INDIVIDUALIZED SHORT-COURSE CYCLOSPORINE THERAPY IN PSORIASIS

The efficacy and side-effects of cyclosporin in psoriasis, namely hype rtension and renal dysfunction, are dose-related, An initial dose of 3 mg/kg per day has a better risk/benefit ratio than 5 mg/kg per day, M aximum efficacy is usually reached after 2-3 months, and effects of th e drug remain even after treatment stops, We therefore suggest the per iodic short-term use of cyclosporin in order to combine persisting the rapeutic-effect with safety, Psoriatic erythroderma and arthropathy al so respond rapidly to oral cyclosporin. Once patients have been succes sfully treated, the drug should be discontinued. Treatment must not ex ceed 6 months, but in the case of relapse, a new cycle of the previous ly effective and tolerated dose can be given, The concomitant use of o ther therapies has been assessed in an attempt to reduce the dose of c yclosporin. There are no significant cyclosporin-sparing effects when etretinate or UVB are used adjunctively, and currently no convincing d ata on the risk of combining low-dose cyclosporin with immunosuppressi ve therapy (including methotrexate, UVB, and PUVA) in dermatological i ndications. The addition of topical corticosteroids or calcipotriol le ads to more rapid clearing of psoriasis plaques, although relapse rate s remain unchanged. Individualized short-course cyclosporin therapy is useful in controlling acute psoriasis flares and/or inducing remissio n; less potent agents can then be used for maintenance therapy, Short courses of low-dose cyclosporin may almost completely eliminate the ri sks of renal dysfunction from this drug.