for 4 weeks. 
Psoriasis Area and Severity Index (PSAI) was used to estimate the severity of the 
disease. The mean PASI score in the bathing group decreased from 20.8 to 2.8 (p < 
0.01). In the control UVB group, the PASI score decreased from 16. 7 to 6.9. The 
percentage difference between the groups was significant after 1, 2, 2 and 4 weeks. 
Bathing in the lagoon combined with UVB was found to be a very effective treatment 
and better than UVB treatment in our control group. 

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51.) Alternative therapies commonly used within a population of patients with psoriasis. 
===================================================================== 
Fleischer AB Jr; Feldman SR; Rapp SR; Reboussin DM; Exum ML; Clark AR 
Department of Dermatology, Bowman Gray School of Medicine of Wake Forest 
University, Winston-Salem, North Carolina, USA. 
Cutis (UNITED STATES) Sep 1996 58 (3) p216-20 ISSN: 0011-4162 
Contract/Grant No.: MH51552--MH--NIMH 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9704 
Subfile: INDEX MEDICUS 
Alternative therapies are known to be employed by dermatology patients. This study 
investigates the use of alternative medical treatments for psoriasis and the 
sociodemographic variables, conventional medical treatment, and psoriasis disease 
severity. Our study population consisted of 578 university dermatology clinic 
patients with psoriasis and data was analyzed from 317 (55 percent) questionnaire 
respondents. The majority of our sample were women (57 percent) and nonwhites 
represented 8 percent of our sample. Psoriasis severity was measured using the 
validated Self-Administered Psoriasis Area and Severity Index. Alternative medicine 
was used by 62 percent of respondents. Excluding sunlight and nonprescription 
tanning equipment, 51 percent used one or more of the remaining alternative 
therapeutic modalities. The psoriasis severity was worse in those who had tried 
herbal remedies, vitamin therapy, and dietary manipulation. With the exception of 
vitamin therapy, we observed no association between the intensity of conventional 
medical treatment and alternative treatment. The present or prior use of herbal 
remedies was correlated with the use of vitamin therapy and sunbathing, and dietary 
interventions were significantly correlated with vitamin therapy. Of the 113 (36 
percent) who had used nonprescription tanning equipment for their psoriasis, 68 
percent believed this modality was effective. We found that alternative medical 
therapies were widely utilized by subjects participating in this study. Clinicians 
need to continue to be aware of nonallopathic remedies employed by their patients to 
discover useful information about future therapies and to monitor for adverse 
effects. 

===================================================================== 
52.) Using aromatherapy in the management of psoriasis. 
===================================================================== 
Walsh D 
Homerton School of Health Studies, Cambridge. 
Nurs Stand (ENGLAND) Dec 18 1996 11 (13-15) p53-6 ISSN: 0029-6570 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9704 
Subfile: ; NURSING 
Psoriasis is an uncomfortable, inflammatory skin disease for which there is no cure 
but which can be managed at an acceptable level for the individual. This article 
explores the use of aromatherapy as an alternative management approach. The author 
describes a range of treatment outcomes, which show both physiological and 
psychological benefits. 
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DATA-MEDICOS/DERMAGIC-EXPRESS No (64) 07/07/99 DR. JOSE LAPENTA R. 
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