Case 1

A 40-year-old man with disseminated erythrodermic psoriasis with pustules presented with arthralgias. He had a history of psoriasis vulgaris from infancy, diagnosed by skin biopsy, and had been followed by dermatologists. He had also had psoriatic arthritis since childhood. Physical examination revealed erythematous scaly plaques on his elbows, trunk and umbilical area, perineum and legs (Figure 1). He had interphalangeal distal joint involvement and spondylitis. His medical history was uneventful, with no evidence of underlying systemic disease and he was not taking any medications at the time of presentation.

Figure 1 Patient 1 before treatment with hyperbaric oxygen (Front View). Full size image

He requested a hyperbaric consultation after reading a newspaper article reporting on the use of HBO 2 to treat psoriasis in a study conducted in Cuba. At the hospital he was evaluated to determine whether he was a suitable candidate for HBO 2 therapy. After he had given informed consent, he underwent HBO 2 therapy at 2.8 atmospheres for 60 minutes, once a day (5 days per week). The patient underwent a total of eight sessions, resulting in significant amelioration of symptoms (Figure 2). The patient did not receive any topical treatment before or during HBO 2 therapy.

Figure 2 Patient 1 after treatment with hyperbaric oxygen (Front View). Full size image

Most of the psoriatic lesions were cleared, with marked reduction in itching and scaling. No side effect was reported with the use of HBO 2 . The patient also reported less pain in his hands and joints after the eight sessions of HBO 2 . Follow up at 18 months revealed that the patient had only mild skin symptoms with degenerative changes of the arthritis.

Case 2

A 55-year-old man was referred for HBO 2 for management of chronic bilateral leg ulcers and osteomyelitis. In addition, he had extensive psoriasis vulgaris (Figure 3). He had a long history of psoriasis vulgaris, which had been diagnosed by skin biopsy and followed by a dermatologist. His current medications at the time of admission to the hyperbaric department were topical mineral oil, Eucerin Calming Creme, and diphenhydramine 50 three times a day. He had erythema, and his skin was scaling and itching.

Figure 3 Patient 1 before treatment with hyperbaric oxygen (Back View). Full size image

He underwent daily HBO 2 at 2 atmospheres for 90 minutes, once a day (5 days per week). After six sessions his erythema, scaling and itching were reduced in severity, and after 15 sessions he had improved further (Figure 4). No adverse effect was reported with the use of HBO 2 .