Low strength anthralin in psoriasis

In search for new antipsoriatic agents: NAD topical composition

The aim of the study was to examine the effectiveness of the oxidized form of nicotinamide adenine dinucleotide (NAD(+)), adenosine precursor, in 37 patients suffering from psoriasis. As NAD(+) is known to be relatively unstable, the second goal was to establish the proper conditions for the satisfactory stability of topical NAD(+) composition. In each patient, two matching plaques were selected for the study. Topical treatment with 1 or 0.3% NAD(+) in Vaseline ointment administered twice daily was compared with overnight therapy with 0.1% anthralin applied for 12 h and placebo. The enzymatic method was applied to determine the stability of NAD(+) in Vaseline ointment. After a 4-week application, the reduction in erythema, infiltration and desquamation caused by 1 or 0.3% topical NAD(+) composition was similar to the reduction caused by 0.1% anthralin. It was demonstrated that NAD(+) underwent a considerable decomposition at room temperature, while it was sufficiently stable at 5 degrees C; thus, for a longer use the agent should be stored at fridge temperature. NAD(+) therapy combines good efficacy, cosmetic acceptability and convenient twice-daily application.

Mast cell alterations in chronic psoriasis vulgaris: response to low-strength anthralin treatment. A transmission electron microscopic study

Mast cell degranulation (MCD) was studied in lesions of chronic psoriasis vulgaris before and during topical treatment with low-strength anthralin. Before the treatment, two forms (A and B) of mast cells with Type I MCD were distinguished in the lesions, in addition to mast cells showing Type II MCD. In Type I MCD, electron-dense mast cell granules in form A mast cells, and electron-dense mast cell granules and vacuoles containing granule matrix in form B mast cells, were released as intact structures by the mechanism of diacytosis. Distinct gaps of the mast cell plasma membranes were observed. Around blood vessels, beneath the epidermal-dermal junction and in the intercellular space of strata basale and spinosum, the mast cell granules appeared partly as intact structures and partly in more or less disintegrated form. In Type II MCD the granule matrix was released into the extracellular compartment by the mechanism of exocytosis. During treatment with low-strength anthralin, the mast cell changes underwent regression. In macular psoriasis only form A mast cells of Type I MCD were demonstrated, and the released intact mast cell granules were restricted to the immediate neighbourhood of the mast cells. There were no mast cell granules in the epidermis. At the sites with clinically complete clearance of psoriatic lesions, the mast cells displayed no degranulation but distinct gaps were still found in the mast cell plasma membranes. Low-strength anthralin's mode of action in psoriasis is suggested to involve regression of a series of systems, including prevention of mast cell degranulation, thereby inhibiting release of histamine, proteinase and other mast cell mediators sustaining the psoriatic process.

Anthralin: historical and current perspectives

Anthralin was first synthesized in 1916. Earlier, a natural product, chrysarobin, originally derived from the South American araroba tree, had been used to treat psoriasis. Anthralin was first used in Germany, and later in the Ingram regimen in Britain, but it has never been popular with American dermatologists. This is probably due to the side effects of staining and irritation of the skin. Attempts to reduce these using low concentration, short contact therapy, and concomitant steroid therapy, have been only partially successful. It may be that better instruction of patients and physicians will lead to wider use of this effective topical agent for the treatment of psoriasis. The mode of action of anthralin is thought to be either through its effect on deoxyribonucleic acid (DNA), probably mitochondrial DNA, which reduces cell turnover, or through its effects on various enzyme systems, including those of polyamine synthesis and respiration. The aims of this review are to discuss historical aspects of anthralin and to update its chemistry, pharmacology, and clinical usage.

Recent advances in the treatment of psoriasis

Because psoriasis is a disease of unknown etiology, all treatments are based on empirical experience and diverse scientific theories. Although there is no present cure for psoriasis, many forms of therapy are effective in control of the disorder. These range from topical medications such as tar, anthralin, corticosteroids; phototherapy and photochemotherapy; systemic medication, including cytotoxic agents; and vitamin A analogues or retinoids. This report focuses on modifications of existing therapies based on advances in basic science knowledge and technology, combination therapies, as well as new therapeutic agents and new approaches to the treatment of psoriasis.