What is this Condition?

Psoriasis is a chronic, recurrent skin disease in which the skin's outermost layer is abnormally overgrown. Red patches form and are covered by thick, dry, silvery scales. These lesions vary widely in severity and distribution.

Psoriatic skin cells have an abnormally short life cycle - 4 days as opposed to 28 days for normal skin cells. Four days isn't enough time for skin cells to mature. As a result, the outermost skin layer becomes thick and flaky.

Typically, the disease goes through partial remissions and flare­ups. Flare-ups are often related to specific factors but may be unpredictable. They can usually be controlled with therapy.

Psoriasis affects about 2% of the population in the United States.

The incidence is higher among whites than other races. Although this disorder is most common in young adults, it may strike at any age, including infancy.

What are its Symptoms?

The most common symptom of psoriasis is itching; occasionally, pain from dry, cracked, encrusted lesions may occur. These lesions are red and usually form well-defined patches (also called plaques), which sometimes cover large areas of the body. They're most common on the scalp, chest, elbows, knees, back, and buttocks.

The patches consist of silver scales that either flake off easily or can thicken, covering the lesion. If the scales are removed, fine points of bleeding may occur. Occasionally, small teardrop-shaped lesions appear, either alone or with plaques. Typically, these lesions are thin and red, with few scales. Widespread shedding of scales is common in exfoliative (inflammatory) psoriasis and may also develop in chronic psoriasis

Pustular psoriasis is a rare, severe form of the disorder marked by bright red patches and small, raised areas that contain pus.

In about 30% of cases, psoriasis spreads to the fingernails, producing small indentations and yellow or brown discoloration. In severe cases, buildup of thick, crumbly debris under the nails causes them to separate from the nailbed.

Some people with psoriasis develop arthritic symptoms, usually in one or more joints of the fingers or toes, or sometimes in the joints of the lower back. Some people suffer morning stiffness. People with joint symptoms experience remissions and flare-ups similar to those of rheumatoid arthritis.

Scale Removal

To remove psoriatic scales, the doctor may instruct the person to apply ointments, such as Vaseline, salicylic acid preparations, or preparations containing urea. These medications soften the scales; the person then removes them by scrubbing them carefully with a soft brush while bathing.

Ultraviolet Light Treatment

To retard rapid skin cell production, the doctor may recommend exposure to light (either ultraviolet B or natural sunlight) to the point of minimal skin redness. Ultraviolet B light exposure is the most common treatment for generalized psoriasis.

The person may apply tar preparations or crude coal tar to affected areas about 15 minutes before exposure, or may leave these preparations on overnight and wipe them off the next morning. Exposure time can increase gradually. Outpatient or day treatment with ultraviolet B light avoids long hospitalizations and prolongs remission.

Steroid Therapy

Steroid creams and ointments are useful to control psoriasis. A potent fluorinated steroid works well (except on the face and areas where two skin surfaces come into contact). These creams must be applied twice daily, preferably after bathing to promote absorption; overnight, the person covers the areas with occlusive dressings, such as plastic wrap, plastic gloves or booties, or a vinyl exercise suit (under direct medical or nursing supervision). Small, stubborn plaques may require steroid injections into the lesions.

Calcipotriene

Calcipotriene ointment, a vitamin D3 analogue, is a new topical agent used to treat psoriasis.

Therapy for Severe Psoriasis

For someone with severe chronic psoriasis, the doctor may prescribe the Goeckerman regimen, which combines tar baths and ultraviolet B light treatments. This therapy may induce remission and dear the skin in 3 to 5 weeks. The Ingram technique, a variation of the Goeckerman regimen, uses anthralin instead of tar.

In a therapy called PUVA, the person first receives psoralens (an agent that promotes the action of ultraviolet light) and then is exposed to high-intensity ultraviolet A light.

As a last resort, a drug that inhibits cell proliferation - usually Rheumatrex - may help to relieve severe psoriasis that's unresponsive to conventional treatment.

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Papaverine

Precautions:

Heart: Large doses can produce serious arrhythmias (irregular heartbeats). Liver sensitivity has been reported with intestinal symptoms, yellowing of the skin and eyes and altered liver function tests. Discontinue medication if these symptoms occur.

Pregnancy: Adequate studies have not been done in pregnant women or animal studies may have shown a risk to the fetus. Use only if clearly needed and potential benefits outweigh the possible hazards to the fetus.

Breastfeeding: It is not known if papaverine appears in breast milk. Consult your doctor before you begin breastfeeding.

Children: Safety and effectiveness have not been established.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over­the-counter or prescription medications or dietary supplements with papaverine. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. Levodopa (eg, Larodopa) inter­acts with papaverine.

Side Effects of The Papaverine:

Every drug is capable of producing side effects. Many papaverine users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dosage, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; stomachache; appetite loss; constipation; diarrhea.

Nervous System: Headache; dizziness; drowsiness; feeling of whirling motion.

Circulatory System: Increased heart rate; increased blood pressure. Skin: Yellowing of skin or eyes; sweating; flushing of face; rash.

Other: Fatigue and general body aches; increase in depth of respirations; abnormal liver tests.

Guidelines for Use:

• May cause drowsiness or dizziness. Use caution when driving or performing tasks requiring alertness. Alcohol may intensify these effects.

• May cause flushing, sweating, headache, tiredness, jaundice, rash, nausea, appetite loss, abdominal distress, constipation or diarrhea. Notify your doctor if these effects become pronounced.

• Take at evenly spaced intervals throughout the day.

• Store at controlled room temperature (59° to 86°F). Protect from moisture.

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Vinpocetine Herb Description

Source

Vinpocetine is derived from vincamine, an alkaloid from the extract of the periwinkle plant, Vinca minor. It is a semisynthetic ethyl ester of apovincamine. V minor is indigenous to northern Spain and parts of central and southern Europe. The medicinal parts of the plant include the dried leaves and the flowering plant.

Chemical Components

V. minor contains indole alkaloids (vincamine, vincin, apovincamine, vincadifformin) and flavonoids.

Actions

The actual mechanism of action of vinpocetine is not fully understood. Potentially, it is a vasodilator and enhancer of cerebral metabolism. It is thought to have a stimulating effect on memory and increases metabolic activity in the brain by increasing blood flow. There are also claims that vinpocetine inhibits platelet aggregation and increases the release of serotonin and norepinephrine. Vinpocetine may have direct or indirect cholinergic activity, increase the turnover of brain catecholamine levels, and enhance norepinephrine effects on cortical cAMP levels . Vinpocetine may also block sodium ion channels .

Reported Uses

A study of eight patients with renal failure who were undergoing hemodialysis reported that vinpocetine, IS mg P.O. daily, treated intractable tumoral calcinosis after 6 to 12 months of therapy .

In Europe, vinpocetine is commonly administered to patients with cerebrovascular disorders. It is claimed to be useful for memory and cognitive function enhancement and to increase brain function. Vinpocetine has been evaluated but not shown to be effective in improving symptoms of Alzheimer's disease . Another study evaluated the use of vinpocetine in Alzheimer's disease patients . This study determined the safety of vinpocetine but suggested that vinpocetine did not decrease the rate of disease progression. Vinpocetine, 30 mg P.O. daily, did demonstrate clinical improvement in patients with vascular or degenerative cerebral dysfunction . Another report reviewed the use of vinpocetine in acute ischemic stroke and determined that evidence to recommend vinpocetine to these patients was insufficient . Vinpocetine has been claimed to treat aphasia, unstable blood pressure, poor coordination, depression, dizziness, headache, impaired hearing and vision, insomnia, irritability, mood instability, motor disorders, nervousness, ophthalmic diseases, acute stroke, and vertigo.

Contraindications and Precautions

Vinpocetine is contraindicated in patients who are hypersensitive to this herb. Avoid its use in pregnant or breast-feeding patients. Use vinpocetine cautiously in patients with a history of allergic phenomena during treatment with other vinca alkaloids, in those with hepatic disease, and in those with nonorganic psychoses.

Special Considerations

• Patients with nonorganic psychoses or other mental illnesses should be evaluated before initiating therapy.

• Elderly patients may require higher doses of vinpocetine because they have significantly higher plasma clearance and a larger volume of distribution of vinpocetine.

• Monitor the patient for improvement of neurologic parameters, dementia symptoms, and daily functioning.

• Monitor the patient with seizure disorder closely.

• Routine blood chemistry, blood pressure, and pulse rate monitoring should be performed during long-term therapy with vinpocetine.

• Advise the patient to take vinpocetine tablets or capsules with meals and fluids and not to chew them.

Points of Interest

• In Italy, the flower of V. minor is called "The Flower of Death" because it was used in ancient custom to make garlands placed on dead children. Ironically, in Germany, it is called the "Flower of Immortality:' In France, the flower is considered a symbol of friendship.

Commentary

Although there have been studies in both animals and humans, there is contradictory information for use in the treatment of Alzheimer's disease, dementia, and ischemic stroke. Additional studies are needed to evaluate the efficacy and safety of vinpocetine.

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Ectropion

In ectropion the lower lid of your eye hangs away from the eyeball, so that the lower half of the exposed surface of the eyeball and the lining of the lower lid become dry and sore. Also, the tears that normally lubricate the lining of of your eyelids and the front of the eye may be prevented from entering the tear duct in the lower lid. If this happens, the tears will run down your cheek.

What are The Risks?

Ectropion usually occurs in older people because the muscle in the lower lid that keeps the lid taut against the eyeball may become weak. The condition can also be caused at any age by a scar on the lower lid or cheek that has contracted and pulls down the lid. If ectropion is not treated, corneal ulcers may develop on the exposed cornea and damage it permanently.

What Should be Done?

The condition rarely disappears of its own accord, so you should see your physician, who will arrange for you to have an operation on the tissues beneath the eye. This is a minor procedure that requires only a local anesthe­tic and should clear up the problem.

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