Psoriasis and other papulosquamous diseases in infants and children

Andrographis paniculata (Burm.f.) Nees Alleviates Methotrexate-Induced Hepatotoxicity in Wistar Albino Rats

Andrographis paniculata is a herbal plant used in traditional medicinal approaches to treat various ailments and diseases. Methotrexate (MTX) is a clinically used immunosuppressant and anticancer drug. One of the increasing concerns with MTX use is liver toxicity. The aim of this study is to investigate the potential effect of aqueous leaf extract of Andrographis paniculata against methotrexate-induced hepatotoxicity. Wistar albino rats were grouped into five groups, and the drugs were administered. MTX (20 mg/kg b.w.) was intraperitoneally injected into rats on the ninth day alone. Aqueous leaf extract of Andrographis paniculata (500 mg/kg b.w./day) was orally administered for 10 days. We confirmed the beneficial effect of aqueous extracts of Andrographis paniculata on restoring the hepatic enzyme markers, lipid profile, antioxidant level, anti-inflammatory marker (IL-10), anti-apoptosis (bcl-2), significant suppression of inflammatory cytokines (TNF-α, and IL-6), apoptosis marker (caspase 3) and cellular tissue damage caused by MTX. Overall, we revealed that Andrographis paniculata reduces critical aspects of oxidative stress, inflammatory processes, and apoptosis, thus protecting against methotrexate-induced hepatotoxicity.

Generalized pustular psoriasis in a 6-week-old infant

Generalized pustular psoriasis (GPP) is rare in childhood, especially in early infancy. At this young age, it is essential to make an accurate diagnosis as pustules could be the presentation of serious infectious diseases or unusual dermatologic diseases. We reported clinical manifestations, laboratory examinations, and histopathology findings in a 6-week-old girl with GPP. Acitretin was initiated at 1 mg/kg/day with marked improvement on her psoriasis, and titrated to 0.4 mg/kg/day in the subsequent 6 months without flare. Acitretin proved to be an effective therapeutic option for young infants with GPP.

Complementary therapy for psoriasis

The authors provide some specifications regarding the correct terminology to be applied in the field of complementary medicine, and review and comment on several complementary treatments for psoriasis. Putative psychotherapeutic equivalents are kept distinct from treatments based on the surreptitious administration of physical or pharmacologic agents. Limits on the application of psychotherapeutic techniques are discussed. Risks inherent to complementary treatments (psychological derangements, moral subjugation, physical damage, economic exploitation) are underscored. The authors plead for the application of adequate scientific criticism in complementary medicine, but warn that any approach to the practice of medicine which is not disinterested and patient oriented--as the academic one should be--will be inappropriate, misleading, or even immoral. In the authors' opinion, this could also apply to the evidence-based medicine movement (often perceived as the archenemy of alternative medicine), should this movement be influenced by economical, political, or other nonmedical factors.

Childhood psoriasis

Psoriasis commences by the age of 15 years in one third of patients and is an important childhood disorder. Various human leukocyte antigen associations are important in predisposition to psoriasis, and streptococcal disease is important in its precipitation and exacerbation. The disorder takes many clinical forms, with guttate lesions and anogenital and facial involvement being particularly prominent in the childhood age group. Pustular psoriasis and psoriatic arthropathy are rare in this group of patients. It is important to take the age of the patient into account when making treatment choices.