Abstract
It has been suggested previously that psoriasis is best explained as a distinctive inflammatory response to a variety of microbial stimuli, all acting primarily through activation of the alternative complement pathway. For the past several years we have conducted a "Problem Psoriasis Clinic" based on that premise. Patients are questioned, examined, and subjected to microbiologic laboratory investigations in an attempt to identify possibly relevant microorganisms, and then are treated with antibiotics. This article lists the most commonly found microorganisms in psoriasis patients and describes the usual treatment for each. Results obtained with this approach compare favorably with those achieved with more usual anti-psoriasis treatments. We recommend that a microbiologic investigation and a trial of antimicrobial treatment should precede any plan to treat psoriasis patients with anything more than the simplest topical agents.
Full text
PDF





Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aron-Brunetière R., Dompmartin-Pernot D., Drouhet E. Treatment of pityriasis capitis (dandruff) with econazole nitrate. Acta Derm Venereol. 1977;57(1):77–80. [PubMed] [Google Scholar]
- Belew P. W., Rosenberg E. W., Jennings B. R. Activation of the alternative pathway of complement by Malassezia ovalis (Pityrosporum ovale). Mycopathologia. 1980 Mar 31;70(3):187–191. doi: 10.1007/BF00443030. [DOI] [PubMed] [Google Scholar]
- Brotherton J. Relative effectiveness of different classes of fungicides against Pityrosporum ovale. Br J Dermatol. 1968 Nov;80(11):749–752. doi: 10.1111/j.1365-2133.1968.tb11939.x. [DOI] [PubMed] [Google Scholar]
- Bunse T., Mahrle G. Anthralin is a potent inhibitor of pityrosporum orbiculare/ovale in vitro. Acta Derm Venereol. 1992;72(1):72–73. [PubMed] [Google Scholar]
- Chaudhary S., Bilinsky S. A., Hennessy J. L., Soler S. M., Wallace S. E., Schacht C. M., Bisno A. L. Penicillin V and rifampin for the treatment of group A streptococcal pharyngitis: a randomized trial of 10 days penicillin vs 10 days penicillin with rifampin during the final 4 days of therapy. J Pediatr. 1985 Mar;106(3):481–486. doi: 10.1016/s0022-3476(85)80687-9. [DOI] [PubMed] [Google Scholar]
- Duvic M., Reisman M., Finley V., Rapini R., DiLuzio N. R., Mansell P. W. Glucan-induced keratoderma in acquired immunodeficiency syndrome. Arch Dermatol. 1987 Jun;123(6):751–756. [PubMed] [Google Scholar]
- Farr P. M., Krause L. B., Marks J. M., Shuster S. Response of scalp psoriasis to oral ketoconazole. Lancet. 1985 Oct 26;2(8461):921–922. doi: 10.1016/s0140-6736(85)90853-0. [DOI] [PubMed] [Google Scholar]
- Farr P. M., Shuster S. Treatment of seborrhoeic dermatitis with topical ketoconazole. Lancet. 1984 Dec 1;2(8414):1271–1272. doi: 10.1016/s0140-6736(84)92815-0. [DOI] [PubMed] [Google Scholar]
- Fergusson A. G., Fraser N. G., Grant P. W. Napkin dermatitis with psoriasiform "ide". A review of fifty-two cases. Br J Dermatol. 1966 May;78(5):289–296. doi: 10.1111/j.1365-2133.1966.tb12224.x. [DOI] [PubMed] [Google Scholar]
- Hänel H., Menzel I., Holzmann H. Hohe Phospholipase A-Aktivität von Candida albicans aus dem Darm von Psoriatikern. Mycoses. 1988 Sep;31(9):451–453. [PubMed] [Google Scholar]
- Kaneko F., Gushiken H., Kawagishi I., Miura Y., Kobayashi K., Konno T. Analysis of immunological responses in psoriatic lesions: (1) immunopathological studies on psoriatic lesions. J Invest Dermatol. 1980 Nov;75(5):436–439. doi: 10.1111/1523-1747.ep12524088. [DOI] [PubMed] [Google Scholar]
- Kaplan E. L. The group A streptococcal upper respiratory tract carrier state: an enigma. J Pediatr. 1980 Sep;97(3):337–345. doi: 10.1016/s0022-3476(80)80178-8. [DOI] [PubMed] [Google Scholar]
- Lober C. W., Belew P. W., Rosenberg E. W., Bale G. Patch tests with killed sonicated microflora in patients with psoriasis. Arch Dermatol. 1982 May;118(5):322–325. [PubMed] [Google Scholar]
- Marley W. M., Belew P. W., Rosenberg E. W., Urmson J. R., Stitzel A. E., Spitzer R. E. Abnormalities in the alternative pathway of complement in psoriasis. Clin Exp Dermatol. 1982 Jul;7(4):387–396. doi: 10.1111/j.1365-2230.1982.tb02446.x. [DOI] [PubMed] [Google Scholar]
- Noah P. W. The role of microorganisms in psoriasis. Semin Dermatol. 1990 Dec;9(4):269–276. [PubMed] [Google Scholar]
- Ohkohchi K., Torinuki W., Tagami H. Increased plasma concentrations of complement modulating proteins (C1 inhibitor, C4-binding protein, factor H and factor I) in psoriasis. Tohoku J Exp Med. 1988 Apr;154(4):315–321. doi: 10.1620/tjem.154.315. [DOI] [PubMed] [Google Scholar]
- ROBINSON M. M. The relationship of streptococcus fecalis to psoriasis. J Invest Dermatol. 1953 Jun;20(6):455–459. doi: 10.1038/jid.1953.56. [DOI] [PubMed] [Google Scholar]
- Rosenberg E. W., Belew P. W. Improvement of psoriasis of the scalp with ketoconazole. Arch Dermatol. 1982 Jun;118(6):370–371. [PubMed] [Google Scholar]
- Rosenberg E. W., Belew P., Bale G. Effect of topical applications of heavy suspensions of killed Malassezia ovalis on rabbit skin. Mycopathologia. 1980 Nov 28;72(3):147–154. doi: 10.1007/BF00572657. [DOI] [PubMed] [Google Scholar]
- Rosenberg E. W., Noah P. W. The Koebner phenomenon and the microbial basis of psoriasis. J Am Acad Dermatol. 1988 Jan;18(1 Pt 1):151–158. doi: 10.1016/s0190-9622(88)80063-x. [DOI] [PubMed] [Google Scholar]
- Rosenberg E. W., Noah P. W., Wyatt R. J., Jones R. M., Kolb W. P. Complement activation in psoriasis. Clin Exp Dermatol. 1990 Jan;15(1):16–20. doi: 10.1111/j.1365-2230.1990.tb02011.x. [DOI] [PubMed] [Google Scholar]
- Rosenberg E. W., Noah P. W., Zanolli M. D., Skinner R. B., Jr, Bond M. J., Crutcher N. Use of rifampin with penicillin and erythromycin in the treatment of psoriasis. Preliminary report. J Am Acad Dermatol. 1986 May;14(5 Pt 1):761–764. doi: 10.1016/s0190-9622(86)70090-x. [DOI] [PubMed] [Google Scholar]
- Skinner R. B., Jr, Noah P. W., Taylor R. M., Zanolli M. D., West S., Guin J. D., Rosenberg E. W. Double-blind treatment of seborrheic dermatitis with 2% ketoconazole cream. J Am Acad Dermatol. 1985 May;12(5 Pt 1):852–856. doi: 10.1016/s0190-9622(85)70107-7. [DOI] [PubMed] [Google Scholar]
- Swerlick R. A., Cunningham M. W., Hall N. K. Monoclonal antibodies cross-reactive with group A streptococci and normal and psoriatic human skin. J Invest Dermatol. 1986 Sep;87(3):367–371. doi: 10.1111/1523-1747.ep12524838. [DOI] [PubMed] [Google Scholar]
- Tervaert W. C., Esseveld H. A study of the incidence of haemolytic streptococci in the throat in patients with psoriasis vulgaris, with reference to their role in the pathogenesis of this disease. Dermatologica. 1970;140(5):282–290. doi: 10.1159/000252565. [DOI] [PubMed] [Google Scholar]
- WARIN R. P., FAULKNER K. E. Napkin psoriasis. Br J Dermatol. 1961 Dec;73:445–447. [PubMed] [Google Scholar]
- Xu B., Noah P. W., Skinner R. B., Jr, Bale G., Chesney T. M., Rosenberg E. W. Efficacy of bimolane in the Malassezia ovalis model of psoriasis. J Dermatol. 1991 Dec;18(12):707–713. doi: 10.1111/j.1346-8138.1991.tb03161.x. [DOI] [PubMed] [Google Scholar]
- Yancey K. B., Overholser O., Domloge-Hultsch N., Li L. J., Caughman S. W., Bisalbutra P. Human keratinocytes and A-431 cells synthesize and secrete factor B, the major zymogen protease of the alternative complement pathway. J Invest Dermatol. 1992 Mar;98(3):379–383. doi: 10.1111/1523-1747.ep12499812. [DOI] [PubMed] [Google Scholar]