Prolonged occlusion in the treatment of psoriasis: a clinical and immunohistologic study.
BACKGROUND
An occlusive dressing that is both cosmetically acceptable and long term is needed for psoriasis treatment. The mechanisms that underlie the efficacy of occlusion in psoriasis are unknown.


OBJECTIVE
We performed a clinical and immunohistologic study in patients with psoriasis of the effects of occlusion, topical corticosteroid alone, and occlusion plus corticosteroid, with a new prolonged dressing as the occlusive therapy.


METHODS
Nineteen patients completed a 3-week study of efficacy of prolonged occlusion dressing, fluocinonide ointment, or a combination of the two. An immunohistologic study was performed in 10 patients with psoriasis treated for 1 week with prolonged occlusion.


RESULTS
The combination of fluocinonide ointment and occlusion produced significantly more improvement than either treatment alone (p < 0.01). There was no significant difference between the efficacy of prolonged occlusion or fluocinonide ointment. On 4-week follow-up plaques treated with occlusion alone or combined fluocinonide and occlusion were still significantly improved (p = 0.05 and p < 0.001, respectively). None of the immunohistologic and proliferation markers assessed in psoriatic plaques was significantly affected by occlusion as compared with untreated plaques.


CONCLUSIONS
Prolonged occlusion is an effective therapy for psoriasis either as monotherapy or in combination with a high-potency topical corticosteroid. However, the mechanism of action of prolonged occlusion alone in the improvement of psoriasis is unknown.
Griffiths
C E
CE
Department of Dermatology, University of Michigan Medical Center, Ann Arbor.
Tranfaglia
M G
MG
Kang
S
S
D000279:Administration, Cutaneous; D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D018414:CD8-Positive T-Lymphocytes / Q000473:pathology; D015815:Cell Adhesion Molecules / Q000032:analysis; D003131:Combined Modality Therapy; D019040:E-Selectin; D005260:Female; D005447:Fluocinonide / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D007801:Langerhans Cells / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings / Q000009:adverse effects; D011565:Psoriasis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D011971:Receptors, Immunologic / Q000032:analysis
D015815:Cell Adhesion Molecules; D019040:E-Selectin; D016209:Interleukin-8; D011971:Receptors, Immunologic; D018799:Intercellular Adhesion Molecule-1; D005447:Fluocinonide