IMMUNOMODULATION OF PSORIASIS WITH A TOPICAL CYCLOSPORINE-A FORMULATION

Topical cyclosporin A (CyA; Sandimmun) in a formulation incorporating the penetration enhancers (PE) propylene glycol (18%) and azone (2%) w as tested for efficacy in a double-blind, vehicle-controlled trial in 5 chronic plaque psoriatic patients. On each patient, two similar plaq ues were treated daily, under occlusion, for 4 weeks with either 8% (w /v) CyA, containing PE, or with vehicle comprising olive oil with PE. All sites improved significantly, but there was no significant differe nce between those receiving active and control preparations. Cryostat sections of biopsies performed after 4 weeks' treatment showed signifi cant reductions in CvA compared with vehicle-treated sites in the numb er of cells, positive for CD3 and CD25 in the epidermis and CD25 and H LA-DR in the dermis. These results suggest that amounts of CvA adequat e to affect the lymphocytic infiltrate penetrated the epidermis but th at only partial suppression occurred in the dermis, as indicated by th e reduction in lymphocyte activation status.