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Vitamin B12 Cream Containing Avocado Oil in the Therapy of Plaque Psoriasis
Abstract
There are already many effective topical therapies available for use in the treatment of chronic plaque psoriasis. Unfortunately, these treatments are often associated with a rather significant risk of undesirable effects.
In this randomized, prospective clinical trial, the effects of the vitamin D(3) analog calcipotriol were evaluated against those of a recently developed vitamin B(12) cream containing avocado oil in an intraindividual right/left-side comparison. The trial population consisted of 13 patients, 10 men and 3 women, with chronic plaque psoriasis. The observation period was 12 weeks; the effects of therapy were assessed on the basis of a PASI score adapted to the right/left-side comparison technique, the subjective evaluations of the investigator and patients and the results of 20-MHz sonography.
There was a more rapid development of beneficial effects with the use of calcipotriol in the initial 8 weeks, although differences in effects were significant only at the time point of therapy week 8 (p < 0.05). After 12 weeks, neither the PASI score nor 20-MHz sonography showed significant differences between the two treatments. While the efficacy of the calcipotriol preparation reached a maximum in the first 4 weeks and then began to subside, the effects of the vitamin B(12) cream containing avocado oil remained at a constant level over the whole observation period. This would indicate that the vitamin B(12) preparation containing avocado oil may be suitable for use in long-term therapy, a hypothesis further supported by the fact that the investigator and the patients assessed the tolerability of the vitamin B(12) cream containing avocado oil as significantly better in comparison with that of calcipotriol.
The results of this clinical trial provide evidence that the recently developed vitamin B(12) cream containing avocado oil has considerable potential as a well-tolerated, long-term topical therapy of psoriasis.
... Ao final do tratamento, foi observado que o creme contendo o óleo de abacate atingiu eficácia equivalente à da preparação de calcipotriol, mantendo seu efeito terapêutico constante durante todo o período avaliado. Essa constância, aliada ao fato de que a formulação à base de óleo vegetal não resultou em qualquer efeito colateral, demonstra o potencial do óleo de abacate para o tratamento da psoríase (48). ...
... Espécies vegetais úteis no tratamento auxiliar da psoríase e suas principais características etnobotânicas e fitoquímicas(22,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). ...
A psoríase é uma patologia crônica que afeta pele, unhas e articulações, causando ônus físico e emocional. Essa doença é comumente tratada com formulações tópicas, fototerapia, medicamentos sistêmicos ou terapias combinadas. Entretanto, alguns desses tratamentos podem causar efeitos colaterais e apresentam alto custo, sendo inacessíveis para uma parcela da população. Dessa maneira, surge a necessidade de se buscar novas alternativas terapêuticas para o controle da psoríase. Dentre essas, destaca-se o uso de extratos vegetais. O presente estudo é uma revisão da literatura que teve como objetivos analisar o potencial terapêutico de espécies de plantas ocorrentes no Brasil e de produtos de origem vegetal para o tratamento da psoríase, bem como apresentar um panorama geral das patentes na área e do desenvolvimento de fitoterápicos no país. Para tal, foram consultados trabalhos científicos publicados nos últimos 25 anos, obtidos a partir de buscas nas bases PubMed, Science Direct, Scielo, dentre outras, empregando os termos “psoríase”, “extrato vegetal” e “planta medicinal”. Além disso, foi realizada uma busca de patentes na base de dados do INPI, usando “psoríase”, “extrato”, “planta” e “formulações” como palavras-chave. Os estudos analisados demonstram a eficácia de plantas medicinais e seus metabólitos no controle da psoríase, e os dados compilados acerca das inovações na área mostram que o setor de produção de medicamentos à base de espécies vegetais ainda avança no Brasil. Tais achados contribuem, portanto, para a futura consolidação de tratamentos à base de plantas, mais acessíveis e eficazes para o controle da psoríase.
... In vitro studies supported that Vitamin B12 regulates T-lymphocytes activation and cytokine secretion [204,205]. A few studies have reported an association between psoriasis and Vitamin B12 deficiency [206][207][208]. A retrospective observational study including 98 patients with psoriasis and 98 healthy individuals demonstrated that patients with psoriasis had increased homocysteine levels and lower serum levels of vitamin B12 and folic acid compared to healthy individuals [207]. ...
... After 8 weeks, treatment with calcipotriol had a more beneficial impact on psoriasis severity. However, after 12 weeks, no significant differences between the two treatment regimens were demonstrated [208]. Other studies have evaluated the impact of intramuscular administration of Vitamin B12 on the treatment of psoriasis with inconsistent results. ...
Chronic inflammation and increased oxidative stress are contributing factors to many non-communicable diseases. A growing body of evidence indicates that dietary nutrients can activate the immune system and may lead to the overproduction of pro-inflammatory cytokines. Fatty acids as macronutrients are key players for immunomodulation, with n-3 polyunsaturated fatty acids having the most beneficial effect, while polyphenols and carotenoids seem to be the most promising antioxidants. Psoriasis is a chronic, immune-mediated inflammatory disease with multifactorial etiology. Obesity is a major risk factor for psoriasis, which leads to worse clinical outcomes. Weight loss interventions and, generally, dietary regimens such as gluten-free and Mediterranean diet or supplement use may potentially improve psoriasis’ natural course and response to therapy. However, data about more sophisticated nutritional patterns, such as ketogenic, very low-carb or specific macro- and micro-nutrient substitution, are scarce. This review aims to present the effect of strictly structured dietary nutrients, that are known to affect glucose/lipid metabolism and insulin responses, on chronic inflammation and immunity, and to discuss the utility of nutritional regimens as possible therapeutic tools for psoriasis and psoriatic arthritis.
... 9 The potential efficacies of intramuscular and systemic vitamin B12 in the treatment of psoriasis have been demonstrated previously. 10 A recent randomized, controlled trial study revealed the role of supplementation containing selenium, coenzyme Q10, and vitamin E in hastening the clinical improvement in psoriasis patients compared the patients who were received placebo. 11 Furthermore, statistically significant decrease in the mean PSAI score of chronic plaque psoriatic patients was recorded under highpressure shower regimen and selenium-rich spa water daily for three weeks. ...
... This questionnaire included 10 questions concerning HRQoL related to the last week, before patient admission, which ranged from 0 (no impairment of HRQoL) to 30 (maximum impairment of HRQoL). DLQI is subdivided into six areas related to different features of a person's HRQoL consisting of symptoms and feelings (questions 1, 2), daily activities (3, 4), leisure (5, 6), work/school (7), personal relationships (8,9) and treatment (10). All the patients were asked to complete DLQI before and after 12 weeks' treatment. ...
Background/objectives: Psoriasis is a common dermatologic disorder, with fluctuating response to treatments. We aimed to investigate the efficacy of methotrexate (MTX) plus micronutrient supplement (MM) compare to MTX only on Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) in psoriasis patients in a double-blinded clinical trial study.
Materials and methods: A total number of 30 psoriasis patients who had lesions up to 20 percent of body skin involvement were divided randomly into two groups. Group A were treated by oral methotrexate and group B were received the MTX plus one tablet of micronutrient supplement daily for 12 weeks. Clinical response (scaling, erythema, involvement and thickness of patient's lesion), PASI score and DLQI index were recorded baseline and after 12 weeks. PASI-50, PASI-75, and PASI-90 evaluated as indicators of clinical improvements.
Results: PASI 50/75/90 response rates were 100%, 73.3%, 40% in group B and they were 66.6%, 40%, 20% in group A respectively. Both treatments were effective and caused significant improvements in PASI score and DLQI (P
... Herbal products with anti-psoriasis potential tested in clinical studies are listed in l " Table 2. Topical application of cream with 10 % Mahonia aquifolium extract [34], 0.03 % Camptotheca acuminata nut [35], Aloe vera extract [36], oleoresin from Copeifera langsdorffii (5 %) ointment [37], and cream with Persea americana oil [38] showed significantly greater improvements in psoriatic treatment compared with calcipotriol and fluticasone propionate mixture, hydrocortisone, triamcinolone acetonide, and calcipotriol ointment, respectively. In turn, Aloe vera cream [39], Baphicacanthus cusia ointment [40], Camptotheca acuminata nut extract in tincture/gel/ointment [41], Curcuma longa microemulgel [42], Hypericum perforatum ointment [43], Indigo naturalis ointment [44], Indigo naturalis extract in oil [45], Mahonia aquifolium cream [46], Mahonia aquifolium bark extract ointment [47], Strobilanthes formosanus ointment [48], and cream with capsaicin from Capsicum frutescens [49] were found to be significantly more effective than the vehicle control group. ...
... Moreover, such research is expensive, long lasting and requires a special permission from the regulatory authorities. Also compared to multi- randomized, prospective, right-left comparative clinical trial 13 patients (10 men and 3 women) with chronic plaque psoriasis " cream with vitamin B12 and avocado oil; " vitamin D 3 analog calcipotriol; twice daily for 12 weeks cream with vitamin B12 and avocado oil was effective as calcipotriol cream with regard to PASI score [38] PASI -Psoriasis Area and Severity Index; QLI -Quality of Life Index; NAPSI -Nail Psoriasis Severity Index directional synthetic drug studies, clinical and toxicological studies to prove the efficacy and safety of herbal products are rare. Several factors might contribute to the explanation of such discrepancies, for example a lack of standardization and quality control of the herbal products used in clinical trials, the use of different dosages of herbal medicines, inadequate randomization in most studies and an improper selection of patients, the numbers of patients in most trials are insufficient for the attainment of statistical significance, wide variations in the duration of treatments using herbal medicines, and lacking or insufficient results of toxicological studies. ...
Psoriasis is a chronic inflammatory skin disease characterized histologically by hyperproliferation and aberrant differentiation of epidermal keratinocytes. A wide range of conventional medical therapies to treat psoriasis is established, from topical therapies and systemic medications through to phototherapy or combinations of those. However, most of these therapies have a limited efficacy and may cause a number of side effects, including cutaneous atrophy, organ toxicity, carcinogenicity, and broadband immunosuppression, which are restricting their long-term use. Therefore, it would be desirable to use herbal products as an alternative treatment for psoriasis that causes fewer side effects. For this purpose, several electronic databases and literature references were used to summarize the current knowledge acquired on the basis of animal studies and clinical trials regarding herbal products used to treat psoriasis topically. This review discusses the mechanisms of herbal products activities through (1) inhibition of the keratinocyte hyperproliferation and inducing apoptosis, (2) inhibition of immune-inflammatory reaction, (3) suppression of phosphorylase kinase (PhK) activity, and (4) inhibition of the hedgehog (Hh) signaling pathway. Moreover, the penetration of herbal products through the psoriatic skin barrier, novel herbal drug delivery systems in psoriasis treatment, and possible adverse effects of herbal therapy are discussed.
Georg Thieme Verlag KG Stuttgart · New York.
... It is used for cosmetic purposes because of very high skin penetration and rapid absorption. It has an excellent moisturising, wound healing and antiinflammatuar activity (Nayak et al., 2008;Stücker et al., 2001). ...
... Stücker M. et al compared vitamin B12 cream containing avocado oil with calcipotriol in a randomized, prospective, half-side comparison study in 13 patients with plaque-type psoriasis (Stücker et al., 2001). The cream was applied twice daily for 12 weeks. ...
Psoriasis is a common, chronic, recurrent, immune-mediated inflammatory disorder of skin. Although conventional topical and systemic therapies yield remission for a while, they carry a risk of many side effects that limit the long term use of these agents and the disease recurs generally in a short period of time after cessation of therapy. An increasing number of psoriatic patients are using herbal products as a treatment to control their disease with less side effects. Clinicians should be aware of plants used in psoriasis and side effects related with them. The aim of this article is to review the different herbs used in psoriasis treatment.
... The anti-inflammatory effect was evaluated by a 20-MHz sonography that measured the density of corium in order to determine the degree of acanthosis, where an increase in corium density indicates less inflammatory infiltration. Results showed that calcipotriol cream reached maximum efficacy after four weeks, after which its effect began to decline, while avocado oil cream was as efficient as calcipotriol over the period of treatment, hence indicating the suitability of avocado oil cream for the long-term therapy of psoriasis [97]. ...
Although psoriasis remains one of the most devastating inflammatory disorders due to its huge negative impact on patients’ quality of life, new “green” treatment approaches still need to be fully explored. The purpose of this review article is to focus on the utilization of different essential oils and active constituents of herbal botanical origin for the treatment of psoriasis that proved efficacious via both in vitro and in vivo models. The applications of nanotechnology-based formulations which displayed great potential in augmenting the permeation and delivery of these agents is also addressed. Numerous studies have been found which assessed the potential activity of natural botanical agents to overcome psoriasis. Nano-architecture delivery is applied in order to maximize the benefits of their activity, improve properties, and increase patient compliance. This field of natural innovative formulations can be a promising tool to optimize remediation of psoriasis while minimizing adverse effects.
... Estas características han propiciado un crecimiento vertiginoso del uso del aguacate y en especial de la semilla dentro de la industria cosmética, en específico en el área de la cosmecéutica, así lo demuestran una gran cantidad de productos como cremas con inclusión de aceite de aguacate y alto contenido de vitamina B12 que presentó potencial como terapia tópica a largo plazo frente a la psoriasis (Stücker, Memmel, Hoffmann, Hartung, & Altmeyer, 2001); un jabón líquido estable en condiciones de almacenamiento (Hennessey-Ramos, Murillo-Arango, & Guayabo, 2019); dos cremas preparadas a partir de emulsiones aceite/agua y agua/aceite empleando aceite de aguacate que demostraron tener un efecto de restauración de la barrera cutánea que a su vez mejoraba la hidratación de la piel de los voluntarios tratados (Moldovan, Ionuț, & Bogdan, 2021); una crema elaborada con extracto de azafrán y aceite de aguacate y de uso tópico presentó resultados prometedores como tratamiento eficaz y seguro para el rejuvenecimiento de la piel del rostro (Naeimifar et al., 2020); un acondicionador altamente estructurado para uso capilar sustituyendo los aceites minerales convencionalmente empleados por aceite de aguacate, el cual fue altamente aceptado por los consumidores (Loch et al., 2020). ...
Palabras Clave: Cosmeceútica, compuestos bioactivos, plantas. Introducción Una gran variedad de compuestos extraídos de plantas se utilizan como ingredientes para productos cosméticos, hidratantes etc; estos compuestos generalmente aportan benefi-cios a la salud debido a que poseen actividades comprobadas que mejoran la piel, o aportan algún otro beneficio además del cosmético; ahí es donde tiene su campo de acción la cosme-céutica. Actualmente conocemos una gran variedad de plantas con actividades antioxidantes, an-tiinflamatorias, calmantes, inmunomoduladoras, queratolíticas y antimicrobianas, entre otras. Algo importante que debemos mencionar es que los productos cosmecéuticos deben ser desa-rrollados al igual que probados antes de salir al mercado para que los consumidores obtengan el beneficio adecuado y el producto sea seguro, ya que debemos saber y tomar en cuenta que no por contener un ingrediente natural o que proviene de plantas puede ser inocuo. Se requiere de estudios y pruebas para determinar la concentración benéfica y tomar en cuenta las afeccio-nes previas de la persona que desea utilizarlo. En este capítulo mencionamos algunas espe-cies de plantas qu son el claro ejemplo de ingredientes utilizados en cosmecéutica y por qué. Cosmeceútica y la búsqueda de la piel perfecta La constante búsqueda para tener una piel saludable y perfecta forma parte de la historia de la humanidad. Los sumerios, asirios, babilonios, egipcios, griegos, romanos, judíos, árabes, japoneses e incluso las civilizaciones precolombinas en América (González Minero & Bravo Díaz, 2017) usaban ungüentos, lociones y mascarillas para tener la piel libre de manchas, arrugas, im-Capítulo 8
... Various herbal products having anti-psoriasis potential were tested in clinical studies and topical application of creams containing 10% Mahonia aquifolium extract [56], Aloe vera extract [57], ointment containing oleoresin from Copeifera langsdorffii (5%) [58], and cream with Persea americana oil [59] showed significantly greater improvements in psoriatic treatment compared with calcipotriol and fluticasone propionate mixture, hydrocortisone, triamcinolone acetonide, and calcipotriol ointment, respectively. In turn, studies with Baphicacanthus cusia ointment [60], Curcuma longa microemulgel [61], Hypericum perforatum ointment [62], and Indigo naturalis extract in oil [63], were found to be significantly more effective than the vehicle control group. ...
The aim of this study was to evaluate the phytochemical profile and antioxidant properties 25 of the extracts from three Rosa species (R. canina, R. damascena, R. cairo), to develop and investigate 26 topical formulations with lyophilized forms of extracts for the treatment of psoriasis. Phytochemical 27 screening and in vitro total antioxidant capacity (DPPH, FRAP, CUPRAC, SOD) of studied samples 28 were exmined and compared. Lyophilized extracts of roses were dissolved in Transcutol HP and 29 different formulations of creams were prepared. Franz diffusion method was used to evaluate the 30 drug release and biocompatibility was tested on HaCaT cells. Rosa damascena had the best results 31 regarding all the analyses that were done. After the evaluation of topical products, the formulation 32 with Rosa damascena extract in self-emulsifying drug delivery system was tested on a human clinical 33 study that involved 20 patients. At the end of the clinical study an improvement in the quality of 34 life of the patients was observed and erythema, induration and scaling were reduced. The present 35 study indicates that our examined extracts exhibited great phenolic content, antioxidant capacity 36 and safety profile of topical formulation and therefore can be used as a reliable source of natural 37 antioxidants and may be used as a complementary treatment to improve the quality life of the pa-38 tients with psoriasis or may be tested on another diseases. 39
... The clinical trial results provide evidence that the recently developed vitamin B12 cream containing Avocado oil has considerable potential as a well-tolerated, long-term topical therapy of psoriasis [96]. ...
Avocado (Persea americana Mill.) plant fruits are well-known for their high nutritional value, unique test, and healthy oil. It has a history of about 10,000 years. Avocado fruit offers many health benefits, and its production is rapidly increasing. The Food and Agriculture Organization (FAO)’s recent data suggest that the Avocados produced in the world in 2019 was twice that of 2010 (3778010 tons). Avocado’s global Gross Production Value was about 5.812 billion USD in 2018, and it is likely to increase rapidly because of the increasing demand for Avocado fruits. Avocado oil is also used in the cosmetic industry because of its therapeutic properties, and it boosts the economic value of the Avocado industry. Avocado fruits have a rough green-gold skin; however, fruits are called ‘the green gold’ because of their massive global demand in the worldwide market and a lucrative business. The cultivation of Avocado has tremendous potential in increasing the rural economy, rural agriculture-based employment and reducing the poverty rate of growers. On the other hand, the Avocado industry is highly criticised because of deforestation, massive water utilisation, polluting water bodies with insecticides and fertilisers, posing a threat to other plant species, and environmental pollution. However, it doesn’t preclude the importance of Avocado. Cameroon’s average temperature is about 23 °C, which is considered optimal for Avocado propagation and commercial cultivation. Cameroon Association of Active Youths (CAMAAY) want to explore the possibilities of engaging Cameroon youths in Avocado cultivation. This review is aimed to provide an overview of Avocado. The review also highlights Avocado cultivation related issues from one health and sustainability perspective in line with the global goals.
... Studies in animals and humans (Table 4) show that avocados (fruit and oil) help control weight, reduce the probability of diabetes (Del Toro-Equihua et al., 2016), regulate blood cholesterol levels implicated in liver metabolism (Carvajal-Zarrabal et al., 2014a), and help in skin care (Kopec et al., 2014;Unlu et al., 2005). In addition, unsaponifiable components containing antioxidants regulate anti-inflammatory processes implicated in cancer (Stücker et al., 2001). ...
Avocado is a subtropical/tropical fruit with creamy texture, peculiar flavor, and high nutritional value. Due to its high oil content, a significant quantity of avocado fruit is used for the production of oil using different methods. Avocado oil is rich in lipid‐soluble bioactive compounds, but their content depends on different factors. Several phytochemicals in the oil have been linked to prevention of cancer, age‐related macular degeneration, and cardiovascular diseases and therefore have generated an increase in consumer demand for avocado oil. The aim of this review is to critically and systematically analyze the worldwide production and commercialization of avocado oil, its extraction methods, changes in its fat‐soluble phytochemical content, health benefits, and new trends and applications. There is a lack of information on the production and commercialization of the different types of avocado oil, but there are abundant data on extraction methods using solvents, centrifugation‐assisted aqueous extraction, mechanical extraction by cold pressing (varying concentration and type of enzymes, temperature and time of reaction, and dilution ratio), ultrasound‐assisted extraction, and supercritical fluid to enhance the yield and quality of oil. Extensive information is available on the content of fatty acids, although it is limited on carotenoids and chlorophylls. The effect of avocado oil on cancer, diabetes, and cardiovascular diseases has been demonstrated through in vitro and animal studies, but not in humans. Avocado oil continues to be of interest to the food, pharmaceutical, and cosmetic industries and is also generating increased attention in other areas including structured lipids, nanotechnology, and environmental care.
https://onlinelibrary.wiley.com/share/author/TAPXYTUEBIGPETGIXK8R?target=10.1111/1541-4337.12784
... Topical application of Aloe vera was found effective in psoriasis (Vogler and Ernst, 1999). Vitamin B12 cream containing avocado oil has potential long-term topical therapy of psoriasis (Stucker et al., 2001). ...
Olive oil and olive extracts have been used in folk medicine since ancient times. Romans and Greeks employed olive extracts to treat many diseases and an extract of boiled olive leaves was administered as a drink to malaria patients during the 19th century. Hence, the Mediterranean countries have cultivated the olive tree (Olea europaea L.) to produce olive oil, table olives and olive leaf extracts for centuries. At present, both olive oil and table olives are important components of the Mediterranean diet and are largely consumed throughout the world. In addition, there are many enterprises that commercialize olive leaf extracts to treat a myriad of diseases, many of them caused by microorganisms. Recently, the importance of preventive medicine has been gradually recognized in the field of orthopaedic surgery with a concept that peak bone mass should be increased in childhood as much as possible for the prevention of osteoporosis (Ohtani et al., 2009). The aim of the current study is to explore the antimicrobial activity of olive oil against microbial infections. To achieve the aim of research, the researcher applied the exploratory approach where dozens of relevant studies were reviewed and explored in order to collect the results needed to enrich the discussion within the current study. The results of study indicated the efficiency of antimicrobial activity of olive oil against microbial infections.
... Carotenoids, tocopherols, sterols and chlorophylls are also found in is its composition (1) . Regarding to skin, avocado oil has properties such as antioxidant, anti-aging, anti-inflammatory, and healing (3,4) . Avocado crude oil is more advantageous than refined crude oil in relation to its skin benefits. ...
Introduction:
vegetable ingredients are increasingly common in skin products. Avocado oil is an ingredient of natural sources with various properties on the skin. In this work, crude avocado oil-loaded nanocapsules were evaluated regarding its physicochemical stability to obtain a formulation of skin delivery with adequate quality: suitable physicochemical stability, with low polydispersity and with a pH suitable for cutaneous application.
Method:
nanoparticle formulations with components variation were evaluated for 2 months. Nanoparticle formulation considered the most stable was further evaluated for 6 months. Furthermore, the oxidative stability of crude avocado oil loaded in nanocapsules and standard avocado oil was also performed to detect any sign of oil oxidation.
Results:
all formulations had negative zeta potential after 2 months of storage. pH values of nanoparticles remained stable throughout the test. Formulation with the lowest content of ingredients exhibited the highest stability after 2 months of storage. Nanoencapsulated avocado oil and crude avocado oil showed no evidence of oxidation.
Conclusions:
Aqueous dispersions with the lowest content of ingredients presented the best physicochemical stability. Therefore, we have demonstrated preliminary the feasibility of developing avocado-oil loaded nanocapsules.
... Interestingly, avocado pulp oil has shown a capability to inhibit the enzymes cyclooxygenase-1 (COX-1) and COX-2, similarly to ibuprofen and EVOO, demonstrating its anti-inflammatory capacity (Espinosa-Alonso et al. 2017). In addition, vitamin B12 cream containing avocado oil was well tolerated in the therapy of plaque psoriasis (Stücker et al. 2001). Finally, it has been shown that avocado oil enhances the carotenoid absorption from salads and salsa in humans (Unlu et al. 2005). ...
A substantial change in dietary habits complemented with the consumption of some bioactive compounds, which can be contained in functional foods or nutraceuticals, may constitute an effective way to reduce the incidence of these pathologies. Vegetable and seed oils provide a broad range of components (including micro and macronutrients as well as phytochemicals) that can exert health benefits, related to beneficial bioactivity. This chapter provides a description of the main bioactivities associated with the consumption of some oils. Applications in functional foods include the use of phytosterols, which are naturally contained in vegetable oils and are able to reduce circulating cholesterol levels mainly by reducing its absorption in the gut due to their similar structure. Aside from the bioactive compounds contained in oils and oilseeds, the oil industry generates large amounts of waste that could be potentially recovered and used as valuable dietary components.
... For example, avocado oil could be digested and absorbed efficiently by human body. In addition, it could prevent arteriosclerosis caused by cholesterol accumulation and cerebral mitochondrial dysfunction caused by diabetes [5], and it is also used for skin diseases, such as eczema [6,7]. However, there are certain differences in the oil content of avocados in different verities, origins, and maturities, and there are also certain differences in the avocado oil obtained by different extraction methods [8,9]. ...
To establish a method for fast discrimination of avocado oil for different extracted methods, the headspace-gas chromatography-ion mobility spectroscopy (HS-GC-IMS) combined with principal component analysis (PCA) was used to analyze non-target volatile organic compounds (VOCs). The results showed that 40 VOCs were identified, and the VOCs of the extraction method had a significant difference and had been well distinguished in PCA. The species and content of avocado oil obtained by squeeze method were more than the aqueous methods and supercritical carbon dioxide extraction methods (SC CO2). In addition, the different avocado oil had their characteristic compounds: the 2-acetylthiazole and ethyl propionate were the unique compounds in the avocado oil obtained by SC CO2. A rapid method for the determination of avocado oil obtained by different extraction methods based on HS-GC-IMS had been established, and the method was fast and simple and had a good application prospect in the prediction of avocado oil processing methods.
... Since up to 90% of one dose of systemic vitamin B12 is eliminated by the renal pathway within 48 h and is therefore not available at the skin lesions, Stücker et al [132] considered cutaneous application as the most appropriate way of administration and first carried out a randomized, prospective clinical trial to evaluated the effects of a vitamin B12 cream containing avocado oil in 13 patients against the vitamin D3 analog calcipotriol in an intraindividual right/left-side comparison. After 12 weeks, the PASI score showed no significant differences between the two treatments. ...
Psoriasis is caused by a complex interplay among the immune system, genetic background, autoantigens, and environmental factors. Recent studies have demonstrated that patients with psoriasis have a significantly higher serum homocysteine (Hcy) level and a higher prevalence of hyperhomocysteinaemia (HHcy). Insufficiency of folic acid and vitamin B12 can be a cause of HHcy in psoriasis. Hcy may promote the immuno-inflammatory process in the pathogenesis of psoriasis by activating Th1 and Th17 cells and neutrophils, while suppressing regulatory T cells Moreover, Hcy can drive the immuno-inflammatory process by enhancing the production of the pro-inflammatory cytokines in related to psoriasis. Hcy can induce nuclear factor kappa B activation which is critical in the immunopathogenesis of psoriasis. There may be a link between the oxidative stress state in psoriasis and the effect of HHcy. Hydrogen sulfide (H2S) may play a protective role in the pathogenesis of psoriasis and the deficiency of H2S in psoriasis may be caused by HHcy. As the role of Hcy in the pathogenesis of psoriasis is most likely established, Hcy can be a potential therapeutic target for treatment of psoriasis. Systemic folinate calcium, a folic acid derivative, and topical vitamin B12 have found to be effective in treating psoriasis.
... Avocado pulp oil (Mexican creole genotypes) has shown anti-inflammatory activity by inhibiting the enzymes COX 1 and COX 2 in a similar way to the drug, ibuprofen, and extra virgin olive oil [48]. Additionally, when avocado oil was added to vitamin B12 skin cream preparation, it was well tolerated and had the potential for long-term topical therapy of psoriasis [64]. ...
Avocado oil has generated growing interest among consumers due to its nutritional and technological characteristics, which is evidenced by an increase in the number of scientific articles that have been published on it. The purpose of the present research was to discuss the extraction methods, chemical composition, and various applications of avocado oil in the food and medicine industries. Our research was carried out through a systematic search in scientific databases. Even though there are no international regulations concerning the quality of avocado oil, some authors refer to the parameters used for olive oil, as stated by the Codex Alimentarius or the International Olive Oil Council. They indicate that the quality of avocado oil will depend on the quality and maturity of the fruit and the extraction technique in relation to temperature, solvents, and conservation. While the avocado fruit has been widely studied, there is a lack of knowledge about avocado oil and the potential health effects of consuming it. On the basis of the available data, avocado oil has established itself as an oil that has a very good nutritional value at low and high temperatures, with multiple technological applications that can be exploited for the benefit of its producers.
... Avocado pulp oil (Mexican creole genotypes) has shown anti-inflammatory activity by inhibiting the enzymes COX 1 and COX 2 in a similar way to the drug, ibuprofen, and extra virgin olive oil [48]. Additionally, when avocado oil was added to vitamin B12 skin cream preparation, it was well tolerated and had the potential for long-term topical therapy of psoriasis [64]. ...
Avocado oil has generated growing interest among consumers due to its nutritional and technological characteristics, which is evidenced by an increase in the number of scientific articles that have been published on it. The purpose of the present research was to discuss the extraction methods, chemical composition, and various applications of avocado oil in the food and medicine industries. Our research was carried out through a systematic search in scientific databases. Even though there are no international regulations concerning the quality of avocado oil, some authors refer to the parameters used for olive oil, as stated by the Codex Alimentarius or the International Olive Oil Council. They indicate that the quality of avocado oil will depend on the quality and maturity of the fruit and the extraction technique in relation to temperature, solvents, and conservation. While the avocado fruit has been widely studied, there is a lack of knowledge about avocado oil and the potential health effects of consuming it. On the basis of the available data, avocado oil has established itself as an oil that has a very good nutritional value at low and high temperatures, with multiple technological applications that can be exploited for the benefit of its producers.
... The therapeutic effect of vitamin B 12 cream containing avocado oil (VBAO) on the treatment of plaque psoriasis was reported by Stücker et al. (2001). The effectiveness of VBAO was compared against calcipotriol cream, a common treatment for psoriasis. ...
Avocado oil is growing in popularity as a source of specialty oil with health-promoting properties. Unlike typical fruit oils, avocado oil is extracted from the pulp instead of the seed and can be consumed in its crude form without the necessity of refining. The oil can be graded into extra virgin, virgin or pure, depending on the extraction methods and conditions. Over the last decades, several methods have been developed on avocado oil extraction and these methods are summarized and discussed. The intake of avocado oil is recommended in order to gain the full benefit of essential nutrients and health-promoting minor bioactive lipids that they contain, along with their desirable aroma and taste. Lately, much interest in the health benefits of avocado oil has led to numerous animal and human intervention studies. The therapeutic effects and other issues associated with avocado oil such as oxidative stability, authenticity and toxicity, are also compiled and highlighted.
... 18,19 The use of systemic and topical vitamin B12 for the treatment of psoriasis has been investigated because of the low levels of vitamin B12 found in some patients with psoriasis. 20 In a double-blind, randomized, placebo-controlled trial by Baker and Comaish, 71 patients with psoriasis were given either intramuscular injections of 1,000 µg of vitamin B12 or placebo daily for three weeks. Both groups also used a topical ointment consisting of salicylic acid and liquor carbonis. ...
The use of complementary and alternative medicine has an estimated prevalence of about 51% amongst patients with psoriasis. The relatively lower costs, perceived fewer side effects, and versatile use alone or in combination with standard psoriasis treatments have increased its appeal. Clinical trials and case reports have investigated the use of dietary supplements, herbs, gluten-free diet, acupuncture, psychotherapy, meditation, and hypnosis for the treatment of psoriasis. Fish oil, vitamin D, inositol, curcumin, indigo naturalis, Aloe vera, capsaicin, and Mahonia aquifolium have shown some efficacy in some of the clinical trials covered in this review. Gluten-free diets and the use of meditation and stress-reduction exercises also have shown to help improve the clinical symptoms of psoriasis. Knowledge of these treatments can help dermatologists educate their patients who are interested in alternative remedies for psoriasis.
... (Lauraceae) is a tree popularly known as avocado, native to Central America and cultivated in tropical and subtropical regions (Yasir et al. 2010;Larijani et al. 2010). Avocado oil in nature or in pharmaceutical formulations is effective topically in the wound-healing process (Nayak et al. 2008;Oliveira et al. 2013), skin diseases such as psoriasis (Stücker et al. 2001), and scleroderma (Gaby 2006). The leaves present analgesic activity (Adeyemi et al. 2002;Larijani et al. 2010), including on arthritic pain (Anita et al. 2005), anti-inflammatory and antioxidant (Lee et al. 2012;Wientarsih et al. 2012), and anticonvulsant and antiepileptic (Adisa et al. 2011). ...
Persea americana, popularly known as avocado, has been empirically used as analgesic and anti-inflammatory including in the skin disorder treatment. Species of the genus Persea also show a photoprotective effect against UVB radiation. We investigated the antinociceptive and anti-inflammatory effects from a topical formulation containing the P. americana leaf extract in a UVB irradiation-induced burn model in mice and performed a gel-formulation stability study. The antinociceptive and anti-inflammatory effect was evaluated through mechanical allodynia, paw oedema, and inflammatory cell infiltration. Phenolic compounds were quantified by UHPLC–MS/MS. The gel-formulation stability study was performed analyzing organoleptic characteristics, pH, and viscosity. P. americana (3%) gel was able to prevent the UVB irradiation-induced mechanical allodynia on the 2nd and 3rd day after irradiation with maximum inhibition of 60 ± 12% at 2nd day. Such effect may be attributed, at least in part, due the presence of (+)-catechin (302.2 ± 4.9 μg/g) followed by chlorogenic acid (130 ± 5.1 μg/g) and rutin (102.4 ± 0.9 μg/g) found in the extract. The gel was not able to prevent the inflammatory parameters such as edema and leukocyte infiltration induced by UVB irradiation. No changes important were detected in the stability study, mainly in low temperature. Our results suggest that P. americana gel-formulation, which presented stability, ensuring its quality and the therapeutic effect, could be an interesting strategy for the treatment of the pain associated with sunburn; this effect could be attributed to its biological constituents, especially catechin, chlorogenic acid, and rutin.
Graphical abstract
... Topical vitamin B12 cream was assessed and compared to calcipotriol cream and response assessed by change in PASI score. The vitamin cream showed a slow response and PASI scores were not 55 changed appreciably. More research is needed for the possible 25 use of vitamin B12 in early psoriasis. ...
Psoriasis is a chronic inflammatory disease marked by remissions and exacerbations. The exact etiology is not clear but a mix of genetic and environmental factors is proposed as the cause. The disease is associated with obesity and metabolic syndrome. In these contexts, diet assumes an important role in psoriasis patients. This review aims to discuss the various dietary interventions proposed for the management of psoriasis, the evidence regarding the same and controversies surrounding them. Hypocaloric diet has shown to improve severity of psoriasis of skin and joints. Antibodies to gluten may be seen in otherwise asymptomatic patients of psoriasis and these may benefit from a gluten free diet. Omega-3 fatty acids have shown a strong evidence to be beneficial in several trials. However, the dose and route of administration is yet to be standardized. Amongst the vitamins, vitamin D shows the maximum evidence of benefit, while the role of folate and vitamin B12 needs to be explored further. Same is the case for zinc and selenium. There is evidence of exacerbation of psoriasis with foods such as red meat, eggs and dairy products and those rich in taurine, but the evidence is too scant to advise reduction in intake of these items. Alcohol has been strongly implicated in the initiation and exacerbation of psoriasis. Dermatologists must be aware of these interventions to help their patients make the best choice for dietary modification.
... Since the important renal excretion (nearly 90%) after parenteral administration, vitamin B 12 requires high blood concentrations to reach peripheral targets which can be associated with toxicity. 10 To avoid the possible concentration-related adverse events (AEs), cutaneous application was recently considered the most appropriate way of administration by Stucker et al. 11 The aim of this study was to measure the efficacy of a new topical treatment containing vitamin B 12 (Mavena ® B 12 ointment) in patients suffering from plaque psoriasis. In addition, we evaluated the therapeutic responses and the effects of maintenance treatment thereof in a prospective, intraindividual, right versus left clinical trial, comparing topical vitamin B 12 ointment with a basic moisturizing emollient cream (Cetaphil ® ). ...
Psoriasis is a chronic inflammatory skin disease affecting 2%-3% of the population. The wide range of drugs currently available for its treatment could be associated, in the long term, with organ toxicity and adverse events, thus, clinical monitoring throughout treatment is required. This investigator-initiated trial (IIT) evaluated the efficacy and the safety of a vitamin B12-containing ointment in comparison with glycerol-petrolatum-based emollient cream used twice a day to treat mild-to-moderate plaque psoriasis for a period over 12 weeks followed by a wash-out observation period of 4 weeks. This study was conducted as a randomized, controlled, single-blind, intra-patient left- to right-side trial comparing the efficacy and safety of vitamin B12-containing ointment (M-treatment) with a glycerol-petrolatum-based emollient cream (C-treatment). The Psoriasis Area Severity Index (PASI) was determined at baseline (T0), at time points T2 (14 days), T4 (4 weeks), T8 (8 weeks), T12 (12 weeks) and 4 weeks after the end of the wash-out period (F1). In total, 24 patients with plaque psoriasis were randomized to receive left- or right-side treatment with B12 ointment. From time point T2 to time point F1, there was a statistically significant difference in PASI reduction between M-treatment side and C-treatment side. At time point T 12, the difference between the mean reductions from baseline PASI scores by 5.92 ± 2.49 (87, 6%) in the M-treatment side versus 1.08 ± 1.02 (23, 1%) C-treatment side was statistically highly significant ( PWex < 0.001). On the contemporary panorama in the treatment of psoriasis, we conclude that vitamin B12 ointment will represent a new concrete therapy option and should be considered in the update of therapeutic algorithm for the treatment of psoriasis.
... 10 Cyanocobalamin has been effectively used topically to treat psoriasis, eczema, and AD. [11][12][13] Cyanocobalamin is a nitric oxide (NO) blocker; it neutralizes NO radicals and thus reduces the so-called nitrosative stress, which is responsible for a variety of symptoms and certain skin diseases. NO is especially suspected to be the cause of the irritations and skin changes in eczema and psoriasis. ...
Skin conditions such as psoriasis and eczema negatively impact the patient’s quality of life; the primary goal of topical treatments is to minimize the disease-specific symptoms. This case report discusses the management of two refractory psoriasis skin lesions in an adult male using a topical compounded formula. The psoriasis symptoms were assessed quantitatively using two validated research instruments, the Psoriasis Symptom Inventory, and an adapted Numeric Rating Scale. A qualitative assessment was also performed by evaluating the digital photographs taken by the patient during the course of treatment. The compounded formula containing zinc pyrithione, clobetasol propionate, and cyanocobalamin in the Professional Compounding Centers of America’s proprietary base PCCA XemaTop, applied topically for three weeks, significantly reduced the patient’s self-reported psoriasis symptoms and improved his overall condition by 81.2%. This successful case report is important evidence for healthcare professionals when considering new, innovative topical compounded formulas for managing skin conditions such as psoriasis and eczema.
... The anti-inflammatory activity has been partly attributed to effective inhibition of cytokine TNF-a of the oleic acid in avocado oil on insulin production in rat pancreatic beta cell line INS-1 [7]. Avocado oil interaction with connective tissue metabolism also reflected its anti-inflammatory effect by catabolic activity on collagen in the treatment of atopic dermatitis [57]. The COX inhibitory activities of avocado oils were similar to the ibuprofen-like activity reported for oleocanthal in extravirgin olive oil [58]. ...
Mexico is a major avocado producer and exporter, mainly the Hass variety, while the Mexican creole genotypes remain unexplored. We investigated the physicochemical characteristics, phenolics, and bioactivity of oils from six different Mexican avocado genotypes to increase their consumption and utilization. Oil content varied significantly among Mexican genotypes and increased linearly with dry matter content. Oils from Mexican creole genotypes varied significantly in UV absorbance and generally exhibited low secondary oxidation. Avocado oil displayed two intense fluorescence peaks at 675 and 720 nm (chlorophyll concentration) and two broad bands centered at 465 and 510 nm (oxidation products). The antioxidant activity of avocado oils was independent of total phenolic content and influenced the anti‐inflammatory (COX) activity and selectivity. Three thermal structural transitions occurred in avocado oils between −30 and 20°C. Thermal oxidation by differential scanning calorimetry (DSC) revealed that avocado oils from Mexican genotypes exhibited higher thermal stability than those of Hass. Multivariate data analysis performed on 18 oil characteristics using principal component and cluster analysis demonstrates that fluorescence emission was the major factor segregating Mexican avocado genotypes. Mexican creole avocado is an important beneficial resource for the diversity of its oil quality compared to Hass variety.
Practical applications : Mexican creole avocado oil exhibited superior distinctive physicochemical characteristics than Hass avocado variety. The fluorescence emission can be considered as the predictive attribute to characterize and identify the oil quality and distinguish creole avocado genotypes. Avocado oil from creole genotypes could be an important option to add value to these crop resources, ignored by their delicate post‐harvest management. Cold press avocado oil from creole genotypes provides a distinctive regional origin denomination of gourmet oil, enabling to break its confines by post‐harvest management, simultaneously conserving the huge genetic diversity of this valuable crop.
Mexican creole avocado oils exhibit superior physicochemical characteristics than Hass. Fluorescence emission effectively segregates avocado oil quality by genotypes.
... It is also important to note that the efficacy of some treatments were questionable as randomized clinical trials failed to demonstrate significant improvements in psoriasis patients [15,17]. For example, Stucker et al. treated 13 patients with psoriasis topically with a combination of vitamin B12 and avocado oil, after 12 weeks no statistically significant reduction in PASI scores was observed [33]. ...
Background:
Psoriasis is a frequent skin inflammatory disorder that inflicts millions of patients around the globe. To meet their healthcare needs, patients with psoriasis often seek treatment outside the allopathic paradigm. Use of medicinal plants has emerged as one of the most common and preferred modalities of complementary and alternative medicine (CAM). The aim of this study was to investigate the use of medicinal plants by patients with psoriasis in the West Bank of Palestine.
Methods:
The current study was a questionnaire based cross-sectional descriptive study on the use of medicinal plants by psoriasis patients in the West Bank of Palestine. A sample of 149 patients with psoriasis who were visiting outpatient clinics responded to the questionnaire in face to face interviews.
Results:
Medicinal plants were used by 81 (54.4%) patients with psoriasis. Patients used 33 medicinal plants belonging to 26 families. Plants belonging to Lamiaceae and Leguminosae were the most commonly used by the study patients. Aloe vera, Trigonella arabica, Catharanthus roseus and Anthemis cotula were the most frequently used medicinal plants to treat psoriasis. Leaves and fruits were the most commonly used parts by the study patients. Paste was the most commonly used form of preparation. The use of medicinal plants was significantly associated with age and monthly household income of the patients. Enhancement of immunity, improving conventional therapy and reduction of side effects were the most commonly self-reported reasons for using medicinal plants.
Conclusions:
Patients with psoriasis in Palestine seem to use medicinal plants as a CAM modality to manage their psoriasis. Many medicinal plants were commonly used by patients with psoriasis. More randomized clinical trials are needed to demonstrate safety and efficacy for the majority of these medicinal plants reported to be used by patients with psoriasis in Palestine.
... Although calcipotriol produced rapid improvement, there was no significant difference between both therapies at 12 weeks of treatment and better tolerated. [31] In the Indian set up, dietary supplementation with iron, vitamin B12, and antioxidants might be useful in patients with psoriasis. ...
Psoriasis generally does not affect survival but has significant detrimental effect on quality of life (QOL), which may be comparable to that of ischemic heart disease, diabetes, depression, and cancer. The foremost important thing in the management of psoriasis is counseling of the patient. The clinician needs to be empathetic and spend adequate time with the patient and educating the patient about psoriasis. Clinicians should make it clear to the patient that the primary goal of treatment is control of the disease rather than cure. Eating a balanced and low glycemic diet could be an important adjuvant factor in the prevention and treatment of moderate nonpustular psoriasis. Obese people are more likely to have severe psoriasis and psoriatic arthritis than people with an average body mass index. Dietary supplementation with oily fish, rich in n-3 fatty acids, in psoriasis had shown mixed results in trials. Promising results have been documented for parenteral application of n-3 fatty acid, but not with oral supplementation. Increased smoking or alcohol abuse increases the risk of developing psoriasis and may influence disease severity, and hence must be avoided. Soaking in warm water with bath oil can be done in extensive psoriasis for hydration and emollient effect, and bland soaps or soap substitutes should be used; antiseptics should be avoided as they may irritate the skin. Relatively small, localized patches of psoriasis may improve with occlusion, i.e., waterproof adhesive dressings. The use of emollients is an internationally accepted standard adjunctive to the treatment of psoriasis. Dermatology Life Quality Index is a psychometrically sound and responsive measure of psoriasis-specific outcomes and most comprehensively captures the impact of clinical signs and symptoms on patient's well-being.
... Different studies conducted worldwide have also agreed to the cause of associated hepatotoxicity in pso riasis medications that have been stated more frequently amongst the highly alcohol dependent patient (Gronhoj et al. 2000 andMontaudi et al. 2011). Effect of alcohol dependence on psoriasis patients has elevated alcoholic liver disease, (Tobin & Kirby, 2009) anxiety, depression (Kharaeva et al. 2009), cardiovascular disease (Stücker et al. 2001) and solid tumor risk (Richard et al. 2013). In order to understand whether modi cation of alcohol intake in patients with psoriasis affects disease course or not a systemic study is required. ...
Psoriasis is a common chronic skin disease mediated by Tcell with atypical proliferation of keratinocytes. The in u ence of environment and stress as a cause of psoriasis cannot be undermined. The recent research on diet in psoriasis as cause and cure has gained momentum with several studies correlating it with aetiology and pathogenesis of the disease. Various dietary intolerances have added to the cause and concern of the disease. The alcohol dependence of patients with psoriasis has led to its worsening. Trials on Gluten free diet (GFD) in psoriasis patients has established the reason for its avoidance in the diet, the association between celiac disease (CD) and psoriasis proba bly due to Th1 cytokines is highlighted but in absence of substantial literature cannot be established. Importance of several vitamins and their analogs has also been discussed with insight on vitamin D as a possible medicine in treatment of psoriasis. Likewise, the diet rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) like sh oil was found to improve the clinical condition of patients. The signi cance of antioxidants and antioxidant therapy to remove the toxic waste and its positive impact on patient with psoriasis has been established.
... The oil has also been used for the treatment of skin wounds, stretch marks and psoriasis. It also possess heptoprotective activity [22][23][24][25][26][27][28] . ...
Avocado, also known as the ‘Alligator pear’ is a tropical fruit that has originated from America. The analysis of the fruit constituents reveals that it abounds in various fatty acids, vitamins, carotenoids and other phytochemicals. It is hence a very nutritious food. Avocado oil, extracted from the fruit pulp and seeds also retains most of the nutrients present in the fruit and can be used as an alternate dietary supplement. The extraction and composition of Avocado oil has been discussed. Avocado and its oil possess several salutary properties and hence they have been traditionally used for the treatment of various ailments and disorders. This review highlights and focuses on the important pharmacological activities of this therapeutically important fruit and its oil.
Chronic autoimmune skin disease termed psoriasis is characterised by excessive keratinocyte multiplication, scaly plaques, severe inflammation, and erythema. T lymphocytes, leukocytes, vascular endothelium, and epidermal keratinocytes also contribute in the pathogenesis of psoriasis. Increased leukocyte recruitment and increased levels of cytokines, growth factors, and genetic factors like interleukin (IL)-1, IL-6, IL-17, IL-22, IL-23, tumour necrosis factor (TNF), interferon (IFN), transforming growth factor (TGF), toll-like receptor (TLR)-2, signal transducer and activator of transcription (STAT-3), 15-lipoxygenase (LOX)-2. The most important aspects impacting the treatment of psoriasis are coiled-coil alpha-helical rod protein 1 (CCHCR1), steroidogenic acute regulatory protein (StAR), and vitamin D receptor (VDR). Various synthetic medicinal drugs have also been known to have the side effect of psoriasis. Due to their safety and accessibility, herbal medications may indicate the potential as effective anti-psoriatic agents. Keywords: Psoriasis, Herbal Drug, Silybum marianum, Thespesia populnea, Mahonia aquifolium
Vitamin B12 (cyanocobalamin) deficiency is a widespread condition because of its different aetiologies, like malabsorption syndrome or lifestyles as strict veganism that is increasing its incidence and prevalence in developed countries. It has important haematological consequences that require pharmacological treatment. Current therapy consists of oral or parenteral supplements of cyanocobalamin; however, the oral route is discarded for malabsorption syndrome patients and the parenteral route is not well accepted generally. Topical treatments have been suggested as an alternative, but the molecular weight and hydrophilicity of cyanocobalamin limits its diffusion through the skin. Lipid vesicles can allow the transdermal absorption of molecules >500 Da. The aim of this work was to use different ultraflexible lipid vesicles (transfersomes and ethosomes) to enhance cyanocobalamin transdermal delivery. Vesicles were characterized and lyophilised for long-term stability. The ability to deliver cyanocobalamin through the skin was assessed in vitro using full-thickness porcine skin in Franz diffusion cells. As expected, the best transdermal fluxes were provided by ultraflexible vesicles, in comparison to a drug solution. Moreover, the pre-treatment of the skin with a solid microneedle array boosts the amount of drug that could potentially reach the systemic circulation.
Introduction
Psoriasis is an auto-immune inflammatory skin disease that affects people worldwide. Its topical therapy via different nanoformulations helps in avoiding the long-term side-effects of conventional formulations. Nanocarriers, especially solid lipid nanoparticles (SLNs) and nanostructured lipid carriers (NLCs), pose extra benefits in topical drug delivery due to their lipid constituents. Although both natural and synthetic anti-psoriatic drugs have been successfully incorporated in these nanoformulations, yet further studies including dual drug-loadings are being carried out for assessing their anti-psoriatic efficacy.
Areas covered
This review aims at describing the different aspects of SLNs and NLCs in psoriasis including their skin permeation behavior and the various drug molecules incorporated. The recent studies with single-and dual drug-loaded SLNs and NLCs have also been discussed in the review.
Expert opinion
SLNs and NLCs have been very effective in mitigating psoriasis when compared to commercial formulations. Interestingly, they have also shown promising results when loaded with two drugs, thus overcoming the drawbacks of traditional combination therapy. Therefore, various drug/antibody/siRNA combinations can be selected in the upcoming research works to evaluate their synergistic performance against psoriasis. However, the conclusions drawn so far are only based on the pre-clinical studies and hence further investigations are required to obtain their clinical trial outcomes.
Nutrition and dietary supplements are commonly used in the management of psoriasis; however, evidence of their efficacy is inconsistent. While some dietary interventions have been shown to improve psoriasis consistently, others have little evidence supporting their use. We review common dietary interventions for the management of psoriasis and the evidence behind them. Caloric restriction, especially in overweight and obese individuals, has been shown to consistently diminish psoriatic activity. Evidence about other supplements and dietary interventions is inconsistent. Given the cost and side effects of pharmaceutical treatments for psoriasis, larger, long-term studies on the use of nutrition for the management of psoriasis are necessary.
The skin is the largest organ of the integumentary system with a multifunctional purpose to protect the body from heat and microbes, regulate body temperature, and act as a sensory organ. A topical dosage form applied on the skin will have to cross the stratum corneum, which would then allow the dosage form to traverse the subsequent layers of the skin. The drug with poor solubility and short half‐life would serve as an ideal candidate for its delivery via the transdermal route. This review reports the role of natural oils in enhancing the permeation of drugs through skin as they possess different features like natural origin, favorable penetration enhancement, and partitioning action in the skin. Chemical penetration enhancers have been used widely but are associated with toxicities. Thus, more research should be channelized in the area of extraction of oils from natural sources, along with their active constituents, which can serve as therapeutic alternatives to various disorders and diseases. Natural oils are obtained from leaves, fruits, flowers, seeds, bark, and roots, which have a therapeutic potential as well as penetration enhancing activity. The demerits of oral drug delivery include degradation of drugs in the gastrointestinal tract, addition of taste masking, and coating of tablets, which can be overcome by delivering the drug via the transdermal route. Natural oil contains lipids, flavonoids, and terpenes, which play a significant role in anti‐inflammatory and penetration enhancing activity.
Atopic dermatitis (AD) and psoriasis are the most common chronic inflammatory skin disorders, which importantly affect the quality of life of patients who suffer them. Among other causes, nitric oxide has been reported as part of the triggering factors in the pathogenesis of both conditions. Cyanocobalamin (vitamin B12) has shown efficacy as a nitric oxide scavenger and some clinical trials have given positive outcomes in its use for treating skin pathologies. Passive skin diffusion is possible only for drugs with low molecular weights and intermediate lipophilicity. Unfortunately, the molecular weight and hydrophilicity of vitamin B12 do not predict its effective diffusion through the skin. The aim of this work was to design new lipid vesicles to encapsulate the vitamin B12 to enhance its skin penetration. Nine prototypes of vesicles were generated and characterized in terms of size, polydispersity, surface charge, drug encapsulation, flexibility, and stability with positive results. Additionally, their ability to release the drug content in a controlled manner was demonstrated. Finally, we found that these lipid vesicle formulations facilitated the penetration of cyanocobalamin to the deeper layers of the skin. The present work shows a promising system to effectively administer vitamin B12 topically, which could be of interest in the treatment of skin diseases such as AD and psoriasis.
Introduction: Psoriasis is identified as an inflammatory, chronic, auto-immune disease requiring long-term treatment, imposing an unnecessary burden on the patient. A significant impediment for the treatment of dermatological disorders via transdermal route is the inability of drug molecules to cross the stratum corneum (SC), as the larger size of drug molecules inhibits them to pervade into the skin, thus hampering their absorption. Some drugs exhibit systemic side-effects, which curbs patient compliance, resulting in treatment discontinuation.
Areas covered: This review aims to describe the detailed study such as demographic status, molecular factors of psoriasis, treatment with emerging combination therapy and role of nanotechnology tools in the treatment of psoriasis.
Expert opinion: To overcome problems related to the conventional drug delivery system, several nano-technology based formulations have been devised to enhance bioavailability, drug permeation and accumulation in the skin. Nano-formulations provide better permeation, targeted delivery and enhanced efficacy, thus gaining enormous popularity for cutaneous disorders. This pervasive review provides an overview of the pathophysiology of the disease, its molecular targets and the available herbal, synthetic and combination treatment modalities. The review also systematizes recent works utilizing nano-carriers to improve the treatment denouement of psoriasis.
Cosmetics are applied on skin to enhance the personality, beauty, colour, complexity, tone, texture etc. Maintaining a healthy skin is important for a healthy body. Skin is a protective covering and an attractive feature of the body for both men and women. It forms an important part of personal appearance. There are various cosmetic preparations available in the market like creams, lotions, oils, soaps, gels, moisturizers, etc. These cosmetic can be applied on the skin to enhance beauty and protect the skin from different skin disorders like acne, blackheads, age spots, skin rashes, skin allergy etc. There are also other preparations which include anti-ageing creams, skin whitening agents, gels etc. for protecting the skin from UV radiations, sunscreen lotions and moisturizing creams to protect the skin from different climatic conditions. In the present scenario most of the cosmetics products are adulterated. There are various other cosmetic preparations in the market which are of spurious quality which may produce some side effects like skin rashes, skin allergic reactions and may lead to skin diseases. In this paper we have reviewed different medicinal plants used as cosmetics and these preparations can be used safely without side effects on the skin. In this article a special emphasis has been given to herbal cosmetics because herbals are a part of our life and their uses are increasing day by day all over the world. Scientists are still working on the evaluation of new methods that could increase our knowledge and enable to find new applications for it.
This review summarizes the mechanisms, applications, and adverse effects of colorful dyes, such as Castellani’s paint, gentian violet, and potassium permanganate, as well as two other vibrant topical creams—vitamin B12 and indigo naturalis. Certain dyes such as Castellani’s paint, gentian violet, and potassium permanganate were once commonplace topical therapies for cutaneous infections; these dyes are brightly colored on application and have been suggested to be efficacious and well tolerated through case studies as well as controlled studies. Moreover, topical vitamin B12 and topical indigo naturalis creams for atopic dermatitis and psoriasis have been extensively studied through multiple controlled trials and may also be effective, with minimal adverse effects. Understanding the composition and mechanism of action has helped guide the development of these therapies.
Atopic dermatitis (AD) is a result of complex genetic, epigenetic, environmental, and immunological interactions with an overlapping epidermal barrier defect. The study evaluates the efficacy and tolerability of topical Vitamin B12-barrier cream (MB12) compared with standard glycerol-petrolatum-based emollient cream (GPC) used three times a day for mild AD. The study was conducted as a on one hemi-body randomized, controlled, single-blind, intra-patient left-to-right comparative trial by patients with clinical diagnosis of mild AD measured with total SCORAD index over 4 months. MB12 was compared on one hemi-body treated (GPC). The comparisons of score values were performed primarily by using non-parametric procedures: Mann-Whitney-U test (for independent samples) and Wilcoxon test (for dependent samples). All 22 patients were randomized (left or right side treated with MB12 or GPC). At week 12 a reduction from baseline in SCORAD index was assessed in both body sites with 77.6% SCORAD index reduction in the MB12 treated body sites versus 33.5% in the GPC treated body sites. These results suggest that MB12 could represent a new option in the treatment of mild AD.
Background
Patients with psoriasis often enquire about the use of numerous botanical therapeutics. It is important for dermatologists to be aware of the current evidence regarding these agents. Methods
We conducted a systematic literature search using the PubMed, MEDLINE, and EMBASE databases for controlled and uncontrolled clinical trials that assessed the use of topical botanical therapeutics for psoriasis. The search included the following keywords: ‘psoriasis’ and ‘plant’ or ‘herbal’ or ‘botanical’. We also reviewed citations within articles to identify additional relevant sources. We then further refined the results by route of administration and the topical botanical agents are reviewed herein. ResultsA total of 27 controlled and uncontrolled clinical trials addressing the use of topical botanical agents for psoriasis were assessed in this review. We found that the most highly studied and most efficacious topical botanical therapeutics were Mahonia aquifolium, indigo naturalis, aloe vera, and, to a lesser degree, capsaicin. The most commonly reported adverse effects were local skin irritation, erythema, pruritus, burning, and pain. However, the overall evidence for these therapeutics remains limited in quantity and quality. Conclusion
The literature addresses a large number of studies in regard to botanicals for the treatment of psoriasis. While most agents appear to be safe, further research is necessary before topical botanical agents can be consistently recommended to patients.
Psoriasis is a chronic disease, hereditary, which involves immune-mediated disorder and hyperproliferation of skin cells. Pronounced symptoms of psoriasis are scales and skin debris, silvery scales, red area and flaky skin thickening which appear on legs, knees, elbows, scalp, and back. The exacerbation of psoriasis is triggered by microbial infection, skin injury, drugs, stress, and inflammation. The nutrients for psoriasis therapy are fish oil, vitamin B 12 , vitamin D, vitamin A, selenium, and inositol.
Botanical extracts and single compounds are increasingly used in cosmetics but also in over-the-counter drugs and food supplements. The focus of the present review is on controlled clinical trials with botanicals in the treatment of acne, inflammatory skin diseases, skin infections, UV-induced skin damage, skin cancer, alopecia, vitiligo, and wounds. Studies with botanical cosmetics and drugs are discussed, as well as studies with botanical food supplements. Experimental research on botanicals was considered to a limited extent when it seemed promising for clinical use in the near future. In acne therapy, Mahonia, tea tree oil, and Saccharomyces may have the potential to become standard treatments. Mahonia, Hypericum, Glycyrrhiza and some traditional Chinese medicines appear promising for atopic dermatitis. Some plant-derived substances like dithranol and methoxsalen (8-methoxypsoralen) [in combination with UVA] are already accepted as standard treatments in psoriasis; Mahonia and Capsicum (capsaicin) are the next candidates suggested by present evidence. Oral administration and topical application of antioxidant plant extracts (green and black tea, carotenoids, coffee, and many flavonoids from fruits and vegetables) can protect skin from UV-induced erythema, early aging, and irradiation-induced cancer. Hair loss and vitiligo are also traditional fields of application for botanicals. According to the number and quality of clinical trials with botanicals, the best evidence exists for the treatment of inflammatory skin diseases, i.e. atopic dermatitis and psoriasis. However, many more controlled clinical studies are needed to determine the efficacy and risks of plant-derived products in dermatology. Safety aspects, especially related to sensitization and photodermatitis, have to be taken into account. Therefore, clinicians should not only be informed of the beneficial effects but also the specific adverse effects of botanicals used for dermatologic disorders and cosmetic purposes.
Lemon grass is an aromatic medicinal grass belonging to the genus Cymbopogon. It is prevalent in the semi-temperate and tropical regions of Asian, American and African continents. A strong lemon fragrance, a predominant feature of this grass, is due to the high citral content in its oil. The redolence of the oil enables its use in soaps, detergents and perfumes. It also finds an application in the pharmaceutical industry. A vast array of ethnopharmacological applications of lemon grass exist today. Apart from nutrients such as fats, proteins, fiber and minerals, it also contains various bioactive compounds which may be grouped into alkaloids, terpenoids, flavonoids, phenols, saponins and tannins. The health restorative capacity of lemon grass may be ascribed to the diverse secondary metabolites it produces. This review attempts to give an overall description of lemon grass, highlighting its medicinal properties which make it a potent herb for pharmacognostic applications.
Psoriasis is defined as a chronic autoimmune disease that presents on the skin. Despite being the subject of intensive research over the years, the precise etiology of psoriasis still remains unknown. Immune system dysfunction along with a genetic predisposition is thought to be at the core of the disease process. It presents as thick, scaly plaques and commonly affects the scalp, elbows, knees, arms, stomach, and back. Because of the chronic recurrent nature of psoriasis, medical treatment is a challenge. This article discusses some of the many treatments that are available for the treatment of psoriasis.
Psoriasis is a disease of complex aetiology. Many environmental factors influence its course. Currently applied therapeutic methods have some limitations mainly due to side effects. It has been observed that modified diet has beneficial effect on the course of psoriasis. Temporarily applied low energy diet or even short fasting periods activate certain natural anti-inflammatory mechanisms. Vegetarian diet or low animal-product diet and increased vegetable and fruit consumption cause a decrease in the level of saturated fatty acids and arachidonic acid and simultaneously increase the intake of n-3 polyunsaturated fatty acids. It seems essential for psoriatic patients to have an appropriate serum concentration of vitamin D 3 and calcium. Alcohol intake and cigarette smoking should be restricted, and at the same time increased intake of food rich in antioxidants is recommended. It has been observed that in patients with confirmed gluten intolerance the application of a gluten-free diet can considerably reduce the activity of psoriasis.
What is known and objective:
Anecdotally, topical kunzea oil has been used to treat various skin conditions, including psoriasis and eczema, with good results. This study compared the clinical efficacy of kunzea oil (20%)-containing formulations in mild to moderate psoriasis.
Methods:
A randomized, comparative, double-blind, 8-week study was undertaken. Thirty patients (age range: 25-74 years and mean ± SD: 52·8 ± 13·6 years) with mild to moderate psoriasis (affecting at least 10% of one or more body regions: arms, head, legs and trunk) randomly received ointment and/or scalp lotion containing 20% kunzea oil (test group) or control medications not containing kunzea oil (control group). Formulations in both treatment arms also contained 5% liquor carbonis detergens (LCD) and 3% salicylic acid. The clinical responses to the test and control formulations were evaluated using the Psoriasis Area and Severity Index (PASI).
Results and discussion:
After 8 weeks of treatment, both test and control groups demonstrated a significant (P < 0·05) improvement in PASI scores. Subjects in the test group had a decrease in mean±SD PASI score from 12·7 ± 7·9 to 6·7 ± 7·2, whereas the control group showed a decrease in PASI score from 8·1 ± 4·6 to 3·5 ± 4·7. Comparative efficacy analysis between the test and control groups did not reveal any significant difference (P > 0·05).
What is new and conclusions:
The inclusion of kunzea oil made no difference to the efficacy of topical formulations containing LCD and salicylic acid for the treatment of psoriasis.
Wir untersuchten an unserem stationären Patientenkollektiv, in wieweit die antipsoriatische Wirkung des Dithranols durch Kombination
mit einem externen Retinoidpräparat (Tazaroten) verstärkt werden kann. In einer randomisierten, offenen, prospektiven Studie
untersuchten wir an 50 Psoriatikern (22 Frauen, 28 Männer, PASI>10) die antipsoriatische Effizienz einer externen Dithranol/Retinoid-Kombination
im Vergleich zu einer Dithranol-Monotherapie. Hierbei zeigte sich nach 4 Wochen die Dithranol/Retinoid-Kombination (Kollektiv
2, Rückgang des PASI von 17,2 auf 2,8) der Dithranol Monotherapie (Kollektiv 1, Rückgang des PASI von 18,5 auf 4,8) als signifikant
überlegen. Dieser Unterschied ist bereits nach 1 Woche nachweisbar und läßt sich sonometrisch quantifizieren. Das Irritationspotential
der Kombination (gemessen an einem klinischen Score und an der periläsionalen Hautperfusion mittels Laser Doppler Imaging)
war gegenüber dem monotherapeutischen Dithranolansatz gesteigert. Die antipsoriatische Wirkung von Dithranol läßt sich durch
Kombination mit einem externen Retinoidpräparat (Tazaroten) steigern.
We examined wether it is possible to increase the antipsoriatic action by combining dithranol with a retinoid (tazarotene).
In a randomized, open, prospective study with 50 psoriatic patients (22 females, 28 males, PASI>10) the antipsoriatic effectiveness
of dithranol monotherapy to was compared combined therapy with dithranol and retinoid. The combination dithranol/retinoid
(collective 2, reduction of the PASI from 17,2 to 2,8) revealed a significantly faster healing than the dithranol monotherapy
(collective 1, reduction of the PASI from 18,5 to 4,8). The irritation of the combination therapy as evaluated with clinical
score and laser doppler imaging was increased. Anti-psoriatic effectiveness of dithranol can be increased by combining it
with tazarotene.
A mixture of non-saponifiable fractions of avocado and soya-bean oils was administered percutaneously, for fifteen days, in a 5% dilution in decanol. They resulted in modifications of constituents of connective tissue of the treated skin and in subjacent carrageenan induced granulome. The effect on the granuloma was reduced to an increased total protein content. As for the skin, the effect of the non-saponifiables was different from that induced by the vehicle by an increase of water and lipids and an increased level of soluble proteins, including collagen, as compared to insoluble proteins. The results are in agreement with those obtained using the non-saponifiables taken orally but the effects appear sooner and are localized essentially at skin level.
The experimental work of Robert on the action of the unsaponifiable fractions of the avocado pear and soya bean on inflammatory granulomata of the rat gives rise to the supposition that these have a selective action on inflamed connective tissue by a process of katabolism of collagen through proteolytic enzymes. We have used this anti-inflammatory and collagenolytic action in gynaecology, with favourable results particularly in post-inflammatory and post-infective conditions as well as scarring in the pelvis. The decongesting action of the unsaponifiables of the avocado pear and the soya bean seems also to have a role to play in cellular tissue reactions in the pelvis after cobalt therapy, and in recent retractile scars and in breast inflammations, as well as to prevent scar reactions after operations. Since treatment has to be for a long time and well tolerated, the blood lipids should be estimated as a safety measure. If this is done the unsaponifiables seem to have a place in the treatment of inflammatory conditions in gynaecology.
Recently in Japan, one form of vitamin B12, methylcobalamin also known as methyl B12, has attracted the attention of physicians as a therapy for patients with rheumatoid arthritis. However, its immunological actions in vivo are still unknown. In this study, we induced the in vitro production of such cytokines as interleukin-6 (IL-6), interferon-gamma (IFN-gamma), and interleukin-1 beta (IL-1 beta) by adding various mitogens (phytohemagglutinin:PHA, concanavalin A: ConA, or pokeweed mitogen:PWM) as well as recombinant interleukin-2, and we investigated the effects of methyl B12 (final concentration, 8-8,000 ng/ml) on the production of these cytokines by peripheral mononuclear cells. As compared to the controls, IL-6 production induced by PHA and ConA on Day 4 of the culture was suppressed by an average 60-70% when methyl B12 (80-8,000 ng/ml) was added to the medium. IFN-gamma production decreased dose-dependently with methyl B12, i.e., it decreased to 46% of the control when this production was induced by rIL-2, and decreased to 56-66% when it was induced by mitogens. The effect of methyl B12 on IL-1 beta production on Day I of the culture was small. These findings indicate that methyl B12 suppresses mainly the cytokine production of T lymphocytes. Such suppressive effects as shown in the in vitro situation are expected to be expressed also in vivo in patients with rheumatoid arthritis, especially at articulation lesion sites.
— Skin and serum B:; levels were measured using Lactobacillus leishmanii in 16 non-psoriatic control subjects and in 10 psoriatic patients before and after treatment. There was a significant positive correlation between the B12 levels of the skin and serum of the control group. The B12 level was lower in psoriatic than non-psoriatic skin and active lesions had lower levels than healed lesions. The findings suggest that the increased metabolic activity in psoriatic skin is associated with lowered B12 levels which may precede visible pathological change.
The percutaneous absorption of vitamin Biz by the rat and guinea pig was investigated. Growth experiments in weanling rats indicated that the vitamin was efficiently absorbed in an active form. Studies with "Co-labeled cyanocobalamin dem onstrated that absorption was more efficient from an ethanol solution than from water or dimethyl sulfoxide and was independent of the quantity of vitamin applied to a given area. The skin was found to act as a reservoir absorbing large amounts of cyanocobalamin and releasing it slowly to other tissues. Absorption was similar in the 2 species studied.
Studies were performed using an in vitro assay system to determine whether or not methyl-B12 could affect human T-cell function. When T cells were stimulated with phytohemagglutinin and allogeneic B cells, methyl-B12 did not enhance T-cell proliferation. In contrast, remarkable enhancing effects of methyl-B12 on the proliferative response to concanavalin A (Con A) and autologous B cells at suboptimal concentrations were observed, ranging from 0.1 to 10 micrograms/ml. Concentrations of methyl-B12 sufficient to enhance cellular proliferation were able to enhance the activity of helper T cells for immunoglobulin synthesis of B cells by pokeweed mitogen. Furthermore, the presence of methyl-B12 significantly potentiated the induction of suppressor cells in Con A-activated cultures. These results suggest that methyl-B12 could modulate lymphocyte function through augmenting regulatory T-cell activities.
For objective evaluation of the treatment of psoriasis vulgaris standard techniques are desirable. They should be reproducible, sensitive and non-invasive. In this study non-invasive bioengineering techniques, especially high frequency/high resolution ultrasound for measurement of the healing of psoriasis vulgaris were evaluated. Fifty patients with chronic stationary plaque type psoriasis participated in a prospective study; in each patient two psoriatic plaques were examined by means of sonography, colorimetry and image analysis during treatment until complete resolution had occurred. Skin thickness and density could be quantified by means of high frequency ultrasound. In active psoriatic lesions, an echopoor area underneath the entry echo in the ultrasound image caused by acanthosis and inflammatory infiltrate is typical. Under therapy the thickness of this echopoor area diminishes while its density increases. Intensity of the erythema especially the decrease of erythema through healing could not exactly be quantified with the colorimeter because the 'Lab'-CIE-colour representation system cannot distinguish well enough between the colours red and brown. Image analysis allowed to measure the sizes of the psoriatic plaques and to quantify their resolution under therapy. The measuring of plaque size by the aid of computer based image analysis is possible and useful.
Topical treatment of psoriasis with calcipotriol has been proven effective. The efficacy of calcipotriol has been compared to that of topical corticoids in a number of studies using subjective visual scoring systems such as the PASI index. The purpose of this study was to compare, with objective data, the efficacy of calcipotriol and clobetasol propionate 0.05% in the treatment of plaque type psoriasis. Transepidermal water loss (TEWL) and laser Doppler velocimetry (LDV) were used to monitor restoration of water barrier and normalization of blood flow, respectively, in psoriatic plaques of the limbs of 24 male patients during 3 weeks of treatment. Data were compared to subjective evaluation using the PASI index of the same areas. Significant differences were recorded during treatment in both groups. The results correlated well with the PASI score. Clobetasol was faster in restoring barrier function than calcipotriol. However, no significant differences were detected between the two groups. The use of vitamin analogues may be effective in the topical treatment of psoriasis by normalizing skin biophysical parameters and minimizing the risks of side-effects induced by potent topical corticoids.
One hundred and sixty-eight individuals (psoriatic patients treated with calcipotriol with dermatitis due to calcipotriol, psoriatic patients treated with calcipotriol with no dermatitis, psoriatic patients never treated with calcipotriol, patients with eczema and healthy volunteers) were patch-tested (Finn chambers, back, 48 h) with dilutions of calcipotriol ointment (50, 10, 2, 0.4 micrograms/g) and an ointment vehicle. Test evaluation was based on clinical scoring and various non-invasive measuring methods. Doubtful (?+) and weak (1+) reactions were common, irrespective of patient group and history. Moderate (2+) reactions were uncommon and with no increased frequency among psoriatic patients with adverse dermatitis during calcipotriol treatment. The blood flow of test sites measured by laser Doppler flowmetry was, however, increased in psoriatics, who developed dermatitis during calcipotriol treatment as an isolated finding. Furthermore a 1-week repeated open application test (ROAT) was performed on all subjects. None of the persons having a strong reaction in the patch test showed any dermatitis in the ROAT test, indicating that they were not sensitized. Calcipotriol was found to be a mild irritant of the non-corrosive type, i.e. with no influence on the skin barrier. Reactions were dominated by redness (increased laser Doppler flow and chroma a*) and only oedema formation in advanced reactions. The calcipotriol dose-irritation curve was found to be scattered. Calcipotriol induced no increase of transepidermal water loss (TEWL) versus the ointment vehicle, but the ointment vehicle itself increased TEWL. The special ointment vehicle needed for calcipotriol for stability reasons may itself be irritant and cause some impairment of the skin water barrier, with increase in TEWL values. Future patch test studies for calcipotriol allergy should not be done with this vehicle. The non-irritant threshold concentration of calcipotriol in an appropriate test vehicle is still unknown.
In a randomized study 30 patients with chronic stationary psoriasis were treated with 3 different topical schemes. Group 1 (n = 10) received monotherapy (dithranol (D) twice a day, D/D), group 2 (n = 10) calcipotriol mornings/dithranol evenings (calcipotriol (C)/dithranol (D) C/D) and 3 (mometasone (M) mornings/dithranol (D) evenings, M/D). During the therapy period of 4 weeks we documented the PASI-Score as well as infiltration, erythema and desquamation weekly. The M/D group revealed in the first week a significantly faster reduction of the PASI-score (5.3) than in the D/D group (PASI 13.22). The C/D group (PASI 10.5) show a not significantly faster reduction. After 4 weeks of treatment and after a follow period of 6 weeks there were similar PASI-Scores in all groups. There were less side-effects in the M/D group than in the others. The beginning, more anti-psoriatic effectiveness was achieved by the mometasone/dithranol combination than the other schemes. In the long term, the effects were similar.
Psoriasis is a persistent skin disorder characterized by abnormal keratinocyte differentiation, keratinocyte hyperproliferation, and increased expression of inflammatory markers at the cellular level, leading to erythema, induration, and scaling of the skin. Depending on the severity of the disease, annual outpatient costs range from $1400 to $6600 per patient, totaling $3.2 billion each year in the United States. Because the disease is persistent and progressive, patients receiving a diagnosis of psoriasis early in life can expect to require lifelong care, which translates into lifelong expense. Treatments include topical formulations, systemic therapies, phototherapies, and combination therapies. Of these, topical agents are the first-line treatments, including fluocinonide and other steroids, calcipotriene, and tazarotene, a once-daily retinoid. To establish the relative cost-effectiveness of these drugs (fluocinonide, calcipotriene, and tazarotene), we conducted a pharmacoeconomic study from the perspective of a third-party payer, using a decision-analytic model validated by clinical experts. Data were drawn from a meta-analysis of the contemporary medical literature. Clinical success, clearing, and relapse rates determined the probabilities for therapeutic outcomes and the number of anticipated disease-free days for each study comparator. Costs for physician visits, drug acquisition, laboratory testing, and adverse-events management were added to each branch of the decision tree and multiplied by the appropriate probabilities to establish the expected cost of treatment, stratified by the primary treatment choice. Cost-effectiveness was expressed as the total expected cost of achieving a disease-free day. Tazarotene 0.1% was 16.74% more cost-effective than tazarotene 0.05%, 85.46% more cost-effective than fluocinonide, and 143.75% more cost-effective than calcipotriene. The expected cost of achieving a disease-free day was $49.46 for tazarotene 0.1%, $57.74 for tazarotene 0.05%, $91.73 for fluocinonide, and $120.56 for calcipotriene. Treatment with tazarotene offers an opportunity to reduce the cost of care for patients with mild-to-moderate psoriasis and enhance patient satisfaction by gaining more disease-free days.
The increased number and early activation of cutaneous mast cells is a typical feature of psoriatic inflammation. Interferon-gamma (IFN-gamma) is believed to be one of the important mediators in the cytokine cascade of psoriasis. Human mast cells have been previously reported to release various cytokines upon stimulation including interleukin (IL) -4, IL-5, IL-6, IL-8, IL-13 and tumour necrosis factor-alpha. Here we report that human mast cells synthesize also IFN-gamma at mRNA and protein level and that the number of IFN-gamma producing mast cells is significantly increased in the psoriatic skin. IFN-gamma immunoreactivity in mast cells was demonstrated by staining non-lesional and lesional skin sections from 21 patients with psoriasis. Ten patients with atopic dermatitis (AD) and five healthy persons served as control groups. The percentage (mean +/- SD) of IFN-gamma + mast cells in lesional compared with non-lesional psoriatic skin was 67 +/- 18% vs. 44 +/- 17% (P < 0.0001, paired t-test), respectively, but only 9 +/- 6% vs. 10 +/- 7% in corresponding skin samples of AD. In the skin of healthy controls, only 12 +/- 12% of the mast cells were IFN-gamma +. Using immunoelectron microscopy, we confirmed the ultrastructural localization of IFN-gamma within the granules of mast cells in psoriatic skin. In addition, stimulation of a human mast cell line HMC-1 with phorbol myristate acetate (PMA) (100 nmol/L) for periods of 2-24 h induced expression of IFN-gamma mRNA, which peaked at 24 h. When HMC-1 cells were stimulated with PMA (100 nmol/L) for periods of 0-3 days, the cells released IFN-gamma protein, peaking on day 1. These results provide further evidence for the important role of mast cells in the pathogenesis of psoriasis.
We examined whether it is possible to increase the antipsoriatic action by combining dithranol with a retinoid (tazarotene). In a randomized, open, prospective study with 50 psoriatic patients (22 females, 28 males, PASI>10) the antipsoriatic effectiveness of dithranol monotherapy to was compared combined therapy with dithranol and retinoid. The combination dithranol/retinoid (collective 2, reduction of the PASI from 17,2 to 2,8) revealed a significantly faster healing than the dithranol monotherapy (collective 1, reduction of the PASI from 18,5 to 4,8). The irritation of the combination therapy as evaluated with clinical score and laser doppler imaging was increased. Anti-psoriatic effectiveness of dithranol can be increased by combining it with tazarotene.
Studies about the personality of dermatological patients are numerous. The results are inconsistent and peculiarities of the personality are rarely confirmed. Contrary to the usual procedure, this study asks for the impressions physicians have about their patients.
To elicit associations dependent on a dermatological diagnosis, 27 physicians filled in a three-dimensional differential asking for their impressions about patients with atopic dermatitis, leg ulcer, malignant melanoma, or psoriasis vulgaris in order to quantify these impressions.
The dimension valence (good-bad) did not differ between the groups. The dimensions of excitation (active-passive) and potency (strong-weak) showed the biggest differences between patients with atopic dermatitis and ulcus cruris. The latter get significantly lower values on both dimensions. The correlations between the impression and the duration of employment in dermatology were low.
In our opinion it is necessary to raise the impression of medical personal about their patients because these impressions affect the interaction of the personal with the patient.