We herein describe a 54 year-old female patient with a 5-year history of persistent and painful benign migratory glossitis (BMG), which was remarkably improved by systemic administration of cyclosporin. She had noted some white patches leaving smooth denuded red areas with whitish elevated borders on the dorsum of her tongue, and finally felt strong pain. The lesion was refractory to the previous treatment with topical corticosteroid treatment for the last 2 years. Because clinicopathological findings were compatible with BMG, systemic administration of 20 mg/day prednisolone and topical 0.1% dexamethasone application were started, however, she suffered a severe relapse after tapering the dosage of prednisolone to 10 mg/day. Because some investigations have suggested that BMG is an oral manifestation of psoriasis, we introduced cyclosporin administration. The systemic treatment of cyclosporin microemulsion pre-concentrate, 3 mg/kg/day, resulted in a satisfactory improvement. Two months later, we could reduce cyclosporin microemulsion pre-concentrate dosage to 1.5 mg/kg/day for maintenance therapy, and the disease has been well controlled so far.

Fibroblast-collagen matrix contraction has been used as a model system to study how cells organize connective tissue. Previous work showed that lysophosphatidic acid (LPA)-stimulated floating collagen matrix contraction is independent of Rho kinase while platelet-derived growth factor (PDGF)-stimulated contraction is Rho kinase-dependent. The current studies were carried out to determine the signaling mechanisms of basic fibroblast growth factor (bFGF)-stimulated fibroblast-collagen matrix contraction. Both bFGF and LPA promoted equally collagen matrix contraction well. Three different inhibitors, LY294002 for phosphatidylinositol-3-kinase (PI3K), C3 exotransferase for Rho and Y27632 for Rho kinase, suppressed the bFGF-stimulated fibroblast-collagen matrix contraction. With bFGF stimulation, fibroblasts spread with prominent stress fiber network formation and focal adhesions. In the presence of Rho kinase inhibitor, focal adhesions and stress fibers were mostly lost. We demonstrated that bFGF stimulation for fibroblast caused transient Rac and Rho activation but did not activate Cdc42. In addition, bFGF enhanced fibroblast migration in wound healing assay. The present study implicates PI3K, Rac, Rho, and Rho kinase as being involved in bFGF-stimulated collagen matrix contraction. The elucidation of bFGF-triggered signal transduction may be an important clue to understand the roles of bFGF in wound healing.

The Japanese guidelines for psoriasis therapy with cyclosporin microemulsion preconcentrate (CyA MEPC) has been revised, and the clinical application of CyA MEPC is being expanded to include mild to moderate psoriasis. In this study, we aimed to confirm the clinical efficiency of low-dose cyclosporin therapy in patients with moderate psoriasis vulgaris. After informed consent was obtained, 19 patients with psoriasis vulgaris were enrolled in this study. Each patient basically administrated CyA MEPC, 2.5 mg/kg/day, orally over 12 weeks. When the psoriasis area and severity index (PASI) score showed a 75% reduction from the initial value, the dosage of CyA MEPC was reduced to 1.5 mg/kg/day and added a topical application of active vitamin D3 ointment. We interviewed the patients as to their satisfaction for the usefulness and cost of the treatment. All patients obtained improvement within 12 weeks. In 10 patients whose PASI score reduced over 75%, we could reduce CyA MEPC dosage. No adverse effects were noted in any patients during the treatment. It is of note that the cost for 1.5 mg/kg/day administration of CyA MEPC was accepted by all the patients. In conclusion, this preliminary study suggests that the CyA MEPC is effective, safe and would provide patients with acceptable costs.

In this study, we aimed to compare the clinical effectiveness of highly-concentrated tacalcitol ointment daily versus intermittent application in patients with psoriasis vulgaris who simultaneously took a low dose of cyclosporin. All the patients in both groups showed significant improvements, and the patients in the intermittent application group obtained more patient satisfaction in cost performance. The treatment cost of low-dose cyclosporin and intermittent application of highly-concentrated tacalcitol ointment was less than half of that of high-dose cyclosporin and daily application of highly-concentrated tacalcitol ointment. This preliminary study suggests that the combination therapy with low-dose cyclosporin administration and intermittent application of highly-concentrated tacalcitol is effective, safe and provides acceptable costs for the treatment.

Although the actions of cyclosporin (CyA) on keratinocyte are well established, little is known about its effects on dermal fibroblasts. Interleukin-6 (IL-6) is one of the inflammatory cytokines playing a pivotal role in certain skin diseases such as psoriasis. The aim of this study has been to determine whether CyA modifies the metabolism of extracellular matrix (ECM) by human fibroblasts in vitro. CyA altered the morphology of fibroblasts in the collagen matrix. Fibroblast proliferation was suppressed by CyA at 100 and 10 ng/ml. The production of type I collagen and tissue inhibitor of metalloproteinase 1 was also suppressed by CyA at 1000 ng/ml, and co-stimulation with IL-6 enhanced decreased production at 1000 and 100 ng/ml CyA. The production of matrix metalloproteinase 1 (MMP-1) was also suppressed by CyA in a dose-dependent manner. In contrast, the decreased production of MMP-1 was restored at 0.1-100 ng/ml CyA in the presence of IL-6. Regardless of the presence or absence of IL-6, the production of MMP-2 decreased at 1000 and 100 ng/ml, whereas the production of MMP-9 was unchanged. The production of transforming growth factor-beta decreased at 100 ng/ml CyA. This study thus indicates that CyA influences ECM metabolism and the proliferation of human dermal fibroblasts, and that the effects of CyA are modulated by IL-6. CyA might also, in part, improve psoriatic skin by regulating the remodeling of ECM and by its action on immunocompetent cells.