Psoriasis: Boehncke WH

Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B, Anonymous00272, Anonymous00273. · Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Germany. · J Dtsch Dermatol Ges. · Pubmed #17615051 No free full text.

Abstract: Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1 to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, patient surveys have revealed lack of satisfaction with the efficacy of available treatments and a high rate of non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) initiated a project to develop evidence-based guidelines for the management of psoriasis. These resulting Guidelines focus on induction therapy in cases of mild, moderate, and severe plaquetype psoriasis in adults. The Guidelines include evidence-based evaluation of the efficacy of all currently available therapeutic options in Germany. In addition, they offer detailed information on how best to administer the various treatments and give information on contraindications, adverse drug reactions, and drug interactions as well as estimates of practicability and cost. The Guidelines were developed following the recommendations of the Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften (AWMF). The therapeutic recommendations were developed by an expert group and finalized during interdisciplinary consensus conferences.

Nast A, Kopp I, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B. · Division of Evidence Based Medicine, Klinik für Dermatologie, Venerologie, Allergologie, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, Berlin, Germany. · Arch Dermatol Res. · Pubmed #17497162 links to  free full text

Abstract: Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1-S126, 2006; or http://www.psoriasis-leitlinie.de ).

Nast A, Kopp IB, Augustin M, Banditt KB, Boehncke WH, Follmann M, Friedrich M, Huber M, Kahl C, Klaus J, Koza J, Kreiselmaier I, Mohr J, Mrowietz U, Ockenfels HM, Orzechowski HD, Prinz J, Reich K, Rosenbach T, Rosumeck S, Schlaeger M, Schmid-Ott G, Sebastian M, Streit V, Weberschock T, Rzany B, Anonymous00487. · Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin. · J Dtsch Dermatol Ges. · Pubmed #17187649 No free full text.

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Mrowietz U, Barth J, Boehncke WH, Reich K, Rosenbach T, Streit V, Wozel G. · Universitäts-Hauklinik Kiel. · J Dtsch Dermatol Ges. · Pubmed #16734844 No free full text.

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Boehncke WH. · No affiliation provided · BMJ. · Pubmed #14500410 links to  free full text

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Boehncke WH, Buerger C, Boehncke S. · Zentrum der Dermatologie und Venerologie, Klinikum der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, Frankfurt am Main, Germany. · Hautarzt. · Pubmed #19151962 No free full text.

Abstract: Epidemiologic data document not only a higher prevalence of joint involvement among psoriasis patients than previously thought, but also an association with numerous other diseases, including depression, smoking, alcoholism, Crohn's disease, and metabolic syndrome. The resulting increased cardiovascular mortality is of particular clinical importance, and its pathogenetic link as a complication of the psoriatic inflammation is well recognized. Thus, we need to re-invent the management of psoriasis: Dermatologists are not only the sentinel regarding the early diagnosis of psoriatic arthritis, but also of metabolic complications such as dyslipidemia or diabetes. Moreover, they need to keep in mind interactions between (systemic) anti-psoriatic drugs and the co-medication of their patients as well as possible consequences of these co-medications on the course of psoriasis. To successfully accomplish this mission, a comprehensive management concept and ground-breaking research are urgently needed.

Boehncke WH, Boehncke S. · Department of Dermatology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. · G Ital Dermatol Venereol. · Pubmed #18833072 No free full text.

Abstract: Psoriasis is a common inflammatory skin condition. Around 25% of patients develop joint involvement in the form of psoriatic arthritis as well. Recent epidemiologic studies demonstrated an increased cardiovascular morbidity among psoriasis patients. Although the association of psoriasis with cardiovascular diseases such as hypertension, myocardial infarction, and heart failure, is now widely accepted, the pathogenetic link remains yet unclear. High prevalence of the metabolic syndrome as well as adverse effects of systemic anti-psoriatic therapies may contribute to the observed association. Several pilot studies suggest that insulin resistance may contribute to the development of cardiovascular diseases in psoriasis patients who exhibit metabolic parameters like patients developing diabetes. Retrospective data provide evidence that continuous systemic therapy may reduce the risk of cardiovascular mortality in psoriasis patients. The consequences for the management of psoriasis at this point are two-fold: as co-morbidity goes along with co-medication, potential drug interactions need to be kept in mind when choosing a systemic anti-psoriatic therapy. Moreover, as psoriasis itself is a risk factor for cardiovascular morbidity, patients must avoid other known risk factors such as obesity or smoking. Dermatologists need to communicate this additional risk to their patients and support them accordingly.

Boehncke WH, Boehncke S. · Center for Dermatology and Venerology, Johann Wolfgang Goethe University Clinic, Frankfurt am Main, Germany. · J Dtsch Dermatol Ges. · Pubmed #18564207 No free full text.

Abstract: Psoriasis is a common, chronic inflammatory and frequently severe skin disease. Recent epidemiologic studies have documented an increased cardio-vascular mortality in psoriasis patients. Our own work focuses on endothelial cells as mediators for the development of inflammatory infiltrates and more recently as a victim of injury caused by infiltrating cells. In this context, we have measured systemic effects of this seemingly cutaneous inflammation, which results in a metabolic state much like that in patients developing diabetes mellitus and insulin resistance. The latter is an important pathomechanism causing endothelial cell dysfunction and subsequently cardiovascular diseases such as myocardial infarction or stroke. Co-morbidities observed in psoriatic patients therefore represent complications of the accompanying systemic inflammation and are likely to be mediated through the mechanism of insulin resistance. As psoriasis is a risk factor for cardiovascular diseases, its adequate management must include the treatment of other known risk factors. Dermatologists should discuss the elevated cardiovascular risk with their psoriasis patients and encourage them not to smoke and to normalize their body weight.

Boehncke WH, Schön MP. · Department of Dermatology, University of Frankfurt, D-60590 Frankfurt, Germany. · Clin Dermatol. · Pubmed #18021898 No free full text.

Abstract: Research into the pathogenesis of psoriasis has been severely hampered by the lack of a naturally occurring disorder in laboratory animals that mimics the complex phenotype and pathogenesis of the human disease. A large variety of spontaneous mutations, genetically engineered rodents, immunological reconstitution approaches, and xenotransplantation models have been used to study specific aspects of the pathophysiology of psoriasis, however. Several manipulations of resident cutaneous cell types or immigrating immunocytes appear to result in remarkably similar hyperproliferative inflammatory phenotypes in mice, thus suggesting that interfering with cutaneous homeostasis in general may ultimately result in a rather uniform reaction pattern that mirrors some features of psoriasis. Fully animal models of psoriasis have nonetheless not only shed light on the biological functions of given inflammatory mediators or other molecules but also tremendously contributed to the discussion on central pathogenic questions, such as the roles of innate and adaptive immune mechanisms, keratinocytes, and endothelial cells in psoriasis. Psoriasis research has also been greatly nourished by xenotransplantation of diseased or unaffected human skin onto immunocompromised recipients, an approach that has in many variations been used to study the role of T lymphocytes and other cells and that has been used for preclinical therapeutic studies. General approaches to generate animal models of psoriasis, features of some specific models, their value for psoriasis research, and their use for drug development are discussed in this article.

Boehncke WH, Luger TA, Rzany B. · Department of Dermatology and Venereology, University of Frankfurt/Main, Germany. · J Dtsch Dermatol Ges. · Pubmed #17760901 No free full text.

Abstract: Evidence-based medicine is the explicit use of the currently best available scientific data for decision-making in the management of individual patients, with guidelines being among the instruments for its implementation. Publication of the German S3 guideline on the treatment of plaque-type psoriasis is a mile-stone for German dermatology, as it is the first dermatologic guideline at this highest level of evidence. Standardized analyses of the respective publications provide the basis for this guideline. This article explains the principles of such an analysis, so the reader can gain insight into the methodology of a crucial aspect of guideline generation. This information is of general relevance, as it provides help for every physician who wishes to critically read original scientific publications.

Ludwig RJ, Alban S, Boehncke WH. · Department of Dermatology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany. · Mini Rev Med Chem. · Pubmed #17018000 No free full text.

Abstract: Chronic inflammatory diseases are common and still remain a therapeutic challenge for both efficacy and safety reasons. Hence, novel therapeutics addressing these issues would for example improve treatment of severe diseases such as psoriasis, rheumatoid arthritis, inflammatory bowel disease and multiple sclerosis. Inappropriate leukocyte homing to the affected compartments is a common feature of these diseases. Heparin and related polysaccharides have been shown to interfere with leukocyte homing through a variety of effects distinct from their anticoagulant properties. In this review, data on heparin as an anti-inflammatory agent are presented. In addition, structure-activity requirements for the anti-inflammatory properties of heparin are discussed, which should aid the drug development based on structurally modified heparin or other sulfated carbohydrates for treatment of inflammatory diseases.

Mrowietz U, Boehncke WH. · Department of Dermatology, University of Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany. · Curr Pharm Des. · Pubmed #16918413 No free full text.

Abstract: Inflammatory responses in all tissue compartments require the emigration of leukocytes from the microvasculature through endothelial cells into the respective microenvironment. Adhesion to endothelial cells is the most crucial step in order to facilitate selective and effective capture of leukocytes. The sequence of adhesions events, e.g. rolling, tethering, and firm adhesion are tightly regulated by a variety of molecules expressed by endothelial cells and leukocytes either constitutively or after induction by mainly inflammatory mediators. In diseases with a prominent inflammatory response such as psoriasis, rheumatoid arthritis, or Crohn's disease, interference with leukocyte adhesion and/or emigration may be of substantial clinical effect. A number of therapeutic approaches by using monoclonal antibodies, designed molecules, and other modulators of adhesion molecule expression have been investigated in clinical trials. This review aims to give an overview about the current knowledge of targeting adhesion molecules as a therapeutic strategy to treat inflammatory diseases.

Boehncke WH, Prinz J, Gottlieb AB. · Department of Dermatology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. · J Rheumatol. · Pubmed #16724367 No free full text.

Abstract: Alefacept, efalizumab, etanercept, and infliximab are currently approved for the treatment of adults with moderate to severe plaque psoriasis, and phase 3 trials for adalimumab are ongoing. The high level of evidence from large randomized, double-blind, placebo-controlled clinical studies for each of these biologics allows high-grade recommendations and helps define uncertainties, one of which is longterm safety. For tumor necrosis factor-a blocking agents, safety profiles are available from clinical experience in other indications. In general, biologics are safe and effective in the treatment of psoriasis, with potential to address unmet medical needs. Their distinct profiles allow dermatologists to match the biologic agent to individual characteristics of patients who are candidates for systemic therapy or phototherapy. In this evidence-based review of the literature, we assess the effects on psoriasis of induction therapy with 5 biologics and provide preliminary treatment guidelines.

Radeke HH, Ludwig RJ, Boehncke WH. · Pharmazentrum Frankfurt, Dr-Hans-Schleussner-Foundation Immune Pharmacology, Frankfurt, Germany. · Exp Dermatol. · Pubmed #16098125 No free full text.

Abstract: Lymphocyte trafficking through the dermal compartment is part of the physiological surveillance process of the adaptive immune system. On the other hand, persistent or recurrent lymphocyte infiltrates are hallmarks of both types of chronic inflammatory skin diseases, Th1-type such as psoriasis or Th2/allergic-type like atopic dermatitis. A better understanding of the mechanisms underlying lymphocyte movements is one of the key prerequisites for developing more effective therapies. In this review, we introduce a range of simple-to-sophisticated experimental in vitro and in vivo approaches to analyze lymphocyte migration. These methods start from static in vitro adhesion and chemotaxis assays, include dynamic endothelial flow chamber, intravital dual photon, and transcutaneous live-video microscopy, and finally encompass specific genetically deficient or engineered animal models. Discussing pros and cons of these assay systems hopefully generates both state-of-the-art knowledge about the factors involved in most common chronic skin diseases as well as an improved understanding of the limitations and chances of new biologic pharmaceuticals that are currently introduced into clinical practice.

Pfeffer J, Kaufmann R, Boehncke WH. · Zentrum der Dermatologie und Venerologie, Johann Wolfgang Goethe-Universität, Frankfurt am Main. · Hautarzt. · Pubmed #16028077 No free full text.

Abstract: Psoriasis is characterized by a complex phenotype and pathogenesis along with polygenic determination. Several psoriasis animal models have only been able to incompletely reproduce the disease. A xenogeneic transplantation approach, grafting skin from psoriatic patients onto mice with a severe combined immunodeficiency (SCID), was the first to meet the criteria for a psoriasis model. During the last 10 years, this psoriasis SCID-mouse model not only allowed telling experiments focusing on pathogenetic aspects, but also proved being a powerful tool for drug discovery with a good predictive value.

Schön MP, Boehncke WH. · Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, and the Department of Dermatology, University of Würzburg, Würzburg, Germany. · N Engl J Med. · Pubmed #15872205 No free full text.

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Boehncke WH. · Department of Dermatology, University of Frankfurt Medical School, Germany. · Ernst Schering Res Found Workshop. · Pubmed #15526945 No free full text.

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Sterry W, Barker J, Boehncke WH, Bos JD, Chimenti S, Christophers E, De La Brassinne M, Ferrandiz C, Griffiths C, Katsambas A, Kragballe K, Lynde C, Menter A, Ortonne JP, Papp K, Prinz J, Rzany B, Ronnevig J, Saurat JH, Stahle M, Stengel FM, Van De Kerkhof P, Voorhees J. · Department of Dermatology and Allergy, University Hospital Charité, Berlin, Germany. · Br J Dermatol. · Pubmed #15265063 No free full text.

Abstract: Psoriasis is a chronic, immune-mediated disorder that usually requires long-term treatment for control. Approximately 25% of patients have moderate to severe disease and require phototherapy, systemic therapy or both. Despite the availability of numerous therapeutic options, the long-term management of psoriasis can be complicated by treatment-related limitations. With advances in molecular research and technology, several biological therapies are in various stages of development and approval for psoriasis. Biological therapies are designed to modulate key steps in the pathogenesis of psoriasis. Collectively, biologicals have been evaluated in thousands of patients with psoriasis and have demonstrated significant benefit with favourable safety and tolerability profiles. The limitations of current psoriasis therapies, the value of biological therapies for psoriasis, and guidance regarding the incorporation of biological therapies into clinical practice are discussed.

Schön MP, Drewniok C, Boehncke WH. · Rudolf Virchow Center, DFG Center for Experimental Biomedicine, and Department of Dermatology and Venereology, University of Würzburg, Germany. · Curr Drug Targets Inflamm Allergy. · Pubmed #15180469 No free full text.

Abstract: As leukocytes play a primary role in the immunopathogenesis of psoriasis, it is a reasonable assumption that preventing those cells from localizing to the sites of cutaneous inflammation can stop the disease process. Selectins, a family of three single-chain transmembrane adhesion molecules, which bind to carbohydrate moieties displayed on other cells, are pivotally involved in the initial steps of leukocyte recruitment, i.e. tethering and rolling along the endothelial lining of blood vessels. Thus, compounds impairing selectin functions have been developed to treat inflammatory disorders, such as psoriasis. Potential strategies to interfere with selectin functions include direct inhibition through monoclonal antibodies or small-molecule compounds, transcriptional regulation of selectin expression, and modulation of the post-transcriptional glycosylation of selectin ligands. More than a dozen different compounds targeting selectin functions are currently under development, several of which have shown promising effects on leukocyte recruitment and the therapy of inflammatory conditions under experimental conditions. However, based on preclinical and early clinical investigations, it appears that in some cases specifically targeting the function of single selectins may not be sufficient to effectively interrupt the inflammatory cascade. This is, at least in part, due to considerable redundancies and overlaps in the functions of the selectins, a notion that is corroborated by the apparently more pronounced therapeutic efficacy of some compounds with broader activity against several selectins. Overall, while targeting selectin functions promises rather selective and pathogenesis-based therapeutic approaches against psoriasis, the clinical value of such strategies, alone or in combination with other therapies, remains to be seen.

Schön MP, Zollner TM, Boehncke WH. · Department of Dermatology, Otto-von-Guericke-University, Magdeburg, Germany. · J Invest Dermatol. · Pubmed #14708592 links to  free full text

Abstract: Spatial compartmentalization and tissue-selective localization of T lymphocytes to the skin are crucial for immune surveillance and the pathogenesis of various disorders including common inflammatory diseases such as atopic dermatitis or psoriasis, but also malignancies such as cutaneous T cell lymphomas. Cutaneous recruitment of lymphocytes is a highly complex process that involves extravasation, migration through the dermal connective tissue, and eventually, localization to the epidermis. An intertwined network of cytokines and chemokines provides the road signs for leukocyte migration, while various adhesion receptors orchestrate the dynamic events of cell-cell and cell-substrate interactions resulting in cutaneous localization of T cells. Selectively targeting the functions of molecules involved in this interplay promises exciting new therapeutic options for treating inflammatory skin disorders.

Elliott PJ, Zollner TM, Boehncke WH. · CombinatoRx Inc., Boston, Massachusetts, USA. · J Mol Med. · Pubmed #12700891 No free full text.

Abstract: The ubiquitin-proteasome pathway has a central role in the selective degradation of intracellular proteins. Among the key proteins modulated by the proteasome are those involved in the control of inflammatory processes, cell cycle regulation, and gene expression. Consequently proteasome inhibition is a potential treatment option for cancer and inflammatory conditions. Thus far, proof of principle has been obtained from studies in numerous animal models for a variety of human diseases including cancer, reperfusion injury, and inflammatory conditions such as rheumatoid arthritis, asthma, multiple sclerosis, and psoriasis. Two proteasome inhibitors, each representing a unique chemical class, are currently under clinical evaluation. Velcade (PS-341) is currently being evaluated in multiple phase II clinical trials for several solid tumor indications and has just entered a phase III trial for multiple myeloma. PS-519, representing another class of inhibitors, focuses on the inflammatory events following ischemia and reperfusion injury. Since proteasome inhibitors exhibit anti-inflammatory and antiproliferative effects, diseases characterized by both of these processes simultaneously, as is the case in rheumatoid arthritis or psoriasis, might also represent clinical opportunities for such drugs.

Boehncke WH. · Department of Dermatology, University of Frankfurt, Germany. · J Investig Dermatol Symp Proc. · Pubmed #11924833 No free full text.

Abstract: Both clinical as well as experimental data support the concept of psoriasis being a T-cell-mediated immune disease possibly triggered by bacterial superantigens. Further analysis of its pathogenesis was facilitated by the generation of a xenogeneic transplantation model in which skin from psoriatic patients is grafted onto SCID mice lacking functional B and T cells. Applying this model it was demonstrated that psoriasis can be triggered by bacterial superantigens; this process depends on the presence of immunocytes. Mutated variants of the respective superantigens exhibiting no measurable affinity to HLA class II molecules can function as competitive inhibitors in vivo.

Boehncke WH, Zollner TM. · Zentrum der Dermatologie und Venerologie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main. · Hautarzt. · Pubmed #10097950 No free full text.

Abstract: In contrast to conventional antigens, bacterial superantigens activate a large percentage of an organism's total T-cell repertoire. This has clinical implications particularly in the case of infections with Gram-positive bacteria. Unravelling the molecular mechanisms of superantigen-mediated T-cell activation has yielded new insights in the pathogenesis of a number of diseases, in the field of dermatology namely atopic dermatitis and psoriasis. Moreover, therapeutic applications of superantigens have begun to emerge.

Grundmann-Kollmann M, Ludwig R, Zollner TM, Ochsendorf F, Thaci D, Boehncke WH, Krutmann J, Kaufmann R, Podda M. · Department of Dermatology, Johann Wolfgang Goethe University, Frankfurt, Germany. · J Am Acad Dermatol. · Pubmed #15097957 No free full text.

Abstract: BACKGROUND: Psoralen-UVA (PUVA) and narrowband UVB (311-nm) therapy are considered to be first-line phototherapies for patients with moderate to severe psoriasis. To reduce side effects as a result of systemic resorption of psoralens, topical PUVA therapies have been developed and proven to be effective in the treatment of psoriasis. OBJECTIVE: We sought to evaluate the combination therapy of narrowband UVB plus cream PUVA on selected psoriatic plaques compared with narrowband UVB or cream PUVA alone. METHODS: A total of 30 patients (Psoriasis Area and Severity Index score of 8-15) were included in the randomized study. The combination therapy consisting of narrowband UVB whole-body irradiation followed by cream PUVA therapy for selected psoriatic plaques was evaluated in 10 patients with chronic plaque-stage psoriasis. For comparison, the therapeutic efficacy, number of treatments, and cumulative UV doses until remission (Psoriasis Area and Severity Index score < 4) of cream PUVA therapy or narrowband UVB alone was determined in 10 patients, respectively. RESULTS: Both monotherapies induced clearance of psoriatic lesions in all patients within 5 to 7 weeks. Mean number of treatments for cream PUVA was 24 +/- 5; for narrowband UVB was 21 +/- 3. The mean cumulative UVA dose was 45.0 +/- 16.3 J/cm(2) and the mean cumulative UVB dose was 17.1 +/- 4.1 J/cm(2). Combination therapy resulted in complete clearance of lesions in all patients after 3 to 4 weeks. Mean number of treatment was 14 +/- 2, mean cumulative UVA dose was 18.7 +/- 4.7 J/cm(2), and mean cumulative UVB dose was 8.2 +/- 3.3 J/cm(2). The number of treatments (P <.001, analysis of variance), UVA dose (P <.001, t test), and UVB dose (P <.001, t test) were significantly reduced compared with both monotherapies. CONCLUSIONS: Our results indicate that a combination therapy of narrowband UVB plus cream PUVA appears to have a significantly higher efficacy compared with either monotherapy. The cumulative UV doses were significantly lower in the combination therapy. We conclude that cream PUVA can be used in addition to narrowband UVB for areas that tend to clear less quickly than the rest of the body.

Thaçi D, Daiber W, Boehncke WH, Kaufmann R. · Department of Dermatology and Venereology, J.W. Goethe University Medical School, Frankfurt, Germany. · Dermatology. · Pubmed #11586015 No free full text.

Abstract: BACKGROUND: Psoriasis of the scalp is a very common disease, cosmetically disturbing and therapeutically difficult to manage. OBJECTIVE: The aim of our study was to investigate the efficacy, safety and cosmetic acceptance of calcipotriol solution in a large number of patients with mild to moderate scalp psoriasis and to compare this treatment with previous therapies used. METHODS: In this multicentre prospective observational cohort study 3,396 patients were treated with calcipotriol solution (50 microg/ml) twice daily over an 8-week period either alone or in combination with other treatments. The psoriasis scalp severity index (PSSI) and investigator/patient global assessment were used for the evaluation of clinical response. RESULTS: All psoriasis severity parameters measured were reduced with a significant decrease in PSSI scores from 18.4 to 5.6 after 8 weeks of therapy (p < 0.001). About 80% of the patients showed very good or good clinical improvement. Combination of calcipotriol solution with other treatment modalities e.g. corticosteroids or salicylic acid, showed an increased treatment response. In only 2.4% of the patients side effects occurred (e.g. irritation). CONCLUSION: Calcipotriol solution is an effective, safe, well-tolerated and cosmetically acceptable treatment modality. By patients and physicians, this treatment was found to be a valuable supplement to previously available and established treatments for scalp psoriasis.