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S119 Nonsense acne therapy
s30
IS119
Symposia
Nonsense acne therapy
Andreas D. Katsambas. lJniversi& Sygros”
- Disorders
Hospital,
Athens,
Dermatological
Clinic,
“A.
Greece
The most important factor for the treatment of Acne is the doctor and his knowledge, experience and attitude. Misconceptions, leading to common treatment mistakes and common nonsense, flourish’not only among people and laymen, but also among physicians some of whom are dermatologists. Here are some of the common nonsense and mistakes in the treatment of Acne, leading to poor compliance and treatment failure. (a) Wrong time frame for expected improvement (You’ll clear up in two weeks!!). (b) Rejection of all cosmetics and make up (Never use cosmetics!!). (c) Instructions for diet restriction (Never eat chocolate etc!!). (d) Usage of smelly sulphourous and other “old fashion” ineffective drugs that contribute only to the psychological isolation. (e) Lack of attention to minimal acne (This is nothing, you don’t need treatment!!). (f) Exaggeration of the existing side effects of the very effective antiacne drugs (Istotretinoin - Tretinoin-Tetracycline, Antiandrogens) (g) Exaggeration in using new drugs and methods. (h) Usage of unnecessary methods such as UVB, UVA, massage etc. (i) Treatment that interferes with the patient’s life style. (Tetracycline on an empty stomach - Topical Tretinoin 30 minutes after washing, etc.) (i) Underestimating the patient’s questions. Shortage of time for instructions. (k) Usage of drugs in low doses and for short period of time due to lack of knowledge and expertise.
Disorders of Hair and Nails I S120 Clinical, surgical and therapeutic pearls Philippe Abimelec. France Local anaesthesia of the finger through the flexor tendon sheath- indication and technique: Transthecal digital block anaesthesia of the finger using the flexor tendon sheath will be presented. This technique which has been described recently by Chiu and al is easy to perform and reliable. Local anaesthesia of the finger through the flexor tendon sheath is an interesting alternative for the finger blocks, which carry a significant risk of vascular and neurological compromise. Ungual warts - when and how to biopsy? Early squamous cell carcinoma may be indistinguishable from a common wart. Histopathological examination is mandatory in the immunocompromised host, in atypical warts and finally in long standing warts unresponsive to conventional treatments. Intralesional bleomycin for ungual warts - indications and techniques: Treatment of ungual warts is often frustrating. Numerous reports indicate that Bleomycin is an effective treatment for ungual warts. Treatment of warts with bleomycin involves
of Hair
and Nails
intralesional injections (OS-1 IX/ml) or bleopuncture (1 UYml) with a bifurcated needle. Repeated treatment may be necessary. The treatment is generally well tolerated but several adverse effects have been reported. Since this treatment is not FDA approved and due to the lack of information regarding long term safety, it must be reserved for recalcitrant periungual warts unresponsive to more conventional modes of therapy.
I S121 Evaluation of the role of genital HPV in
pathogenesis of ungual epidermoid carcinoma
J. Andre, J.-Ch. Noel. Brussels
Free
University,
Belgium
Recent studies have associated various genital HPV and particularly HPV 16 in the pathogenesis of ungual epidermoid carcinoma (UEC). However, the exact role of these viruses remains unclear. This is why we have studied the presence of HPV 16 in 5 cases of UEC (4 in situ or Bowen disease, 1 invasive). In two positive cases, we have also studied the integration of viral DNA into the chromosomal host DNA, which appears as an essential prerequisite for malignant progression. Polymerase chain reaction amplification (PCR) and subsequent in situ hybridization (ISH) with probes specific for the DNA of HPV showed strong positivity for HPV 16 in 4 of the 5 cases. Two positive cases were also studied for DNA integration: in one of these cases, HPV 16 DNA was probably integrated in host DNA, as proved by a punctiform pattern revealed by ISH and by the persistence of a total amplification of the E2 fragment by PCR. To the best of our knowledge, this result represents the first indication of a demonstrable genomic integration of HPV 16 DNA sequences in UEC and it seems to confirm the potential role of this virus in the pathogenesis of the disease. It also confirms recent data by McHugh et al (1) who have described the presence of HPV-type 35 RNA, not only in a primitive UEC, but also in its lymph node metastases. References [l] R.W. McHugh, P. Hazen, Y.D. Eliezri, G.J. Nuovo: Metastatic periungual squamous cell carcinoma: Detection of human papillomavirus type 35 RNA in the digital tumor and axillary lymph node metastases. J. Amer. Acad. Dermatol. 1996, 34: 1080-1082. I S122 The different faces of the pili bifurcati Francisco M. &macho. Virgen Macarena Universitary Hospital,
Sevila,
Spain
Pili bifurcati is an uncommon developmental defect of the hair growth characterized by intermittent bifurcation of the whole hair shaft repeated at irregular intervals. This defects in relation with a kynetic papilla which changes its form from one tip to two tips, and back to one tip; one of the tips may even bifurcate again producing a double bifurcation. Pili bifurcati can be divided as follow: A) Congenital defects (genuine pili gemlnl): (Each separated branch is of different diameter and is covered with its own cuticle)
IS119
Symposia
Nonsense acne therapy
Andreas D. Katsambas. lJniversi& Sygros”
- Disorders
Hospital,
Athens,
Dermatological
Clinic,
“A.
Greece
The most important factor for the treatment of Acne is the doctor and his knowledge, experience and attitude. Misconceptions, leading to common treatment mistakes and common nonsense, flourish’not only among people and laymen, but also among physicians some of whom are dermatologists. Here are some of the common nonsense and mistakes in the treatment of Acne, leading to poor compliance and treatment failure. (a) Wrong time frame for expected improvement (You’ll clear up in two weeks!!). (b) Rejection of all cosmetics and make up (Never use cosmetics!!). (c) Instructions for diet restriction (Never eat chocolate etc!!). (d) Usage of smelly sulphourous and other “old fashion” ineffective drugs that contribute only to the psychological isolation. (e) Lack of attention to minimal acne (This is nothing, you don’t need treatment!!). (f) Exaggeration of the existing side effects of the very effective antiacne drugs (Istotretinoin - Tretinoin-Tetracycline, Antiandrogens) (g) Exaggeration in using new drugs and methods. (h) Usage of unnecessary methods such as UVB, UVA, massage etc. (i) Treatment that interferes with the patient’s life style. (Tetracycline on an empty stomach - Topical Tretinoin 30 minutes after washing, etc.) (i) Underestimating the patient’s questions. Shortage of time for instructions. (k) Usage of drugs in low doses and for short period of time due to lack of knowledge and expertise.
Disorders of Hair and Nails I S120 Clinical, surgical and therapeutic pearls Philippe Abimelec. France Local anaesthesia of the finger through the flexor tendon sheath- indication and technique: Transthecal digital block anaesthesia of the finger using the flexor tendon sheath will be presented. This technique which has been described recently by Chiu and al is easy to perform and reliable. Local anaesthesia of the finger through the flexor tendon sheath is an interesting alternative for the finger blocks, which carry a significant risk of vascular and neurological compromise. Ungual warts - when and how to biopsy? Early squamous cell carcinoma may be indistinguishable from a common wart. Histopathological examination is mandatory in the immunocompromised host, in atypical warts and finally in long standing warts unresponsive to conventional treatments. Intralesional bleomycin for ungual warts - indications and techniques: Treatment of ungual warts is often frustrating. Numerous reports indicate that Bleomycin is an effective treatment for ungual warts. Treatment of warts with bleomycin involves
of Hair
and Nails
intralesional injections (OS-1 IX/ml) or bleopuncture (1 UYml) with a bifurcated needle. Repeated treatment may be necessary. The treatment is generally well tolerated but several adverse effects have been reported. Since this treatment is not FDA approved and due to the lack of information regarding long term safety, it must be reserved for recalcitrant periungual warts unresponsive to more conventional modes of therapy.
I S121 Evaluation of the role of genital HPV in
pathogenesis of ungual epidermoid carcinoma
J. Andre, J.-Ch. Noel. Brussels
Free
University,
Belgium
Recent studies have associated various genital HPV and particularly HPV 16 in the pathogenesis of ungual epidermoid carcinoma (UEC). However, the exact role of these viruses remains unclear. This is why we have studied the presence of HPV 16 in 5 cases of UEC (4 in situ or Bowen disease, 1 invasive). In two positive cases, we have also studied the integration of viral DNA into the chromosomal host DNA, which appears as an essential prerequisite for malignant progression. Polymerase chain reaction amplification (PCR) and subsequent in situ hybridization (ISH) with probes specific for the DNA of HPV showed strong positivity for HPV 16 in 4 of the 5 cases. Two positive cases were also studied for DNA integration: in one of these cases, HPV 16 DNA was probably integrated in host DNA, as proved by a punctiform pattern revealed by ISH and by the persistence of a total amplification of the E2 fragment by PCR. To the best of our knowledge, this result represents the first indication of a demonstrable genomic integration of HPV 16 DNA sequences in UEC and it seems to confirm the potential role of this virus in the pathogenesis of the disease. It also confirms recent data by McHugh et al (1) who have described the presence of HPV-type 35 RNA, not only in a primitive UEC, but also in its lymph node metastases. References [l] R.W. McHugh, P. Hazen, Y.D. Eliezri, G.J. Nuovo: Metastatic periungual squamous cell carcinoma: Detection of human papillomavirus type 35 RNA in the digital tumor and axillary lymph node metastases. J. Amer. Acad. Dermatol. 1996, 34: 1080-1082. I S122 The different faces of the pili bifurcati Francisco M. &macho. Virgen Macarena Universitary Hospital,
Sevila,
Spain
Pili bifurcati is an uncommon developmental defect of the hair growth characterized by intermittent bifurcation of the whole hair shaft repeated at irregular intervals. This defects in relation with a kynetic papilla which changes its form from one tip to two tips, and back to one tip; one of the tips may even bifurcate again producing a double bifurcation. Pili bifurcati can be divided as follow: A) Congenital defects (genuine pili gemlnl): (Each separated branch is of different diameter and is covered with its own cuticle)