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Use of griseofulvin
Volume 24 Number 4 April 1991
in reducing all forms of ache lesions analyzed, by one formulation, and the maintenance of numeric superiority by the same formulation over the duration of the study may prove meaningful to the objective observer. There is no reference 16. Table I appeared in both the February and March articles with an asterisk. In the February 1990 article it was stated that the asterisk denoted that the grading scale is modified from the Cook method. In the March article, about which Dr. Sweren wrote, indeed the typesetting gremlins have seemingly substituted "reference 16" for the explanation the asterisk denoted. Lest our correspondent, Dr. Sweren, didn't have sufficient angst, I feel a tinge of guilt to point out that he missed the fact there are no references 11 through 15 either.
Lawrence Sehachner, AID, and Arm Pestana, AID Department of Dermatology and Cutaneous Surgery, P. O. Box 016250 (R-250), Miami, FL 33101
REFERENCES 1. Hollander M, Wolfe DA. Nonparametric statistical methods. New York: John Wiley & Sons, 1973:69-74. 2. BrownBW, Hollander M. Statistics: a biomedicalintroduction. New York: John Wiley & Sons, 1977:456. 3. Schachner L, Eaglstein W, Kitties C, et al. Topical erythromycin and zinc therapy for acne. J AM ACADDERMATOL 1990;22:253-60. 4. Schachner L, Pestana A, Kitties C. A clinical trial comparing the safety and efficacy of a topical erythromycin-zinc formulation with a topical elindamycin formulation. J AM ACADDERMATOL1990;22:489-95.
"Cello scrotum" questioned To the Editor: I applaud the comprehensive, excellent recent review of"Derrnatologic Problems of Musicians" by Rimmer and Spielvogel (J AM AcaI3 DERMATOL 1990;22:657-63). As a former professional cellist, I appredate the descriptions of "cellist's chest" and "cello knee." However, I question the accuracy of the information under the designation of "cello scrotum." The authors cite just one case, which is not their own (Br Med J 1974;2:335). That case consists of a brief (9-line) letter to the editor in which the author states that a professional cellist had "cello scrotum" caused by "irritation from the body of the cello." I find this a bit puzzling. When the cello is held in typical playing position, the body of the instrument is not near the scrotum. Contact of the body of the cello with the scrotum would require an extremely awkward playing position, which I have never seen a playing cellist assume. If the scrotal dermatitis of the cellist in question was truly associated with cello playing, I think it more likely was associated with irritation from the forward edge of the chair; this is a location with which a cellist's scrotum
Correspondence
665
typically comes into contact. However, because even this is speculation and because this problem would not be unique to the cellist but could occur in anyone who does not sit still in his chair, I think it would be best to expunge the term "cdlo scrotum" from the dermatologic literature.
Philip E. Shapiro, MD Department of Dermatology, Yale University New Haven, Connecticut
Use of griseofulvin To the Editor: At the end of his report of oral contraceptive failure apparently caused by the concurrent use of griseofulvin (J AM ACAD DERMATOL 1990;22:124-5), Dr. C6t6 says that he favors ketoconazole as a noninteracting substitute for treatment periods of more than 3 months. However, the use of ketoeonazole is controversial. One study found that 7 of 147 women taking low-dose oral contraceptives (Ovidon, Rigevidon, Anteovin) experienced break-through bleeding within 2 to 5 days of starting a 5-day course of 400 mg ketoconazole daffy.~No pregnancies occurred but intermenstrual bleeding is a sign of a decrease in the effectiveness of the oral contraceptives. I do not know of any direct evidence of total contraceptive failure caused by ketoconazole, but it may not be a safe substitute for griseofulvin. Ivan 1-1.Stockley, PhD, MRPharm S The University of Nottingham Medical School Nottingham, NG7 2UH, U.K.
REFERENCE l. Kovacs L, Somos P, Hamori M. Examination of the potential interaction between ketoconazole (Nizoral) and oral contraceptives with special regard to products of low hormone content (Rigevidon, Anteovin). Ther Hung 1986; 34:167.
Short-contact anthralin therapy To the Editor."Short-contact anthralin therapy (SCAT) involves the removal of anthralin by washing after a short period of contact. Logic dictates that either all the anthralin is thereby removed from the tissue (in which case there is no need for further neutralization by amines or anything else) or, if there is residual, active anthralin within the tissue, such active anthralin cannot be ignored when considering the reasons for the demonstrable effectiveness of SCAT. The relative inhibitory effects on anthralin-induced inflammation, postulated for primary, secondary, and tertiary amines, make interesting reading insofar as they
in reducing all forms of ache lesions analyzed, by one formulation, and the maintenance of numeric superiority by the same formulation over the duration of the study may prove meaningful to the objective observer. There is no reference 16. Table I appeared in both the February and March articles with an asterisk. In the February 1990 article it was stated that the asterisk denoted that the grading scale is modified from the Cook method. In the March article, about which Dr. Sweren wrote, indeed the typesetting gremlins have seemingly substituted "reference 16" for the explanation the asterisk denoted. Lest our correspondent, Dr. Sweren, didn't have sufficient angst, I feel a tinge of guilt to point out that he missed the fact there are no references 11 through 15 either.
Lawrence Sehachner, AID, and Arm Pestana, AID Department of Dermatology and Cutaneous Surgery, P. O. Box 016250 (R-250), Miami, FL 33101
REFERENCES 1. Hollander M, Wolfe DA. Nonparametric statistical methods. New York: John Wiley & Sons, 1973:69-74. 2. BrownBW, Hollander M. Statistics: a biomedicalintroduction. New York: John Wiley & Sons, 1977:456. 3. Schachner L, Eaglstein W, Kitties C, et al. Topical erythromycin and zinc therapy for acne. J AM ACADDERMATOL 1990;22:253-60. 4. Schachner L, Pestana A, Kitties C. A clinical trial comparing the safety and efficacy of a topical erythromycin-zinc formulation with a topical elindamycin formulation. J AM ACADDERMATOL1990;22:489-95.
"Cello scrotum" questioned To the Editor: I applaud the comprehensive, excellent recent review of"Derrnatologic Problems of Musicians" by Rimmer and Spielvogel (J AM AcaI3 DERMATOL 1990;22:657-63). As a former professional cellist, I appredate the descriptions of "cellist's chest" and "cello knee." However, I question the accuracy of the information under the designation of "cello scrotum." The authors cite just one case, which is not their own (Br Med J 1974;2:335). That case consists of a brief (9-line) letter to the editor in which the author states that a professional cellist had "cello scrotum" caused by "irritation from the body of the cello." I find this a bit puzzling. When the cello is held in typical playing position, the body of the instrument is not near the scrotum. Contact of the body of the cello with the scrotum would require an extremely awkward playing position, which I have never seen a playing cellist assume. If the scrotal dermatitis of the cellist in question was truly associated with cello playing, I think it more likely was associated with irritation from the forward edge of the chair; this is a location with which a cellist's scrotum
Correspondence
665
typically comes into contact. However, because even this is speculation and because this problem would not be unique to the cellist but could occur in anyone who does not sit still in his chair, I think it would be best to expunge the term "cdlo scrotum" from the dermatologic literature.
Philip E. Shapiro, MD Department of Dermatology, Yale University New Haven, Connecticut
Use of griseofulvin To the Editor: At the end of his report of oral contraceptive failure apparently caused by the concurrent use of griseofulvin (J AM ACAD DERMATOL 1990;22:124-5), Dr. C6t6 says that he favors ketoconazole as a noninteracting substitute for treatment periods of more than 3 months. However, the use of ketoeonazole is controversial. One study found that 7 of 147 women taking low-dose oral contraceptives (Ovidon, Rigevidon, Anteovin) experienced break-through bleeding within 2 to 5 days of starting a 5-day course of 400 mg ketoconazole daffy.~No pregnancies occurred but intermenstrual bleeding is a sign of a decrease in the effectiveness of the oral contraceptives. I do not know of any direct evidence of total contraceptive failure caused by ketoconazole, but it may not be a safe substitute for griseofulvin. Ivan 1-1.Stockley, PhD, MRPharm S The University of Nottingham Medical School Nottingham, NG7 2UH, U.K.
REFERENCE l. Kovacs L, Somos P, Hamori M. Examination of the potential interaction between ketoconazole (Nizoral) and oral contraceptives with special regard to products of low hormone content (Rigevidon, Anteovin). Ther Hung 1986; 34:167.
Short-contact anthralin therapy To the Editor."Short-contact anthralin therapy (SCAT) involves the removal of anthralin by washing after a short period of contact. Logic dictates that either all the anthralin is thereby removed from the tissue (in which case there is no need for further neutralization by amines or anything else) or, if there is residual, active anthralin within the tissue, such active anthralin cannot be ignored when considering the reasons for the demonstrable effectiveness of SCAT. The relative inhibitory effects on anthralin-induced inflammation, postulated for primary, secondary, and tertiary amines, make interesting reading insofar as they