Description:
<jats:title>Summary</jats:title><jats:sec><jats:title>Background/Purpose</jats:title><jats:p>Psoriasis continues to be a debilitating skin disease affecting 1–3% of the United States population. Although the effectiveness of several current biologic therapies have described this pathology as a <jats:styled-content style="fixed-case">IL</jats:styled-content>‐23, <jats:styled-content style="fixed-case">TNF</jats:styled-content>‐a and Th17‐mediated disease, less invasive approaches are still in use and in need of refinement. One of these is the usage of narrow band‐<jats:styled-content style="fixed-case">UVB</jats:styled-content> (<jats:styled-content style="fixed-case">NB</jats:styled-content>‐<jats:styled-content style="fixed-case">UVB</jats:styled-content>) therapy to deplete specifically intra‐epidermal <jats:styled-content style="fixed-case">CD</jats:styled-content>3+, <jats:styled-content style="fixed-case">CD</jats:styled-content>4+ and <jats:styled-content style="fixed-case">CD</jats:styled-content>8+ cells to clear psoriatic plaques.</jats:p></jats:sec><jats:sec><jats:title>Aims/Objectives</jats:title><jats:p>In order to improve <jats:styled-content style="fixed-case">NB</jats:styled-content>‐<jats:styled-content style="fixed-case">UVB</jats:styled-content> therapy, we sought to determine whether skin pre‐treatment with the <jats:styled-content style="fixed-case">TLR</jats:styled-content>7 agonist imiquimod (<jats:styled-content style="fixed-case">IMQ</jats:styled-content>) would help increase the efficiency of the former at resolving psoriatic plaques.</jats:p></jats:sec><jats:sec><jats:title>Materials and Methods</jats:title><jats:p>Eucerin<jats:sup>®</jats:sup> Original Moisturizing Lotion (topical vehicle) or Aldara<jats:sup>®</jats:sup> (imiquimod 5% topical cream) were applied for 5 days once daily to a maximum contiguous area of 25 cm<jats:sup>2</jats:sup> (5 cm × 5 cm area). Patients were provided with sachets containing 12.5 mg of imiquimod each and were instructed to apply imiquimod (I) to two psoriasis plaques (5 sachets of imiquimod allotted to each plaque). A <jats:styled-content style="fixed-case">PHAROS</jats:styled-content> excimer Laser <jats:styled-content style="fixed-case">EX</jats:styled-content>‐308 (Ra Medical Systems, Inc. Carlsbad, <jats:styled-content style="fixed-case">CA</jats:styled-content>, USA) with an output of monochromatic 308‐nm light and pulse width of 20–50 ns was used for all patients. Punch biopsies of psoriatic lesions (6 mm) were taken at 4 and 48 h after final application of topical treatment with or without excimer laser treatment. Real‐time quantitative <jats:styled-content style="fixed-case">RT</jats:styled-content>‐<jats:styled-content style="fixed-case">PCR</jats:styled-content> was performed according to manufacturer's instructions and Inmunohistochemistry was used as described before.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Our results suggests that although <jats:styled-content style="fixed-case">IMQ</jats:styled-content> seemed to activate the type I interferon pathway as previously described, its concomitant usage with <jats:styled-content style="fixed-case">NB</jats:styled-content>‐<jats:styled-content style="fixed-case">UVB</jats:styled-content> for clearing psoriatic skin was ineffective. Although upregulation of genes MxA, <jats:styled-content style="fixed-case">GRAMD</jats:styled-content>1A and <jats:styled-content style="fixed-case">DMXL</jats:styled-content>2 suggested that <jats:styled-content style="fixed-case">IMQ</jats:styled-content> treatment did induce skin changes in psoriasis patients, more optimal dosing of <jats:styled-content style="fixed-case">IMQ</jats:styled-content> and <jats:styled-content style="fixed-case">NB</jats:styled-content>‐<jats:styled-content style="fixed-case">UVB</jats:styled-content> might be necessary to achieve desired treatment responses.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The observation that psoriasis involvement was not aggravated by usage of topical <jats:styled-content style="fixed-case">IMQ</jats:styled-content> was encouraging. Additional observational studies might be necessary to further tailor the combination of <jats:styled-content style="fixed-case">IMQ</jats:styled-content> with <jats:styled-content style="fixed-case">NB</jats:styled-content>‐<jats:styled-content style="fixed-case">UVB</jats:styled-content> therapy to reliably improve the psoriatic pathology.</jats:p></jats:sec>