JULY 2009 • WWW.SKINANDALLERGYNEWS.COM NEWS 9 Plus Diabetes Drug May Calm

ARTICLES BY tipsoriatic drugs used in combi- Given that acitretin and PPAR- change in Psoriasis Area and edged the small size of the CHARLES BANKHEAD nation with acitretin, pioglita- gamma activators decrease pro- Severity Index (PASI) from base- study, that they used the lowest zone may offer a safer alterna- liferation, induce differentiation, line to 12 weeks. available dose of pioglitazone, P RAGUE — The diabetes tive, as it has been used in and have anti-inflammatory ac- The baseline PASI score aver- and that women of child-bear- drug pioglitazone significantly patients with diabetes mellitus tivity, the investigators combined aged 19.3 in the acitretin-place- ing potential were excluded improved psoriasis control for several years, and bo group and 17.5 in from the study. when added to oral acitretin, most placebo-con- ‘In comparison to other antipsoriatic the acitretin-pioglita- “PPAR-gamma agonists are data from a small trolled trials have zone group. The mean known to possess an array of found. shown the incidence drugs used in combination with PASI score had wors- beneficial effects, including de- The combination led to a of side effects due to acitretin, pioglitazone may offer a ened at 2 weeks in 37% creased blood pressure, in- 64% reduction in psoriasis pioglitazone to be ap- of the acitretin-piogli- creased HDL, and improved fib- severity, compared with 52% proximately equal to safer alternative, as it has been used tazone group and 50% rinolysis,” the investigators said. for acitretin alone, Dr. Sunil that found with place- in patients with diabetes mellitus for of the acitretin-place- “Moreover, the occurrence of Dogra of the Postgraduate In- bo,” he reported. bo group. diabetes, hypertension, and stitute of Medical Education The rationale for us- several years.’ At 12 weeks, the metabolic syndrome in patients and Research in Chandigarh, ing a thiazolidinedione median PASI score in with psoriasis is not uncom- India, and colleagues reported drug to treat psoriasis came from the drugs to try and achieve ther- the pioglitazone group was 6.0, mon. These conditions may co- at the International Congress of evidence that activation of per- apeutic synergy. They hypothe- a reduction of 11.5 from base- exist more often than predicted Dermatology. oxisome-proliferator activated sized that pioglitazone might line. That compared with a me- from the prevalence of either “From our study results it is receptor-gamma (PPAR-gamma) counter acitretin-induced lipid dian score of 10.0 in the placebo disorder alone. Pioglitazone apparent that the addition of pi- may inhibit proliferation and abnormalities. group and a reduction of 9.7 may be particularly useful in oglitazone [Actos] to acitretin promote cell differentiation, ac- Dr. Dogra and colleagues from baseline. The difference these subsets of patients.” [Soriatane] therapy can en- cording to the investigators. randomized 41 patients with translated into a statistically sig- The results warrant addition- hance antipsoriatic efficacy,” he Experience with troglitazone plaque psoriasis requiring sys- nificant advantage in favor of al studies of the combination, reported in a poster presenta- showed reduced psoriasis dis- temic therapy. Patients received acitretin-pioglitazone. including evaluations of the tion. Initial worsening of dis- ease activity and normalized acitretin 25 mg/day plus either No unexpected adverse ef- safety and efficacy combining ease severity occurred less often histologic features of psoriatic pioglitazone 15 mg/day or fects occurred in either treat- higher doses of pioglitazone with the combination, but the skin, Dr. Dogra noted. And, placebo. ment group, and no patients with acitretin. difference did not achieve sta- studies of pioglitazone in psori- Patients had follow-up visits had any laboratory abnormali- The investigators declared tistical significance. asis have shown response rates at 2, 4, 8, and 12 weeks. The pri- ties during the study. having no relevant conflicts of “In comparison to other an- as high as 50%. mary efficacy end point was the The investigators acknowl- interest. ■ Found as Effective Mind-Body Connection Plays As for Psoriasis Role in Coping With Disease

P RAGUE — For psoriasis patients who Each patient was treated simultane- P RAGUE — A mind-body connection chosocial aspects of psoriasis, Dr. can handle the smell and mess, coal tar ously with both agents in an unblinded may play a role in a psoriasis patients’ Pietrzak and her colleagues studied 104 remains an effective, inexpensive treat- manner: tazarotene on the right side of disease adaptation, study data suggest. patients with psoriasis. The cohort had ment option for stable disease, according the body and coal tar on the left. Treat- Lipoprotein levels and the amino- a mean Psoriasis Area and Severity In- to Dr. Uma Kumar. ment continued for 12 weeks, and pa- terminal fragment of pro-brain natri- dex score of about 24 and body surface Coal tar proved just as effective as topi- tients were assessed at 2-week intervals. uretic peptide (NT-proBNP) correlated involvement of about 30%. cal tazarotene (Tazorac) in a small ran- Response was determined by change in with various psychosocial aspects of The patients’ lipid profiles and NT- domized study of patients with stable an erythema, scaling, and induration psoriasis, Dr. Aldona Pietrzak of the proBNP levels were compared with plaque psoriasis. All patients in both (ESI) score, which averaged about 28 at Medical University of Lublin, Poland, scores derived from three psychosocial groups had either marked or moderate baseline. reported at the International Congress assessment tools: the Skindex 29 mea- improvement after 12 weeks of treatment. The ESI scores did not differ signifi- of Dermatology. sure of disease-related quality of life, “Our results indicate that tazarotene cantly between treatments at any of the Higher levels of certain lipoproteins the Acceptance of Disease Scale, and a 0.1% gel and coal tar 5% ointment ap- assessments. At 12 weeks, ESI scores av- correlated with disease acceptance and disease-related social support scale. The pear to have comparable efficacy in sta- eraged 7.1 with tazarotene treatment quality-of life-problems. Quality of life lipid profile comprised total choles- ble plaque psoriasis,” Dr. Kumar of the and 5.9 with coal tar. The mean ESI decreased as levels of NT-proBNP in- terol, LDL cholesterol, HDL choles- All Indian Institute of Medical Sciences score for lesions treated with coal tar creased, particularly among men. terol, triglycerides, apolipoprotein-A1 in New Delhi reported at the Interna- were lower at 6 and 10 weeks, in addition “Parameters of cardiovascular abnor- (apo-A1) and apo-B. tional Congress of Dermatology. to the end of the study. malities, such as NT-proBNP and lipid The analysis showed that higher LDL “Considering the overall cost to bene- Dr. Kumar reported that 27 patients levels, are associated with psychological levels were associated with a lower ac- fit ratio in a chronic disease like psoriasis, completed the study. Psoriasis lesions im- dimensions of adjustment to psoriasis,” ceptance of life with disease, and high- coal tar ointment is still an effective treat- proved by at least 50% in all patients on said Dr. Pietrzak. “The mechanisms elu- er NT-proBNP levels were associated ment modality for patients with stable both sides of the body. Investigators rat- cidating these associations require fur- with a lower quality of life. plaque psoriasis, especially in developing ed the improvement as marked in 41% of ther studies.” Among men, higher NT-proBNP lev- countries where the treatment/health tazarotene-treated areas and 59% of areas Epidemiologic data have shown that els also correlated with increased phys- care costs are borne by patients them- treated with coal tar. The figures were re- psoriasis patients have an increased risk ical symptoms and emotional stress. selves,” he said. versed for moderate improvement. of cardiovascular disease. Explanations In women the degree of acceptance The findings came from a comparison “Coal tar is one of the commonest for the increased risk are incomplete but of life with disease correlated inverse- of tazarotene gel and crude coal tar in conventional treatment modalities for likely involve conventional and uncon- ly with total cholesterol, LDL choles- 30 patients with stable plaque psoriasis. psoriasis,” Dr. Kumar said. “Various ventional cardiac risk factors, she said. terol, and apo-B levels. Levels of apo-B The patients had limited disease, de- studies have proved its effectiveness time Lipid abnormalities have a well-doc- significantly influenced physical symp- fined as involvement of less than 20% of and again. umented association with coronary toms, emotions, and disease-related body surface area. Disease duration av- “Patient acceptability is the major prob- heart disease, and elevated NT-proBNP quality of life in women. eraged about 9 years. Before the initia- lem with coal tar. The preparations are has been linked to worse outcomes in Perceived level of social support had tion of randomized treatment, patients usually greasy and unpleasant smelling, heart failure. Both metabolic parame- a positive correlation with acceptance completed a 4-week washout period for and they can stain clothing,” he noted. ters have been implicated in psoriasis of life with disease. systemic therapy—2 weeks for topical Dr. Kumar and his colleagues reported severity, she continued. Dr. Pietrzak reported having no rel- therapy. having no relevant conflicts of interest.■ Expanding the associations to psy- evant conflicts of interest. ■