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Pearce DJ, Spencer L, Hu J, Balkrishnan R, Fleischer AB, Feldman SR. Class I topical corticosteroid use by psoriasis patients in an academic practice. J DERMATOL TREAT 2009; 15:235-8. [PMID: 15764038 DOI: 10.1080/09546630410033745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Psoriasis is a chronic skin disorder that can have a profound impact on the quality of life of patients. The treatment of psoriasis is complicated by the availability of numerous topical agents, systemic agents, and phototherapy. Of the topical preparations available, the ultra-high potency, or Class I steroids, have an important role in treating psoriasis. Their use is most appropriate for the treatment of plaques in regions excluding the face, axilla, groin and genitals. OBJECTIVE The purpose of this study was to examine the prescribing patterns of Class I topical corticosteroids within a large academic dermatology practice for patients with all types of psoriasis. METHODS A retrospective chart review of 650 patients with psoriasis from an academic dermatology practice was performed. Class I steroid use was defined as those patients who were observed to be currently using clobetasol propionate, halobetasol propionate, diflorasone, or augmented betamethasone dipropionate. RESULTS A total of 79% of patients were prescribed topical steroids of any class while 46% of patients were prescribed a Class I steroid. In all, 58% of patients who received topical steroid therapy received a Class I agent; 11% of patients prescribed Class I steroids also received systemic therapy for their psoriasis. Conversely, 35% of patients who received systemic therapy were also receiving Class I topical therapy. DISCUSSION In our department, Class I topical steroids are commonly used in the treatment of psoriasis. The superpotent topicals are often used as an adjunct to systemic therapy and will likely remain a mainstay of psoriasis therapy.
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Affiliation(s)
- D J Pearce
- Center for Dermatology Research, Department of Dermatology, Wake Forest University of Helath Sciences, Winston-Salem, NC 27157-1071, USA
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52
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Abstract
BACKGROUND Psoriasis is a relatively common, chronic and disabling skin disease, due to a disturbed proliferation and differentiation of keratinocytes, accompanied by vascular alterations and infiltration of inflammatory cells with a local T(H)1-type cytokine immune response. There is no cure, but several treatment options are available. OBJECTIVE The treatment of psoriasis is far from being satisfactory, due to the impractical modalities of topical treatment and the suboptimal safety profile of the systemic treatments available. In the last few years, parallel to an improved understanding of the disease pathogenesis, there has been a boosting of research in new agents for the treatment of psoriasis. These new agents are the focus of this paper. METHODS After a short review of the treatment options already available (mainly based on the available systematic reviews), we focused on agents that are still in clinical development (Phase I - III) and have not yet entered the market. For the purpose of this study, we systematically searched the main registries of ongoing trials up to August 2008. RESULTS/CONCLUSION The field is very dynamic, with both immunopharmacology of recombinant DNA techniques and more traditional small-molecule pharmacology actively delivering new agents. With the increasing number of new options, there is a need for research systems that enable to effectively collect long-term safety data on treated patients.
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Affiliation(s)
- Luigi Naldi
- Department of Dermatology, Ospedali Riuniti, Bergamo, Italy.
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Abstract
BACKGROUND Chronic plaque psoriasis is the most common type of psoriasis and is characterised by redness, thickness and scaling. First line management of chronic plaque psoriasis is with topical treatments, including vitamin D analogues, topical corticosteroids, tar-based preparations, dithranol, salicylic acid and topical retinoids. OBJECTIVES To compare the effectiveness, tolerability and safety of topical treatments for chronic plaque psoriasis with placebo; to compare vitamin D analogues with other topical treatments. SEARCH STRATEGY The Cochrane Skin Group's Trials Register was searched (2004/12). To update an unpublished 2002 review we also searched CENTRAL in The Cochrane Library (Issue 1,2005); MEDLINE (to 2005/02); EMBASE (to 2005/08); Science Citation Index (to 2005); Biosis (to 2005); Dissertation Abstracts (all publication years); Inside Conferences (all publication years); SIGLE (to 2005); National Research Register (all projects with a start date of 2001 to 2005); metaRegister of Current Controlled Trials. SELECTION CRITERIA Randomised trials comparing treatments against placebo or against vitamin D analogues in people with chronic plaque psoriasis. DATA COLLECTION AND ANALYSIS One author extracted study data and assessed study quality. A second author checked these data. We routinely contacted triallists and companies for missing data. We extracted data on withdrawals and adverse events. MAIN RESULTS The review included 131 RCTs with 21,448 participants. Vitamin D was significantly more effective than placebo, although there was a wide variation in effect size with the standardised mean difference (SMD) ranging from -0.82 (95% CI -1.34 to -0.29) to -1.90 (95% CI -2.09 to -1.71). With one exception, all corticosteroids performed better than placebo, with potent corticosteroids (SMD: -0.95 (95% CI: -1.11 to -0.80; I(2): 61.1%; 17 studies; 2386 participants)) having smaller benefits than very potent corticosteroids (SMD: -1.29 (95% CI: -1.45 to -1.13; I(2): 53.2%; 11 studies; 1571 participants)). Dithranol and tazarotene performed better than placebo. Head-to-head comparisons of vitamin D against potent or very potent corticosteroids found no significant differences. However, combined treatment with vitamin D /corticosteroid performed significantly better than either vitamin D alone or corticosteroid alone. Vitamin D performed better than coal tar, but findings relative to dithranol were mixed. Potent corticosteroids were less likely than vitamin D to cause local adverse events. No comparison of topical agents found a significant difference in systemic adverse effects. AUTHORS' CONCLUSIONS Corticosteroids perform as well as vitamin D analogues and are associated with a lower incidence of local adverse events. Further research is required to inform long-term maintenance treatment.
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Affiliation(s)
- Anne R Mason
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, York, UK, YO10 5DD.
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54
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Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol 2009; 60:643-59. [DOI: 10.1016/j.jaad.2008.12.032] [Citation(s) in RCA: 327] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 12/16/2008] [Accepted: 12/19/2008] [Indexed: 11/26/2022]
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55
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Tabolli S, Alessandroni L, Didona B, Di Pietro C, Gisondi P, Rota L, Sampogna F, Abeni D. A randomized controlled trial to evaluate short-term treatment with eosin vs. topical steroids in psoriasis. Clin Exp Dermatol 2009; 34:304-8. [DOI: 10.1111/j.1365-2230.2008.02932.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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56
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57
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Albanesi C, Scarponi C, Pallotta S, Daniele R, Bosisio D, Madonna S, Fortugno P, Gonzalvo-Feo S, Franssen JD, Parmentier M, De Pità O, Girolomoni G, Sozzani S. Chemerin expression marks early psoriatic skin lesions and correlates with plasmacytoid dendritic cell recruitment. J Exp Med 2009; 206:249-58. [PMID: 19114666 PMCID: PMC2626680 DOI: 10.1084/jem.20080129] [Citation(s) in RCA: 251] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 12/04/2008] [Indexed: 11/10/2022] Open
Abstract
Psoriasis is a type I interferon-driven T cell-mediated disease characterized by the recruitment of plasmacytoid dendritic cells (pDC) into the skin. The molecules involved in pDC accumulation in psoriasis lesions are unknown. Chemerin is the only inflammatory chemotactic factor that is directly active on human blood pDC in vitro. The aim of this study was to evaluate the role of the chemerin/ChemR23 axis in the recruitment of pDC in psoriasis skin. Prepsoriatic skin adjacent to active lesions and early lesions were characterized by a strong expression of chemerin in the dermis and by the presence of CD15(+) neutrophils and CD123(+)/BDCA-2(+)/ChemR23(+) pDC. Conversely, skin from chronic plaques showed low chemerin expression, segregation of neutrophils to epidermal microabscesses, and few pDC in the dermis. Chemerin expression was localized mainly in fibroblasts, mast cells, and endothelial cells. Fibroblasts cultured from skin of psoriatic lesions expressed higher levels of chemerin messenger RNA and protein than fibroblasts from uninvolved psoriatic skin or healthy donors and promoted pDC migration in vitro in a chemerin-dependent manner. Therefore, chemerin expression specifically marks the early phases of evolving skin psoriatic lesions and is temporally strictly associated with pDC. These results support a role for the chemerin/ChemR23 axis in the early phases of psoriasis development.
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MESH Headings
- Adult
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacology
- Antigens, CD/metabolism
- Blotting, Western
- Calcitriol/pharmacology
- CD8-Positive T-Lymphocytes/cytology
- CD8-Positive T-Lymphocytes/drug effects
- CD8-Positive T-Lymphocytes/metabolism
- Cells, Cultured
- Chemokine CXCL10/genetics
- Chemokine CXCL10/metabolism
- Chemokines/genetics
- Chemokines/metabolism
- Chemotaxis, Leukocyte/drug effects
- Chemotaxis, Leukocyte/physiology
- Culture Media, Conditioned/pharmacology
- Dendritic Cells/cytology
- Dendritic Cells/metabolism
- Dermatitis, Atopic/genetics
- Dermatitis, Atopic/metabolism
- Dermatitis, Atopic/pathology
- Extracellular Signal-Regulated MAP Kinases/metabolism
- Fibroblasts/cytology
- Fibroblasts/drug effects
- Fibroblasts/metabolism
- Gene Expression/drug effects
- Intercellular Adhesion Molecule-1/metabolism
- Intercellular Signaling Peptides and Proteins
- Lectins, C-Type/genetics
- Lectins, C-Type/metabolism
- Membrane Glycoproteins/genetics
- Membrane Glycoproteins/metabolism
- Neutrophils/cytology
- Neutrophils/drug effects
- Neutrophils/metabolism
- Psoriasis/genetics
- Psoriasis/metabolism
- Psoriasis/pathology
- Receptors, Chemokine/genetics
- Receptors, Chemokine/immunology
- Receptors, Chemokine/metabolism
- Receptors, Immunologic/genetics
- Receptors, Immunologic/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Skin/metabolism
- Skin/pathology
- Tretinoin/pharmacology
- Humans
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Affiliation(s)
- Cristina Albanesi
- Istituto Dermopatico dell'Immacolata, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00167 Rome, Italy
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58
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Abstract
Topical therapy in psoriasis is of use in mild cases. It is also applied as an adjunct to phototherapy and systemic treatments in moderate to severe cases. Long-established pharmaceuticals such as cignolin, tar preparations, and glucocorticoids are still in use. Newer topical agents such as vitamin A and D derivatives are gradually replacing them. Combining a vitamin D derivative and a strong glucocorticoid now seems to be the most efficient way to treat psoriasis when topical agents are indicated. There is a growing list of "alternative" treatment options, where evidence is generally absent. Rewarding investments should perhaps be directed at intervening with molecules of innate immunity. Superfluous activation of natural immune system cascades is now in view as the major culprit in psoriasis, replacing the T-cell hypothesis of the disease. Agents directed at tumor necrosis factor alpha, Toll-like receptors, and neutrophils may have great impact in future topical therapy of psoriasis. Finally, innovations in the development of more targeted glucocorticoids and vitamin A and D derivatives, where desired effects are better separated from undesired side effects, may lead to an increased benefit/risk ratio of these nuclear receptor-directed therapies.
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Affiliation(s)
- Jan D Bos
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
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59
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Carrascosa J, Vanacloch F, Borrego L, Fernández-López E, Fuertes A, Rodríguez-Fernández-Freire L, Zulaica A, Tuneu A, Caballé G, Colomé E, Bordas X, Hernanz J, Brufau C, Herrera E. Update of the Topical Treatment of Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70044-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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60
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Sola-Ortigosa J, Sánchez-Regaña M, Umbert-Millet P. An Update on Scalp Psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2009. [DOI: 10.1016/s1578-2190(09)70121-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Feldman SR, Horn EJ, Balkrishnan R, Basra MK, Finlay AY, McCoy D, Menter A, van de Kerkhof PC. Psoriasis: Improving adherence to topical therapy. J Am Acad Dermatol 2008; 59:1009-16. [DOI: 10.1016/j.jaad.2008.08.028] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 08/21/2008] [Accepted: 08/24/2008] [Indexed: 10/21/2022]
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62
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Wozel G. Psoriasis treatment in difficult locations: scalp, nails, and intertriginous areas. Clin Dermatol 2008; 26:448-59. [DOI: 10.1016/j.clindermatol.2007.10.026] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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63
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Abstract
Psoriasis is a complex chronic non-infectious inflammatory skin disease with many different presentations. The classic presentation is of well-defined red plaques with silver scale. The characteristic scale makes the disorder highly visible and intrusive on the patient's lifestyle. The visible nature of the disease ensures that psoriasis has both physical and psychosocial effects. In normal skin, epidermal cell reproduction and proliferation takes 28 days. In psoriasis, this process is considerably accelerated to approximately four days, resulting in the deposit of immature cells on the skin. While the exact cause of this process is unknown, certain environmental and genetic factors are known to be provoking factors. Disease management will be dependent on disease severity, psychosocial effects and the patient's lifestyle. To effectively treat this disease the nurse must be skilled in psoriasis management, and in patient education and motivation. This article reviews the characteristics, aetiology, psychosocial effects and treatment strategies of psoriasis.
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Affiliation(s)
- Sheila Ryan
- Dermatology Department, St Vincent's University Hospital, Dublin, Republic of Ireland
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64
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65
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Abstract
Psoriasis is an inflammatory skin disease that affects 1-3% of Caucasian populations and may be persistent, disfiguring and stigmatizing. There is a range of severity, but even when the affected body surface area is relatively limited the impact on day-to-day activities and social interactions may be significant. An understanding of the psychological burden and an appreciation that many patients are currently dissatisfied with their management has driven the development of more effective treatment. In recent years psoriasis has been the focus of intense investigation resulting in an improved understanding of the immunopathogenesis, and the development of new, targeted biological treatments.
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Affiliation(s)
- A MacDonald
- Alan Lyell Dermatology Centre, Western Infirmary, Glasgow, G11 6NT, UK.
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66
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Braun GS, Witt M, Mayer V, Schmid H. Hypercalcemia caused by vitamin D3 analogs in psoriasis treatment. Int J Dermatol 2007; 46:1315-7. [DOI: 10.1111/j.1365-4632.2007.03347.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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van de Kerkhof PCM, Barker J, Griffiths CEM, Kragballe K, Mason J, Menter A, Papp K. Psoriasis: consensus on topical therapies. J Eur Acad Dermatol Venereol 2007; 22:859-70. [PMID: 18081748 DOI: 10.1111/j.1468-3083.2007.02534.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE A consensus conference was convened to evaluate the topical treatment of psoriasis. PARTICIPANTS Members of the International Psoriasis Council (IPC) with broad clinical experience in the treatment of psoriasis and a specialist in meta- and pharmacoeconomic analyses were invited to participate on the consensus panel. Those accepting the invitation convened in Saariselkä, Finland. EVIDENCE An advisory group on topical treatments was nominated by the organizing panel members. All participants reported at the consensus conference on evidence based data with respect to disease severity assessment, the available data on efficacy and safety and on a comparative efficacy/safety analysis. CONSENSUS PROCESS At the consensus conference, the presentations were discussed and conclusions, which were reached by the group, were recorded. Active participants of the group wrote assigned sections of this consensus document with a majority of participants agreed on the conclusions.
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Affiliation(s)
- P C M van de Kerkhof
- Department of Dermatology, University Medical Centre St Radboud, Nijmegen, The Netherlands
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68
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De Korte J, Van Der Valk P, Sprangers M, Damstra R, Kunkeler A, Lijnen R, Oranje A, De Rie M, De Waard-van der Spek F, Hol C, Van De Kerkhof P. A comparison of twice-daily calcipotriol ointment with once-daily short-contact dithranol cream therapy: quality-of-life outcomes of a randomized controlled trial of supervised treatment of psoriasis in a day-care setting. Br J Dermatol 2007; 158:375-81. [DOI: 10.1111/j.1365-2133.2007.08337.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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69
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Kémeny L, Esposito M, Katsambas A. Corticothérapie locale : l’opinion des experts. Ann Dermatol Venereol 2007. [DOI: 10.1016/s0151-9638(07)92554-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Papp K, Berth-Jones J, Kragballe K, Wozel G, de la Brassinne M. Scalp psoriasis: a review of current topical treatment options. J Eur Acad Dermatol Venereol 2007; 21:1151-60. [PMID: 17894698 DOI: 10.1111/j.1468-3083.2007.02424.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The scalp is the most common site of disease involvement at the onset and throughout the course of psoriasis. For many patients, psoriasis of the scalp is the most difficult aspect of their disease; yet, despite a wide range of therapy options and an extensive literature base, scalp psoriasis remains difficult to treat, highlighting a long-standing unmet need for the effective treatment of scalp psoriasis. A review of past and current medical literature reveals that a number of interesting therapeutic approaches have been used in the treatment of scalp psoriasis. The diverse and sometimes extreme therapeutic approaches, the marginal benefit of many topical agents, the paucity of controlled studies evaluating the efficacy of topical agents in the treatment of scalp psoriasis and the high level of patient dissatisfaction with currently available treatments for psoriasis all support the need for new, effective and well-tolerated treatment options for scalp psoriasis.
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Affiliation(s)
- K Papp
- Probity Medical Research-Union, Waterloo, Ontario, Canada.
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71
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Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. Evidence-based (S3) guidelines for the treatment of psoriasis vulgaris. J Dtsch Dermatol Ges 2007; 5 Suppl 3:1-119. [PMID: 17615051 DOI: 10.1111/j.1610-0387.2007.06172.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1 to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, patient surveys have revealed lack of satisfaction with the efficacy of available treatments and a high rate of non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) initiated a project to develop evidence-based guidelines for the management of psoriasis. These resulting Guidelines focus on induction therapy in cases of mild, moderate, and severe plaquetype psoriasis in adults. The Guidelines include evidence-based evaluation of the efficacy of all currently available therapeutic options in Germany. In addition, they offer detailed information on how best to administer the various treatments and give information on contraindications, adverse drug reactions, and drug interactions as well as estimates of practicability and cost. The Guidelines were developed following the recommendations of the Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften (AWMF). The therapeutic recommendations were developed by an expert group and finalized during interdisciplinary consensus conferences.
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Affiliation(s)
- Alexander Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Germany
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Abstract
Management of psoriasis begins with identification of the extent of cutaneous disease. However, a holistic, contractual approach to treatment is encouraged, with particular reference to psychosocial disability and quality-of-life issues. The presence of psoriasis on palms, soles, body folds, genitals, face, or nails, and concomitant joint disease, are also important when considering treatment options. An evidence-based approach is essential in delineating differences between the many available treatments. However, archaic approaches, especially combinational ones, are routinely used by some clinicians, with inadequate prospective or comparative evidence. Treatments currently available are: topical agents used predominantly for mild disease and for recalcitrant lesions in more severe disease; phototherapy for moderate disease; and systemic agents including photochemotherapy, oral agents, and newer injectable biological agents, which have revolutionised the management of severe psoriasis. Other innovative treatments are undergoing clinical studies, with the aim of maintaining safe, long-term control of the condition.
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Affiliation(s)
- Alan Menter
- Baylor Research Institute and Southwestern Medical School, Dallas, Texas, 75246, USA
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73
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Synergetic effects of isopropyl alcohol (IPA) and isopropyl myristate (IPM) on the permeation of betamethasone-17-valerate from semisolid Pharmacopoeia bases. J Drug Deliv Sci Technol 2007. [DOI: 10.1016/s1773-2247(07)50052-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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74
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Anna B, Blazej Z, Jacqueline G, Andrew CJ, Jeffrey R, Andrzej S. Mechanism of UV-related carcinogenesis and its contribution to nevi/melanoma. EXPERT REVIEW OF DERMATOLOGY 2007; 2:451-469. [PMID: 18846265 PMCID: PMC2564815 DOI: 10.1586/17469872.2.4.451] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Melanoma consists 4-5 % of all skin cancers, but it contributes to 71-80 % of skin cancers deaths. UV light affects cell and tissue homeostasis due to its damaging effects on DNA integrity and modification of expression of a plethora of genes. DNA repair systems protect cells from UV-induced lesions. Several animal models of melanoma have been developed (Xiphophorus, Opossum Monodelphis domestica, mouse models and human skin engrafts into other animals). This review discusses possible links between UV and genes significantly related to melanoma but does not discuss melanoma genetics. These include oncogenes, tumor suppressor genes, genes related to melanocyte-keratinocyte and melanocyte-matrix interaction, growth factors and their receptors, CRH, ACTH, α-MSH, glucocorticoids, ID1, NF-kappaB and vitamin D3.
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Affiliation(s)
- Brozyna Anna
- Department of Medical Biology, Nicolaus Copernicus University, Torun, Poland, Tel: (4856)611-4776, Fax: (4856)611-4772, E-mail:
| | - Zbytek Blazej
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, 930 Madison Ave, Memphis, TN 38163, Tel: (901)448-6300, Fax: (901)448-6979, E-mail:
| | - Granese Jacqueline
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, 930 Madison Ave, Memphis, TN 38163, Tel: (901)448-6300, Fax: (901)448-6979, E-mail:
| | - Carlson J. Andrew
- Department of Pathology & Laboratory Medicine, Albany Medical Center, 47 New Scotland Avenue, Albany, NY, Tel: (518)262-8099, Fax: (518)262-8092, E-mail:
| | - Ross Jeffrey
- Department of Pathology & Laboratory Medicine, Albany Medical Center, Albany, NY, 47 New Scotland Avenue, Albany, NY, Tel: (518)262-5461 fax: (518)262-8092, E-mail:
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75
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Tse WP, Che CT, Liu K, Lin ZX. Evaluation of the anti-proliferative properties of selected psoriasis-treating Chinese medicines on cultured HaCaT cells. JOURNAL OF ETHNOPHARMACOLOGY 2006; 108:133-41. [PMID: 16730935 DOI: 10.1016/j.jep.2006.04.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 04/23/2006] [Accepted: 04/29/2006] [Indexed: 05/09/2023]
Abstract
Psoriasis is a chronic inflammatory skin disorder, which affects approximately 2-3% of the population worldwide. The current conventional therapy cannot offer satisfactory clinical results for most of the patients, largely due to the fact that many anti-psoriatic drugs have serious side effects and psoriasis is prone to developing drug resistance after long term exposure. Traditionally, Chinese herbal medicine has been extensively used to treat psoriasis and produced promising clinical results; however, its underlying mechanisms of action have not been systematically investigated. The aim of this study was to investigate those Chinese medicinal materials, which are commonly prescribed in Chinese medicine practice for psoriasis, for their anti-proliferative effects on HaCaT cells in vitro. Sixty Chinese medicinal materials were selected and extracted with 80% aqueous ethanol. The dry extracts were evaluated for their anti-proliferative activities by microplate SRB and MTT assays. Three Chinese medicinal materials i.e. the root of Rubia cordifolia L. (Rubiaceae), Realgar and the rhizome of Coptis chinensis Franch. (Ranunculaceae) were found to have significant anti-proliferative effects, with IC(50) being 1.4, 6.6 and 23.4 microg/ml, respectively as measured by MTT assay. While Realgar was also able to modestly inhibit the growth of Hs-68 cells in vitro, Rubia cordifolia and Coptis chinensis did not exert cytotoxicity to this human fibroblast cell line.
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Affiliation(s)
- Wai-Pui Tse
- School of Chinese Medicine, Faculty of Science, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
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Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. S3-Leitlinie zur Therapie der Psoriasis vulgaris. J Dtsch Dermatol Ges 2006; 4 Suppl 2:S1-126. [PMID: 17187649 DOI: 10.1111/j.1610-0387.2006.06172.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Alexander Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin
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77
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Luba KM, Stulberg DL. Chronic Plaque Psoriasis. S Afr Fam Pract (2004) 2006. [DOI: 10.1080/20786204.2006.10873463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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78
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Affiliation(s)
- Catherine H Smith
- Skin Therapy Research Unit, St Johns Institute of Dermatology, Kings College London, St Thomas' Hospital, London SE1 7EH.
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79
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Abstract
In most cases mild to moderate forms of psoriasis can be treated with topical therapy. In addition, topical agents are also routinely combined with UV or systemic therapy to treat severe forms of psoriasis. A variety of standard products are available. The oldest topical treatment is anthralin. Since 1952 the development of topical corticosteroids has revolutionized not only dermatological treatment in general but the treatment of psoriasis in particular. Through the continuous development of these compounds, a better risk-benefit profile has been achieved. Corticosteroids are the most frequently employed topical agent for psoriasis treatment worldwide.
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Affiliation(s)
- S Gerdes
- Psoriasis-Zentrum an der Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein. Campus Kiel, Schittenhelmstrasse 7, 24105 , Kiel.
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80
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van de Kerkhof PCM, van der Valk PGM, Swinkels OQJ, Kucharekova M, de Rie MA, de Vries HJC, Damstra R, Oranje AP, de Waard-van der Spek FB, van Neer P, Lijnen RLP, Kunkeler ACM, van Hees C, Haertlein NGJ, Hol CW. A comparison of twice-daily calcipotriol ointment with once-daily short-contact dithranol cream therapy: a randomized controlled trial of supervised treatment of psoriasis vulgaris in a day-care setting. Br J Dermatol 2006; 155:800-7. [PMID: 16965431 DOI: 10.1111/j.1365-2133.2006.07393.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Calcipotriol has become a first-line treatment for psoriasis. Its efficacy and safety have been shown in many comparative clinical trials carried out in outpatients. In a comparative study in patients visiting the outpatient department once every 14 days, it was shown that calcipotriol was more effective and better tolerated compared with dithranol. OBJECTIVES To compare the clinical efficacy of calcipotriol ointment with that of dithranol cream in a supervised treatment regimen. METHODS In a multicentre randomized controlled trial in six centres in the Netherlands, 106 patients with chronic plaque psoriasis were included, 54 receiving calcipotriol ointment twice daily and 52 dithranol cream once daily. Patients were treated at the day-care centre, using the care instruction principle of daily visits during the first week and twice-weekly visits subsequently for up to 12 weeks. RESULTS This study failed to prove that calcipotriol is as efficacious as dithranol when used in a day-care setting (noninferiority test). The mean percentage reduction in Psoriasis Area and Severity Index from baseline to end of treatment was 57.0% in the calcipotriol group vs. 63.6% in the dithranol group. However, the two-sided test for superiority indicated no statistically significant difference between the treatment groups (P = 0.39). At the end of treatment, 15% of the patients treated with calcipotriol ointment and 25% of those treated with dithranol cream did not require any further treatment. Although calcipotriol ointment appeared to be more effective during the first 8 weeks, a difference was no longer apparent at 12 weeks. In comparison with the high number of drop-outs due to cutaneous side-effects in the calcipotriol group, the frequency of a tolerable degree of irritation appeared to be higher in patients treated with dithranol. However, concomitant corticosteroid treatment of dithranol irritation in seven patients may have contributed to this difference between both treatments. Moreover, patients receiving therapy with calcipotriol ointment experienced fewer application-related skin and subcutaneous tissue disorders than patients treated with dithranol cream: 21 of 53 (40%) and 37 of 52 (71%), respectively. This difference is statistically significant (P = 0.001). CONCLUSIONS The hypothesis that calcipotriol ointment might be at least as effective as dithranol cream in the day-care setting could not be proven in the present study. Whereas calcipotriol has become a mainstay in the routine outpatient treatment of psoriasis not requiring a day-care setting, dithranol treatment, being difficult as a routine outpatient therapy, has increased efficacy and improved tolerability if the treatment is carried out in a day-care setting.
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Affiliation(s)
- P C M van de Kerkhof
- Department of Dermatology, Academisch Medisch Centrum, Meibergdreef 9, 1105 AC Amsterdam, The Netherlands.
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81
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Maiti TK, Ghosh KS, Debnath J, Dasgupta S. Binding of all-trans retinoic acid to human serum albumin: Fluorescence, FT-IR and circular dichroism studies. Int J Biol Macromol 2006; 38:197-202. [PMID: 16569428 DOI: 10.1016/j.ijbiomac.2006.02.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 02/10/2006] [Accepted: 02/15/2006] [Indexed: 11/16/2022]
Abstract
All-trans retinoic acid derived from vitamin A is an essential component for the modulation of angiogenesis, the process of blood vessel formation. We have investigated the binding of all-trans retinoic acid to the carrier protein, human serum albumin (HSA) under physiological conditions. Fluorescence quenching methods in combination with Fourier transform infrared (FT-IR) spectroscopy and circular dichroism (CD) spectroscopy were used for the biophysical studies. The binding parameters were determined by a Scatchard plot and the results found to be consistent with those obtained from a modified Stern-Volmer equation. From the thermodynamic parameters calculated according to the van't Hoff equation, the enthalpy change DeltaH(0) and entropy change DeltaS(0) are found to be 106.17 and 106.14J/molK, respectively. These values suggest that apart from hydrophobic interactions electrostatic interactions are present. Changes in the CD spectra and FT-IR spectra were observed upon ligand binding along with a significant degree of tryptophan fluorescence quenching on complex formation. Docking studies performed substantiated our experimental findings and it was observed that all-trans retinoic acid hydrogen bonded with Trp 214 and Asp 451 residues of subdomain IIA and IIIA of HSA, respectively.
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Affiliation(s)
- Tushar Kanti Maiti
- Department of Chemistry, Indian Institute of Technology, Kharagpur 721302, India
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82
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Abstract
A variety of therapeutic options are available to treat psoriasis and atopic dermatitis (AD). Local agents typically are used to treat localized and milder forms of disease, whereas phototherapy and systemic agents are used for more generalized and severe disease. Various combinations and sequences of topical or systemic therapies, or both, have been utilized in the treatment of psoriasis and, less frequently, of AD. Conventional systemic therapies for psoriasis, such as corticosteroids, oral calcineurin inhibitors, antimetabolites, and retinoids, are limited by their propensity to cause serious side effects. More recently, a number of immunobiologic agents, such as monoclonal antibodies, recombinant cytokines, and fusion proteins, have been approved by the Food and Drug Administration or are undergoing development as systemic antipsoriatic treatments. In many of these categories, a number of exciting new therapies are in development that may augment the existing armamentarium available to clinicians for the treatment of inflammatory skin diseases.
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Affiliation(s)
- Alice B Gottlieb
- Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ 08901, USA.
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83
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Abstract
Topical corticosteroids remain the most commonly used topical treatments for inflammatory dermatoses, including psoriasis and atopic dermatitis. Topical corticosteroids are available in a variety of vehicles-creams, ointments, lotions, gels, and, more recently, foam. The vehicle used can substantially affect the individual agent's clinical action, potency, and acceptability to the patient. Moreover, some vehicles are better suited for specific body areas. Selection of the appropriate product should be determined by area of usage, physician experience, cost, and patient preference, particularly regarding vehicle. Although topical corticosteroids are associated with several side effects, including skin atrophy, telangiectases, purpura, and striae formation, appropriate usage can minimize these occurrences. Judicious use includes short-term, appropriate application as initial monotherapy or in combination strategies with other therapeutic agents that ideally possess complementing mechanisms of action. Examples include pulsing with high-potency topical corticosteroids and combination regimens with other topical agents such as topical calcineurin inhibitors, calcipotriene, or tazarotene. Appropriate education of patients and caregivers alike will facilitate the optimal use of these medications.
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Affiliation(s)
- James Del Rosso
- Department of Dermatology, University of Nevada School of Medicine, Las Vegas, Nevada, USA
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84
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Abstract
Psoriasis is a chronically recurring inflammatory disease that affects the skin, scalp, and joints. It ranges in severity from mild to severe, and patients with moderate to severe disease experience significant deterioration in quality of life. The goals of psoriasis treatment are to gain initial and rapid control of the disease process, decrease the percentage of body surface area involved, decrease plaque lesions, achieve and maintain long-term remission, minimize adverse events, and improve patient quality of life. Therapy varies depending on disease severity and spread and will shift from control of acute flares to long-term maintenance. Topical treatment for mild psoriasis includes the use of topical corticosteroids, calcipotriene, tazarotene, topical tars, anthralin, and keratolytics. Treatment of moderate to severe psoriasis includes systemic therapies, such as methotrexate, acitretin, cyclosporine, and biologic agents. Treatment can be effected using combination, rotational, or sequential regimens. Treatment algorithms developed by a 2002 consensus conference are described. Because some degree of therapy will always be necessary, ranging from maintenance of long-term remission to control of acute psoriasis flares, each patient requires an individualized plan.
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Affiliation(s)
- Mark Lebwohl
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York 10029, USA.
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85
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Seibert E, Levin NW, Kuhlmann MK. Immunomodulating effects of vitamin D analogs in hemodialysis patients. Hemodial Int 2005; 9 Suppl 1:S25-9. [PMID: 16223440 DOI: 10.1111/j.1542-4758.2005.01167.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Apart from its well-known functions in calcium homeostasis and parathyroid hormone regulation, 1,25-(OH)2D3 and its synthetic analogs are being increasingly recognized for their potent antiproliferative, pro-differentiative and immunomodulating activities. The effects of these drugs are exerted either via vitamin D receptor-dependent genomic, or cell-surface receptor-mediated, non-genomic pathways. Several vitamin D analogs with fewer hypercalcemic side effects have been developed for use in secondary hyperparathyroidism. These analogs may potentially improve treatment of autoimmune disorders and graft rejection, and in dialysis patients may open a new opportunity for amelioration of the chronic inflammatory status. It has recently been shown that hemodialysis (HD) patients treated with paricalcitol have lower total and cardiovascular mortality and morbidity rates and experience improved hospitalization outcomes compared with HD patients treated with calcitriol, suggesting a potential beneficial effect in chronic inflammation and the development of cardiovascular disease. Specific studies on the immunomodulating effects of vitamin D are needed in the HD population.
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Affiliation(s)
- Eric Seibert
- Renal Research Institute, New York, New York 10128, USA
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86
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Egawa K. Topical vitamin D3 derivatives in treating hyperkeratotic palmoplantar eczema: a report of five patients. J Dermatol 2005; 32:381-6. [PMID: 16043902 DOI: 10.1111/j.1346-8138.2005.tb00911.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 12/14/2004] [Indexed: 11/29/2022]
Abstract
The treatment of hyperkeratotic palmoplantar eczema is notoriously difficult. A considerable number of patients do not or only partially respond to the current treatments such as topical corticosteroids, topical keratolytics, or PUVA therapy. The purpose of this pilot study was to look for an alternative treatment for hyperkeratotic palmoplantar eczema. We treated five patients with topical vitamin D3 derivatives (calcipotriol 50 microg/g and maxacalcitol 25 microg/g ointments). The lesions almost disappeared after 2 to 8 weeks of treatment in four patients and extremely improved with a seven week treatment in one patient. No adverse effect was observed during or after the treatment, and routine laboratory investigations were within normal ranges. When relapses occurred, they responded well to retreatment. Although the study is preliminary, the results suggest that vitamin D3 derivatives offer a safe, effective alternative form of treatment for recalcitrant hyperkeratotic palmoplantar eczema.
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Affiliation(s)
- Kiyofumi Egawa
- Department of Dermatology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, Japan
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87
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Abstract
Several topical treatments are available for patients with psoriasis. Although individualization of the treatment remains important, there is a need for treatment recommendations to identify the best treatment out of the available treatments and to help with improvement in treatment compliance. In this communication we give our views on the assessment of severity of psoriasis. We provide recommendations for selection of treatments, reconciling the clearance phase and the long-term management. Finally, we provide recommendations for the treatment of particular localizations: the scalp and psoriasis at sensitive sites.
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88
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Reygagne P, Mrowietz U, Decroix J, de Waard-van der Spek FB, Acebes LO, Figueiredo A, Caputo R, Poncet M, Arsonnaud S. Clobetasol propionate shampoo 0.05% and calcipotriol solution 0.005%: a randomized comparison of efficacy and safety in subjects with scalp psoriasis. J DERMATOL TREAT 2005; 16:31-6. [PMID: 15897165 DOI: 10.1080/09546630410024853] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Scalp involvement in psoriatic patients represents a common issue. Treatment of the hairy skin requires adequate pharmaceutical formulations; hence, a new specific shampoo formulation of clobetasol propionate 0.05% was developed by Galderma R&D, Inc. METHODS For this multicenter, randomized, investigator-masked, parallel group study, 151 subjects with moderate to severe scalp psoriasis were randomized to 4 weeks of treatment with clobetasol propionate shampoo or calcipotriol solution. RESULTS Clobetasol propionate demonstrated significantly superior efficacy to calcipotriol solution (total severity score: mean difference 0.51, 95% CI 0.05-0.97, p = 0.028; global severity score: mean difference 0.43, 95% CI 0.08-0.78, p = 0.016). Adverse events were more common in the calcipotriol group than in the clobetasol propionate shampoo group. Telangiectasia and skin atrophy did not differ significantly between treatments; however, a burning sensation was significantly more common in the calcipotriol solution group. CONCLUSIONS Short contact therapy of scalp psoriasis with this new shampoo formulation of clobetasol propionate was significantly more effective and better tolerated than calcipotriol solution for the treatment of scalp psoriasis.
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89
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Fenton C, Plosker GL. Calcipotriol/betamethasone dipropionate: a review of its use in the treatment of psoriasis vulgaris. Am J Clin Dermatol 2005; 5:463-78. [PMID: 15663344 DOI: 10.2165/00128071-200405060-00012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The two-compound product containing calcipotriol 50 microg/g plus betamethasone dipropionate 0.5 mg/g (Dovobet, Daivobet) [referred to here as calcipotriol/betamethasone dipropionate], is a topical treatment for psoriasis vulgaris, combining a vitamin D analog and a corticosteroid. For most adult patients with psoriasis vulgaris on the trunk and limbs, up to 4 weeks of therapy with calcipotriol/betamethasone dipropionate provides an effective and well tolerated treatment. In clinical trials, patients with a mean baseline psoriasis area and severity index (PASI) of 9.5-10.9 experienced a mean 65.0-74.4% PASI improvement within 4 weeks, significantly better than improvements with calcipotriol 50 microg/g monotherapy, betamethasone dipropionate 0.5 mg/g monotherapy, or placebo. In addition, in 6.4%-20.1% of patients, lesions cleared. In patients who were subsequently treated with calcipotriol maintenance therapy, benefits were retained for at least 4 weeks. The safety of calcipotriol/betamethasone dipropionate in patients treated for up to 1 year was generally good; fewer than 5% of patients experienced adverse events possibly associated with long-term corticosteroid use.
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Affiliation(s)
- Caroline Fenton
- Adis International Limited, Yardley, Pennsylvania 19067, USA.
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90
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Abstract
Therapeutics in dermatology underwent complete change after the introduction of topical hydrocortisone in the Fifties. At the time, stronger derivatives than hydrocortisone were synthetised and the indications for topical corticosteroids were expanded. Around twenty different molecules, classified according to their strength, are currently available for prescription in France. Many inflammatory or tumoral skin diseases respond to these products. The choice of a topical corticosteroid (strength, vehicle.) and of its mode of application (technique, rhythm of application) is oriented by the context (dermatitis treated, localization) and must respect "Good clinical practice" guidelines so as to select the best benefit/risk ratio.
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Affiliation(s)
- B Lebrun-Vignes
- Service de Pharmacologie, Centre de Pharmacovigilance, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris.
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91
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Abstract
Vitamin D was discovered as a preventive agent of nutritional rickets, a defect in bone development due to inadequate uptake of dietary calcium. However, a variety of studies over the last several years has revealed that Vitamin D controls much more than calcium homeostasis. In particular, there is widespread evidence that the hormonal form of Vitamin D, 1alpha,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)], is an important regulator of cellular differentiation and proliferation. Direct genomic signaling by 1,25(OH)(2)D(3) occurs through the Vitamin D receptor, which is a nuclear receptor and a ligand-activated regulator of gene transcription. 1,25(OH)(2)D(3) can therefore directly regulate patterns of gene expression within a target cell. The development of high throughput genomics technologies have greatly enhanced our capacity to identify the genetic and biochemical changes associated with the physiological actions of 1,25(OH)(2)D(3). Microarray analyses of expression profiles in 1,25(OH)(2)D(3)-treated cells have underlined its widespread effects on cellular differentiation and proliferation. They have provided a molecular basis for the accumulating epidemiological and preclinical evidence indicating that 1,25(OH)(2)D(3) can act as a chemopreventive agent against several malignancies including cancers of the prostate and colon. In addition, they have underlined the therapeutic potential of 1,25(OH)(2)D(3) analogues as modulators of immune system function.
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Affiliation(s)
- John H White
- Department of Physiology, McIntyre Medical Sciences Bldg., Room 1128, McGill University, 3655 Drummond St., Montreal, Que., Canada H3G 1Y6.
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92
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Egawa K, Ono T. Topical vitamin D3 derivatives for recalcitrant warts in three immunocompromised patients. Br J Dermatol 2004; 150:374-6. [PMID: 14996120 DOI: 10.1111/j.1365-2133.2003.05766.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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93
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Matalon A, Calo H, Yaphe J. The role of the staff meeting in resolving professional dilemmas in family medicine: concealing a diagnosis. Eur J Gen Pract 2004; 10:35-6, 40. [PMID: 15060482 DOI: 10.3109/13814780409094227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Staff meetings are an integral part of the family medicine process but little has been written in the family medicine literature about their utility. In addition to filling administrative or management functions, the staff meeting can be a creative process for growth of staff members and the road to innovative solutions to clinical problems. Presentation of illness narratives is common in staff meetings. This report describes a staff meeting where a difficult doctor-patient narrative was presented by the treating physician. Contributions from all the doctors in the clinic at the meeting led to improved understanding of the problem and a shared sense of well-being.
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Affiliation(s)
- Andre Matalon
- Department of Family Medicine, Rabin Medical Centre, Petach Tikvah 49100, Israel
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94
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Abstract
General knowledge of the role of vitamin D3 in human physiology has been shaped by its discovery as a preventive agent of nutritional rickets, a defect in bone development due to inadequate uptake of dietary calcium. Studies on the function of the hormonal form of vitamin D3, 1alpha,25-dihydroxyvitamin D3, have been greatly accelerated by the molecular cloning and structural analysis of the vitamin D3 receptor, which is a ligand-activated regulator of gene transcription. Molecular genetic techniques including genomics have helped reveal that 1alpha,25-dihydroxyvitamin D3 can control more than calcium homeostasis. It has widespread effects on cellular differentiation and proliferation, and can modulate immune responsiveness, and central nervous system function. Moreover, accumulating epidemiological and molecular evidence suggests that 1alpha,25-dihydroxyvitamin D3 acts as a chemopreventive agent against several malignancies including cancers of the prostate and colon. Here, we survey the most-recent findings and discuss their implications for the potential therapeutic uses of vitamin D analogues.
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Affiliation(s)
- Roberto Lin
- Department of Physiology, McGill University, Montreal, Quebec, Canada
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