ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1990.tb02875.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYCyclosporin A (CyA) is the forerunner of a new generation of immunosuppressive drugs. It is highly effective in both antibody‐ and cell‐mediated immunity and in inhibiting chronic inflammatory reactions. Cyclosporin A is, therefore, widely used to prevent rejection in clinical organ transplantation and appears to be very promising in the treatment of several autoimmune diseases, in particular psoriasis. Cyclosporin A is not only effective when given at the time of sensitization (prevention of rejection), but also when administered therapeutically during an immune response, such as during the active course of an autoimmune disease. The most important aspect of its immunosuppressive mechanism is the inhibition of lymphokine production secreted by activated T cells. The pharmacological effects of CyA are rapid in onset, dose‐dependent and often quickly reversible when treatment is st

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1990.tb02876.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYThe effect of photochemotherapy with 4,4′,6 trimethylangelicin (TMA), a new monofunctional furocoumarin with a high antiproliferative activity, was studied on murine dendritic epidermal cells. Female mice (C3H/HeN[MTV‐]) were treated topically with the drug three times a week for 4 consecutive weeks followed each time by I J/cm2of UVA radiation. At the end of the treatment almost total depletion of ATPase+, Ia+and Thy‐I+dendritic epidermal cells was observed, associated with marked hyperpigmentation but no gross or microscopic phototoxicity. Although 4,4′,6 TMA is not phototoxic in mice, it affects the cutaneous immun

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1990.tb08233.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYForty‐four patients with severe psoriasis have been treated with cyclosporin A (CyA) for 2–50 months (mean 17 months). During the study, 31 (70%) of these patients achieved a>70% reduction in PASI score, 39 (88%) achieved a>60% reduction and 42 (95%) a>50% reduction. The mean initial dose of CyA was 3 mg/kg/day and the mean dose was 3–3 mg/kg/day throughout the study. Twenty‐five (57%) patients were maintained on 3 mg and six (14%) required>5 mg/kg/day for limited periods to obtain significant improvement. In three of these patients, this was achieved with 6 mg/kg/day but, of the remainder, one required 7 mg and two required 10 mg/kg/day. Of the 44 patients, 32 (73%) are still taking CyA. Patients were discontinued because of: side‐effects directly attributable to treatment (n= 4); remission of psoriasis (n= 4); death (n= 1); defaulting (n= 1); infrequent attendance (n= 1); high doses of NSAID were necessary for arthritis (n= 1). Before starting CyA, 39 patients were normotensive; 21 (54%) developed mild hypertension. In 28 patients where the GFRs were estimated before and during treatment, there was a 16% reduction (P>0–0001) during a mean period of 8 months. Two patients developed malignancies. The incidence of hypertension and percentage decrease in GFR were strongly correlated with the dose required to control th

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1990.tb02877.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYA morphological and biochemical analysis was made of cornified envelopes isolated from patients with different congenital disorders. Nomarski contrast microscopy of the envelopes showed that their morphology was not greatly altered in several types of keratoderma and parapsoriasis, but it was grossly modified in ichthyotic disorders. The various types of ichthyoses, keratoderm ‐lysine isopeptide bonds. In the epidermis two morphologically distinct types of CEs have recently been identified:4a polygonal rigid type (CEr) and an irregularly shaped type with a fragile appearance (CEf) which, in healthy skin, is only present in the lower part of the stratum corneum. These two types possibly represent two successive steps of CE maturation. The stratum corneum of normal subjects contains mainly CEr, whereas the scales in psoriasis contain a much higher proportion of CEf. Keratinocytes in submerged cultures are only able to form CE

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1990.tb08234.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYSince its discovery in 1972, cyclosporin A (CyA) has been widely used in the experimental treatment of multiple inflammatory diseases considered to be of immune‐mediated aetiology. In dermatology, oral CyA is most effective in the treatment of psoriasis and has been used successfully for plaque‐type, pustular and erythrodermic forms of the disease. While dosages ranging from 1 to 14 mg/kg/day have been used, a starting dose of 4 mg/kg/day gives a rapid response with few side‐effects. Nephrotoxicity remains the greatest concern in long‐term use of the drug. Although intralesional CyA has proven effective in psoriasis, topical preparations have not. It is hoped that future research will provide effective topical formulations of CyA which are efficacious without the risks inherent in systemic adminis

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1990.tb02878.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYAn in vitro model has been developed to study the effect of soluble bacterial products on the viability and detachment of skin cell types utilized for cultured grafts. Microbial products prepared from clinical isolates of bacterial species which most commonly colonize burn lesions showed marked variation in their ability to detach and kill both keratinocytes and fibroblasts. All three isolates ofAcinetobacterspp. tested were effective in causing detachment and death of keratinocytes and fibroblasts, whereasEscherichia coli, Proteus mirabilisandEnterobacterspp. tested had little, or no, effect on detachment or viability for either skin cell type. FourStaphylococcus aureusisolates elicited variable strain‐dependent results with regard to detachment and viability. One isolate possessed activity specific for keratinocyte detachment and death. These results indicate the possible undesirable effects such bacterial species may have on graft success in colonized burn wound

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1990.tb08235.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYThis is a review of the clinical studies performed so far in The Netherlands of the treatment of psoriasis with cyclosporin A (CyA), a selective immunosuppressive drug that has caused a major breakthrough in transplant medicine. Data derived from a double‐blind placebocontrolled study (5 mg/kg/day of CyA), dose‐finding studies (2.5 mg vs 5 mg/kg/day and 1 mg, 2 mg or 3 mg/kg/day), and long‐term treatment of chronic plaque‐type psoriasis (1.1–7.2 mg/kg/day) suggest an initial starting dose of 3 mg/kg/day irrespective of the severity of the disease. Long‐term treatment brought about dose‐ and time‐dependent (reversible) side effects, including renal dysfunction and hypertension. Efforts to reduce the dose included concomitant administration of drugs known to have anti‐psoriatic efficacy. Only combination with topical steroids appeared to add to the clinical efficacy of CyA, but did not allow a dose reduction sufficient to restore renal function. Dose reduction through intermittent treatment, however, postponed exacerbations sufficiently to permit at least partial normalization of serum creatinine levels. A similar effect was seen in the treatment of pustular palmoplantar psoriasis, which responded to doses of

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1990.tb02879.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYPhotosensitivity to drugs and chemicals in the elderly is more prevalent due to more frequent use of medications. Phototoxic reactions to common, orally administered drugs such as diuretics, cardiac agents and antidiabetics may occur and the reactions may be remedied by discontinuing drug therapy. Photocontact dermatitis due to the ingredients in sunscreens or other agents, such as perfumes, may also arise. Diagnosis is often confirmed by photopatch testing and subsequent avoidance of these agents leads to gradual resolution. Idiopathic photodermatoses, such as sunlight‐induced polymorphic light eruption or solar urticaria, may occur and persist from an early age and, in elderly subjects, they can cause mild to marked disability. The most disturbing disorder of this type is the severe, widespread eczematous chronic actinic dermatitis, which can be difficult to diagnose. Porphyrias, such as variegate porphyria or erythropoietic protoporphyria, may persist from an early age, whereas porphyria cutanea tarda generally begins in later life. Porphyrias all have specific clinical and biochemical features and, apart from variegate porphyria, usually respond well to treatment following diagnosis. Exposure of elderly skin to sunlight may also cause deterioration of many ordinary dermatoses, particularly seborrhoeic eczema, which generally respond to protection from UV exposure and to treatment of the underlying abnormality. Progress in identifying the underlying causes, the availability of increasingly sophisticated diagnostic techniques, and improvements in sunscreen preparations and therapeutic medications will probably significantly reduce abnormal photosensitivity in the elderly in the near futur

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1990.tb16122.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

SUMMARYThe efficacy of cyclosporin A (CyA) in severe psoriasis was analysed in 457 adult patients included in five European multicentre dose‐finding studies. Initial CyA doses were 1–25 mg/kg/day in 33 patients, 2.5–3 mg/kg/day in 285 and 5 mg/kg/day in 139. After 3 months of treatment, the reduction of the Psoriasis Area and Severity Index (PASI) score was 35 ± 6% with 1–25 mg/kg/day of CyA, 57 ± 2% with 2.5 mg or 3 mg/kg/day and 86 ± 2% with 5 mg/kg/day (P<0.001). The rates of success, defined by a PASI score reduction ± 75% or a score ± 8, were 24%, 52% and 88%, respectively. There were no differences in age, initial severity or duration of psoriasis. The improvement was maintained for 9 months or more in the majority of patients receiving continuous

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1990.tb02880.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY