Dermatologica 157 (Suppl. 1): 32-37 (1978)
Oral Retinoids and Psoriasis P.A. V iglioglia and A. Barclay Faculty of Medicine, University of Buenos Aires, Buenos Aires
Materia/ and Method Our experience concerns the use of a derivative of the retinoic acid, Ro 10-9359, administered orally to a group of 32 psoriatic patients; 16 were males and 16 females, with an average age and weight of 42.5 ± 2.3 years and 69.5 ±3.2 kg, respectively. The diagnosis was erythrodermic psoriasis in 9 cases, vulgar in 9 cases, and vulgar extended in 14 cases. The duration of the disease ranged between 4 months and 50 years. The dosage of Ro 10-9359 was as shown in table I.
Results
Effects o f the Treatment on the Normal Skin These effects are shown in figure 5. Due to the fragility of the skin, scratching excoriations and sunburns were facilitated.
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Effects o f the Treatment on Psoriatic Signs and Symptoms On signs. Figure 1 shows the evolution of erythema. The average score of improvement in all forms of psoriasis was 51.72%. The effect on the scaling is shown in figure 2, while figure 3 shows the effect on the infiltration. The average score for all forms of psoriasis indicates an improvement of 77.77%. The evolution of the extension of the lesions is shown in figure 4. The aver age of improvement was 44.82%. On symptoms. The evolution of itching and/or warm at the site of lesions was favorable in 70% of the cases. On the psoriatic arthropathy. Table II summarizes the obtained results. The improvement was evident; pain and swelling diminished and an increase of the joint mobility was observed.
Oral Retinoids and Psoriasis
33
Week
Ro 10-9359, mg/day
1- 2 3- 4 5- 6 7- 8 9-10 11-12 13-14
50 75 100 50 50 50 50
Fig. /. Evolution of erythema according to week of treatment (32 cases). Fig. 2. Evolution of scaling according to week of treatment (32 cases).
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Table I. Dosage of Ro 10-9359 administered orally in 32 patients
34
V ig l io g l ia / B
arclay
Average score
Week of treatment
Fig. 3. Evolution of infiltration according to week of treatment (32 cases). Fig. 4. Evolution of the extension of the lesions (32 cases).
Evolution
Number of cases
Average
Remission Marked improvement Moderate improvement Without change
1 4 3 1
0.11 0.44 0.33 0.11
Total
9
1.00 Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 10:22:03 PM
Table II. Evolution of the arthropathy
Oral Retinoids and Psoriasis
35
Cases
o • • • • • • • • • Scaling of palms and soles
011
Thinness of skin — Itching
o " " " " " " " " Warm sensation
Cases
o• • • • • • • • • Cheilitis o—
— Sweating
o»———- Dryness of mucosa o""—
Alopecia
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 10:22:03 PM
Fig. 5. Effect of the treatment with Ro 10-9359 on the normal skin. Fig. 6. Other side effects during the treatment with Ro 10-9359.
36
V lG LIOG LI A /B ARCLA Y
Cases
Complete remission
Excellent
Good
Moderate
General evaluation
Better
Similar
Worse
Comparison with the previous treatment
Fig. 7. Physician’s evaluation of treatment with Ro 10-9359.
Side Effects o f the Treatment on Mucosas and Skin Annexes These are analyzed and summarized in figure 6. Onychocryptosis was observed in 5 cases; onychomadesis in 4. Diffuse alopecia was noticed in 10 patients and prevailed in females. Effects o f the Treatment on Laboratory Controls Ro 10-9359 had no influence on the humoral laboratory examinations performed before, during and after treatment. The physician’s evaluation of the treatment is shown in figure 7.
The treatment of a group of psoriatic patients with the retinoic acid derivative, Ro 10-9359, presents very interesting connotations whose meaning might determine that we should be in the third stage of the present treatment of the disease. The first one was the stage of corticoids and the second of cytostatics, conditioning compounds of collateral effects, visceral and humoral, as hazardous as they are well known. The benefit of the treatment was evident in all cases, independently of the evolutive chronicity as well as of the extension of the disease. A psoriasis
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 10:22:03 PM
Discussion
Oral Retinoids and Psoriasis
37
with a 50-year evolution improves as much as a case of a 4-month duration. This concerns an erythrodermic form as well as a vulgar one. Concerning the affected area, it seems that the more extended the psoria sis is, the more favorable is the response to the treatment with Ro 10-9359. Upon analyzing the side effects of the treatment on the cutaneous annexes it is concluded that the most important ones are those observed on hair and nails. Alopecia and onychomadesis or onychodystrophia, when appearing, break out suddenly, showing a slow course, and are a source of worry on the part of the patient. It should be noted, however, that both processes are re versible. When these secondary effects are compared with those which may be caused by corticoids and systemic cytostatics, one recognizes to be in the presence of a new therapy innocuous to the visceral and humoral sectors, capable of controlling the symptoms and signs of the most serious cases of psoriasis. Relapses consecutive to the interruption of the treatment present signi ficant individual variations. In 1 patient the lesions remained clean for 1 year; the psoriasis reappeared at the death of the patient’s father. In some other cases, it reappeared 1 month after treatment was interrupted, but generally it can be established that the period of time until a relapse is about 2 months. The new eruption is generally mild and in any case as severe as the one observed when interrupting corticoids. It resembles the relapse follow ing the interruption of cytostatics and responds favorably in all the cases to a second treatment even with a daily dose of 0.5 mg/kg.
References 1 Boguth , W .; H orn , V.; Solliman, M.K. und W eiser, H.: Eine neue Methode zur Bestimmung kurz wirksamer A-Präparate. Int. Z. VitamForsch. 31: 6-10 (1960). 2 Description for Clinical Trials: Ro 10-9359 (Hoffmann-La Roche, Basle 1976).
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 10:22:03 PM
Prof. Dr. P.A. Viguoglia , Faculty of Medicine, University of Buenos Aires, Buenos Aires (Argentine)
Oral Retinoids and Psoriasis P.A. V iglioglia and A. Barclay Faculty of Medicine, University of Buenos Aires, Buenos Aires
Materia/ and Method Our experience concerns the use of a derivative of the retinoic acid, Ro 10-9359, administered orally to a group of 32 psoriatic patients; 16 were males and 16 females, with an average age and weight of 42.5 ± 2.3 years and 69.5 ±3.2 kg, respectively. The diagnosis was erythrodermic psoriasis in 9 cases, vulgar in 9 cases, and vulgar extended in 14 cases. The duration of the disease ranged between 4 months and 50 years. The dosage of Ro 10-9359 was as shown in table I.
Results
Effects o f the Treatment on the Normal Skin These effects are shown in figure 5. Due to the fragility of the skin, scratching excoriations and sunburns were facilitated.
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 10:22:03 PM
Effects o f the Treatment on Psoriatic Signs and Symptoms On signs. Figure 1 shows the evolution of erythema. The average score of improvement in all forms of psoriasis was 51.72%. The effect on the scaling is shown in figure 2, while figure 3 shows the effect on the infiltration. The average score for all forms of psoriasis indicates an improvement of 77.77%. The evolution of the extension of the lesions is shown in figure 4. The aver age of improvement was 44.82%. On symptoms. The evolution of itching and/or warm at the site of lesions was favorable in 70% of the cases. On the psoriatic arthropathy. Table II summarizes the obtained results. The improvement was evident; pain and swelling diminished and an increase of the joint mobility was observed.
Oral Retinoids and Psoriasis
33
Week
Ro 10-9359, mg/day
1- 2 3- 4 5- 6 7- 8 9-10 11-12 13-14
50 75 100 50 50 50 50
Fig. /. Evolution of erythema according to week of treatment (32 cases). Fig. 2. Evolution of scaling according to week of treatment (32 cases).
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 10:22:03 PM
Table I. Dosage of Ro 10-9359 administered orally in 32 patients
34
V ig l io g l ia / B
arclay
Average score
Week of treatment
Fig. 3. Evolution of infiltration according to week of treatment (32 cases). Fig. 4. Evolution of the extension of the lesions (32 cases).
Evolution
Number of cases
Average
Remission Marked improvement Moderate improvement Without change
1 4 3 1
0.11 0.44 0.33 0.11
Total
9
1.00 Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 10:22:03 PM
Table II. Evolution of the arthropathy
Oral Retinoids and Psoriasis
35
Cases
o • • • • • • • • • Scaling of palms and soles
011
Thinness of skin — Itching
o " " " " " " " " Warm sensation
Cases
o• • • • • • • • • Cheilitis o—
— Sweating
o»———- Dryness of mucosa o""—
Alopecia
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 10:22:03 PM
Fig. 5. Effect of the treatment with Ro 10-9359 on the normal skin. Fig. 6. Other side effects during the treatment with Ro 10-9359.
36
V lG LIOG LI A /B ARCLA Y
Cases
Complete remission
Excellent
Good
Moderate
General evaluation
Better
Similar
Worse
Comparison with the previous treatment
Fig. 7. Physician’s evaluation of treatment with Ro 10-9359.
Side Effects o f the Treatment on Mucosas and Skin Annexes These are analyzed and summarized in figure 6. Onychocryptosis was observed in 5 cases; onychomadesis in 4. Diffuse alopecia was noticed in 10 patients and prevailed in females. Effects o f the Treatment on Laboratory Controls Ro 10-9359 had no influence on the humoral laboratory examinations performed before, during and after treatment. The physician’s evaluation of the treatment is shown in figure 7.
The treatment of a group of psoriatic patients with the retinoic acid derivative, Ro 10-9359, presents very interesting connotations whose meaning might determine that we should be in the third stage of the present treatment of the disease. The first one was the stage of corticoids and the second of cytostatics, conditioning compounds of collateral effects, visceral and humoral, as hazardous as they are well known. The benefit of the treatment was evident in all cases, independently of the evolutive chronicity as well as of the extension of the disease. A psoriasis
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 10:22:03 PM
Discussion
Oral Retinoids and Psoriasis
37
with a 50-year evolution improves as much as a case of a 4-month duration. This concerns an erythrodermic form as well as a vulgar one. Concerning the affected area, it seems that the more extended the psoria sis is, the more favorable is the response to the treatment with Ro 10-9359. Upon analyzing the side effects of the treatment on the cutaneous annexes it is concluded that the most important ones are those observed on hair and nails. Alopecia and onychomadesis or onychodystrophia, when appearing, break out suddenly, showing a slow course, and are a source of worry on the part of the patient. It should be noted, however, that both processes are re versible. When these secondary effects are compared with those which may be caused by corticoids and systemic cytostatics, one recognizes to be in the presence of a new therapy innocuous to the visceral and humoral sectors, capable of controlling the symptoms and signs of the most serious cases of psoriasis. Relapses consecutive to the interruption of the treatment present signi ficant individual variations. In 1 patient the lesions remained clean for 1 year; the psoriasis reappeared at the death of the patient’s father. In some other cases, it reappeared 1 month after treatment was interrupted, but generally it can be established that the period of time until a relapse is about 2 months. The new eruption is generally mild and in any case as severe as the one observed when interrupting corticoids. It resembles the relapse follow ing the interruption of cytostatics and responds favorably in all the cases to a second treatment even with a daily dose of 0.5 mg/kg.
References 1 Boguth , W .; H orn , V.; Solliman, M.K. und W eiser, H.: Eine neue Methode zur Bestimmung kurz wirksamer A-Präparate. Int. Z. VitamForsch. 31: 6-10 (1960). 2 Description for Clinical Trials: Ro 10-9359 (Hoffmann-La Roche, Basle 1976).
Downloaded by: Univ. of California Santa Barbara 128.111.121.42 - 3/7/2018 10:22:03 PM
Prof. Dr. P.A. Viguoglia , Faculty of Medicine, University of Buenos Aires, Buenos Aires (Argentine)
