Effectiveness of topical therapy for psoriasis: results of a national survey.

Topical therapy is the major treatment approach for patients with psoriasis. However, the effectiveness of available drugs (response rates and long-term maintenance) is not well known. This study investigated the current perceptions of American dermatologists on the effectiveness of topical medications for patients with mild or limited psoriasis. In a survey of 225 American dermatologists, class I to II topical steroids were regarded as most effective: 29 percent of dermatologists expected most of their patients to experience clearing of lesions when treated with these agents. Much lower response rates were found with medium and low-potency steroids, anthralin, or tars. The percentage of patients whose skin remained clear of lesions decreased to 50 percent while receiving maintenance corticosteroid therapy by three months and to 29 percent after one year. Topical corticosteroids were considered less effective than the available photo/systemic therapies by 79 percent of physicians. More effective topical modalities need to be developed to treat patients with mild/limited psoriasis.

Localized bullous scabies. Uncommon presentation of scabies.

A previously unreported form of localized bullous scabies mimicking bullous pemphigoid is described. The patient presented with a localized, severely pruritic erythematous plaque with a cutaneous eruption consisting of several papules and a single tense bulla on an erythematous base. The histologic findings consisted of a subepidermal inflammatory bullous dermatosis with lymphocytes, neutrophils, and many eosinophils, and the results of direct immunofluorescence were negative. Correlation of the clinical course with the histologic and immunofluorescence findings were necessary to establish the diagnosis of infestation by Sarcoptes scabiei.

Propylthiouracil in psoriasis: results of an open trial.

BACKGROUND: Propylthiouracil (PTU) is an antithyroid thioureylene that has immune modulatory and free radical scavenging abilities. In view of the immunomodulatory effects of PTU, we decided to study the therapeutic response of patients with psoriasis to oral PTU. OBJECTIVE: Our purpose was to study the effect of oral PTU in patients with stable plaque psoriasis. METHODS: Oral PTU, 100 mg, was administered every 8 hours for 8 weeks to 10 patients with long-standing psoriasis. Skin biopsy specimens were taken from the lesions before and at the end of the study. Clinical response was monitored with the Psoriasis Area and Severity Index scoring system. Histologic scores were graded with a 5-point grading scale. Complete blood cell count was obtained at the beginning and at the end of the study. Thyroid-stimulating hormone (TSH) was obtained at the beginning and every 2 weeks thereafter until completion of the study. RESULTS: Three patients dropped out of the study. Of the remaining seven, two showed near-complete resolution of their psoriatic lesions, whereas the remainder showed moderate improvement in their clinical scores. Histologic scores were significantly improved in the group with all but one patient showing improvement or no change. Thyroid function tests were unchanged in all but one patient who showed a slight increase in serum TSH at the sixth week of therapy. CONCLUSION: Because of its low toxicity relative to other oral treatments of psoriasis, PTU may have a role in the treatment of patients with this disorder.