Ann Dermatol.  2013 May;25(2):156-162. 10.5021/ad.2013.25.2.156.

Effectiveness of Conventional Drug Therapy of Plaque Psoriasis in the Context of Consensus Guidelines: A Prospective Observational Study in 150 Patients

• Gupta AK
• Pandey SS
• Pandey BL

• KMID: 2171782
• DOI: http://doi.org/10.5021/ad.2013.25.2.156

Abstract

BACKGROUND
Evidence for superior outcome by adhering to therapy guidelines is imperative to their acceptance and adaptation for the optimal management of disease variants.
OBJECTIVE
Comparative study of prospective outcomes in simultaneous consideration of independent variables in groups of 150 patients of plaque psoriasis either treated adhering to or in digression of standard guidelines.
METHODS
The psoriasis area severity index (PASI) and the dermatology life quality index (DLQI), prior to and after three months of uninterrupted therapy were examined in treatment groups among 150 patients. Recovery rates of 75% or more in PASI were compared. Independent variables were also examined for their bearing on the outcome.
RESULTS
The vast majority was early onset disease phenotype. All three treatment regimens when administered in adherence to the guidelines yielded significantly superior rates of defined recovery both in PASI and DLQI. Compromise of the therapeutic outcome appeared in high stress profiles, obesity, female sex and alcohol, tobacco or smoking habit.
CONCLUSION
Conventional drug therapy of plaque psoriasis yields superior outcome by adhering to the consensus guidelines. Psychiatric address to stress must be integral and special considerations for phenotypic/syndromic variants is emphasized for effective therapy of psoriasis.

Keyword

Comparative effectiveness study; DLQI; PASI; Psoriasis; Therapeutic guidelines

MeSH Terms

Consensus
Dermatology
Female
Humans
Obesity
Phenotype
Prospective Studies
Psoriasis
Quality of Life
Smoke
Smoking
Tobacco
Ursidae
Smoke

Reference

1. Woolf RT, Smith CH. How genetic variation affects patient response and outcome to therapy for psoriasis. Expert Rev Clin Immunol. 2010. 6:957–966.

2. Ryan C, Menter A, Warren RB. The latest advances in pharmacogenetics and pharmacogenomics in the treatment of psoriasis. Mol Diagn Ther. 2010. 14:81–93.

3. Rahman P, Elder JT. Genetic epidemiology of psoriasis and psoriatic arthritis. Ann Rheum Dis. 2005. 64:Suppl 2. ii37–ii39.

4. Zhou X, Krueger JG, Kao MC, Lee E, Du F, Menter A, et al. Novel mechanisms of T-cell and dendritic cell activation revealed by profiling of psoriasis on the 63,100-element oligonucleotide array. Physiol Genomics. 2003. 13:69–78.

5. Dubertret L. Recent progress in psoriasis treatment. Eur Dermatol Rev. 2006. 10–12.

6. Louden BA, Pearce DJ, Lang W, Feldman SR. A Simplified Psoriasis Area Severity Index (SPASI) for rating psoriasis severity in clinic patients. Dermatol Online J. 2004. 10:7.

7. Callen JP, Krueger GG, Lebwohl M, McBurney EI, Mease P, Menter A, et al. AAD. AAD consensus statement on psoriasis therapies. J Am Acad Dermatol. 2003. 49:897–899.

8. Krueger GG, Feldman SR, Camisa C, Duvic M, Elder JT, Gottlieb AB, et al. Two considerations for patients with psoriasis and their clinicians: what defines mild, moderate, and severe psoriasis? What constitutes a clinically significant improvement when treating psoriasis? J Am Acad Dermatol. 2000. 43:281–285.

9. Fredriksson T, Pettersson U. Severe psoriasis--oral therapy with a new retinoid. Dermatologica. 1978. 157:238–244.

10. Jose RM, Roy DK, Vidyadharan R, Erdmann M. Burns area estimation-an error perpetuated. Burns. 2004. 30:481–482.

11. Ramsay B, Lawrence CM. Measurement of involved surface area in patients with psoriasis. Br J Dermatol. 1991. 124:565–570.

12. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994. 19:210–216.

13. Reich K, Mrowietz U. Treatment goals in psoriasis. J Dtsch Dermatol Ges. 2007. 5:566–574.

14. Mehta TK, Shah RN, Marquis L. A study of 300 cases of psoriasis. Indian J Dermatol Venereol Leprol. 1978. 44:242–244.

15. Kaur I, Kumar B, Sharma KV, Kaur S. Epidemiology of psoriasis in a clinic from North India. Indian J Dermatol Venereol Leprol. 1986. 52:208–212.

16. Mallbris L, Larsson P, Bergqvist S, Vingård E, Granath F, Ståhle M. Psoriasis phenotype at disease onset: clinical characterization of 400 adult cases. J Invest Dermatol. 2005. 124:499–504.

17. Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum. 2009. 61:233–239.

18. Dogra S, Kaur I. Childhood psoriasis. Indian J Dermatol Venereol Leprol. 2010. 76:357–365.

19. Sharma TP, Sapaha GC. Psoriasis a clinical study. Indian J Dermatol Venereol Leprol. 1984. 30:191–203.

20. Henseler T, Christophers E. Psoriasis of early and late onset: characterization of two types of psoriasis vulgaris. J Am Acad Dermatol. 1985. 13:450–456.

21. Kao JS, Fluhr JW, Man MQ, Fowler AJ, Hachem JP, Crumrine D, et al. Short-term glucocorticoid treatment compromises both permeability barrier homeostasis and stratum corneum integrity: inhibition of epidermal lipid synthesis accounts for functional abnormalities. J Invest Dermatol. 2003. 120:456–464.

22. Coderch L, López O, de la Maza A, Parra JL. Ceramides and skin function. Am J Clin Dermatol. 2003. 4:107–129.

23. Horrobin DF. Essential fatty acids in clinical dermatology. J Am Acad Dermatol. 1989. 20:1045–1053.

24. Wertz PW, Swartzendruber DC, Abraham W, Madison KC, Downing DT. Essential fatty acids and epidermal integrity. Arch Dermatol. 1987. 123:1381–1384.

25. Burton JL. Dietary fatty acids and inflammatory skin disease. Lancet. 1989. 1:27–31.

26. Malerba M, Gisondi P, Radaeli A, Sala R, Calzavara Pinton PG, Girolomoni G. Plasma homocysteine and folate levels in patients with chronic plaque psoriasis. Br J Dermatol. 2006. 155:1165–1169.

27. Libetta C, Sepe V, Zucchi M, Pisacco P, Portalupi V, Adamo G, et al. Influence of methylprednisolone on plasma homocysteine levels in cadaveric renal transplant recipients. Transplant Proc. 2006. 38:2893–2894.

28. Boyd AS, Menter A. Erythrodermic psoriasis. Precipitating factors, course, and prognosis in 50 patients. J Am Acad Dermatol. 1989. 21:985–991.

29. Baiqiu W, Songbin F, Guiyin Z, Pu L. Study of the relationship between psoriasis and the polymorphic site C677T of methylenetetrahydrofolate reductase. Chin Med Sci J. 2000. 15:119–120.

30. Weigl BA. The significance of stress hormones (glucocorticoids, catecholamines) for eruptions and spontaneous remission phases in psoriasis. Int J Dermatol. 2000. 39:678–688.

31. Schmid-Ott G, Jaeger B, Adamek C, Koch H, Lamprecht F, Kapp A, et al. Levels of circulating CD8(+) T lymphocytes, natural killer cells, and eosinophils increase upon acute psychosocial stress in patients with atopic dermatitis. J Allergy Clin Immunol. 2001. 107:171–177.

32. Stern RS. Psoriasis. Lancet. 1997. 350:349–353.

33. Ackerman LS. Sex hormones and the genesis of autoimmunity. Arch Dermatol. 2006. 142:371–376.

34. Lander ES, Schork NJ. Genetic dissection of complex traits. Science. 1994. 265:2037–2048.

35. Risch N, Merikangas K. The future of genetic studies of complex human diseases. Science. 1996. 273:1516–1517.

36. Higgins E. Alcohol, smoking and psoriasis. Clin Exp Dermatol. 2000. 25:107–110.

37. Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornasa C, Grosso G, et al. Family history, smoking habits, alcohol consumption and risk of psoriasis. Br J Dermatol. 1992. 127:212–217.

38. Reich A, Szepietowski JC. Mediators of pruritus in psoriasis. Mediators Inflamm. 2007. 2007:64727.

39. Lamba S, Lebwohl M. Combination therapy with vitamin D analogues. Br J Dermatol. 2001. 144:Suppl 58. 27–32.

40. Chandraratna RA. Tazarotene--first of a new generation of receptor-selective retinoids. Br J Dermatol. 1996. 135:Suppl 49. 18–25.

41. Gottlieb AB, Chamian F, Masud S, Cardinale I, Abello MV, Lowes MA, et al. TNF inhibition rapidly down-regulates multiple proinflammatory pathways in psoriasis plaques. J Immunol. 2005. 175:2721–2729.

42. Leonardi CL, Kimball AB, Papp KA, Yeilding N, Guzzo C, Wang Y, et al. PHOENIX 1 study investigators. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet. 2008. 371:1665–1674.

43. Ståhle M, Sánchez F. The immunogenetics of psoriasis. ASHI Q. 2006. 19:16–19.

44. Bhalerao J, Bowcock AM. The genetics of psoriasis: a complex disorder of the skin and immune system. Hum Mol Genet. 1998. 7:1537–1545.