Acitretin plus UVB therapy for psoriasis

Lowe, Nicholas J.; Prystowsky, Janet H.; Bourget, Teresa; Edelstein, Josef; Nychay, Stephen; Armstrong, R. B.

doi:10.1016/0190-9622(91)70089-k

Cited by 156 publications

(20 citation statements)

References 7 publications

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“…In some cases, when monotherapy is insufficient in controlling a patient’s psoriasis, combinations of treatments are used, such as UVB phototherapy and oral retinoid (acitretin), UVB and topical tar (Goeckerman therapy) and UVB and anthralin (Ingram therapy) [3,4,5]. These therapies, however, are both inconvenient and costly.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Systemic Treatments for Moderate to Severe Plaque Psoriasis: Systematic Review and Meta-Analysis

et al. 2009

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Aims: To compare the efficacy of psoriasis treatments through a systematic literature review and meta-analysis. Methods: Randomized controlled trials evaluating the Psoriasis Area and Severity Index (PASI) were identified and assessed for quality. PASI responses were modeled using a mixed-treatment comparison, which enabled the estimation of the relative effectiveness of several treatments. Sensitivity analyses were performed. Results: Twenty-two trials were included. Tumor necrosis factor (TNF) inhibitors were most likely to achieve PASI 75, with a mean relative risk (RR) of 15.57 (95% CI 12.46–19.25) versus mean RRs of 9.24 (95% CI 5.33–13.91) for systemic and 5.65 (95% CI 3.74–7.97) for T-cell therapies. Infliximab (81%) and adalimumab (71%) had greater probabilities of achieving PASI 75 than etanercept (50%). Dosage was an important determinant of outcome. Conclusions: TNF inhibitors were more effective than T cell agents; adalimumab and infliximab were more effective than systemic therapies and etanercept. Evidence-based comparisons support patient and physician decisions.

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Section: Introductionmentioning

confidence: 99%

Efficacy of Systemic Treatments for Moderate to Severe Plaque Psoriasis: Systematic Review and Meta-Analysis

et al. 2009

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“…The induction of ODC in murine skin by phorbol esters (PMA) and the inhibition of this phenomenon by retinoids [2,3] has formed the basis for screening retinoid compounds for biological activity [4] ; retinoids are commonly used as agents for the prevention or treatment of hyperproliferative skin diseases including skin cancer [5] and psoriasis [6]. Because it was reported that PMA induced ODC in itro in heat-split human skin biopsies [7], this suggested the potential to use this model to study the influence of retinoids on signalling pathways from tumour promoters in human skin cells in itro.…”

Section: Introductionmentioning

confidence: 99%

Phorbol 12-myristate 13-acetate inhibits epidermal growth factor signalling in human keratinocytes, leading to decreased ornithine decarboxylase activity

Xue

Zheng

Chen

et al. 1996

Biochemical Journal

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Several studies have suggested that murine and human keratinocytes respond differently to phorbol 12-myristate 13-acetate (PMA). Using an in vitro assay, we found that in contrast to its effect on murine skin, PMA did not induce ornithine decarboxylase (ODC) activity in human skin biopsies. To explore the signalling induced by PMA and to determine whether an in vitro culture system could be used to predict biological activity of retinoids in human keratinocytes, we studied a simian virus 40 (SV40)-transformed human keratinocyte cell line. Epidermal growth factor (EGF) stimulates ODC activity and increases the steady-state level of ODC mRNA in a dose- and time-dependent manner in these cells [Prystowsky, Clevenger and Zheng (1993) Exp. Dermatol. 2, 125–132]. In this report, 10-10 M–10-7 M PMA induced ODC mRNA and enzyme synthesis at 7 h, but did not significantly induce ODC activity and inhibited the EGF induction of ODC activity. To explore the mechanism whereby PMA interferred with EGF signalling, the effect of PMA on EGF binding to its cell-surface receptor was studied; acute treatment with PMA (within 7 h) decreased EGF binding to 41–57% of the baseline level. In contrast, chronic treatment with PMA (24 h) increased EGF binding to 156% of the baseline level and was associated with an increase in quantity of EGF receptor protein. Protein kinase C (PKC) activation correlated with the acute decrease in EGF binding following PMA treatment. In summary, PMA induced ODC mRNA and ODC enzyme synthesis, while steady-state levels of immunoprecipitable ODC enzyme protein and ODC activity were not increased, demonstrating possible increased turnover of ODC enzyme protein. Additionally, PMA inhibited the induction of ODC by EGF through decreased EGF binding, possibly mediated by PKC activation. Finally treatment of the keratinocytes with retinoids including etretinate, Ro13-7410, etarotene, Ro40-8757, 13-cis-retinoic acid, and acitretin blocked the PMA induction of ODC mRNA, suggesting this in vitro model could be a valuable screening assay for predicting biological activity in humans.

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“…One of the most effective treatments for psoriasis is the combination of phototherapy and oral retinoids [ 23 ]. Acitretin and tanning bed UV exposure combination therapy has been studied and is more effective than tanning alone, with 83% of patients achieving clearance or near clearance in a retrospective review, and PASI scores demonstrating an average reduction of 79% from baseline in a prospective open-label trial of 17 patients [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

A Review of the Use of Tanning Beds as a Dermatological Treatment

Radack

Farhangian

Anderson

et al. 2015

Dermatol Ther (Heidelb)

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IntroductionIn-office phototherapy is an effective treatment for many dermatologic conditions, however, many patients are unable to adhere to the rigorous travel and time commitments sometimes needed. Tanning bed facilities are nearly ubiquitous in modern society and could represent a more convenient means to obtain ultraviolet (UV) exposure when office phototherapy is not feasible. The purpose of this study was to review available evidence on the use of tanning facilities as a treatment for dermatologic conditions.MethodsPubMed was searched on February 2015 for “tanning beds” and “phototherapy”, and with some dermatologic conditions sensitive to UV light, including “psoriasis”, “mycosis fungoides”, “acne”, “atopic dermatitis” and “eczema”. From there, further articles were found using the reference sections of the initial papers. A similar methodology was used with the Google Scholar search engine. Only articles in English and prospective studies were included in this review.ResultsWe found studies validating the use of tanning facilities for psoriasis treatment. Use as a treatment option for atopic dermatitis, mycosis fungoides, acne, scleroderma, vitiligo, and pruritus, as well as other UV sensitive dermatoses, may also be beneficial. This study is limited by the lack of double-blind, placebo-controlled trials, long-term follow-up studies, and meta-analyses for tanning facility use in dermatologic phototherapy, and by the lack of standardization of both tanning facilities and exposure dosing.ConclusionUnsupervised sun exposure is a standard recommendation for some patients to obtain phototherapy. Selected use of commercial tanning beds in the treatment of dermatologic conditions may be another useful and effective treatment for those patients with an inability to access office-based or home-based phototherapy.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-015-0071-8) contains supplementary material, which is available to authorized users.

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Acitretin plus UVB therapy for psoriasis

Cited by 156 publications

References 7 publications

Efficacy of Systemic Treatments for Moderate to Severe Plaque Psoriasis: Systematic Review and Meta-Analysis

Efficacy of Systemic Treatments for Moderate to Severe Plaque Psoriasis: Systematic Review and Meta-Analysis

Phorbol 12-myristate 13-acetate inhibits epidermal growth factor signalling in human keratinocytes, leading to decreased ornithine decarboxylase activity

A Review of the Use of Tanning Beds as a Dermatological Treatment

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