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Haulrig MB, Zachariae C, Skov L. Off-Label Treatments for Pediatric Psoriasis: Lessons for the Clinic. PSORIASIS (AUCKLAND, N.Z.) 2021; 11:1-20. [PMID: 33604269 PMCID: PMC7886293 DOI: 10.2147/ptt.s268462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/14/2021] [Indexed: 11/23/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease that affects up to 1.2% of children and adolescents. The treatment options for childhood psoriasis are often based on the same principles as in adults. However, most data on safety and efficacy derive from adult studies, and only a few of the frequently used treatments have achieved approval for use in children. The aim of this study was to review the current literature on off-label treatments for psoriasis in children and adolescents. We searched PubMed and identified 50 studies on off-label treatments. Of these, 23 studies were clinical trials (four randomized). There are only a small number of available studies on off-label treatments for children and adolescents with psoriasis, and many of these are retrospective reviews with few participants. Despite the current lack of studies, we still recommend the use of unapproved treatments since we have clinical experience with treatments such as topical corticosteroids, vitamin D analogs, and methotrexate that have shown promising effects. Regular clinical trials are needed to investigate the safety and efficacy of unapproved treatments. Due to The Pediatric Investigation Plans issued by The European Union, new drugs developed by pharmaceutical companies are required to undergo clinical trials in a pediatric population to get their application for marketing authorization processed. This will hopefully lead to much more data on the efficacy and safety of the new treatments, including treatments for children and adolescents with psoriasis.
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Affiliation(s)
- Morten B Haulrig
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
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2
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Holmannová D, Císařová B, Borský P, Fiala Z, Andrýs C, Hamaková K, Švadláková T, Krejsek J, Palička V, Kotingová L, Borská L. Goeckerman Regimen Reduces Alarmin Levels and PASI Score in Paediatric Patients with Psoriasis. ACTA MEDICA (HRADEC KRALOVE) 2021; 64:204-212. [PMID: 35285442 DOI: 10.14712/18059694.2022.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Psoriasis is a chronic systemic inflammatory disease with (extra-)cutaneous manifestations. Inflammation is associated with cellular stress and tissue damage which lead to the release of alarmins (signals of danger). Goeckerman regimen (GR) is a highly efficacious treatment consisting of the application of pharmaceutical crude tar and UVB light exposure. The reduction of inflammatory processes in the skin is accompanied by changes in the levels of inflammatory markers - alarmins (HMBG-1, S100A7, S1000A8, S100A9, S100A12, IL-17, IL-22, and IL-33). METHODS The alarmin levels in sera of 19 paediatric patients with psoriasis were determined before and after GR using commercial ELISA kits. The Psoriasis area severity index (PASI) was used to determine the disease severity. RESULTS GR reduced both PASI and the levels of all measured alarmins. The levels of S100A7, S100A9, IL-22, IL-33, and HMGB-1 were significantly decreased. Positive correlations between IL-22 and PASI, between S100A9 and IL-17, S100A9 and IL-22, and a negative correlation between S100A8 and IL-33 were found. CONCLUSIONS Goeckerman regimen is a very effective, safe and low-cost therapy. We confirmed, it modulates the immune system reactivity, ameliorates the severity of the disease and reduces the levels of alarmins reflecting the presence and intensity of inflammation.
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Affiliation(s)
- Drahomíra Holmannová
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Barbora Císařová
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Pavel Borský
- Institute of Pathological Physiology, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic.
| | - Zdeněk Fiala
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Ctirad Andrýs
- Institute of Clinical Immunology and Allergology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Květoslava Hamaková
- Clinic of Dermal and Venereal Diseases, University Hospital, Hradec Králové, Czech Republic
| | - Tereza Švadláková
- Institute of Clinical Immunology and Allergology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Jan Krejsek
- Institute of Clinical Immunology and Allergology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Vladimír Palička
- Institute of Clinical Biochemistry and Diagnostics, University Hospital and Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Lenka Kotingová
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Lenka Borská
- Institute of Preventive Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
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Menter A, Cordoro KM, Davis DM, Kroshinsky D, Paller AS, Armstrong AW, Connor C, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Parra SL, Pathy AL, Farley Prater EA, Rupani RN, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol 2020; 82:161-201. [DOI: 10.1016/j.jaad.2019.08.049] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/29/2022]
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4
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Lavaud J, Mahé E. Scores de sévérité dans le psoriasis de l’enfant : revue systématique de la littérature. Ann Dermatol Venereol 2019; 146:771-782. [DOI: 10.1016/j.annder.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 12/31/2018] [Accepted: 03/06/2019] [Indexed: 12/11/2022]
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Abstract
Phototherapy has been used successfully to treat a wide range of pediatric skin conditions. It is a viable option in children with severe dermatologic disease or who have failed first-line treatments, and several studies have demonstrated its efficacy and safety in the pediatric population. Despite the growing body of evidence on the use of phototherapy in children, large controlled trials and long-term studies are lacking. Moreover, special considerations must be taken when using phototherapy in children. This review highlights the recent evidence supporting the efficacy and safety of phototherapy in children, with focus on the common light-sensitive pediatric skin conditions.
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Affiliation(s)
- Michelle C Juarez
- The Johns Hopkins School of Medicine, 733 North Broadway, Baltimore, MD 21205, USA
| | - Anna L Grossberg
- Department of Dermatology, Division of Pediatric Dermatology, The Johns Hopkins University School of Medicine, 200 North Wolfe Street, Unit 2107, Baltimore, MD 21287, USA.
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6
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Datz E, Zeman F, Koller M, Szeimies RM, Berneburg M, Landthaler M, Bosserhoff AK, Karrer S. Phototherapy-induced elevation of serum level of melanoma inhibitory activity. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2019; 35:255-260. [PMID: 30815924 DOI: 10.1111/phpp.12461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/27/2019] [Accepted: 02/25/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Phototherapy is a frequently used treatment modality for a variety of dermatologic diseases. UV radiation has different effects on the skin, for example increased production and release of cytokines and other proteins, and is involved in the initiation and progression of skin cancer. Objective of this clinical trial was to investigate potential systemic effects of UV phototherapy on cytokine profiles in blood. METHODS In a prospective, mono-centric, one-armed study, the serum levels of the melanoma tumour marker "melanoma inhibitory activity" (MIA), Il-1α, Il-4, Il-6, Il-10, TNF-α and IFN-γ of 115 patients with different skin diseases were compared before and 24-48 hours as well as 2-4 weeks after the first phototherapy with PUVA (psoralen and ultraviolet A), UVA or UVB, or both. Data were analysed using linear mixed models. RESULTS Estimated marginal means of MIA levels were 6.05 ng/mL (95%-CI: 5.37-6.72, range: 2.83-14.49) before the first treatment, which had significantly increased to 6.79 ng/mL 2-4 weeks after the first phototherapy (CI 95%: 6.12-7.47, range: 3.09-15.45; P = 0.0042). MIA levels 2-4 weeks after the first phototherapy were significantly higher than 24-48 hours after the first phototherapy (P = 0.0083). 2-4 weeks after the first treatment, TNF-α levels had decreased significantly (P = 0.033) more in patients with psoriasis who had responded well to phototherapy than in patients unresponsive to treatment. Serum levels of the other cytokines had not changed significantly. CONCLUSIONS Short-term phototherapy significantly increased the serum levels of the melanoma tumour marker MIA. The potential clinical relevance of these findings (ie an increased risk of melanoma) is unclear and should be further investigated.
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Affiliation(s)
- Elisabeth Datz
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Michael Koller
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Mark Berneburg
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
| | - Michael Landthaler
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
| | - Anja K Bosserhoff
- Institute of Biochemistry, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sigrid Karrer
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
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7
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Eichenfield LF, Paller AS, Tom WL, Sugarman J, Hebert AA, Friedlander SF, Siegfried E, Silverberg N, Cordoro KM. Pediatric psoriasis: Evolving perspectives. Pediatr Dermatol 2018; 35:170-181. [PMID: 29314219 DOI: 10.1111/pde.13382] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Childhood-onset psoriasis is a common skin disorder that has recently received increasing attention, particularly because of its significant medical, social, financial, and psychological burdens and its associated comorbidities. With limited data available and lack of standardized management guidelines for pediatric psoriasis, an expert panel desired to provide an updated critical overview and practical guidance for management of the affected population. METHODS A panel of pediatric dermatologists with extensive experience in pediatric psoriasis defined and prioritized a core set of topics, performed an English-language literature review, prepared critical evaluations and presentations of topic areas, and carried out a consensus meeting and follow-up consensus manuscript. RESULTS The summation of evolving perspectives in pediatric psoriasis includes epidemiology and natural history of the disease, precipitating factors and comorbidities, quality of life and burden of disease, clinical features and disease presentation, differential diagnosis, pathogenesis and treatment, including topical, photo, and systemic therapies. CONCLUSION Pediatric psoriasis is an important immune-mediated inflammatory skin disease with potential for significant impact on affected individuals and their caregivers. Current state-of-the-art care is based primarily on experience and expert consensus, but pediatric data are accumulating and therapeutic options are rapidly evolving.
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Affiliation(s)
- Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Wynnis L Tom
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Adelaide A Hebert
- Pediatric Dermatology, McGovern School of Medicine and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Sheila Fallon Friedlander
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Elaine Siegfried
- Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA.,Department of Dermatology, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Nanette Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA.,Department of Pediatrics, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
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8
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Borský P, Andrýs C, Krejsek J, Hamáková K, Kremláček J, Málková A, Bartošová L, Fiala Z, Palička V, Borská L. Serum Level of Antibodies (IgG, IgM) Against Benzo[a]pyrene-7,8-diol-9,10-epoxide-DNA Adducts in Children Dermatologically Exposed to Coal Tar. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017; 60:27-31. [PMID: 28467299 DOI: 10.14712/18059694.2017.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Crude coal tar (CCT) contains polycyclic aromatic hydrocarbons (PAHs). Benzo[a]pyrene (BaP) is metabolized into a highly reactive metabolite benzo[a]pyrene-7,8-diol-9,10-epoxide (BPDE) that is able to bind to DNA and creates BPDE-DNA adducts. Adducted DNA becomes immunogenic and induces immune response by production of antibodies against BPDE-DNA adducts (Ab-BPDE-DNA). Circulating Ab-BPDE-DNA was proposed as potential biomarker of genotoxic exposure to BaP (PAHs). Goeckerman therapy (GT) of psoriasis uses dermal application of CCT ointment (PAHs). In presented study (children with psoriasis treated by GT; n = 19) the therapy significantly increased the level of Ab-BPDE-DNA (EI = 0.29/0.19-0.34 vs. 0.31/0.25-0.40; median/lower-upper quartile; p < 0.01). The results support the idea of Ab-BPDE-DNA level as a possible tentative indicator of exposure, effects and susceptibility of the organism to the exposure of BaP (PAHs).
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Affiliation(s)
- Pavel Borský
- Institute of Hygiene and Preventive Medicine, Charles University, Faculty of Medicine, Hradec Králové, Czech Republic
| | - Ctirad Andrýs
- Institute of Clinical Immunology and Allergology, Charles University, Faculty of Medicine, Hradec Králové, Czech Republic
| | - Jan Krejsek
- Institute of Clinical Immunology and Allergology, Charles University, Faculty of Medicine, Hradec Králové, Czech Republic
| | - Květoslava Hamáková
- Clinic of Dermal and Venereal Diseases, Charles University Hospital, Hradec Králové, Czech Republic
| | - Jan Kremláček
- Institute of Pathological Physiology, Charles University, Faculty of Medicine, Hradec Králové, Czech Republic
| | - Andrea Málková
- Institute of Hygiene and Preventive Medicine, Charles University, Faculty of Medicine, Hradec Králové, Czech Republic
| | - Lenka Bartošová
- Institute of Hygiene and Preventive Medicine, Charles University, Faculty of Medicine, Hradec Králové, Czech Republic
| | - Zdeněk Fiala
- Institute of Hygiene and Preventive Medicine, Charles University, Faculty of Medicine, Hradec Králové, Czech Republic
| | - Vladimír Palička
- Institute of Clinical Biochemistry and Diagnostics, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Lenka Borská
- Institute of Pathological Physiology, Charles University, Faculty of Medicine, Hradec Králové, Czech Republic.
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9
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Abdulrahim H, Thistleton S, Adebajo AO, Shaw T, Edwards C, Wells A. Apremilast: a PDE4 inhibitor for the treatment of psoriatic arthritis. Expert Opin Pharmacother 2015; 16:1099-108. [DOI: 10.1517/14656566.2015.1034107] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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Lara-Corrales I, Corrales IL, Ramnarine S, Lansang P. Treatment of childhood psoriasis with phototherapy and photochemotherapy. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2013; 7:25-33. [PMID: 23966809 PMCID: PMC3735876 DOI: 10.4137/cmped.s8045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Phototherapy and photochemotherapy are well-described treatment modalities for psoriasis in adults. Like many other treatments, the experience and long-term safety of their use in children is limited. We conducted a literature search and identified publications reporting the use of phototherapy and photochemotherapy in pediatric populations. This article summarizes the existing literature on this topic. Although many studies report good improvement with these treatment modalities, long-term safety data on their use is lacking for pediatric patients.
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Affiliation(s)
| | - Irene Lara Corrales
- Assistant Professor of Pediatrics, University of Toronto, Staff Physician Pediatric Dermatology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8
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11
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Abstract
Psoriasis is a common yet complex inflammatory dermatosis that may be seen in infants, children, and adolescents. The clinical presentation and course may be quite variable, and while patients with mild disease are often easily managed, those with recalcitrant or more severe disease often present a therapeutic dilemma given the number of therapies available and the relative lack of data on the efficacy and safety of use of these therapies in children. This review presents the reader with an overview of the current understanding of the pathophysiology, diagnosis, and treatment of pediatric psoriasis, with an emphasis on the available data in the literature that pertains to the use in children of currently available topical and systemic therapies, including topical corticosteroids, vitamin D analogs, phototherapy, systemic immunosuppressive medications, and biologic agents.
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12
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Pohl D, Andrýs C, Borská L, Fiala Z, Hamaková K, Ettler K, Krejsek J. Serum level of a soluble form of endoglin (CD105) is decreased after Goeckerman's therapy of psoriasis. ACTA MEDICA (HRADEC KRÁLOVÉ) 2011; 54:59-62. [PMID: 21842718 DOI: 10.14712/18059694.2016.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Goeckerman's therapy (GT) of psoriasis is based on daily application of pharmacy grade coal tar on affected skin with subsequent exposure to UV light. Disturbances in angiogenic activity are characteristic for the immunopathogenesis of psoriasis. The aim of study was to evaluate the influence of GT of psoriasis on proinflammatory and angiogenic activities expressed as changes in levels of endoglin (CD105). METHODS Serum levels of a soluble form of endoglin were measured in peripheral blood samples of 38 patients with psoriasis before and after therapy. Sixty three otherwise healthy blood donors serve as a control group. The efficacy of GT was expressed as changes in Psoriasis Area and Severity Index (PASI). RESULTS PASI score was significantly diminished by GT (p < 0.001). Serum levels of soluble CD105 were significantly diminished after GT. The serum level of soluble CD105 dropped from 7.85 +/- 2.26 ng/ml before therapy to 7.01 +/- 1.71 ng/ml after therapy (p = 0.0002). Compared to serum levels of soluble CD105 in healthy blood donors, serum levels of soluble CD105 in patients before GT were significantly higher (p < 0.001) and remained elevated after therapy (p < 0.001). Angiogenic activity expressed as serum endoglin is diminished in patients with psoriasis treated by GT.
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Affiliation(s)
- David Pohl
- Department of Clinical Immunology and Allergy, Charles University in Prague, Faculty of Medicine, Czech Republic
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13
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Schett G, Sloan VS, Stevens RM, Schafer P. Apremilast: a novel PDE4 inhibitor in the treatment of autoimmune and inflammatory diseases. Ther Adv Musculoskelet Dis 2010; 2:271-8. [PMID: 22870453 PMCID: PMC3383510 DOI: 10.1177/1759720x10381432] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Phosphodiesterase 4 (PDE4) is a key enzyme in the degradation of cyclic adenosine monophosphate and is centrally involved in the cytokine production of inflammatory cells, angiogenesis, and the functional properties of other cell types such as keratinocytes. In this review article, apremilast, a novel small molecule inhibitor of PDE4, is introduced. Apremilast has profound anti-inflammatory properties in animal models of inflammatory disease, as well as human chronic inflammatory diseases such as psoriasis and psoriatic arthritis. Apremilast blocks the synthesis of several pro-inflammatory cytokines and chemokines, such as tumor necrosis factor alpha, interleukin 23, CXCL9, and CXCL10 in multiple cell types. In contrast to the biologics, which neutralize pro-inflammatory mediators at the protein level, apremilast modulates production of these mediators at the level of mRNA expression. Apremilast also interferes with the production of leukotriene B4, inducible nitric oxide synthase, and matrix metalloproteinase and reduces complex inflammatory processes, such as dendritic cell infiltration, epidermal skin thickening, and joint destruction. As this novel PDE4 inhibitor interferes with several key processes of inflammation, it may emerge as a promising new drug for the treatment of chronic inflammatory diseases such as those of the skin and the joints.
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14
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Kortuem KR, Davis MDP, Witman PM, McEvoy MT, Farmer SA. Results of Goeckerman treatment for psoriasis in children: a 21-year retrospective review. Pediatr Dermatol 2010; 27:518-24. [PMID: 21182642 DOI: 10.1111/j.1525-1470.2010.01124.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Goeckerman treatment has been used for the management of widespread psoriasis in children for several decades at Mayo Clinic. We aimed to review our institutional experience with the effectiveness of Goeckerman treatment for psoriasis in children. We retrospectively reviewed the records of pediatric patients who underwent Goeckerman treatment over a 21-year period (1983-2003). The main outcome measure was improvement in psoriasis. During the study period, 65 children received Goeckerman treatment for predominantly widespread, recalcitrant psoriasis. The mean age was 11.6 years (range, 3 mos to 18 yrs), and the female-to-male ratio was 2:1. Psoriasis improved in all patients: 55 patients (85%) had >80% clearance of their psoriasis. The only adverse effect was folliculitis, occurring in 27 patients (42%). Mean duration of follow-up was 2.6 years (range, 17 days-18.2 yrs); average duration of remission was 2.6 years (range, 2 mos-12.79 yrs). Goeckerman treatment is an effective treatment for widespread psoriasis in children.
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15
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Urinary mutagenicity and genotoxic risk in children with psoriasis after therapeutic exposure to polycyclic aromatic hydrocarbons and ultraviolet radiation. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2010; 696:144-7. [DOI: 10.1016/j.mrgentox.2010.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 09/15/2009] [Accepted: 01/08/2010] [Indexed: 11/17/2022]
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16
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Abstract
Treating children with psoriasis represents one of the most rewarding yet constantly challenging endeavors in dermatology. These patients require time, energy, enthusiasm, empathy, and current, comprehensive knowledge of the unique clinical presentations in children and available therapies, including clinical action spectrum, mechanism of action, potential toxicity, and monitoring. Longitudinal trials examining the epidemiology and natural history of psoriasis, as well as the safety and efficacy of current and emerging treatments, are desperately needed in the pediatric population. Partner with the patient, family, and other multidisciplinary providers to form an educational and therapeutic alliance. Early in the course of disease, schedule frequent visits for reinforcement of the therapeutic plan, education, clinical and treatment monitoring, and support. As the disease and the patient's physical, psychosocial and emotional level of functioning evolve, so too will the requirement for follow-up and monitoring. Patient advocacy and education groups, such as the National Psoriasis Foundation (www.psoriasis.org; 800-723-9166) are excellent resources and can serve as an extension of your comprehensive care.
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Affiliation(s)
- Kelly M Cordoro
- University of California, San Francisco, 1701 Divisadero Street, Box 0316, San Francisco, CA 94115, USA.
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17
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Borska L, Andrys C, Krejsek J, Hamakova K, Kremlacek J, Ettler K, Vellappally S, Vimal J, Fiala Z. Genotoxic hazard and cellular stress in pediatric patients treated for psoriasis with the Goeckerman regimen. Pediatr Dermatol 2009; 26:23-7. [PMID: 19250400 DOI: 10.1111/j.1525-1470.2008.00774.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The Goeckerman regimen (GR) represents a local treatment of psoriasis and includes topical dermal application of crude coal tar (containing polycyclic aromatic hydrocarbons) and exposure to UV-irradiation. The aim of the study was to evaluate contribution of GR to genotoxic risk and cellular stress in pediatric patients who represent a sensitive population subgroup. Genotoxic risk (42 patients) was evaluated by using chromosomal aberrations (CA) in peripheral lymphocytes. Cellular stress (26 patients) was assessed by using heat shock proteins (Hsp70). All indicators were determined in blood samples collected before GR and immediately after GR. Decreasing of psoriasis area and severity index (PASI) score indicated higher likelihood of GR (p < 0.001). Significantly increased CA (p < 0.001) and Hsp70 (p < 0.05) indicated higher genotoxic risk and cellular stress in sensitive pediatric patients, immediately after GR.
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Affiliation(s)
- Lenka Borska
- Faculty of Medicine in Hradec Kralove, Institute of Pathological Physiology, Charles University in Prague, Simkova, Hradec Kralove, Czech Republic.
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