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October 1993

Psoriasis and Cigarettes: Another Nail in the Coffin

Author Affiliations

Section of Dermatology Hitchcock Clinic Lebanon, NH 03756

Arch Dermatol. 1993;129(10):1329-1330. doi:10.1001/archderm.1993.01680310099018

IN THEIR prospective, double-blind, placebocontrolled study in this issue of the Archives, Reitamo et al1 have demonstrated that palmoplantar pustulosis (PPP) is responsive to low-dose (1.25-to 2.5-mg/kg per day) oral cyclosporine. Increases in serum creatinine concentrations occurred but did not exceed normal limits, and blood pressure level increases were not noted at these doses. Simply having another therapeutic alternative for this vexing and often incapacitating problem would be welcome in itself. In addition, however, remissions exceeded expectations. In follow-up of 4 to 14 months after cessation of therapy, 27 of 38 patients remained "in remission" and 10 of the 27 patients in remission had no signs of PPP at all, despite the fact that there was no change in the behavioral risk factor most commonly associated with PPP, namely, cigarette smoking.

Buried in Table 11 is the fact that all 40 of the original patients were, at the

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