Correspondence
Patients had suffered from psoriasis for a minimum of 2 years, were in good health, and did not present any altered hepatic, renal, and cardiocirculatory functions. In each patient we chose a symmetrical psoriatic plaque, whicb we evaluated for erythema, infiltrate, and scaling, using a range from 0 to 3 (0 = absent, 1 = mild, 2 = moderate, 3 = severe). Cyclosporine formulation (2 mL) was applied topically b.i.d. on psoriasis plaques, and 2 mL of control solution, containing only the solvent, was applied on tbe opposite body side. The treatment was performed for 1 montb. Patients were examined every 7 days for 1 montb. No patient was responsive to the cyclosporine treatment. A light reduction of scaling was registered in five patients. Cyclosporine blood levels were in tbe range of 54 to 61 mg/mL after 15 days of treatment and in the range of 73 to 90 mg/niL after 30 days. No side effects were registered. Our results suggest tbat topical cyclosporine is ineffective in tbe treatment of psoriasis, even though we used different solvents with higher concentrations, and we registered a light blood cyclosporine absorption in these patients. The different nature of vehicle was not important for cyclosporine absorption. M. Delfino, M.D. B. Brunetti, M.D. G. Eabbrocini, M.D. Naples, Italy
References 1. Center for Disease Control. Condyloma acuminata United States. MMWR 1983; 32:306-308. 2. Eron LJ, Judson F, Tucker S, et al. Interferon therapy for condylomata acuminata. N Engl J Med 1986; 315: 1059-1064. 3. Foldvari M, Gesztes A, Mezei M. Dermal drug delivery by liposome encapsulation. Clinical and electron microscopic studies. J Microencapsul 1990; 7:479-489. 4. Eriedman-Kien AE, Eron LJ, Conant M, et al. Natural interferon alfa for treatment of condylomata acuminata. JAMA 1988; 259:533-538. 5. Gesztes A, Mezei M. Topical anesthesia of the skin by liposome-encapsulated tetracaine. Anesth Analg 1988; 67:1079-1081.
Topical Cyclosporine is Ineffective in the Treatment of Psoriasis To the Editor: Cyclosporine is a neutral lipopbilic cyclic polypeptide with a potent immunosuppressive effect on T-helper lymphocytes. Cyclosporine is able to inbibit tbe T-helper lymphocytes proliferation and inbibits tbe production of some lympbokines, sucb as interleukin 1 (n.-l), interleukin 2 (lL-2), and interferon gamma. Oral and topical formulations of cyclosporine have been tried in patients suffering from psoriasis; these patients register an increase of T-helper/T-suppressor ratio in the tissues.''An Italian multicenter double-blind placebo-controlled study performed with lower doses of cyclosporine (3 and 5 mg/kg/day) than previously used showed, in 631 of 724 patients (80%) with severe psoriasis (I'ASi score of more than 18), a remission of 75% in I'ASI score after 8 weeks of treatment with no difference between tbe two different doses. The use of bigh dose or long-term therapy with oral cyclosporine in psoriasis is limited by its nephrotoxicity, therefore, topical cyclosporine formulations bave been used in psoriasis without any prior success. Earlier trials used cyclosporine at a concentration between 2 and 5%, diluted in different solvents.''^'" On the basis of a literature review and the favorable experience reported, we evaluated tbe efficacy of topical cyclosporine at higher concentration (5%) and diluted in three different solvents (divinylpirrolidinone, dimethyl sulfoxide, and olive oil) to evaluate if there was some difference in cyclosporine absorption and in responsivity to tbe treatment. We treated 15 patients (7 women and 8 men), aged from 30 to 60 years, witb psoriatic plaques (PASI score 14). Tbey were divided in tbree groups of five persons each and treated with the three different topical solutions of cyclosporine . Cyclosporine blood levels were checked after 15 and 30 days of therapy, at least 8 hours after the last topical application.
References 1. Dubetret L, Perussel M, Robiola O, Eeutren G. Cyclosporin in psoriasis: a long-term randomized study on 37 patients. Acta Derm Venereol (Stockh) 1989; 146(suppl): 147.
895
2.
Einzi AF, Mozzanica N, Cattaneo A, et al. Effectiveness of cyclosporine treatment in severe psoriasis: a clinical and immunological study. J Am Acad Dermatoi 1989; 21:91-97.
3.
Gilbar A, Winterstein G, Golan DT. Topical Sandimmun in psoriasis. J Am Acad Dermatoi 1988; 18:378-379.
4.
Griffitbs CEM, Powles AV, Leonard JN, dry L. Clearance of psoriasis witb low dose of cyclosporin. BMJ 1986; 293:731-732.
5.
Griffiths CEM, Powles AV, Baker BS. Topical Sandimmun for psoriasis. Lancet 1987; i:806.
6.
Mozzanica N, Cattaneo A, Pigatto PD, Finzi AF. Cyclosporine A in psoriasis: an immunohistological study. Transplant Proc 1988; 20 (suppl 4):84.
7.
Schauder CS, Gorsulowsky DC. Topical Sandimmun in the treatment of psoriasis. Clin Res 1986; 34:
8.
Schulze HJ, et al. Topical Sandimmun for psoriasis. Br J Dermatoi 1990; 122:1 13-114.
Patients had suffered from psoriasis for a minimum of 2 years, were in good health, and did not present any altered hepatic, renal, and cardiocirculatory functions. In each patient we chose a symmetrical psoriatic plaque, whicb we evaluated for erythema, infiltrate, and scaling, using a range from 0 to 3 (0 = absent, 1 = mild, 2 = moderate, 3 = severe). Cyclosporine formulation (2 mL) was applied topically b.i.d. on psoriasis plaques, and 2 mL of control solution, containing only the solvent, was applied on tbe opposite body side. The treatment was performed for 1 montb. Patients were examined every 7 days for 1 montb. No patient was responsive to the cyclosporine treatment. A light reduction of scaling was registered in five patients. Cyclosporine blood levels were in tbe range of 54 to 61 mg/mL after 15 days of treatment and in the range of 73 to 90 mg/niL after 30 days. No side effects were registered. Our results suggest tbat topical cyclosporine is ineffective in tbe treatment of psoriasis, even though we used different solvents with higher concentrations, and we registered a light blood cyclosporine absorption in these patients. The different nature of vehicle was not important for cyclosporine absorption. M. Delfino, M.D. B. Brunetti, M.D. G. Eabbrocini, M.D. Naples, Italy
References 1. Center for Disease Control. Condyloma acuminata United States. MMWR 1983; 32:306-308. 2. Eron LJ, Judson F, Tucker S, et al. Interferon therapy for condylomata acuminata. N Engl J Med 1986; 315: 1059-1064. 3. Foldvari M, Gesztes A, Mezei M. Dermal drug delivery by liposome encapsulation. Clinical and electron microscopic studies. J Microencapsul 1990; 7:479-489. 4. Eriedman-Kien AE, Eron LJ, Conant M, et al. Natural interferon alfa for treatment of condylomata acuminata. JAMA 1988; 259:533-538. 5. Gesztes A, Mezei M. Topical anesthesia of the skin by liposome-encapsulated tetracaine. Anesth Analg 1988; 67:1079-1081.
Topical Cyclosporine is Ineffective in the Treatment of Psoriasis To the Editor: Cyclosporine is a neutral lipopbilic cyclic polypeptide with a potent immunosuppressive effect on T-helper lymphocytes. Cyclosporine is able to inbibit tbe T-helper lymphocytes proliferation and inbibits tbe production of some lympbokines, sucb as interleukin 1 (n.-l), interleukin 2 (lL-2), and interferon gamma. Oral and topical formulations of cyclosporine have been tried in patients suffering from psoriasis; these patients register an increase of T-helper/T-suppressor ratio in the tissues.''An Italian multicenter double-blind placebo-controlled study performed with lower doses of cyclosporine (3 and 5 mg/kg/day) than previously used showed, in 631 of 724 patients (80%) with severe psoriasis (I'ASi score of more than 18), a remission of 75% in I'ASI score after 8 weeks of treatment with no difference between tbe two different doses. The use of bigh dose or long-term therapy with oral cyclosporine in psoriasis is limited by its nephrotoxicity, therefore, topical cyclosporine formulations bave been used in psoriasis without any prior success. Earlier trials used cyclosporine at a concentration between 2 and 5%, diluted in different solvents.''^'" On the basis of a literature review and the favorable experience reported, we evaluated tbe efficacy of topical cyclosporine at higher concentration (5%) and diluted in three different solvents (divinylpirrolidinone, dimethyl sulfoxide, and olive oil) to evaluate if there was some difference in cyclosporine absorption and in responsivity to tbe treatment. We treated 15 patients (7 women and 8 men), aged from 30 to 60 years, witb psoriatic plaques (PASI score 14). Tbey were divided in tbree groups of five persons each and treated with the three different topical solutions of cyclosporine . Cyclosporine blood levels were checked after 15 and 30 days of therapy, at least 8 hours after the last topical application.
References 1. Dubetret L, Perussel M, Robiola O, Eeutren G. Cyclosporin in psoriasis: a long-term randomized study on 37 patients. Acta Derm Venereol (Stockh) 1989; 146(suppl): 147.
895
2.
Einzi AF, Mozzanica N, Cattaneo A, et al. Effectiveness of cyclosporine treatment in severe psoriasis: a clinical and immunological study. J Am Acad Dermatoi 1989; 21:91-97.
3.
Gilbar A, Winterstein G, Golan DT. Topical Sandimmun in psoriasis. J Am Acad Dermatoi 1988; 18:378-379.
4.
Griffitbs CEM, Powles AV, Leonard JN, dry L. Clearance of psoriasis witb low dose of cyclosporin. BMJ 1986; 293:731-732.
5.
Griffiths CEM, Powles AV, Baker BS. Topical Sandimmun for psoriasis. Lancet 1987; i:806.
6.
Mozzanica N, Cattaneo A, Pigatto PD, Finzi AF. Cyclosporine A in psoriasis: an immunohistological study. Transplant Proc 1988; 20 (suppl 4):84.
7.
Schauder CS, Gorsulowsky DC. Topical Sandimmun in the treatment of psoriasis. Clin Res 1986; 34:
8.
Schulze HJ, et al. Topical Sandimmun for psoriasis. Br J Dermatoi 1990; 122:1 13-114.
