Hans-Dieter Orzechowski

European S3‐Guidelines on the systemic treatment of psoriasis vulgaris

Of the 131 studies on monotherapy or combination therapy assessed, 56 studies on the different forms of phototherapy fulfilled the criteria for inclusion in the guidelines. Approximately three-quarters of all patients treated with phototherapy attained at least a PASI 75 response after 4 to 6 weeks, and clearance was frequently achieved (levels of evidence 2 and 3). Phototherapy represents a safe and very effective treatment option for moderate to severe forms of psoriasis vulgaris. The onset of clinical effects occurs within 2 weeks. Of the unwanted side effects, UV erythema from overexposure is by far the most common and is observed frequently. With repeated or long-term use, the consequences of high, cumulative UV doses (such as premature aging of the skin) must be taken into consideration. In addition, carcinogenic risk is associated with oral PUVA and is probable for local PUVA and UVB. The practicability of the therapy is limited by spatial, financial, human, and time constraints on the part of the physician, as well as by the amount of time required by the patient. From the perspective of the cost-bearing institution, phototherapy has a good cost-benefit ratio. However, the potentially significant costs for, and time required of, the patient must be considered.

S3 – Guidelines on the treatment of psoriasis vulgaris (English version). Update

Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5% to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, surveys have shown that patients still do not received optimal treatments. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologi sche Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence‐based guidelines for the management of psoriasis. They were first published in 2006 and updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate and severe plaque‐type psoriasis in adults including systemic therapy, UV therapy and topical therapies.

German evidence-based guidelines for the treatment of Psoriasis vulgaris (short version)

Psoriasis vulgaris is a common and chronic inflammatory skin disease which has the potential to significantly reduce the quality of life in severely affected patients. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. The guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. The short version of the guidelines reported here consist of a series of therapeutic recommendations that are based on a systematic literature search and subsequent discussion with experts in the field; they have been approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs as well as detailed information on how best to apply the treatments described (for full version, please see Nast et al., JDDG, Suppl 2:S1–S126, 2006; or http://www.psoriasis-leitlinie.de).

German S3-guidelines on the treatment of psoriasis vulgaris (short version)

Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5 to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, patient surveys have revealed insufficient satisfaction with the efficacy of available treatments and a high rate of medication non-compliance (Richards et al. in J Am Acad Dermatol 41(4):581–583, 1999). To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologische Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis first published in 2006 and now updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate, and severe plaque-type psoriasis in adults. This short version of the guidelines presents the resulting series of therapeutic recommendations, which were based on a systematic literature search and discussed and approved by a team of dermatology experts. In addition to the therapeutic recommendations provided in this short version, the full version of the guidelines includes information on contraindications, adverse events, drug interactions, practicality, and costs, as well as detailed information on how best to apply the treatments described (for full version please see Nast et al. in JDDG Suppl 2:S1–S104, 2011 or http://www.psoriasis-leitlinie.de).

A natural fiber complex reduces body weight in the overweight and obese: a double-blind, randomized, placebo-controlled study.

A proprietary natural fiber complex (Litramine IQP G‐002AS) derived from Opuntia ficus‐indica, and standardized on lipophilic activity, was previously shown in preclinical and human studies to reduce dietary fat absorption through gastrointestinal (GI) fat binding. Here, we investigated the efficacy and safety of IQP G‐002AS in body weight reduction.

S3-Leitlinie zur Therapie der Psoriasis vulgaris Update 2011

Alexander Nast, Wolf-Henning Boehncke, Ulrich Mrowietz, Hans-Michael Ockenfels, Sandra Philipp, Kristian Reich, Thomas Rosenbach, Adel Sammain, Martin Schlaeger, Michael Sebastian, Wolfram Sterry, Volker Streit, Matthias Augustin, Ricardo Erdmann, Joachim Klaus, Joachim Koza, Siegrid Müller, Hans-Dieter Orzechowski, Stefanie Rosumeck, Gerhard Schmid-Ott, Tobias Weberschock, Berthold Rzany (1) Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin (2) Zentrum der Dermatologie und Venerologie, Klinikum der Johann Wolfgang Goethe Universität, Frankfurt/M. (3) Klinik für Dermatologie, Venerologie, Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel (4) Hautund Allergieklinik, Klinikum Hanau (5) Psoriasisstudienzentrum, Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin (6) Dermatologikum Hamburg (7) Niedergelassener Dermatologe, Osnabrück (8) Niedergelassener Dermatologe, Oldenburg (9) Niedergelassener Dermatologe, Mahlow (10) Klinik für Dermatologie, Venerologie und Allergologie, Charité – Universitätsmedizin Berlin (11) Niedergelassener Dermatologe, Buchholz (12) Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Dermatologie und Venerologie, Hamburg (13) Deutscher Psoriasis Bund e.V. (14) Pflegevertreterin, Ravenstein (15) Institut für Klinische Pharmakologie und Toxikologie, Charité – Universitätsmedizin Berlin (16) Berolina Klinik, Löhne

Single low-dose administration of pharmacological inhibitor of mitogen-activated ERK kinase to the adventitia of the injured rat carotid artery suppresses neointima formation and inhibits nuclear ERK signaling

Arterial injury has been reported to activate the mitogen-activated ERK kinase (MEK)/extracellular signal-regulated kinase (ERK) signaling pathway. Pharmacological MEK inhibition was previously shown to inhibit injury-induced neointima formation in rodent models, but inhibitor compounds were administered either locally at a high dose or systemic treatment was performed over an extended period of time. Aim of this study was, therefore, to explore the efficiency of single low-dose administration of the MEK inhibitor PD98059 on neointima formation in the injured rat carotid artery. The second aim of the study was to analyse treatment effects on MEK-dependent signaling and protein expression. PD98059 (at doses of 10 and 40 nmol) was administered to the adventitia immediately after injury using Pluronic gel as drug carrier. Compared to untreated controls, PD98059 treatment (10 nmol) resulted in significant reductions of neointima-to-media ratio (by 66%) and injury-induced lumen loss (by 53%). Conversely, lumen was increased by 33% in PD98059-treated arteries. There were no significant differences between the 10 and 40 nmol treatment groups. Dual ERK1/2 phosphorylation, and also ERK1/2 protein expression, was significantly inhibited by PD98059 treatment. Expression of the transcription factor Ets-1, a nuclear target protein of ERK1/2 was significantly suppressed in PD98059-treated arteries. Attenuation of neointima formation was associated with significantly decreased expression of the proliferation marker PCNA. In contrast, we did not find biochemical evidence of increased apoptosis in PD98059-treated arteries. Our data show that the single adventitial administration of low-dose MEK inhibitor PD98059 is sufficient to suppress neointima formation in injured arteries.