Ardelean, Gavril - Buicu, Florin (szerk.): Satu Mare. Studii şi comunicări. Seria ştiinţele naturale 7. (2006)
Medicină
Satu Mare - Studii şi Comunicări Seria Ştiinţele Naturii Voi. VII (2006) Anthralin Anthralin, or dithranol, slows cellular proliferation, decreases inflammation, and increases cellular differentiation in psoriasis. !12! Since the introduction of vitamin D analogs, use of anthralin has declined because of its propensity to cause perilesional irritation and stain skin and clothing. Current usage patterns of anthralin include shortcontact regimens and novel, more acceptable formulations. Coal T ar Coal tar is inexpensive, relatively free of side effects, safe for use on large body surfaces, and an effective treatment for psoriasis. It is an antipruritic and antibacterial agent that inhibits deregulated epidermal proliferation and dermal infiltration without causing injury to normal skin when applied widely. Its odor and potential for causing local irritation and staining of clothing has limited its utility. A comparative study against calcipotriol suggests that coal tar (15% solution in aqueous cream) is less effective than calcipotriol after 6 weeks of treatment.! In current therapeutic regimens, tar preparations are most often used in shampoos for treatment of scalp psoriasis. Newer Agents There have been reports that new immunomodulators, including tacrolimus and pimecrolimus, might have a role in the treatment of intertriginous and facial psoriasis, a promising usage because other agents either have unacceptable side effects in such areas (e.g., corticosteroids) or are too irritating (e.g., calcipotriene and tazarotene). These agents are expensive and lack . Conclusions Topical therapies possess the fewest side effects and are successful in treating most patients with limited disease. The old standbys of coal tar and anthralin therapies are cost-effective agents that are probably underused despite their new, more appealing regimens and formulations. The combination of topical corticosteroids and calcipotriene is a particularly useful treatment for psoriasis on the torso and extremities, but it is expensive. Therapies must be individualized to each patient's disease and preferences. References Greaves MW, Weinstein GD. Drug therapy: treatment of psoriasis. N Engl J Med. 1995;332:581-588. Feier V , Dermato-venerology, Ed. Amarcord, 200, Timisoara Lebwohl M, Ali M. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol. 2001;45:487-498. Katz HI. Corticosteroids. Dermatol Clin. 1995;13(4):805-815. E. Cristophers, Psoriasis-Epidemiology and Clinical Spectrum”, Clin. Exp. Dermatol., 26(2001),pp314-320 Lebwohl MG. Psoriasis. In: Lebwohl M, Heymann W, Berth-Jones J, et al. Treatment of Skin Disease. New York, NY: Mosby; 2002:533-543. Perez A, Chen TC, Turner A, et al. Efficacy and safety of topical calcitriol (1,25-dihydroxy vitamin D3) for the treatment of psoriasis. Br J Dermatol. 1996;134:238-246. Lebwohl M, Siskin SB, Epinette W, et al. A multicenter trial of calcipotriene ointment and halobetasol ointment to either agent alone for the treatment of psoriasis. J Am Acad Dermatol. 1996;35:268-269. Weinstein GD, Krueger GG, Lowe NJ, et al. Tazarotene gel, a new retinoid for topical therapy of psoriasis: vehicle-controlled study of safety, efficacy, and duration of therapeutic effect.] Am Acad Dermatol. 1997;37:85-92. Lebwohl MG, Breneman DL, Goffe BS, et al. Tazarotene 0.1% gel plus corticosteroid cream in the treatment of plaque psoriasis. J Am Acad Dermatol. 1998;39(4 pt l):590-596. Lebwohl M. The role of salicylic acid in the treatment of psoriasis. Int J Dermatol. 1999;38:16-24. Kanzler MH, Gorsulowsky DC. Efficacy of topical 5% liquor carbonis detergens vs. its emollient base in the treatment of psoriasis. Br J Dermatol. 1993;129(3):310-314. Tham SN, Lun KC, Cheong WK. A comparative study of calcipotriol ointment and tar in chronic plaque psoriasis. Br J Dermatol. 1994;131 (5):673- 677. Runne U, Kunze J. Short duration Cminutes1) therapy with dithranol for psoriasis: a new outpatient regimen. Br J Dermatol. 1982;106:135-139 113
