| Objective: Pustular psoriasis is a subtype of psoriasis. Its characteristic is localized or generalized sterile pustular formation. It is a kind of inflammatory disease and its aetiology is still unknown. Topic and systemic treatment of psoriasis with retinoids has been shown to be effective, especially for pustular psoriasis. Arotinoid ethylester(AE) belongs to the third generation of retinoids and possesses pharmacologically more potent effect than that of other available retinoids. The purpose of this study is to evaluate the efficacy of AE on pustular psoriasis and to search the effect of AE on adhesion molecule and chemotaxis of polymorphonuclear leukocyte. It will be helpful to revealing the mechanism of treatment of pustular psoriasis with AE, and offering theoretical foundation for clinical therapy.Methods: ①Patients with pustular psoriasis were treated with AE and the evaluation was made after treatment for 4 weeks. ② Routine histological examination and immunohischemical localization of ICAM-1, VCAM-1, CD11a of lesions of patients were performed at pre- and post-treated with AE. ③ The expression of CD11b and CD15 on superficies of PMN from patients with pustular psoriasis was examined by flow cytometry before and after treatment with AE. ④ The expression of CD11b and CD15 on differentiated HL-60 cells which achieved by adding DMSO at a final concentration of 1.3% or all-trans-retinoic acid(ATRA) at a final concentration of 1×10-6mmol/L or AE at a final concentration of 1×10-8mmol/L and culturing for 5 days was examined by flow cytometry. ⑤ In order to search the effect of AE on chemotaxis of polymorphonuclear leukocyte, we used a modified murinemodel in vivo, in which gelatin sponges were socked with zymosan and implanted into the mice's peritoneal cavity, then counted the PMNs attracted out by sponge at 0, 1, 2, 4, 6, 8 day after the mice were treated by different dosage of AE. Results: ①Among 30 patients treated with AE for 4 weeks, 11 and 18 were cured and markedly improved, respectively, just 1 was not effective. The PASI of pretreatment was 25.12±28.54, but post-treatment was 2.43±3.07.There was significant difference(P<0.05). Treated with AE for 3.7±1.18 days, the pustule began to resolve, and for 8.43±2.16 days it completely resolved. ② Along with the clinical improvement the spongiform pustules vanished, and the inflammation in dermis also lessened. In speciments from cutaneous lesions of patients with pustular psoriasis, ICAM-1 and VCAM-1 was expressed on pustule wall, blood vessels in the dermal papillary, and ICAM-1 positive keratinocytes were grouped focally in the epidermis. CD11a was detected on cells infiltrating into and beneath the pustule. But after the treatment, the speciments showed weaker or negative immunohis- chemical stainning by above mentioned three kinds of antibody.③The expression of CD11b and CD15 on PMN from pustular psoriasis patients was obviously enhanced when compared with healthy controls. But after treatment the expression were obviously decline. ④5 days After differentiation with DMSO, ATRA and AE, the expression of CD11b and CD15 on HL-60 cells were all enhanced, especially DMSO groups, were similar as that of healthy controls. But the expression of ATRA groups and AE groups was lower than that of DMSO groups, and AE groups were the lowest. ⑤ The chemotaxis of PMNs in large and small dosage groups were lower than that of controls, but there was no significant difference between the large and small groups. From the first day of treatment with AE, the chemotaxis of mice PMN began to descend and the effect of large dosagegroups were greater than that of small dosage groups. The chemotaxis of large dosage groups began to rise from the fourth day, but then the small dosage groups got its lowest. After then, it began to rise, and rise faster. Till the eighth day, the chemotaxis of the two groups was still on lower lever than normal.Conclusion: ①Oral treatment of pustular psoriasis with AE was effective.② AE could indu... |
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