Psoriasis Causes and Treatment
In our view, psoriasis, a condition considered to be inherited in a polygenic manner 40J, is also associated with bile or bile acid deficiency, as in most cases supplementation of the usual treatment with bile acids will diminish the severity of the clinical signs within a short period. One of my co-workers (Klara Gyurcsovics) treated a total of 551 psoriasis patients with bile acids (Suprachol Acidum dehydrocholicum) given orally for 1-8 weeks. The clinical efficacy of the treatment was evaluated by means of the Psoriasis Area Severity Index (PASI score). During this treatment 434 patients (78.8 ) became asymptomatic. Of 249 psoriatics receiving the conventional therapy, only 62 (24.9 ) showed clinical recovery during the same period of time (p
Psoriasis is an acceleration in the growth of skin cells that results in patches of dry scaly itchy skin. The cause is unknown although it tends to run in families. Stress is often a trigger and gluten in foods or alcohol can precipitate the condition in some individuals. A sluggish liver may also be a factor. Getting sunlight is a common and effective remedy to alleviate symptoms. Antioxidants neutralize free radicals that play a role in inflammatory diseases like psoriasis.
In Chapter 2, we discussed ways of describing data derived from a sample of people or things, called descriptive statistics. When you get the poor folks to imbibe gallons of clam juice, your hope as an experimenter is to infer some general rule about the effects of clam juice on patients with psoriasis that holds true for more people than the people who actually were involved in the study. In statistical jargon, you want to make inferences about the population, based on the sample you have studied. The statistical population has little to do with our everyday notion of population unless we're talking about census data or Gallup polls. The experimenter's population is the group of people about whom he or she wishes to make generalizations (eg, patients with psoriasis). In the best of all possible worlds, the experimenter should sample randomly from this population. In point of fact, this utopia can never be realized, if for no other reason than that any experimenter who doesn't have a...
A set of genes unique for psoriatic skin disease was recently reported in a study using DNA microarray. By comparing lesional and uninvolved skin from patients with psoriasis, a set of 159 genes that showed twofold or greater difference in their expression level was defined. Of these, several were mapped to disease-associated loci (126). The gene set predicted expression patterns unique to normal versus lesional skin with 100 accuracy, and a subset of these genes was also useful for monitoring treatment response (126).
Acquired inhibitors develop in the elderly, during pregnancy, in association with autoimmune and malignant disease, various skin disorders (psoriasis, pemphigus, erythema multiforme) infections, drug therapy (penicillin, aminoglycosides, phenothiazines, etc). Symptoms include bleeding (postoperatively this can cause major problems), easy bruising haemarthrosis is rare. The mortality is significant, as many as 25 patients with persisting VIII inhibitors will die from bleeding.
Infection with enteroviruses may also be responsible. The incidence of AGEP has been underestimated and many cases have been confused with pustular psoriasis. Synonyms are pustular drug rash, pustular eruption, pustuloderma (Staughton et al., 1984). Proposed diagnosis criteria (Roujeau et al., 1991) include AGEP must be differentiated from acute pustular psoriasis of the von Zumbusch type. The pustules in both diseases are clinically indistinguishable the histopathology can be helpful.
Application of ammonium chloroplatinate, (NH4)2PtCl6, on guinea pig skin in vivo (187 mg cm2over 3 days) resulted in reduced weight gain and reduced oxygen consumption. On dissection, all internal organs and the blood showed the presence of platinum (9). On hairless mouse skin in vitro, carboplatin was shown to penetrate in pharmacologically significant amounts. Applied on mouse skin in vivo, platinum complexes exhibit an antimitotic effect and therefore have a therapeutic potential against hyperproliferative skin diseases such as psoriasis (10).
The apparent effective amelioration of inflammatory skin diseases such as psoriasis and atopic dermatitis by balneotherapy, using spa waters high in strontium (and selenium), prompted the investigation of possible modulatory effects of strontium on the production of cutaneous inflammatory cytokines (8). Effects on the induction of three cytokines in human keratinocytes namely, IL-1a, IL-6, and TNF-a were monitored in culture medium. The addition of strontium salts to both normal and inflammatory reconstituted skin in the medium had an inhibi-
Furthermore, many inflammatory skin diseases can involve the periorbital region. Periorbital eczema may be an expression of a constitutional disease, an irritant or allergic dermatitis. Other inflammatory dermatoses that can involve the eyelids are seborrheic dermatitis, psoriasis, rosacea and dermatomyositis. Other causes of inflammation of the eyelids include bacterial, fungal and viral infections.
The randomized control trial (RCT) provides the strongest research design. A group of people are randomly allocated by the researcher to two or more groups. The experimental group receives the new treatment whereas the control group receives either conventional therapy, a placebo, or nothing. For example, our psoriasis patients would be split into two groups by the flip of a coin. The heads group would receive clam juice, and the tails group would receive a placebo concoction. Ideally, in order to minimize various biases, neither the patient nor the researcher knows who got what until the trial is over. This is referred to as being double blind. (If the pharmacist who dispensed the stuff loses the code, it can be called either a triple blind or a disaster. In either case, the pharmacist's life is in jeopardy.) More than two groups can be used in an RCT as long as subjects are allocated by some randomizing device.
Psoriasis Psoriasis is associated with chronic inflammatory skin lesions that are characterized by epidermal hyperplasia, impaired epidermal differentiation, and accumulation of distinct leukocyte subpopulations. Cutaneous blood vessels show major abnormalities in psoriatic lesions and are found to be enlarged, tortuous, and hyperpermeable. In 1994, VEGF was identified as a major epidermis-derived vessel-specific growth factor that was strongly upregulated in pso-riatic skin lesions 8 . Since then, several studies have demonstrated that VEGF expression is increased in lesional psoriatic skin, that the serum levels of circulating VEGF protein are significantly elevated in patients with severe disease, and that VEGF serum levels were directly correlated with disease activity. A major role of VEGF in the pathogenesis of psoriasis was further corroborated by the phenotype of transgenic mice with epidermis-specific overexpression of VEGF. At about 6 months of age, these mice spontaneously...
Psoralens form covalent linkages with pyrimidine bases in DNA when exposed to light of the appropriate wavelength, and if oxygen is present, reactive oxygen species also are generated. Although inhibition of DNA replication may account for some of the beneficial effects of PUVA therapy in certain hyperproliferative disorders such as psoriasis, PUVA has other important biological effects. It suppresses contact hypersensitivity and may evoke other immunological changes by affecting T lymphocytes and epidermal Langerhans cells. It increases melanin pigmentation in the skin and is useful in treating vitiligo. PUVA also inhibits mast cell release of inflammatory mediators. PUVA is most useful for the treatment of severe psoriasis. Early (patch and plaque) stage cutaneous T-cell lymphoma (CTCL) also responds to PUVA therapy. In addition, patients in advanced stages of CTCL have been treated with a modification of PUVA known as extracorporeal photopheresis. In this therapy, blood from a CTCL...
HPV can often be detected in common dermatoses, leading to speculation that HPV may play a role in the development of conditions such as psoriasis vulgaris. It has been postulated that EDV HPV types may play a role in the hyperproliferation of skin in psoriasis vulgaris. Anti-HPV 5 antibodies have been demonstrated in epidermal repair processes, including second degree burn and autoimmune skin diseases, including bullous disorders. Thus, it initially appeared that antibodies to the EDV HPVs were artifactual 55 . More recently, a French group looked at the presence of EDV HPV types 5 and 36 in scrapings from adults and children with psoriasis vulgaris. More than 42 of children and adults demonstrated HPV 5 DNA sequences. The most compelling, although anecdotal, piece of evidence was demonstration of HPV 5 DNA in an 18-month-old girl and a boy with a 1-week history of disease 56 . The mechanism by which hyperproliferative HPV types may trigger a widespread epidermal disorder like...
Influence of angiogenesis inhibitors over angiogenic stimuli. The major proangiogenic factor in the skin, vascular endothelial growth factor (VEGF), occurs in at least four isoforms of 121, 165, 189, and 201 amino acid residues. VEGF121 and VEGF165 are the predominant isoforms found in human skin. VEGF mediates its activity mainly through interaction with two type III tyrosine kinase receptors, VEGF receptor-1 (flt-1) and VEGF receptor 2 (KDR, flk-1), which are selectively expressed on the cutaneous endothelium. VEGF-165 also binds the neuropilin receptors on endothelial and other cells. VEGF is expressed at low levels in normal epidermis, whereas keratinocyte VEGF expression is rapidly upregulated by hypoxia and is also induced by several growth factors that mediate epidermal hyperplasia (Figure 1). In psoriasis, healing wounds, and squamous cell carcinomas, transforming growth factor-a and other ligands of the epidermal growth factor receptor are released by suprabasal...
Topical corticosteroids are the most widely used treatment for psoriasis. Corticosteroids have anti-inflammatory, immunosuppressive and antiproliferative properties. Topical Agents for Psoriasis Commonly used for psoriasis of the scalp First topical retinoid indicated by the FDA for treatment of psoriasis C. Coal tar has antiproliferative and anti-inflammatory actions. It is beneficial when used alone in mild to moderate psoriasis, and is useful in combination with ultraviolet B radiation. The use of coal tar is limited by its unpleasant odor it can also stain clothing and bedding. 1. Patients with psoriatic involvement of greater than 10 of body surface area or with severe, incapacitating, or disfiguring psoriasis are candidates for photochemotherapy or systemic therapy.
Systemic diseases of the skin (e.g., psoriasis, lupus erythematosus, scleroderma) can affect the ear canal and eventually cause external canal obstruction. One important feature of psoriasis is that mild trauma to surrounding skin induces lesions localized to the area of injury.9 Therefore, patients with psoriasis in or near the ear canal should be asked to avoid manipulation of the lesions, so as to prevent stenosis. Cutaneous (contact dermatitis) reactions to shampoos, medications, and foreign material in the ear canal can be severe and may require rapid medical attention to prevent scarring and stenosis of the soft tissue of the canal.
The guanosine nucleotides required for DNA and RNA synthesis. MPA has been used for decades as a systemic treatment for moderate to severe psoriasis. MMF was developed to increase the bioavailability of MPA. MMF is indicated for the prophylaxis of organ rejection in patients receiving renal, hepatic, and cardiac transplants it is often used in combination with other immunosuppressive agents for this indication. In dermatology, MMF is particularly useful as monotherapy, or as a steroid-sparing agent, for treatment of autoimmune blistering diseases (bullous pemphigoid and pemphigus). It may also be useful for the treatment of inflammatory skin diseases mediated by neutrophilic infiltration, such as pyoderma gangrenosum, and psoriasis.
That vitamin D has the ability to regulate growth and differentiation of other cell types, including cancer cells, B and T lymphocytes, melanocytes, fibroblasts, endothelial cells, and monocyte macrophages (55-61). Furthermore, 1,25-dihydroxyvita-min D3 reverses corticosteroid-induced epidermal atrophy (62) and promotes the differentiation and proliferation of normal epidermal keratinocytes (59,63-69). In contrast, inhibitory effects of 1,25-dihydroxyvitamin D3 on proliferation of hyperplastic epidermis occurs (52,70-72), possibly mediated through growth factors and cytokines (73). Pharmacologic amounts of 1,25-dihydroxyvitamin D3 has been used as an effective agent for inhibiting hyperproliferative diseases, such as psoriasis (52,71,72) and cancer (52,59,74-76).
Let's begin by examining a simple experiment. Suppose an investigator has a hunch that clam juice is an effective treatment for the misery of psoriasis. He assembles a group of patients, randomizes them to a treatment and control group, and gives clam juice to the treatment group and something that looks, smells, and tastes like clam juice (but isn't) to the control group. After a few weeks, he measures the extent of psoriasis on the patients, perhaps by estimating the percent of body involvement or by looking at the change in size of a particular lesion. He then does some number crunching to determine if clam juice is as good a treatment as he hopes it is. Let's have a closer look at the data from this experiment. To begin with, there are at least two variables. A definition of the term variable is a little hard to come up with, but basically it relates to anything that is measured or manipulated in a study. The most obvious variable in this experiment is the measurement of the...
Topical corticosteroids are most useful in inflammatory dermatoses, such as eczematous dermatitis and psoriasis they may also be helpful in other skin diseases that have a prominent inflammatory component, such as autoimmune blistering diseases (e.g., bullous pemphigoid and pemphigus vulgaris) and lupus erythematosus.
Recently, the production of natural antibiotic peptides has emerged as an important mechanism of natural immunity in plants and animals. Defensins are diverse members of a large family of antimicrobial peptides, contributing to the antimicrobial action of granulocytes, mucosal host defence in the small intestine and epithelial host defence in the skin and elsewhere (see also Chapter 4 and 10). It has been proposed that a defensin deficiency may play a pivotal role in the aetiopathogenesis of Crohn's disease 11 , Moreover, defensins and other antimicrobial peptides such as cathelicidins, are found to be increased in patients with psoriasis and decreased in patients with atopic dermatitis. A deficiency in the expression of these antimicrobial peptides may account for the susceptibility of patients with atopic dermatitis to skin infection 12 , It has also been reported that pathologies characterised by severe neutropenia and frequent bacterial infections such as morbus Kostmann 13 and...
Psoriasis is a chronic, recurrent disease of the skin, characterized by reddish, rounded lesions that are covered by silvery scales. When a scale is removed, it leaves a small bleeding point. The disease tends to begin on the elbows, knees, or scalp, and to spread over the whole body.
The striking feature is the presence of polymorphonuclear leukocytic mi-croabscesses in the upper stratum spinosum (Fig. 3.11). These spongiform pustules are not pathognomonic of geographical tongue and can be seen in oral psoriasis, acute and chronic candidosis, Reiter syndrome and plasma cell gingivostomatosis. Some describe elongation of the rete ridges, but this is by no means a consistent observation. However, occasionally there may be psoriasi-form hyperplasia in geographical tongue and it may be difficult or impossible to distinguish from psoriasis. Indeed, geographical tongue and migratory stomatitis are 4-5 times more common in patients with psoriasis and some believe that geographical tongue is the oral ho-mology of psoriasis 179, 194 . The presence of spon-giform pustules in oral biopsies should always prompt the search for candidal hyphae with a PAS or Grocott stain. These are not usually seen in geographical tongue and their presence...
Inorganic arsenic has been known as a human carcinogen for decades. The first evidence suggesting arsenic could cause cancer occurred in 1977.50 During this time, arsenic was being applied directly to the skin as a treatment for psoriasis, which resulted in the development of skin cancers.51 Arsenic is released into the atmosphere from both natural and anthropogenic sources, the latter being responsible for the majority of emissions released.51 The production of arsenic in the Unites States has been banned since 1985 however, it is still imported for use. The current concern lies in being exposed to arsenic through food and drinking water. Additionally, individuals may be exposed to arsenic compounds through air emissions from industrial facilities that manufacture pesticides, glass, and cigarette tobacco, smelting operations, and the burning of fossil fuels.2
In the United States, tazarotene has been approved for topical treatment of psoriasis (involving up to 20 body surface area) and mild to moderate facial acne. Application site burning, stinging, and desquamation are common side effects, especially with acne. Tazarotene is contraindicated in women who are pregnant.
Side-effects most likely to be associated with non-compliance or discontinuation of the drug include a sense of psychomotor slowing, cognitive dulling, acne or psoriasis, and weight gain. There is preliminary evidence that the anticonvulsant topiramate may help to reverse or stabilize the lithium-related weight gain. Isolated
Many of the signals were first published in articles in Prescriber Update or the NZ Family Physician published by the Royal NZ College of General Practitioners. The topics of these articles are listed in Tables 27.5 and 27.6. An example of the signals generated from the IMMP is given in Table 27.7 for sumatriptan. Signals published in the wider medical literature include ACE inhibitors and anaemia (Edwards and Coulter, 1989), the intestinal effects of captopril (Edwards et al., 1992), psoriasis with ACE inhibitors (Coulter and Pillans, 1993), hypertension with moclobemide (Coulter and Pillans, 1995b) and fluoxetine and extrapyramidal effects (Coulter and Pillans, 1995a).
Several factors have been limiting for autologous transplants. First, regimens have been less than maximally intensive and thus have not achieved eradication of immunologic memory. Second, reinfusion of potentially pathogenic T and B cells is a potential cause of relapse. The latter has been thought to justify allogeneic transplantation, with its attendant higher risks (10-30 mortality), mainly relating to graft versus host disease (GVHD). Several case reports and series support this notion. A child with autoimmune hemolytic anemia that was refractory to immunosuppression and splenectomy had only a 7-week remission after autologous transplantation, but was still in remission 18 months after an HLA-identical unrelated donor transplant (De Stefano et al., 1999). A graft-versus-autoimmunity effect has been proposed in a patient given an allogeneic stem cell transplant for chronic myeloid leukemia, who also had severe psoriasis (Slavin et al., 2000). This is also compatible with long-term...
The skin is the site of several common disorders that include acne vulgaris, psoriasis, eczema dermatitis, contact dermatitis, drug-induced dermatitis, and burns. Some disorders result from viral infections such as herpes simplex and herpes zoster. Some result from fungal infections such as tinea pedis (athlete's foot) and tinea capitis (ringworm).
One alternative to the RCT is the cohort study. In this type of study, two groups (or cohorts ) of subjects are identified one that by choice, luck, or chance has been exposed to the clinical intervention or putative causal agent, and one that has not been exposed. Our researcher, for example, can try to locate a group of clam juice drinkers and compare the proportion of those who have psoriasis in that group with the porportion of those with psoriasis in a group of abstainers.
In vitro antiinflammatory effects have been documented, and the herb has a long history of being used externally for wound healing, psoriasis, and the reduction of skin irritation. Although there are a few small positive studies, the available evidence is not yet conclusive in regard to clinical use.
Morphologically, Sezary cells are either small (approximately 8 m) or larger (approximately 15 to 20 im), the latter reportedly reflecting a block in the cell cycle between G1 and S phase.239 Sezary cells contain a hyperchromatic convoluted or cerebriform nucleus, which is more serpentine than the convoluted nuclei in T-cell lymphoblastic lymphoma (Plate 3-2Q). Similar-appearing peripheral T cells with cerebriform nuclear contours may rarely be found in patients with non-Hodgkin's lymphoma of the diffuse mixed cell type,246 although they generally are pathognomonic for CTCL. Sezary cells have also been observed in the skin and blood of patients with a number of benign dermatoses, including erythrodermic eczema, psoriasis, lichen planus, and actinic reticuloid.247 However, while Sezary
6-Thioguanine is a purine analogue structurally related to 6-mercaptopurine and azathioprine. Thioguanine interferes with several enzymes required for de novo purine synthesis, and its metabolites are incorporated into DNA and RNA, further impeding nucleic acid synthesis. The mechanism of action of thioguanine in psoriasis is not clearly understood it has been hypothesized to affect the proliferation and trafficking of lymphocytes as well as the proliferation of keratinocytes. Although 6-thioguanine is chiefly used in chemotherapy for acute myelocytic leukemia and other marrow-based malignancies, lower doses are very effective for moderate to severe psoriasis, particularly in
Helpful in other disorders of keratinization, but it is not useful for psoriasis. High doses of isotretinoin (2mg kg day) are effective as cancer chemoprevention agents to reduce the frequency of cutaneous malignancies in patients at increased risk, such as those with xeroderma pigmentosum, an inherited disorder in which DNA repair is deficient, or in immunosuppressed patients.
Briefly, during the 4- to 6-week study to determine safety in use, subtle skin condition symptoms (e.g., itching, burning, stinging, tingling) and even more significant irritant or allergic reactions can be evaluated under real-world consumer use conditions. Furthermore, one must remember that millions of end users with common yet compromised skin conditions (sensitive skin, atopy, psoriasis, chronic eczema, etc.) will also want to purchase and routinely use these complex products. This rather sizable niche population of consumers with compromised skin usually is excluded from routine skin, hair, and nail safety studies, yet the relatively long 6-week in-use study can provide the manufacturer with safety information for this important population as well. The completion of the foregoing safety tests provides the manufacturer and raw material distributors of these multifunctional personal care products with a compelling and comprehensive safety database for market entr e.
Salicylic acid is a potent antiin-flammatory agent. Urea is highly hygroscopic, enhancing the ability of tissue to absorb and retain water. Keratolytics are especially useful for treatment of corns and calluses, warts, palmoplantar keratodermas, ich-thyoses, and psoriasis. When used in conjunction with topical steroids for treatment of psoriasis, keratolytics enhance the steroid's penetration. Urea may also be used for chemical avulsion of dystrophic nails.
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Natural Treatments For Psoriasis
Do You Suffer From the Itching and Scaling of Psoriasis? Or the Chronic Agony of Psoriatic Arthritis? If so you are not ALONE! A whopping three percent of the world’s populations suffer from either condition! An incredible 56 million working hours are lost every year by psoriasis sufferers according to the National Psoriasis Foundation.