Pulsed dye laser versus treatment with calcipotriol/betamethasone dipropionate for localized refractory plaque psoriasis: effects on T-cell infiltration, epidermal proliferation and keratinization.
BACKGROUND
Selective photothermolysis of diseased capillaries by pulsed dye laser (PDL) treatment has been described as a mechanism for long-lasting clearance of psoriatic plaques.


OBJECTIVE
To evaluate PDL and a two-compound formulation of calcipotriol/betamethasone dipropionate ointment for the treatment of localized, recalcitrant plaque psoriasis.


METHODS
Eight psoriatic patients were treated for 4 weeks with both PDL and topical calcipotriol/betamethasone dipropionate in an open, intra-patient, left-right comparison. Biopsies were analyzed for T-cell subsets, cells expressing NK-receptors, epidermal proliferation, differentiation and epidermal thickness.


RESULTS
After active treatment, both treatments showed statistically significant but comparable improvements of T-cell subsets, epidermal proliferation, differentiation and epidermal thickness. In line with the clinical results, after an 8-week follow-up period statistically significant further reductions were observed for dermal CD3(+), CD4(+), CD45RO(+), CD2(+) T cells, epidermal CD3(+), CD8(+), CD45RO(+), CD2(+), CD25(+) T cells and the epidermal parameters for the PDL-treated plaques, in contrast to the topically treated plaques.


CONCLUSIONS
After 8 weeks of follow-up, PDL treatment for localized and recalcitrant plaque psoriasis resulted in persistent reductions of activated and memory effector T-helper cells in the dermis, cytotoxic T cells in the epidermis, and normalization of epidermal proliferation and keratinization, in contrast to treatment with calcipotriol/betamethasone dipropionate ointment.
Bovenschen
H Jorn
HJ
Radboud University Nijmegen medical Centre, Rene Descartesdreef 1, 6525 GL, Nijmeger, The Netherlands.
Erceg
Angelina
A
Van Vlijmen-Willems
Ivonne
I
Van De Kerkhof
Peter C M
PC
Seyger
Marieke M B
MM
D000279:Administration, Cutaneous; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015703:Antigens, CD / Q000378:metabolism; D001623:Betamethasone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001706:Biopsy; D002117:Calcitriol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D049109:Cell Proliferation / Q000187:drug effects / Q000528:radiation effects; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004817:Epidermis / Q000187:drug effects / Q000528:radiation effects; D005260:Female; D006801:Humans; D015603:Keratinocytes / Q000187:drug effects / Q000528:radiation effects; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D009824:Ointments; D011565:Psoriasis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D012867:Skin / Q000473:pathology; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology / Q000528:radiation effects; D013602:T-Lymphocytes, Cytotoxic; D006377:T-Lymphocytes, Helper-Inducer; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D015703:Antigens, CD; D003879:Dermatologic Agents; D009824:Ointments; C055085:calcipotriene; C011175:betamethasone-17,21-dipropionate; D001623:Betamethasone; D002117:Calcitriol