Comparison of Calcipotriol Monotherapy and a Combination of Calcipotriol and Methylprednisolone Aceponate Therapy in Psoriasis Patients

BACKGROUND: Complete clearance of the lesions by using calcipotriol alone have not been re-ported commonly in the treatment of psoriatic patients. Moreover, lesional and perilesional irritation are reported in some patients using calcipotriol, which may result in premature termination of the treatment due to impairing the compliance. OBJECTIVE: A clinical study was conducted to determine whether, in the topical treatment of psoriasis, a combination of calcipotriol cream and methylprednisolone aceponate was more effective than calcipotriol monotherapy. METHODS: Twenty-one psoriasis patients who had the symmetric lesions on the right and left lower legs were enrolled in the study. A combination of calcipotriol cream and methylprednisolone aceponate therapy was done on the left lower legs, whereas calcipotriol alone was applied on the right lower legs twice daily. PASI score and adverse events were recorded at each visit (1, 2, 3, 4, 6 week). The overall therapeutic result was also assessed by the physician and patients. RESULTS: The initial PASI score was 7.09 on both legs. After 6 weeks, the mean PASI score was 3.85 on the left leg, and 5.70 on the right leg (p<0.05). In the physicianOs global assessment, the percentage of patients who showed the improvement of more than half of lesions was 29% in the monotherapy and 62% in the combination therapy area. Two patients complained of mild itching sense on monotherapy, but there was no specific side effect on combination area. CONCLUSION: The combination therapy was more effective, as assessed by all evaluated variables. Furthermore, this combination reduces the adverse effects caused by long-term use of topical corticosterois as well as the irritation associated with. calcipotriol.

A Case of a Patient with Psoriasis Aggravated by Scabies Infstation

Scabies may be seen in psoriatic patients, although not frequent. This situation provokes many problems including the difficulty of diagnosis and uncertainty of appropriate therapy. We report a case of a young female with an existing psoriasis aggravated following scabetic infestation. At first, she took an antiscabetic treatment but the severity of psoriasis persisted. Subsequently, cyclosporine treatment was started and the psoriatic lesions improved deamatically.

Minimal Erythema Dose of Narrow Band UVB in Korean Psoriasis Patients / 대한피부과학회지

BACKGROUND: In planning narrow band UVB (NBUVB) phototherapy protocol, assessing a minimal erythema dose (MED) of NBUVB may be essential to gain optimal therapeutic results. However, there are few data regarding to the MED of NBUVB in Koreans and the results are variable according to skin types and photosensors. OBJECTIVE: We assessed MED of NBUVB in psoriasis patients by a photometer designed for NBUVB phototesting, the relationship of skin type and ultraviolet responses. METHODS: Forty psoriasis patients were phototested on their backs with newly developed Waldmann UV meter(R)(Waldmann Co. Germany) for NBUVB phototesting. The MED was investigated by irradiating several NBUVB doses ranging from 200 mJ/cm2 to 1500 mJ/cm2 and then was judged visually 24 hours after. RESULTS: 1.The median and mode value of MED of NBUVB in Korean psoriasis patients were 950 mJ/cm2 (35%). 2. Skin type was well correlated with the MED. CONCLUSION:The MED value of NBUVB in our study may be useful data to set the phototherapy protocol. Skin types are related with MED value and the study is more required to know the exact relationship.

Nucleotide Sequence of Internal Transcribed Spacer 1 of Trichophyton mentagrophytes Isolated from Human and Animals / 대한피부과학회지

BACKGROUND: Trichophyton mentagrophytes is a complex species and 3 perfect states, Arthroderma benhamiae, A. vanbreuseghemii, and A. simii have been described. In Korea and Japan, all of the isolates of T. mentagrophytes of which the perfect states determined were known as A. vanbreuseghemii till recently. However, in Japan, one isolate from a monkey was reported as A. simii and several strains from rabbits or patients were A. benhamiae. Therefore, it is necessary to confirm the existence of A. simii or A. benhamiae in Korea. OBJECTIVES: We performed this study to determine the teleomorphs of 19 strains of T. mentagrophytes isolated from Korean patients infected from pets and 4 from the skin lesions of rabbits. METHODS: DNA sequences of internal transcribed spacer 1 (ITS1) area of the 23 isolates and 3 reference strains were determined and matched with the data registered in GenBank nucleotide sequence database. RESULTS: The sequencing data of 22 isolates were very similar to those of A. vanbreuseghemii and 1 to T. mentagrophytes var. interdigitale respectively. CONCLUSION: Although all of the clinical isolates were related with A. vanbreuseghemii in this study, the possibility of the existence of A. simii and A. benhamiae in Korea is still high and further study is needed.

A Case showing Improved Psoriasis along the Hemiparetic area after Cerebrovascular Accident / 대한피부과학회지

The role of the nervous system in the pathogenesis of psoriasis has been receiving increasing attention. We report a case of improvement of psoriasis after hemiparesis following cerebrovascular accident. This case is worthy in that it supports the neurogenic origin of psoriasis.

The Study of Dose Incremental Regimen for Narrow-Band UVB Phototherapy in Psoriatic patients / 대한피부과학회지

BACKGROUND: Narrow-band UVB phototherapy using 311+/-2nm wavelength is in widespread use due to its greater efficacy and, possibly, safety compared with broad-band UVB sources. However, its optimal dose increment regimen is not determined. OBJECTIVE: We performed narrow-band UVB(NBUVB) phototherapy to compare clinical efficacy between fixed and 20% incremental regimen in Korean psoriasis patients. METHODS: Twenty four psoriasis patients received narrow-band UVB phototherapy. Among them, fifteen patients received fixed regimen and nine patients, 20% incremental regimen. We categorized each patient into clearing, improvement, or failure groups based on the therapeutic efficacy, measured the PASI score every two weeks and calculated cumulative dose of narrow-band UVB. RESULTS: We found no statistically significant difference between two regimen. However, there is a tendency that irradiation number and duration of treatment are smaller in 20% incremental regimen but, in terms of cumulative dose, fixed incremental regimen is better than 20%. CONCLUSION: These results suggests that 20% incremental regimen may clear psoriasis faster than fixed but that the latter regimen may be equally effective as it requires slighty more treatment sessions at a lower cumulative dose.