Immunological changes following treatment of psoriasis with cyclosporin

Five patients treated for severe plaque psoriasis with cyclosporin were studied. Cryostat sections of biopsies taken from the same lesional skin areas before and during therapy were examined for immunological surface markers, and deposits of immunoglobulins and complement using a panel of monoclonal and polyclonal antibodies. Fc gamma-receptors (FcR) were detected using soluble immune complexes of horseradish peroxidase (HRP)-anti-HRP. During therapy the dermal accumulation of T-lymphocytes (CD3+, CD4+, CD8+ and IL2R+ cells), macrophages (OKM1+), CD1a+ and FcR+ cells decreased, paralleling clinical improvement. However, in normalized skin there were still patchy accumulations of mononuclear cells in some dermal papillae close to the dermo-epidermal junction. In the epidermis CD8+ and IL2R+ cells rapidly disappeared during clinical improvement. The numbers of epidermal dendritic CD1a+ and HLA-DR+ cells increased and their distribution pattern became regular. The percentage of CD1a+ epidermal cells expressing FcR was reduced during therapy. IgM deposits regularly found along the dermal vessels and the dermoepidermal junction before therapy gradually disappeared. Serum levels of IgA increased and C4 decreased, though not significantly. Serum levels of gamma-IFN, alpha 2-IFN and TNF remained unchanged. The findings indicate that cyclosporin inhibits various sides of the immune response.