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Background: New topical treatments in scalp psoriasis are needed because many current topical treatments are disliked by patients and associated with poor compliance., Objective: To compare the efficacy and safety of once-daily, two-compound scalp formulation containing calcipotriene plus betamethasone dipropionate with the individual components in the same vehicle and the vehicle alone., Methods: In this 8-week, multicenter, randomized, double-blind study, patients with scalp psoriasis were randomized to treatment with the two-compound scalp formulation (calcipotriene 50 microg/g plus betamethasone 0.5 mg/g, as dipropionate) (n = 541), betamethasone 0.5 mg/g (as dipropionate) in the same vehicle (n = 556), calcipotriene 50 microg/g in the same vehicle (n = 272), or vehicle alone (n = 136)., Results: More patients achieved "absent" or "very mild" disease at week 8 with the two-compound scalp formulation (71.2%) compared with betamethasone dipropionate in the same vehicle (64.0%, p = .011), calcipotriene in the same vehicle (36.8%, p < .0001), or the vehicle (22.8%, p < .0001)., Limitations: Efficacy of the active comparators in the study has not been established in relation to calcipotriene and betamethasone formulations available for clinical use., Conclusion: Calcipotriene plus betamethasone dipropionate scalp formulation was more effective than either of the individual components or the vehicle alone.

It has been suggested that trioxsalen bath and ultraviolet (UV) A (PUVA) is associated with a very low or no risk of non-melanoma skin cancer, but the numbers of patients in individual studies have been limited. In order to attain statistically relevant information about the cancer risk associated with trioxsalen bath PUVA, two follow-up studies were combined and the joined cancer incidence was analysed among 944 Swedish and Finnish patients with psoriasis. The mean follow-up time for skin cancer was 14.7 years. Standardized incidence ratios (SIR) were calculated as a ratio of observed and expected numbers of cases. The expected numbers of cases were based on the national cancer incidence rates in the respective countries. There was no excess of squamous cell skin carcinoma [SIR 1.1, 95% confidence interval (CI) 0.2-3.2] or malignant melanoma (SIR 0.9, 95% CI 0.1-3.2) in the combined cohort. Basal cell skin carcinoma was not studied. The incidence of all non-cutaneous cancers was not increased (SIR 1.1, 95% CI 0.8-1.4). A threefold excess risk of squamous cell skin carcinoma after trioxsalen bath PUVA could therefore be excluded, which is a markedly lower risk than that associated with oral 8-methoxypsoralen PUVA. The result needs to be confirmed in a future follow-up, however, as the number of patients with high PUVA exposures was low.

There is concern about the long-term carcinogenic effects of psoralen and ultraviolet A radiation (PUVA) for treatment of skin disorders. Many authors have found an increased risk for cutaneous squamous cell carcinoma (SCC). Except in anecdotal reports, malignant melanoma had not been observed in patients treated with PUVA until recently. In the U.S.A., a 16-centre prospective study of 1380 patients showed for the first time that there might also be an increased risk for malignant melanoma in patients treated with high cumulative dosages of PUVA. We have therefore followed up the Swedish PUVA cohort until 1994. This cohort had previously been followed up until 1985. Information from 4799 Swedish patients (2343 men, 2456 women) who had received PUVA between 1974 and 1985 was linked to the compulsory Swedish Cancer Registry in order to identify individuals with cancer. The average follow-up period was 15.9 years for men and 16.2 for women. We did not find any increased risk for malignant melanoma in our total cohort of 4799 patients treated with PUVA or in a subcohort comprising 1867 patients followed for 15-21 years. For cutaneous SCC there was an increase in the risk: the relative risk was 5.6 (95% confidence interval, CI 4. 4-7.1) for men and 3.6 (95% CI 2.1-5.8) for women. Significant (P < 0.05) increases were also found in the incidence of respiratory cancer in men and women and of kidney cancer in women. In conclusion, we did not find any increased risk for malignant melanoma in our patients treated with high doses of PUVA and followed up for a long time. We confirm previous reports of an increase in the incidence of cutaneous SCC in patients treated with PUVA, and recommend that patients should be carefully selected for PUVA and rigorously followed up.

To evaluate if whole body UVB irradiation has effects on the neutrophil function, eleven patients with mild to moderate psoriasis and 14 healthy subjects were treated with whole body UVB irradiation 3 times weekly for 4 weeks. Eight healthy untreated subjects served as controls. After 2 weeks of treatment the individual change of phagocytosis measured by the ingestion of IgG-coated particles was related to the pre-treatment value both in the psoriatic patients and healthy subjects (p less than 0.05 and p less than 0.001, respectively). Similar results were obtained for ingestion of IgG-C3b-coated particles. Thus, the change in phagocytic rate seemed to be dependent on the functional activity before treatment. UV irradiation of PMNs in vitro did not influence the phagocytic rate. After 4 weeks of UV treatment the healthy subjects showed a significant decrease in the rate of phagocytosis of IgG-C3b particles (p less than 0.02) and of the serum chemokinetic activity (p less than 0.01). In the psoriatic patients the mean chemokinetic activity in heated sera was decreased after 2 weeks (p less than 0.02). There appeared to be no relation between improvement of psoriasis and changes in PMN function. In an untreated group of healthy subjects no significant changes in neutrophil function were found. The results indicate that there is a change in PMN function during UVB treatment. The degree of change seems to vary, not only between individuals but possibly also between groups, e.g. healthy subjects compared with psoriatic patients.

Forty-three out-patients with stable plaque-type psoriasis involving 10-30% of the skin participated in a single-blind controlled study. The psoriasis lesions on one half of the body were treated with a lubricating base of the oil-in-water type before UVB exposure, while those on the other side of the body received UVB only. The rates of improvement of scaling, infiltration and erythema were compared in 127 symmetrical pairs of psoriasis plaques. The scores for the three variables were then summed to yield a total score for the effect of treatment. After only 2 weeks of treatment and throughout the treatment period the rate of improvement in the total score was significantly (p less than 0.001) accelerated on the body half treated with the emollient compared with the control side. Pretreatment with a suitable lubricating base can thus result in shorter treatment periods, which means that the surrounding skin will be exposed to smaller doses of UVB, with a diminished risk of actinic damage.

A thorough clinical follow-up study with regard to the occurrence of degenerative skin changes and cutaneous carcinomas was undertaken in 1982 in 149 patients with moderate to severe psoriasis treated with PUVA baths (trioxsalen + UVA). The PUVA treatment had been commenced between 1974 and 1978. With trioxsalen baths a high sensitivity to UVA is obtained. The initial UVA dosage is therefore as low as 0.04-0.08 J/cm2 and in the majority of the patients the maximum daily dose was about 1.0 J/cm2. The accumulated UVA dosage was low. Thus 89% of the patients had received less than 50 J/cm2 in 5-8 years of bath PUVA treatment. No degenerative skin changes were found on PUVA-exposed skin that were not also seen on the facial skin not exposed to PUVA. Two patients showed mild mottling of exposed skin. Otherwise no PUVA-related degenerative changes were observed. No carcinomas were found on bath PUVA-treated skin.

Concentrations of selenium in whole blood and plasma in 113 patients with moderate to severe psoriasis were compared with those in 104 healthy reference subjects. Most of the patients (85%) had had their psoriasis for at least 10 years and all had previously been treated with PUVA baths. Selenium concentrations both in whole blood and plasma were decreased both in male and female psoriasis patients. Male psoriatics 20-49 years old and women with disease of long duration (greater than 20 years) had particularly low selenium concentrations in whole blood. The lowest whole blood values were found in a subgroup of male patients with widespread disease of long duration who had also required treatment with methotrexate and/or retinoids to control their disease. The blood selenium in patients who also had psoriatic arthritis or arthralgia did not differ from those without such symptoms.

The long-chained fatty acids, which are precursors of prostaglandins and leukotrienes, were examined in plasma lipid esters and adipose tissue obtained from 20 male psoriatic patients and 36 matched controls. The fatty-acid composition of the plasma lipid esters (cholesterol esters, triglycerides and phospholipids) and adipose tissue was assayed using thin-layer and gas chromatography. In comparison with healthy controls, the patients' plasma lipid esters contained significantly lower levels of linoleic acid (18:2 omega 6) and alpha-linolenic acid (18:3 omega 3), and higher levels of dihomo-gamma-linolenic acid (20:3 omega 6). In the adipose tissue of the patients, the amount of alpha-linolenic acid was significantly decreased, while that of arachidonic acid (20:4 omega 6) was increased. The observed changes were more pronounced in patients with severe psoriasis than in those with a milder form of the disease. Our results suggest that psoriatic patients differ from healthy controls with regard to the distribution of several of the essential long-chained fatty acids involved in the biosynthesis of prostaglandins and leukotrienes. The relevance of these findings to the development of psoriasis remains to be established.

The long-chained fatty acids, which are precursors of prostaglandins and leukotrienes, were examined in plasma lipid esters and adipose tissue obtained from 20 male psoriatic patients and 36 matched controls. The fatty-acid composition of the plasma lipid esters (cholesterol esters, triglycerides and phospholipids) and adipose tissue was assayed using thin-layer and gas chromatography. In comparison with healthy controls, the patients' plasma lipid esters contained significantly lower levels of linoleic acid (18:2 ω6) and α-linolenic acid (18:3 ω3), and higher levels of dihomo-γ-linolenic acid (20:3 ω6). In the adipose tissue of the patients, the amount of α-linolenic acid was significantly decreased, while that of arachidonic acid (20:4 ω6) was increased. The observed changes were more pronounced in patients with severe psoriasis than in those with a milder form of the disease. Our results suggest that psoriatic patients differ from healthy controls with regard to the distribution of several of the essential long-chained fatty acids involved in the biosynthesis of prostaglandins and leukotrienes. The relevance of these findings to the development of psoriasis remains to be established. [ABSTRACT FROM AUTHOR]