title: The effects of keratolytic pretreatment prior to fluorescence diagnosis and photodynamic therapy with aminolevulinic acid-induced porphyrins in psoriasis.
abstract: BACKGROUND
  Psoriasis lesions accumulate protoporphyrin IX (PpIX) with a variable distribution within plaques due to variations in hyperkeratosis causing differences in penetration of cream or light.
  
  
  OBJECTIVE
  To study the effects of different keratolytic pretreatments in PpIX-induced fluorescence diagnosis (FDAP) and during photodynamic therapy (PDT).
  
  
  METHODS
  Two psoriasis plaques of 10 patients were treated with either topical retinoic acid or with a hydrocolloid dressing. The hydrocolloid dressing gave the best results. Subsequently, two different contralateral plaques of eight patients were pretreated with a hydrocolloid dressing or the standard pretreatment, salicylic acid in petrolatum, during the 6 weeks of PDT. Biopsies were investigated with respect to stratum corneum thickness, proliferation, differentiation and inflammation.
  
  
  RESULTS
  Irritation and point bleedings were noticed after retinoic acid. A hydrocolloid dressing induced the best clinical improvement. Therefore, it was used as alternative pretreatment for psoriasis prior to PDT. We observed significant clinical and immunohistochemical improvement of psoriasis in the salicylic acid as well as the hydrocolloid dressing pretreated plaques.
  
  
  CONCLUSIONS
  Salicylic acid in petrolatum and a hydrocolloid dressing prior to FDAP and PDT induce improvement of hyperkeratosis. Thus, a hydrocolloid dressing is a good alternative to the current keratolytic pretreatment regime.
authors.affiliation: Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. M.Kleinpenning@derma.umcn.nl
authors.forename: Marloes M
authors.initials: MM
authors.lastname: Kleinpenning
authors.forename: Josine H
authors.initials: JH
authors.lastname: Kanis
authors.forename: Tim
authors.initials: T
authors.lastname: Smits
authors.forename: Piet E J
authors.initials: PE
authors.lastname: van Erp
authors.forename: Peter
authors.initials: P
authors.lastname: van de Kerkhof
authors.forename: Rianne M J P
authors.initials: RM
authors.lastname: Gerritsen
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage*; D000704:Analysis of Variance; D047070:Bandages, Hydrocolloid; D001707:Biopsy, Needle; D005260:Female; D005453:Fluorescence; D006801:Humans; D007150:Immunohistochemistry; D007641:Keratolytic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy / Q000379:methods*; D010865:Pilot Projects; D011336:Probability; D011524:Protoporphyrins / Q000378:metabolism*; D011565:Psoriasis / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D012869:Skin Absorption / Q000187:drug effects; D016896:Treatment Outcome; D014212:Tretinoin / Q000627:therapeutic use*
chemical_list: D007641:Keratolytic Agents; D011524:Protoporphyrins; D014212:Tretinoin; D000622:Aminolevulinic Acid; C028025:protoporphyrin IX