RESUMO
Chronic and localized plaque-type-psoriasis is often therapy resistant as a result of which dermatologists often have trouble finding a suitable treatment option. Traditional therapies for psoriasis merely focus on the inhibition of epidermal proliferation, inflammation, or both. The earliest changes, however, in a novel psoriatic lesion concern abnormal microvasculature. The position of lasers in the treatment of psoriatic lesions is debatable, as different views exist with respect to efficacy and tolerability. The current investigation evaluates the clinical and immunohistochemical effect of the Nd:YAG (1,064 nm) laser in chronic localized psoriasis, as this laser can penetrate up to the deeper abnormal psoriatic vasculature. The effects are compared to treatment with the well-established calcipotriol/betamethasone dipropionate ointment. The use of the Nd:YAG laser with treatment-intervals of four weeks was found not to be of additional value in the array of treatment modalities for chronic localized plaque-psoriasis. Targeting the more superficially located microvasculature in psoriasis seems of stronger significance for achieving a clinical effect than the deeper vasculature targeted by the Nd:YAG laser. Therefore, the present data are of importance in preserving dermatologists from treating psoriatic lesions with a Nd:YAG laser. However, further studies incorporating changes in methodology, in particular shortened time-intervals between treatments, are needed in order to refute or confirm this position.
Assuntos
Lasers de Estado Sólido , Terapia com Luz de Baixa Intensidade , Psoríase/radioterapia , Betametasona/administração & dosagem , Betametasona/análogos & derivados , Complexo CD3/análise , Calcitriol/administração & dosagem , Calcitriol/análogos & derivados , Fármacos Dermatológicos/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Imuno-Histoquímica , Queratinócitos/imunologia , Masculino , Pessoa de Meia-Idade , Molécula-1 de Adesão Celular Endotelial a Plaquetas/análise , Psoríase/metabolismo , Psoríase/patologiaRESUMO
PURPOSE: To determine the effectiveness of adjuvant dendritic cell (DC) vaccination to induce tumor-specific immunological responses in stage III melanoma patients. EXPERIMENTAL DESIGN: Retrospective analysis of stage III melanoma patients, vaccinated with autologous monocyte-derived DC loaded with tumor-associated antigens (TAA) gp100 and tyrosinase after radical lymph node dissection. Skin-test infiltrating lymphocytes (SKILs) obtained from delayed-type hypersensitivity skin-test biopsies were analyzed for the presence of TAA-specific CD8(+) T cells by tetrameric MHC-peptide complexes and by functional TAA-specific T cell assays, defined by peptide-recognition (T2 cells) and/or tumor-recognition (BLM and/or MEL624) with specific production of Th1 cytokines and no Th2 cytokines. RESULTS: Ninety-seven patients were analyzed: 21 with stage IIIA, 34 with stage IIIB, and 42 had stage IIIC disease. Tetramer-positive CD8(+) T cells were present in 68 patients (70%), and 24 of them showed a response against all 3 epitopes tested (gp100:154-162, gp100:280-288, and tyrosinase:369-377) at any point during vaccinations. A functional T cell response was found in 62 patients (64%). Rates of peptide-recognition of gp100:154-162, gp100:280-288, and tyrosinase:369-377 were 40%, 29%, and 45%, respectively. Median recurrence-free survival and distant metastasis-free survival of the whole study population were 23.0 mo and 36.8 mo, respectively. CONCLUSIONS: DC vaccination induces a functional TAA-specific T cell response in the majority of stage III melanoma patients, indicating it is more effective in stage III than in stage IV melanoma patients. Furthermore, performing multiple cycles of vaccinations enhances the chance of a broader immune response.