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    <recommendedItem id="20090101_19_1634"
                     title="ICD: Aloe Vera Shows Promise for Psoriasis"
                     score="-0.007"
                     href="http://www.medpagetoday.com/Dermatology/ICD/tb/14382?impressionId=1265804872072"
                     
       PRAGUE, May 26 -- Patients with plaque psoriasis had a greater reduction in disease activity when treated with topical aloe vera compared with a topical steroid, data from a randomized trial demonstrated. 
              &lt;p&gt;&lt;p&gt;Patients treated with aloe vera had a significantly greater reduction in the Psoriasis Area and Severity Index (PASI) after eight weeks of treatment, Charoen Choonhakarn, M.D., of Khon Kaen University in Khon Kaen, Thailand, and colleagues reported here at the International Congress of Dermatology. 
              &lt;p&gt;The difference did not achieve statistical significance, but the magnitude of change from baseline to eight weeks differed significantly in an adjusted analysis. 
              &lt;p&gt;The advantage demonstrated in the study landed in a middle ground between two previous studies that produced conflicting results. 
              &lt;p&gt;&quot;Although contrary results were reported from two previous placebo-controlled studies, our study showed that aloe vera cream was more effective than 0.1% triamcinolone acetonide cream after eight weeks of treatment,&quot; the investigators concluded. 
              &lt;p&gt;&quot;The between-group difference in adjusted means was statistically significant,&quot; they added. &quot;Thus, aloe vera cream can be considered a safe alternative treatment for mild to moderate chronic plaque psoriasis.&quot; 
              &lt;p&gt;Topical steroids remain central to most management strategies for psoriasis, but chronic use poses a risk of local and systemic adverse effects. 
              &lt;p&gt;A systematic review of clinical applications of topical aloe vera suggested the agent is helpful in psoriasis (&lt;em&gt;Br J Gen Pract&lt;/em&gt; 1999; 49: 823-28). However, two small placebo-controlled clinical trials conducted a decade apart yielded widely disparate results, one showing a clear advantage for aloe vera and the other a significant placebo advantage (&lt;em&gt;Trop Med Int Health&lt;/em&gt; 1996; 1: 505-09, &lt;em&gt;J Eur Acad Dermatol Venereol&lt;/em&gt; 2005; 19: 326-31). 
              &lt;p&gt;In the current study, Dr. Choonhakarn and colleagues evaluated aloe vera and an active comparator. The study involved 80 patients who had a baseline PASI score of about 11. 
              &lt;p&gt;The patients were randomized to 70% aloe vera cream or 0.1% triamcinolone acetonide. The primary outcome was the change in PASI score from baseline to eight weeks. 
              &lt;p&gt;At the end of the study, the PASI score decreased by an average of 7.7 points in the aloe vera group and 6.6 in the patients treated with the topical steroid. The difference was statistically significant (&lt;em&gt;P&lt;/em&gt;=0.0237), although the 95% confidence intervals crossed 1.0 (2.13 to -0.16). 
              &lt;p&gt;The change in disease-related quality of life scores did not differ significantly between groups. 
              &lt;p&gt;No patient in either group had complete clearance of psoriasis lesions. 
              &lt;p&gt;Six patients (16.2%) in the aloe vera group had PASI 75 responses compared with four (10.5%) in the steroid group. 
              &lt;p&gt;More patients treated with the topical steroid had PASI 50 responses (66% versus 54%). 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; The study was supported by Khon Kaen University. 
              &lt;p&gt;The authors reported no disclosures. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1645"
                     title="ICD: Palmoplantar Psoriasis Responds to Retinoid"
                     score="-0.007"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICD/tb/14392?impressionId=1265804872072"
                     
      PRAGUE, May 27 -- Treatment with the oral vitamin A derivative acitretin (Soriatane) led to measurable improvement in 100% of patients with palmoplantar psoriasis in a small clinical series reported here. 
              &lt;p&gt;
              &lt;p&gt;Among patients who completed three months of follow-up, the mean Psoriasis Area and Severity Index (PASI) score declined from 11 at baseline to 1.65, Krupa Shankar, M.D., of Manipal Hospital in Bangalore, India, told attendees at the International Congress of Dermatology. 
              &lt;p&gt;
              &lt;p&gt;Dry skin was the most common adverse effect associated with acitretin. A quarter of patients had moderate elevation of triglycerides that were controlled with lipid-lowering therapy. 
              &lt;p&gt;
              &lt;p&gt;&quot;All of the patients in the study showed good results clinically and reported improvement in quality of life,&quot; said Dr. Shankar. &quot;The results suggest that oral acitretin is a useful option for the treatment of palmoplantar psoriasis.&quot; 
              &lt;p&gt;
              &lt;p&gt;The findings came from an evaluation of the vitamin D analog in 45 patients with mild or moderate psoriasis involving the hands and feet who ranged in age from 28 to 66. 
              &lt;p&gt;
              &lt;p&gt;Investigators excluded patients with abnormal liver function tests or lipid levels, women of reproductive age, and individuals on other systemic or topical therapies for psoriasis. 
              &lt;p&gt;
              &lt;p&gt;The patients received an acitretin dose of 0.5 mg/kg/day for three months and were evaluated monthly by means of clinical photographs and a modified PASI. Liver function tests and lipid profile were evaluated at baseline and at each monthly follow-up visit. 
              &lt;p&gt;
              &lt;p&gt;The modified disease index assumed a score of 0 for the head and trunk, and evaluation of extremities was limited to the palms and soles of the feet. Total possible score ranged from 0 to 72. 
              &lt;p&gt;
              &lt;p&gt;Dr. Shankar reported that 36 patients completed the first month of follow-up, 28 patients the second, and 25 the third. Five patients discontinued before taking the first dose of acitretin. 
              &lt;p&gt;
              &lt;p&gt;Among patients who attended the first follow-up visit, the mean PASI score decreased from 11 at baseline to 6.5. The average score decreased to 3.4 at the second follow-up visit and to 1.65 among patients who remained in the study through the final follow-up. 
              &lt;p&gt;
              &lt;p&gt;Dr. Shankar said 35 patients developed dry skin, and 27 had cheilitis. Both conditions improved with topical skin-care regimens. 
              &lt;p&gt;
              &lt;p&gt;Moderate triglyceride elevations of 160 to 273 mg/dL were seen in 10 patients. Eight were treated with fenofibrate, and the number of patients with elevated triglycerides decreased to three at the second and third follow-up visits, including two of the patients who received fenofibrate. 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;Dr. Shankar reported that he had no disclosures. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
         
    </recommendedItem>
    <recommendedItem id="20090101_19_1646"
                     title="ICD: Cytokine Levels May Offer Psoriasis Clues"
                     score="-0.007"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICD/tb/14394?impressionId=1265804872072"
                     
      PRAGUE, May 27 -- Monitoring cytokine levels in patients with psoriasis may offer an early indication of response to therapy, according to data reported here. 
              &lt;p&gt;
              &lt;p&gt;In patients with psoriasis, tumor necrosis factor-alpha (TNF-&amp;#945;) and interleukin 6 (IL-6) were significantly elevated at baseline, and levels of TNF-&amp;#945;, IL-4, and IL-6 declined significantly with effective treatment, Ram Chander, M.D., of Lady Hardinge Medical College in New Delhi, India, said at the International Congress of Dermatology. 
              &lt;p&gt;
              &lt;p&gt;Levels of IL-10 increased during treatment, an unexplained observation that requires further study. 
              &lt;p&gt;
              &lt;p&gt;&quot;On the basis of these findings, we believe that validation of the role of cytokines in prospective, multicentric, double-blind studies is warranted,&quot; said Dr. Chander. 
              &lt;p&gt;
              &lt;p&gt;&quot;Studies also are needed to delineate the role of specific cytokines in the pathogenesis of psoriasis and thus make cytokines a more specific and predictable tool for monitoring the disease.&quot; 
              &lt;p&gt;
              &lt;p&gt;Growing use of biological agents to treat psoriasis has focused attention on the role of cytokines in the pathogenesis of the disease. Monitoring cytokine levels might help clinicians predict response to therapy and impending relapse, said Dr. Chander. 
              &lt;p&gt;
              &lt;p&gt;He and his colleagues measured serum cytokine levels in 30 patients with psoriasis (principally psoriasis vulgaris) and 30 age- and sex-matched controls without psoriasis. Baseline levels of TNF-&amp;#945;, IL-4, IL-6, and IL-10 were measured and levels in the two groups were compared. 
              &lt;p&gt;
              &lt;p&gt;The investigators also looked for associations between patients&apos; baseline cytokine levels and disease activity and assessed the effect of psoriasis therapy on cytokine levels. 
              &lt;p&gt;
              &lt;p&gt;Baseline Psoriasis Area and Severity Index (PASI) was &amp;lt;5 (mild) in four patients, 5 to 10 (moderate) in 10 patients, and &amp;gt;10 (severe) in 16 patients. The approach to treatment varied according to baseline disease severity.
              &lt;p&gt; 
              &lt;p&gt;The patients had significantly higher baseline levels of TNF-&amp;#945; and IL-6 compared with the control group (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001). 
              &lt;p&gt;
              &lt;p&gt;IL-4 tended to be elevated in patients versus controls but not significantly so, and the patients also tended to have lower IL-10 levels. 
              &lt;p&gt;
              &lt;p&gt;Among the psoriasis patients, the impact of treatment on cytokine levels varied by baseline severity (PASI). 
              &lt;p&gt;
              &lt;p&gt;Patients with mild disease at baseline had a significant decrease in IL-6 levels during treatment (&lt;em&gt;P&lt;/em&gt;=0.044), but the other three cytokines did not change significantly. 
              &lt;p&gt;
              &lt;p&gt;Patients with moderate baseline disease activity had significant decreases in TNF-&amp;#945; (&lt;em&gt;P&lt;/em&gt;=0.028) and IL-6 (&lt;em&gt;P&lt;/em&gt;=0.001) and a significant increase in IL-10 (&lt;em&gt;P&lt;/em&gt;=0.03) in response to therapy. 
              &lt;p&gt;
              &lt;p&gt;Patients with the most severe baseline disease activity had significant decreases in TNF-&amp;#945; (&lt;em&gt;P&lt;/em&gt;=0.004), IL-4 (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001), and IL-6 (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) but no change in IL-10 from baseline. 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;Dr. Chander reported no competing interests.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
        
    </recommendedItem>
    <recommendedItem id="20090101_19_1648"
                     title="ICD: Biology-Psyche Link Explored in Psoriasis"
                     score="-0.007"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICD/tb/14397?impressionId=1265804872072"
                     
      PRAGUE, May 27 -- A mind-body connection may play a role in psoriasis patients&apos; adaptation to the chronic disease, data from a Polish study suggest. 
              &lt;p&gt;
              &lt;p&gt;Lipoprotein levels and the amino-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) correlated with various psychosocial aspects of psoriasis, Aldona Pietrzak, M.D., of the Medical University of Lublin, reported at the International Congress of Dermatology. 
              &lt;p&gt;
              &lt;p&gt;Higher levels of certain lipoproteins correlated with problems related to acceptance and disease-related quality of life. Quality of life decreased as levels of NT-proBNP increased, particularly among men, Dr. Pietrzak said. 
              &lt;p&gt;
              &lt;p&gt;&quot;The mechanisms elucidating these associations require further studies,&quot; she added. 
              &lt;p&gt;
              &lt;p&gt;The study grew out of epidemiologic data showing that psoriasis patients have an increased risk of cardiovascular disease. Explanations for the increased risk are incomplete but likely involve conventional and unconventional cardiac risk factors. 
              &lt;p&gt;
              &lt;p&gt;Lipid abnormalities have a well-documented association with coronary heart disease, and elevated NT-proBNP has been linked to worse outcomes in heart failure. Both metabolic parameters have been implicated in psoriasis severity, Dr. Pietrzak continued.
              &lt;p&gt;
              &lt;p&gt;Expanding the associations to psychosocial aspects of psoriasis, Dr. Pietrzak and colleagues studied 104 patients with psoriasis. The cohort had a mean Psoriasis Area and Severity Index (PASI) score of about 24 and body surface involvement of about 30%. 
              &lt;p&gt;
              &lt;p&gt;The patients&apos; lipid profiles and NT-proBNP levels were compared with scores derived from three psychosocial assessment tools: the Skindex 29 measure of disease-related quality of life, the Acceptance of Disease Scale, and the Disease-Related Social Support Scale. 
              &lt;p&gt;
              &lt;p&gt;The lipid profile comprised total cholesterol, LDL, HDL, triglycerides, apolipoprotein-A1 (apo-A1) and apo-B. 
              &lt;p&gt;
              &lt;p&gt;The analysis showed that higher LDL levels were associated with lower acceptance of life with disease and higher NT-proBNP levels with lower quality of life (&lt;em&gt;P&lt;/em&gt;d0.05). 
              &lt;p&gt;
              &lt;p&gt;Among men, higher NT-proBNP levels correlated with increased physical symptoms and emotional stress (&lt;em&gt;P&lt;/em&gt;d0.05). 
              &lt;p&gt;
              &lt;p&gt;In women the degree of acceptance of life with disease correlated inversely with total cholesterol, LDL, and apo-B (&lt;em&gt;P&lt;/em&gt;d0.01 for all). Levels of apo-B significantly influenced physical symptoms, emotions, and disease-related quality of life (&lt;em&gt;P&lt;/em&gt;d0.05). 
              &lt;p&gt;
              &lt;p&gt;None of the biological parameters correlated with social support. However, perceived level of social support had a positive correlation with acceptance of life with disease (&lt;em&gt;P&lt;/em&gt;d0.001). 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;Dr. Pietrzak reported no competing interests. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
        
    </recommendedItem>
    <recommendedItem id="20090101_19_1652"
                     title="ICD: Coal Tar Still Viable for Psoriasis"
                     score="-0.007"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICD/tb/14402?impressionId=1265804872072"
                     
       PRAGUE, May 27 -- For psoriasis patients who can handle the smell and mess, coal tar remains an effective, inexpensive treatment option for stable disease, investigators concluded. 
              &lt;p&gt;&lt;p&gt;Coal tar proved just as effective as topical tazarotene (Tazorac, Avage) in a small study of patients with stable plaque psoriasis who served as their own controls, Uma Kumar, M.D., of All India Institute of Medical Sciences in New Delhi, reported at the International Congress of Dermatology. 
              &lt;p&gt;All patients in both groups had either marked or moderate improvement after 12 weeks of treatment. 
              &lt;p&gt;&quot;Our results indicate that tazarotene 0.1% gel and coal tar 5% ointment appear to have comparable efficacy in stable plaque psoriasis,&quot; Dr. Kumar said. 
              &lt;p&gt;&quot;Considering the overall cost/benefit ratio in a chronic disease like psoriasis, coal tar ointment is still an effective treatment modality for patients with stable plaque psoriasis, especially in developing countries where the treatment/healthcare costs are borne by patients themselves.&quot; 
              &lt;p&gt;The findings came from a comparison of tazarotene gel and crude coal tar in 30 patients with stable plaque psoriasis. The patients had limited disease, defined as involvement of &amp;lt;20% of body surface area. Disease duration averaged about nine years. 
              &lt;p&gt;Before the initiation of study treatment, patients completed a four-week washout of systemic therapy, two weeks for existing topical therapy. 
              &lt;p&gt;Each patient was treated simultaneously with both agents in an unblinded manner: tazarotene on the right side of the body and coal tar on the left. 
              &lt;p&gt;Treatment continued for 12 weeks, and patients were assessed at two-week intervals. Response was determined by change in the erythema, scaling, and induration (ESI) score, which averaged about 28 at baseline. 
              &lt;p&gt;The ESI scores did not differ significantly between treatments at any of the assessments. 
              &lt;p&gt;At 12 weeks, ESI scores averaged 7.11 with tazarotene treatment and 5.93 with coal tar. 
              &lt;p&gt;The mean ESI score for lesions treated with coal tar was lower at six and 10 weeks, as well as at the end of the study. 
              &lt;p&gt;Dr. Kumar reported that 27 patients completed the study. Psoriasis lesions on both sides of the body improved by at least 50% in all patients. 
              &lt;p&gt;The investigators rated the improvement as marked in 40.7% of tazarotene-treated areas and in 59.2% of areas treated with coal tar. The figures were reversed for moderate improvement. 
              &lt;p&gt;&quot;Coal tar is one of the commonest conventional treatment modalities for psoriasis,&quot; Dr. Kumar and colleagues concluded. &quot;Various studies have proved its effectiveness time and again. 
              &lt;p&gt;&quot;Patient acceptability is the major problem with coal tar. The preparations are usually greasy and unpleasant smelling, and they can stain clothing.&quot; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; The authors reported no competing interests.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
</recommendedContent>