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AIM: The aim of this study was to provide practical recommendations for optimizing the use of conventional and biological systemic treatments for moderate-severe chronic plaque psoriasis, particularly in case of transitioning and switching. METHODS: A total number of 147 dermatologists from 33 different countries including Italy achieved consensus in providing practical recommendations for the use of conventional and biological treatments for moderate to severe psoriasis based on systematic literature review and/or expert opinion. RESULTS: In general, the continuous treatment regimen should be preferred in order to achieve a complete and long-term control of psoriasis. However, the treatment could be stopped or the dose reduced in case of complete disease clearance. A conventional drug could be associated to biological treatment in selected cases. Transitioning and/or switching could be considered in case of inefficacy or intolerance. A period of wash up is required if transitioning or switching is due to safety issues. CONCLUSION: This study provides practical suggestions for the optimal use of conventional and biological treatments for chronic plaque psoriasis.

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OBJECTIVE: This is a multicentric, observational and controlled study designed to verify the existence of a significant association between plaque-type psoriasis and oral lesions, such as geographic tongue and/or fissured tongue. STUDY DESIGN: during a period of 9 months all consecutive patients with plaque-type psoriasis were enrolled using simple nonrandom (sequential) sampling. The control group included healthy subjects presenting to the same Dermatology centers to monitor pigmented skin lesions; the patients were matched for age and sex. All patients were examined for oral lesions. RESULTS: Out of a total of 535 psoriatic patients and 436 control group patients, oral mucosal lesions were detected in 188 (35.1%) and 86 (19.7%) cases, respectively, and the difference is statistically significant. Fissured tongue (FT) and geographic tongue (GT), which were most frequently detected, were seen more frequently in psoriatic patients (FT: 22.6%; GT: 9.1%) than the control group (FT: 10.3%; GT: 5.2%) (p<0.05). CONCLUSIONS: On the basis of the similar studies reported in the literature and the large number of patients involved in our study, we can conclude that FT and GT can be clearly suggested as oral manifestations of plaque-type psoriasis, although the reason for this association is not clear.

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Studies on scalp hair from psoriatic lesions have revealed marked irregularities in the cuticular pattern. The aim of this study was to investigate the incidence of hair shaft disorders in psoriatic patients and to evaluate the possibility of a correlation with scalp involvement. We examined hair from 39 psoriatic patients using scanning electron microscopy and compared it with hair from a control group of 12 healthy people. We confined our observations of the hair fibres to the areas nearest the root. Our data confirm previous observations indicating that dystrophic changes in hair cuticle cells occur more often in hairs from both unaffected and affected skin of psoriatic patients compared with normal subjects. No differences were observed between hair shafts taken from affected and unaffected psoriatic areas; cuticular breakage and an abraded cuticular surface were present only in the hair of psoriatic patients.

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BACKGROUND: Association of different treatments are often used in erythrodermic psoriasis in order to increase the effectiveness and decrease the incidence of side effects due to single drugs. MATERIALS AND METHODS: Three in-patients affected by erythrodermic psoriasis, not responding to cyclosporine, (two patients) and etretinate, (one patient), were treated with the association cyclosporine plus etretinate. RESULTS: Clinical response was prompt to the combined therapy. The two drugs were tapering off gradually over 6 months; the patients maintained the remission for prolonged period. CONCLUSIONS: Combined cyclosporine-etretinate therapy may be considered as an effective and well tolerated treatment of erythrodermic psoriasis in patients not responding to monotherapy regimen.

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OBJECTIVE: The aim of this study was to evaluate the efficacy and tolerability of the association of calcipotriol ointment (50 micrograms/g) plus cyclosporine versus cyclosporine alone in the treatment of moderate psoriasis (mean PASI: 13). METHODS: Twenty patients were enrolled in this right-left open study. All the patients admitted were treated with cylosporine at an initial dose of 4.5 mg/kg/day; in case of clinical improvement this dosage was reduced by 0.5 mg/kg/day every 15 days. In each patient we chose two similar, symmetrical lesions and calcipotriol ointment was applied only on the right lesion, twice a day, until the healing of the lesion or for 1 month. Patients were checked at baseline and every 15 days. RESULTS: Eighteen patients completed the study and 17 of the 18 presented more evident improvement on the side treated with combined therapy, while only one patient showed a better result on the side treated with cyclosporine alone. A significant difference of the total score was already present after 15 days of therapy and was confirmed at the following check-ups. CONCLUSIONS: These results underline the usefulness of the association of calcipotriol and cyclosporine in order to decrease the total dosage of cyclosporine.

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Impetigo herpetiformis is a rare acute eruption associated with severe systemic disturbances, typically occurring in pregnant women. We describe the case of a 33-year-old woman who presented with impetigo herpetiformis during her third pregnancy, the appearance of which coincided with an increase in the titer of E antigen antibodies.

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It is well known that UVB therapy of psoriasis vulgaris is potentiated by the association with topical and oral drugs, while till now there have been very few reports on the association between UVB and calcipotriol. In order to evaluate the efficacy and tolerance of this association, we studied 19 patients with psoriasis vulgaris of mild severity (PASI: 5-10). Each patient was treated with UVB and invited to apply calcipotriol 50 micrograms/g ointment twice a day on one lesion usually on elbows or knees in order to compare it with the opposite side. The evaluation of each lesion was performed before and after 4 weeks of therapy. Our data show that the association between UVB and calcipotriol is significantly more effective than UVB therapy alone: 17 out of 19 patients (89%) showed a greater improvement with UVB plus calcipotriol as compared to UVB alone.

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Calcipotriol is a synthetic analogue of vitamin D, used in the treatment of psoriasis. Until now no specific sid-effects have been described after combined therapy with calcipotriol and UV. We describe 3 patients, who in the summer of 1993, after a combined treatment of calcipotriol and heliotherapy, developed hyperpigmentation in the site where the ointment had been applied. Hyperpigmentation healed spontaneously in less than 7 months. To the best of our knowledge there are no other reports of this side-effect due to calcipotriol. In our opinion the fact that the 3 patients presented the hyperpigmentation only on the treated lesions and that, in the past, they had not presented similar lesions after exposure to sunlight confirms the relationship between the hyperpigmentation and the combined treatment used.

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