Systemic steroids in the treatment of psoriasis: what is fact, what is fiction?

BACKGROUND: The use of systemic steroids in the treatment of psoriasis is not recommended by dermatological textbooks and guidelines because of the risk of disease deterioration after dose reduction or withdrawal. In contrast to these recommendations, a recent analysis using data from a German nationwide healthcare insurance revealed that systemic steroids were the most frequently prescribed drugs for psoriasis by general practitioners, internal medicine physicians and dermatologists. OBJECTIVE: As there is an obvious discrepancy between the use of systemic steroids for psoriasis and the reported adverse effects, a non-systematic literature search starting 1950 until today was performed to address beneficial and adverse effect of systemic steroids in psoriasis. METHODS: Non-systematic literature search. RESULTS: Regarding the widespread use of systemic steroids in psoriasis and other medical conditions taking the high prevalence of psoriasis of 2-3% at least in Caucasians into consideration, there is a remarkable lack of literature addressing adverse effects such as rebound, pustular or erythrodermic flares or even new occurrence of psoriasis in patients with a negative disease history. CONCLUSION: A re-evaluation of the treatment of psoriasis and/or psoriatic arthritis with systemic steroids is necessary.

Long-term treatment with fumaric acid esters in an 11-year-old male child with psoriasis.

Moderate to severe psoriasis is common in childhood and adolescence and is often a challenge for the treating dermatologist. In most cases, systemic therapies in children are only available 'off-label'. Fumaric acid esters (FAEs) have been used successfully in the treatment of moderate to severe psoriasis in adults and are recommended for long-term treatment in the German S3 guideline. In childhood psoriasis, FAEs may be a treatment alternative if a systemic therapy is indicated. Here, we report about the successful long-term treatment with FAEs in a male child with severe psoriasis.

Topical corticosteroids in psoriasis: strategies for improving safety.

Corticosteroids are a mainstay of topical therapy for psoriasis. While efficacious and relatively safe when used carefully, the potential for side effects, notably skin atrophy and adrenal suppression, have been associated with excesses in potency, prolonged or widespread use. The International Psoriasis Council Working Group on Topical Therapy has reviewed the efficacy and safety of topical corticosteroids and recommends strategies for safe, long-term use of these agents.

The impact of treatment with tumour necrosis factor-alpha antagonists on the course of chronic viral infections: a review of the literature.

Biologics that antagonize the biological activity of tumour necrosis factor (TNF)-alpha, namely infliximab, etanercept and adalimumab, are increasingly used for treatment of immune-mediated inflammatory diseases, including psoriasis, worldwide. TNF-alpha antagonists are known to increase the risk of reactivation and infection, particularly of infections with intracellular bacteria such as Mycobacterium tuberculosis. More frequently these agents are given to patients with viral infections. Viral hepatitis and human immunodeficiency virus infections are often present in these patients, with a considerable geographical variation. Other concomitant viral infections such as herpes, cytomegalovirus and varicella zoster virus may occur much more frequently than tuberculosis or leprosy. General recommendations about the management related to possible problems associated with anti-TNF-alpha treatment and these viral infections are lacking. This short review will give an overview of the most recent data available on the effects of anti-TNF-alpha therapy on viral infections with a particular focus on patient management and screening recommendations.

A case of rapidly progressive multiple system degeneration: morphological findings and pathogenetic implications.

A 62-year-old woman was referred to our psychiatric hospital by the municipal health office, because she was in such a neglected condition that she was a danger to herself. Initially, it was suspected that she was suffering from dementia or psychosis. X-rays led to the suspicion of bronchial carcinoma. Consequently, the mental changes were interpreted as probable effects of metastases to the brain. There was not enough time, however, to check the patient thoroughly to find the actual cause of her altered personality. The patient developed a high fever (up to 42 degrees C). A few days later, she died of cardiorespiratory failure with severe abscess-forming obstructive pneumonia. An autopsy confirmed the bronchial carcinoma. However, metastases were only found in the hilar lymph nodes. No metastases were detectable in the CNS, either macroscopically or microscopically. The neuropathological examination of the brain revealed multiple system degeneration. The striking microscopic findings (a large number of typical apoptotic figures visible with the light microscope in ganglion cells, lack of cytoplasmic inclusion bodies in the oligodendroglia and an unusually strong monocytic reaction (so-called reactive satellitosis) indicated that the disease course had been very rapid. Perhaps these were early steps in the evolution of a multisystem atrophy. A kind of time-lapse effect, as it were, revealed simultaneously individual details of the pathogenetic course, which would have disappeared in the usual long course of the disease and thus could not have been observed, even with the most up-to-date molecular methods. It is very likely that this was a paraneoplastic syndrome.

Transcriptional analysis of major heat shock genes of Helicobacter pylori.

The transcriptional organization and heat inducibility of the major heat shock genes hrcA, dnaK, dnaJ, groEL, and htpG were analyzed on the transcriptional level in Helicobacter pylori strain 69A. The strongly heat-induced dnaK operon was found to be tricistronic, consisting of the genes hrcA, grpE, and dnaK. The dnaJ gene specified one monocistronic mRNA which was also heat inducible. The genes groES and groEL were transcribed as one strongly heat-inducible bicistronic mRNA which exhibited exactly the same induction kinetic as the dnaK operon. Surprisingly, transcription of the monocistronic htpG gene was switched off after heat shock. The data presented are discussed with regard to the different mechanisms regulating expression of heat shock genes in H. pylori

[Experimental Echinococcus multilocularis infections of the maternal mouse and their significance for the offspring]. / Die experimentelle Echinococcus multilocularis-Infektion von Muttermäusen und ihre Bedeutung für die Nachkommen.

Experimental infection of mother mice by intraperitoneal injection of Echinococcus multilocularis cyst material does not result in the transfer of protective immunity to the offspring. In the contrary, if infected via the same route, filial mice show a lower antibody titer, when examined 36, 78 and 120 days p.i. and a higher worm burden (average: 1455 mg) in comparison with control mice born of non-infected mothers (average parasite weight: 844 mg). The question is discussed, whether these observations are due to the suppressive action of transferred antibodies or whether the offspring become immunologically tolerant by the transfer of parasite antigen.