Articles

Practice guidelines recommend fixed combinations of calcipotriol, a topical vitamin D analogue, and betamethasone dipropionate, a high potency corticosteroid, as first line topical treatment for mild to moderate plaque psoriasis of the body and scalp. A new foaming lotion for treatment of Psoriasis was developed and patented by the Spanish Ministry of Industry, Trade and Tourism (Invention patent reference number 202030824). The foaming lotion is composed of clobetasol, papaverine hydrochloride, spironolactone, milk-peptide-complex and propylene glycol. Three cases with moderate Psoriasis aged 34, 36 and 66 years old were treated with our new foaming lotion for 7-8 days. The three patients reported important improvement in the itching sensations and remission of the scaled lesions. Before and after application of the new foaming lotion, Psoriasis Area Severity Index (PASI) scores improved in the first patient from 24.3 to 1.8, in the second patient from 26.1 to 1.8, and in the third patient from 27 to 1.8. Our results show the short-term effectiveness of the new foaming lotion in treating moderate and extensive Psoriasis. Long follow-up is needed to evaluate the remission period of Psoriasis and possible side effects of the new topical treatment.

Psoriasis is a multi-systemic chronic autoimmune inflammatory disorder affecting 125 million people worldwide. The most common type of psoriasis is plaque psoriasis affecting up to 90% of the patients and is characterized by well-demarcated, symmetric, and erythematous plaques with overlying silvery scales that may be painful or itchy. Psoriasis may also affect the joints; increase the risk of developing metabolic syndrome, diabetes, Crohn’s disease, ulcerative colitis, uveitis, certain cancers and an increase in the risk of cardiovascular diseases. Both the skin and the gut microbiome can modulate the development and progression of psoriasis. A connection between the microbiome and immunological mechanisms are antimicrobial peptides, which regulate the microbiome at interfaces and, as antigens, can trigger psoriasis. Few studies were conducted to demonstrate the effect of probiotics on different diseases, as they are living microorganisms that confer a health benefit when administrated in adequate amounts. The effects of administering probiotics include the stabilization of the gut bacterial community and the restoration of “signature” of bacterial microbiota, which is a result of lowering the pH, producing bacteriocins, altering microRNA (miRNAs), competing with pathogens for certain nutrients and improving the gut barrier function. Probiotics counter weight aggressive commensals in the body and reinforce the barrier function of the epithelium while also contributing to the regulation of innate and adaptive immune responses of the host under healthy or pathogenic conditions. Several clinical trials were conducted based on those findings to examine the role of probiotics in psoriasis, but till now there is no evidence of their efficacy.

<b>Background:</b> Psoriasis is extensively studied among middle-aged adults, but not many have studied psoriasis in older adults(geriatrics). OBJECTIVES: To analyze epidemiological, clinical, comorbidities and therapeutic profile of geriatric psoriasis(GP). METHODS: All consenting clinically diagnosed psoriatic patients ≥60 years were divided into two groups: Elderly psoriatic(EP)(60-75 years) and Ultra elderly psoriatic(UP)(>75 years). The dermatologist filled their clinical characteristics’ standardised questionnaire to determine comorbidities, drug interactions profile and compared with age-matched controls using Chi square test. RESULTS: Prevalence of GP is 14.5%(Average age:68 years; Sex ratio=2.5:1)among geriatrics attending dermatology OPD. Most common(49.9%) as well as initial site affected(39.3%) were Palms±Soles. Nummular plaque (90.2%) was most common type. Superficial fungal infection(26.9%) and pruritus(90.8%) were commonly associated cutaneous disease and symptom(p<0.05) respectively. Hypertension(49.7%),Diabetes Mellitus(22.8%), dyslipidemia(25.8%) and Metabolic syndrome(MS)(17.8%) were associated systemic comorbidities. Dyslipidemia and MS(p<0.0001) were more common among GP(163) than controls(963). Drug aggravated psoriasis could not be linked to polypharmacy. Although, topicals were mainstay, oral Methotrexate was most efficacious systemically. CONCLUSION: Our findings suggest a trimodal age of psoriasis onset at 68 years. As age advances, psoriasis severity decreases, unstable guttate lesions decrease; palms±soles commonly involved; infrequent familial occurrence with Polypharmacy not aggravating psoriasis. Active screening for cardiovascular comorbidities in all geriatric psoriasis patients is highly recommended.