Antiproliferative, antiangiogenic and apoptotic effect of photochemotherapy (PUVA) in psoriasis patients.

The aim of the study was to investigate the antiproliferative, antiangiogenic and apoptotic effect of photochemotherapy (PUVA) in psoriatic patients, and to compare it with a control group of psoriatics treated with local corticosteroid therapy. The study included 60 psoriasis patients, 30 of them allocated to PUVA therapy and local corticosteroid each. Immunohistochemical methods of staining with Ki-67, F-8 and bcl-2 antibodies were used to determine proliferative keratinocyte count, to visualize the number of blood vessels in the dermis, and to determine the number of cells exhibiting expression of the antiapoptotic oncoprotein bcl-2, respectively. In all study patients, the values of Ki-67, F-8, bcl-2 and PUVA score were recorded pre- and at six weeks post-therapeutically. Study results showed a statistically significant decrease in the epidermal proliferative keratinocyte count and dermal number of blood vessels after both therapeutic modalities (p < 0.001 both). The value of bcl-2 showed a statistically significant increase in the group of patients treated with PUVA therapy (p = 0.001) and an increase in the control group, demonstrating enhanced keratinocyte apoptosis after treatment. Accordingly, study results demonstrated the antiproliferative, antiangiogenic and apoptotic effect of both PUVA and local corticosteroids. These very mechanisms appear to play a key role in the action of most antipsoriatic therapies.

Laser therapy for solar lentigines: review of the literature and case report.

Solar lentigines are benign, brownish lesions that occur on light exposed skin surfaces from age 30 onwards, as a sign of photoaging. As they are of cosmetic importance to many patients, different therapeutic modalities have been tried to remove these unwanted spots. The recent development of short-pulsed, pigment-specific lasers has enabled physicians to selectively destroy the pigment within the solar lentigo lesions with significant clinical improvement, low risk of adverse effects, and high patient acceptance. Therefore this therapeutic option is superior to traditional treatment modalities and represents the treatment of choice in the management of solar lentigines. A case is reported of the successful use of Q-switched ruby laser in the treatment of solar lentigo on the face.

Folliculotropic mycosis fungoides with follicular mucinosis--case report.

Reports on clinical and histologic follicular alterations in patients previously diagnosed with mycosis fungoides (MF) or at the time of MF diagnosis are rare. The clinical and histologic criteria to distinguish MF associated with follicular mucinosis from follicular MF are a matter of debate. A patient is described with advanced clinical and histologic alterations predominated by follicular lesions and presence of mucin. In the early stage of the disease, folliculotropism was clinically and histologically present but less pronounced than epidermotropism and classic plaque-like lesions. The patient died four years after the diagnosis. As the term 'folliculotropic' describes a particular histopathologic finding, we consider it correct to use the term "folliculotropic MF" to denote atypical lymphocyte folliculotropism in the absence or presence of mild epidermotropism, presence of mucin, or no evidence for intrafollicular mucin. Folliculotropic MF seems to represent a specific clinicopathologic entity which may have a poorer prognosis than classic MF.

Treatment of childhood psoriasis.

Psoriasis is a common disease in children and adolescents. Because of the chronic course of the disease, appropriate choice of therapy in particular stage of the disease, so-called rotation therapy, is of paramount importance. This article provides a review of therapeutic options for childhood psoriasis. Local therapy for psoriasis in children consists of corticosteroid preparations, calcipotriol, tars and dithranol, local retinoids, and local immunomodulators. Phototherapy (narrow band UVB, photochemotherapy PUVA baths) is now a part of psoriasis therapy in children. Systemic therapy retinoids (acitretin) methotrexate, cyclosporine is only used in severe forms of the disease such as erythrodermic, pustular and arthritic psoriasis. All these therapeutic options can be used as monotherapy or in various combinations.

New treatment modalities for vitiligo: focus on topical immunomodulators.

The development of effective treatment modalities for vitiligo is dependent on an understanding of the events leading to depigmentation. However, the exact pathogenesis of vitiligo is still mostly unknown. Abnormalities in both humoral and cell-mediated immunity have been documented in vitiligo patients and they present a basis for using immunomodulating agents, such as corticosteroids and macrolide immunomodulators, in the treatment of vitiligo. Macrolide immunomodulators, such as tacrolimus and pimecrolimus, which can be used topically, are known as topical immunomodulators (TIMs). TIMs inhibit the action of calcineurin, and consequently inhibit T-cell activation and the production of various cytokines; this is considered the working mechanism of action of TIMs in vitiligo. Several small studies and case reports on the use of TIMs in vitiligo have been published so far. Tacrolimus achieves better results on the face and neck than on other body areas. Particular advantages of TIMs are safety in treating these areas because of lack of skin atrophy and good tolerability. The incidence of application site adverse events in vitiligo seems to be lower than in the treatment of atopic dermatitis. On the face and neck, TIMs may become a useful tool in the treatment of adults and children with vitiligo despite possibly lower efficacy than topical corticosteroids. Further, larger, controlled clinical studies are warranted to determine the definite role of TIMs as monotherapy or in combination with other modalities in the treatment of vitiligo.

Update on psoriasis therapies.

New psoriasis therapies offer a great hope for the people who suffer from chronic inflammatory skin diseases. Psoriasis and psoriatic arthritis are the diseases that can be treated with biological therapy, which targets either the interaction between an antigen-presenting cell and the T-cell, or cytokines, such as tumor necrosis factor alpha (TNF-alpha), that are presumed to be involved in the pathogenesis of psoriasis vulgaris and psoriatic arthritis. Current biological therapies now seem to hold promise of potentially excellent effect, with the toxicities associated with existing therapies: phototherapy (PUVA or UVB), retinoids, cyclosporin, methotrexate (MTX). Topical therapy will continue to be used in combination with the new biological therapies for residual psoriatic plaques. In this paper, we highlight the current psoriasis treatments, new biological therapies, and their use in practice.

Phototherapy of psoriasis: review and update.

Along with topical and systemic therapy, phototherapy is one of the three fundamental treatment options for managing psoriasis. The use of UVB continues to be one of the most important therapeutic interventions for mild to moderate psoriasis. An advance in UVB phototherapy has been the introduction of narrowband UVB lamps (311 nm). UVB lamps are superior to conventional broadband UVB in clearing psoriasis. PUVA is very effective therapy and is still the most effective form of phototherapy for severe, extensive form od the disease. There has been a trend towards whole-body PUVA-bath. Advantages of PUVA bath are lack of gastrointestinal side effects and no need for post-treatment eye photoprotection because there is no systemic photosensitization. UVB and PUVA can be administered in combination with a variety of topical and systemic treatments to achieve more effective results more quickly. The most recent form of phototherapy, 308-nm excimer laser, holds promise for becoming a useful tool in the treatment of stable, localized psoriasis.

Phototherapy in pediatric patients.

The treatment of children with psoriasis, atopic dermatitis (AD), pityriasis lichenoides, and scleroderma poses a therapeutic problem because all therapeutic options are associated with numerous side effects. Therefore ultraviolet A and B (UVA and UVB) phototherapy is presented as a possible alternative to some of these therapies, primarily topical and systemic corticosteroids, in children. Our results in treating children with phototherapy and psoralen plus UVA (PUVA) bath phototherapy over the past 5 years are reported. UVB therapy (TL01) was used in 20 psoriatic children (6 boys, 14 girls; ages 6-14 years) during the stage of disease exacerbation and in 9 children (3 boys, 6 girls; ages 8-16 years) with pityriasis lichenoides. Combined UVA/UVB phototherapy was applied in 21 AD children (7 boys, 14 girls; ages 4-15 years). Photochemotherapy with local application of a PUVA bath was used in six children (2 boys, 4 girls; ages 9-16 years) with circumscribed scleroderma and in one girl with systemic scleroderma. All children received short courses of phototherapy with either no maintenance or short maintenance. All three therapeutic protocols resulted in a certain degree of improvement in most of the study patients. None of the patients exhibited any early phototherapy side effects. We conclude that phototherapy and PUVA bath are valuable and safe therapeutic options for selected children who do not respond to other treatments.