P C M van de Kerkhof

..Many patients with moderate to severe chronic plaque psoriasis fail to respond to or are not appropriate candidates for conventional systemic therapies and/or phototherapy...

..In previous studies, etanercept 25 mg twice weekly (BIW) or 50 mg BIW significantly reduced disease severity in patients with plaque psoriasis and demonstrated a favourable safety profile...

..In this article the opportunities and limitations of the available treatments are presented...

..4) In case topical therapies are not effective, phototherapy and systemic treatments are indicated. (5) For future drug development the combination of vitamin D3 analogues with low strength corticosteroids is recommended...

..In this review observations on the evolution from the symptomless skin to lesional skin in patients with psoriasis will be integrated with observations in various animal models of psoriasis...

..Finally, retinoid X receptor ligands and retinoic acid metabolism blocking agents will be introduced as potential future retinoid mimetics in psoriasis...

..Psoriasis is a common disease and may have a significant impact on patients' quality of life (QoL)...

..Challenging new options comprise blue light, photodynamic therapy, retinoic acid metabolism blocking agents and inhibitors of Th-1 cytokines...

..In a comparative study in patients visiting the outpatient department once every 14 days, it was shown that calcipotriol was more effective and better tolerated compared with dithranol...

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..Finally, we provide recommendations for the treatment of particular localizations: the scalp and psoriasis at sensitive sites...

..In clinical practice, a host of factors must be evaluated alongside possible metric measures. This requires experience and the specialized medical education of those involved in the treatment of patients with psoriasis...

..In this article, we will provide a patient-based approach on the management of psoriasis, which reconciles the heterogeneity of psoriasis in individual patients...

..A two-compound product containing calcipotriol and betamethasone dipropionate (Daivobet/Dovobet) has been evaluated in a large clinical trial programme, providing a wealth of data on the treatment of psoriasis vulgaris...

..The majority of studies do not address the important need for long-term treatment...

..Phase 2 data indicate that ABT-874 is also efficacious in the treatment of moderate-to-severe plaque psoriasis across a range of dosing strategies...

..This review covers features of topical corticosteroid formulations that affect bioavailability, efficacy and safety when used as monotherapy and in combination with other agents for the treatment of mild to moderate psoriasis...

..Once daily treatment with betamethasone dipropionate cream during the first 4 weeks of an intramuscular alefacept course did not provide substantial additional clinical and immunohistochemical improvement...

..Variations in fluorescence might explain the variable and the mostly partial clinical response of psoriasis seen after photodynamic therapy (PDT)...

..No analyses of T-cell counts in both compartments have been conducted in order to confirm or refute the hypothesized shifts between them...

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..The abnormal DPPIV distribution in psoriatic skin does not coincide with known markers of aberrant growth and differentiation of keratinocytes, which makes DPPIV (expression and enzyme activity) a marker standing on its own...

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..Selective photothermolysis of diseased capillaries by pulsed dye laser (PDL) treatment has been described as a mechanism for long-lasting clearance of psoriatic plaques...

..However, studies comparing both treatment modalities are scarce. Especially, there are almost no studies comparing the effects on epidermal cell populations in a quantitative manner...

..Although insight into physical symptoms accompanying skin diseases is relevant for the management and treatment of skin diseases, the prevalence of physical symptoms among patients with skin diseases is a rather unexplored territory...

..Comparison between different antipsoriatic treatments should, besides clearing capacity, reconcile duration of remission, safety, patient acceptability and costs...

..Quality of life, i.e. the physical, psychological, and social functioning and well-being of the patient, has become an essential outcome measure in chronic skin disease...

..It is concluded that the action spectra of calcipotriol and betamethasone on the psoriatic plaque are different and that the combination has effects on T-cell subsets, beyond the addition of the effects of monotherapies...

..As dithranol does not reduce the number of T lymphocytes, it is attractive to speculate that the combination of dithranol with immunosuppressive treatments might be a very effective combination...

..It can be concluded that the addition of a low-dose calcipotriol treatment does not contribute to the clinical efficacy of alefacept, both at the clinical level and with respect to markers for epidermal proliferation and differentiation...

..Out-patient short-contact dithranol treatment is effective with regard to clinical response rate and relapse rate after 1 year. A drawback, however, is the relatively long treatment duration...

..Recent genome-wide association studies have identified several genetic risk factors for psoriasis, but data on their association with age at onset are lacking...

..In these studies different treatment parameters were used, there was a variable clinical response, and a nonhomogeneous fluorescence was seen after irradiation with Wood's light...

..Preferential PpIX accumulation has been reported in terminally differentiated cell cultures but ex vivo data are lacking...

..Furthermore, the addition of calcipotriol cream to alefacept treatment was studied and compared with alefacept monotherapy...

..In more than one-third of the psoriatic population, the first manifestations occur in childhood. Whether the age of onset of psoriasis influences the march of psoriasis is not known...

..g. the transcription of proinflammatory cytokines, keratinocyte hyperproliferation and the expression of HLA-DR in lesional psoriatic skin...

..Treatment modifications and patient characteristics may influence treatment safety and efficacy. So far, long-term results from the use of biological treatment in clinical practice are lacking...

..In these cases it might be indicated to combine etanercept with other conventional treatments. Objectives To provide daily practice safety and efficacy data for etanercept and methotrexate combination therapy...

..Well-known effects of RA are normalization of aberrant epithelial growth and differentiation. Hence, rambazole might be beneficial in the treatment of plaque psoriasis...

..It has been suggested that negative emotions may play a role in itch and pain. To date, however, the role of emotions has only been studied for pain in experimental studies, not yet for itch...

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..In 2003, the Dutch guideline 'Photo(chemo) therapy and systemic therapy for severe chronic plaque psoriasis' was established...

..CONCLUSIONS: PDL treatment might be considered for the treatment of localized, recalcitrant plaque psoriasis, when other topical therapies have failed...

..Safety and clinical effectiveness of clobetasol-17 propionate 0.05% shampoo have been shown in patients with scalp psoriasis...

..In childhood psoriasis, physicians aim for an effective and safe treatment such as with dithranol. This study presents the largest study of dithranol-treated patients described in the literature...

..While several clinical and treatment-related factors predict time to clearance, the effect of itching and scratching on the number of irradiation sessions is insufficiently understood...

..A new retinoid, bexarotene (Targretin), was recently investigated in a large multicentre trial for its efficacy and safety in psoriasis. Bexarotene is a novel retinoid X receptor (RXR)-selective ligand...

..We compared the effect of cipamfylline ointment with a strong corticosteroid (betamethasone-17-valerate) and with a placebo ointment...

..However, the dynamics of the changes in the epidermal subpopulations-basal cells, transit amplifying cells and differentiated cells-have not been studied in the transition between symptomless and lesional skin...

..Within-subject comparisons do not take into account the systemic effects of UVB phototherapy. The area of the body treated with low-dose UVB may benefit from the systemic effects of the site treated with a higher UVB dose...

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..Juvenile psoriasis has a negative effect on the quality of life (QoL). The influence of treatments on QoL of these children has never been investigated before in a prospective observational study...

..The cumulative exposition to biologics is increasing with prolonged treatment with a certain biologic or consecutive biological treatment. However, long-term safety data are limited available...

..However, we could not demonstrate the superiority of this particular emollient containing skin-related lipids in patients with chronic hand dermatitis...

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..In conclusion, simple pretreatments or additions to the regular practice of PDT, aimed to optimize intralesional PpIX content, improve the clinical outcome...

..Active participants of the group wrote assigned sections of this consensus document with a majority of participants agreed on the conclusions...

..Depletion of CD4+ CD25+ Foxp3+ naturally occurring regulatory T cells (T(reg)) induces autoimmune phenomena. These cells have not yet been fully characterized in the skin of psoriatic patients...

..Psychological stressors might contribute to the severity of chronic inflammatory diseases such as psoriasis by dysregulating hypothalamic-pituitary-adrenal (HPA) axis activity...

..Although the psychosocial consequences of skin diseases in secondary care has been extensively studied, little is known about the psychosocial well-being of patients with skin diseases in primary care...

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..In theory, the expression of CD26/DPP-IV has common grounds with three principal key players of the psoriatic pathogenesis: keratinocytes, T cells and cytokines...

..The under-representation of CD8+CD45RO+ cells is compatible with the dynamics of acquired immunity, which requires a time log after the relapse of the lesions to differentiate from CD45RA+ naive cells...

..As narrow band UVB is more effective than broad band UVB, the present study suggests superiority of narrow band UVB as a treatment with a better benefit risk ration...

..Different models and clinical trials are needed to establish the usefulness in specific conditions of emollients containing skin-related lipids...

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..Despite the carcinogenicity of PUVA, this photochemotherapy is frequently prescribed by dermatologists, mainly in Flanders...

..However, no histologic and immunohistochemical studies have been performed to further substantiate these observations...

..CONCLUSIONS: CD8+, CD45RO+, CD2+ and CD25+ T cells have a role in the early phase of the psoriatic process, whereas CD94- and CD161-expressing cells together with epidermal proliferation and keratinization are involved in a later phase...

..A multicentre, randomized, double-blind, vehicle-controlled, parallel-group study was carried out to study the effect of the addition of calcipotriol ointment to methotrexate (MTX) therapy in patients with psoriasis vulgaris...

..In cell suspensions obtained with thermolysin, only sparse colonies were formed. We conclude that our methodology permits the use of small human tissue samples for cell labelling and sorting, while preserving the clonogenic potential...

..This study was part of a large national cost-effectiveness analysis, and was funded by the National Fund for Investigational Medicine of the Health Care Insurance Board...

..There is a need for new treatments for scalp psoriasis, as many topical treatments are cosmetically unacceptable and difficult to apply, resulting in poor compliance...

..No optimal long-term dosing advice is available...

..Our results indicate that an optimal timing for biopsies in future dithranol irritation studies lies between 4 and 8 days after the first dithranol challenge...

..As psoriasis patients often require continuous treatment optimal therapy has to provide efficacy and a good safety profile over the long term...

..Further study of bexarotene photo(chemo)therapy in cutaneous T-cell lymphoma and psoriasis is warranted...

..g. pain in chronic pain patients (symptom-specific sensitization)...

..New, well-designed, epidemiological studies are necessary to assess the risk of skin tumors and other malignancies after dermatological use of coal tar...

..Although treatment with an emollient showed hardly any clinical response, changes towards a more normal phenotype could already be detected in several epidermal markers using this method...

..CONCLUSIONS: Using Zenon technology and image analysis, a description of morphology, co-expression, and quantification of representative markers for epidermal cell populations is possible...

..In benign, hyperproliferative, and retinoid sensitive disorders, such as psoriasis, bexarotene has not been evaluated so far and no information on these parameters is available...

..T-cell subsets in ILVEN cum psoriasis had an intermediary position...

..Eruptive naevi have been described to potentially arise in immune compromised patients...

..Biologicals such as alefacept are the most recent treatment modalities for psoriasis. In the present study we evaluated changes in nail pathology in patients with plaque psoriasis and nail involvement during treatment with alefacept...

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..Further studies are needed to clarify the ambiguous role of conventional pathogenic T cells in plaque psoriasis...

..Interestingly, comparative analyses of the disease-specific composition of the lesional T-cell infiltrate in plaque psoriasis and other inflammatory dermatoses have only sparsely been performed...

..Based on the available literature and illustrated by the present case we may conclude that tacrolimus ointment 0.1% can be recommended as a first-line treatment for facial psoriasis...

..Juvenile psoriasis is a chronic and incurable skin disease that affects approximately 0·7% of children...

..We propose the decreased quantity of lesional CD161+ cells in the dermis of flexural psoriatic lesions may result from chronic microbial challenge in flexural psoriasis...

..This also applies to the efficacy and safety of adalimumab in patients previously treated with etanercept. The relationship between the reasons for discontinuation of etanercept and the response to adalimumab is not clear in psoriasis...

..Knowledge about quality of life and sexual health in patients with genital psoriasis is limited...

..However, the treatment course in clinical practice is different from the setting in which trials are conducted...

..Phototherapy with visible light is gaining interest in dermatological practice. Theoretically, blue light could induce biological effects comparable to ultraviolet A (UVA) radiation...

..Oral fumaric acid esters are an effective therapy for psoriasis and are believed to exert their effects mainly through their anti-inflammatory properties...

..The brief multidisciplinary itch-coping programme in adults with atopic dermatitis considerably reduced itch-scratching patterns, improved their skin status and reduced the use of dermatological care, both in the short and longer term...

..Combining flow cytometric sorting, cell culture and image analysis provides powerful means for phenotypical and functional characterization of epidermal subpopulations...