Alocado Dermatologists Report

Psoriasis is a classic and common dermatological condition. It is defined as follows: an “inflammatory skin condition with increased epithelial proliferation, characterized by infiltrated plaques and silvery scaling”. According to international statistics 2-3% of the overall population are affected by this condition in varying degrees. (Varies geographically).
In Hungary, the estimated number of patients lies between 200,000 and 300,000, although much fewer visit their physicians, because part of them have already lost faith in receiving effective treatment; the other reason for not seeing a physician is that they are in remission and do not see its importance. The causes of psoriasis are still unclear, but research has significantly advanced our understanding concerning the inflammatory process and the immunological background of the illness.
The cause of this condition is believed to be genetic in nature. The condition is characterized by an increased sensitivity of the skin, reacting to external and internal stimuli. These stimuli are the so-called “provoking factors”. The most important provoking factors are mechanical (injury or irritation of the skin), immunological, metabolic stimuli, and provocation by medicine and stress.
A characteristic feature of the illness is the deterioration of quality of life. This is not a life-threatening illness and its gravity is determined not by the physician, but the patient. This condition influences the patient’s everyday life as well as their social and working activities. Deterioration of the quality of life due to psoriasis can be as serious as that caused by heart disease or depression.

Clinically speaking, it is the most versatile skin disease. The most often affected parts of the body are: the scalp, the knees, the elbow, the buttocks, the genitalia, the navel, the flexures and the nails. Its most frequent forms: thick, silvery plaque, extensive, inflammatory plaque, tiny, punctiform lesions and incidental small blisters.
From a medical point of view, the degrees of illness can range from an asymptomatic state through mild symptoms, with isolated plaques to persistent, thick plaques; from a gradual spread to a degree when joints are also affected and the complete surface of the skin is covered by erythroderma.
According to Prof. Christopher Griffith, the gravity of the illness depends on the degree of deterioration of quality of life, the resistance to therapy and the degree lesion spreading.
Seeing as psoriasis is an illness that influences the quality of life and its gravity is determined by the patient, the physician compares his or her own findings with the evaluation of the patient and offers the patient all available therapeutic alternatives.
Finally they will be able to mutually choose the best one. The therapy can be either local or systemic.
Local treatment consists of two phases: the first is stopping acute symptoms, and the second is maintaining therapy with the aim of avoiding a relapse. As for the medication used in maintenance therapy it is of utmost importance that they be well tolerated by the patient, without any side effects.
There are very few preparations used so far, that comply with the above requirements. Traditional treatment possibilities for the acute phase are: coal tar, local corticosteroids, vitamin D analogues, local retinoids, and keratolytic agents (compounds
containing salicylic acid, for external application). Besides these, Photo-therapy (PUVA, UVB) and bath therapy may also be applied.
The above therapies are effective, but they have several side effects.
• Corticosteroids can cause atrophy of the skin, vasodilation may occur; fungal or bacterial infections may emerge.
• Vitamin D may be irritating and expensive.
• The application of coal tar and some of the photo-therapies in large doses are carcinogenic.
• Salicylic acid in high concentrations is irritating.
From the list of above-mentioned therapies only vitamin D is suitable for maintenance therapy.
So the need for a phase-specific, non-aggressive (non-irritating) maintenance therapy is justified.

The Alocado™ product line was developed in 1988 based on formulas developed by physicians and pharmacists working in clinics near the Dead Sea. At that time it was recognized that the surroundings, the water and the mud of the Dead Sea had a healing effect on the patients suffering from skin diseases.
This was also the time when some publications on side effects and disadvantageous features of steroids appeared. Realizing these facts, the inventors were inspired to develop a range of products solving all varying problems using a phase specific range of products that were a revolutionary departure from the “all in one” existing medicines. During their work, they could make use of some publications analysing therapeutic effects of some vegetable oils like Avocado oil and the Aloe Vera extract.

Besides this, patients wished to enjoy remission not only for a week for as long as their treatment at the Dead Sea lasted, but for a longer period of time. This was made possible by being able to take these natural remedies back home. 

Advantages of the Alocado™ product line are as follows:

* It does not contain steroids.
* It doses not contain tar.
* It doses not contain synthetic vitamin D.
* The acid content never exceeds 2%.
* The active ingredients are combined with very strong emollients.
* A unique composition of natural oils (mainly Avocado), Aloe Vera extract and salt from the Dead Sea (not reaching salt concentration levels that could irritate skin).
* There are special products to treat different symptoms, including open wounds.
* We offer products for maintenance therapy to be used in state of remission to contribute to palliate symptoms of the next relapse.
* These products do not have any side effects neither after short- nor after long-term treatment.

We began testing Alocado™ products in September 2006. Approximately 25-30 volunteers were recruited to take part in the test, which was not launched at the most favourable period, because psoriasis generally relapses when cold weather is to be expected.
Baseline data were collected along with the dermatological examination, i.e. personal data, medical history, and all medication taken before and at the time of this examination were recorded. The state of the skin was photographed, some of these photos will
be shown later and are saved on the enclosed DVD. The photos don’t always document the changes of conditions exactly, since there was no possibility to take professional photos, and in many cases the pictures are distorted by inappropriate lighting or positioning. This is why we used the PASI index widely accepted in specialist literature to establish condition changes. We established values on the basis of PASI index from the starting state of illness, and during the repeated follow-ups.

A short summary on PASI:
The objective skin condition of the patient is expressed by the so called PASI index. This is an internationally accepted index to demonstrate the state of the skin and to establish efficacy of the therapy.
The index evaluates the main symptoms of psoriasis: erythema, induration, and scaling, and the size of the affected area are taken into consideration as well. All these factors are taken into account in the regions of the head, the upper limbs, the torso and the lower limbs. Using different multipliers a relative number is achieved from the sum of these values. This relative number is not quite perfect; e.g. changing from PASI 20 to PASI 10 is much easier than to change from 10 to 5. There is a version of this index where
the patients analyse the values themselves. (This happened in our case, when we had weekly or bi-weekly phone consultations with the patients.)

Due to the fact that psoriasis is an illness influencing the quality of life, it is the patient who evaluates the illness most precisely; his or her opinion is crucial.
Administering ALOCADO™ products, our aim was to give emollient, nourishing and calming preparations to the patient. These products are phase-specific, meaning that they always exert their effect against the most irritating symptom and they support maintenance therapy in conjunction with drug therapy or without. The products prolong the period between relapses and make the patients feel more comfortable with their skin.

In the above table, the first column shows the number of volunteers, and the other columns contain PASI index scores as per follow-up. The dates of follow-ups vary from volunteer to volunteer. Due to the fact that they did not start at the same time, but one after the other, in some cases it was possible to have even six follow-ups whereas in other cases only 1-2. The intervals between the follow-ups also vary; they changed individually. In some cases, this interval was 10-14 days, while in others, it was several weeks. So the columns show PASI index scores registered during follow-ups, irrespective of the time elapsed. At the bottom of the table, the index scores measured during the first, second, third, etc. follow-ups are summarized, where a decreasing trend can already be identified. Besides this, we have calculated the mean index scores as well, this can be seen in the bottom row.
The index scores do not show a smooth decrease, which means that there have been relapses. Further on, individual data will also be introduced.
In the first column, PASI index score changes are highlighted in a different colour. In the case of volunteer 20, the dark green colour means that this patient suffered from Atopic Dermatitis (and in his row the PASI index score is zero throughout the test).

This case has demonstrated that certain preparations of the Alocado™ product line, suitable for the treatment of very dry skin, may be useful for other conditions as well.
We can see very fast and very effective results in this case as shown by those before and after pictures: