[Show abstract][Hide abstract] ABSTRACT: Our aim was to determine whether a regimen of sequential applications of topical corticosteroids and topical tacrolimus would be effective in the treatment of adult atopic dermatitis (AD) and to assess the impact of this regimen on quality of life (QOL). The study regimen consisted of 3 phases. In the induction phase, 20 patients were treated for a 2-week period with application of 0.1% tacrolimus ointment in the morning and application of two corticosteroid ointments in the evening : a very strong ointment for torso and extremities, and a medium-potency ointment for face and neck. In the transitional phase, they were treated for an additional 2 week period with 0.1% tacrolimus ointment twice daily on weekdays and concurrent application of topical corticosteroid ointments and tacrolimus on weekend days. In the maintenance phase, corticosteroid ointments were discontinued and tacrolimus ointment was applied twice daily for an additional 2 week period. The EASI score, severity of pruritus, and sleep disturbance scores, as well as QOL evaluations by DLQI and SF-36 were measured. After 6 weeks, the patients completed a retrospective version of the pretreatment QOL evaluation for analysis of response shift bias. EASI scores and the pruritus and sleep disturbance scores decreased by 2 weeks, and continued improvement was observed throughout the study. On SF-36 and DLQI surveys, the mean QOL scores improved after completion of therapy at week 6. The mean difference between the pretest and the retrospective pretest DLQI scores indicated the presence of a response shift bias. Although this was an uncontrolled and open-label study, we established that a fixed sequential regimen of 0.1% tacrolimus ointment with tapering of topical corticosteroids could maintain clinical control of adult AD and improve the QOL. The finding of a response shift bias suggests that adult AD patients underestimate the seriousness of skin disease and its impact on their QOL.
No preview · Article · Jan 2012 · Nishi Nihon Hifuka
[Show abstract][Hide abstract] ABSTRACT: We performed sequential topical therapy with calcipotriol ointment (Dovonex® Ointment 0.005%) and betamethasone butyrate propionate ointment (Antebate® Ointment 0.05%) for 9 weeks in 19 patients with psoriasis vulgaris (PS) to assess the clinical usefulness of this therapy in terms of the symptom score and quality of life (QOL). During the induction phase of the sequential topical therapy, both drugs were applied twice daily for a two to four-week period. During the following transitional phase, calcipotriol ointment alone was applied on weekdays, while both of these drugs were applied twice daily on weekends for an additional two to four weeks. During the maintenance phase, calcipotriol ointment alone was applied for another two to four weeks. Skin symptoms were assessed using the score of the modified psoriasis area and severity index (PASI) scoring system, which excludes assessment of the face and head from the PASI scoring system, and a visual analog scale (VAS) score reported by the subjects. QOL in PS patients was assessed using the Dermatology Life Quality Index (DLQI Japanese version). The mean modified PASI score was 20.2 at baseline, was reduced by 60% to 8.1 on completion of the induction phase (P<0.01), and subsequently decreased over time to 4.4 on completion of the maintenance phase (a 78% decrease from baseline, P<0.01). The severity of skin lesions and itching measured by VAS also decreased significantly. Total DLQI score was 9.2 at baseline, and was reduced to 3.1 at the completion of observation (P<0.01); in particular, the aspects of symptoms and feelings, daily activities, and leisure were significantly improved (P<0.01). Neither local irritation nor abnormal changes in serum calcium levels were noted. The present study suggested that this sequential topical therapy for psoriasis vulgaris promptly improved skin symptoms, subsequently provided long-term remission, and improved QOL in terms of mentality, daily activities, and behavior.
No preview · Article · Jan 2010 · Nishi Nihon Hifuka
[Show abstract][Hide abstract] ABSTRACT: The involvement of oxidative stress in the pathogenesis of various skin disorders has been suggested for decades. However, few clinical studies have assessed oxidative stress in skin diseases. The easiest and least invasive method to assess oxidative stress in patients may be the measurement of oxidation products in urine.
This study aims to assess oxidative stress in psoriasis and atopic dermatitis patients.
Urine samples were collected from 29 psoriasis patients (25 males and 4 females), 21 atopic dermatitis patients (14 males and 7 females) and 20 healthy controls (16 males and 4 females). The severity and extent of psoriasis and atopic dermatitis was assessed by their area and severity index. We measured nitrate as a metabolite of nitric oxide, malondialdehyde as a major lipid oxidation product, and 8-hydroxydeoxyguanosine (8-OHdG) as a DNA oxidation marker.
Urinary nitrate and 8-OHdG levels, but not malondialdehyde, were significantly higher in psoriasis patients than those in healthy controls. On the contrary, only urinary nitrate level was significantly higher in atopic dermatitis patients than those in healthy controls. The severity and extent of both psoriasis and atopic dermatitis significantly correlated with urinary nitrate level and malondialdehyde level, but it did not correlate with urinary 8-OHdG level.
Measurement of these three urinary oxidative products is non-invasive. Above all, measurement of urinary nitrate may be most useful in the clinical assessment of oxidative stress in both psoriasis and atopic dermatitis patients. There is a possibility that urinary 8-OHdG level may indicate the different pathogenesis between psoriasis and atopic dermatitis.
No preview · Article · Dec 2009 · Journal of the European Academy of Dermatology and Venereology