DOCSLIB.ORG

Systemic Treatment of Pediatric Psoriasis: a Review

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Systemic Treatment of Pediatric Psoriasis: a Review Dermatol Ther (Heidelb) DOI 10.1007/s13555-016-0117-6 REVIEW Systemic Treatment of Pediatric Psoriasis: A Review Maddalena Napolitano . Matteo Megna . Anna Balato . Fabio Ayala . Serena Lembo . Alessia Villani . Nicola Balato Received: February 29, 2016 Ó The Author(s) 2016. This article is published with open access at Springerlink.com ABSTRACT addition, due to psoriasis’ chronic nature and frequently occurring relapses, psoriatic patients Psoriasis is a chronic, immune-mediated, tend to have an impaired quality of life, often inflammatory skin disease, affecting 1–3% of requiring long-term treatment. Therefore, the white population. Although the existence of education of both pediatric patients and their two psoriasis incidence peaks has been parents is essential to successful and safe disease suggested (one in adolescence before 20 years management. Given the lack of officially of age and another in adulthood), its onset may approved therapies, the very limited occur at any age, including childhood and evidence-based data from randomized adolescence, in which the incidence is now controlled trials, and the absence of estimated at 40.8 per 100,000. As for adult standardized guidelines, to date, pediatric psoriasis, pediatric psoriasis has recently been psoriasis treatment is primarily based on associated with obesity, metabolic syndrome, published case reports, case series, guidelines increased waist circumference percentiles and for adult psoriasis, expert opinions and metabolic laboratory abnormalities, warranting experience with these drugs in other pediatric early monitoring and lifestyle modifications. In disorders coming from the disciplines of rheumatology, gastroenterology and oncology. This review focuses on the use of systemic treatments in pediatric psoriasis and their Enhanced content To view enhanced content for this specific features, analyzing the few literature article go to www.medengine.com/Redeem/15B4F0600 F2B8B8E. evidences available, expanding the treatment repertoire and guiding dermatologists in better M. Napolitano and M. Megna contributed equally to this managing of recalcitrant pediatric psoriasis. study. M. Napolitano Á M. Megna (&) Á A. Balato Á F. Ayala Á S. Lembo Á A. Villani Á N. Balato Keywords: Biologics; Childhood; Pediatric Department of Dermatology, University of Naples Federico II, Naples, Italy psoriasis; Systemic treatments e-mail: [email protected] Dermatol Ther (Heidelb) INTRODUCTION psoriasis in the following databases through 7 February 2016: PubMed, Embase, The Cochrane Psoriasis is a chronic inflammatory skin disease Library, Google Scholar, Scopus and EBSCO. that affects 1–3% of the population [1]. This The following key words were used: ‘‘pediatric multifactorial papulosquamous disorder is also psoriasis,’’ ‘‘childhood psoriasis,’’ ‘‘systemic believed to be common in pediatrics [2]. therapy,’’ ‘‘systemic treatments,’’ ‘‘psoriasis,’’ Particularly, psoriasis is reported to affect 0.5–1% ‘‘childhood,’’ ‘‘children,’’ ‘‘infancy,’’ of children in Europe [3]. Moreover, the incidence ‘‘cyclosporine,’’ ‘‘methotrexate,’’ ‘‘acitretin,’’ of pediatric psoriasis is significantly increased over ‘‘etretinate,’’ ‘‘fumaric acid esters,’’ ‘‘biologics,’’ time, being now estimated at 40.8 per 100,000 ‘‘adalimumab,’’ ‘‘etanercept,’’ ‘‘infliximab’’ and with a median age onset between 7 and 10 years [4, ‘‘ustekinumab.’’ This article reviews especially 5]. Furthermore, a few prevalence surveys have newer data to address the issues that surround demonstrated that about one-third of psoriasis pediatric psoriasis and to provide an update on patients sometimes develop their symptoms its systemic treatments. All the evidence was during childhood, although some of these may evaluated by the authors, who then combined not be diagnosed until adulthood [6, 7]. Since this with clinical experience of everyday children differ from adults, specific guidelines practice in an effort to provide a complete underlining clinical pictures and management review of the management of psoriasis in are needed to support early intervention, which childhood. is also fundamental to achieving psychological This article is based on previously conducted comfort and preventing the appearance of studies and does not involve any new studies of comorbidities, apart from controlling and human or animal subjects performed by any of limiting the burden of the disease [8]. However, the authors. there are currently no international standardized guidelines for medical treatment of pediatric MANAGEMENT OF PEDIATRIC psoriasis. Indeed, to date, treatment is primarily PSORIASIS: SYSTEMIC THERAPY based on published case reports, case series, guidelines for adult psoriasis, expert opinions and The management of pediatric psoriasis is a experience with these drugs in other pediatric complicated and intriguing task. Standardized disorders. As a consequence, most anti-psoriatic guidelines for the treatment of children with drugs, especially systemic ones, are often used off psoriasis are lacking, although certain published label [2].Thisreviewfocusesontheuseofsystemic psoriasis guidelines for adults address several treatments in pediatric psoriasis and their specific issues that concern younger populations [9, 10]. and peculiar features analyzing the few literature Both available systemic therapies for pediatric evidences and studies regarding systemic therapy psoriasis and randomized controlled trials in childhood psoriasis management. supporting their use are limited, so that physicians have to rely on data from case METHODS reports and case series from the field of dermatology as well as from the application of We searched for English-language literature the same drugs but for rheumatologic or regarding systemic treatments in pediatric gastroenterological pediatric conditions. Given Dermatol Ther (Heidelb) Table 1 General approach to pediatric psoriasis treatment General approach to pediatric psoriasis treatment Factors to consider Special issues Patient age Girls of childbearing potential (avoid retinoids) Type of psoriasis (guttate, plaque, Unstable disease (consider cyclosporine) pustular or erythrodermic) Clinical severity of the disease Presence of psoriatic arthritis (consider methotrexate or biologics) Location of psoriasis Intense physical activity (avoid retinoids) Impact on quality of life Psychological burden of the condition Comorbidities (psoriatic arthritis, obesity, etc.) Patient’s previous treatments Patient’s preferences the lack of guidelines, a general approach (311–313 nm) and UVA (320–400 nm). They should be performed (Table 1): the choice of inhibit DNA synthesis and keratinocyte the most appropriate treatment should be proliferation and induce apoptosis of T influenced by several factors such as patient lymphocytes and production of age, clinical severity of the disease, the impact anti-inflammatory mediators [13]. BB-UVB on quality of life, the psychological burden of comprises the most active portion of sunlight the condition, the presence of comorbidities radiation and produces excellent responses in (psoriatic arthritis, obesity, etc.), as well as the case of guttate psoriasis. NB-UVB is less patient’s previous treatments and preferences erythemogenic than BB-UVB and has been [2, 11]. shown to be effective especially for guttate or thin plaque disease; it is now considered the PHOTOTHERAPY first-line phototherapy, because of its association with milder side effects [14, 15]. Short-term side Children with psoriasis typically respond very effects from UVB phototherapy have been well well to treatment with phototherapy, which is described also in pediatric population and considered an appropriate treatment in case of comprise dry skin, itch, erythema, blistering debilitating palmo-plantar psoriasis, diffuse and herpes virus activation [16]. On the other psoriasis involving more than 15–20% of the hand, long-term side effects, mainly consisting body surface area, refractory plaque/ of premature photoaging and carcinogenesis, are guttate/pustular psoriasis or patients who not well documented in children [15, 16]. cannot receive systemic drugs for their However, the cumulative effect of UVB moderate to severe psoriasis [12]. There are phototherapy and chronic sun exposure has three main alternatives: broadband ultraviolet been linked to skin cancer. Thus, long-term B (BB-UVB, 280–320 nm), narrowband (NB)-UVB follow-up of psoriatic children who attend Dermatol Ther (Heidelb) phototherapy is necessary to clarify the ingestion-related toxicity, including nausea associations with adverse effects. The and vomiting, headaches, ocular and hepatic cumulative UVB dose and cancer risk can be toxicity, generalized photosensitization needing reduced combining phototherapy with systemic photoprotection for 24 h, the possibility of or topical treatment, such as acitretin and burning and long-term risk of skin cancer [12, calcipotriol, respectively [16–18]. NB-UVB is 26]. Indeed, PUVA is now rarely used in children considered the most efficacious and safe type of because of long-term toxicity; topical PUVA phototherapy in children [19]. In 2011, a treatments are generally preferred [15]. retrospective study in pediatric psoriasis patients showed complete clearance in 51% NON-BIOLOGIC SYSTEMIC DRUGS and a good response (at least 75% improvement) in 41% of the subjects through a Severe or refractory plaque, pustular or mean treatment duration of 3.3 months [20]. erythrodermic psoriasis and psoriatic arthritis Recently, Wong et al. performed a retrospective
Load more

Recommended publications
  • In Silico Methods for Drug Repositioning and Drug-Drug Interaction Prediction
    In silico Methods for Drug Repositioning and Drug-Drug Interaction Prediction Pathima Nusrath Hameed ORCID: 0000-0002-8118-9823 Submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy Department of Mechanical Engineering THE UNIVERSITY OF MELBOURNE May 2018 Copyright © 2018 Pathima Nusrath Hameed All rights reserved. No part of the publication may be reproduced in any form by print, photoprint, microfilm or any other means without written permission from the author. Abstract Drug repositioning and drug-drug interaction (DDI) prediction are two fundamental ap- plications having a large impact on drug development and clinical care. Drug reposi- tioning aims to identify new uses for existing drugs. Moreover, understanding harmful DDIs is essential to enhance the effects of clinical care. Exploring both therapeutic uses and adverse effects of drugs or a pair of drugs have significant benefits in pharmacology. The use of computational methods to support drug repositioning and DDI prediction en- able improvements in the speed of drug development compared to in vivo and in vitro methods. This thesis investigates the consequences of employing a representative training sam- ple in achieving better performance for DDI classification. The Positive-Unlabeled Learn- ing method introduced in this thesis aims to employ representative positives as well as reliable negatives to train the binary classifier for inferring potential DDIs. Moreover, it explores the importance of a finer-grained similarity metric to represent the pairwise drug similarities. Drug repositioning can be approached by new indication detection. In this study, Anatomical Therapeutic Chemical (ATC) classification is used as the primary source to determine the indications/therapeutic uses of drugs for drug repositioning.
    [Show full text]
  • Nurse-Led Drug Monitoring Clinic Protocol for the Use of Systemic Therapies in Dermatology for Patients
    Group arrangements: Salford Royal NHS Foundation Trust (SRFT) Pennine Acute Hospitals NHS Trust (PAT) Nurse-led drug monitoring clinic protocol for the use of systemic therapies in dermatology for patients with inflammatory dermatoses Lead Author: Dawn Lavery Dermatology Advanced Nurse Practitioner Additional author(s) N/A Division/ Department:: Dermatology, Clinical Support and Tertiary Medicine Applies to: (Please delete) Salford Royal Care Organisation Approving Committee Dermatology clinical governance committee Salford Royal Date approved: 13 February 2019 Expiry date: February 2022 Contents Contents Section Page Document summary sheet 1 Overview 2 2 Scope & Associated Documents 2 3 Background 3 4 What is new in this version? 3 5 Policy 4 Drugs monitored by nurses 4 Acitretin 7 Alitretinoin Toctino 11 Apremilast 22 Azathioprine 26 Ciclosporin 29 Dapsone 34 Fumaric Acid Esters – Fumaderm and Skilarence 36 Hydroxycarbamide 39 Hydroxychloroquine 43 Methotrexate 50 Mycophenolate moefetil 57 Nurse-led drug monitoring clinic protocol for the use of systemic therapies in dermatology for patients with inflammatory dermatoses Reference Number GSCDerm01(13) Version 3 Issue Date: 11/06/2019 Page 1 of 77 It is your responsibility to check on the intranet that this printed copy is the latest version Standards 67 6 Roles and responsibilities 67 7 Monitoring document effectiveness 67 8 Abbreviations and definitions 68 9 References 68 10 Appendices N/A 11 Document Control Information 71 12 Equality Impact Assessment (EqIA) screening tool 73 Group arrangements: Salford Royal NHS Foundation Trust (SRFT) Pennine Acute Hospitals NHS Trust (PAT) 1. Overview (What is this policy about?) The dermatology directorate specialist nurses are responsible for ensuring prescribing and monitoring for patients under their care, is in accordance with this protocol.
    [Show full text]
  • Ehealth DSI [Ehdsi V2.2.2-OR] Ehealth DSI – Master Value Set
    MTC eHealth DSI [eHDSI v2.2.2-OR] eHealth DSI – Master Value Set Catalogue Responsible : eHDSI Solution Provider PublishDate : Wed Nov 08 16:16:10 CET 2017 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 1 of 490 MTC Table of Contents epSOSActiveIngredient 4 epSOSAdministrativeGender 148 epSOSAdverseEventType 149 epSOSAllergenNoDrugs 150 epSOSBloodGroup 155 epSOSBloodPressure 156 epSOSCodeNoMedication 157 epSOSCodeProb 158 epSOSConfidentiality 159 epSOSCountry 160 epSOSDisplayLabel 167 epSOSDocumentCode 170 epSOSDoseForm 171 epSOSHealthcareProfessionalRoles 184 epSOSIllnessesandDisorders 186 epSOSLanguage 448 epSOSMedicalDevices 458 epSOSNullFavor 461 epSOSPackage 462 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 2 of 490 MTC epSOSPersonalRelationship 464 epSOSPregnancyInformation 466 epSOSProcedures 467 epSOSReactionAllergy 470 epSOSResolutionOutcome 472 epSOSRoleClass 473 epSOSRouteofAdministration 474 epSOSSections 477 epSOSSeverity 478 epSOSSocialHistory 479 epSOSStatusCode 480 epSOSSubstitutionCode 481 epSOSTelecomAddress 482 epSOSTimingEvent 483 epSOSUnits 484 epSOSUnknownInformation 487 epSOSVaccine 488 © eHealth DSI eHDSI Solution Provider v2.2.2-OR Wed Nov 08 16:16:10 CET 2017 Page 3 of 490 MTC epSOSActiveIngredient epSOSActiveIngredient Value Set ID 1.3.6.1.4.1.12559.11.10.1.3.1.42.24 TRANSLATIONS Code System ID Code System Version Concept Code Description (FSN) 2.16.840.1.113883.6.73 2017-01 A ALIMENTARY TRACT AND METABOLISM 2.16.840.1.113883.6.73 2017-01
    [Show full text]
  • Acitretin in Dermatology A.D
    BJD GUIDELINES British Journal of Dermatology British Association of Dermatologists guidelines on the efficacy and use of acitretin in dermatology A.D. Ormerod, E. Campalani* and M.J.D. Goodfield Department of Dermatology, University of Aberdeen, Foresterhill, Aberdeen AB9 2ZB, U.K. *Department of Dermatology, Royal London Hospital, Whitechapel Road, London E1 1BB, U.K. Department of Dermatology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, U.K. Correspondence Acitretin, a synthetic retinoid, is the pharmacologically active Anthony Ormerod. metabolite of etretinate. It replaced etretinate in the late 1980s E-mail: [email protected] because of its more favourable pharmacokinetic profile, and it is an established systemic second-line therapy for severe psori- Accepted for publication asis resistant to topical therapy. Bioavailability is enhanced by 9 February 2010 food, especially fatty food.1 Acitretin is 50 times less lipophilic Key words than etretinate and has a shorter elimination half-life. How- acitretin, ichthyosis, psoriasis, safety, systematic ever, there is evidence that small amounts of acitretin are review, treatment guidelines re-esterified to etretinate, which has a very long half-life, especially in the presence of alcohol.2,3 Intracellularly, it inter- Conflicts of interest acts with cytosolic proteins and nuclear receptors, which are None declared. part of the steroid-thyroid hormone superfamily. We know that these nuclear receptors act as transcriptional factors for This is a new set of guidelines prepared for the BAD specific DNA sequences; however, their role in the retinoid Clinical Standards Unit, made up of the Therapy & pathway is largely unknown. In psoriasis and other disorders Guidelines Subcommittee (T&G) and the Audit & of keratinization, acitretin normalizes epidermal cell prolifera- Clinical Standards Subcommittee (A&CS).
    [Show full text]
  • Acitretin, Isotretinoin and Bexarotene
    REVIEW ARTICLE A review of three systemic retinoids in dermatology: acitretin, isotretinoin and bexarotene Hossein Mortazavi, MD 1,2 Retinoids are synthetic and natural analogues of vitamin A that Nessa Aghazadeh, MD 1 have various effects on cellular differentiation, cellular proliferation, Maryam Ghiasi, MD 1 immune system, and embryonic development. The present study reviews the history of systemic retinoids in medicine, the structure Vahideh Lajevardi, MD 1 of synthetic retinoids and their mechanisms. The main focus is on their biologic functions, clinical uses, and the adverse effects 1. Department of Dermatology, Tehran of isotretinoin, acitretin, and bexarotene representing the most University of Medical Sciences, commonly used first, second, and third generation systemic Tehran, Iran 2. Autoimmune Bullous Diseases retinoids, respectively. Research Center, Tehran University Keywords: acitretin, bexarotene, etretinate, isotretinoin, retinoids of Medical Sciences, Tehran, Iran Iran J Dermatol 2013; 16: 144-158 Corresponding Author: Hossein Mortazavi, MD Razi Hospital, Vahdat Islamic Square, Tehran, Iran Email: [email protected] Conflict of interest: none to declare Received: 18 October 2013 Accepted: 24 November 2013 effects of retinoids has led to various clinical INTRODUCTION applications of these drugs in dermatology and The term “retinoid” applies to the synthetic and oncology 1. natural analogues of vitamin A 1. Retinoids show The introduction of isotretinoin, etretinate, and biologic activities that are specific to vitamin A. its active metabolite acitretin and bexarotene, To enhance the beneficial effects of vitamin A, the RXR-selective retinoid, to dermatology has especially its anti-keratinization property and revolutionized medical therapy in dermatology 1,4. the promotion of cellular differentiation, new synthetic retinoids were engineered 2, 3.
    [Show full text]
  • C:\Data\NDA\19821 Soriatane\AP Ltr3
    NDA 19-821/S-002 NDA 19-821/S-006 Page 3 ________________________________________________________________ Professional Package Insert SORIATANE® (acitretin) CAPSULES CAUSES BIRTH DEFECTS DO NOT GET PREGNANT CONTRAINDICATIONS AND WARNINGS: Soriatane must not be used by females who are pregnant, or who intend to become pregnant during therapy or at any time for at least 3 years following discontinuation of therapy. Soriatane also must not be used by females who may not use reliable contraception while undergoing treatment or for at least 3 years following discontinuation of treatment. Acitretin is a metabolite of etretinate (Tegison®), and major human fetal abnormalities have been reported with the administration of acitretin and etretinate. Potentially, any fetus exposed can be affected. NDA 19-821/S-002 NDA 19-821/S-006 Page 4 Clinical evidence has shown that concurrent ingestion of acitretin and ethanol has been associated with the formation of etretinate, which has a significantly longer elimination half-life than acitretin. Because the longer elimination half-life of etretinate would increase the duration of teratogenic potential for female patients, ethanol must not be ingested by female patients either during treatment with Soriatane or for 2 months after cessation of therapy. This allows for elimination of acitretin, thus removing the substrate for transesterification to etretinate. The mechanism of the metabolic process for conversion of acitretin to etretinate has not been fully defined. It is not known whether substances other than ethanol are associated with transesterification. Acitretin has been shown to be embryotoxic and/or teratogenic in rabbits, mice, and rats at oral doses of 0.6, 3 and 15 mg/kg, respectively.
    [Show full text]
  • Analytical Methods for the Determination of Anti-Psoriatic Drugs - a Review
    Acta Scientific Pharmaceutical Sciences (ISSN: 2581-5423) Volume 4 Issue 2 February 2020 Review Article Analytical Methods for the Determination of Anti-Psoriatic Drugs - A Review Sistla Mounica Pratyusha* and Choppala Asha Deepti Department of Pharmaceutical Analysis and Quality Assurance, GITAM Institute Received: January 20, 2020 of Pharmacy, GITAM (Deemed to be) University, Visakhapatnam, Andhra Pradesh, Published: January 31, 2020 India © All rights are reserved by Sistla Mounica *Corresponding Author: Sistla Mounica Pratyusha, Department of Pharma- Pratyusha and Choppala Asha Deepti. ceutical Analysis and Quality Assurance, GITAM Institute of Pharmacy, GITAM (Deemed to be) University, Visakhapatnam, Andhra Pradesh, India. DOI: 10.31080/ASPS.2020.04.0490 Abstract Psoriasis is a long-lasting autoimmune disease characterized by patches of abnormal skin. Typical psoriatic scales are in thick, red patches. Sometimes, these patches will crack and bleed. Psoriasis is the result of a sped-up skin production process. Some of the drugs used in the treatment of psoriasis are Acitretin, Etretinate, Bergapten, Methoxsalen, Tazarotene, Calcipotriol, Anthralin etc. A brief review of the analytical methods developed for the determination of drugs used for the treatment of Psoriasis was discussed in the present study. Keywords: Acitretin; Etretinate; Bergapten Introduction Psoriasis is a chronic autoimmune condition that causes the rapid build-up of skin cells. This build-up of cells causes scaling on the skin’s surface. Typically, skin cells grow deep in the skin and slowly rise to the surface. The typical life cycle of a skin cell is one month. Some of the drugs used in the treatment of psoriasis: Acitretin, Etretinate, Bergapten, Methoxsalen, Tazarotene, Calci- potriol, Anthralin and the chemical structures of these drugs were - termination of these drugs were summarized in table 1.
    [Show full text]
  • SORIATANE® (Acitretin) CAPSULES
    NDA 019821/S-023 Page 3 SORIATANE® (acitretin) CAPSULES Rx Only CONTRAINDICATIONS AND WARNINGS: Soriatane must not be used by females who are pregnant, or who intend to become pregnant during therapy or at any time for at least 3 years following discontinuation of therapy. Soriatane also must not be used by females who may not use reliable contraception while undergoing treatment and for at least 3 years following discontinuation of treatment. Acitretin is a metabolite of etretinate (Tegison®), and major human fetal abnormalities have been reported with the administration of acitretin and etretinate. Potentially, any fetus exposed can be affected. Clinical evidence has shown that concurrent ingestion of acitretin and ethanol has been associated with the formation of etretinate, which has a significantly longer elimination half-life than acitretin. Because the longer elimination half-life of etretinate would increase the duration of teratogenic potential for female patients, ethanol must not be ingested by female patients either during treatment with Soriatane or for 2 months after cessation of therapy. This allows for elimination of acitretin, thus removing the substrate for transesterification to etretinate. The mechanism of the metabolic process for conversion of acitretin to etretinate has not been fully defined. It is not known whether substances other than ethanol are associated with transesterification. Acitretin has been shown to be embryotoxic and/or teratogenic in rabbits, mice, and rats at oral doses of 0.6, 3 and 15 mg/kg, respectively. These doses are approximately 0.2, 0.3 and 3 times the maximum recommended therapeutic dose, respectively, based on a mg/m2 comparison.
    [Show full text]
  • A Possible Mode of Action of Dithranol (Anthralin)*
    An Investigation of the Ability of Antipsoriatic Drugs to Inhibit Calnlodulin Activity: A Possible Mode of Action of Dithranol (Anthralin)* William F. G. Tucker, M .B., M .R.C.P., Sheila Mac N eil, Ph.D., Rebecca A. Dawson, H .N.D., S. Tomlinson, M .D ., F.R.C.P. , and Stanley S. Bleehen, M .B., F.R.C.P. Department of Dermatology, Royal Hallamshire Hospital (WFGT , SSB), Sheffield, and Department of Medi cine, Clinica l Sciences Centre. N orthern General Hospital (S MacN , RAD. ST). Sheffield. U . K. Epidermal calmodulin (CaM) has been reported to be el­ hydrocortisone and crude coal tar showed minimal C aM evated in psoriasis and to decrease following clea rance of inhibitory activity. Dithranol (anthralin), however, whether psoriasis with treatment. We set out to inves ti gate whether freshly prepared or oxidized, produced substantial inhibi­ any of the principle drugs used in the trea tment of psoriasis tion of CaM activity and was demonstrated to be a potent had inherent CaM antagonist activity. Utilizing a CaM­ competitive antagonist of CaM, suggesting another pos­ activated phosphodiesterase we have demonstrated that even sible therapeutic mode of action of dithra nol in psoriasis . at very hi gh concentrations, the systemic drugs etretinate, J Invest D ermatol 87:232-235, 1986 methotrexate, and 8-methoxypsoralen, and the topical agents evels of the intracellular calcium binding protein cal­ trexate, and 8-methoxypsoralen to inhibit the CaM ac tivation of modulin (CaM) have been shown to be elevated in both a CaM-sensitive enzyme, beef hea rt phosphodies terase. lesionQl [1-5] and nonl esional [2-5] psori ati c epidermis.
    [Show full text]
  • Retinoid Treatment of Skin Diseases
    Review Eur J Dermatol 2015; 25(5): 384-91 Lisa BECKENBACH1 Retinoid treatment of skin diseases Jens M. BARON2 Hans F. MERK2 Harald LOFFLER¨ 1 , Retinoids (vitamin A and its metabolites) are potent natural regula- Philipp M. AMANN1 2 tors of cellular activities, including cell growth and differentiation, and they mediate many essential regulatory functions, especially in the skin. 1 Department of Dermatology, SLK Hospital Heilbronn, Am Gesundbrunnen Biologically active retinoids exert their effects by binding to nuclear 20 -26, 74078 Heilbronn, Germany retinoic acid receptors and retinoid-X-receptors. The group of pharma- 2 Department of Dermatology and cologically used retinoids include naturally occurring and chemically Allergology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, synthesised vitamin A derivatives. Due to their influence on keratinocyte Germany proliferation, epidermal differentiation and keratinisation, retinoids are commonly used in the field of dermatopharmacology. For safe admin- Reprints: P. M. Amann istration of retinoids, in-depth information about adverse effects and <[email protected]> comprehensive information of the patient are important. This article gives an overview on the effects, use, and side-effects of topical and systemic retinoids in dermatology. Key words: dermatopharmacology, retinoid therapy, retinoids, vitamin Article accepted on 05/2/2015 A derivatives itamin A (all-trans retinol) and its naturally occurring and synthetic derivatives, collectively Nonaromatic endogenous retinoids (1st generation) V referred to as retinoids, exert a wide variety of O profound effects during embryogenesis, reproduction, reg- OH OH ulation of inflammation, cell growth and cell differentiation. Their decisive role as critical gene regulators is primarily Vitamin A (all-trans retinol) Tretinoin (all-trans retinoic acid) mediated by their interaction with the nuclear retinoic acid receptors (RAR) and retinoid-X-receptors (RXR) [1].
    [Show full text]
  • Bullous Congenital Ichthyosiform Erythroderma: Safe and Effective Topical Treatment with Calcipotriol Ointment in a Child
    52 Letters to the Editor Bullous Congenital Ichthyosiform Erythroderma: Safe and Effective Topical Treatment with Calcipotriol Ointment in a Child Thomas Bogenrieder, Michael Landthaler and Wilhelm Stolz Department of Dermatology, University of Regensburg, Regensburg, Germany. E-mail: [email protected] Accepted August 14, 2002. Sir, case of BCIE (5). Here, we report the safe and Bullous congenital ichthyosiform erythroderma (BCIE), successful long-term (w3 years) topical therapy with or epidermolytic hyperkeratosis (MIM# 113.800), is a calcipotriol ointment in a 9-year-old boy with BCIE. rare disorder of keratinization associated with blistering in its early phase. It was first described by Jean-Louis Brocq in 1902 as e´rythrodermie conge´nitale ichthyosi- CASE REPORT forme avec hypere´pidermotrophie. Although most cases A 9-year-old boy was first seen in September 1998 with are sporadic, familial cases show an autosomal domi- a keratinization disorder. Immediately after birth he nant pattern of inheritance. The disorder is linked to was diagnosed with BCIE by histology and electron keratin clusters on chromosome 12q and 17q (1). microscopy at the University of Heidelberg, Germany. Several researchers have described mutations in the There was no family history of keratinization disorders. highly conserved regions of keratins K1 and K10 (2, 3). The erythroderma faded in infancy, but the scaling Moreover, transgenic mice carrying mutant K10 have progressed. developed skin abnormalities similar to BCIE (4). On clinical examination at our clinic, the patient Emollients are of only limited value in the treatment showed yellow-brown waxy scales with a cobblestone of BCIE, as the scales are often waxy and macerated appearance, predominantly on the trunk and joint (5).
    [Show full text]
  • A New Family with Papillon-Lefèvre Syndrome: Effectiveness Of
    continuing medical education A New Family with Papillon-Lefèvre Syndrome: Effectiveness of Etretinate Treatment Maddalena Siragusa, MD, Troina, Italy Corrado Romano, MD, Troina, Italy Nunzio Batticane, MD, Troina, Italy Dario Batolo, MD, Messina, Italy Carmelo Schepis, MD, Troina, Italy GOAL To describe Papillon-Lefèvre syndrome and the efficacy of etretinate. OBJECTIVES 1. To discuss the epidemiology, inheritance, and clinical appearance of Papillon-Lefèvre syndrome (PLS). 2. To outline possible etiologies including the differential diagnosis of PLS. 3. To describe the different therapies and their efficacy with special focus placed on the retinoid etretinate. CME Test on page 156 Papillon-Lefèvre syndrome is characterized by the ear), by the presence of other associated abnormali- association of palmoplantar hyperkeratosis, severe ties, and the pattern of inheritance.1 Among PPK, the periodontitis, and early loss of deciduous and so-called Papillon-Lefèvre syndrome (PLS) received permanent teeth. We report two patients from the particular attention and was distinguished from the same family, aged 21 and 30 years, who were un- Meleda disease because of the peculiar association of aware of their pathology; one was successfully palmoplantar hyperkeratosis transgrediens and severe treated with etretinate. periodontitis with precocious loss of deciduous and permanent teeth.2,3 nherited palmoplantar keratodermas (PPK) are a Although an important causative role was assigned heterogeneous group of disorders of keratinization, to hypovitaminosis A in the past, consequent to a I characterized by erythema and hyperkeratosis of general deficit or to a tissue-altered metabolism,2 it is the palms and soles, which can be distinguished from now known that PLS is an inherited autosomal re- each other on the basis of histopathologic findings cessive disorder that affects both genders equally and (the presence or absence of epidermolysis), on the as- does not show ethnic preferences.
    [Show full text]