Search PubMed⌕ Search

Biomedical subjects

C N Ellis

Publications and source records attributed to C N Ellis.

At least 127 records · Page 7Linked to original sources
PubMed1989

Cyclosporine in the treatment of psoriatic arthritis.

The short-term efficacy of cyclosporine in the treatment of six patients with moderately severe to severe psoriatic arthritis was evaluated in an open study. Patients received oral cyclosporine (6 mg/kg/d) for eight weeks. In all patients, significant improvement of psoriasis was noted within two to four weeks. At the end of therapy, rheumatologic assessment revealed the following trends in disease activity: a decrease in the number of tender joints, joint tenderness index, duration of morning stiffness, and an increase in grip strength. There was a decrease in the number of swollen joints, joint swelling index, and the time taken to walk 50 ft. Overall disease activity significantly improved as assessed independently by the patient and physician. For psoriasis and psoriatic arthritis, disease activity worsened toward baseline within four weeks of discontinuation of therapy. Short-term, low-dose cyclosporine therapy may be effective in treating psoriasis and psoriatic arthritis.

Adult↗
PubMed1988

Pruritus in psoriasis. A prospective study of some psychiatric and dermatologic correlates.

Among 82 inpatients with psoriasis, 67% (55 patients) reported moderate or severe pruritus. The degree of depressive psychopathology discriminated between the mild, moderate, and severe pruritus groups at admission. Prospectively, the change in depression scores correlated with the change in pruritus pretreatment to posttreatment. Pruritus severity did not correlate significantly with stress due to life events, age at onset, ethyl duration of psoriasis, age, sex, marital status, and average reported daily alcohol (ethanol) consumption. Among the objective dermatologic measures, including extent and severity of lesions, only the degree of perilesional irritation discriminated between the mild, moderate, and severe pruritus groups at admission, and prospectively, change in this measure correlated with the change in pruritus pretreatment to posttreatment. This finding was most likely related to the self-excoriation associated with pruritus. Intrapsychic factors (eg, the severity of depression) rather than external psychosocial or well-defined dermatologic factors, were the most significant correlates of pruritus in psoriasis.

Adult↗
PubMed1988

A new syndrome of axial muscle rigidity associated with etretinate therapy.

We report on three cases of a novel syndrome associated with treatment for psoriasis with the retinoid etretinate. The distinctive features of this syndrome include rigidity that is restricted to the axial muscles, impairment of neck extension greater than flexion, impairment of anteflexion at the waist, severe impairment of lateral flexion at both the waist and the neck, and, in one case, rigidity of proximal lower extremity muscles. Peripheral nerve block extinguished the lower extremity rigidity in one patient, and two patients had a favorable response to Sinemet. One patient had persistence of symptoms and findings 2 years after discontinuation of etretinate. The clinical features of this syndrome are consistent with an effect of etretinate on central, possible catecholaminergic neurons.

Adult↗
PubMed1988

Acitretin improves psoriasis in a dose-dependent fashion.

Acitretin, a metabolite of etretinate, was given to 38 patients for the treatment of psoriasis. During the first 8 weeks patients received either placebo, 10 mg, 25 mg, 50 mg, or 75 mg of acitretin daily in a double-blind manner. The dosages of 10 mg and 25 mg daily did not achieve any statistically significant improvement in psoriasis over placebo; however, both the 50 and 75 mg dosages were statistically significantly better than placebo. Side effects were primarily mucocutaneous and occurred in most patients receiving 25 mg or more of acitretin daily. After the double-blind period, patients continued treatment in an open fashion until they had received a total of 24 weeks of acitretin therapy. Most patients received 50 mg of acitretin daily, which adequately cleared their psoriasis. After approximately 3 months without acitretin, most patients required retreatment. Subsequent 24-week courses of therapy were generally effective and well tolerated. The most common laboratory abnormalities were elevations of triglyceride, cholesterol, and liver transaminase levels. The efficacy and side effects of acitretin appear to be similar to those of etretinate; the principal advantage of acitretin is its shorter half-life. Although acitretin is a potent teratogen, its rapid elimination makes it a viable treatment for psoriasis among women of childbearing potential.

Acitretin↗
PubMed1988

Long-term radiographic follow-up after isotretinoin therapy.

We evaluated the effects of long- and short-term isotretinoin therapy on the skeletons of patients. Eight patients who were treated with isotretinoin for disorders of keratinization received frequent radiographic evaluations for 4 to 9 years. Seven patients developed multiple hyperostoses at the spine and extremities. Hyperostoses increased in size and number over the course of therapy, although relatively few sites were symptomatic. Hyperostoses typically developed first in the spine and later in the extremities, where both bilaterally symmetric and asymmetric involvement was observed. After 5 years of therapy one patient did not develop hyperostosis. In a group of nine patients who received a relatively high dose of isotretinoin in 1982 for the treatment of acne, two patients developed tiny, asymptomatic hyperostoses. One patient had hyperostoses 1 year after isotretinoin therapy, which remained unchanged 3 years later, whereas the other patient had one hyperostosis 4 years after therapy had been stopped. Although we suspect that these hyperostoses were retinoid induced, they should not be of concern for the patient needing routine isotretinoin therapy for the treatment of cystic acne.

Acne Vulgaris↗
PubMed1988

Topical tretinoin in the treatment of aging skin.

We review the use of topical tretinoin (all-trans-retinoic acid) in the treatment of aging skin. We have found topical tretinoin capable of improving aged-appearing skin in both a double-blind, vehicle-controlled trial and our clinic patients. The most impressive improvement occurs after application of tretinoin 0.1% cream for 8 to 12 months. Side effects have been limited to a mild, transient, and clinically insignificant burning sensation in the eyes and mild irritation of tretinoin-exposed skin.

Administration, Topical↗
PubMed1988

Levels of cyclosporin in epidermis of treated psoriasis patients differentially inhibit growth of keratinocytes cultured in serum free versus serum containing media.

Cyclosporin A, which is a specific immunosuppressive compound, has recently been demonstrated to be of significant benefit in the treatment of psoriasis. Because hyperplasia is a major feature of psoriasis, we have investigated whether this drug acts directly to inhibit keratinocyte growth. We have determined the concentration range of cyclosporin in the epidermis of psoriatic patients undergoing cyclosporin therapy and the effect of this concentration range on the growth of cultured keratinocytes. After 7 days of treatment, psoriatic involved epidermis contained 1.1 +/- 0.3 ng cyclosporin/micrograms DNA. Based on tissue wet weight this is approximately 2.8 micrograms cyclosporin/ml. This value was 10 times that of trough blood samples. On day 3 of treatment, involved epidermis contained 7 times more cyclosporin than scale, while on day 7 this ratio was reduced to 2. This suggests that cyclosporin was initially associated with the lower layers of the epidermis and distributed upward with time. Exposure of adult human keratinocytes, cultured on collagen in the presence of human serum, to cyclosporin (0.1-30 micrograms/ml, 0.4-13-fold higher than lesional cyclosporin) for 2-6 d had no effect on the rate of incorporation of thymidine into DNA. Cyclosporin (1-30 micrograms/ml) also had not effect on the reinitiation of DNA synthesis of quiescent cells subsequent to the reintroduction of serum. In contrast, cyclosporin (1-10 micrograms/ml) inhibited growth of keratinocytes cultured on plastic culture dishes in serum free media (MCDB 153). For a given dose of cyclosporin, cell associated drug was 2-3 times greater in serum free compared to serum containing media. This may contribute in part to the sensitivity of keratinocytes in serum free media to growth inhibition by cyclosporin. These data demonstrate that human epidermis contains a high concentration of cyclosporin after oral administration, and that, under certain conditions, concentrations of cyclosporin within the range found in vivo can inhibit growth of cultured keratinocytes. Because cyclosporin regulates lymphocyte function in vivo and in vitro, the demonstrated antiproliferative effects of cyclosporin on psoriatic keratinocytes in vivo may be due to inhibition of a mononuclear leukocyte-derived keratinocyte growth factor(s) in combination with direct inhibition of keratinocyte growth.

Blood Physiological Phenomena↗
PubMed1988

Determination of 5,12, and 15-lipoxygenase products in keratomed biopsies of normal and psoriatic skin.

Keratomed epidermal tissue from normal individuals and from the lesional and non-lesional skin of psoriasis patients served as source materials for the extraction, separation, and quantitation of eicosanoids that may be important to cutaneous function and pathophysiology. The eicosanoids were extracted in ethanol and buffer, partially purified on SEP-PAKs, separated by reverse phase microbore high-performance liquid chromatography, and quantitated by radioimmunoassay or integration of absorbency peaks obtained by high performance liquid chromatography. The involved areas from psoriasis patients contained a statistically significant seven- to 11-fold increase in the levels of leukotriene B4, 13-hydroxyoctadecadienoic acid-like compound, 15-hydroxyeicosatetraenoic acid compound and 12-hydroxyeicosatetraenoic acid in comparison to normal samples and a three- to sevenfold increase in comparison to uninvolved tissue. The uninvolved areas contained 40% to 100% increases in the levels of these compounds in comparison to normal tissue; these increases were statistically significant except for 13-hydroxyoctadecadienoic acid-like compound. From a single keratome biopsy, multiple eicosanoids can be separated and quantitated; in addition, levels before, during, and after therapy for psoriasis may be compared.

12-Hydroxy-5,8,10,14-eicosatetraenoic Acid↗
PubMed1988

Measurement of epidermal thickness in normal skin and psoriasis with high-frequency ultrasound.

In this study, we employed a high-frequency ultrasound system to measure the epidermal thicknesses of psoriasis plaques and normal skin in vivo. Eighty-four percent of the ultrasound measurements fell within the range of epidermal thickness determined by histology. The average thickness of untreated psoriasis measured by ultrasound was significantly greater than that of either treated psoriasis or normal skin. Ultrasound measurement of thickness was consistent with clinical assessment. Ultrasound measurements also demonstrated known variations in epidermal thickness by body site. Further development is needed to obtain measurements that are fully representative of the epidermis.

Adult↗
PubMed1988

Topical ciclosporin for psoriasis: in vitro skin penetration and clinical study.

In contrast to oral administration, topical ciclosporin is not effective in the treatment of psoriasis. This may be due to the drug's inability to penetrate the stratum corneum or to a need for systemic metabolism of ciclosporin to active metabolites. We conducted a preliminary evaluation of the ability of ciclosporin, in a variety of vehicles, to penetrate excised human skin in a two-compartment diffusion cell, a standard in vitro technique for evaluating percutaneous drug delivery. A high-pressure liquid chromatography assay for ciclosporin did not detect the passage of ciclosporin through skin. This finding was consistent through multiple trials, some of which evaluated Azone or liposomal formulations, which are reported to enhance the penetrability of certain compounds. These results indicate that ciclosporin is unable to penetrate human skin in the vehicles tested. This may explain the lack of clinical efficacy we demonstrated in 5 patients with psoriasis treated with topical ciclosporin for 14-16 days.

Administration, Topical↗
PubMed1988

Evolution of skeletal hyperostoses caused by 13-cis-retinoic acid therapy.

Seven patients with disorders of keratinization (ichthyosis in six and Darier disease in one) were treated with 13-cis-retinoic acid and followed with annual skeletal surveys for 4-6 years. Six of the seven patients developed hyperostoses attributable to the retinoid therapy, manifested as multifocal entheseal calcifications or ossifications in both the axial and appendicular skeletons. In general, the earliest appearing hyperostoses became the largest with time, although in some instances, growth ceased at some foci and progressed at others. The severity of skeletal involvement was seemingly independent of dose, and may have been related to the patient's age at time of therapy. Involvement of the spine was earlier and more pronounced than the appendicular involvement, consisting of tiny hyperostoses arising from the corners of the vertebral bodies, primarily in the cervical and thoracic spine; these later matured into either discrete ossific spurs, or focal or flowing ossification of the anterior longitudinal ligament. The most prominent appendicular hyperostoses were at the tendinous or aponeurotic insertions on the calcaneus, were often unilateral or asymmetric when small, and became bilateral with time. Appendicular hyperostoses occurring at locations besides the calcanei were much smaller, often unilateral, and occurred later (generally between the third and fifth years of therapy). Our findings indicate that the earliest hyperostoses occurring in patients with 13-cis-retinoic acid occur in the spine and feet, and become the most prominent with time. Most appendicular hyperostoses occur later, are smaller, and frequently are asymmetric or unilateral.

Adolescent↗
PubMed1988

Erythromycin 2 percent gel in the treatment of acne vulgaris.

A gel formulation of erythromycin 2 percent was compared with its vehicle in a double-blind multicenter study involving patients with mild to moderate acne vulgaris. In an analysis of 187 patients treated twice daily for 8 weeks, erythromycin 2 percent gel proved to be significantly more effective than vehicle in reducing the numbers of both inflammatory and noninflammatory lesions. After 8 weeks, 60 percent of erythromycin-treated patients had good or excellent responses compared with 36 percent of those using vehicle (p = 0.001); the lesions in two patients using erythromycin were completely cleared. The majority of patients had a favorable impression of the cosmetic characteristics of the gel formulation.

Acne Vulgaris↗
PubMed1988

A comparison of Cleocin T Solution, Cleocin T Gel, and placebo in the treatment of acne vulgaris.

A twelve-week study in which investigators were blinded to the agents studied included 135 patients (aged twelve to thirty-five years) with moderately severe acne vulgaris. Patients were randomized into groups to compare the efficacy and local tolerance of 1 percent clindamycin phosphate gel, 1 percent clindamycin phosphate solution, and the gel vehicle which served as a placebo. One hundred and twenty-eight patients who completed at least six weeks of treatment were evaluated for efficacy of these agents. Both the solution and the gel were equivalent in reducing papule and pustule counts and results were superior to those produced by the placebo. All three treatments were tolerated well.

Acne Vulgaris↗
PubMed1988

Mometasone furoate ointment and cream 0.1 percent in treatment of psoriasis: comparison with ointment and cream formulations of fluocinolone acetonide 0.025 percent and triamcinolone acetonide 0.1 percent.

Mometasone furoate (Elocon) is a newly formulated and unique medium-potency synthetic 17-heterocyclic corticosteroid. The efficacy and safety of the ointment and cream formulations (0.1 percent) of the corticosteroid, administered once daily, were compared with those of the ointment and cream formulations of fluocinolone acetonide 0.025 percent administered three times daily and triamcinolone acetonide 0.1 percent administered twice daily in four multicenter clinical studies. They were conducted involving psoriasis patients with chronic and moderate to severe disease. Evaluation of change in disease sign scores indicated that mometasone ointment, applied once daily, was significantly more effective (P less than 0.01) than fluocinolone ointment, applied three times daily, and triamcinolone ointment, applied twice daily. The cream formulation of mometasone was significantly more effective (p less than 0.001) than fluocinolone cream, applied three times daily, and equivalent to triamcinolone cream, applied twice daily. The incidence of local adverse experiences following treatment with the ointment or cream formulations of mometasone was minimal. Mometasone ointment and cream provide a highly effective once-a-day treatment for moderate to severe psoriasis with minimal risk of side effects.

Administration, Topical↗
PubMed1988

Rapid occurrence of nodular cutaneous T-lymphocyte infiltrates with cyclosporine therapy.

Cyclosporine, a potent immunosuppressive agent, has been successfully used in the treatment of several dermatologic conditions including psoriasis. However, the drug does have an array of toxic side effects that need to be carefully considered when determining the risk-benefit ratio for the treatment of skin disease. We present another potential adverse effect of cyclosporine, namely, a benign lymphocytic infiltrate. This eruption developed in a patient with psoriasis after only ten days of cyclosporine therapy. The exact mechanism by which cyclosporine induced the lymphocytic infiltrate is unknown, but it is postulated that cyclosporine caused an imbalance of T-cell regulatory systems, thus resulting in an expanded T-cell subpopulation and the clinical manifestation of erythematous papules and nodules.

Biopsy↗