Ayurvedic Management of Psoriasis: A Case Study

Skin, the body’s largest organ, protects from deleterious environmental impacts (physical, chemical, microbiological) and is crucial for the maintenance of temperature, electrolyte and fluid balance and tactile sensation, it sets a boundary between the organism and the environment. Any change in the normal skin texture disturb the patient both mentally and physically. Psoriasis is a common, chronic, recurrent inflammatory disease of the skin, characterized by circumscribed, erythematous, dry, scaly plaques of varying sizes. The severity of psoriasis is found to be ever fluctuating. Individuals are likely to cycle between differing levels of severity throughout lifetime. The course of the disease is punctuated by spontaneous flare-ups and remissions. Psoriasis being a chronic and often disfiguring condition, cause a marked impairment in quality of life. There is no certain cure for this disease. Ayurvedic diagnosis is as Vatha-Kapha predominant Mahakushta namely Sidhma kushta. Here an effort to treat a 13-year-old child having plaque psoriasis by Samsodhana and Samsamana therapy. Initially 6 days Virechana was performed and then followed by Samsamana with intermittent Virechana karma. PASI score is used to assess the severity of psoriatic lesions and the patient’s response to treatment. PASI score before the treatment was found to be 15.7 which became 0 at the end of the treatment. This case report showed the treatment modalities done in the patient obtained great result with no recurrence in the last 1.5 years.

Correlation between Plasma-soluble Urokinase Plasminogen Activator Receptor(suPAR) Levels and Disease Severity in Psoriasis Patients / 现代检验医学杂志

Objective To investigate the correlation between plasma-soluble urokinase plasminogen activator receptor (suPAR) levels and disease severity in psoriasis patients.Method 60 psoriasis patients and 60 healthy controls were enrolled from Jan.2013 to Dec.2015 in the hospital.The plasma suPAR of all objects were measured by ELISA.Kruskal-Wallis and Mann-Whitney U test were used to compared plasma suPAR in the difference groups.Correlation between clinical data and plasma suPAR were analyzed by Spearmans's rho method.Result The plasma suPAR of psoriasis patients (3.92± 1.74 ng/ml) were higher than controls (3.03 ± 1.08 ng/ml,Z=13.05,P=0.009).The plasma suPAR of mild patients (PASI＜ 10) were lower than moderate patients (10≤ PASI≤ 20,3.90 ± 1.67 ng/ml,Z =8.00,P =0.035) and severity patients (PASI＞20,4.55 ± 1.88 ng/ml,Z=48.5,P=0.031).Positive correlation were found between plasma suPAR and psoriasis area and severity dndex (PASI) score (r=0.264,P=0.041).The plasma suPAR of the patients with disease duration＞10years (n=35,4.43 ± 1.98 ng/ml) were higher than the patients with disease duration＜10 years (n=25,3.41 ± 0.69 ng/ ml,Z=-2.064,P=0.035).Conclusion There was a positive correlation between the plasma suPAR and psoriasis disease severity.The Plasma suPAR can be the biomarker of psoriasis disease severity.It facilitate the clinical diagnosis of psoriasis.

Association between smoking and the severity of psoriasis

Introduction: Smoking is a risk factor for development of psoriasis. The severity of psoriasis has also been associated with smoking. Smoking may be an important modifiable factor in psoriasis treatment. Reduction or cessation of smoking in psoriasis patients is relevant as psoriasis is also associated with cardiovascular disease. Objectives: This study aims to determine the association between smoking and severity of psoriasis, and to investigate the frequency of concomitant cardiovascular risk factors in our psoriasis patients. Method: A 6-month prospective, controlled study. Consecutive patients with chronic plaque psoriasis attending Dermatology Clinic, Kuala Lumpur Hospital were screened. Smokers were identified, age, gender and ethnic matched non-smokers were recruited. Patients were evaluated for Psoriasis Severity Index (PASI) and body surface area (BSA) affected by psoriasis. Results: A total of 89 chronic plaque psoriasis patients were screened. Twenty four smokers and 24 matched non-smokers were included in the study. There were no significant differences in the presence of medical co-morbidities, blood pressure, body mass index (BMI), age of psoriasis onset and duration of disease in both groups. The mean age patients started smoking was 20.2±5.6 years, the mean duration of smoking was 16.3±11.1 years, the number of cigarette per day 11.9±6.1 sticks and the number of cigarette pack years was 10.7±9.2. BSA affected by psoriasis and PASI score were significantly higher in the subjects who smoked compared to the non smokers. Conclusion: Smoking is associated with more severe psoriasis in terms of BSA and PASI. Cardiovascular risk factors are common in psoriasis patients. These patients (smokers and non-smokers) require interventions to reduce their cardiovascular risks.

The Correlation between the Tc2 Cells and the CCR4 Expression and the PASI Score in the Peripheral Blood of Psoriasis Patients / 대한피부과학회지

BACKGROUND: Psoriasis is a chronic relapsing skin disorder that is characterized by abnormal epidermal proliferation, inflammation and angiogenesis. It causes emotional and social consequences that go far beyond the skin; therefore, many methods to measure and monitor the severity of psoriasis have been reported. OBJECTIVE: This study aims to evaluate the usability of the flow cytometric analysis of the T cell subsets and their chemokine receptors in the peripheral blood of the psoriasis patients as a severity index. METHODS: The T cell subsets and their chemokine receptor expression (CXCR3, CCR4) in the circulating blood of thirty psoriasis patients (PASI score:2.2~44.2) and twenty healthy controls were examined by flow cytometry. The relationship between the PASI score and the T cell subsets/chemokine receptors was also analyzed. RESULTS: The patients showed significantly higher number of Tc1 (CD8+CXCR3+), Tc2 (CD8+CCR4+) and CXCR3/CCR4 expressing cells than did the control group. Especially, the moderate to severe patients (a PASI score greater that 5) showed a higher number of Tc1, Tc2 and CCR4 expressing cells than did the control group. In the severe patients (a PASI score greater than 10), the frequency of circulating Tc2 cells and CCR4 expressing cells was directly correlated with the PASI score. CONCLUSION: Our findings suggest that flow cytometric analysis of the circulating T cell subsets with further classification could serve as an indicator of the disease severity in psoriasis patients.

An Inverse Relationship Between Ceramide Synthesis and Clinical Severity in Patients with Psoriasis

Ceramides play major roles in maintaining the epidermal barrier. It has been sus-pected that the depletion of ceramides, associated with disrupted barrier function in the epidermis, leads to the clinical manifestation of dryness and inflammation seen in patients with psoriasis. The aim of the present study was to determine the relation-ship between the level of ceramide synthesis in the epidermis and the clinical severity in patients with psoriasis. Samples from lesional and unlesional epidermis obtained from psoriasis patients were incubated with [14C]serine, an initiator of ceramide syn-thesis. otal ceramide was fractionated using high performance thin layer chromato-graphy, and the radioactivity was measured. The clinical severity of psoriasis was graded according to the psoriasis area and severity index scoring system. The level of ceramide synthesis in the lesional epidermis of patients was significantly lower than that in the unlesional epidermis and bore a negative correlation with the clinical severity of psoriasis. The present results suggest that the decreased level of ceramide synthesis in the epidermis contributes to the clinical severity of psoriasis.