British Journal of Dermatology (1990) 122, 113-123.

Correspondence Topical cyclosporin A in psoriasis SIR, There has been considerable interest recently in the efficacy of cyclosporin A (CsA), a potent immunosuppressive drug, in some inflammatory diseases. Several studies'-^ have reported the beneflcial effect of oral CsA on patients with psoriasis, including studies on short-term'* and low-dose CsA therapy.^"^ The effect of topical CsA in psoriasis has been investigated because of the dose-related sideeffects of systemic CsA, particularly its nephrotoxicity. Previous studies on topical CsA in psoriasis failed to observe any clinical response,*""* but conversely, Powles et al.'' have shown that intralesional injections of CsA may generate a local but not a systemic antipsoriatic effect. We report the results of a bilateral comparison of topically applied CsA with placebo, using higher concentrations of CsA than in previous studies and applied under occlusion. This study on six patients with chronic plaque psoriasis had local ethical committee approval. The oral solution of CsA (Sandimmune®, Sandoz Ltd, Basle, Switzerland) was made up of 5% w/w in Decoderm ointment base® (Merck, Darmstadt, F.R.G.) and applied under plastic film occlusion to plaques of psoriasis for 6 h/day over 2-3 weeks. The placebo ointment containing only the solvent of CsA in the same vehicle was applied under identical conditions to corresponding lesions on the opposite side of the body. The lesions were scored for erythema, plaque thickness, and scaling on a 0-3 point scale at weekly intervals. Since the most sensitive indicators of the effect of systemic CsA on psoriatic lesions are the reduction of the cell infiltrate and the decrease of epidermal mitoses i week after onset of therapy,' we monitored the possibe topical effect of CsA on psoriasis by immunostaining of the cell infiltrate (Leu i. Leu 2, Leu 3, CD22, HLA-DR, OKT6) and by autoradiography using the in vitro double labelling technique with ['H]- and ['*C]thymidine. The CsA level in pooled skin from treated lesions was measured using the standarized polyclonal radioimmunoassay-kit (Sandoz Ltd) in skin extracts. Before measurement the horny and upper layers of the epidermis were removed by a scalpel in order to measure only CsA absorbed in the lower epidermis and dermis. One week after the onset of therapy the CsA concentration in CsA treated lesions was 3880 ng/g tissue wet weight. This equals the concentration in psoriatic lesions after 7 days of systemic therapy, which has been found to be i • i + o 3 ng//

Topical cyclosporin A in psoriasis.

British Journal of Dermatology (1990) 122, 113-123. Correspondence Topical cyclosporin A in psoriasis SIR, There has been considerable interest recen...
143KB Sizes 0 Downloads 0 Views