Management of erythrodermic psoriasis with low-dose cyclosporin

B. Giannotti, P. Carli, C. Veller-Fornasa, G. Cancian, A. Fadel, P. Amerio, S. Masci, M. Gravante, A. Rebora, A. Parodi, O. Carlesimo, R. Clerico, V. Indelicato, E. Mian, D. Beconcini, G. Galbiati, A. Nicoletti, F. Atzori, G. Laurenti

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Abstract

Thirty-three patients (M/F 25/8, aged 19-71 years) with severe erythrodermic psoriasis entered an open multicenter study to evaluate the efficacy (induction and maintenance of clinical remission) and tolerability of long-term treatment with cyclosporin. It was given at a maximum initial dose of 5 mg/kg/day (initial mean dose 4.2 mg/kg/day), subsequently adjusted during the course of treatment according to clinical response, patient tolerability and any modification in laboratory parameters or blood pressure, carefully monitored each month. All of the patients were unsatisfactory responders to conventional systemic therapy (PUVA therapy, retinoids, corticosteroids), free of any clinically obvious immunodeficiencies, malignancies or blood dyscrasia and within the normal range for renal and hepatic function and blood pressure. At remission (defined as complete resolution of erythema in the body area involved), cyclosporin was slowly tapered off (0.5 mg/kg every 2 weeks) until total discontinuation or the reappearance of signs of disease. As concomitant therapy, white petrolatum in association with cyclosporin as well as specific local therapy between cyclosporin in cycles was allowed. After 6.3 ± 3.4 months (mean ± SD), cyclosporin doses of 3-5 mg/kg/day had led to complete remission in 67% of patients (22/33) in a median time of 2-4 months; in a further 27% of cases, considerable improvement in skin involvement was observed, with a reduction of more than 70% in comparison with baseline. The rapid and progressive improvement in the degree of skin involvement, pruritus and the severity of the characteristics of the psoriatic lesions (erythema and desquamation) proved to be significant versus baseline as early as the first month of treatment, as well as at all of the subsequent visits (p <0.05, Dunnett's test). Four patients, previously achieving remission, relapsed between 3 and 12 months after entering the study with a relapse-free interval of between 2 and 8 months; 3 of them were in the drug withdrawal phase, the fourth had completely discontinued treatment. No evidence of any signs of disease rebound was seen. Side effects were observed in 15/33 patients, 8 of whom were considered to be certainly drug related. Cyclosporin was discontinued in 6 patients because of side effects: in 2 as main reason for discontinuation (hypertension and cerebrovascular disorders), in the remaining 4 as secondary reason to poor protocol compliance. The adverse events reported were mild/moderate and reversible on dose adjustment. In conclusion, given the rapidity of action and good tolerability of low-dose cyclosporin (3-5 mg/kg/day), it can be considered as the new therapy of choice in patients with erythrodermic psoriasis. An intermittent regimen (such as an attack therapy for an acute and severe form of psoriasis followed by gradual withdrawal) makes the drug manageable and well tolerated.

Original languageEnglish
Pages (from-to)30-37
Number of pages8
JournalDermatology
Volume187
Issue numberSUPPL. 1
Publication statusPublished - 1993

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Keywords

  • Erythrodermic psoriasis
  • Intermittent regimen
  • Low-dose cyclosporin

ASJC Scopus subject areas

  • Dermatology

Cite this

Giannotti, B., Carli, P., Veller-Fornasa, C., Cancian, G., Fadel, A., Amerio, P., Masci, S., Gravante, M., Rebora, A., Parodi, A., Carlesimo, O., Clerico, R., Indelicato, V., Mian, E., Beconcini, D., Galbiati, G., Nicoletti, A., Atzori, F., & Laurenti, G. (1993). Management of erythrodermic psoriasis with low-dose cyclosporin. Dermatology, 187(SUPPL. 1), 30-37.