Tazarotene gel with narrow-band UVB phototherapy: a synergistic combination in psoriasis

Abstract: BACKGROUND: Narrow-band UVB (NB-UVB) has been shown to be one of the most effective treatment modalities for psoriasis. Tazarotene, a known effective anti-psoriatic modality, when combined with NB-UVB may enhance the therapeutic success. OBJECTIVE: To study clinical efficacy and safety of combination of NB-UVB with topical tazarotene 0.05% gel in psoriasis. METHOD: Thirty patients with plaque psoriasis having symmetrical lesions were enrolled for 12 weeks. All patients were instructed to apply tazarotene gel on target plaque on left side of body once daily. In addition, the whole body was irradiated with NB-UVB twice weekly. Efficacy was assessed by target plaque scoring and number of treatment sessions for clearance. RESULT: Our study resulted in 3 key findings: Firstly, therapeutic efficacy of NB-UVB was enhanced by addition of tazarotene. This enhanced efficacy was more apparent in decreasing scaling and thickness as compared to decrease in erythema. Secondly, combination therapy showed faster clearance of target plaques, with reduction in mean number of treatment sessions. Thirdly, mean cumulative NB-UVB dose needed to achieve clearance of target plaques was significantly reduced with combination therapy. STUDY LIMITATIONS: The study was not randomized or controlled, but an open-label trial. The study period was relatively short, i.e., 12 weeks, without any follow-up period. CONCLUSION: Tazarotene gel significantly enhances the therapeutic efficacy of NB-UVB irradiation with faster clearance and without serious side effects.

Comparison of clinical efficacy of topical tazarotene 0.1% cream with topical clobetasol propionate 0.05% cream in chronic plaque psoriasis: a double-blind, randomized, right-left comparison study.

BACKGROUND: No controlled data is available till date comparing topical tazarotene and clobetasol in Indian psoriatic patients. OBJECTIVE: The aim was to compare the clinical efficacy of 12 weeks of once-daily tazarotene 0.1% cream with that of once-daily clobetasol propionate 0.05% cream in the treatment of patients with chronic plaque psoriasis. METHODS: About 36 patients with bilaterally symmetrical lesions were enrolled in this double-blind randomized controlled study. A left-right randomized study was conducted. RESULTS: Clobetasol cream was better than tazarotene cream in reducing the erythema throughout the treatment period with statistically significant differences favoring clobetasol at weeks 2, 4, 6 and 8 ( P <0.05). Tazarotene was better in reducing the induration at weeks 2 ( P <0.05), 4, 10 and 12. Clobetasol cream was better in reducing the scaling throughout the treatment period with statistically significant differences favoring clobetasol over the entire treatment period. Treatment success rate was 100% with clobetasol and 88% with tazarotene at the end of week 12 with clobetasol achieving 100% success rate at the end of week 6. Treatment with tazarotene resulted in uniform reduction of plaque elevation and was not associated with the development of hot spots. CONCLUSION: Topical tazarotene 0.1% cream is less effective than topical clobetasol propionate 0.05% cream in the treatment of plaque psoriasis. It has more effect on induration than on erythema and scaling of psoriatic lesions.

Ichthyosis bullosa of Siemens: response to topical tazarotene.

In 1937, Siemens described a Dutch family with superficial blistering, flexural hyperkeratosis, and characteristic mauserung appearance. Since then, less than 20 kindreds with this condition have been described in the English dermatologic literature. A 14-year-old boy presented with history of recurrent blistering and peeling of skin since the age of 1 month, predominantly seen over limbs and trunk, often associated with secondary infection. His mother also had similar symptoms from childhood. On examination, the child had typical mauserung peeling of the skin and dirty gray hyperkeratosis in a rippled pattern over flexures. Skin biopsy from the boy showed intracorneal blistering with epidermolytic hyperkeratosis in the upper spinous layers. The typical history and clinical features along with characteristic histological findings confirmed our diagnosis of ichthyosis bullosa of Siemens. It must be differentiated from other conditions with epidermolytic hyperkeratosis and skin peeling, such as bullous ichthyosiform erythroderma of Brocq and peeling skin syndrome. Our patient responded well to 0.05% topical tazarotene gel over four weeks.

Role of hypolipidemic doses of nicotinic acid on glucose tolerance and severity of diabetes in male rats

The present work was devoted to study the effect of varying doses of nicotinic acid on glucose tolerance, and its role in modulating the severity of STZ- diabetes in male rats. Three oral nicotinic acid doses of, 31 5, 63.5 and 126.0 mg/kg b. w. respectively, comparable to half, equal and two folds rodent equivalent of 600 mg [daily human hypolipidemnic dose], were administered to three equal sized groups of male albino rats, prior to oral glucose load of 1.0 g/kg b.w. Serial post loading glucose determinations, revealed marked increases in glucose tolerance, in parallel with the rise in nicotinic acid dosage, as verified by lower magnitudes of post-loading hyperglycaema, compaired to parallel non-medicated Controls. Moreover, the results of serum glucose 'FSG estimates in groups of STZ- diabetic rats, receiving daily repeated oral nicotinic acid medication in doses of 63.0 and 126.0 mg/kg. b.w. respectively, yielded evidence of very highly significant magnitudes of antagonistic attenuation of STZ- hyperglycaemia, coupled with marked increase in serum insulin activity, progressively accentuated with longer duration of medication

Noradrenaline release by nicotinic acid.

In doses (from 100 mug to 1 mg) nicotinic acid produced positive inotropic and chronotropic action on isolated frog heart. This effect was blocked by pronethalol and guanethidine administration. This effect was not observed in reserpinised frogs. Repeated administration of the same dose of nicotinic acid caused development of tachyphylaxis, in frog's heart preparation. The observations indicate that nicotinic acid induced a release of noradrenaline in frog's heart. On other preparations, such as isolated rabbit heart, rabbit's intestine and guinea pig seminal vesicles, nicotinic acid produced a nonspecific direct depressant action.