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A double-blind, randomized, placebo-controlled trial of n-3 fatty acid based lipid infusion in acute, extended guttate psoriasis

Rapid improvement of clinical manifestations and changes in neutrophil leukotriene profile

  • Clinical Pharmacology Original Article
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Summary

Twenty patients hospitalized for acute psoriasis guttata with a minimum 10% of body surface area involvement (range 10–90%) completed a 10-day trial in which they were randomly allocated to receive daily infusions with either an n-3 fatty acid based lipid emulsion [100 ml/day with 2.1 g eicosapentaenoic (EPA) and 21 g docosahexaenoic acid (DHA)] or a conventional n-6 lipid emulsion (EPA+DHA<0.1 g/100 ml). The severity of disease was evaluated by scoring daily erythema, infiltration, and desquamation and by a subjective scoring of clinical manifestations offered by the patients. Leukotriene (LT) and platelet-activating factor (PAF) generation were investigated in ionophore-stimulated neutrophils obtained on days 0, 1, 3, 5, 10, and 40. Moderate improvement in clinical manifestations was noted in the n-6 group (changes in score systems between 16–25% from baseline within 10 days). In contrast, the severity of disease markedly decreased in all patients of the n-3 group, with improvements in all score systems ranging between 45% and 76% within 10 days (P<0.05 for each variable). The difference in response to the two regimens was evident within 4–7 days after onset of lipid infusion. A more than ten fold increase in neutrophil EPA-derived 5-1ipoxygenase product formation (LTB5, its omega-oxidation products, non-enzymatic degradation products of LTA5 and 5-hydroxyeicosapentaenoic acid) was noted in the n-3 group but not in the n-6 group. Neutrophil PAF generation increased in the n-6 group but decreased in the n-3 group. In conclusion, modulation of eicosanoid metabolism by intravenous n-3 fatty acid supplementation appears to exert a rapid beneficial effect on inflammatory skin lesions in acute guttate psoriasis.

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Abbreviations

AA:

arachidonic acid

DHA:

docosahexaenoic acid

EPA:

eicosapentaenoic acid

5-HEPE:

5-hydroxyeicosapentaenoic acid

5-HETE:

5-hydroxyeicosatetraenoic acid

LT:

leukotriene

PAF:

platelet activating factor

PMN:

polymorphonuclear leukocyte

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Author information

Authors and Affiliations

  1. Zentrum für Innere Medizin, Justus-Liebig-Universität Gießen, Germany

    F. Grimminger, C. Papavassilis, K.-U. Heuer, D. Führer, D. Walmrath & W. Seeger

  2. Zentrum für Dermatologie and Andrologie, Justus-Liebig-Universität Gießen, Germany

    P. Mayser, M. Thomas, K.-D. Hinsch & W.-B. Schill

  3. Fresenius AG, Oberursel, Germany

    E. Schlotzer

  4. Zentrum für Innere Medizin, Justus-Liebig-Universität Gießen, Klinikstrasse 36, D-35392, Gießen, Germany

    F. Grimminger

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  1. F. Grimminger
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Additional information

The study was supported by the Deutsche Forschungsgemeinschaft (DFG La 73/20-1)

The manuscript includes portions of the doctoral thesis of C. Papavassilis

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Grimminger, F., Mayser, P., Papavassilis, C. et al. A double-blind, randomized, placebo-controlled trial of n-3 fatty acid based lipid infusion in acute, extended guttate psoriasis. Clin Investig 71, 634–643 (1993). https://doi.org/10.1007/BF00184491

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  • DOI: https://doi.org/10.1007/BF00184491

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