- Email: [email protected]
P087 Clobetasol propionate in psoriasis — Monotherapy and in combinations
Posters - General Dermatology to x3 the predetermined minimal erythema dose of solar simulated radiation and biopsies were taken 0.5, 1, 2, 4 and 24 hours after irradiation as well as control unirradiated skin from the opposite buttock. A similar staining pattern was observed in each of the three volunteers. ~53 protein was detectable in all skin samples examined. p21WafnCir protein was visible in the nuclei of cells at 4 hours and staining intensity increased at 24 hours. MDM2 protein expression was noted in isolated nuclei in the epidermis at 24 hours. Bax cytoplasmic staining was evident in the basal layer of the epidermis of all samples and this staining appeared to increase in intensity in the 4 and 24 hour specimens. There was no Bcl-2 immunohistochemical staining in any sample. These results suggest that ~53 and p53 functionally related proteins are altered or activated in normal human skin in response to solar simulated radiation. Work supported by the EU (Environment Programme), Grant number EVSV-CT94-0564.
General Dermatology
IPO83
Combination therapy with cyclosporin and methotrexate in severe psoriasis
D.K.B. Armstrong, J.C. McMillan. Department of Dermatology, Belfast City Hospital, Lisburn Road, Belfast, N Ireland Psoriasis may be a severe and disabling dermatosis or rarely a life-threatening condition. In such cases systemic treatment with agents with potentially serious side-effects is often indicated. The traditional approach to drug treatment is a stepwise use of one medication at a time. Combination regimes offer the potential for improved efficacy but at the risk of increased toxicity. We present five cases of severe psoriasis treated with a combination of cyclosporin and methotrexate. Indications for combination therapy included lack of efficacy of monotherapy, unacceptable toxicity of monotherapy at a dose necessary to control the psoriasis and severe associated arthropathy. Although follow-up to date is limited, combination therapy has been well tolerated. We propose that combination treatment with cyclosporin and methotrexate is a therapeutic option in these difficult cases.
IPO84
The use of Daivonexscalp solution in the treatment of patient with scalp psoriasis
I. Hartmane. Clinic of Dermatovenerology
srl3
after the treatment, including serum calcium. After the treatment significant improvement has been stated in 28 patients. Eighteen of 30 patients noted a quick response within two weeks or less, in two patients of 30 patients - without clinical effect. There was a statistically significant reduction in the mean of score from 5.3 at baseline to 2.3 at the end of treatment (p < 0.01). No serious adverse effects and no clinically significant consistent changes in laboratory parameters have been reported. In conclusion, Duivonex scalp solution is well tolerated and effective treatment for scalp psoriasis. ElPO85 A case of extremely widespread and severe
bullous mastocytosis
N. Martinovic ’ , S. Vesif ’ , K. Martinovic 2. ‘Institute for skin and veneral diseases, School ofMedicine, University of Belgrade: 2Clinic for dermatology, University of Priftina, Yugoslavia A case of extremely widespread bullous mastocytosis in a one month old girl is presented. A papular urticarial and bullous eruption was associated with rhinorrhoea, vomiting, diarrhoea and hypovolemic crises. Histopathological findings revealed massive mastocytic infiltration of dermis, with 95% of the cells showing metachromatic change. I PO86 Can helicobacter pylori be a factor in
rosacea etiopathogenesis?
B. Ciesla, B. Raszeja-Kotelba. Department of Dermatology Karol Marcinkowski University of Radical Sciences, Poznari, Polund Rosacea is considered as polietiologic dermatosis. Helicobacter pylori (H.p.) infection seems to be one of the etiopathogenetic factors due to dyspeptic complaints and digestive tract disorders in rosacea patients. Fifty eight patients with rosacea (41 women, 17 men) mean aged 44, 21 with dyspeptic complains and 37 without dyspeptic complains were examinated. The control group consisted of 11 healthly volunteers. All patients underwent gastroscopy with biopsy. H.p. was detected by positive urease test and positive microbiologic or histopathologic examination. Anti-H.p. antibodies were tested in patients sera. H.p. infection in rosacea patients occurred more frequently (76%) compared to control group (27%). Tetracycline and metronidazol have been used for years in rosacea therapy with good results. H.p. is eradicated from digestive tract by those drugs which confirms the role of H.p. in rosacea pathogenesis.
in Riga, Latvia
The aim of study was to examine effectiveness and side-effects of the vitamin D analogue calcipotriol scalp solution applied locally to psoriatic lesions on the scalp localizations. 30 patients (age 18-16, duration of illness 3-12 years) with psoriasis vulgaris which presented with psoriatic lesions in the scalp were observed and treated with Daivonex scalp solution, which contain 50 mcg/ml calcipotriol twice daily for four weeks. The extent and severity of psoriatic lesions of scalp was evaluated and expressed with a grading system like as PAS1 score (sum of redness, thickness and scaliness) in the course of treatment. Laboratory examinations were performed before and
ElPO87 Clobetasol propionate in psoriasis -
Monotherapy and in combinations
B.T. Gjertsen ’ , J. Korsvold2. ‘Dept. of Dermatology, Sentral Hospital in Sogn; 2Fjordane, nor@, Glaxo Wellcome AS, Bergen, Norway Background: Rapid healing and shorter treatment periods are significant considerations for successful management strategies for patients with psoriasis. Clobetasol propionate (CP) offer effective and rapid healing of psoriatic lesions, but has limited usefulness as monotherapy in long-term, daily treatment, due
s174
Posters
-
General
to risk of side effects assosiated with long-term therapy. The extent and speed of effectiveness of CP, both alone and in combinations with other treatments, is summarized from a series of comparative clinical studies. Material and Methods: Studies with CP have been carried out in patients with moderate to severe, chronic plaque psoriasis. Psoriatic lesions unresponsive to other therapy. have been treated with CP occluded with hydrocolloid dressings. In order to induce rapid healing and increased safety a sequential therapy with initial CP followed by calcipotriol has been studied. Results: CP on uncomplicated moderate to severe psoriasis will reduce scaling (71-89%), erythema (67-86%) and skin thickening (71-80%) within 14 days. Chronic plaque psoriasis and psoriasis on palms and soles unresponsive to other treatments have been sucsessfully treated under hydrocolloid dressings. Time to complete remission varied between l-6 weeks. Follow up l-6 months showed few relapses. Daily treatment with CP for 2 weeks, followed by 4 weeks calcipotriol was seen to be superior to calcipotriol alone after 6 weeks treatment (p < O.OOOl), and continued to maintain significantly lower severity score (p = 0.0002) after a further 4 week observational period. Conclusions: Different combination regimes (CP + hydrocolloid dressing) or CP followed by calcipotriol) provide rapid relief from psoriatic symptoms, with no increase in relapse rate. Using CP in such combination regimes can ensure optimal efficacy with minimal potential for any adverse effects.
Dermatology
IPO89
M. Carducci, A. Mussi, C. Bonifati, G. Sacerdoti, L. D’Auria, G. D’ Agosto. M. Fazio, F. Ameglio. S. Gallicano Institute, Rome,
in psoriatic patients treated with dithranol
A. Pietrzak’, G. Chodorowska’, .I. Tomaszewski2, B. Lecewicz-Torun’ , D. Czelej ’ . ‘Department of Dermatology; 22”d Clinic School, Lublin, Poland
of Gynecological
Surgery,
Medical
EGF is a mitogen stimulating cell division of various cells of epidermal origin. The present study was undertaken to clarify whether the serum level of EGF was correlated with disease activity and local therapy with dithranol in psoriasis. We have examined EGF serum concentration in acute and chronic type of psoriasis, before and after the local treatment with dithranol and their correlation with PAS1 score. 21 male patients were divided into two groups: 1. acute psoriasis (AP- 10 cases) and 2. chronic psoriasis- (CP-11 cases). Control group (C) were 20 healthy male volunteers. Radioimmunoassay of EGF was performed using commercial kit-hEGF reagent pack for RIA, Amersham, UK. In CP group mean value of the EGF was higher than in AP and C groups. EGF concentrations after the treatment were higher in CP group in comparison to AP group (p c. 0.05). In AP group, however, they were statistically significantly decreased after the treatment. No correlation between EGF and PAS1 was observed. After the treatment, in 12 patients, the increase of EGF concentration occurred. It is possible that EGF control mechanisms undergo disregulation.
Italy
The aim of this study is to analyze the levels of spontaneous release of 4 molecules belonging to the group of the hemopoietines (IL-6, G-CSF, IL- 11, OSM and LIF) observed in short-term organ cultures represented by skin biopsies obtained from lesional and non-lesional areas of psoriatic patients and from the skin of normal donors. The lesional spontaneous release concentrations of all 4 hematopoietins were higher than in non-lesional and normal samples (p at least ~0.02). No differences were observed between non-lesional and normal samples. These data showed an involvement of all 4 hematopoietins in the inflammatory processes associated to psoriasis, although their specific roles in determining or maintaining the clinical expression of the disease are still not known. ElPO90 Case of atypical course of Lichen ruber
planus et atophicus
E. Cerina. Department Academy
I PO88 Serum EGF concentrations
IL-6, IL-1 1, OSM and LIF spontaneous releases are increased in supernatants of biopsies from lesional skin of psoriatic patients
of Latvia,
of Dermatovenerology, Riga, Latvia
Medical
An atypical course of Lichen tuber planus et atophicus in the hairy part of the head and on the body of a 58-year-old women has been described. Over the last year the patient observed loss of hair, desquamation in the hairy part of the head as well as quite recently eruption on the body. Objective signs - on the hairy part of the head tiny atrophic local alopecia and erythematous patches, in places covered with grayish scales and rare pustules. On the body and forearms tiny, polygonal, glassy papules of a cyanotic and violet in color, some of them with a hollow in the centre. The diagnosis was confirmed histologically: Lichen tuber planus et atophicus. ElPO91 Plasma levels of selected cytokines and
acute phase proteins in psoriatic patients treated with low - Dose cyclosporin A
G. Chodorowska, D. Czelej, D. Krasowska, B. Lecewicz-Toruri. Department of Dermatology, School
in Lublin,
Medical
Poland
We investigated the influence of cyclosporin A on the plasma levels of selected cytokines and acute phase proteins in 13 male patients with plaque-type psoriasis. Mean PAS1 score was 31 (range 18.2-70.8); mean age was 40 years. Cyclosporin A was administered at a daily dose of 2.5 mg/kg. Mean duration of treatment was 11 weeks. The plasma levels of: IL-2, IL-2R, IL-6, TNF-a, IFN-y, GM-CSF, C-Reactive Protein and a-2 Macroglobulin were measured before and after the treatment. Mean plasma levels of the examined cytokines and acute phase proteins proved to be significantly higher in psoriatic patients when compared to the
General Dermatology
IPO83
Combination therapy with cyclosporin and methotrexate in severe psoriasis
D.K.B. Armstrong, J.C. McMillan. Department of Dermatology, Belfast City Hospital, Lisburn Road, Belfast, N Ireland Psoriasis may be a severe and disabling dermatosis or rarely a life-threatening condition. In such cases systemic treatment with agents with potentially serious side-effects is often indicated. The traditional approach to drug treatment is a stepwise use of one medication at a time. Combination regimes offer the potential for improved efficacy but at the risk of increased toxicity. We present five cases of severe psoriasis treated with a combination of cyclosporin and methotrexate. Indications for combination therapy included lack of efficacy of monotherapy, unacceptable toxicity of monotherapy at a dose necessary to control the psoriasis and severe associated arthropathy. Although follow-up to date is limited, combination therapy has been well tolerated. We propose that combination treatment with cyclosporin and methotrexate is a therapeutic option in these difficult cases.
IPO84
The use of Daivonexscalp solution in the treatment of patient with scalp psoriasis
I. Hartmane. Clinic of Dermatovenerology
srl3
after the treatment, including serum calcium. After the treatment significant improvement has been stated in 28 patients. Eighteen of 30 patients noted a quick response within two weeks or less, in two patients of 30 patients - without clinical effect. There was a statistically significant reduction in the mean of score from 5.3 at baseline to 2.3 at the end of treatment (p < 0.01). No serious adverse effects and no clinically significant consistent changes in laboratory parameters have been reported. In conclusion, Duivonex scalp solution is well tolerated and effective treatment for scalp psoriasis. ElPO85 A case of extremely widespread and severe
bullous mastocytosis
N. Martinovic ’ , S. Vesif ’ , K. Martinovic 2. ‘Institute for skin and veneral diseases, School ofMedicine, University of Belgrade: 2Clinic for dermatology, University of Priftina, Yugoslavia A case of extremely widespread bullous mastocytosis in a one month old girl is presented. A papular urticarial and bullous eruption was associated with rhinorrhoea, vomiting, diarrhoea and hypovolemic crises. Histopathological findings revealed massive mastocytic infiltration of dermis, with 95% of the cells showing metachromatic change. I PO86 Can helicobacter pylori be a factor in
rosacea etiopathogenesis?
B. Ciesla, B. Raszeja-Kotelba. Department of Dermatology Karol Marcinkowski University of Radical Sciences, Poznari, Polund Rosacea is considered as polietiologic dermatosis. Helicobacter pylori (H.p.) infection seems to be one of the etiopathogenetic factors due to dyspeptic complaints and digestive tract disorders in rosacea patients. Fifty eight patients with rosacea (41 women, 17 men) mean aged 44, 21 with dyspeptic complains and 37 without dyspeptic complains were examinated. The control group consisted of 11 healthly volunteers. All patients underwent gastroscopy with biopsy. H.p. was detected by positive urease test and positive microbiologic or histopathologic examination. Anti-H.p. antibodies were tested in patients sera. H.p. infection in rosacea patients occurred more frequently (76%) compared to control group (27%). Tetracycline and metronidazol have been used for years in rosacea therapy with good results. H.p. is eradicated from digestive tract by those drugs which confirms the role of H.p. in rosacea pathogenesis.
in Riga, Latvia
The aim of study was to examine effectiveness and side-effects of the vitamin D analogue calcipotriol scalp solution applied locally to psoriatic lesions on the scalp localizations. 30 patients (age 18-16, duration of illness 3-12 years) with psoriasis vulgaris which presented with psoriatic lesions in the scalp were observed and treated with Daivonex scalp solution, which contain 50 mcg/ml calcipotriol twice daily for four weeks. The extent and severity of psoriatic lesions of scalp was evaluated and expressed with a grading system like as PAS1 score (sum of redness, thickness and scaliness) in the course of treatment. Laboratory examinations were performed before and
ElPO87 Clobetasol propionate in psoriasis -
Monotherapy and in combinations
B.T. Gjertsen ’ , J. Korsvold2. ‘Dept. of Dermatology, Sentral Hospital in Sogn; 2Fjordane, nor@, Glaxo Wellcome AS, Bergen, Norway Background: Rapid healing and shorter treatment periods are significant considerations for successful management strategies for patients with psoriasis. Clobetasol propionate (CP) offer effective and rapid healing of psoriatic lesions, but has limited usefulness as monotherapy in long-term, daily treatment, due
s174
Posters
-
General
to risk of side effects assosiated with long-term therapy. The extent and speed of effectiveness of CP, both alone and in combinations with other treatments, is summarized from a series of comparative clinical studies. Material and Methods: Studies with CP have been carried out in patients with moderate to severe, chronic plaque psoriasis. Psoriatic lesions unresponsive to other therapy. have been treated with CP occluded with hydrocolloid dressings. In order to induce rapid healing and increased safety a sequential therapy with initial CP followed by calcipotriol has been studied. Results: CP on uncomplicated moderate to severe psoriasis will reduce scaling (71-89%), erythema (67-86%) and skin thickening (71-80%) within 14 days. Chronic plaque psoriasis and psoriasis on palms and soles unresponsive to other treatments have been sucsessfully treated under hydrocolloid dressings. Time to complete remission varied between l-6 weeks. Follow up l-6 months showed few relapses. Daily treatment with CP for 2 weeks, followed by 4 weeks calcipotriol was seen to be superior to calcipotriol alone after 6 weeks treatment (p < O.OOOl), and continued to maintain significantly lower severity score (p = 0.0002) after a further 4 week observational period. Conclusions: Different combination regimes (CP + hydrocolloid dressing) or CP followed by calcipotriol) provide rapid relief from psoriatic symptoms, with no increase in relapse rate. Using CP in such combination regimes can ensure optimal efficacy with minimal potential for any adverse effects.
Dermatology
IPO89
M. Carducci, A. Mussi, C. Bonifati, G. Sacerdoti, L. D’Auria, G. D’ Agosto. M. Fazio, F. Ameglio. S. Gallicano Institute, Rome,
in psoriatic patients treated with dithranol
A. Pietrzak’, G. Chodorowska’, .I. Tomaszewski2, B. Lecewicz-Torun’ , D. Czelej ’ . ‘Department of Dermatology; 22”d Clinic School, Lublin, Poland
of Gynecological
Surgery,
Medical
EGF is a mitogen stimulating cell division of various cells of epidermal origin. The present study was undertaken to clarify whether the serum level of EGF was correlated with disease activity and local therapy with dithranol in psoriasis. We have examined EGF serum concentration in acute and chronic type of psoriasis, before and after the local treatment with dithranol and their correlation with PAS1 score. 21 male patients were divided into two groups: 1. acute psoriasis (AP- 10 cases) and 2. chronic psoriasis- (CP-11 cases). Control group (C) were 20 healthy male volunteers. Radioimmunoassay of EGF was performed using commercial kit-hEGF reagent pack for RIA, Amersham, UK. In CP group mean value of the EGF was higher than in AP and C groups. EGF concentrations after the treatment were higher in CP group in comparison to AP group (p c. 0.05). In AP group, however, they were statistically significantly decreased after the treatment. No correlation between EGF and PAS1 was observed. After the treatment, in 12 patients, the increase of EGF concentration occurred. It is possible that EGF control mechanisms undergo disregulation.
Italy
The aim of this study is to analyze the levels of spontaneous release of 4 molecules belonging to the group of the hemopoietines (IL-6, G-CSF, IL- 11, OSM and LIF) observed in short-term organ cultures represented by skin biopsies obtained from lesional and non-lesional areas of psoriatic patients and from the skin of normal donors. The lesional spontaneous release concentrations of all 4 hematopoietins were higher than in non-lesional and normal samples (p at least ~0.02). No differences were observed between non-lesional and normal samples. These data showed an involvement of all 4 hematopoietins in the inflammatory processes associated to psoriasis, although their specific roles in determining or maintaining the clinical expression of the disease are still not known. ElPO90 Case of atypical course of Lichen ruber
planus et atophicus
E. Cerina. Department Academy
I PO88 Serum EGF concentrations
IL-6, IL-1 1, OSM and LIF spontaneous releases are increased in supernatants of biopsies from lesional skin of psoriatic patients
of Latvia,
of Dermatovenerology, Riga, Latvia
Medical
An atypical course of Lichen tuber planus et atophicus in the hairy part of the head and on the body of a 58-year-old women has been described. Over the last year the patient observed loss of hair, desquamation in the hairy part of the head as well as quite recently eruption on the body. Objective signs - on the hairy part of the head tiny atrophic local alopecia and erythematous patches, in places covered with grayish scales and rare pustules. On the body and forearms tiny, polygonal, glassy papules of a cyanotic and violet in color, some of them with a hollow in the centre. The diagnosis was confirmed histologically: Lichen tuber planus et atophicus. ElPO91 Plasma levels of selected cytokines and
acute phase proteins in psoriatic patients treated with low - Dose cyclosporin A
G. Chodorowska, D. Czelej, D. Krasowska, B. Lecewicz-Toruri. Department of Dermatology, School
in Lublin,
Medical
Poland
We investigated the influence of cyclosporin A on the plasma levels of selected cytokines and acute phase proteins in 13 male patients with plaque-type psoriasis. Mean PAS1 score was 31 (range 18.2-70.8); mean age was 40 years. Cyclosporin A was administered at a daily dose of 2.5 mg/kg. Mean duration of treatment was 11 weeks. The plasma levels of: IL-2, IL-2R, IL-6, TNF-a, IFN-y, GM-CSF, C-Reactive Protein and a-2 Macroglobulin were measured before and after the treatment. Mean plasma levels of the examined cytokines and acute phase proteins proved to be significantly higher in psoriatic patients when compared to the