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Dermatologic therapy: December 1985 to December 1986
Therapv Dermatologic therapy" December 1985 to December 1986 Ralph J. Coskey, M.D. Detroit, MI I have reviewed the significant therapeutic changes reported in the English literature between December 1985 and December 1986. Readers should review the Original articles in toto before attempting any new experimental or controversial therapy summarized. (J AM ACAD DERMATOL1987; 16:1219-25.) ACNE AND RELATED CONDITIONS Topical clindamycin phosphate was compared with its vehicle in a randomized double-blind study on 32 patients with acne. This study was done to evaluate the active agents' effects on intestinal microflora in patients with acne. No significant changes in the intestinal microflora were detected in patients treated with topical clindamycin phosphate, t Clindamycin and its metabolites are found in the urine of patients treated with topical clindamycin hydrochloride. This is not true with topical clindamycin phosphate, however. Pseudomembranous colitis has been reported after topical application of clindamycin hydrochloride? It was also recently reported to occur after topical application of clindamycin phosphate? Thus it is possible that minute amounts of clindamycin phosphate, not detectable by present assay methods, may be absorbed from the skin. Metronidazole 1% in a cream base was compared with tetracycline 250 mg twice daily for the treatment of 75 patients with rosacea. After 8 weeks there was not a statistically significant difference between the results of the two treatments .4 In patients with rosacea who cannot tolerate oral tetracycline, topical 1% metronidazole in a cream base should be Considered. Oral spironolactone was evaluated in 21 women From the~[)ermatology Department, Wayne State University, School of Medicine. Reprint requests to: Dr. Ralph J. Coskey, 23133 Orchard Lake Rd., Farmington, MI 48024.
with acne in a randomized placebo-controlled double-blind crossover study over a period of 3 months. A dose of 200 mg was given daily. Significant improvement occurred with the active agent. Levels of plasma sex hormone binding globulin fell but not plasma testosterone and free testosterone. 5 Spironolactone is an antagonist of aldosterone. It is used primarily as a diuretic and antihypertensive drug. However, it dots have antiandrogenic effects. It inhibits testosterone biosynthesis and also inhibits the binding of dihydrotestosterone to receptors in the skin. COLLAGEN DISEASES Eight of ten patients with chronic or subacute cutaneous lupus erythematosus completed a 16week trial o f oral isotretin0in therapy (80 mg/day). All patients had an excellent clinical response. The histopathologic abnormalities and also abrlormal direct immunofluorescence resolved. Newton et al e stated that the mechanism of action of isotretinoin remains to be established. It might affect epidermal differentiation or immunoreactant deposition on the basement membrane or cell-mediated inflammatory response. Twenty-three patients with discoid lupus erythematosus, unresponsive to conventional treatment, were treated with oral gold (Auranofin), 3 mg twice daily. If they did not respond after months, the dose was increased to 9 mg daily. Nineteen patients showed clinical improvement and four showed complete resolution. 7 Auranofin is an antiarthritic, anti-inflammatory, 1219
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Coskey
and immunoregulatory agent. In a study of 3,082 patients receiving Auranofin for up to 8 years for rheumatoid arthritis, 11.2% withdrew from treatment because of adverse effects. However, 25% of 465 patients stopped injectable gold therapy because of adverse effects) This drug could be considered in patients who are resistant to standard therapy for lupus erythematosus. Nine of l l patients with Raynaud's phenomenon improved after taking nifedipine in a randomized double-blind crossover study. These patients immersed their hands in ice water for 20 seconds. When they took placebo it took 44.9 plus or minus 18 minutes for their skin temperatures to return to normal. 9 When they took nifedipine it took 28.5 plus or minus 20.8 minutes for their skin temperatures to return to normal. HAIR
Minoxidil lotion, 1%, was used to treat 670 male patients with androgenetic alopecia; 430 completed 6 months of treatment; 28% had good results. One-year follow-up after the drug was stopped showed that regrowth was present in only 33% of patients who originally had good results. ~0 Topical tretinoin alone and in combination with 0.5% minoxidil was evaluated in 56 patients with androgenetic alopecia. After 1 year the combination of topical tretinoin with 0.5% minoxidil resulted in terminal hair growth in 66% of patients. Tretinoin alone stimulated Some hair growth in approximately 58 % of patients. One female patient with alopecia for more than 20 years had regrowth of hair using only tretinoin for 18 months. ~1 A 6-month double-blind placebo-controlled study was done to evaluate 0.01%, 0.1%, and 2% topical minoxidil in male pattern baldness. Topical minoxidil, 1% and 2%, showed a statistically significant increase in total and nonvellus target area hair counts after 6 months compared with subjects treated with 0.01% and 0.1%, as well as subjects treated with placebo. Subjects on 2% topical minoxidil had more impressive objective and subjective responses than those on 1% topical minoxidil, although the differences were not statistically significant. Olsen et aP 2 believed that 2% minoxidil should be the preferred treatment for male pattern baldness.
For best results in the treatment of androgenetic alopecia, 2% minoxidil lotion and topical tretinoin, together, should be considered. Topical 5% minoxidil solution was used to treat 47 patients with severe alopecia areatal Forty of the patients had terminal hair growth after 48 to 60 weeks. However, in the majority of patients hair growth was not cosmetically acceptable.I3 Alopecia areata is a very difficult condition to treat. Other therapies include topical and intralesional corticosteroids, topical anthralin, topical photochemotherapy, topical diphenylcyclopropenone, topical squaric acid dibutylester, and topical dinitrochlorobenzene, as well as oral isoprinosine and systemic corticosteroids. BACTERIAL INFECTIONS Topical mupirocin was evaluated in a doubleblind 8-day study done on 38 patients with impetigo or ecthyma. Staphylococcus aureus was isolated from 94 patients before treatment. It was eliminated in 88% of mupirocin-treated patients and in 47% of patients treated with vehicle. Group beta hemolytic streptococci were eliminated in 100% of the mupirocin-treated patients and in none of the vehicle-treated patients. Mupirocin is a broad-spectrum topical antibacterial agent. It is unrelated in chemical structure and mode of action to other antibacterial agents. When given parenterally it is not effective. 14 The treatment of chancroid recommended by Schmid 15 from the Centers for Disease Control includes the following: 1. Erythr0mycin, 500 mg four times a day for 7 days 2. If erythromycin-resistant strains occur, sulfamethoxazole/trimethoprim, 800 mg/160 mg orally twice a day for 7 days 3. Ceftriaxone, 250 mg intramuscularly one time only 4. Amoxicillin/clavulanic acid, 500 rag/125 nag orally three times a day for 7 days PARASITIC DISEASES
A single-blinded, randomized, controlled clinical trial was done comparing 1% permethrin cream rinse versus 1% lindane shampoo in treating pediculosis capitis. Comparison was made of a
Volume 16 Number 6 June 1987
single application of 1% permethrin cream rinse applied for 10 minutes with a single application of 1% lindane shampoo, applied as recommended by the manufacturer, for 4 minutes. Two hundred fifty-seven patients who were treated with 1% permethrin cream rinse were 99% lice-free at 14 days while 251 patients treated with 1% lindane shampoo were 85% lice-free at 14 days. 16 In another study 1% lindane shampoo offered no advantage in pediculicidal or ovicidal activity compared with four synergized pyrethrin products (RID, R and N Shampoo, A-200 Pyrinate Shampoo, A-200 Pyrinate Liquid). ~7 In the same study it was found that 0.5% malathion lotion was more effective than any of the latter products. However this product is no longer available in the United States. Permethrin 5% dermal cream was compared with 1% lindane lotion in the treatment of scabies. Eleven of 23 patients treated with permethrin cream were cured in 2 weeks. Only two patients had scabies following the single treatment and one of these patients was believed to have a reinfesration. In the group treated with lindane, 3 of 23 patients were free of scabies 2 weeks after a single treatment and 15 of 23 were cured at 1 month. The authors of the study believed that the high percentage of treatment failures following lindane therapy may have been related to the fact that these studies were carried out in a community in the Republic of Panama where lindane had been used extensively for the treatment of head lice and scabies during the preceding 5 years. Permethrin 5 % dermal cream may offer an alternative to lindane therapy in communities in which lindane has demonstrated an unacceptable level of treatment failures. ~s FUNGUS INFECTIONS One hundred one patients with tinea versicolor were treated with once-daily 2% ketoconazole or placebo cream for 2 weeks. At the end of the study 98% of patients using ketoconazole and 28% of those using placebo responded. The mycologic cure rate was 84% with the active agent and 10% with placebo cream. A follow-up done 2 years after the study was started revealed that 79% of patients treated with ketoconazole cream remained clear. 19
Dermatologic therapy 1221
In another study itraconazole, which is a new orally active triazole antifungal agent, was evaluated in 73 patients who had tinea versicolor. It was given in a dosage of 200 mg daily for 15 days or 200 mg daily for 5 days. The former dosage gave 100% response rate and the latter dosage 80% response rate. 2° Itraconazole (100 rag/day) was also evaluated in the treatment of 17 patients with cutaneous and lymphangitic sporotrichosis. It was effective in all cases. The lesions disappeared and cultures became negative in 90 to 100 days. Itraconazole is not available in the United States. It is a triazole derivative. It shows slightly higher activity for Sporotrichum schenchkii. In patients who do not tolerate iodide therapy, it might prove to be a useful alternative for treatment of sporotrichosis once it becomes available in the United States. z~ VIRUS INFECTIONS A prospective randomized trial was done to compare intravenous acyclovir and vidarabine in the treatment of varicella zoster infections in severely immunocompromised patients. Ten patients were treated in each group. Cutaneous dissemination occurred in none of the 10 acyclovir recipients but did occur in 5 of 10 of the vidarabine recipients. Acyclovir also shortened the time period during which cultures were positive for the virus and decreased the time for decrease of pain. Crusting of lesions occurred in 7 versus 17 days and complete healing occurred in 17 versus 28 days. The drug also decreased fever. 2z Oral acyclovir was used for a period of 10 to 26 months in four patients who had previously had repeated attacks of herpes simplex-associated erythema multiforme. No significant side effects were noted and only one recurrence occurred. Oral acyclovir was also used to treat eight patients with culture-proved recurrent herpes simplex whitlow. It was given at the first morning of recurrence in a dosage of 800 mg twice a day for 5 days. No cutaneous lesions occurred, z3,24 Thirty immunosuppressed women with genital condylomas were treated with various methods of therapy. Krebs et alz5 found that once lesions were eliminated, topical application of 5-fluorouracil cream, applied monthly, biweekly, or weekly, pre-
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vented recurrences in six of seven patients Only two of nine patients who did not use the preceding therapy d:d not develop recurrences 25 In another study intraleslonal bleomycin was evaluated m the treatment of recalcitrant warts It was found that 0 5 U/ml was as effect:ve as 1 U/ml Seventy-nine warts were treated with bleomycm and 62 were cured after one to three rejections 26
METABOLIC DISORDERS Twenty-five patients with porphyrIa cutanea tarda took part in a study comparing phlebotomy with slow subcutaneous desferrloxamme treatment Fifteen patients were treated with intensive venesection therapy while 10 patients received 1 5 gm of desferrioxamine by slow subcutaneous infusion 5 days a week Serum iron, ferrmn, and uroporphyrlns were normahzed m all subjects by the end of the treatment The mean time necessary for recovery was 13 8 months and 11 2 months, respectively Liver function improved during and after treatment of both groups Although desfernoxamlne therapy ~s very expensive, it could be cons:dered m patients who are not able to take antimalarial drugs or who cannot be treated by phlebotomy 27 A patient with erythropoletIc protoporphyrm with abnormal hver functmn tests was treated w:th oral :ron therapy A substantml decrease m free erythrocyte and stool protoporphynn levels w:th return of hver functmn to normal occurred after treatment 2~ For most cases of erythropo:enc protoporphyrla, beta carotene is generally taken orally If liver abnormahties are present, oral iron therapy should definitely be considered Other therapy that has been used includes cholestyramlne or erythrocyte transfusmns A 10-year-old boy with congemtal erythropo:etic porphyna was treated with long-term transfusion therapy This was done to suppress erythropolesis The patients' porphyrlns decreased and photosenslt~wty almost disappeared 29
PAPULOSQUAMOUS ERUPTIONS In a multlcenter double-bhnd study, clobetasol proplonate 0 05% ointment was compared with an
Journal of the American Academy of Dermatology
optimized betamethasone dxproplonate 0 05% ointment in the treatment of psoriasis One hundred thirty patients were evaluated The agents were apphed twice dally without occlusion for 2 weeks Both drugs were effective, but more patients showed greater improvement with clobetasol proplonate Also, longer remissions occurred with clobetasol 3o In another study clobetasol and halclnonlde creams were applied twice dally for 2 weeks to 73 patients with moderate to severe psoriasis One preparation was apphed to the right side and the other to the left side Clobetasol was superior to halcmomde both during and after therapy Two weeks after discontinuation of therapy, 3% of the clobetasol patients relapsed, as did 60% of the hacmonlde patients No mole than 50 gm was used per week 3J In another study evaluating betamethasone &proplonate, 11 patients with psoriasis were treated by apphcatlon of betamethasone dlproplonate in alcohol for 3 to 5 minutes This was washed off and then occluded for 20 minutes with polythylene foil and elastic bandages Six of the patients healed completely and five healed partially after 2 to 7 weeks 32 Psoriasis was treated with dlthranol and ultraviolet B (UVB) 5 days a week in 50 patients Twenty-six of these patients also were treated with topical clobetasol proplonate The mean time to clearance was 2 5 weeks for those treated w:th the addition of clobetasol proplonate compared with 4 weeks for those treated with only &thranol and UVB The time of remission for both groups was the same 33 It appears that top:cal clobetasol proplonate ointment IS the most potent of the topical steroids available Its use should be hmlted to localized areas of psoriasis At present, because of systemic absorptmn, the drug manufacturers recommend that it be used for a period of only 2 weeks A bilateral comparison study of 22 patients with psorias:s was done to assess the effectiveness of oil added to UVB phototherapy Thus m these patients tar oll was applied to one side of the body and oil to the other side Both sides were treated with suberythemogemc doses of UVB three t:mes a week Of the 18 patients who complied w~th the
Volume 16 Number 6 June 1987
protocol, 14 cleared. There was no difference between both halves with regard to the number of treatments or cleating dose of UVB to clearing or remission. Stern et aP 4 stated that there is insufficient evidence, for substantial clinical benefits, to recommend tar oil use along with UVB for psoriasis. Seventeen patients with psoriasis were given la-hydroxyvitamin D3 in a dosage of 1 ~g/day for 6 months. Four other patients were given la,25-dihydroxyvitamin D3 at a dosage of 0.5 rag/day for 6 months. Also, 19 patients were given l a , 2 5 - d i h y d r o x y v i t a m i n D 3 applied topically in a concentration of 0.5 ~zg/gm of base for 8 weeks. Improvement was noted at the end of the study in 13 patients in group I, in one patient in group 2, and in 16 patients in group 3. No side effects were noted. 35 In another study 11 patients were treated with the vitamin D analog la,24-dihydroxycholecalciferol. In 10 of 15 patients the lesions cleared completely within 1 to 4 weeks? 6 It was believed that the data from these two studies suggested that psoriasis may respond to active metabolites of vitamin D and that abnormalities in vitamin D metabolism or unresponsiveness of skin cells to active metabolites of vitamin D may be involved in the pathogenesis of psoriasis. Two patients with psoriasis were given etretinate for 6 to 18 months. Skeletal changes did not occur. 37 In another study 38 patients who had received etretinate for an average period of 60 months for psoriasis or other disorders of keratinization were evaluated. Thirty-two had radiographic evidence of extraspinal tendon and ligament calcification, with the most common sites of involvement being the ankles, pelvis, and knees. Involvement tended to be bilateral or multifocal. 38 Thus it appears that if etretinate is used for 6 to 18 months calcification does not occur, but if used for prolonged periods of time it is a common side effect. Topical isotretinoin gel was evaluated in oral lichen planus in a double-blind study involving 20 patients. Patients who were treated with the active agent had significantly greater improvement than patients given placebo. 39
Dermatologic therapy
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TUMORS A 54-year-old man with Hodgkin's disease and lymphomatoid papulosis was treated with intravenous acyclovir. The eruption cleared after the patient was given acyclovir; it recurred later at numerous times but responded after each course of intravenous acyclovir, n° Eight basal cell carcinomas were treated with recombinant alpha-2 interferon. Injections of 0.15 rnl each were given intralesionally three times a week for 3 weeks. Biopsies 2 months after completion of therapy revealed no evidence of basal cell carcinoma in any patients. 41 Recombinant a2A-interferon was given three times weekly to 20 patients with advanced stages of cutaneous T cell lymphoma. Objective remissions were noted in 45% of patients, including two who had complete remission and seven who had partial remission. The median duration of response was 5.5 months. The authors believed that this treatment was the treatment o f choice for patients with advanced cutaneous T cell lymphomas refractory to chemotherapy and other standard methods. 42 VESICULOBULLOUS ERUPTIONS Four patients with bullous pemphigoid were treated with oral niacinamide, 500 mg three times a day, and tetracycline, 500 mg three times a day. Excellent clinical response was observed in all patients. It was believed that these drugs suppressed the complement-mediated inflammatory response to the basement membrane zone by suppressing neutrophil chemotaxis and mediators of the inflammatory response. 43 MISCELLANEOUS CONDITIONS Ten cases of keratoderma climactericum were reported. Etretinate, 0.78 mg/kg/day, brought about partial or total remission of the hyperkeratosis. Pain on walking disappeared in all of the patients .44 Forty-two patients with polymorphous light eruption were treated with oral nicotinamide, 3 gm daily for 2 weeks. Twenty-five of these patients cleared despite extensive sun exposure. Neumann et a145 proposed that polymorphous light eruption may be due to an abnormality of tryptophan me-
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Coskey
t a b o h s m , w h i c h is partmlly corrected b y m c o t , n am_tde T w o patients with h n e a r porokeratosls o f MIbelh were treated with 5-fluorouracd a p p h e d twice dally for 2 weeks Both patients s h o w e d an excellent r e s p o n s e 46 Six patients with g e n e r a h z e d g r a n u l o m a annulare were treated with d a p s o n e A l l patients cleared during the time period o f 4 weeks to 3 months D o s a g e was b e t w e e n 50 a n d 100 mg per d a y 47 A study w a s done to c o m p a r e the efficacy o f intravenous g a m m a g l o b u h n plus a s p m n with that o f a s p m n alone m r e d u c i n g the f r e q u e n c y o f coro n a r y artery a b n o r m a l m e s in c h d d r e n w~th acute K a w a s a k l s y n d r o m e m a multxcenter r a n d o m i z e d ~ a l G a m m a g l o b u h n was given intravenously m a d o s a g e o f 4 0 0 m g per k d o g r a m of b o d y weight per d a y f o r 4 c o n s e c u t i v e days Both groups received aspirin, 100 m g / k g / d a y , through the 14th day o f illness and then 3 to 5 m g per d a y Two weeks after enrollment, c o r o n a r y artery abnormahtles were present in 18 o f 78 children m the aspirin g r o u p c o m p a r e d with 6 o f 75 m the g a m m a globulin g r o u p Seven weeks after enrollment, abnormalities were present in 14 o f 79 c h d d r e n m the a s p l n n g r o u p and in 3 o f 7 4 m the g a m m a globuhn group H i g h - d o s e g a m m a g l o b u h n thus appears to be effective m r e d u c i n g the prevalance o f c o r o n a r y artery abnormahtxes w h e n g i v e n with aspirin early in the course o f K a w a s a k l disease 48 REFERENCES
1 Slegle RJ Fekety R Sarbone PD Finch RN, Deery HG Voorhees JJ Effects of topical chndamycln on intestinal mlcroflora m patients with ache J"AM ACAD DERMATOL 1986 15 180-5 2 Mflstone EB McDonald A J, Scholamer CF Jr Pseu domembranous cohtls after topical apphcat~on of chndamycm Arch Dermatol 1981 117 154 5 3 Parry MF Rha CK Pseudomembranous cohtts caused by topical chndamycm phosphate Arch Dermatol 1986, 122 583 4 4 Velen NK Chnsttansen KV H.Iorth N Schmldt H qop lcal metromdazole m the treatment of rosacea Cuus 1986,38 209-10 5 Muhlemann MF, Carter GD Cream JJ Wise P Oral splronolactone an effectwe treatment for acne vulgarts in women Br J Dermatol 1986 1t5 227 32 6 Newton RC, Jorazzo JL, Solomon AR, et al Mechamsmoriented assessment of lsotretmom in chrome or subacute cutaneous lupus erythematosus Arch Dermatol 1986 122 170-6
7 Dalzlel K Going G Cartwrlght PH, et al Treatment of chromc discoid lupus erythematosus with an oral gold compound (Auranofin) Br J Dermatol 1986,115 211 6 8 Heuer MA, Morris RW Srmth Khne and French world wide experience with Auranofin a review In Capell HA, Cole DS Mangham KK Morns RW eds Auranofin Amsterdam Excerpta Me&ca pp 474 503 9 White CJ, Phllhps WA Abrahams LA, Watson D Sm gleton PT Objectwe benefit of mfedlpme m the treatment of Raynauds phenomenon Double bland controlled study Am J Med 1986,80 623 5 10 Tosti A Topical mmoxxdlluseful m 18% of patients with androgenetlc alopecm A study of 430 cases Dermato loglca 1986,173 136 8 11 Bazzano GS Terezalos N, Galen W Topical tretmom for hair growth promotion J AM ACAD DERMATOL 1986,16 880 3 12 Olsen EA DeLong ER, Weaner MS Dose response study of topical mmox~dd m male pattern baldness J AM ACADDERMATOL1986 15 30 7 13 Fledler-Welss VS West DP Buys CM, Rumsfield JA Toplcal mmoxldal dose-response effect in alopecla areata Arch Deamatol 1986 22 180 2 14 Eells LD Mertz PM Plovanetta Y, Pekoe GM, Eaglstem WH Topical antibiotic treatment of xmpeUgo with mu parocm Arch Dermatol 1986 122 1273 6 15 Schmad GP The treatment of chancroid JAMA 1986, 255 1757 62 16 Bradenburg K, Delnard AS, Dmapoh J, Englender SJ Orthoefer J, Wagner D 1% permethrm cream rinse vs 1% hndane shampoo in treating pedlculos~s captltlS Am J D~s Child 1986,140 894 6 17 Melnkmg TL Taphn D, Kalter DC, Eberle MW Com paratlve efficacy of treatments for pe&culosls capltas m festatlons Arch Dermatol 1986 122 267 71 18 Taphn D Memklng TL Porcelain SL Castallero PM, Chert JA Permethrm 5% dermal cream a new treatment for scabies J AM ACADDERMATOL1986 15 995 1001 19 Savln RC, Horwatz SN Double bhnd comparrson of 2% ketoeonazole cream and placebo an the treatment of tmea verslcolor J AM ACADDERMA'rOL1986,15 500-3 20 Delescluse J, Cauwenbergh G Degreef H Itraconazole, a new orally active antffungal m the treatment of pity rlasls verstcolor Br J Dermatol 1986 1114 701 13 21 RestrepoA Robledo J Gomez I Tabares AM Gutlerrez MT Itraconazole therapy an lymphangmc and cutaneous sporotnchosls Arch Dermatol 1986 22 413 7 22 Shepp DH, Dandhker PS, Meyers JD Treatment of vaneella zoster virus refection m severely immunocom promised patients A randomized comparison of acyclo vat and wdarabme N Engl J Med 1986,314 208 12 23 Lemak MA Duvac M, Bean SF Oral acyelovar for the prevention of herpes assocmted erythema multfforme J AM ACADDERMATOL1986,15 50 4 24 Gill MJ Arlette J Buchan K, Tyrrell DL Therapy for recurrent herpetic whitlow (letter) Ann Intern Med 1986,105 631 25 KrebsHB, Schneider V, Hurt WG Goplerud DR Gemtal condylomas in lmmunosuppressed women A therapeutw challenge South Med J 1986,79 183 7 26 Hayes ME O Keefe EJ Reduced dose of bleomycm in the treatment of recalcitrant warts J AM ACAD DERMATOL
1986 15 1002-6
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27. Rocchi E, Gibertini P, Cassanelti M, et al. Irbn removal therapy in porphyria cutanea tarda. Phlebotomy versus slow subcutaneous desferrioxamine infusion. Br J Dermatol 1986; 114:621-9. 28. Gordeuk VR, Brittenham GM, Hawkins CW, Mukhtar H, Bickers DR. Iro n therapy for hepatic dysfunction in erythropoietic protoporphyria. Ann Intern Med 1986; 105:27-31. 29. Piomelli S, Poh-Fitzpatrick MB, Seaman C, Skolnick LM, Berdon WE. Complete suppression of the symptoms of congenital erythropoietie porphyria by long-term treatment with high-level transfusions. N Engl J Med 1986;314:1029-31. 30. Jacobson C, Cornell RC, Savin RC. A comparison of clobetaso! propionate 0.05 percent ointment and an optimized betamethasone dipropionate 0.05 percent ointment in the treatment of psoriasis. Curls 1986;37: 213-20. 31. Ellis CN, Van Scott EJ. Clobetasol propionate cream versus halcinonide cream in psoriasis. Int J Dermatol 1986;25:332-3. 32. Jaeger L. Psoriasis treatment with betamethasone dipropionate using short term application and short term occlusion. Acta Derm Venereol (Stoekh) 1986;66:84-7. 33. Lidbrink P, Johannesson A, Hammar H. Psoriasis treatment: faster clearance when UVB-dithranol is combined with topical clobetasol propionate. Dermatologica 1986; 172:164-8. 34. Stern RS, Gange RW, Parrish JA, Tang SV, Arndt KA. Contribution of topical tar oil to ultraviolet B phototherapy for psoriasis. J AM ACAO DERMATOL 1986; 14:742-7. 35. Morimoto S, Yoshikawa K, Kozuka T, et al. An open study of vitamin D3 treatment in psoriasis vulgaris. Br J Dermatol 1986;115:421-9. 36. Kato T, Rokugo M, Terui T, Tagami H. Successful treatment of psoriasis with topical application of active vitamin D3 analogue, la,24-dihydroycholecalciferol. Br J Dermatol 1986;115:43!-3. 37. Gilbert M, Ellis CN, Vorrhees JJ. Lack of skeletal ra-
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diographic changes during short-term etretinate therapy for psoriasis. Dermatologica 1986;172:160-3. DiGiovanna JJ, Helfgott RK, Gerber LH, Peck GL. Extraspinal tendon and ligament calcification associated with long-term therapy with etretinate. N Engl J Med 1986;315:1177-82. Giustina TA, Stewart JCB, Ellis CN, et al. Topical application of isotretinoin gel improves oral lichen planus. A double-blind study. Arch Dermatol 1986;122:534-6. Baumgartner G, Duschet P, Schwarz TH, Partsch H, Gschnait F, Stacher A. Lymphomatoid papulosis: remission following intravenously administered acyclovir. Dermatologica 1986;172:305-9. Greenway HT, Cornell RC, Tanner DJ, Peers E, Bordin GM, Nagi C. Treatment of basal cell carcinoma with intralesional interferon. J AM ACAD DERMA'roL 1986; 15:437-43. Bunn PA, Ihde DC, Foon KA. The role of recombinant interferon Alfa-2a in the therapy of cutaneous T-cell lymphomas. Cancer 1986;57:1689-95. Berk MA, Lorincz AL. The treatment of bullous pemphigoid with tetracycline and niacinamide: a preliminary report. Arch Dermatol 1986; 122:670-4. Deschamps P, Leroy D,d Pedailles S, Mandard JC. Keratoderma climactericum (Haxthausen's disease); clinical signs, laboratory findings and etretinate treatment in 10 patients. Dermatologica 1986;172:258-62. Neumann R, Rappold E, Pohl-Markl H. Treatment of polymorphous light eruption with nicotinamide: a pilot study. Br J Dermatol 1986;115:77-80. Balato N, DiNardo G, Boccia L, et al. Linear porokeratosis: topical treatment with 5-FU. G Ital Dermatol Venereol 1986;121:147-8. Czamecki DB, Gin D. The response of generalized granuloma annulare to dapsone. Acta Derm Venereol (Stockh) 1986;66:82-4. Newburger JW, Takahashi M, Burns JC, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 1986;315:341-7.
ABSTRACTS
Contact sensitivity to aluminum
Oral acyclovir in acute herpes zoster
Bohler-Sommeregger K, Lindemayr H. Contact Dermatitis 1986;15:278-81
McKendrick MW, McGill Jl, White JE, Wood MJ. Br Med J 1986;293:1529-32
A patient sensitive to aluminum following immunization with an alumlnum-adsorbed vaccine is reported and previous cases are reviewed.
Two hundred five elderly immunocompetent patients with herpes zoster were entered into a study within 72 hours of onset in a randomized, double-blind trial, using oral acyclevir ~ata dose of 800 mg five times daily for 7 days compared with placebo. Acyclovir significantly reduced the time to arrest of new lesions, 10ss of vesicles, and cresting in those patients started on the drug within 48 hours of onset. There was also significant reduction in pain during treatment as compared with placebo, and of those patients with severe pain on entry, 40% (10/25) treated with acyclovir had no or only mild pain at the end of the treatment whereas in the placebo group all had moderate or severe pain (p > 0.001). There were no major adverse effects observed.
J. Graham Smith, Jr., M.D.
Aluminum allergy Veien NK, Hattel T, Justesen O, Norholm A. Contact Dermatitis 1986;15:295-7 Thirteen children, aged 1 to 13 years, and one adult patient had posit!ve patch tests to 2% aluminum chloride in water. Sensitization was produced by immunization with products containing aluminum. J. Graham Smith, Jr., M.D.
J. Graham Smith, Jr., M.D.
with acne in a randomized placebo-controlled double-blind crossover study over a period of 3 months. A dose of 200 mg was given daily. Significant improvement occurred with the active agent. Levels of plasma sex hormone binding globulin fell but not plasma testosterone and free testosterone. 5 Spironolactone is an antagonist of aldosterone. It is used primarily as a diuretic and antihypertensive drug. However, it dots have antiandrogenic effects. It inhibits testosterone biosynthesis and also inhibits the binding of dihydrotestosterone to receptors in the skin. COLLAGEN DISEASES Eight of ten patients with chronic or subacute cutaneous lupus erythematosus completed a 16week trial o f oral isotretin0in therapy (80 mg/day). All patients had an excellent clinical response. The histopathologic abnormalities and also abrlormal direct immunofluorescence resolved. Newton et al e stated that the mechanism of action of isotretinoin remains to be established. It might affect epidermal differentiation or immunoreactant deposition on the basement membrane or cell-mediated inflammatory response. Twenty-three patients with discoid lupus erythematosus, unresponsive to conventional treatment, were treated with oral gold (Auranofin), 3 mg twice daily. If they did not respond after months, the dose was increased to 9 mg daily. Nineteen patients showed clinical improvement and four showed complete resolution. 7 Auranofin is an antiarthritic, anti-inflammatory, 1219
1220
Journal of the American Academyof Dermatology
Coskey
and immunoregulatory agent. In a study of 3,082 patients receiving Auranofin for up to 8 years for rheumatoid arthritis, 11.2% withdrew from treatment because of adverse effects. However, 25% of 465 patients stopped injectable gold therapy because of adverse effects) This drug could be considered in patients who are resistant to standard therapy for lupus erythematosus. Nine of l l patients with Raynaud's phenomenon improved after taking nifedipine in a randomized double-blind crossover study. These patients immersed their hands in ice water for 20 seconds. When they took placebo it took 44.9 plus or minus 18 minutes for their skin temperatures to return to normal. 9 When they took nifedipine it took 28.5 plus or minus 20.8 minutes for their skin temperatures to return to normal. HAIR
Minoxidil lotion, 1%, was used to treat 670 male patients with androgenetic alopecia; 430 completed 6 months of treatment; 28% had good results. One-year follow-up after the drug was stopped showed that regrowth was present in only 33% of patients who originally had good results. ~0 Topical tretinoin alone and in combination with 0.5% minoxidil was evaluated in 56 patients with androgenetic alopecia. After 1 year the combination of topical tretinoin with 0.5% minoxidil resulted in terminal hair growth in 66% of patients. Tretinoin alone stimulated Some hair growth in approximately 58 % of patients. One female patient with alopecia for more than 20 years had regrowth of hair using only tretinoin for 18 months. ~1 A 6-month double-blind placebo-controlled study was done to evaluate 0.01%, 0.1%, and 2% topical minoxidil in male pattern baldness. Topical minoxidil, 1% and 2%, showed a statistically significant increase in total and nonvellus target area hair counts after 6 months compared with subjects treated with 0.01% and 0.1%, as well as subjects treated with placebo. Subjects on 2% topical minoxidil had more impressive objective and subjective responses than those on 1% topical minoxidil, although the differences were not statistically significant. Olsen et aP 2 believed that 2% minoxidil should be the preferred treatment for male pattern baldness.
For best results in the treatment of androgenetic alopecia, 2% minoxidil lotion and topical tretinoin, together, should be considered. Topical 5% minoxidil solution was used to treat 47 patients with severe alopecia areatal Forty of the patients had terminal hair growth after 48 to 60 weeks. However, in the majority of patients hair growth was not cosmetically acceptable.I3 Alopecia areata is a very difficult condition to treat. Other therapies include topical and intralesional corticosteroids, topical anthralin, topical photochemotherapy, topical diphenylcyclopropenone, topical squaric acid dibutylester, and topical dinitrochlorobenzene, as well as oral isoprinosine and systemic corticosteroids. BACTERIAL INFECTIONS Topical mupirocin was evaluated in a doubleblind 8-day study done on 38 patients with impetigo or ecthyma. Staphylococcus aureus was isolated from 94 patients before treatment. It was eliminated in 88% of mupirocin-treated patients and in 47% of patients treated with vehicle. Group beta hemolytic streptococci were eliminated in 100% of the mupirocin-treated patients and in none of the vehicle-treated patients. Mupirocin is a broad-spectrum topical antibacterial agent. It is unrelated in chemical structure and mode of action to other antibacterial agents. When given parenterally it is not effective. 14 The treatment of chancroid recommended by Schmid 15 from the Centers for Disease Control includes the following: 1. Erythr0mycin, 500 mg four times a day for 7 days 2. If erythromycin-resistant strains occur, sulfamethoxazole/trimethoprim, 800 mg/160 mg orally twice a day for 7 days 3. Ceftriaxone, 250 mg intramuscularly one time only 4. Amoxicillin/clavulanic acid, 500 rag/125 nag orally three times a day for 7 days PARASITIC DISEASES
A single-blinded, randomized, controlled clinical trial was done comparing 1% permethrin cream rinse versus 1% lindane shampoo in treating pediculosis capitis. Comparison was made of a
Volume 16 Number 6 June 1987
single application of 1% permethrin cream rinse applied for 10 minutes with a single application of 1% lindane shampoo, applied as recommended by the manufacturer, for 4 minutes. Two hundred fifty-seven patients who were treated with 1% permethrin cream rinse were 99% lice-free at 14 days while 251 patients treated with 1% lindane shampoo were 85% lice-free at 14 days. 16 In another study 1% lindane shampoo offered no advantage in pediculicidal or ovicidal activity compared with four synergized pyrethrin products (RID, R and N Shampoo, A-200 Pyrinate Shampoo, A-200 Pyrinate Liquid). ~7 In the same study it was found that 0.5% malathion lotion was more effective than any of the latter products. However this product is no longer available in the United States. Permethrin 5% dermal cream was compared with 1% lindane lotion in the treatment of scabies. Eleven of 23 patients treated with permethrin cream were cured in 2 weeks. Only two patients had scabies following the single treatment and one of these patients was believed to have a reinfesration. In the group treated with lindane, 3 of 23 patients were free of scabies 2 weeks after a single treatment and 15 of 23 were cured at 1 month. The authors of the study believed that the high percentage of treatment failures following lindane therapy may have been related to the fact that these studies were carried out in a community in the Republic of Panama where lindane had been used extensively for the treatment of head lice and scabies during the preceding 5 years. Permethrin 5 % dermal cream may offer an alternative to lindane therapy in communities in which lindane has demonstrated an unacceptable level of treatment failures. ~s FUNGUS INFECTIONS One hundred one patients with tinea versicolor were treated with once-daily 2% ketoconazole or placebo cream for 2 weeks. At the end of the study 98% of patients using ketoconazole and 28% of those using placebo responded. The mycologic cure rate was 84% with the active agent and 10% with placebo cream. A follow-up done 2 years after the study was started revealed that 79% of patients treated with ketoconazole cream remained clear. 19
Dermatologic therapy 1221
In another study itraconazole, which is a new orally active triazole antifungal agent, was evaluated in 73 patients who had tinea versicolor. It was given in a dosage of 200 mg daily for 15 days or 200 mg daily for 5 days. The former dosage gave 100% response rate and the latter dosage 80% response rate. 2° Itraconazole (100 rag/day) was also evaluated in the treatment of 17 patients with cutaneous and lymphangitic sporotrichosis. It was effective in all cases. The lesions disappeared and cultures became negative in 90 to 100 days. Itraconazole is not available in the United States. It is a triazole derivative. It shows slightly higher activity for Sporotrichum schenchkii. In patients who do not tolerate iodide therapy, it might prove to be a useful alternative for treatment of sporotrichosis once it becomes available in the United States. z~ VIRUS INFECTIONS A prospective randomized trial was done to compare intravenous acyclovir and vidarabine in the treatment of varicella zoster infections in severely immunocompromised patients. Ten patients were treated in each group. Cutaneous dissemination occurred in none of the 10 acyclovir recipients but did occur in 5 of 10 of the vidarabine recipients. Acyclovir also shortened the time period during which cultures were positive for the virus and decreased the time for decrease of pain. Crusting of lesions occurred in 7 versus 17 days and complete healing occurred in 17 versus 28 days. The drug also decreased fever. 2z Oral acyclovir was used for a period of 10 to 26 months in four patients who had previously had repeated attacks of herpes simplex-associated erythema multiforme. No significant side effects were noted and only one recurrence occurred. Oral acyclovir was also used to treat eight patients with culture-proved recurrent herpes simplex whitlow. It was given at the first morning of recurrence in a dosage of 800 mg twice a day for 5 days. No cutaneous lesions occurred, z3,24 Thirty immunosuppressed women with genital condylomas were treated with various methods of therapy. Krebs et alz5 found that once lesions were eliminated, topical application of 5-fluorouracil cream, applied monthly, biweekly, or weekly, pre-
1222
Coskey
vented recurrences in six of seven patients Only two of nine patients who did not use the preceding therapy d:d not develop recurrences 25 In another study intraleslonal bleomycin was evaluated m the treatment of recalcitrant warts It was found that 0 5 U/ml was as effect:ve as 1 U/ml Seventy-nine warts were treated with bleomycm and 62 were cured after one to three rejections 26
METABOLIC DISORDERS Twenty-five patients with porphyrIa cutanea tarda took part in a study comparing phlebotomy with slow subcutaneous desferrloxamme treatment Fifteen patients were treated with intensive venesection therapy while 10 patients received 1 5 gm of desferrioxamine by slow subcutaneous infusion 5 days a week Serum iron, ferrmn, and uroporphyrlns were normahzed m all subjects by the end of the treatment The mean time necessary for recovery was 13 8 months and 11 2 months, respectively Liver function improved during and after treatment of both groups Although desfernoxamlne therapy ~s very expensive, it could be cons:dered m patients who are not able to take antimalarial drugs or who cannot be treated by phlebotomy 27 A patient with erythropoletIc protoporphyrm with abnormal hver functmn tests was treated w:th oral :ron therapy A substantml decrease m free erythrocyte and stool protoporphynn levels w:th return of hver functmn to normal occurred after treatment 2~ For most cases of erythropo:enc protoporphyrla, beta carotene is generally taken orally If liver abnormahties are present, oral iron therapy should definitely be considered Other therapy that has been used includes cholestyramlne or erythrocyte transfusmns A 10-year-old boy with congemtal erythropo:etic porphyna was treated with long-term transfusion therapy This was done to suppress erythropolesis The patients' porphyrlns decreased and photosenslt~wty almost disappeared 29
PAPULOSQUAMOUS ERUPTIONS In a multlcenter double-bhnd study, clobetasol proplonate 0 05% ointment was compared with an
Journal of the American Academy of Dermatology
optimized betamethasone dxproplonate 0 05% ointment in the treatment of psoriasis One hundred thirty patients were evaluated The agents were apphed twice dally without occlusion for 2 weeks Both drugs were effective, but more patients showed greater improvement with clobetasol proplonate Also, longer remissions occurred with clobetasol 3o In another study clobetasol and halclnonlde creams were applied twice dally for 2 weeks to 73 patients with moderate to severe psoriasis One preparation was apphed to the right side and the other to the left side Clobetasol was superior to halcmomde both during and after therapy Two weeks after discontinuation of therapy, 3% of the clobetasol patients relapsed, as did 60% of the hacmonlde patients No mole than 50 gm was used per week 3J In another study evaluating betamethasone &proplonate, 11 patients with psoriasis were treated by apphcatlon of betamethasone dlproplonate in alcohol for 3 to 5 minutes This was washed off and then occluded for 20 minutes with polythylene foil and elastic bandages Six of the patients healed completely and five healed partially after 2 to 7 weeks 32 Psoriasis was treated with dlthranol and ultraviolet B (UVB) 5 days a week in 50 patients Twenty-six of these patients also were treated with topical clobetasol proplonate The mean time to clearance was 2 5 weeks for those treated w:th the addition of clobetasol proplonate compared with 4 weeks for those treated with only &thranol and UVB The time of remission for both groups was the same 33 It appears that top:cal clobetasol proplonate ointment IS the most potent of the topical steroids available Its use should be hmlted to localized areas of psoriasis At present, because of systemic absorptmn, the drug manufacturers recommend that it be used for a period of only 2 weeks A bilateral comparison study of 22 patients with psorias:s was done to assess the effectiveness of oil added to UVB phototherapy Thus m these patients tar oll was applied to one side of the body and oil to the other side Both sides were treated with suberythemogemc doses of UVB three t:mes a week Of the 18 patients who complied w~th the
Volume 16 Number 6 June 1987
protocol, 14 cleared. There was no difference between both halves with regard to the number of treatments or cleating dose of UVB to clearing or remission. Stern et aP 4 stated that there is insufficient evidence, for substantial clinical benefits, to recommend tar oil use along with UVB for psoriasis. Seventeen patients with psoriasis were given la-hydroxyvitamin D3 in a dosage of 1 ~g/day for 6 months. Four other patients were given la,25-dihydroxyvitamin D3 at a dosage of 0.5 rag/day for 6 months. Also, 19 patients were given l a , 2 5 - d i h y d r o x y v i t a m i n D 3 applied topically in a concentration of 0.5 ~zg/gm of base for 8 weeks. Improvement was noted at the end of the study in 13 patients in group I, in one patient in group 2, and in 16 patients in group 3. No side effects were noted. 35 In another study 11 patients were treated with the vitamin D analog la,24-dihydroxycholecalciferol. In 10 of 15 patients the lesions cleared completely within 1 to 4 weeks? 6 It was believed that the data from these two studies suggested that psoriasis may respond to active metabolites of vitamin D and that abnormalities in vitamin D metabolism or unresponsiveness of skin cells to active metabolites of vitamin D may be involved in the pathogenesis of psoriasis. Two patients with psoriasis were given etretinate for 6 to 18 months. Skeletal changes did not occur. 37 In another study 38 patients who had received etretinate for an average period of 60 months for psoriasis or other disorders of keratinization were evaluated. Thirty-two had radiographic evidence of extraspinal tendon and ligament calcification, with the most common sites of involvement being the ankles, pelvis, and knees. Involvement tended to be bilateral or multifocal. 38 Thus it appears that if etretinate is used for 6 to 18 months calcification does not occur, but if used for prolonged periods of time it is a common side effect. Topical isotretinoin gel was evaluated in oral lichen planus in a double-blind study involving 20 patients. Patients who were treated with the active agent had significantly greater improvement than patients given placebo. 39
Dermatologic therapy
1223
TUMORS A 54-year-old man with Hodgkin's disease and lymphomatoid papulosis was treated with intravenous acyclovir. The eruption cleared after the patient was given acyclovir; it recurred later at numerous times but responded after each course of intravenous acyclovir, n° Eight basal cell carcinomas were treated with recombinant alpha-2 interferon. Injections of 0.15 rnl each were given intralesionally three times a week for 3 weeks. Biopsies 2 months after completion of therapy revealed no evidence of basal cell carcinoma in any patients. 41 Recombinant a2A-interferon was given three times weekly to 20 patients with advanced stages of cutaneous T cell lymphoma. Objective remissions were noted in 45% of patients, including two who had complete remission and seven who had partial remission. The median duration of response was 5.5 months. The authors believed that this treatment was the treatment o f choice for patients with advanced cutaneous T cell lymphomas refractory to chemotherapy and other standard methods. 42 VESICULOBULLOUS ERUPTIONS Four patients with bullous pemphigoid were treated with oral niacinamide, 500 mg three times a day, and tetracycline, 500 mg three times a day. Excellent clinical response was observed in all patients. It was believed that these drugs suppressed the complement-mediated inflammatory response to the basement membrane zone by suppressing neutrophil chemotaxis and mediators of the inflammatory response. 43 MISCELLANEOUS CONDITIONS Ten cases of keratoderma climactericum were reported. Etretinate, 0.78 mg/kg/day, brought about partial or total remission of the hyperkeratosis. Pain on walking disappeared in all of the patients .44 Forty-two patients with polymorphous light eruption were treated with oral nicotinamide, 3 gm daily for 2 weeks. Twenty-five of these patients cleared despite extensive sun exposure. Neumann et a145 proposed that polymorphous light eruption may be due to an abnormality of tryptophan me-
1224
Journal of the Amerlcan Academy of Dermatology
Coskey
t a b o h s m , w h i c h is partmlly corrected b y m c o t , n am_tde T w o patients with h n e a r porokeratosls o f MIbelh were treated with 5-fluorouracd a p p h e d twice dally for 2 weeks Both patients s h o w e d an excellent r e s p o n s e 46 Six patients with g e n e r a h z e d g r a n u l o m a annulare were treated with d a p s o n e A l l patients cleared during the time period o f 4 weeks to 3 months D o s a g e was b e t w e e n 50 a n d 100 mg per d a y 47 A study w a s done to c o m p a r e the efficacy o f intravenous g a m m a g l o b u h n plus a s p m n with that o f a s p m n alone m r e d u c i n g the f r e q u e n c y o f coro n a r y artery a b n o r m a l m e s in c h d d r e n w~th acute K a w a s a k l s y n d r o m e m a multxcenter r a n d o m i z e d ~ a l G a m m a g l o b u h n was given intravenously m a d o s a g e o f 4 0 0 m g per k d o g r a m of b o d y weight per d a y f o r 4 c o n s e c u t i v e days Both groups received aspirin, 100 m g / k g / d a y , through the 14th day o f illness and then 3 to 5 m g per d a y Two weeks after enrollment, c o r o n a r y artery abnormahtles were present in 18 o f 78 children m the aspirin g r o u p c o m p a r e d with 6 o f 75 m the g a m m a globulin g r o u p Seven weeks after enrollment, abnormalities were present in 14 o f 79 c h d d r e n m the a s p l n n g r o u p and in 3 o f 7 4 m the g a m m a globuhn group H i g h - d o s e g a m m a g l o b u h n thus appears to be effective m r e d u c i n g the prevalance o f c o r o n a r y artery abnormahtxes w h e n g i v e n with aspirin early in the course o f K a w a s a k l disease 48 REFERENCES
1 Slegle RJ Fekety R Sarbone PD Finch RN, Deery HG Voorhees JJ Effects of topical chndamycln on intestinal mlcroflora m patients with ache J"AM ACAD DERMATOL 1986 15 180-5 2 Mflstone EB McDonald A J, Scholamer CF Jr Pseu domembranous cohtls after topical apphcat~on of chndamycm Arch Dermatol 1981 117 154 5 3 Parry MF Rha CK Pseudomembranous cohtts caused by topical chndamycm phosphate Arch Dermatol 1986, 122 583 4 4 Velen NK Chnsttansen KV H.Iorth N Schmldt H qop lcal metromdazole m the treatment of rosacea Cuus 1986,38 209-10 5 Muhlemann MF, Carter GD Cream JJ Wise P Oral splronolactone an effectwe treatment for acne vulgarts in women Br J Dermatol 1986 1t5 227 32 6 Newton RC, Jorazzo JL, Solomon AR, et al Mechamsmoriented assessment of lsotretmom in chrome or subacute cutaneous lupus erythematosus Arch Dermatol 1986 122 170-6
7 Dalzlel K Going G Cartwrlght PH, et al Treatment of chromc discoid lupus erythematosus with an oral gold compound (Auranofin) Br J Dermatol 1986,115 211 6 8 Heuer MA, Morris RW Srmth Khne and French world wide experience with Auranofin a review In Capell HA, Cole DS Mangham KK Morns RW eds Auranofin Amsterdam Excerpta Me&ca pp 474 503 9 White CJ, Phllhps WA Abrahams LA, Watson D Sm gleton PT Objectwe benefit of mfedlpme m the treatment of Raynauds phenomenon Double bland controlled study Am J Med 1986,80 623 5 10 Tosti A Topical mmoxxdlluseful m 18% of patients with androgenetlc alopecm A study of 430 cases Dermato loglca 1986,173 136 8 11 Bazzano GS Terezalos N, Galen W Topical tretmom for hair growth promotion J AM ACAD DERMATOL 1986,16 880 3 12 Olsen EA DeLong ER, Weaner MS Dose response study of topical mmox~dd m male pattern baldness J AM ACADDERMATOL1986 15 30 7 13 Fledler-Welss VS West DP Buys CM, Rumsfield JA Toplcal mmoxldal dose-response effect in alopecla areata Arch Deamatol 1986 22 180 2 14 Eells LD Mertz PM Plovanetta Y, Pekoe GM, Eaglstem WH Topical antibiotic treatment of xmpeUgo with mu parocm Arch Dermatol 1986 122 1273 6 15 Schmad GP The treatment of chancroid JAMA 1986, 255 1757 62 16 Bradenburg K, Delnard AS, Dmapoh J, Englender SJ Orthoefer J, Wagner D 1% permethrm cream rinse vs 1% hndane shampoo in treating pedlculos~s captltlS Am J D~s Child 1986,140 894 6 17 Melnkmg TL Taphn D, Kalter DC, Eberle MW Com paratlve efficacy of treatments for pe&culosls capltas m festatlons Arch Dermatol 1986 122 267 71 18 Taphn D Memklng TL Porcelain SL Castallero PM, Chert JA Permethrm 5% dermal cream a new treatment for scabies J AM ACADDERMATOL1986 15 995 1001 19 Savln RC, Horwatz SN Double bhnd comparrson of 2% ketoeonazole cream and placebo an the treatment of tmea verslcolor J AM ACADDERMA'rOL1986,15 500-3 20 Delescluse J, Cauwenbergh G Degreef H Itraconazole, a new orally active antffungal m the treatment of pity rlasls verstcolor Br J Dermatol 1986 1114 701 13 21 RestrepoA Robledo J Gomez I Tabares AM Gutlerrez MT Itraconazole therapy an lymphangmc and cutaneous sporotnchosls Arch Dermatol 1986 22 413 7 22 Shepp DH, Dandhker PS, Meyers JD Treatment of vaneella zoster virus refection m severely immunocom promised patients A randomized comparison of acyclo vat and wdarabme N Engl J Med 1986,314 208 12 23 Lemak MA Duvac M, Bean SF Oral acyelovar for the prevention of herpes assocmted erythema multfforme J AM ACADDERMATOL1986,15 50 4 24 Gill MJ Arlette J Buchan K, Tyrrell DL Therapy for recurrent herpetic whitlow (letter) Ann Intern Med 1986,105 631 25 KrebsHB, Schneider V, Hurt WG Goplerud DR Gemtal condylomas in lmmunosuppressed women A therapeutw challenge South Med J 1986,79 183 7 26 Hayes ME O Keefe EJ Reduced dose of bleomycm in the treatment of recalcitrant warts J AM ACAD DERMATOL
1986 15 1002-6
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Dermatologic therapy 1225
27. Rocchi E, Gibertini P, Cassanelti M, et al. Irbn removal therapy in porphyria cutanea tarda. Phlebotomy versus slow subcutaneous desferrioxamine infusion. Br J Dermatol 1986; 114:621-9. 28. Gordeuk VR, Brittenham GM, Hawkins CW, Mukhtar H, Bickers DR. Iro n therapy for hepatic dysfunction in erythropoietic protoporphyria. Ann Intern Med 1986; 105:27-31. 29. Piomelli S, Poh-Fitzpatrick MB, Seaman C, Skolnick LM, Berdon WE. Complete suppression of the symptoms of congenital erythropoietie porphyria by long-term treatment with high-level transfusions. N Engl J Med 1986;314:1029-31. 30. Jacobson C, Cornell RC, Savin RC. A comparison of clobetaso! propionate 0.05 percent ointment and an optimized betamethasone dipropionate 0.05 percent ointment in the treatment of psoriasis. Curls 1986;37: 213-20. 31. Ellis CN, Van Scott EJ. Clobetasol propionate cream versus halcinonide cream in psoriasis. Int J Dermatol 1986;25:332-3. 32. Jaeger L. Psoriasis treatment with betamethasone dipropionate using short term application and short term occlusion. Acta Derm Venereol (Stoekh) 1986;66:84-7. 33. Lidbrink P, Johannesson A, Hammar H. Psoriasis treatment: faster clearance when UVB-dithranol is combined with topical clobetasol propionate. Dermatologica 1986; 172:164-8. 34. Stern RS, Gange RW, Parrish JA, Tang SV, Arndt KA. Contribution of topical tar oil to ultraviolet B phototherapy for psoriasis. J AM ACAO DERMATOL 1986; 14:742-7. 35. Morimoto S, Yoshikawa K, Kozuka T, et al. An open study of vitamin D3 treatment in psoriasis vulgaris. Br J Dermatol 1986;115:421-9. 36. Kato T, Rokugo M, Terui T, Tagami H. Successful treatment of psoriasis with topical application of active vitamin D3 analogue, la,24-dihydroycholecalciferol. Br J Dermatol 1986;115:43!-3. 37. Gilbert M, Ellis CN, Vorrhees JJ. Lack of skeletal ra-
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diographic changes during short-term etretinate therapy for psoriasis. Dermatologica 1986;172:160-3. DiGiovanna JJ, Helfgott RK, Gerber LH, Peck GL. Extraspinal tendon and ligament calcification associated with long-term therapy with etretinate. N Engl J Med 1986;315:1177-82. Giustina TA, Stewart JCB, Ellis CN, et al. Topical application of isotretinoin gel improves oral lichen planus. A double-blind study. Arch Dermatol 1986;122:534-6. Baumgartner G, Duschet P, Schwarz TH, Partsch H, Gschnait F, Stacher A. Lymphomatoid papulosis: remission following intravenously administered acyclovir. Dermatologica 1986;172:305-9. Greenway HT, Cornell RC, Tanner DJ, Peers E, Bordin GM, Nagi C. Treatment of basal cell carcinoma with intralesional interferon. J AM ACAD DERMA'roL 1986; 15:437-43. Bunn PA, Ihde DC, Foon KA. The role of recombinant interferon Alfa-2a in the therapy of cutaneous T-cell lymphomas. Cancer 1986;57:1689-95. Berk MA, Lorincz AL. The treatment of bullous pemphigoid with tetracycline and niacinamide: a preliminary report. Arch Dermatol 1986; 122:670-4. Deschamps P, Leroy D,d Pedailles S, Mandard JC. Keratoderma climactericum (Haxthausen's disease); clinical signs, laboratory findings and etretinate treatment in 10 patients. Dermatologica 1986;172:258-62. Neumann R, Rappold E, Pohl-Markl H. Treatment of polymorphous light eruption with nicotinamide: a pilot study. Br J Dermatol 1986;115:77-80. Balato N, DiNardo G, Boccia L, et al. Linear porokeratosis: topical treatment with 5-FU. G Ital Dermatol Venereol 1986;121:147-8. Czamecki DB, Gin D. The response of generalized granuloma annulare to dapsone. Acta Derm Venereol (Stockh) 1986;66:82-4. Newburger JW, Takahashi M, Burns JC, et al. The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 1986;315:341-7.
ABSTRACTS
Contact sensitivity to aluminum
Oral acyclovir in acute herpes zoster
Bohler-Sommeregger K, Lindemayr H. Contact Dermatitis 1986;15:278-81
McKendrick MW, McGill Jl, White JE, Wood MJ. Br Med J 1986;293:1529-32
A patient sensitive to aluminum following immunization with an alumlnum-adsorbed vaccine is reported and previous cases are reviewed.
Two hundred five elderly immunocompetent patients with herpes zoster were entered into a study within 72 hours of onset in a randomized, double-blind trial, using oral acyclevir ~ata dose of 800 mg five times daily for 7 days compared with placebo. Acyclovir significantly reduced the time to arrest of new lesions, 10ss of vesicles, and cresting in those patients started on the drug within 48 hours of onset. There was also significant reduction in pain during treatment as compared with placebo, and of those patients with severe pain on entry, 40% (10/25) treated with acyclovir had no or only mild pain at the end of the treatment whereas in the placebo group all had moderate or severe pain (p > 0.001). There were no major adverse effects observed.
J. Graham Smith, Jr., M.D.
Aluminum allergy Veien NK, Hattel T, Justesen O, Norholm A. Contact Dermatitis 1986;15:295-7 Thirteen children, aged 1 to 13 years, and one adult patient had posit!ve patch tests to 2% aluminum chloride in water. Sensitization was produced by immunization with products containing aluminum. J. Graham Smith, Jr., M.D.
J. Graham Smith, Jr., M.D.