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Therapeutic effect of hyperbaric oxygen in psoriasis vulgaris: Two case reports and a review of the literature

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  • CEO/Founder - Life Support Technologies group, SVP/Partner - Off-Loading Technologies, Inc.
  • Waili Foundation for Science

Abstract and Figures

Psoriasis is an inflammatory and immunological cutaneous disease. The high morbidity in patients with psoriasis results from severe clinical manifestations and/or adverse effects of treatment. The Undersea and Hyperbaric Medical Society and Federal Medicare and Medicaid Services have approved the use of hyperbaric oxygen (HBO(2)) for more than 15 indications, including wound healing, infections and late effects of radiation, which are largely unresponsive to conventional treatments. Accumulated data show that HBO(2) has anti-inflammatory effects and other positive influences on the immune system, making it a rational treatment in the management of psoriasis plaques and arthritis. We present the cases of two patients with long histories of psoriasis vulgarus who exhibited marked improvement with use of HBO(2.) The first patient was 40 years old and had pustular psoriasis and psoriatic arthritis. He was treated with six sessions of HBO(2) (at 2.8 atmospheres of pressure for 60 minutes), which successfully controlled his symptoms. At the 18-month post-treatment follow up, the patient exhibited complete remission of psoriasis and marked improvement in psoriatic arthritis without medication. The second patient was 55 years old with extensive psoriatic lesions, and exhibited marked improvement within 15 sessions of HBO(2). No adverse effects of HBO(2) were identified. HBO(2) may possess potential therapeutic efficacy in the management of psoriasis. We outline the pathogenesis of psoriasis and the selective anti-inflammatory and immunosuppressive effects of HBO(2). We hope that this will provide a basis for elucidating the mechanisms of action and consequently pave the way for further controlled studies.
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Case report
Open Access
Therapeutic effect of hyperbaric oxygen in psoriasis vulgaris:
two case reports and a review of the literature
Glenn Butler
1
*, Julio Chávarri Michaels
5
, Noori Al-Waili
1,2
,
Michael Finkelstein
3
, Michael Allen
1
, Richard Petrillo
2
, Zev Carrey
2
,
Bangaruraju Kolanuvada
2
, Bok Y Lee
1,4
, Alfonso Gonzales Riera
5
,
Cesar Chávarri Michaels
5
and Gary Urteaga
6
Addresses:
1
Life Support Technologies, The Mount Vernon Hospital, Mount Vernon, NY, USA
2
Department of Medicine, The Mount Vernon Hospital, South Shore Health System, Valley Stream, NY, USA
3
Dr J Beales Chronic Wound Management and Hyperbaric Center, The Mount Vernon Hospital, Mount Vernon, NY, USA
4
Department of Surgery, New York Medical College, New York, USA
5
Lima Center for Hyperbaric Medicine, Peru
6
Corporación Hiperbárica Peruana, Peru
Email: GB* - gjblst@aol.com; JCM - gjblst@aol.com; NAW - drnoori6@yahoo.com; MF - gjblst@aol.com; MA - gjblst@aol.com; RP - zavmd@aol.com;
ZC - zavmd@aol.com; BK - BYLee2100@ aol.co m; BL - zavmd@ao l.com; AGR - gjblst@ aol.com; CCM - g jblst@aol. com; GU - gjblst@aol. com
* Corresponding author
Received: 30 July 2008 Accepted: 23 January 2009 Published: 10 August 2009
Journal of Medical Case Reports 2009, 3:7023 doi: 10.4076/1752-1947-3-7023
This article is available from: http://jmedicalcasereports.com/jmedicalcasereports/article/view/7023
© 2009 Butler et al.; licensee Cases Network Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (
http://creativecommons.org/licenses/by/3.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Introduction: Psoriasis is an inflammatory and immunological cutaneous disease. The high
morbidity in patients with psoriasis results from severe clinical manifestations and/or adverse effects
of treatment. The Undersea and Hyperbaric Medical Society and Federal Medicare and Medicaid
Services have approved the use of hyperbaric oxygen (HBO
2
) for more than 15 indications, including
wound healing, infections and late effects of radiation, which are largely unresponsive to conventional
treatments. Accumulated data show that HBO
2
has anti-inflammatory effects and other positive
influences on the immune system, making it a rational treatment in the management of psoriasis
plaques and arthritis.
Case presentation: We present the cases of two patients with long histories of psoriasis vulgarus
who exhibited marked improvement with use of HBO
2.
The first patient was 40 years old and had
pustular psoriasis and psoriatic arthritis. He was treated with six sessions of HBO
2
(at 2.8
atmospheres of pressure for 60 minutes), which successfully controlled his symptoms. At the 18-
month post-treatment follow up, the patient exhibited complete remission of psoriasis and marked
improvement in psoriatic arthritis without medication. The second patient was 55 years old with
extensive psoriatic lesions, and exhibited marked improvement within 15 sessions of HBO
2
.No
adverse effects of HBO
2
were identified.
Conclusions: HBO
2
may possess potential therapeutic efficacy in the management of psoriasis. We
outline the pathogenesis of psoriasis and the selective anti-inflammatory and immunosuppressive
effects of HBO
2
. We hope that this will provide a basis for elucidating the mechanisms of action and
consequently pave the way for further controlled studies.
Page 1 of 5
(page number not for citation purposes)
Introduction
Psoriasis is a chronic, remitting and relapsing, immune-
mediated inflammatory skin disorder with a strong genetic
predisposition. It is among the most common immune-
mediated diseases in humans, affecting 2.6% of the US
population, and has significant social and economic
impact. Current topical therapies used to manage psoriasis
include steroids, vitamin D derivatives, retinoids, immu-
nosuppressants, anthralin, coal tar ointment, and several
other agents [1-5]. These drugs often have adverse effects
that may be poorly tolerated. Light therapy includes
ultraviolet B phototherapy or psoralen and ultraviolet
A (PUVA) photochemotherapy. However, increased
rates of nonmelanoma skin cancer have been observed
following PUVA therapy [6]. Systemic therapies for
psoriasis include methotrexate, cyclosporine, oral reti-
noids, and biologic therapies. A recent report reviewed the
effectiveness and safety of the biologics alefacept, efalizu-
mab, etanercept, and infliximab [7]. In addition to the
reported adverse effects of the drugs, it was found that up
to 40% of patients did not use their medication as
directed.
Hyperbaric oxygen (HBO
2
) treatment is defined as
breathing pure (100%) oxygen under conditions of
increased atmospheric pressure. This results in elevated
arterial oxygen tension to 2,000 mmHg or greater, which
provides tissues with abundant oxygen. Possible compli-
cations of HBO
2
therapy include barotrauma, oxygen
toxicity (affecting the central nervous system and lungs),
claustrophobia and anxiety, and ocular effects such as
myopia and cataract. HBO
2
promotes proliferation of
fibroblasts, epithelial cells, and blood vessels in a wound.
It can increase the killing ability of leukocytes and is lethal
to certain anaerobic bacteria. Furthermore, it inhibits toxin
formation by certain anaerobes, increases the flexibility of
red cells, reduces tissue edema, and conserves intracellular
ATP.
The Undersea and Hyperbaric Medical Society and the
Federal Center for Medicare and Medicaid Services have
approved the use of HBO
2
in 14 indications including gas
gangrene, necrotizing soft-tissue infections, diabetic foot
ulcer, compromised grafts and flaps, bone infection,
intracranial abscess, anemia and blood loss, crush injury,
carbon monoxide and c yanide poisoning, ra diation
complications, decompression sickness, and gas embo-
lism. HBO
2
has potential effects on mediators of
inflammation and the immune response. Our recent
reviews [8,9] support the contention that HBO
2
has anti-
inflammatory and immunosuppressive properties. These
properties mak e this tr eatment a p otentially useful
intervention that should be tested in the management of
psoriasis and psoriatic arthritis.
Case presentation
Case 1
A 40-year-old man with dissemi nated erythrodermi c
psoriasis with pustules presented with arthralgias. He had
a history of psoriasis vulgaris from infancy, diagnosed by
skin biopsy, and had been followed by dermatologists. He
had also had psoriatic arthritis since childhood. Physical
examination revealed erythematous scaly plaques on his
elbows, trunk and umbilical area, perineum and legs
(Figure 1). He had interphalangeal distal joint involvement
and spondylitis. His medical history was uneventful, with
no evidence of underlying systemic disease and he was not
taking any medications at the time of presentation.
He requested a hyperbaric consultation after reading a
newspaper article reporting on the use of HBO
2
to treat
psoriasis in a study conducted in Cuba. At the hospital he
was evaluated to determine whether he was a suitable
candidate for HBO
2
therapy. After he had given informed
consent, he underwent HBO
2
therapy at 2.8 atmospheres for
60 minutes, once a day (5 days per week). The patient
underwent a total of eight sessions, resulting in significant
amelioration of symptoms (Figure 2). The patient did not
receive any topical treatment before or during HBO
2
therapy.
Most of the psoriatic lesions were cleared, with marked
reduction in i tching and scaling. No side effect was
reported with the use of HBO
2
. The patient also reported
less pain in his hands and joints after the eight sessions of
HBO
2
. Follow up at 18 months revealed that the patient
had only mild skin symptoms with degenerative changes
of the arthritis.
Case 2
A 55-year-old man was referred for HBO
2
for management
of chronic bilateral leg ulcers and osteomyelitis. In
addition, he had extensive psoriasis vulgaris (Figure 3).
He had a long history of psoriasis vulgaris, which had been
diagnosed by skin biopsy and followed by a dermatolo-
gist. His current medications at the time of admission to
the hyperbaric department were topical m ineral oil,
Eucerin Calming Creme, and diphenhydramine 50 three
times a day. He had erythema, and his skin was scaling and
itching.
He underwent daily HBO
2
at 2 atmospheres for 90
minutes, once a day (5 days per week). After six sessions
his erythema, scaling and itching were reduced in severity,
and after 15 sessions he had improved further (Figure 4).
No adverse effect was reported with the use of HBO
2
.
Discussion
The results presented here demonstrate the effectiveness of
HBO
2
in alleviating signs and symptoms of psoriasis in
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Journal of Medical Case Reports 2009, 3:7023 http://jmedicalcasereports.com/jmedicalcasereports/article/view/7023
two patients. No adverse effects were reported during or
after treatment with HBO
2
.
Leukocytes, cytokines, and keratinocyte growth or differ-
entiation abnormalities are involved in psoriatic skin
lesions. Psoriasis vulgaris is a T-cell-driven disease, with
type I (interferon-ү-producing) T cells predominating in
skin lesions [10,11]. A lymphocytic infiltrate in psoriasis
plaques consists of a mixture of activated CD4
+
and CD8
+
T cells; the latter predominate in lesional epidermis and
CD4
+
cells in the dermis [12]. The therapeutic benefit of
immunosuppressive drugs supports the view that activated
T cells are pathogenic effectors of psoriasis [10]. Dendritic
cells are found in psoriatic skin lesio ns, producin g
interleukin (IL)-12 and IL-23. Cytokine changes in
psoriatic lesions consist of elevated levels of interferon-ү,
tumor necrosis factor (TNF)-a, numerous interleukins
(such as IL-1, IL-2, IL-6, IL-8, IL-12, IL-17, and IL-19),
and multiple chemokines (MIG/CXCL9, IP-10/CXCL10,
I-TAC/CXCL11, and MIP3a/CCL20) [11]. IL-12 p40
mRNA and expression of interferon-ү, inducible nitric
Figure 2. Patient 1 after treatment with hyperbaric oxygen
(Front View).
Figure 3. Patient 1 before treatment with hyperbaric oxygen
(Back View).
Figure 4. Patient 1 after treatment with hyperbaric oxygen
(Back View).
Figure 1. Patient 1 before treatment with hyperbaric oxygen
(Front View).
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Journal of Medical Case Reports 2009, 3:7023 http://jmedicalcasereports.com/jmedicalcasereports/article/view/7023
oxide synthase, B7-1, and TNF-a are elevated in psoriatic
tissue [11]. A rheumatoid-like pattern has been identified
as one of the most common types of psoriatic arthritis.
Autoantibodies directed against nuclear antigens, cytoker-
atins, epidermal keratins, and heat shock proteins have
also been reported in psoriatic arthritis.
HBO
2
suppresses the proliferation of macrophages and
the formation of foam cells in atherosclerotic lesions [12].
HBO
2
also intensifies the suppressive function of T
lymphocytes, normalizes cell-bound immunity, and
decreases the serum concentration in immune complexes
[13]. The immunosuppressive effects of HBO
2
include
suppression of autoimmune symptoms, decreased pro-
duction of IL-1 and CD4
+
cells, and increased percentage
and absolute number of CD8
+
cells [9]. In addition, long-
term HBO
2
exposure suppresses development of auto-
immune symptoms such as proteinuria, facial erythema,
Figure 6. Patient 2 after treatment with hyperbaric oxygen
(Side View Torso).
Figure 8. Patient 2 after treatment with hyperbaric oxygen
(Side View Legs).
Figure 5. Patient 2 before treatment with hyperbaric oxygen
(Side View Torso).
Figure 7. Patient 2 before treatment with hyperbaric oxygen
(Side View Legs).
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Journal of Medical Case Reports 2009, 3:7023 http://jmedicalcasereports.com/jmedicalcasereports/article/view/7023
and lymphadenopathy. HBO
2
decreases the CD4:CD8
ratio and proliferation of lymphocytes, and activates
neutrophils to migrate to regions of high oxygen tension
[14]. HBO
2
suppresses TNF-a production induced by
lipopolysaccharide, lipid A, and phytohemagglutinin A
[15]. A marked decrease in IL-1 and IL-2 production, and a
significant decrease in prostaglandin E
2
production have
been observed.
The positive clinical effects that HBO
2
has in the treatment
of chronic inflammation may relate to its effects on
secretion of IL-1, IL-6, and TNF-a. The effects of HBO
2
on
prostaglandin, nitric oxide, and cytokines involved in
wound pathophysiology and inflammation in particular
were recently reviewed [8]. That review indicates that
HBO
2
has important effects on the biology of cytokines
and other medi ators of inflammation. HBO
2
causes
downregulation of cytokines and upregulation of growth
factors. It transiently suppresses stimulus-induced proin-
flammatory cytokine production and affects the liberation
of TNF-a and endothelins. Vascular endothelial growth
factor levels are significantly increased with HBO
2
therapy,
whereas levels of prostaglandin E
2
and cyclo-oxygenase-2
mRNA are markedly reduced. Therefore, the anti-inflam-
matory and immunosuppressive properties of HBO
2
might account for its efficacy in the cases presented here.
Conclusions
Our case reports, although suggestive, do not allow one to
conclude that HBO
2
treatment is useful in the treatment of
psoriasis, because this condition can improve sponta-
neously. We emphasize that the findings presented here
require confirmation by further controlled studies before a
definitive conclusion may be drawn. We hope that our
findings will also stimulate further investigation of the
therapeutic potential of HBO
2
alone or in combination
with other modalities such as phototherapy in psoriasis.
HBO
2
therapy may have a place in the management of
psoriasis. Further studies including large numbers of
patients and involving monitoring cytokines and inflam-
matory mediators will help us to explore the effect of
hyperoxygenation on psoriasis and to elucidate its
mechanism of action.
Abbreviations
HBO
2
, hyperbaric oxygen; IL, interleukin; PUVA, psoralen
and ultraviolet A; TNF, tumor necrosis factor.
Competing interests
The authors declare that they have no competing interests.
Consent
Written informed consent was obtained from the patient
for publication of this case report and any accompanying
images. A copy of the written consent is available for
review by the Editor-in-Chief of this journal.
Authors contributions
GB conceived of the report and participated in its writing.
NA-W conceived of the report, and conducted work and
writing. RP, ZC, BK, MF, MA, and BL were involved
in writing the Discussion. JM conceived of the report
and conducted work. GU conceived of the report and
conducted work. CM conceived of the report and conducted
work. AR conceived of the report and conducted work. All
authors read and approved the final manuscript.
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... Meanwhile, many studies reported the therapeutic or preventive effect of HBOT in various kinds of inflammatory or immune-mediated diseases, such as systemic lupus erythematosus [27,28], atherosclerosis [29], collagen-induced arthritis [30], Crohn's disease [31], ulcerative colitis [32,33] and atopic dermatitis [34], although these diseases are not included in the current indication of HBOT. In particular, Butler et al. (2009) reported successful treatment of two severe cases of psoriasis vulgaris by HBOT [35]. Inflammatory and antiinflammatory cytokines have been investigated in several studies [29], but the therapeutic mechanism of HBOT in immunemediated diseases still remains enigmatic. ...
... Meanwhile, many studies reported the therapeutic or preventive effect of HBOT in various kinds of inflammatory or immune-mediated diseases, such as systemic lupus erythematosus [27,28], atherosclerosis [29], collagen-induced arthritis [30], Crohn's disease [31], ulcerative colitis [32,33] and atopic dermatitis [34], although these diseases are not included in the current indication of HBOT. In particular, Butler et al. (2009) reported successful treatment of two severe cases of psoriasis vulgaris by HBOT [35]. Inflammatory and antiinflammatory cytokines have been investigated in several studies [29], but the therapeutic mechanism of HBOT in immunemediated diseases still remains enigmatic. ...
... Actually in the present study, we demonstrated that HBOT attenuated a murine model of PD. Successful treatment of human cases of psoriasis vulgaris by HBOT has been also reported [35]. Photo(chemo)therapy has been used for a long time for the treatment of psoriasis, but the exact mechanism of action has not yet been clear. ...
Article
Full-text available
Psoriasis is a chronic inflammatory skin disease resulting from immune dysregulation. Regulatory T cells (Tregs) are important in the prevention of psoriasis. Traditionally, reactive oxygen species (ROS) are known to be implicated in the progression of inflammatory diseases, including psoriasis, but many recent studies suggested the protective role of ROS in immune-mediated diseases. In particular, severe cases of psoriasis vulgaris have been reported to be successfully treated by hyperbaric oxygen therapy (HBOT), which raises tissue level of ROS. Also it was reported that Treg function was closely associated with ROS level. However, it has been only investigated in lowered levels of ROS so far. Thus, in this study, to clarify the relationship between ROS level and Treg function, as well as their role in the pathogenesis of psoriasis, we investigated imiquimod-induced psoriatic dermatitis (PD) in association with Treg function both in elevated and lowered levels of ROS by using knockout mice, such as glutathione peroxidase-1-/- and neutrophil cytosolic factor-1-/- mice, as well as by using HBOT or chemicals, such as 2,3-dimethoxy-1,4-naphthoquinone and N-acetylcysteine. The results consistently showed Tregs were hyperfunctional in elevated levels of ROS, whereas hypofunctional in lowered levels of ROS. In addition, imiquimod-induced PD was attenuated in elevated levels of ROS, whereas aggravated in lowered levels of ROS. For the molecular mechanism that may link ROS level and Treg function, we investigated the expression of an immunoregulatory enzyme, indoleamine 2,3-dioxygenase (IDO) which is induced by ROS, in PD lesions. Taken together, it was implied that appropriately elevated levels of ROS might prevent psoriasis through enhancing IDO expression and Treg function.
... In the research by Kim et al. 44 , it was shown that, as in the case of AD, modulation of T reg regulatory T lymphocyte activity is a key issue in the treatment of autoimmune psoriatic disorders. The effectiveness of HBOT in this disease is confirmed in the study by Butler et al. 45 . In the first patient suffering from pustular psoriasis and arthritic psoriasis, the use of HBOT (60 minutes, 2.8 ATA) after 6 sessions -resulted in reduction of itching, and after 8 sessions -reduction of joint pain. ...
... The second patient suffering from psoriasis vulgaris manifested in skin erythema, itching sensation and bilateral leg ulceration, experienced a significant relief of itching and a reduction in the intensity of erythema after 6 HBOT sessions (90 minutes, 2 ATA). No side effects were reported in any of the patients 45 . ...
Article
Full-text available
Introduction: Hyperbaric oxygen therapy (HBOT) involves the use of 100% pure oxygen in conditions of increased pressure, exceeding atmospheric pressure. This allows the supply of several times more oxygen to the internal organs and blood serum than when using standard pressure. HBOT has proven to support the treatment of autoimmune skin diseases, complications of metabolic diseases and burns, as confirmed by clinical studies. In addition, this therapy can also be used to improve the physiological condition of the skin after cosmetology procedures. Objectives: The aim of this work is to review information on the therapeutic effects of hyperbaric oxygen therapy in the treatment of skin diseases, especially atopic dermatitis, psoriasis, diabetic foot, 2nd-degree burns and complications following cosmetic procedures. Method: The review was based on the works published in the last 20 years (1999-2019), available in the following databases: PubMed, Google Scholar and PEDro. Results and conclusions: The use of HBOT is becoming more common in the treatment of skin complications related to diabetes, as well as burn wounds. It is estimated that HBOT reduces the risk of foot ulcers and amputation in diabetic foot syndrome. In addition, HBOT promotes faster healing of burn wounds, also with the use of allogenic skin grafts. By increasing the level of reactive oxygen species (ROS), hyperbaric oxygen therapy significantly supports the treatment of psoriasis and atopic dermatitis. Despite this, the exact mechanisms of hyperbaric oxygen are still poorly understood, and the use of HBOT in the treatment of skin diseases has not yet been included in treatment protocols.
... Similarly, currently presented results indicate both a beneficial therapeutic effect, manifested by a subjective and objective improvement of the clinical condition of the patients, as well as an inhibitory effect on the dynamics of changes in the tested laboratory parameters, particularly immunoglobulin E and C3 complement component. Furthermore, these observations are consistent with the findings of other researchers dealing with the use of hyperbaric oxygenation as a therapeutic option for other groups of diseases associated with an immune activation and inflammatory cascade [11,15,16,17,18,19,20,21]. ...
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The paper discusses the treatment results of ten patients with severe atopic dermatitis (AD) who did not respond to standard pharmacotherapy and underwent hyperbaric oxygen therapy (HBOT). Each patient was subject to 10 oxygen exposures at pO2 2.5 ATA (~ 250 kPa) with the duration time of 60 minutes. In the period of implementation of the hyperbaric procedures the general treatment plan was suspended for all patients while maintaining typical local treatment. Clinical evaluation was performed in the study group as well as determination of levels of immunoglobulins: IgA, IgG, IgM and IgE and C3 and C4 complement. All patients indicated clinical improvement and a decreased IgE immunoglobulin and complement C3 level upon the completion of the exposure cycle. Taking into account the authors’ own observations and data from literature, an overall improvement in the clinical status and a decrease in the level of immunoglobulin E and C3 complement following a cycle of exposures may be indicative of an immunomodulating HBOT effect on AD, whereas hyperbaric oxygenation may constitute a therapeutic option for some patients with AD, especially those exhibiting a poor response to standard treatment.
... Furthermore, HBO 2 treatment alone did not change the expression of proinflammatory cytokines in the colon, MLN, or spleen of the control mice; however, DSSinduced colitis resulted in a significant IL-1 and IL-6 gene upregulation in the colonic tissue and IL-2 gene upregulation in the MLN ( Figure 5). Consistent with previous studies, HBO 2 treatment abolished these effects, further confirming its anti-inflammatory potential [47][48][49]. ...
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Reactive oxygen species (ROS) and nitrogen species have an indispensable role in regulating cell signalling pathways, including transcriptional control via hypoxia inducible factor-1 α ( HIF-1 α ). Hyperbaric oxygenation treatment (HBO 2 ) increases tissue oxygen content and leads to enhanced ROS production. In the present study DSS-induced colitis has been employed in BALB/c mice as an experimental model of gut mucosa inflammation to investigate the effects of HBO 2 on HIF-1 α , antioxidative enzyme, and proinflammatory cytokine genes during the colonic inflammation. Here we report that HBO 2 significantly reduces severity of DSS-induced colitis, as evidenced by the clinical features, histological assessment, impaired immune cell expansion and mobilization, and reversal of IL-1 β , IL-2 , and IL-6 gene expression. Gene expression and antioxidative enzyme activity were changed by the HBO 2 and the inflammatory microenvironment in the gut mucosa. Strong correlation of HIF-1 α mRNA level to GPx1 , SOD1 , and IL-6 mRNA expression suggests involvement of HIF-1 α in transcriptional regulation of these genes during colonic inflammation and HBO 2 . This is further confirmed by a strong correlation of HIF-1 α with known target genes VEGF and PGK1 . Results demonstrate that HBO 2 has an anti-inflammatory effect in DSS-induced colitis in mice, and this effect is at least partly dependent on expression of HIF-1 α and antioxidative genes.
... HBOT is also effective for gas gangrene, anaerobic infection, diabetic foot, Buerger's disease and other oxygen-deficient conditions [27,28]. Other than the current indications, many inflammatory or immune-mediated diseases were reported to be successfully treated by HBOT, implying immunomodulatory effects of HBOT [29][30][31][32][33][34][35][36][37]. Inflammatory and anti-inflammatory cytokines have been investigated in several studies, but the therapeutic mechanism of HBOT in immune-mediated diseases is not well-understood [31]. ...
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Atopic dermatitis (AD) is a chronic inflammatory skin disease resulting from excessive stimulation of immune cells. Traditionally, reactive oxygen species (ROS) have been implicated in the progression of inflammatory diseases, but several opposing observations suggest the protective role of ROS in inflammatory disease. Recently, we demonstrated ROS prevented imiquimod-induced psoriatic dermatitis through enhancing regulatory T cell function. Thus, we hypothesized AD might also be attenuated in elevated levels of ROS through tissue hyperoxygenation, such as by hyperbaric oxygen therapy (HBOT) or applying an oxygen-carrying chemical, perfluorodecalin (PFD). Elevated levels of ROS in the skin have been demonstrated directly by staining with dihydroethidum as well as indirectly by immunohistochemistry (IHC) for indoleamine 2,3-dioxygenase (IDO). A murine model of AD was developed by repeated application of a chemical irritant (1% 2,4-dinitrochlorobenzene) and house dust mite (Dermatophagoide farinae) extract on one ear of BALB/c mice. The results showed treatment with HBOT or PFD significantly attenuated AD, comparably with 0.1% prednicarbate without any signs of side effects, such as telangiectasia. The expressions of interleukin-17A and interferon-γ were also decreased in the AD lesions by treatment with HBOT or PFD. Enhanced expression of IDO and reduced level of hypoxia-inducible factor-1α, in association with increased frequency of FoxP3+ regulatory T cells in the AD lesions, might be involved in the underlying mechanism of oxygen therapy. Taken together, it was suggested that tissue hyperoxygenation, by HBOT or treatment with PFD, might attenuate AD through enhancing skin ROS level.
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Mild to moderate psoriasis is a disease that can often be treated with topical medications. The diversity of topical therapies and their disparate side effects complicates treatment planning. Our purpose is to compare the rates of adverse events associated with different topical psoriasis treatments. A review of medical literature from 1996 to March, 2002 was conducted using guidelines set by QUORUM statement criteria. In monotherapy studies, corticosteriods caused fewer adverse reactions compared to vitamin D analogues and tazarotene. In combination studies adverse event rates were higher than in monotherapy studies, except for the combination of topical steroid and calcipotriene which decreased irritation. Irritant contact dermatitis was the main side effect with vitamin D analogues, tazarotene, dithranol or coal tar, while side effects of topical corticosteriods included headache, viral infection and skin atrophy. Topical agents for psoriasis are usually well-tolerated without severe side effects. Formulating a patient's medication regimen should take into account the needs for short-term management and long-term control of psoriasis. Since clearance is not a realistic expectation, reasonable goals should be set as excessive use of topical treatments may increase the risk of both cutaneous and systemic side effects.
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Tazarotene in a gel formulation is widely used in the treatment of psoriasis. To determine the efficacy and safety of tazarotene 0.1% and 0.05% creams in the treatment of psoriasis. A total of 1303 patients participated in 2 clinical trials. Patients applied tazarotene creams 0.1% and 0.05% or vehicle once daily to all psoriatic lesions for 12 weeks followed by a 12-week posttreatment period. Both creams were significantly more effective than vehicle on the basis of an overall assessment of psoriasis, a global response to treatment, and reduction in plaque elevation and scaling. Therapeutic effect was maintained during the posttreatment period. Common adverse events included signs and symptoms of skin irritation. Tazarotene creams were associated with significant reductions in the severity of the clinical signs of psoriasis and were found to be safe with acceptable tolerability. Tazarotene cream 0.1% was generally more effective, although slightly less well tolerated, than the 0.05% cream.