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Naltrexone for neurotic excoriations
Volume 20 Number 5, Part 1 May 1989
Correspondence
several encouraging reports in the veterinary t,2 (Dodman N H , personal communication, Oct. 26, 1987) and medical literature, 3-5 describing cases in which narcotic antagonists were successfully used in the management of self-destructive behavior. It is postulated that narcotic antagonists are effective in this disorder because they inhibit receptor binding of the endogenous endorphins released in response to painful stimuli such as serfinflicted injury. By blocking this endorphin-mediated "reward," narcotic antagonists act to extinguish selfinjurious behavior. Naltrexone is a safe and relatively inexpensive form of treatment for what can otherwise be an intractable and disruptive problem.
Kevin C. Smith, MD, and Mark R. Pittelkow, MD Mayo Clinic and Mayo Foundation Rochester, M N 55905
REFERENCES 1. Dodman NH, Shuster L, Court MH, Dixon R. Investigation into the use of narcotic antagonists in the treatment of a stereotypic behavior pattern (crib-biting) in the horse. Am J Vet Res 1987;48:311-9. 2. Kelsey JE, Belluzzi JD, Stein L. Does naloxone suppress self-stimulation by decreasing reward or by increasing aversion? Brain Res 1984;307:55-9. 3. Sandyk R. Naloxone abolishes self-injurlng in a mentally retarded child [Letter]. Ann Neurol 1985;17:520. 4. Davidson PW, Kleene BM, Carroll M, Roekowitz RJ. Effects of naloxone on self-injurious behavior: a case study. App[ Res Ment Retard 1983;4:1-4. 5. Sandman CA, Datta PC, Barron J, Hoehler FK, Williams C, Swanson JM. Naloxone attenuates self-abusive behavior in developmentally disabled clients. Appl Res Ment Retard 1983;4:5-I1.
Nystatin for treatment of acne vulgaris To the Editor." By chance I have discovered that powdered oral nystatin (Nilstat) shows promise as a valuable drug for the treatment of acne vulgaris. I would like to pass along information gathered so that others can follow up with more extensive clinical trials. Also, the following observations may give new insight into the pathogenesis of acne and lead to more effective treatments. A M E D L I N E search of the literature from 1966 to the present failed to reveal any references on the use of nystatin for the treatment of acne.
861
injection, was found to be critical in reducing his sensitivities. While taking the testosterone he was able to return to work in the city where he had previously lived. Three attempts were made to gradually reduce the amount of testosterone, but each time he relapsed and again became extremely chemically sensitive. Even though the testosterone gave him marked acne vulgaris on his back, he had no choice but to take it. In an attempt to further reduce his sensitivity, he was later given a therapeutic trial of powdered oral nystatin (Nilstat), 500 mg (V2 teaspoon) in water six times daily. The nystatin did nothing to lessen his sensitivities, but his acne disappeared. Twice the nystatin was withdrawn. Both times the acne flared. The acne cleared with return of the nystatin. Case 2. After consulting numerous physicians without being helped, a 33-year-old white man visited me complaining that he was markedly sensitive to many chemicals and foods. This 5-foot 11-inch man weighed 113 pounds and appeared close to starvation. Laboratory test results were not remarkable, except for a serum testosterone level of 0.04 ~g/100 ml (normal 0.3 to 1.0). He was started on testosterone enanthate in sesame oil by injection, 150 mg weekly. He now weighs 180 pounds and has acceptable chemical tolerance. The testosterone produced extensive acne on his back. He could not, however, function on smaller dosages of testosterone. Because of the experience with case 1, this patient was placed on nystatin. Only 250 mg (1A teaspoon) twice daily was needed to clear the acne. Several attempts were made to withdraw the nystatin. On each occasion the ache returned. When the nystatin was reinstated, the ache cleared. Case 3. A 37-year-old white woman consulted me because she had chronic monilial vaginitis that bad not cleared with conventional therapy. Incidentally, she also had acne on her face. Both her vaginitis and her acne were controlled when she took nystatin 500 mg (89 teaspoon) six times a day. Trial and error revealed that she could reduce the dosage of nystatin to half if she stayed on a diet free of most grains, sugar, and dairy products. At present she is not taking nystatin and has no acne or vaginitis if she stays on her diet and limits herself to rare, small amounts of rice, potato, and fruit. Most of her calories come from fish, chicken, and beef that includes generous amounts of fat.
Discussion. On initiating nystatin therapy, patients may experience Herxheimer's reaction that lasts 3 to 5 days. The presumption is that the killing of the Candida allows large amounts of the dead yeast to be absorbed from the gastrointestinal tract. Patients m a y have a hypersensitivity reaction to dead Candida. H. L. Newbold, MD 115 E. 34th St. New York, NIP 10016
Case reports Case 1. A 44-year-old white man had marked chemical sensitivities. If a city bus happened to blow exhaust fumes his way, he would go into a coma and be taken to a hospital emergency room. His hypersensitivities forced him to leave the city and retreat to a country residence in Maine. Testosterone enanthate in sesame oil, 200 mg/week by
Adverse reactions to tretinoin and collagen injections To the Editor." Recent communications regarding treatment of aging skin have led to the use of various
Volume 20 Number 5, Part 1 May 1989
Correspondence
several encouraging reports in the veterinary t,2 (Dodman N H , personal communication, Oct. 26, 1987) and medical literature, 3-5 describing cases in which narcotic antagonists were successfully used in the management of self-destructive behavior. It is postulated that narcotic antagonists are effective in this disorder because they inhibit receptor binding of the endogenous endorphins released in response to painful stimuli such as serfinflicted injury. By blocking this endorphin-mediated "reward," narcotic antagonists act to extinguish selfinjurious behavior. Naltrexone is a safe and relatively inexpensive form of treatment for what can otherwise be an intractable and disruptive problem.
Kevin C. Smith, MD, and Mark R. Pittelkow, MD Mayo Clinic and Mayo Foundation Rochester, M N 55905
REFERENCES 1. Dodman NH, Shuster L, Court MH, Dixon R. Investigation into the use of narcotic antagonists in the treatment of a stereotypic behavior pattern (crib-biting) in the horse. Am J Vet Res 1987;48:311-9. 2. Kelsey JE, Belluzzi JD, Stein L. Does naloxone suppress self-stimulation by decreasing reward or by increasing aversion? Brain Res 1984;307:55-9. 3. Sandyk R. Naloxone abolishes self-injurlng in a mentally retarded child [Letter]. Ann Neurol 1985;17:520. 4. Davidson PW, Kleene BM, Carroll M, Roekowitz RJ. Effects of naloxone on self-injurious behavior: a case study. App[ Res Ment Retard 1983;4:1-4. 5. Sandman CA, Datta PC, Barron J, Hoehler FK, Williams C, Swanson JM. Naloxone attenuates self-abusive behavior in developmentally disabled clients. Appl Res Ment Retard 1983;4:5-I1.
Nystatin for treatment of acne vulgaris To the Editor." By chance I have discovered that powdered oral nystatin (Nilstat) shows promise as a valuable drug for the treatment of acne vulgaris. I would like to pass along information gathered so that others can follow up with more extensive clinical trials. Also, the following observations may give new insight into the pathogenesis of acne and lead to more effective treatments. A M E D L I N E search of the literature from 1966 to the present failed to reveal any references on the use of nystatin for the treatment of acne.
861
injection, was found to be critical in reducing his sensitivities. While taking the testosterone he was able to return to work in the city where he had previously lived. Three attempts were made to gradually reduce the amount of testosterone, but each time he relapsed and again became extremely chemically sensitive. Even though the testosterone gave him marked acne vulgaris on his back, he had no choice but to take it. In an attempt to further reduce his sensitivity, he was later given a therapeutic trial of powdered oral nystatin (Nilstat), 500 mg (V2 teaspoon) in water six times daily. The nystatin did nothing to lessen his sensitivities, but his acne disappeared. Twice the nystatin was withdrawn. Both times the acne flared. The acne cleared with return of the nystatin. Case 2. After consulting numerous physicians without being helped, a 33-year-old white man visited me complaining that he was markedly sensitive to many chemicals and foods. This 5-foot 11-inch man weighed 113 pounds and appeared close to starvation. Laboratory test results were not remarkable, except for a serum testosterone level of 0.04 ~g/100 ml (normal 0.3 to 1.0). He was started on testosterone enanthate in sesame oil by injection, 150 mg weekly. He now weighs 180 pounds and has acceptable chemical tolerance. The testosterone produced extensive acne on his back. He could not, however, function on smaller dosages of testosterone. Because of the experience with case 1, this patient was placed on nystatin. Only 250 mg (1A teaspoon) twice daily was needed to clear the acne. Several attempts were made to withdraw the nystatin. On each occasion the ache returned. When the nystatin was reinstated, the ache cleared. Case 3. A 37-year-old white woman consulted me because she had chronic monilial vaginitis that bad not cleared with conventional therapy. Incidentally, she also had acne on her face. Both her vaginitis and her acne were controlled when she took nystatin 500 mg (89 teaspoon) six times a day. Trial and error revealed that she could reduce the dosage of nystatin to half if she stayed on a diet free of most grains, sugar, and dairy products. At present she is not taking nystatin and has no acne or vaginitis if she stays on her diet and limits herself to rare, small amounts of rice, potato, and fruit. Most of her calories come from fish, chicken, and beef that includes generous amounts of fat.
Discussion. On initiating nystatin therapy, patients may experience Herxheimer's reaction that lasts 3 to 5 days. The presumption is that the killing of the Candida allows large amounts of the dead yeast to be absorbed from the gastrointestinal tract. Patients m a y have a hypersensitivity reaction to dead Candida. H. L. Newbold, MD 115 E. 34th St. New York, NIP 10016
Case reports Case 1. A 44-year-old white man had marked chemical sensitivities. If a city bus happened to blow exhaust fumes his way, he would go into a coma and be taken to a hospital emergency room. His hypersensitivities forced him to leave the city and retreat to a country residence in Maine. Testosterone enanthate in sesame oil, 200 mg/week by
Adverse reactions to tretinoin and collagen injections To the Editor." Recent communications regarding treatment of aging skin have led to the use of various
Correspondence
several encouraging reports in the veterinary t,2 (Dodman N H , personal communication, Oct. 26, 1987) and medical literature, 3-5 describing cases in which narcotic antagonists were successfully used in the management of self-destructive behavior. It is postulated that narcotic antagonists are effective in this disorder because they inhibit receptor binding of the endogenous endorphins released in response to painful stimuli such as serfinflicted injury. By blocking this endorphin-mediated "reward," narcotic antagonists act to extinguish selfinjurious behavior. Naltrexone is a safe and relatively inexpensive form of treatment for what can otherwise be an intractable and disruptive problem.
Kevin C. Smith, MD, and Mark R. Pittelkow, MD Mayo Clinic and Mayo Foundation Rochester, M N 55905
REFERENCES 1. Dodman NH, Shuster L, Court MH, Dixon R. Investigation into the use of narcotic antagonists in the treatment of a stereotypic behavior pattern (crib-biting) in the horse. Am J Vet Res 1987;48:311-9. 2. Kelsey JE, Belluzzi JD, Stein L. Does naloxone suppress self-stimulation by decreasing reward or by increasing aversion? Brain Res 1984;307:55-9. 3. Sandyk R. Naloxone abolishes self-injurlng in a mentally retarded child [Letter]. Ann Neurol 1985;17:520. 4. Davidson PW, Kleene BM, Carroll M, Roekowitz RJ. Effects of naloxone on self-injurious behavior: a case study. App[ Res Ment Retard 1983;4:1-4. 5. Sandman CA, Datta PC, Barron J, Hoehler FK, Williams C, Swanson JM. Naloxone attenuates self-abusive behavior in developmentally disabled clients. Appl Res Ment Retard 1983;4:5-I1.
Nystatin for treatment of acne vulgaris To the Editor." By chance I have discovered that powdered oral nystatin (Nilstat) shows promise as a valuable drug for the treatment of acne vulgaris. I would like to pass along information gathered so that others can follow up with more extensive clinical trials. Also, the following observations may give new insight into the pathogenesis of acne and lead to more effective treatments. A M E D L I N E search of the literature from 1966 to the present failed to reveal any references on the use of nystatin for the treatment of acne.
861
injection, was found to be critical in reducing his sensitivities. While taking the testosterone he was able to return to work in the city where he had previously lived. Three attempts were made to gradually reduce the amount of testosterone, but each time he relapsed and again became extremely chemically sensitive. Even though the testosterone gave him marked acne vulgaris on his back, he had no choice but to take it. In an attempt to further reduce his sensitivity, he was later given a therapeutic trial of powdered oral nystatin (Nilstat), 500 mg (V2 teaspoon) in water six times daily. The nystatin did nothing to lessen his sensitivities, but his acne disappeared. Twice the nystatin was withdrawn. Both times the acne flared. The acne cleared with return of the nystatin. Case 2. After consulting numerous physicians without being helped, a 33-year-old white man visited me complaining that he was markedly sensitive to many chemicals and foods. This 5-foot 11-inch man weighed 113 pounds and appeared close to starvation. Laboratory test results were not remarkable, except for a serum testosterone level of 0.04 ~g/100 ml (normal 0.3 to 1.0). He was started on testosterone enanthate in sesame oil by injection, 150 mg weekly. He now weighs 180 pounds and has acceptable chemical tolerance. The testosterone produced extensive acne on his back. He could not, however, function on smaller dosages of testosterone. Because of the experience with case 1, this patient was placed on nystatin. Only 250 mg (1A teaspoon) twice daily was needed to clear the acne. Several attempts were made to withdraw the nystatin. On each occasion the ache returned. When the nystatin was reinstated, the ache cleared. Case 3. A 37-year-old white woman consulted me because she had chronic monilial vaginitis that bad not cleared with conventional therapy. Incidentally, she also had acne on her face. Both her vaginitis and her acne were controlled when she took nystatin 500 mg (89 teaspoon) six times a day. Trial and error revealed that she could reduce the dosage of nystatin to half if she stayed on a diet free of most grains, sugar, and dairy products. At present she is not taking nystatin and has no acne or vaginitis if she stays on her diet and limits herself to rare, small amounts of rice, potato, and fruit. Most of her calories come from fish, chicken, and beef that includes generous amounts of fat.
Discussion. On initiating nystatin therapy, patients may experience Herxheimer's reaction that lasts 3 to 5 days. The presumption is that the killing of the Candida allows large amounts of the dead yeast to be absorbed from the gastrointestinal tract. Patients m a y have a hypersensitivity reaction to dead Candida. H. L. Newbold, MD 115 E. 34th St. New York, NIP 10016
Case reports Case 1. A 44-year-old white man had marked chemical sensitivities. If a city bus happened to blow exhaust fumes his way, he would go into a coma and be taken to a hospital emergency room. His hypersensitivities forced him to leave the city and retreat to a country residence in Maine. Testosterone enanthate in sesame oil, 200 mg/week by
Adverse reactions to tretinoin and collagen injections To the Editor." Recent communications regarding treatment of aging skin have led to the use of various
Volume 20 Number 5, Part 1 May 1989
Correspondence
several encouraging reports in the veterinary t,2 (Dodman N H , personal communication, Oct. 26, 1987) and medical literature, 3-5 describing cases in which narcotic antagonists were successfully used in the management of self-destructive behavior. It is postulated that narcotic antagonists are effective in this disorder because they inhibit receptor binding of the endogenous endorphins released in response to painful stimuli such as serfinflicted injury. By blocking this endorphin-mediated "reward," narcotic antagonists act to extinguish selfinjurious behavior. Naltrexone is a safe and relatively inexpensive form of treatment for what can otherwise be an intractable and disruptive problem.
Kevin C. Smith, MD, and Mark R. Pittelkow, MD Mayo Clinic and Mayo Foundation Rochester, M N 55905
REFERENCES 1. Dodman NH, Shuster L, Court MH, Dixon R. Investigation into the use of narcotic antagonists in the treatment of a stereotypic behavior pattern (crib-biting) in the horse. Am J Vet Res 1987;48:311-9. 2. Kelsey JE, Belluzzi JD, Stein L. Does naloxone suppress self-stimulation by decreasing reward or by increasing aversion? Brain Res 1984;307:55-9. 3. Sandyk R. Naloxone abolishes self-injurlng in a mentally retarded child [Letter]. Ann Neurol 1985;17:520. 4. Davidson PW, Kleene BM, Carroll M, Roekowitz RJ. Effects of naloxone on self-injurious behavior: a case study. App[ Res Ment Retard 1983;4:1-4. 5. Sandman CA, Datta PC, Barron J, Hoehler FK, Williams C, Swanson JM. Naloxone attenuates self-abusive behavior in developmentally disabled clients. Appl Res Ment Retard 1983;4:5-I1.
Nystatin for treatment of acne vulgaris To the Editor." By chance I have discovered that powdered oral nystatin (Nilstat) shows promise as a valuable drug for the treatment of acne vulgaris. I would like to pass along information gathered so that others can follow up with more extensive clinical trials. Also, the following observations may give new insight into the pathogenesis of acne and lead to more effective treatments. A M E D L I N E search of the literature from 1966 to the present failed to reveal any references on the use of nystatin for the treatment of acne.
861
injection, was found to be critical in reducing his sensitivities. While taking the testosterone he was able to return to work in the city where he had previously lived. Three attempts were made to gradually reduce the amount of testosterone, but each time he relapsed and again became extremely chemically sensitive. Even though the testosterone gave him marked acne vulgaris on his back, he had no choice but to take it. In an attempt to further reduce his sensitivity, he was later given a therapeutic trial of powdered oral nystatin (Nilstat), 500 mg (V2 teaspoon) in water six times daily. The nystatin did nothing to lessen his sensitivities, but his acne disappeared. Twice the nystatin was withdrawn. Both times the acne flared. The acne cleared with return of the nystatin. Case 2. After consulting numerous physicians without being helped, a 33-year-old white man visited me complaining that he was markedly sensitive to many chemicals and foods. This 5-foot 11-inch man weighed 113 pounds and appeared close to starvation. Laboratory test results were not remarkable, except for a serum testosterone level of 0.04 ~g/100 ml (normal 0.3 to 1.0). He was started on testosterone enanthate in sesame oil by injection, 150 mg weekly. He now weighs 180 pounds and has acceptable chemical tolerance. The testosterone produced extensive acne on his back. He could not, however, function on smaller dosages of testosterone. Because of the experience with case 1, this patient was placed on nystatin. Only 250 mg (1A teaspoon) twice daily was needed to clear the acne. Several attempts were made to withdraw the nystatin. On each occasion the ache returned. When the nystatin was reinstated, the ache cleared. Case 3. A 37-year-old white woman consulted me because she had chronic monilial vaginitis that bad not cleared with conventional therapy. Incidentally, she also had acne on her face. Both her vaginitis and her acne were controlled when she took nystatin 500 mg (89 teaspoon) six times a day. Trial and error revealed that she could reduce the dosage of nystatin to half if she stayed on a diet free of most grains, sugar, and dairy products. At present she is not taking nystatin and has no acne or vaginitis if she stays on her diet and limits herself to rare, small amounts of rice, potato, and fruit. Most of her calories come from fish, chicken, and beef that includes generous amounts of fat.
Discussion. On initiating nystatin therapy, patients may experience Herxheimer's reaction that lasts 3 to 5 days. The presumption is that the killing of the Candida allows large amounts of the dead yeast to be absorbed from the gastrointestinal tract. Patients m a y have a hypersensitivity reaction to dead Candida. H. L. Newbold, MD 115 E. 34th St. New York, NIP 10016
Case reports Case 1. A 44-year-old white man had marked chemical sensitivities. If a city bus happened to blow exhaust fumes his way, he would go into a coma and be taken to a hospital emergency room. His hypersensitivities forced him to leave the city and retreat to a country residence in Maine. Testosterone enanthate in sesame oil, 200 mg/week by
Adverse reactions to tretinoin and collagen injections To the Editor." Recent communications regarding treatment of aging skin have led to the use of various