ABSTRACT
Plaque Psoriasis, a common type of Psoriasis typically characterized by circular to oval red plaques distributed over extensors of body surface and scalp.The plaques usually exhibit scaling as a result of epidermal hyperproliferation and dermal inflammation with well defined sharply demarcated boundaries sometimes carry a violacious tint. Both early onset and a family history of disease are considered poor prognostic indicators. We here by presenting a case of chronic plaque psoriasis admitted to the IPD of SJIIM Hospital simulating the lakshanas of kitibhakushta treated with shodhna and shamana therapies with the objective of reducing the frequency of relapses,duration of remission and alleviating the symptoms.
ABSTRACT
Background: Guttate psoriasis has a well-known association with streptococcal throat infections, but the effects of these infections in patients with chronic plaque type of psoriasis remains to be evaluated. In Bangladesh several studies were done on psoriasis but no data about association between streptococcal throat infection and plaque type psoriasis are available so far. Considering the co-morbidities of psoriasis patients, it might be justifiable to find out the events that provoke the initiation or exacerbation of psoriatic disease process. Objective: To observe the association of streptococcus with plaque type of psoriasis. Materials and Methods: This observational study was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Forty seven patients clinically and histopathologically diagnosed as having plaque psoriasis were selected as cases and patients with skin diseases other than psoriasis were selected as controls. Results: In this study majority of subjects (55%) were diagnosed as chronic plaque psoriasis. Among the subjects with guttate flare of chronic plaque psoriasis 64.2% gave a positive history of sore throat. ASO titer was raised (>200 IU/mL) in 28 (59.5%) patients of chronic plaque psoriasis and 7 (17.9%) patients of non-psoriatic respondents. The difference between two groups was significant (p<0.05). Streptococcus pyogenes was found in 12 (25.5%) in chronic plaque psoriasis patients versus in 4 (10.2%) in controls (p>0.05). Conclusion: This study shows that streptococcal throat infections are associated with plaque psoriasis and early treatment of throat infections may be beneficial for plaque type of psoriasis patients.
ABSTRACT
Group A Streptococcal infection in the throat is responsible for causing initial and recurrent attacks of acute guttate psoriasis (AGP). Up to 70% of these AGP patients go on to develop chronic plaque psoriasis (CPP). We hypothesized that chronic sub-clinical, on-going streptococcal infection might solely be responsible for CPP in a genetically predisposed individual. Rifampin, a useful drug for several types of bacterial infections including Group A Streptococci (GAS) because of its broad spectrum, excellent tissue penetration, low sideeffect profile and its salivary concentrations after oral administration greatly exceeds the minimum inhibitory concentration for most GAS, thus helpful in eradicating pharyngeal carriage of GAS, was considered for long term use in CPP. Fifty patients with moderate to severe CPP were enrolled. Of these 25 were randomly selected to receive rifampin for 36 weeks as a single oral morning dose of 10 mg/kg body weight (approx. patient weighing <50 kg received 450mg per day and patients >50 kg received 600mg per day). Remaining 25 patients received placebo. Rifampin group was further followed-up to one more year. Significant improvement in PASI score was noted from 12 weeks in majority of patients in Rifampin group. Relevant investigations and clinical assessment was done at regular intervals to observe any side effects and check progress of the disease. Data were analyzed statistically using the t-test. As psoriasis is a chronic disorder that waxes and wanes over time, withdrawal of treatments usually is accompanied by relapse of skin manifestations so a follow-up with one year drug-free period was added to verify treatment consistency. Patients tolerated the therapy well.
ABSTRACT
BACKGROUND: Psoriasis is a chronic inflammatory disease occurs worldwide. At the Philippine General Hospital dermatology clinic, psoriasis accounted for 2.2% -2.4 % of new consults seen in 2004-2010. Its pathogenesis remains obscure but current studies indicate that activated Thai and Thai response mechanisms mediate inflammation and are implicated as key players in psoriasis genesis. Ustekinumab is a fully human monoclonal antibody that targets two interleukins (IL): IL-12 and IL-23 which influence T-cell differentiation into Thi and Thai, respectively. These naturally occurring proteins help regulate the immune system secondary to their role in linking innate and adaptive immune responses.CASE SERIES: This is a retrospective chart review on the use of ustekinumab in 22 adult Filipinos (10 males and 12 females) conducted at six (6) dermatologists' clinics in 2010. Included were patients enrolled in the Named Patient Program (NPP) of Janssen Pharmaceutical Companies of Johnson & Johnson Philippines, diagnosed with moderate to severe long-standing plaque psoriasis and contraindicated for, or with inadequate response to, conventional systemic treatment. Patients received ustekinumab subcutaneously at loading doses of 45mg during the initial visit and at four weeks. Subsequently, it was given every twelve weeks. For patients who weighed 100 kg or more, 90mg of ustekinumab was administered. Clinical responses to the drug were assessed using Psoriasis Area and Severity Index (PASI) at initial visit and at the end of the program (52 weeks). At the end of the one-year program period, the median (range) PASI score of patients was 1.50 (0-29.2). Sixteen of the twenty-two subjects (72.73%) were able to achieve ±75% improvement from baseline (PASI 75). There was a significant (94.52%) reduction in median PASI scores of the patients from baseline to end visit (p CONCLUSION: Ustekinumab was shown to significantly reduce the median PASI scores of 22 adult Filipino patients with moderate to severe plaque psoriasis. It was also shown to be well tolerated, with relatively mild adverse events.