The quality of life (QOL) of patients with psoriasis is markedly impaired by chronic skin lesions and the negative body image due to the presence of the skin lesions. In US and Europe as well as in Japan, the development of QOL scales and the drug therapies which can improve QOL have been actively investigated. We reviewed these QOL-related articles and summarized the current information focused on the degree of impairment of QOL, the scales to evaluate QOL and the correlation of QOL scores and the disease severity in patients with psoriasis. Furthermore, we discussed the current researches of QOL in Japan and also proposed “treatment options” to improve QOL of the patients with psoriasis. In conclusion, we emphasized the evaluation of QOL should play an important role in the patient’s oriented treatment of psoriasis in Japan.
We developed an optimal radiation protocol of bath-PUVA therapy for psoriasis in Japan as referring British and Japanese guidelines. We intended for a total of 100 refractory patients with psoriasis and analyzed it as a retrospective observational study. The following 3 protocols were employed for this study. In all protocols, the initial exposure dose was 0.2 J/cm2 and the maximum exposure dose was 4.0 J/cm2. Inprotocol1, the fixed increment dose was used as 0.3 J/cm2 and the patients were irradiated 4 times a week. In protocol 2 and 3, the gradually increased increment was 0.3–0.7 with J/cm2 and the patients were irradiated 4 times a week (protocol 2) and 5 times a week (protocol 3). In all protocols, the remission rate was achieved in about 90% without obvious adverse effects. The remission duration was 4.0–6.6 months with protocol 1 and 2. In protocol 3, the period of hospitalization to achieve remission was 36.5 days and significantly shorter than those of the other protocols. The number of irradiation in protocol 3 was 20 and significantly shorter than that of protocol 1. The total cumulative dose in protocol 3 was the smallest in 56.4 J/cm2. The combination effect of calcipotriol ointment with bath-PUVA therapy showed almost equal to that of maxacalcitol ointment in the remission rate, the duration of hospitalization and the number of irradiation. This result indicated that safe and effective bath-PUVA therapy can be performed in Japan by introducing protocol 3.
77 patients with metastatic melanoma in 13 hospitals were treated with DAC-Tam regimen (dacarbazine 220 mg/m2 and cisplatin 25 mg/m2 intravenously daily on days 1 to 3, nimustine 60 mg/m2 intravenously on day 1, and tamoxifen 20 mg orally daily). We observed tumor response, survival time and toxicity. Result: An overall response rate was 20.7% and complete response rate was 1.3%. Responses have been observed mainly in liver, lung and lymph node metastases. Liver metastases were most effective, the response rate was 33.3%. Patients with single organ metastases were a higher response rate than those with multiple organs metastases. Patients previously exposed to dacarbazine have a lower rate of response to this regimen than those untreated with dacarbazine. The major toxicities were thrombocytopenia, neutropenia, nausea and vomiting. No one developed deep venous thrombosis.
Cyclosporin has prominent effects on blood vessels leading to an increase in blood pressure. No detailed data exist on antihypertensives for psoriatic patients during treatment with cyclosporine in Japan. Forty-three psoriatic patients treated with cyclosporine for longer than 6 months in our clinic were analyzed. Thirteen of the patients were receiving antihypertensives. The prevalence of cyclosporin-induced hypertension was about 9% (4/43). Calcium-channel blockers were mostly used in the treatment of hypertension in our research (10/13). The concomitant administration of cyclosporin and calcium-channel blocker resulted in significantly increased percentage of gingival overgrowth (2/10), which improved by changing to angiotensin II receptor antagonist without discontinuation of cyclosporin. In our study, angiotensin II receptor antagonists are relatively “preferred” agent for cyclosporin-induced hypertension.
Two patients, 75-year-old (case1) and 71-year-old (case2) women had a 4-year- and 1-year-history, respectively, of papules and annular erythematous eruptions on the body and extremities. Histological examinations revealed typical findings of granuloma annurale, showing the degeneration of connective tissues surrounded by histiocytes or epithelioid cells and associated with perivascular infiltrations of lymphocytes in the upper and mid dermis. In both patients, there were no past and present histories of diabetus mellitus. Topical application of steroid ointments had been used without satisfactory therapeutic effect. Narrow-band UVB phototherapy was started with initial doses of 400 mJ/cm2 (case 1) and 300 mJ/cm2 (case 2). Then, UVB dose was gradually increased up to 900mJ/cm2 and to 800mJ/cm2, respectively. At total exposures of 21 (15.1 J/cm2) and 35 (21.5 J/cm2) treatments, the skin changes subsided almost completely without adverse effects. Thereafter, no recurrences were observed during maintenance therapy with Narrow-band UVB. Narrow-band UVB phototherapy is easy to use, since, in contrast to PUVA, there is no need for the intake of photosensitizers and for photoprotection of skin and eyes on treatment days.