EFFECTS OF TOPICAL TREATMENT WITH BUDESONIDE ON PARAMETERS FOR EPIDERMAL PROLIFERATION, KERATINIZATION AND INFLAMMATION IN PSORIASIS

Corticosteroids are important in the treatment of inflammatory dermato ses, such as psoriasis. They have antiinflammatory, anti-proliferative and immunosuppressive effects. In this study, the effect of budesonid e on proliferation, inflammatory cells and cytokines in psoriasis was investigated. In order to elucidate the time course of the different e ffects of corticosteroid treatment in psoriasis, six patients were tre ated for 3 weeks with budesonide 0.025% ointment (Preferid(R)), and bi opsies were studied immunohistochemically, before treatment and after 1 and 3 weeks of treatment. Clinical scores together with staining wit h antibodies indicating proliferation, keratin 16, keratin 10, T-lymph ocytes, monocytes, polymorphonuclear leukocytes, Langerhans cells, int erleukin-1 alpha, (IL-1 alpha) interleukin-6 (IL-6), interleukin-8 (IL -8), tumor necrosis factor-alpha (TNF-alpha), and intercellular adhesi on molecule-1 (ICAM-1) were performed. 'Psoriasis area' and 'severity index' (PASI) scores were significantly reduced after 1 week and 3 wee ks of treatment. Epidermal hyperproliferation (Ki-67 binding) and supr abasal keratin 16 (Ks8.12) expression decreased within 1 week, while k eratin 10 (RKSE60) expression did not change. Five out of 6 patients s howed cytokine levels (IL-1 alpha, IL-6, IL-8, and TNF-alpha; detected immunohistochemically) in the normal range, while 1 patient had highl y increased cytokine levels. In this patient, cytokine levels decrease d during treatment. In 4 patients, showing high dermal ICAM-1 expressi on before treatment, a consistent reduction of ICAM-1 on endothelial c ells was observed. The inflammatory infiltrate (T-lymphocytes (Tl1), m onocytes/macrophages (WT14), polymorphonuclear leukocytes (PMN, antiel astase)) was reduced to some extent after 3 weeks. The number of Lange rhans cells (OKT6) did not change. These results indicate that the pso riatic lesions, although clinically comparable, show interindividual d ifferences in cytokine expression. Corticosteroid treatment for 1-3 we eks improves clinical scores and hyperproliferation. Cytokine levels a re reduced during steroid treatment in the patient who showed high lev els before treatment. To suppress the infiltrate entirely, longer ster oid treatment is probably necessary. This may explain the relapse seen after short term corticosteroid therapy.