- Email: [email protected]
FC149 Pyoderma gangrenosum successfully treated with Cyclosporin A (NEORAL)
s150
Free Communications
a sub-group of 5 randomized trials showed a 26% greater proportional difference over standard therapy (95% CI:O. 18 to 0.35). Similarly, in a sub-group of 4 randomized trials with Imunovir as adjuvant to standard treatment the proportional difference was 24% (95% CI:O.13 to 0.34). Meta-analyses of available data from all studies combined showed a proportional difference over standard treatment in excess of 20% regardless of lesion count (single vs. multiple) and site (excluding perianal warts in either sex), but specific for female patients with histologically- and/or cytologically-determined typical or benign cellular pathology up to the CIN I level in severity, and in those patients of either sex with a history of warts 22 months, regardless of having been treated with other agents or procedures (95% CI:O.O.l6 to 0.37, lowest to highest ranges over 5 sub-analyses), and showing a consistency in resulting significance using meta-analysis to integrate and provide a statistical basis for the collection of clinical findings.
FCI 47 A case of widespread cutaneous bacillary angiomatosis due to Bartonella Quintana in an Hlkeroposltive patient A.L. De Coninck, D. Pierard, P.L. Lacer, J. Andre ’ , D.I. Roseeuw. Depts of Dermatology, Microbiology, Internal Medicine, Akademisch Ziekenhuis Vrije ’ Dept of Dermatopathology Sint Pieters Ziekenhuis Brussel, Germany
Universiteit Universiteit
Brussel;
A 33-year-old IIIV infected I.V.-drug user presented to our department with numerous subcutaneous nodules for which he had been treated unsuccessfully in another institution with radiotherapy for suspicion of Kaposi sarcoma. The lesions appeared approximately one year earlier as slightly infiltrated plaques. Cutaneous examination revealed several dark red papulonodular lesions on the face, trunk and extremities. On the right leg he presented a well-circumscribed fungating mass with a central ulceration measuring 6 cm in diameter. Laboratory studies showed anaemia and CD4 count of 20 cells/mm3 with a CD4/CD8 ration of 0.14. Histological examination of skin biopsies disclosed lesions of bacillary angiomatosis, both by light and electron microscopy. PCR for a 60-kDA Bartonella protein and for the intergenic spacer region between 16 and 23 S RNA were both positive and restriction analysis of the PCR product of the latter identified Bartonella Quintana DNA. Tentatives to grow the bacteria remained unsuccessful. In spite of initiation of erythromycin, the patient’s condition worsened. He rejected further therapy, left the hospital and died a few days later. Although no louses were found on this patient, they were probably the vector of transmission, since his personal hygiene was very poor.
-
Therapy
Therapy FC148 Comparison of the efficacies of cyproterone acetate, spironolactone and flutamide in the treatment of hirsutism F. Kay a ’ , D. Se9kin *, A.Y. Turanh ’ . ’ Ondokuz
Mayis University Faculty of Medicine, Department of Dermatology, Samsun; *BaTkent University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
Hirsutism, a marker for increased production or action of androgens, is an important clinical and psychosocial problem. Antiandrogens, which prevent androgen action at the target level, have been extensively used in the treatment of hirsutism. The aim of this study was to evaluate and compare the effectiveness of cyproterone acetate (CA), spironolactone (S), and flutamide (F) in the treatment of hirsutism. Thirteen women received 50 mg/day CA, thirteen received 50 mg S bid, and thirteen were treated with 250 mg F bid. Hirsutism scores were determined according to the FerrimanGallwey (FG) scoring system and hair diameter was also measured. FG scores were decreased significantly in all 3 groups at the end of 6 months. The percent of change in FG scores in CA, S, and F groups were 61%, 63%, and 60%, respectively. Hair diameter was also reduced significantly in CA, S, and F groups by 47.5%, 56%, and 48%, respectively. There were no differences between groups in terms of the degree of reduction in FG score. Reduction in hair diameter was most prominent in the S group. Menstrual irregularity was observed in 4 (31%), 3 (23%) and 5 (38%) patients in CA, S, and F groups, respectively. Side effects did not continue in the F group after 2 months of therapy. In conclusion, CA, S, and F were similarly effective in the treatment of hirsutism, but the side effects appeared to be more acceptable in the F group.
FCI 49 Pyoderma gangrenosum successfully ’ treated with Cyclosporin A (NEORAL) H. Okrasinski. Clinic Hospital,
Khamis
of Dermatology Mushayt, KSA
at Armed
Forces
A 5 1-year old man with NIDDM developed on the right lower leg a painless ulcer 14.0 x 10.0 cm. in diameter with irregular, raised and undermined borders. Ulcer base was coverted by necrotic tissue and purulent, haemorrhagic exudate. Laboratory tests: Liver function tests are normal. HBsAb +ve, FBS-6.9-13.0 mmol/l. Cultures from ulcer grew Staph. aureus and pseudomonas aeruginosa. Histopathology: In the deep dermis, there was ulceration with infiltration of neutrophils and lymphocytes. It has 8 months history not respond to conventional treatment. After treatment orally with Cyclosporin (1.9 mglkglday), an improvement was seen within 10 days and after 2 months resulted in a complete resolution without recurrence after 3 months follow-up. Seventy to eighty percent of the patients with pyodenna gangrenosum have an associated systemic disease. Our patient suffered from NIDDM and had positive serology for hepatitis B but with normal liver function tests. Low dosages and short
Free Communications
periods using of Cyclosporin A, provide encouraging pathway treatment of Pyoderma Gangrenosum. FC150
Cutaneous toxicity associated with high-dose cytosine arabinoside
P. Cetkovska’ , K. Pizinger’, Dermatology; 2Department Charles University Hospital,
P. Skopek2. ‘Department of Haematology Pilsen, Czech
of
and Oncology,
-
dosage schedule of each pulse was 200 mg twice daily for 1 week with 2 weeks off therapy between successive pulses. Two pulses of itraconazole therapy are effective in the treatment of Majocchi’s granuloma. It is also possible that one pulse may be sufficient in some patients. FC153
Republic
High-dose cytosine arabinoside (HiDAC) is used increasingly to treat haematological malignancies. The therapy is associated with various nonhaematological toxicities frequently involving the skin. The purpose of the study was to evaluate the actual occurrence of HiDAC adverse skin reactions. One hundred and eight patients with acute myelogenous leukemia (n = 73) and acute lymphoblastic leukemia (n = 35) between 16 and 71 years of age were treated with 141 post-remission consolidation regimens with HiDAC in combination with standard doses of other cytotoxic drugs (33 patients received 2 courses). The incidence of cutaneous toxicity was 5 1.1% with rashes occurring in 76.6% and 38.3% of subjects having received total doses of 30 and 24 gl sq m, respectively. Surprisingly, the second regimens in 33 patients did not reproduce the reactions in patients suffering from the rash after the first course (46 vs 33%). Morbilliform eruptions over the trunk and extremities and painful erythematous desquamating lesions of palms and soles were most commonly observed, onycholysis developed in occasional cases. The onset ranged from day 8 to day 20 of treatment, the rash generally resolved within 2 weeks. In conclusion, HiDAC induced cutaneous toxicity in 5 1% of patients. These skin changes were dose-related, fully reversible and generally not requiring treatment.
s151
Therapy
The efficacy of oral potassium iodide in the treatment of erythema multiforme
I. Candan, I.E. Aydmoz, T. Mansur. Haydarpaya Hospital,
Istanbul,
Numune
Turkey
Erythema multiforme (EM) is a frequently recurrent but selflimited syndrome characterized by the abrupt onset of symmetrical red papules some of which evolve into distinctive target lesions. The clinical course is variable lasting up to 3 to 4 weeks. In this open trial clinical efficacy of oral potassium iodide (KI) was assessed in 13 patients with a treatment period of 7 days. The therapy was initiated within maximum 7 days after clinical onset in all of our patients. In each patient clinical features were scored on admission and during treatment on the 3rd and 7th days. KI was initially started with a dose of 2 x 200 mg/day and in only 2 patients due to absence of symptomatic relief, it was increased to 3 x 200 mg on the 3rd day. There was a dramatic healing in all of our patients at the end of a week. The average pretreatment score which was 9.07 f 2.36 was found to be reduced to 0.62 f 0.77 which is statistically significant (p < 0.05). Side effects were recorded in 2 patients, which did not necessitate drug cessation. In conclusion, oral KI is found to be an effective alternative drug in the symptomatic treatment of EM reducing disease course with few side effects. FCI 54 A retrospective
FC151
Dermatitis fragellaris as a rare side effect of the Bleomycin included chemotherapy
I. Orojan, L. T&ok, M. Tapai. Dermatology County
Hospital,
Kecskeme’t,
Department,
Hungary
Our 48-year-old non-Hodgkin’s lymphomas female patient has been given operation, irradiation, and chemotherapy since 1978. She was given Bleomycin medication combined treatment in 1997. Within 24 hours sharp-edged, stripe like, protruding, pruritic laesions appeared on her whole body. After the withdrawal of Bleomycin medication the laesions regrediated leaving hyperpigmentation behind. During the chemotherapy containing Bleomycin rarely but recognisable dermatitis fragellaris occurs. FC152
ltraconazole is effective in the treatment of Majocchi’s granuloma: A clinical and pharmacokinetic evaluation
A.K. Gupta ’ , P. De Doncker 2. ’ University 2 Janssen
Research
Foundation,
of Toronto;
Canada
Four patients (age range: 25-66 years) with Majocchi’s granuloma were effectively treated with clinical and mycological cure using itraconazole therapy given as pulse dosing. None of the patients has relapsed over a one year following period. The
study on the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic
C.L. Goh, L. Khoo. National
Skin Centre,
Singapore
This is a retrospective study on the epidemiology and morbidity of herpes zoster and risk factors for herpes zoster morbidity in Singapore. The mean age of 164 patients with herpes zoster was 48.8 years with a 1:l sex ratio. The common presenting symptoms were pain (90%) followed by feeling helpless/depressed (20%) and flu-like symptoms (12%). The commonest prodrome include pain (41%), itch (27%) and paraesthesia (12%). Prodromal pain was more frequently experienced by patients >50 year (42%) than patients 130 years (25%). The thoracic (45%), followed by the cervical (23%) dermatomes were the commonest affected dermatomes in all age groups. Pain was experienced by 95% patients during the course of their disease. It tends to be more severe in older patients. A higher proportion of old patients (>50 years old) (20%) suffered from the post herpetic neuralgia compared to the younger patient (~30 years old) (7%) (ns). Patients in all age group considered the acute pain (46%) and persistent pain (25%) as their most unbearable symptoms during the course of their herpes zoster. Insomnia was significantly more commonly experienced by patients >50 years old (36%) than those ~30 years old (p = 0.026).
Free Communications
a sub-group of 5 randomized trials showed a 26% greater proportional difference over standard therapy (95% CI:O. 18 to 0.35). Similarly, in a sub-group of 4 randomized trials with Imunovir as adjuvant to standard treatment the proportional difference was 24% (95% CI:O.13 to 0.34). Meta-analyses of available data from all studies combined showed a proportional difference over standard treatment in excess of 20% regardless of lesion count (single vs. multiple) and site (excluding perianal warts in either sex), but specific for female patients with histologically- and/or cytologically-determined typical or benign cellular pathology up to the CIN I level in severity, and in those patients of either sex with a history of warts 22 months, regardless of having been treated with other agents or procedures (95% CI:O.O.l6 to 0.37, lowest to highest ranges over 5 sub-analyses), and showing a consistency in resulting significance using meta-analysis to integrate and provide a statistical basis for the collection of clinical findings.
FCI 47 A case of widespread cutaneous bacillary angiomatosis due to Bartonella Quintana in an Hlkeroposltive patient A.L. De Coninck, D. Pierard, P.L. Lacer, J. Andre ’ , D.I. Roseeuw. Depts of Dermatology, Microbiology, Internal Medicine, Akademisch Ziekenhuis Vrije ’ Dept of Dermatopathology Sint Pieters Ziekenhuis Brussel, Germany
Universiteit Universiteit
Brussel;
A 33-year-old IIIV infected I.V.-drug user presented to our department with numerous subcutaneous nodules for which he had been treated unsuccessfully in another institution with radiotherapy for suspicion of Kaposi sarcoma. The lesions appeared approximately one year earlier as slightly infiltrated plaques. Cutaneous examination revealed several dark red papulonodular lesions on the face, trunk and extremities. On the right leg he presented a well-circumscribed fungating mass with a central ulceration measuring 6 cm in diameter. Laboratory studies showed anaemia and CD4 count of 20 cells/mm3 with a CD4/CD8 ration of 0.14. Histological examination of skin biopsies disclosed lesions of bacillary angiomatosis, both by light and electron microscopy. PCR for a 60-kDA Bartonella protein and for the intergenic spacer region between 16 and 23 S RNA were both positive and restriction analysis of the PCR product of the latter identified Bartonella Quintana DNA. Tentatives to grow the bacteria remained unsuccessful. In spite of initiation of erythromycin, the patient’s condition worsened. He rejected further therapy, left the hospital and died a few days later. Although no louses were found on this patient, they were probably the vector of transmission, since his personal hygiene was very poor.
-
Therapy
Therapy FC148 Comparison of the efficacies of cyproterone acetate, spironolactone and flutamide in the treatment of hirsutism F. Kay a ’ , D. Se9kin *, A.Y. Turanh ’ . ’ Ondokuz
Mayis University Faculty of Medicine, Department of Dermatology, Samsun; *BaTkent University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
Hirsutism, a marker for increased production or action of androgens, is an important clinical and psychosocial problem. Antiandrogens, which prevent androgen action at the target level, have been extensively used in the treatment of hirsutism. The aim of this study was to evaluate and compare the effectiveness of cyproterone acetate (CA), spironolactone (S), and flutamide (F) in the treatment of hirsutism. Thirteen women received 50 mg/day CA, thirteen received 50 mg S bid, and thirteen were treated with 250 mg F bid. Hirsutism scores were determined according to the FerrimanGallwey (FG) scoring system and hair diameter was also measured. FG scores were decreased significantly in all 3 groups at the end of 6 months. The percent of change in FG scores in CA, S, and F groups were 61%, 63%, and 60%, respectively. Hair diameter was also reduced significantly in CA, S, and F groups by 47.5%, 56%, and 48%, respectively. There were no differences between groups in terms of the degree of reduction in FG score. Reduction in hair diameter was most prominent in the S group. Menstrual irregularity was observed in 4 (31%), 3 (23%) and 5 (38%) patients in CA, S, and F groups, respectively. Side effects did not continue in the F group after 2 months of therapy. In conclusion, CA, S, and F were similarly effective in the treatment of hirsutism, but the side effects appeared to be more acceptable in the F group.
FCI 49 Pyoderma gangrenosum successfully ’ treated with Cyclosporin A (NEORAL) H. Okrasinski. Clinic Hospital,
Khamis
of Dermatology Mushayt, KSA
at Armed
Forces
A 5 1-year old man with NIDDM developed on the right lower leg a painless ulcer 14.0 x 10.0 cm. in diameter with irregular, raised and undermined borders. Ulcer base was coverted by necrotic tissue and purulent, haemorrhagic exudate. Laboratory tests: Liver function tests are normal. HBsAb +ve, FBS-6.9-13.0 mmol/l. Cultures from ulcer grew Staph. aureus and pseudomonas aeruginosa. Histopathology: In the deep dermis, there was ulceration with infiltration of neutrophils and lymphocytes. It has 8 months history not respond to conventional treatment. After treatment orally with Cyclosporin (1.9 mglkglday), an improvement was seen within 10 days and after 2 months resulted in a complete resolution without recurrence after 3 months follow-up. Seventy to eighty percent of the patients with pyodenna gangrenosum have an associated systemic disease. Our patient suffered from NIDDM and had positive serology for hepatitis B but with normal liver function tests. Low dosages and short
Free Communications
periods using of Cyclosporin A, provide encouraging pathway treatment of Pyoderma Gangrenosum. FC150
Cutaneous toxicity associated with high-dose cytosine arabinoside
P. Cetkovska’ , K. Pizinger’, Dermatology; 2Department Charles University Hospital,
P. Skopek2. ‘Department of Haematology Pilsen, Czech
of
and Oncology,
-
dosage schedule of each pulse was 200 mg twice daily for 1 week with 2 weeks off therapy between successive pulses. Two pulses of itraconazole therapy are effective in the treatment of Majocchi’s granuloma. It is also possible that one pulse may be sufficient in some patients. FC153
Republic
High-dose cytosine arabinoside (HiDAC) is used increasingly to treat haematological malignancies. The therapy is associated with various nonhaematological toxicities frequently involving the skin. The purpose of the study was to evaluate the actual occurrence of HiDAC adverse skin reactions. One hundred and eight patients with acute myelogenous leukemia (n = 73) and acute lymphoblastic leukemia (n = 35) between 16 and 71 years of age were treated with 141 post-remission consolidation regimens with HiDAC in combination with standard doses of other cytotoxic drugs (33 patients received 2 courses). The incidence of cutaneous toxicity was 5 1.1% with rashes occurring in 76.6% and 38.3% of subjects having received total doses of 30 and 24 gl sq m, respectively. Surprisingly, the second regimens in 33 patients did not reproduce the reactions in patients suffering from the rash after the first course (46 vs 33%). Morbilliform eruptions over the trunk and extremities and painful erythematous desquamating lesions of palms and soles were most commonly observed, onycholysis developed in occasional cases. The onset ranged from day 8 to day 20 of treatment, the rash generally resolved within 2 weeks. In conclusion, HiDAC induced cutaneous toxicity in 5 1% of patients. These skin changes were dose-related, fully reversible and generally not requiring treatment.
s151
Therapy
The efficacy of oral potassium iodide in the treatment of erythema multiforme
I. Candan, I.E. Aydmoz, T. Mansur. Haydarpaya Hospital,
Istanbul,
Numune
Turkey
Erythema multiforme (EM) is a frequently recurrent but selflimited syndrome characterized by the abrupt onset of symmetrical red papules some of which evolve into distinctive target lesions. The clinical course is variable lasting up to 3 to 4 weeks. In this open trial clinical efficacy of oral potassium iodide (KI) was assessed in 13 patients with a treatment period of 7 days. The therapy was initiated within maximum 7 days after clinical onset in all of our patients. In each patient clinical features were scored on admission and during treatment on the 3rd and 7th days. KI was initially started with a dose of 2 x 200 mg/day and in only 2 patients due to absence of symptomatic relief, it was increased to 3 x 200 mg on the 3rd day. There was a dramatic healing in all of our patients at the end of a week. The average pretreatment score which was 9.07 f 2.36 was found to be reduced to 0.62 f 0.77 which is statistically significant (p < 0.05). Side effects were recorded in 2 patients, which did not necessitate drug cessation. In conclusion, oral KI is found to be an effective alternative drug in the symptomatic treatment of EM reducing disease course with few side effects. FCI 54 A retrospective
FC151
Dermatitis fragellaris as a rare side effect of the Bleomycin included chemotherapy
I. Orojan, L. T&ok, M. Tapai. Dermatology County
Hospital,
Kecskeme’t,
Department,
Hungary
Our 48-year-old non-Hodgkin’s lymphomas female patient has been given operation, irradiation, and chemotherapy since 1978. She was given Bleomycin medication combined treatment in 1997. Within 24 hours sharp-edged, stripe like, protruding, pruritic laesions appeared on her whole body. After the withdrawal of Bleomycin medication the laesions regrediated leaving hyperpigmentation behind. During the chemotherapy containing Bleomycin rarely but recognisable dermatitis fragellaris occurs. FC152
ltraconazole is effective in the treatment of Majocchi’s granuloma: A clinical and pharmacokinetic evaluation
A.K. Gupta ’ , P. De Doncker 2. ’ University 2 Janssen
Research
Foundation,
of Toronto;
Canada
Four patients (age range: 25-66 years) with Majocchi’s granuloma were effectively treated with clinical and mycological cure using itraconazole therapy given as pulse dosing. None of the patients has relapsed over a one year following period. The
study on the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic
C.L. Goh, L. Khoo. National
Skin Centre,
Singapore
This is a retrospective study on the epidemiology and morbidity of herpes zoster and risk factors for herpes zoster morbidity in Singapore. The mean age of 164 patients with herpes zoster was 48.8 years with a 1:l sex ratio. The common presenting symptoms were pain (90%) followed by feeling helpless/depressed (20%) and flu-like symptoms (12%). The commonest prodrome include pain (41%), itch (27%) and paraesthesia (12%). Prodromal pain was more frequently experienced by patients >50 year (42%) than patients 130 years (25%). The thoracic (45%), followed by the cervical (23%) dermatomes were the commonest affected dermatomes in all age groups. Pain was experienced by 95% patients during the course of their disease. It tends to be more severe in older patients. A higher proportion of old patients (>50 years old) (20%) suffered from the post herpetic neuralgia compared to the younger patient (~30 years old) (7%) (ns). Patients in all age group considered the acute pain (46%) and persistent pain (25%) as their most unbearable symptoms during the course of their herpes zoster. Insomnia was significantly more commonly experienced by patients >50 years old (36%) than those ~30 years old (p = 0.026).