Major Findings

This study compared the efficacy and safety of low-dose short-term cyclosporine therapy with etretinate therapy in patients with moderate to severe chronic plaque psoriasis. The cyclosporine group demonstrated significantly greater improvement in the Psoriasis Area and Severity Index (PASI) after 10 weeks of treatment compared to the etretinate group. The cyclosporine group also showed significantly better improvement in nail abnormalities and joint symptoms. Furthermore, the cyclosporine group required significantly fewer dose increases compared to the etretinate group, indicating that a low dose of cyclosporine can effectively achieve good clinical response. When cyclosporine treatment was discontinued and replaced with dithranol (anthralin), the increase in PASI and the incidence of relapse were significantly higher compared to patients who tapered cyclosporine or were pretreated with etretinate. This suggests that cyclosporine therapy may be a more effective and safer option for psoriasis treatment compared to etretinate, but discontinuing cyclosporine treatment can increase the risk of relapse. 1

Reasons for Side Effects

Cyclosporine is an immunosuppressant that works by suppressing the immune system, which helps improve psoriasis symptoms. The immune system plays a crucial role in protecting the body from pathogens, and immunosuppressants can increase the risk of infections by suppressing the immune system. Cyclosporine can also affect organs such as the kidneys, liver, and heart, leading to side effects like hypertension, hyperglycemia, and hyperlipidemia. Etretinate is a vitamin A derivative that improves psoriasis symptoms. While etretinate is not as immunosuppressive as cyclosporine, its use during pregnancy can harm the fetus. Etretinate can also cause side effects such as dry skin, dry lips, and visual disturbances. 1

Common Side Effects

Renal Dysfunction

Cyclosporine can affect the kidneys and cause renal dysfunction. 1

Hypertension

Cyclosporine can cause hypertension. 1

Hepatic Dysfunction

Cyclosporine can affect the liver and cause hepatic dysfunction. 1

Infections

Cyclosporine is an immunosuppressant and can increase the risk of infections. 1

Tremor

Cyclosporine can cause tremor. 1

Headache

Cyclosporine can cause headache. 1

Gastrointestinal Symptoms

Cyclosporine can cause gastrointestinal symptoms. 1

Hyperglycemia

Cyclosporine can cause hyperglycemia. 1

Hyperlipidemia

Cyclosporine can cause hyperlipidemia. 1

Dry Skin

Etretinate can cause dry skin. 1

Dry Lips

Etretinate can cause dry lips. 1

Visual Disturbances

Etretinate can cause visual disturbances. 1

Effects on the Fetus

Etretinate can harm the fetus if used during pregnancy. 1

Side Effect Management

Renal Dysfunction

To prevent renal dysfunction, adequate hydration, salt restriction, and blood pressure management are crucial. 1

Hypertension

To prevent hypertension, salt restriction, exercise, and smoking cessation are important. 1

Hepatic Dysfunction

To prevent hepatic dysfunction, it is essential to avoid alcohol consumption. 1

Infections

To prevent infections, hand washing, gargling, and vaccinations are important. 1

Tremor

Tremor can be alleviated by adjusting the cyclosporine dosage. 1

Headache

Headache can be alleviated by using analgesics. 1

Gastrointestinal Symptoms

Gastrointestinal symptoms can be alleviated through dietary therapy and medication. 1

Hyperglycemia

To prevent hyperglycemia, dietary therapy, exercise, and blood glucose management are important. 1

Hyperlipidemia

To prevent hyperlipidemia, dietary therapy, exercise, and lipid-lowering drugs are important. 1

Dry Skin

Dry skin can be alleviated by using moisturizers. 1

Dry Lips

Dry lips can be alleviated by using lip balm. 1

Visual Disturbances

It is important to see an ophthalmologist for visual disturbances and receive treatment as needed. 1

Effects on the Fetus

Etretinate should not be used during pregnancy. 1

Research Comparison

Research Commonalities

Both studies compared the efficacy and safety of cyclosporine and etretinate in treating psoriasis. Both are double-blind, randomized, controlled trials that randomly assigned patients to either the cyclosporine or etretinate group. 1

Research Differences

This study stands out from others by comparing the relapse rates after cyclosporine treatment discontinuation. 1

Real-World Application Considerations

Both cyclosporine and etretinate are effective medications for treating psoriasis, but they carry the risk of side effects. Always follow your doctor's instructions when taking these medications. Particularly, avoid using etretinate during pregnancy. 1

Limitations of Current Research

This study had a relatively small number of participants, necessitating larger studies. 1

Future Research Directions

Future research should focus on evaluating the long-term efficacy and safety of cyclosporine and etretinate. Additionally, further research is needed to explore methods for preventing relapse after cyclosporine treatment discontinuation. 1

Conclusion

Low-dose short-term cyclosporine therapy may be a more effective and safer treatment option for psoriasis compared to etretinate therapy, but discontinuing cyclosporine treatment can increase the risk of relapse. When considering cyclosporine therapy, it is crucial to understand the risks and benefits of side effects and consult with a physician to determine the best treatment approach. 1