Certain aspects of combined therapy of severe
psoriasis.
K.N.Suvorova,
I.M.Korsunskaya, A.Yu.Putintsev.
Pediatric and Adolescent Dermatology and Venereology Section, Chiar of
Pediatric Infectious Diseases, Russian Medical Academy of Professional
Advancement Education; V.G.Korolenko Municipal Clinical Hospital.
Psoriasis is one of the most widespread forms of dermatosis. In various
countries its prevalence ranges from 0.1 to 3%, while the share of psoriasis
patients among those with dermatologic and venereologic diseases is 12 to 15%.
Recently there has been a certain increase in the incidence of this dermatosis,
severe drug-resistant forms of psoriasis, such as psoriatic erythrodermia,
arthropathic psoriasis, exudative psoriasis becoming more prevalent.
Psoriasis is a chronic dermatosis of multifactor nature genetic factors
dominating in its development. The search for psoriasis genetic markers has
confirmed that, apart from the HLA-system, dominant forms of psoriasis are
linked with the distal part of the 17th chromosome. An important
role in psoriasis pathogenesis also belongs to factors the effect of which on
cutaneous processes is probably mediated by immune status impairments and
various biochemical defects.
Immunological changes associated with psoriasis consist in decreased
absolute and relative T-lymphocyte count in circulating blood mostly due to a
decrease in the subpopulation of T-helpers. Histochemical examination of biopsy
samples from psoriatic foci using monoclonal antibodies revealed that dermal
infiltration consists mostly of T-lymphocytes, while B-lymphocytes are only
present in individual samples as isolated cells. Most T-lymphocytes
infiltrating the derma belong to the subpopulation of T-helper cells.
Expression of the HLA-DR-complex on some keratinocytes also indicates a change
in their immunological phenotype. According to modern conceptions this reflects
the ability of HLA-DR-keratinocytes to activate epidermal T-lymphocytes as well
as to produce cytokines, some of which are capable of inducing
hyperproliferation of epithelial cells.
Analysis of metabolic disorders in psoriasis patients using the standard
set of biochemical blood tests has demonstrated that in at least 80% of
exudative psoriasis, psoriatic erythrodermia and arthropathic psoriasis cases
inflammatory biochemical serum syndrome is present.
As a lot of patients with severe, predominantly exudative forms of
psoriasis are treated in V.G.Korolenko municipal Clinical Hospital No. 14,
Glutoxim was included in the complex therapy of this group of patients.
Glutoxim belongs to thiopoietins, a new class of drugs possessing
immunomodulating and systemic cytoprotective effects. It acts differently
on normal cells, where it stimulates proliferation and differentiation, and on
transformed ones, where it induces apoptosis.
The following parameters were taken into account when prescribing the
drug: erithrodermal eruptions, torpidity of disease development on traditional
therapy as well as changed biochemical parameters of the blood (AsAT, AlAT,
GGT, APh, thymol test) which were more frequent in alcohol abusing men.
25 patients (9 women and 16 men) aged from 19 to 72 were observed.
The study group included 15 patients with exudative psoriasis
(7 patients), arthropathic psoriasis (6 patients) and erythrodermal
course of dermatosis. 3 of the study group patients has elevated
transaminase activity. The control group included 10 patients with similar
forms of psoriasis.
As basis therapy, all patients received disintoxicating and
hyposensibilizing drugs, 2 patients were on methotrexate (15 mg
intramuscularly once a week). Steroid ointments were used as local therapy.
Glutoxim was administered daily for 10 days as intramuscular injections of
1 ml of 10% solution.
Patients of the study group demonstrated a marked decrease of skin
infiltration at sites of eruption as early as on day 3 of therapy; by the end
of therapy residual infiltration was minimal and persisted only along the patch
circumference. Skin edema decreased only by the end of therapy. Itching
subsided considerably in all patients receiving Glutoxim.
In the 10 patients of the control group no regress of psoriatic
eruption was registered for 10 days.
According to repeated biochemical blood tests, in 3 patients of the
study group transaminases decreased to normal values.
Example. Patient B., male, 59
years old. Diagnosis: arthropathic psoriasis with exudative skin
manifestations. At admission to the Dermatology department of V.G.Korolenko
Municipal Clinical Hospital No. 14 the patient had monomorphic rash in the
form of papules and patches on forearms, thighs and torso merging into
irregular infiltrated edemic foci covered with off-white scaly crust.
Biochemical blood parameters: cholesterol — 5.8 mM/l, total
bilirubin — 20.5 uM/l, conjugated bilirubin — 7.9 uM/l, urea —
7.42mM/l, AsAT — 56.4 U/l, AlAT — 24.0 U/l, GGT —
69.5 U/l, thymol turbidity test — 2.5. After 3 days of Glutoxim
administration infiltration and skin edema reduced considerably, peeling
practically disappeared, itching diminished. The repeated biochemical blood
test indicated a decrease in transaminase activity: cholesterol —
5.5 mM/l, total bilirubin — 9.6 uM/l, urea —
4.10 mM/l, AsAT — 17.5 U/l, AlAT — 24.0 U/l,
GGT —51.8 U/l, thymol turbidity test — 0.5.
Glutoxim was well tolerated by all patients of the study group. No
adverse reactions were observed.
Thus, the use of Glutoxim in psoriasis ensures faster and more complete
regression of the disease symptoms; its hepatoprotective effect is primarily
manifests itself in normalization of transaminase activity, which makes it
possible to use Glutoxim as part of complex therapy of severe psoriasis.
Further studies of the possibility of using this drug in psoriasis are
required.
For more
references:
Dr. Giorgio Castello
Corso Torino, 32/6
16129 – Genova (Italy)
Tel: +39.010.58.94.95
Mobil
phone: +39.335.628.34.24
e-mail:
castello@tiopoietine.info