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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">GJMCR</journal-id>
      <journal-title-group>
        <journal-title>Global Journal of Medical Case Reports</journal-title>
      </journal-title-group>
      <issn pub-type="epub">2770-8691</issn>
      <issn pub-type="ppub"></issn>
      <publisher>
        <publisher-name>Science Publications</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.31586/gjmcr.2023.714</article-id>
      <article-id pub-id-type="publisher-id">GJMCR-714</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Case Report</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>
          A Report of Three Cases with Moderate Psoriasis Treated with New Topical Treatment
        </article-title>
      </title-group>
      <contrib-group>
<contrib contrib-type="author">
<name>
<surname>Calvo</surname>
<given-names>Jos&#x000e9; Miguel Ingelmo</given-names>
</name>
<xref rid="af1" ref-type="aff">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cobo</surname>
<given-names>Jos&#x000e9; Ruiz</given-names>
</name>
<xref rid="af2" ref-type="aff">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Allam</surname>
<given-names>Mohamed Farouk</given-names>
</name>
<xref rid="af3" ref-type="aff">3</xref>
<xref rid="cr1" ref-type="corresp">*</xref>
</contrib>
      </contrib-group>
<aff id="af1"><label>1</label> Department of Plastic Surgery, Hospital HM Malaga, Malaga, Spain</aff>
<aff id="af2"><label>2</label> Distrito Sanitario Costa del Sol, SUAP Torremolinos, Malaga, Spain</aff>
<aff id="af3"><label>3</label> Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt</aff>
<author-notes>
<corresp id="c1">
<label>*</label>Corresponding author at: Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
</corresp>
</author-notes>
      <pub-date pub-type="epub">
        <day>13</day>
        <month>10</month>
        <year>2023</year>
      </pub-date>
      <volume>3</volume>
      <issue>1</issue>
      <history>
        <date date-type="received">
          <day>25</day>
          <month>06</month>
          <year>2023</year>
        </date>
        <date date-type="rev-recd">
          <day>30</day>
          <month>08</month>
          <year>2023</year>
        </date>
        <date date-type="accepted">
          <day>11</day>
          <month>10</month>
          <year>2023</year>
        </date>
        <date date-type="pub">
          <day>13</day>
          <month>10</month>
          <year>2023</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>&#xa9; Copyright 2023 by authors and Trend Research Publishing Inc. </copyright-statement>
        <copyright-year>2023</copyright-year>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
          <license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p>
        </license>
      </permissions>
      <abstract>
        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&#x000a0;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.
      </abstract>
      <kwd-group>
        <kwd-group><kwd>Psoriasis</kwd>
<kwd>Topical Treatment</kwd>
<kwd>Psoriasis Area Severity Index</kwd>
<kwd>Case Report</kwd>
<kwd>Malaga</kwd>
</kwd-group>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec1">
<title>Introduction</title><p>Psoriasis is a chronic papulosquamous skin disease, presenting at any age, and leading to an important deterioration of the quality of life of affected patients. Complications of psoriasis include depression, psoriatic arthritis, and cardiometabolic syndrome [
<xref ref-type="bibr" rid="R1">1</xref>]. </p>
<p>Treatments of Psoriasis include topical agents for mild disease, topical agents and phototherapy for moderate disease, and systemic agents including photochemotherapy, oral agents, and newer injectable biological agents for severe psoriasis [
<xref ref-type="bibr" rid="R2">2</xref>].</p>
<p>Because of the strong and extensive evidence, the American and European guidelines recommended fixed combinations of calcipotriol, a topical vitamin D analogue, and betamethasone dipropionate, a high potency corticosteroid, as the first line topical treatment for mild to moderate plaque psoriasis of the body and scalp [
<xref ref-type="bibr" rid="R3">3</xref>,<xref ref-type="bibr" rid="R4">4</xref>].</p>
<p>Long-term use of topical corticosteroids, like clobetasol propionate, can result in numerous adverse effects including skin atrophy, formation of striae, telangiectasia, and hypothalamic pituitary adrenal axis suppression [
<xref ref-type="bibr" rid="R5">5</xref>]. </p>
<p>Clobetasol propionate has a vasoconstrictor effect on the peripheral dermal vessels, and this is the reason for skin atrophy in psoriatic patients applying it for long times [
<xref ref-type="bibr" rid="R6">6</xref>]. </p>
<p>A new foaming lotion for psoriasis was developed and patented by the Spanish Ministry of Industry, Trade and Tourism (Invention&#x26;#x000a0;patent reference number 202030824). The foaming lotion &#x26;#x0201c;Psorisbye&#x26;#x0201d; is composed of clobetasol, papaverine hydrochloride, spironolactone, milk-peptide-complex and propylene glycol. </p>
<p>We describe and summarize three cases of moderate Psoriasis treated with our new patented foaming lotion &#x26;#x0201c;Psorisbye&#x26;#x0201d;.</p>
</sec><sec id="sec2">
<title>Psoriasis Case 1</title><p>A 34-year-old male presented with extensive Psoriasis lesions in the trunk, and upper and lower limbs. The patient had irrelevant past medical history, and was complaining mainly from itching in the psoriatic lesions. </p>
<p>On examination, it was observed multiple plaque lesions in the chest, abdomen, back, elbows, arms, forearms, popliteal regions and back areas of the legs. Patients was diagnosed 15 years ago and was treated with calcipotriol&#x26;#x000a0;and&#x26;#x000a0;betamethasone&#x26;#x000a0;cutaneous foam (Enstilar&#x26;#x000ae; or Daivobet&#x26;#x000ae;). The patient was not previously treated with immunosuppressive drugs like methotrexate or cyclosporine. &#x26;#x000a0;</p>
<p>The patient was instructed to use our new patented foaming lotion &#x26;#x0201c;Psorisbye&#x26;#x0201d; once daily for one week. A total of 120ml of &#x26;#x0201c;Psorisbye&#x26;#x0201d; was used for 1 week.  </p>
<p>After 7 days of local application of &#x26;#x0201c;Psorisbye&#x26;#x0201d; the patient was examined in the outpatient clinic. The patient reported remission of the scaled lesions and important improvement in the itching sensations. </p>
<p>Comparing the psoriatic lesions before and after the application of &#x26;#x0201c;Psorisbye&#x26;#x0201d; for 7 days, it was observed that Psoriasis Area Severity Index (PASI) score improved from 24.3 to 1.8.</p>
<p><bold>Figure 1 </bold>shows the left leg of the patient before and after the application of the new topical treatment with 7 days apart. </p>
<fig id="fig1">
<label>Figure 1</label>
<caption>
<p>The left leg of the patient before and after the application of the new topical treatment.</p>
</caption>
<graphic xlink:href="714.fig.001" />
</fig></sec><sec id="sec3">
<title>Psoriasis Case 2</title><p>A 39-year-old male presented with extensive Psoriasis lesions in the scalp, and upper and lower limbs. The patient had irrelevant past medical history, and was complaining mainly from itching in the psoriatic lesions. </p>
<p>On examination, it was observed multiple plaque lesions in the scalp, retroauricular region, chest, abdomen, back, elbows, arms, forearms, thighs, popliteal regions and back areas of the legs. Also, few erythrodermic psoriatic lesions were observed mainly in the abdomen and the back. </p>
<p>Patient was diagnosed 16 years ago and was treated with calcipotriol and betamethasone cutaneous foam (Enstilar&#x26;#x000ae; or Daivobet&#x26;#x000ae;). The patient was not previously treated with immunosuppressive drugs like methotrexate or cyclosporine. &#x26;#x000a0;</p>
<p>The patient was instructed to use our new patented foaming lotion &#x26;#x0201c;Psorisbye&#x26;#x0201d; once daily for 8 days. A total of 120ml of &#x26;#x0201c;Psorisbye&#x26;#x0201d; was used for 8 days.  </p>
<p>After 8 days of local application of &#x26;#x0201c;Psorisbye&#x26;#x0201d; the patient was examined in the outpatient clinic. The patient reported remission of the scaled lesions and important improvement in the itching sensations. </p>
<p>Comparing the psoriatic lesions before and after the application of &#x26;#x0201c;Psorisbye&#x26;#x0201d; for 8 days, it was observed that PASI score improved from 26.1 to 1.8.</p>
<p><bold>Figure 2 </bold>shows the right forearm of the patient before and after the application of the new topical treatment with 8 days apart. </p>
<fig id="fig2">
<label>Figure 2</label>
<caption>
<p>The right forearm of the patient before and after the application of the new topical treatment.</p>
</caption>
<graphic xlink:href="714.fig.002" />
</fig></sec><sec id="sec4">
<title>Psoriasis Case 3</title><p>A 66-year-old female presented with extensive Psoriasis lesions in the scalp, trunk, and upper and lower limbs. The patient had irrelevant past medical history, and was complaining mainly from itching in the psoriatic lesions. </p>
<p>On examination, it was observed multiple plaque lesions in the scalp, retroauricular region, chest, abdomen, back, elbows, forearms, wrists, thighs, popliteal regions and back areas of the legs. Also, few erythrodermic psoriatic lesions were observed mainly in the back. </p>
<p>Patient was diagnosed 15 years ago and treated with calcipotriol and betamethasone cutaneous foam (Enstilar&#x26;#x000ae; or Daivobet&#x26;#x000ae;). The patient was not previously treated with immunosuppressive drugs like methotrexate or cyclosporine.  &#x26;#x000a0;</p>
<p>The patient was instructed to use our new patented foaming lotion &#x26;#x0201c;Psorisbye&#x26;#x0201d; once daily for 8 days. A total of 120ml of &#x26;#x0201c;Psorisbye&#x26;#x0201d; was used for 8 days.  </p>
<p>After 8 days of local application of &#x26;#x0201c;Psorisbye&#x26;#x0201d; the patient was examined in the outpatient clinic. The patient reported remission of the scaled lesions and important improvement in the itching sensations. </p>
<p>Comparing the psoriatic lesions before and after the application of &#x26;#x0201c;Psorisbye&#x26;#x0201d; for 8 days, it was observed that PASI score improved from 27 to 1.8.</p>
<p><bold>Figure 3 </bold>shows both thighs and popliteal regions of the patient before and after the application of the new topical treatment with 8 days apart. </p>
<fig id="fig3">
<label>Figure 3</label>
<caption>
<p>Thighs and popliteal regions of the patient before and after the application of the new topical treatment.</p>
</caption>
<graphic xlink:href="714.fig.003" />
</fig></sec><sec id="sec5">
<title>Discussion and Conclusions</title><p>Our study presented three patients with moderate Psoriasis that were treated with &#x26;#x0201c;Psorisbye&#x26;#x0201d;, a new foaming lotion, patented recently by the Spanish Ministry of Industry, Trade and Tourism. </p>
<p>The 3 patients reported important improvement in the itching sensations and remission of the scaled lesions. Before and after application of the new foaming lotion, 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.  </p>
<p>Our results show the short-term effectiveness of the new foaming lotion &#x26;#x0201c;Psorisbye&#x26;#x0201d; in treating moderate and extensive Psoriasis. This could be explained by the combined effects and equilibrated dosages of the drugs incorporated in &#x26;#x0201c;Psorisbye&#x26;#x0201d;. </p>
<p>Our new foaming lotion combines clobetasol, papaverine hydrochloride, spironolactone, milk-peptide-complex and propylene glycol.  Clobetasol, a corticosteroid widely used Psoriasis, has a well-known effectiveness in mild, moderated and severe cases [
<xref ref-type="bibr" rid="R3">3</xref>,<xref ref-type="bibr" rid="R4">4</xref>,<xref ref-type="bibr" rid="R5">5</xref>]. </p>
<p>Papaverine hydrochloride is a known potent arteriolar vasodilator that opens potassium channels of the smooth muscles of the peripheral arteries [
<xref ref-type="bibr" rid="R7">7</xref>].</p>
<p>Spirolactone regulates sebaceous gland activity and reduces the seborrheic hyperproduction [
<xref ref-type="bibr" rid="R8">8</xref>], frequently occurs in Psoriasis [
<xref ref-type="bibr" rid="R1">1</xref>]. Milk-peptide-complex reactivates skin cells inducing the production of collagen, hyaluronic acid and fibronectin, improving and softening skin&#x26;#x02019;s structure [
<xref ref-type="bibr" rid="R9">9</xref>]. Propylene glycol acts by helping the skin to better absorb hydration by providing softness [
<xref ref-type="bibr" rid="R10">10</xref>].</p>
<p>Although the results in the three cases with moderate Psoriasis are promising, long follow-up is needed to evaluate the remission period of Psoriasis and possible side effects of the new topical treatment.</p>
</sec><sec id="sec6">
<title>Declarations </title><p><bold>Acknowledgement:</bold> None.</p>
<p><bold>Ethical statement: </bold>Written informed consent was obtained for the patient for treatment and for publication of this case report and the accompanying image.<bold> </bold></p>
<p><bold>Funding:</bold> None.</p>
<p><bold>Conflict of interest:</bold> None. </p>
<p><bold>Authors&#x26;#x02019; contributions:</bold> Study design (JIC, JRC, MFA), analysis and interpretation of data (JIC, JRC), manuscript writing (JRC, MFA), collection of data (JIC, JRC), critical revision (JRC, MFA).</p>
<p></p>
</sec>
  </body>
  <back>
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</mixed-citation>
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</mixed-citation>
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<label>[3]</label>
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</mixed-citation>
</ref>
<ref id="R4">
<label>[4]</label>
<mixed-citation publication-type="other">Jalili A, Yosipovitch G. Fixed-dose combination calcipotriol/betamethasone dipropionate foam provides a rapid onset of action, effective itch relief and improves patient quality of life. J Eur Acad Dermatol Venereol 2021;35(Suppl 1):20-7. doi: 10.1111/jdv.17085.
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</mixed-citation>
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</mixed-citation>
</ref>
<ref id="R7">
<label>[7]</label>
<mixed-citation publication-type="other">Kim YJ, Hong HK, Lee HS, Moh SH, Park JC, Jo SH, Choe H. Papaverine, a vasodilator, blocks the pore of the HERG channel at submicromolar concentration. J Cardiovasc Pharmacol. 2008;52(6):485-93. doi: 10.1097/FJC.0b013e31818e65c2.
</mixed-citation>
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<mixed-citation publication-type="other">Kim YJ, Hong HK, Lee HS, Moh SH, Park JC, Jo SH, Choe H. Papaverine, a vasodilator, blocks the pore of the HERG channel at submicromolar concentration. J Cardiovasc Pharmacol. 2008;52(6):485-93. doi: 10.1097/FJC.0b013e31818e65c2.
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</ref>
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  </back>
</article>