Takashima A, Morita A, Tsuji T
Department of Dermatology, Nagoya City University Medical School, Nagoya, Japan.
J Dermatol. 1990 Aug;17(8):482-8. doi: 10.1111/j.1346-8138.1990.tb01680.x.
Twenty patients with severe psoriasis were treated with the oral administration of 5 mg/kg/day of cyclosporin A (CyA) for 12 weeks. These patients had either failed to respond to or had become unresponsive to conventional treatments including PUVA, UVB, or combinations of etretinate and PUVA or UVB. Complete clearance and marked improvement were observed in 12 (60%) and 4 patients (20%), respectively. The average score of the Psoriasis Area and Severity Index (PASI) was 26.2 before treatment, decreasing to 18.3 in 2 weeks, 8.2 in 6 weeks, and 5.1 in 12 weeks of CyA treatment. There was a tendency for patients with lower blood levels of CyA to show smaller decreases in their PASI scores. In four patients who received skin biopsies, histological improvement was noted within 10 days of treatment; epidermal thickness had decreased by 32%, intraepidermal mitoses by 66%, and parakeratosis had disappeared almost completely. No clinical side effects or alterations in laboratory values were observed that required cessation of CyA. Exacerbations of psoriasis occurred in 11 of 16 patients within 6 weeks after stopping treatment. These results suggest that CyA could be the first choice of treatment for resistant severe psoriasis.
20例重度银屑病患者口服环孢素A（CyA），剂量为5mg/kg/天，持续12周。这些患者对包括补骨脂素紫外线A光化学疗法（PUVA）、紫外线B（UVB），或维甲酸与PUVA或UVB联合使用等传统治疗方法无反应或不再有反应。分别有12例（60%）患者完全清除，4例（20%）患者显著改善。银屑病面积和严重程度指数（PASI）治疗前平均评分为26.2，CyA治疗2周时降至18.3，6周时降至8.2，12周时降至5.1。CyA血药浓度较低的患者PASI评分下降幅度较小。4例接受皮肤活检的患者在治疗10天内组织学有改善；表皮厚度下降32%，表皮内有丝分裂减少66%，角化不全几乎完全消失。未观察到需要停用CyA的临床副作用或实验室值改变。16例患者中有11例在停药后6周内银屑病病情加重。这些结果表明，CyA可能是顽固性重度银屑病的首选治疗药物。
