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Psoriasis Case Studies

Decent Essays
Psoriasis is a multifactorial disease that remains largely idiopathic. It is known to be autoimmune and inflammatory, with both genetic and environmental triggers and aggravators. [1,34] In fact 71% of children affected have a family history of psoriasis, as reported by Morris et al. [36]
A vicious cycle exists in predisposed individuals, where an abnormal and inflated immune response to an allergen occurs, with cytokines released actually causing both inflammation, as well as keratinocyte hyper-proliferation; hence the distinctive raised plaques and scales of psoriasis. [34] The cell cycle of the keratinocytes is also expedited. [35] These keratinocytes produce cytokines, themselves, that attract more leukocytes to the lesion, further propagating
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[31,32] In 1976, Kaplan et al conducted a preliminary trial on 20 patients, where they compared the effectiveness of 10% caffeine (in a hydrophilic base) with a placebo, on the following scales: erythema, pruritus, scaling, oozing, lichenification, and overall subjective evaluation. [31] They found a statistically significant improvement in overall subjective evaluation, so pursued a follow up study using a caffeine concentration of 30% on 40 AD patients (28 were included in the analysis). [31,32] In the second research, published the year after, Kaplan et al reported a statistically significant improvement in all scales tested in the caffeine group, while the placebo group showed improvement only in pruritus. [32] In 1978, another study on 83 AD patients was published comparing three formulations (all in hydrophilic bases): 0.5% hydrocortisone ointment, caffeine 30% and hydrocortisone 0.5% ointment, and betamethasone valerate 0.1% cream. They noted improvement in all groups on all scales; however, the caffeine-hydrocortisone group and the betamethasone group were significantly superior to the hydrocortisone group on the scales of excoriation, lichenification, and global impression. Moreover, the caffeine-hydrocortisone and the betamethasone groups did not differ statistically significantly on any scale.
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