Management of erythrodermic psoriasis with low-dose cyclosporin. Studio Italiano Multicentrico nella Psoriasi (SIMPSO).

Thirty-three patients (M/F 25/8, aged 19-71 years) with severe erythrodermic psoriasis entered an open multicenter study to evaluate the efficacy (induction and maintenance of clinical remission) and toleratility of long-term treatment with cyclosporin. It was given at a maximum initial dose of 5 mg/kg/day (initial mean dose 4.2 mg/kg/day), subsequently adjusted during the course of treatment according to clinical response, patient tolerability and any modification in laboratory parameters or blood pressure, carefully monitored each month. All of the patients were unsatisfactory responders to conventional systemic therapy (PUVA therapy, retinoids, corticosteroids), free of any clinically obvious immunodeficiencies, malignancies or blood dyscrasia and within the normal range for renal and hepatic function and blood pressure. At remission (defined as complete resolution of erythema in the body area involved), cyclosporin was slowly tapered off (0.5 mg/kg every 2 weeks) until total discontinuation or the reappearance of signs of disease. As concomitant therapy, white petrolatum in association with cyclosporin as well as specific local therapy between cyclosporin cycles was allowed. After 6.3 +/- 3.4 months (mean +/- SD), cyclosporin doses of 3-5 mg/kg/day had led to complete remission in 67% of patients (22/33) in a median time of 2-4 months; in a further 27% of cases, considerable improvement in skin involvement was observed, with a reduction of more than 70% in comparison with baseline.(ABSTRACT TRUNCATED AT 250 WORDS)