Enhancement of epidermal function delays relapse of psoriasis

Though psoriasis is widely viewed an immunological disorder, the role of epidermal dysfunction in disease pathogenesis is also well appreciated. Hence, we hypothesized that enhancing epidermal function could prevent/attenuate disease development in two cohorts of patients with psoriasis that was temporarily in remission. Both groups of patients had a history of lesion appearance on both forearms at around the same time of year for 2+ consecutive years. In the first study (N=30), an in-house-prepared emollient, known to improve epidermal function, was applied twice-daily to one forearm for 20 days, while the contralateral arm was left untreated. In the second study (N=60), a commercially available cream, containing physiologic lipid mixture, was applied twice-daily to one arm for 30 days. Based upon each patients history, treatment was started 10 days prior to expected lesion appearance, and subjects were instructed to return to clinic as soon as lesions appeared on either forearm. In the first study, 22 out of 30 subjects developed lesions during the 20-day period. 21/22 (95.5%) patients developed lesions on the untreated side, while 14 out of 22 (64%) developed lesions on the treated side, but treatment delayed the appearance of lesions in 55% of patients. In the second study, 49 out of 60 subjects developed lesions during 30 day of treatment period. 45/49 (92%) of patients developed lesions on the untreated side, while 34/49 (69%) developed psoriatic lesions on the treated side, but treatment again delayed the appearance of lesions in 35 patients (71%). The preventive benefits of the topical corrective regimen correlated with improvements in epidermal permeability function and stratum corneum hydration. Thus, enhancement of epidermal function can prevent/attenuate the development of psoriasis.