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Atopic dermatitis — Management through Europe: Geographical differences
Satellite
S106
symposium
ST1 1. Atopic
pregnancy, and one was lost to follow up. These results indicate that once-weekly fluconazole 150 mg is effective and that the treatment period could be shortened. In an earlier open study from Finland by Kuokkanen and Alava, 20 patients with onychomycosis caused by Trichaphyton rtttbrutn were treated with Ruconazole I50 mg once weekly for a maximum of 12 months. All fingernails and 92% of toenails were cured (mean time 9.3 months). After six months follow-up the cure rate was 83% in toenails and 100% in fingernails. In another open study by Montero-Gei et al. 74 patients with onychomycosis caused by dermatophytes were treated with fluconazole I50 mg once weekly for a maximum of I2 months. Seventy-three patients, 57 with toenail and 16 with fingernail infections were evaluable. Seventy-one (97%) were clinically cured or improved and 59 (81%) were mycologically cured after a mean treatment of eight months (toenails). No adverse events were observed. The efficacy and safety of long-term fluconazole (150 mg once weekly) has also been evaluated in I I4 patients with onychomycosis (Fraki et al, 1997). Clinical and mycological success rates were 77% and 76%, respectively, at the 6-month follow-up. Investigators and patients considered fluconazole tolerance excellent or good in 97% and 98% of cases, respectively. The very high concentrations of Ruconazole found in nails and the persistence of the drug for at least 6 months after cessation of treatment indicate that fluconazole 150 mg once weekly is effective in onychomycosis, and that the length of therapy could be shortened. STIO-3
US experience with fluconazole in nail infections
B.E. Elewski. University Western
Reserve
University,
Centerfor Medical Mycology, Cleveland, USA
Case
Intermittent Auconazole is effective in both fingernail and toenail onychomycosis caused by Candida and dermatophyte fungi. Once-weekly dosing regimens can be justified by the long half-life of fluconazole in the nail. Levels are detectable in the nail shortly after initial dosing (2 hours), and persist for up to five months after therapy. A US multicenter study compared the efficacy of onceweekly fluconazole dosing regimens of I50 mg, 300 mg and 450 mg with placebo in subjects with fingernail or toenail onychomycosis caused by dermatophyte fungi. Approximately 300 subjects with toenail onychomycosis and a further 300 with lingemail onychomycosis were enrolled. Most subjects had greater than 50% involvement of the target nail, and about one-third had 75-995 involvement. At six months follow-up, clinical success rates in subjects with toenail infection were: 77% (150 mg), 798, (300 mg), 86% (450 mg), and 9% (placebo). In fingernail infection, clinical success rates were: 89% (150 mg), 96% (300 mg), 100% (450 mg), and ~5% (placebo). The onset of clinical success was one month for fingernails and three months for toenails; the mean time to clinical success was three months for fingernails and six months for toenails. Relapse rates were 2.6% in the fingernail study and 4.4% in the toenail study. Fluconazole was a highly effective treatment for onychomycosis at all dosages studied. There was no significant difference in efficacy between dosing regimens. The study also showed that Buconazole 150 mg, administered once weekly for six
dermatitis:
Current
trends
months for pedal onychomycosis, or three months for fingernail infection, is a cost-effective and well-tolerated alternative antimycotic for the treatment of onychomycosis.
STll. ST1l-1
Atopic dermatitis: Current trends Atopic dermatitis - Management through Europe: Geographical differences
0. Enjolras, J.F! Ortonne. hdpital I’Arclret
II, Nice,
Taker;
Paris;
Hipital
France
Introduction: General rules of management of AD include unavoidable topical treatment (baths, moisturizers and topical corticosteroids, although without universal guidelines). Furthermore avoidance of triggering factors (aeroallergens, food allergens and contact irritants) as well as psychologic support are needed. As second modalities we find antihistamine drugs and EFA supplementation. Experimental therapies may be necessary for the most severe cases (cyclosporin A, interferon gamma, tacrolimus ointment, Chinese herbal medicine, etc.). We decided to focus on the differences between North and South in Europe for the topical treatments. Material and Methods: First we did a review of the literature, based on a Medline search, but it was poorly informative on the therapeutic modalities. Therefore a survey done for BHI (ISIS, 1997/350 european dermatologists) was used. We compared data from Germany and Northern France versus Spain and Italy (countries with rather similar, important, number of dermatologists). In the UK, the small number of dermatologists (~350) bringing some bias in the AD management, we decided not to include data from the UK. Results: Topical corticosteroids and emollients are in the frontline for treating AD in Europe. This survey alowed us to evidence differences in their use depending on countries, and type of practice: topical corticosteroids are more widely used in northern than in southern countries, while it is the contrary for emollients. Conclusion: This is a first approach of North-South differences in the current topical treatment of AD in Europe. More extensive insight in the modalities of topical management of AD should be interesting to evaluate in parallel with the growing publications concerning “quality of life” in these patients. ST1 I-3
Emollient therapy of atopic eczema: Education and outcome
M.J. Cork. Royal Hallamshire
Hospital,
Shefield,
UK
Breakdown of the epidermal barrier in atopic eczema allows the penetration of irritants and allergens with trigger the developpement of eczematous lesions. Emollients restore the epidermal barrier and therefore prevent this interaction. In addition, they have direct anti-inflammatory actions. The use of a large quantities of emollients has a marked steroid-sparing effect. In one multi-centre, double-bIind clinical trial comparing topical steroids alone with emollients plus topical steroids, there was no difference between the two groups in the clinical improvement produced after three weeks. However, in the group treated width
S106
symposium
ST1 1. Atopic
pregnancy, and one was lost to follow up. These results indicate that once-weekly fluconazole 150 mg is effective and that the treatment period could be shortened. In an earlier open study from Finland by Kuokkanen and Alava, 20 patients with onychomycosis caused by Trichaphyton rtttbrutn were treated with Ruconazole I50 mg once weekly for a maximum of 12 months. All fingernails and 92% of toenails were cured (mean time 9.3 months). After six months follow-up the cure rate was 83% in toenails and 100% in fingernails. In another open study by Montero-Gei et al. 74 patients with onychomycosis caused by dermatophytes were treated with fluconazole I50 mg once weekly for a maximum of I2 months. Seventy-three patients, 57 with toenail and 16 with fingernail infections were evaluable. Seventy-one (97%) were clinically cured or improved and 59 (81%) were mycologically cured after a mean treatment of eight months (toenails). No adverse events were observed. The efficacy and safety of long-term fluconazole (150 mg once weekly) has also been evaluated in I I4 patients with onychomycosis (Fraki et al, 1997). Clinical and mycological success rates were 77% and 76%, respectively, at the 6-month follow-up. Investigators and patients considered fluconazole tolerance excellent or good in 97% and 98% of cases, respectively. The very high concentrations of Ruconazole found in nails and the persistence of the drug for at least 6 months after cessation of treatment indicate that fluconazole 150 mg once weekly is effective in onychomycosis, and that the length of therapy could be shortened. STIO-3
US experience with fluconazole in nail infections
B.E. Elewski. University Western
Reserve
University,
Centerfor Medical Mycology, Cleveland, USA
Case
Intermittent Auconazole is effective in both fingernail and toenail onychomycosis caused by Candida and dermatophyte fungi. Once-weekly dosing regimens can be justified by the long half-life of fluconazole in the nail. Levels are detectable in the nail shortly after initial dosing (2 hours), and persist for up to five months after therapy. A US multicenter study compared the efficacy of onceweekly fluconazole dosing regimens of I50 mg, 300 mg and 450 mg with placebo in subjects with fingernail or toenail onychomycosis caused by dermatophyte fungi. Approximately 300 subjects with toenail onychomycosis and a further 300 with lingemail onychomycosis were enrolled. Most subjects had greater than 50% involvement of the target nail, and about one-third had 75-995 involvement. At six months follow-up, clinical success rates in subjects with toenail infection were: 77% (150 mg), 798, (300 mg), 86% (450 mg), and 9% (placebo). In fingernail infection, clinical success rates were: 89% (150 mg), 96% (300 mg), 100% (450 mg), and ~5% (placebo). The onset of clinical success was one month for fingernails and three months for toenails; the mean time to clinical success was three months for fingernails and six months for toenails. Relapse rates were 2.6% in the fingernail study and 4.4% in the toenail study. Fluconazole was a highly effective treatment for onychomycosis at all dosages studied. There was no significant difference in efficacy between dosing regimens. The study also showed that Buconazole 150 mg, administered once weekly for six
dermatitis:
Current
trends
months for pedal onychomycosis, or three months for fingernail infection, is a cost-effective and well-tolerated alternative antimycotic for the treatment of onychomycosis.
STll. ST1l-1
Atopic dermatitis: Current trends Atopic dermatitis - Management through Europe: Geographical differences
0. Enjolras, J.F! Ortonne. hdpital I’Arclret
II, Nice,
Taker;
Paris;
Hipital
France
Introduction: General rules of management of AD include unavoidable topical treatment (baths, moisturizers and topical corticosteroids, although without universal guidelines). Furthermore avoidance of triggering factors (aeroallergens, food allergens and contact irritants) as well as psychologic support are needed. As second modalities we find antihistamine drugs and EFA supplementation. Experimental therapies may be necessary for the most severe cases (cyclosporin A, interferon gamma, tacrolimus ointment, Chinese herbal medicine, etc.). We decided to focus on the differences between North and South in Europe for the topical treatments. Material and Methods: First we did a review of the literature, based on a Medline search, but it was poorly informative on the therapeutic modalities. Therefore a survey done for BHI (ISIS, 1997/350 european dermatologists) was used. We compared data from Germany and Northern France versus Spain and Italy (countries with rather similar, important, number of dermatologists). In the UK, the small number of dermatologists (~350) bringing some bias in the AD management, we decided not to include data from the UK. Results: Topical corticosteroids and emollients are in the frontline for treating AD in Europe. This survey alowed us to evidence differences in their use depending on countries, and type of practice: topical corticosteroids are more widely used in northern than in southern countries, while it is the contrary for emollients. Conclusion: This is a first approach of North-South differences in the current topical treatment of AD in Europe. More extensive insight in the modalities of topical management of AD should be interesting to evaluate in parallel with the growing publications concerning “quality of life” in these patients. ST1 I-3
Emollient therapy of atopic eczema: Education and outcome
M.J. Cork. Royal Hallamshire
Hospital,
Shefield,
UK
Breakdown of the epidermal barrier in atopic eczema allows the penetration of irritants and allergens with trigger the developpement of eczematous lesions. Emollients restore the epidermal barrier and therefore prevent this interaction. In addition, they have direct anti-inflammatory actions. The use of a large quantities of emollients has a marked steroid-sparing effect. In one multi-centre, double-bIind clinical trial comparing topical steroids alone with emollients plus topical steroids, there was no difference between the two groups in the clinical improvement produced after three weeks. However, in the group treated width