rifampin and Psoriasis

Topics: Animals; Anti-Bacterial Agents; Humans; Immunologic Factors; Macrolides; Psoriasis; Randomized Controlled Trials as Topic; Rifampin; Severity of Illness Index

Psoriasis is a chronic skin disease that affects approximately two per cent of the general population. Plaque psoriasis is the most common form: it usually appears as raised, red patches of inflamed skin, covered with silvery white scales. The patches often occur in a symmetrical pattern. Guttate psoriasis is a particular form of psoriasis with widespread, small erythematosquamous lesions. Streptococcal infection is suspected to be a triggering factor for the onset of guttate psoriasis, and flare-up of chronic plaque psoriasis. The previous Cochrane Review on this topic was published in 2000; it required an update because antistreptococcal treatment continues to be used to treat psoriasis, especially for the acute form of guttate psoriasis.. To assess the effects of antistreptococcal interventions for guttate and chronic plaque psoriasis.. We searched Cochrane Skin Specialised Register, Cochrane Register of Studies Online, CENTRAL, MEDLINE, Embase, LILACS, and five trials registers (January 2019). We checked the reference lists of included and excluded studies and searched conference proceedings from the American Academy of Dermatology, Society for Investigative Dermatology, and European Academy of Dermatology and Venereology.. We considered randomised controlled trials (RCTs) assessing antistreptococcal interventions (tonsillectomy or systemic antibiotic treatment) in people with clinically diagnosed acute guttate and chronic plaque psoriasis compared with placebo, no intervention, or each other.. We used standard methodological procedures expected by Cochrane. Primary outcome measures were: 1) time-to-resolution; achieving clear or almost clear skin (Physician Global Assessment (PGA) 0 or 1 or Psoriasis Area and Severity Index (PASI) 90 or 100); 2) proportion of participants with adverse effects and severe adverse effects. Secondary outcomes were: 1) proportion of participants achieving clear or almost clear skin; 2) proportion of participants achieving PASI 75 or PGA 1 to 2; 3) risk of having at least one relapse at long-term follow-up. Short-term assessment was defined as within eight weeks of the start of treatment; long-term was at least one year after the start of treatment.. We included five trials (162 randomised participants); three were conducted in a hospital dermatology department. One study declared funding by a pharmaceutical company. Participants' ages ranged from 12 to 77 years; only two participants were younger than 15 years. Mean PASI score at baseline varied from 5.7 (i.e. mild) to 23 (i.e. severe) in four studies. Twenty-three of 162 participants had streptococcus-positive throat swab culture. We did not perform a meta-analysis due to heterogeneity of participants' characteristics and interventions.None of the trials measured our efficacy primary outcome, time-to-resolution, or the secondary outcome, risk of having at least one relapse at long-term follow-up.We rated the quality of the results as very low-quality evidence, due to high risk of bias (absence of blinding of participants and caregivers, and high risk of outcome reporting bias) and imprecision (single study data with a low number of events). Hence, we are very uncertain about the results presented.Guttate psoriasisOne three-armed trial (N = 43) assessed penicillin (50,000 international units (IU)/kg/day in three doses) versus erythromycin (250 mg four times per day) versus no treatment (treatment for 14 days, with six-week follow-up from start of treatment). Adverse events and the proportion of participants achieving clear or almost clear skin were not measured.One trial (N = 20) assessed penicillin (1.6 MU (million units) intramuscularly once a day) versus no treatment (six weeks of treatment, with eight-week follow-up from start of treatment). At six-week (short-term) follow-up, no adverse events were observed in either group, and there was no statistically significant difference between the two groups in the proportion of participants with clear or almost clear skin (risk ratio (RR) 2.00, 95% confidence interval (CI) 0.68 to 5.85).One trial (N = 20) assessed rifampicin (300 mg twice daily) versus placebo (14-day treatment duration; six-week follow-up from start of treatment); none of the review outcomes were measured.These trials did not measure the proportion of participants achieving PASI 75 or PGA 1 to 2.Chronic plaque psoriasisOne trial (N = 50) assessed long-term azithromycin treatment (500 mg daily dose) versus vitamin C. Adverse events were reported in the azithromycin group (10 out of 30 had nausea and mild abdominal upset), but not in the vitamin C group. The proportion of participants who achieved clear or almost clear skin was not measu. We found only five trials (N = 162), which assessed the effects of five comparisons (systemic antibiotic treatment (penicillin, azithromycin) or tonsillectomy). Two comparisons (erythromycin compared to no treatment, and rifampicin compared to placebo) did not measure any of the outcomes of interest. There was very low-quality evidence for the outcomes that were measured, Therefore, we are uncertain of both the efficacy and safety of antistreptococcal interventions for guttate and chronic plaque psoriasis.The included trials were at unclear or high risk of bias and involved only a small number of unrepresentative participants, with limited measurement of our outcomes of interest. The studies did not allow investigation into the influence of Streptococcal infection, and a key intervention (amoxicillin) was not assessed.Further trials assessing the efficacy and tolerance of penicillin V or amoxicillin are needed in children and young adults with guttate psoriasis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ascorbic Acid; Azithromycin; Child; Erythromycin; Humans; Middle Aged; Penicillin V; Psoriasis; Randomized Controlled Trials as Topic; Rifampin; Streptococcal Infections; Tonsillectomy; Vitamins

Topics: Adult; Antibiotics, Antitubercular; Child; Drug Interactions; Female; Half-Life; Humans; Intestinal Absorption; Leprosy; Male; Microbial Sensitivity Tests; Middle Aged; Psoriasis; Rifampin; Tuberculosis

The efficacy of traditional systemic therapies for psoriasis is limited by various side effects, toxicity, drug-drug interactions, and the need for frequent laboratory monitoring. In animal models, rifampicin causes immunosuppression and in conventional doses it suppresses the T-cell function.. To show that rifampicin has a therapeutic effect in eruptive psoriasis and to try to explain its mode of action.. A total of 76 patients (34 men and 42 women, aged between 12 and 68 years) with eruptive psoriasis were enrolled in the study. They were divided into two groups according to the evidence of a concomitant streptococcal infection. Rifampicin was administered orally in a 600 mg daily dosage for at least 60 days. Only emollients were given for topical therapy.. A statistical (chi-squared test) analysis was done and it could be concluded that improvement in the two groups was statistically indistinguishable (p = 0.892), while comparison with the control group showed a significant difference (p = 0.00082).. The results express that there is no statistically significant difference between the treating groups and the effect of rifampicin could not be related only to its antimicrobial properties. Its therapeutic effect most probably is due to its immunosuppressive properties.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Female; Humans; Male; Middle Aged; Psoriasis; Rifampin; Streptococcal Infections; Treatment Outcome

After the publication of an uncontrolled trial of nine patients with streptococcus-associated psoriasis who appeared to benefit from a course of oral penicillin or erythromycin with the addition of rifampin in the last 5 days, we wished to confirm or refute the validity of this observation.. Our purpose was to confirm the effectiveness of antibiotics in the treatment of streptococcus-associated psoriasis.. Twenty patients were placed randomly into two groups. One group was given penicillin or erythromycin for 14 days with a placebo added during the last 5 of the 14 days. The other group received the same medication with the addition of rifampin in the last 5 days.. Although all the patients studied met the criteria of the reported preliminary study, we were unable to detect any evidence of improvement in their psoriasis.. There was no apparent benefit for patients with streptococcus-associated psoriasis from a course of oral penicillin or erythromycin with the addition of rifampin in the last 5 days in a 14-day trial.

Topics: Adolescent; Adult; Aged; Child; Drug Therapy, Combination; Erythromycin; Female; Humans; Male; Middle Aged; Penicillin V; Psoriasis; Rifampin; Streptococcal Infections

The addition of 5 days of rifampin therapy to a 10- or 14-day course of penicillin or erythromycin therapy has been shown to reduce greatly the rate of chronic streptococcal carriage. The empiric use of rifampin in combination with penicillin or erythromycin in nine of nine patients with streptococcal-associated psoriasis appeared to coincide with a marked improvement in their skin.

Topics: Adult; Carrier State; Child; Child, Preschool; Drug Therapy, Combination; Erythromycin; Female; Humans; Male; Penicillin V; Psoriasis; Rifampin; Skin Diseases, Infectious; Streptococcal Infections

Some biologics for psoriasis, especially anti-tumor necrosis factor (TNF)-α therapies, may re-activate latent tuberculosis (TBC) infection with consequent morbidity and mortality. However, there is a low reported incidence of conversion to positive TBC status among patients with psoriasis treated with second-generation biologic therapies, particularly anti-interleukin (IL)-17 therapies such as secukinumab.. To evaluate the safety profile of secukinumab in psoriasis patients with latent TBC infection.. Real-life data were collected by retrospective chart review on patients with moderate-to-severe psoriasis who showed positivity for TBC screening at baseline and underwent secukinumab treatment for psoriasis at six Italian centers. Patients received secukinumab 300 mg at week 0/1/2/3/4, then every 4 weeks.. Fifty-nine patients were enrolled; 30.5% also had psoriatic arthritis and other comorbidities were common. At baseline, the mean psoriasis duration was 14.5 years. Ten (17%) patients did not undergo prophylaxis before starting secukinumab. Conversely, isoniazid ± rifampicin or rifampicin alone prophylaxis was administered in 49/59 (83.1%) patients. After a mean treatment duration of 84 weeks, there were no cases of TBC reactivation and no unexpected safety signals.. Secukinumab use over an extended period was safe in psoriasis patients with latent TBC, even in patients who did not receive chemoprophylaxis.

Topics: Antibodies, Monoclonal, Humanized; Humans; Isoniazid; Latent Tuberculosis; Psoriasis; Retrospective Studies; Rifampin; Severity of Illness Index; Treatment Outcome; Tuberculosis

Rifampicin is an essential first line anti-tuberculosis drug. However, several cases of adverse reactions associated with this drug have been reported, the most common of which are cutaneous drug reactions. We report a case of mixed lichenoid and psoriasiform drug eruption induced by rifampicin.

Topics: Antitubercular Agents; Drug Eruptions; Humans; Lichenoid Eruptions; Psoriasis; Rifampin

Topics: Aged; Antibodies, Monoclonal, Humanized; Antitubercular Agents; Contraindications, Drug; Dermatologic Agents; Female; Humans; Interleukin-17; Isoniazid; Latent Tuberculosis; Male; Middle Aged; Psoriasis; Rifampin

Topics: Adalimumab; Anti-Inflammatory Agents; Antitubercular Agents; Biopsy; Humans; Isoniazid; Male; Middle Aged; Psoriasis; Rifampin; Thoracic Surgery, Video-Assisted; Tuberculosis, Pleural

Psoriasis is a multifaceted disease in terms of its pathophysiological mechanisms, inducing and aggravating factors, clinical types and clinical severity, associated comorbidities and therapeutic modalities. In recent years, an attracting perspective has emerged to identify variants of the disease with their own specific clinical course and management which could stratify the variable spectrum of the disease into different entities (such as palmo-plantar pustulosis). We hypothesize the existence of a unique Tuberculosis-related type of psoriasis that could be managed successfully with rifampicin.

Topics: Anti-Bacterial Agents; Antitubercular Agents; Biological Therapy; Comorbidity; Humans; Models, Theoretical; Prevalence; Psoriasis; Rifampin; Tuberculosis

Topics: Adult; Aged; Antitubercular Agents; Biological Products; Chemoprevention; Female; Humans; Isoniazid; Latent Tuberculosis; Male; Middle Aged; Prevalence; Psoriasis; Retrospective Studies; Rifampin; Tuberculin Test

The study aimed to clarify the role of electric pulses in combination with chemotherapy on the viability of keratinocyte cell line HaCaT, in the context of its application as a new therapeutic approach for psoriasis. The data show that electroporation of HaCaT cells in combination with rifampicin induces cytoskeleton disruption and increases permeability of cell monolayer due to cell-cell junctions' interruption, visualized by fluorescent imaging of E-cadherin and actin integrity. This was accompanied with synergistic reduction of cell viability. The study proposes a new opportunity for more effective skin treatment than chemotherapy. The future application of this electrochemotherapeutic approach for combined local treatment of psoriasis may have serous benefits because of a high possibility to avoid side-effects of conventional chemotherapy.

Topics: Cadherins; Cell Line; Cell Survival; Combined Modality Therapy; Electroporation; Fluorescent Dyes; Humans; Keratinocytes; Microtubules; Permeability; Psoriasis; Rifampin

The immunosuppressive properties of rifampicin have been discussed in the literature for more than 30 years. It is hypothesized that rifampicin acts as a mild immunosuppressive agent in psoriasis rather than an antibacterial one. We report our studies on the therapeutic efficacy of rifampicin in guttate psoriasis. We try to give light on the mechanism of action of rifampicin in psoriasis. Our therapeutic results together with data from the literature revealed rifampicin to be a mild immunosuppressive agent. Its best effectiveness is in the guttate type of the disease.

Topics: Adolescent; Adult; Aged; Antibiotics, Antitubercular; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Psoriasis; Rifampin; Severity of Illness Index; Young Adult

Psoriasis - systemic disease, including complex of interdependent pathogenetic links, which attach great importance to immunological disorders. According to recent years, the basis of the pathogenesis of psoriasis is the migration of T-lymphocytes from the blood into the skin, where they activate and start a cascade release of proinflammatory cytokines. The aim of the study was the assessment of therapeutic effectiveness of the phased application of Rifampicin and electropulse therapy in the treatment of patients with psoriasis. Under observation were 25 patients with vulgar psoriasis (13 women and 12 men aged from 18 to 65 years, with duration of illness from 1 month to 25 years). Rifampicin was prescribed to a daily dose of 600 mg for 60 days. Topical therapy was limited by the use of emollients. During the sessions of electropulse therapy the apparatus of elctronarcosis has been used. The state of the patients assessed 2 times a month. The effectiveness of treatment in patients receiving Rifampicin was the same regardless of the presence or absence of concomitant bacterial infection, which suggests that the positive therapeutic results of rifampicin is related not to its antibacterial, but to immunomodulatory effects. As a conclusion we can say that, the application of electropulse therapy and Rifampicin phase-treatment in patients with psoriasis reduces the period of the normalization of clinical indices for 7 days, as well as 2,5 times reduces the frequency of relapses in the year.

Topics: Adolescent; Adult; Aged; Antitubercular Agents; Combined Modality Therapy; Electric Stimulation Therapy; Female; Humans; Male; Middle Aged; Psoriasis; Rifampin; Treatment Outcome; Young Adult

Topics: Adolescent; Adult; Female; Humans; Male; Middle Aged; Psoriasis; Rifampin; Treatment Outcome

Topics: Clinical Trials as Topic; Humans; Psoriasis; Rifampin

Topics: Humans; Psoriasis; Remission Induction; Rifampin

The production of 14CO2 in the breath from an intravenous dose of [14C-N-methyl]-erythromycin (the erythromycin breath test [ERMBT]) and the measurement of the ratio of 6-beta-cortisol to free cortisol (6-beta-F/FF) in the urine have each been proposed as means of measuring hepatic P450IIIA catalytic activity in patients. We found that there was a significant correlation between the results of each test (r = 0.59, p less than 0.001) in 47 patients who were without liver disease and who were not taking medications believed to influence P450IIIA catalytic activity. In the 24 of these patients who were subsequently treated with the P450IIIA substrate cyclosporine, the ERMBT result was highly correlated with the mean trough cyclosporine blood level observed; however, there was no correlation between urinary 6-beta-F/FF and the cyclosporine blood levels. In a separate study of a patient during the anhepatic phase of liver transplantation surgery, the ERMBT result decreased by greater than 85%, whereas urinary 6-beta-F/FF decreased by just 50%. We conclude that the ERMBT and urinary 6-beta-F/FF do not always provide similar information about P450IIIA catalytic activity in patients, possibly because of extrahepatic production of 6-beta-F. Of the two tests, the ERMBT appears to provide the most relevant information for cyclosporine administration.

Topics: Aryl Hydrocarbon Hydroxylases; Breath Tests; Carbon Dioxide; Cyclosporine; Cytochrome P-450 CYP3A; Cytochrome P-450 Enzyme System; Humans; Hydrocortisone; Liver; Oxidoreductases, N-Demethylating; Psoriasis; Regression Analysis; Rifampin; Troleandomycin

Topics: Acquired Immunodeficiency Syndrome; Adult; HIV Seropositivity; Humans; Male; Penicillins; Psoriasis; Recurrence; Rifampin