2014.3-21.Low

                                                                                                                            article in PDF  
Our Dermatol Online.  2014; 5(3): 304-305
DOI:.  10.7241/ourd.20143.79
Date of submission:  20.03.2014 / acceptance: 02.05.2014
Conflicts of interest: None
 

LOW-DOSE CICLOSPORIN THERAPY OF ERYTHRODERMIC PSORIASIS

Ryszard Galus1, Katarzyna Borowska2, Marian Jędrych3, Barbara Jodłowska-Jędrych4, Longin Niemczyk5, Marek Antiszko6, Agnieszka Terlikowska-Brzósko7, Witold Owczarek7, Stanisław Zabielski8

1Department of Histology and Embryology, Center for Biostructure, Medical University of Warsaw, Chalubinskiego 5 Str., 02-004 Warsaw, Poland
2Department of Cosmetology, The Bronisław Markiewicz State Higher School of Technology and Economics in Jarosław, 16 Czarnieckiego Str., 37-500 Jarosław, Poland
3Department of Mathematic and Biostatistic, Medical University of Lublin, Jaczewskiego 4 Str., 20-090 Lublin, Poland
4Department of Histology and Embryology with Experimental Cytology Unit, Medical University of Lublin, Radziwiłowska 11 Str., 20-080 Lublin, Poland
5Department of Nephrology, Dialysotherapy and Internal Medicine, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
6La Beauté, Gabinet Dermatologii i Medycyny Estetycznej, Waszyngtona 45/51 Str. app. 133, 04-008 Warsaw, Poland
7Department of Dermatology, Military Institute of Health, Szaserów 128 Str., 00-909 Warszawa, Poland
8School of Economics, Law and Medical Sciences in Kielce, Jagiellońska 109A Str., 25-734 Kielce, Poland
 

Corresponding author:  Dr. Ryszard Galus, MD PhD    e-mail: rkgalus@wp.pl


 

Introduction
Psoriasis is a chronic, recurrent inflammatory skin disease which affects around 2% of the population and is characterized by erythematous and scaly macules and papules of greatly varying degree of involvement. Ciclosporin (Cs) is a therapeutic agent rarely used in the treatment of erythrodermic psoriasis as a monotherapy [1].
 
Case Report
We present a 42-year-old male affected with biopsy-proven vulgar psoriasis admitted to our Department for the appearance of an erythrodermic psoriasis (Fig. 1A). Before admission to the hospital patient suffered from relapsing episodes of diffuse psoriasis, since the age of 19, which responded well to topical emollients and UVB therapy. 5 years ago has suffered from hepatitis C. The laboratory tests did not revealed any abnormalities related to renal and hepatic function. The patient was treated with ciclosporin 2.5 mg/kg per day, doxycycline (2 x 100mg per day) and hydroxyzine tablets for symptomatic relief. The clinical response was not immediate, although at the begining of the third week of the therapy a marked reduction of erythema and scaling was evident. Since week 4 of the treatment, ciclosporin was gradually reduced (0.5 mg/kg per day). Presently patient receives 1.17 mg/kg per day and is under a complete remission (Fig. 1B).
 
Figure 1. Clinical course of a 42-year-old male with erythrodermic psoriasis before (A) and after 2 month ciclosporin 2.5 – 1.17 mg/kg daily administration. The degree of improvement in PASI scores 85.3 % (B).
Discussion
Because of hepatitis C in the past, we have consciously disqualified treatment with methotrexate, acitretin or with combined therapy, although combined therapy is often used in psoriasis to increase clinical efficacy and to reduce side effects [2]. This case is noteworthy because we have observed clinical improvement at low doses of Cs alone. The degree of improvement in PASI scores was 85.3 % achieved comparatively late, which obtain with relatively low dose of Cs [3]. This case is negatory to papers reporting, that starting with dosages lower than 3.0 mg/kg daily may lead to insuficient efficacy [4] and strengthens reports suggesting minimising potentially harmful side-effects by treatment with initial daily oral dose of 2.5 – 5.0 mg/kg daily, which may be modulated only in a case of insufficient efficacy [5-7].
 
REFERENCES
1. Burgdorf WHC, Plewig G, Wolf HH, Landthaler M: Braun–Falco’s Dermatology. 3rd ed. Springer Medizin Verlag, Heidelberg, 2009.
2. Lebwohl M, Menter A, Koo J, Feldman SR. Combination therapy to treat moderate to severe psoriasis. J Am Acad Dermatol. 2004;50:416-30.
3. Timonen P, Friend D, Abeywickrama K, Laburte C, von Graffenried B, Feutren G. Efficacy of low-dose cyclosporin A in psoriasis: results of dose-finding studies. Br J Dermatol. 1990;122(Suppl 36):33-9.
4. Christophers E, Mrowietz U, Henneicke HH, Farber L, Welzel D. Ciclosporin psoriasis: a multicenter dose-finding study in severe plaque psoriasis. J Am Acad Dermatol. 1992;26:86-90.
5. Griffiths CE, Dubertret L, Ellis CN, Finlay AY, Finzi AF, Ho VC, Johnston A, Katsambas A, Lison AE, Naeyaert JM, Nakagawa H, Paul C, Vanaclocha F. Ciclosporin in psoriasis clinical practice: an international consensus statement. Br J Dermatol. 2004;150(Suppl 67):11-23.
6. Griffiths CE. Ciclosporin in psoriasis consensus statement: reply from authors. Br J Dermatol. 2000;152:811.
7. Bos JD, Meinardi MM, van Joost T, Heule F, Powles AV, Fry L. Use of cyclosporin in psoriasis. Lancet 1989;2:1500-2.


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