[Show abstract][Hide abstract] ABSTRACT: In order to evaluate the effect of Cyclosporin–A (CyA) at doses of 5 mg/kg per day in atopic dermatitis we studied clinical effects, immunoglobulin production, lymphocytes subset, immunphenotype and local cytokine production in seven patients before and after 3 months CyA therapy. Clinically CyA was very effective in eliminating pruritus, erythema and vescicles with no significant adverse side effects. Using flow cytometric analysis we demonstrated that CyA treatment restored an overexpression of circulating CD25-positive cells. Similar results have been recorded with HLA-DR expression. CyA normalized the number of CD29 cells which were reduced in the blood of patients before starting treatment. Furthermore, after treatment, several cytokines (IL-2, IL-1 and IL-1β) had diasappeared from the epidermis.
No preview · Article · Jul 2006 · Journal of the European Academy of Dermatology and Venereology
[Show abstract][Hide abstract] ABSTRACT: Blood lymphocyte subset evaluation was performed before after oral challenge with 10 mg of Ni, in 9 healthy women and in 15 allergic to Ni. Following challenge, 7 allergic showed a flare up of eczema and/or urticaria. In the controls, CD4+ lymphocytes were modified 24 hours after Ni challenge: CD4+/CD44RO- "virgin" cells were reduced while CD4+/CD45RO+ "memory" cells increased. The allergic women, not sensitive to oral Ni, showed an increase of B lymphocytes after the test. On the contrary, the oral Ni reacting patients presented a reduction of monocytes 4 hours after Ni ingestion and marked reduction (ranging from 20 to 50%) of T and B lymphocytes after 24 hours. These significant T and B lymphocytes changes suggest a migration of the cells in peripheral tissues, likely skin and GUT mucosa.
No preview · Article · Jan 1997 · Giornale italiano di medicina del lavoro ed ergonomia
[Show abstract][Hide abstract] ABSTRACT: Effective treatment is not currently available for suppressing the recurrence of genital herpes simplex virus (HSV) infections. Since intravenous immunoglobulins (IVIG) proved useful against HSV in experimental models, we treated patients with very high frequency of HSV genital recurrences (more than 15 episodes per year) with IVIG (400 mg/Kg every fourth week). The control group was treated with intermittent oral acyclovir (800 mg twice a day for one week every month). Both groups were treated for six months and, then, patients were followed-up to further six months. Both IVIG and acyclovir were effective in reducing the frequency of HSV genital recurrences as compared to base-line. However, patients treated with IVIG had a more striking reduction in the frequency of recurrences as well as both a shorter mean duration and a minor severity of the lesions as compared to acyclovir-treated patients. Furthermore, we found a trend indicating IVIG as more effective in reducing the viral load. Since in IVIG-recipients we found a strong increase of peripheral blood lymphocytes with natural killer (NK) surface phenotype, we suggest that the clinical effectiveness of IVIG treatment is probably mediated via the expansion of NK cell populations. Our study indicates that the treatment with IVIG is an effective and safe tool for suppressing the recurrences of genital HSV infections.
No preview · Article · Mar 1995 · Immunopharmacology and Immunotoxicology
[Show abstract][Hide abstract] ABSTRACT: The study concerns the histological and immunohistochemical findings of the gastrointestinal mucosa of 20 patients (group A) suffering from contact allergic dermatitis (CAD) to Ni, with symptom recrudescence due to food ingested Ni. Results were compared with those observed in 20 patients suffering from CAD to Ni (group B), without sensitivity to food ingested Ni, and in 20 normal subjects (controls). The sensitivity to food ingested Ni, as suggested by history, was demonstrated by placebo-controlled oral-Ni challenge. The biopsies for histological and immunohistochemical study were performed during endoscopy and obtained from the antrum and from the duodenal mucosa. In the biopsies obtained from 16 of group A patients there was evidence of inflammatory infiltrate of lymphocytes and plasma cells with oedema and vasodilation in the lamina propria. Slight flattening of the villi and enlongation of the crypts were concomitant. These findings were light in the 4 patients of group A and in 11 of group B and instead were absent in the remaining group B patients and in the controls. Immunohistochemically, lymphocytes in the lamina propria were prevalently CD20 + (B cells) and CD4 + (Th cells), some were CD45RO + (memory) and finally few CD8 + (Tc/s cells). CD45RO + cells was found in cluster in patients of group A and in 4 of group B, whereas in the others were isolated. Since some studies have shown that immunological pattern of skin reaction to Ni is characterized by increased CD45RO + cells, it may be hypothesized that in patients suffering from CAD to Ni, the sensitivity to food-ingested Ni may be induced by a type IV immunological reaction in the gut.
No preview · Article · Jan 1995 · Giornale italiano di medicina del lavoro
[Show abstract][Hide abstract] ABSTRACT: Psoriasis, a chronic and unpredictable dermatosis, is a constant therapeutical challenge to dermatologists. However, new knowledge in immunodermatology has stimulated interest in and encourage the use of new molecules, especially cyclosporin A (CyA). Thanks to certain characteristics, this molecule is capable of modulating and blocking the intense network of cytochine that seems to cause this dermatosis. The first clinical experiments have demonstrated that low dosages (3-5/kg die) can achieve rapid and effective remissions. The Italian experience gathered from numerous centres has been assessed to better understand and manage the use of CyA, especially as regards to tolerance and reliability. There is proven remission in 77% of the cases of plaque psoriasis. The duration of remission, as well as the paucity of side effects, has brought to the concept of cyclical therapy with CyA. The advantages of this mode of therapy are: the possibility of determining the most effective dosage; quantification of the dermatosis-free period; opportunity to personalize treatment and decide its duration; early intervention, should the dermatosis recur; exclusion of side effects and better control over those remaining.
No preview · Article · Feb 1994 · Acta dermato-venereologica. Supplementum
[Show abstract][Hide abstract] ABSTRACT: Methylprednisolone aceponate is a new and very strong steroid created for topical therapy of numerous dermatoses. It is a non-halogenated molecule with a very strong, local pharmacological activity and without systemic side effects. It has a very high lipophilicity, thanks to a double esterification on C17 and C21. Other characteristics of the molecule are its capability of binding to the steroid receptor (thanks to the methylation on C6) and a long disactivating time (thanks to the double bind between C1 and C2). Once applied, it penetrates through the skin where it undergoes hydrolysis by the skin esterases. Methylprednisolone-17-propionate is thus produced, which is the real active metabolite of the molecule because it has a capability of binding to the steroid receptors three times more than the original molecule. Other metabolites that can be formed are methylprednisolone-21-propionate and 6α-methylprednisolone. The excretion of the drug and its metabolites are due to the conjugation with glucuronic acid and like such excreted with urine. According to Miller and Munro, tests done to evaluate pharmacological activity-methylprenisolone aceponate was placed in Category 2. It is a molecule which has a very low capability of atrophy and which doesn't influence the circadian cycle and the cortisol values. Tests done to evaluate photosensitizing proprieties on the skin were negative. The half life of the drug is 16 hours. The kidney, in seven days, excretes the glucuronated products. All possibilities of drug accumulation in the body are excluded. No pharmacological interferences with other drugs are known. With methylprednisolone aceponate, a long term therapy is possible, with only a daily application.
[Show abstract][Hide abstract] ABSTRACT: Thirty-three patients (M/F 25/8, aged 19-71 years) with severe erythrodermic psoriasis entered an open multicenter study to evaluate the efficacy (induction and maintenance of clinical remission) and tolerability of long-term treatment with cyclosporin. It was given at a maximum initial dose of 5 mg/kg/day (initial mean dose 4.2 mg/kg/day), subsequently adjusted during the course of treatment according to clinical response, patient tolerability and any modification in laboratory parameters or blood pressure, carefully monitored each month. All of the patients were unsatisfactory responders to conventional systemic therapy (PUVA therapy, retinoids, corticosteroids), free of any clinically obvious immunodeficiencies, malignancies or blood dyscrasia and within the normal range for renal and hepatic function and blood pressure. At remission (defined as complete resolution of erythema in the body area involved), cyclosporin was slowly tapered off (0.5 mg/kg every 2 weeks) until total discontinuation or the reappearance of signs of disease. As concomitant therapy, white petrolatum in association with cyclosporin as well as specific local therapy between cyclosporin in cycles was allowed. After 6.3 ± 3.4 months (mean ± SD), cyclosporin doses of 3-5 mg/kg/day had led to complete remission in 67% of patients (22/33) in a median time of 2-4 months; in a further 27% of cases, considerable improvement in skin involvement was observed, with a reduction of more than 70% in comparison with baseline. The rapid and progressive improvement in the degree of skin involvement, pruritus and the severity of the characteristics of the psoriatic lesions (erythema and desquamation) proved to be significant versus baseline as early as the first month of treatment, as well as at all of the subsequent visits (p < 0.05, Dunnett's test). Four patients, previously achieving remission, relapsed between 3 and 12 months after entering the study with a relapse-free interval of between 2 and 8 months; 3 of them were in the drug withdrawal phase, the fourth had completely discontinued treatment. No evidence of any signs of disease rebound was seen. Side effects were observed in 15/33 patients, 8 of whom were considered to be certainly drug related. Cyclosporin was discontinued in 6 patients because of side effects: in 2 as main reason for discontinuation (hypertension and cerebrovascular disorders), in the remaining 4 as secondary reason to poor protocol compliance. The adverse events reported were mild/moderate and reversible on dose adjustment. In conclusion, given the rapidity of action and good tolerability of low-dose cyclosporin (3-5 mg/kg/day), it can be considered as the new therapy of choice in patients with erythrodermic psoriasis. An intermittent regimen (such as an attack therapy for an acute and severe form of psoriasis followed by gradual withdrawal) makes the drug manageable and well tolerated.