Lymphocytapheresis in the treatment of psoriasis vulgaris

Abstract

Psoriasis is a common autoimmune chronic inflammatory skin disease that affects approximately 2% of the world's population; fundamental for its immunopathogenic mechanism is secretion of type 1 (Th1) cytokines by T cells and their activation. Since cytapheresis has been widely applied to autoimmune disorders, emphasizing the recently reported results of granulocyte and monocyte adsorption apheresis in psoriasis, a small series of psoriasis vulgaris (PV) patients underwent lymphocytapheresis (LCA) with the aim to remove lymphocytes. Five patients were submitted to weekly LCA. The severity of the disease had been evaluated through psoriasis area and severity index (PASI) score before LCA and one week after the last apheresis. PASI score before: patient A: 66; patient B: 33; patient C: 50; patient D: 56; patient E: 29. All the patients showed improvement of skin lesions. PASI score after LCA: patient A: 24; patient B: 8; patient C: 5; patient D: 36; patient E: 2.1. No side effects linked to apheresis were reported. LCA seems to produce interesting results in PV, and PASI improvement related to apheresis is clinically significant. Further studies to address its mechanism of action and potential long-term side effects are needed. It could become a valuable therapeutic alternative or a complementary tool, which might even be used to reduce the dosages of conventional pharmacological therapies adopted for this chronic disease.

The efficacy of therapeutic apheresis in patients with refractory neuromyelitis optica spectrum disorders: a single-center retrospective study

“…Lymphoplasmapheresis (LPE) is a combined technique that integrates both TPE and lymphocytapheresis, resulting in both pathogenic antibody removal and immunoregulation (12). In previous studies, lymphocytapheresis was shown to be efficacious in the treatment of autoimmune disorders including psoriasis vulgaris and multiple sclerosis (13,14). Recently, LPE was reported to be effective in patients with Guillain-Barre syndrome by directly removing immunoglobulins, complements, monocytes, and fibrinogen, as well as regulating lymphocyte subsets in the peripheral blood (15).…”

Immunoadsorption in Dermatology

“…Cytapheresis has been successfully applied in rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease (7–9). In dermatology, patients with psoriasis and pyoderma gangrenosum have been successfully subjected to leukocytpheresis (10,11).…”

Therapeutic Apheresis in Dermatological Diseases

“…Fundamental for its immunopathogenic mechanism is the secretion of type 1 (Th 1) cytokines by T cells and their activation. 92 Cytokines are intercellular molecules that have an important role in the development and maintenance of cutaneous inflammation. 93 The indication for TPE in psoriasis vulgaris is also based on the presumption of immunopathogenesis.…”

“…But the skin lesions did not respond to photopheresis. 92,100 However, blocking TNF-α by infliximab or etanercept has shown particular promise, especially in the management of psoriasis. But further studies to address its mechanism of action and potential long-term side effects are needed.…”