PSORIASIS AND CALCIPOTRIENE
============================



I need help with an overweight (230lb) 14 year old female with severe
psoriasis.  it is moderately inflamed but without pustules, and covers 90% 
of her body.  her scalp has diffuse cement like scale.  she is very 
distraugt, won't go out of the house, and is threatening suicide.  her 
psoriasis was limited to her scalp until about 3 months ago.  she has not 
responded to uvb, and there has been no response to empiric systemic 
antibiotics or antifungals (diflucan). i suppose puva would be the next best 
option, but i need to do something with quicker results.  any thoughts on 
accutane, mtx, steroids, other. of course, topical options have been tried 
extensively, and she has recently developed some striae over her shoulders.

William Liss
------------


How about Dovonex/PUVA?  Safer then retinoids or MTX, and appears to have 
promise.

Daniel F Mitchell
-----------------


latest stuff I saw published suggests a lack of synergy between 
calcipotriene and photoRx, in contrast to tar, anthralin. anyone with 
comments pro/con?

Mark Ling, M.D., Ph.D.
----------------------


Dovonex is very safe - I've used it on kids under 1 year of age [I try not 
to use more than 40 grams / week / square meter of body surface area in 
kids].  Oral Dovonex is degraded very fast [first pass through the liver, I 
think] which is why it has to be used topically. I've used it with good 
results on the nails of kids, and I'm not worried at all if a bit gets in 
the mouth. I'd be a bit more worried if they got topical corticosteroids or 
tar in the mouth [though those are no major threat either.]

Kevin C. Smith MD FRCPC
Niagara Falls ON
----------------