Differential clinical response to alefacept in combination with methotrexate in two patients with refractory palmar psoriasis

Abstract

Our two patients accidentally ingested selenium orally at a concentration 10 times higher than that intended. As a result, clear symptoms of acute selenium intoxication were noticed a few days later. The determination of the selenium level in serum revealed for both patients concentrations that were three times above the normal range.Only a few cases of acute selenium intoxication in humans have been reported previously. In these cases, the most common symptoms described, among others, were nausea and diarrhoea. However, according to the literature death resulting from haemolysis and cardiovascular failure occurred after poisoning with exceptionally high doses. 2,4,6,7 In commercially available selenium preparations, such as sodium selenite, daily dosages of 100 lg are recommended, which reach 300 lg on a short-term basis. It is known that orally or parenterally administered selenium has a limited therapeutic range. 4 No agreement has been reached in the literature regarding the safe upper limit of selenium intake. Studies on selenium in humans revealed that toxic effects occur following a daily intake of at least 300 lg.Noncritical intake of selenium without a physician's recommendation has to be urgently dissuaded. Our two cases show that during the administration of selenium, for example as part of a fasting treatment, it is necessary to consider its limited therapeutic range in order to avoid an overdose and related toxicity. Fig 1. A subcutaneous deep-seated nodule with cutaneous horn 7 · 7 mm in diameter on the left periocular area.

Efficacy and safety of systemic methotrexate vs. acitretin in psoriasis patients with significant palmoplantar involvement: a prospective, randomized study

“…Despite this impact only few clinical studies have addressed its treatment. There is lack of data beyond anecdotal case reports and small studies with alefacept, 13,14 efalizumab, 15–17 acitretin 10–12 and PUVA 8 . Topical agents remain the most widely used treatment modality in PP 5 .…”

“…Besides, there are few case reports and small case series. Treatment of PP has ranged from superpotent topical steroids alone or in combination with calcipotriene, 7 PUVA, 8 excimer light 9 and systemic agents including methotrexate, 5,6 retinoids 5,6,10–12 and biologics 13–17 …”

Palmoplantar psoriasis: A phenotypical and clinical review with introduction of a new quality-of-life assessment tool

“…13 Palmoplantar psoriasis is a therapeutically challenging condition that can significantly impact patient quality of life. However, despite this impact, few clinical studies address treatment, and there is a lack of data and quality-of-life assessment beyond anecdotal case reports and small studies with alefacept, 14,15 acitretin, [16][17][18] psoralen plus ultraviolet A, 19 and efalizumab. 20,21 This lack of data is in large part because these patients are seldom included in clinical trials.…”

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“…Apremilast, being a phosphodiesterase 4 inhibitors, causes an increased level of cyclic adenosine monophosphate, which modulates anti-inflammation and proinflammation. US FDA and by European Commission approved apremilast for psoriatic arthritis later in 2001, and 2014.30 mg of Apremilast BID shows a considerable improvement [50][51][52][53][54][55][56][57][58] .…”