Psoriasis: Thomas P

Schmutz JL, Jeanmougin M, Martin S, Amblard P, Thomas P. · Service de Dermatologie, Hôpital Fournier, 36, quai de la Bataille, 54035 Nancy Cedex. · Ann Dermatol Venereol. · Pubmed #11011174 No free full text.

This publication has no abstract.

Maire C, Delesalle F, Carpentier O, Lequint P, Delaporte E, Thomas P. · Clinique de dermatologie, hôpital Claude-Huriez, CHRU de Lille, université de Lille-2, rue Michel-Polonovski, 59037 Lille cedex, France. · Ann Dermatol Venereol. · Pubmed #19361704 No free full text.

Abstract: BACKGROUND: Several cases of skin cancer have been reported after treatment with etanercept although the causal relationship remains uncertain. We report the case of a patient who rapidly developed multiple basal cell carcinomas (BCC) after discontinuation of this treatment. PATIENTS AND METHODS: A 42-year-old man presented severe plaque psoriasis after receiving topical therapy, less than 100 sessions of PUVA-therapy, retinoids and repeated solar exposure. Severe worsening of the psoriasis led us to use etanercept for seven months with excellent results. However, 11 BCCs gradually appeared within a year starting one month after the end of treatment. DISCUSSION: There is some controversy about the risk of non melanoma skin cancer associated with etanercept treatment. However, even the most recent studies are contradictory and they mostly concern rheumatological indications. In the past four years, a dozen cases of BCC have been reported following treatment for cutaneous psoriasis. As regards our patient, a genetic predisposition is possible but a potentiating effect of solar exposure is strongly suspected. This observation should lead to reinforced screening for BCC and restriction of anti-TNFalpha therapy to patients who have received less than 1000 J of PUVA-therapy, as recommended by the British Society of Rheumatology for psoriatic rheumatism. Levels of natural solar exposure must be also be taken into account.

Ghoreschi K, Thomas P, Breit S, Dugas M, Mailhammer R, van Eden W, van der Zee R, Biedermann T, Prinz J, Mack M, Mrowietz U, Christophers E, Schlöndorff D, Plewig G, Sander CA, Röcken M. · Department of Dermatology and Allergology, Ludwig-Maximilians University Munich, Munich, Germany. · Nat Med. · Pubmed #12461524 No free full text.

Abstract: Selective skewing of autoreactive interferon-gamma (IFN-gamma)-producing T helper cells (Th1) toward an interleukin-4 (IL-4)-producing (Th2) phenotype can in experimental animals alleviate autoimmune disease without inducing general immunosuppression. In a prospective dose escalation study, we assessed treatment with human IL-4 (rhuIL-4) in 20 patients with severe psoriasis. The therapy was well tolerated, and within six weeks all patients showed decreased clinical scores and 15 improved more than 68%. Stable reduction of clinical scores was significantly better at 0.2-0.5 microg rhuIL-4 than at < or =0.1 microg rhuIL-4 (P = 0.009). In psoriatic lesions, treatment with 0.2-0.5 microg/kg rhuIL-4 reduced the concentrations of IL-8 and IL-19, two cytokines directly involved in psoriasis; the number of chemokine receptor CCR5+ Th1 cells; and the IFN-gamma/IL-4 ratio. In the circulation, 0.2-0.5 microg/kg rhuIL-4 increased the number of IL-4+CD4+ T cells two- to three-fold. Thus, IL-4 therapy can induce Th2 differentiation in human CD4+ T cells and has promise as a potential treatment for psoriasis, a prototypic Th1-associated autoimmune disease.