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Tazarotene gel for Darier’s disease
Journal of the American Academy of Dermatology Volume 38, Number 6, Part 1
Brief communications 1001
Tazarotene gel for Darier’s disease Craig G. Burkhart, MSPH, MD,a and Craig N. Burkhartb Sylvania and Toledo, Ohio
Darier’s disease is inherited in an autosomal dominant fashion.1 Nevertheless, half of affected persons have no family history of the condition. Darier’s disease presents with scattered, greasy, keratotic papules on the face, neck, chest, back, and extremities that coalesce forming plaques. It is exacerbated by heat and sweating, and usually worsened by exposure to sunlight.1 The cause of the distorted keratinization is dissolution of desmosomal plaque proteins, specifically, desmoplakin I and II, plakoglobin, and desmoglein.2 The result of this defect is a deficiency in the tonofilament/desmosome attachment, leading to tonofilament clumping and vesicle formation. Because oral isotretinoin is effective in this condition,3 the From the Department of Medicine, Medical College of Ohio,a the Department of Medicine, Ohio University College of Osteopathic Medicine,a and the Department of Biology, University of Toledo.b Reprint requests: Craig G. Burkhart, 5600 Monroe St., Suite 106B, Sylvania, OH 43560. J Am Acad Dermatol 1998;38:1001-2. Copyright © 1998 by the American Academy of Dermatology, Inc. 0190-9622/98/$5.00 + 0 16/54/90028
new topical acetylenic retinoid tazarotene was tried in a patient. CASE REPORT A 45-year-old white woman had Darier’s disease since childhood involving her scalp, face, neck, seborrheic areas of the trunk, and flexures of her extremities. She had been treated with topical steroids, various antibiotics, and topical retinoic acid with discouraging results. Tazarotene 0.05% gel was applied to her skin lesions once daily in the morning, followed by an afternoon application of a weak topical steroid cream to allay the dryness and irritation of the acidic retinoid. Within 6 weeks improvement was noted, and by 3 months, results superior to all former therapies were achieved. After 12 weeks, therapy was continued on alternate days to maintain improvement and diminish skin irritation. DISCUSSION
Tazarotene modulates abnormal keratinocyte differentiation and proliferation, and decreases inflammation in psoriasis.4 Although slightly irri-
Journal of the American Academy of Dermatology June 1998
1002 Brief communications tating, it has minimal systemic side effects.5 The drug is not recommended for use in pregnancy.6 In our patient, tazarotene gel appeared to be effective in the treatment of Darier’s disease. Further evaluation appears warranted. REFERENCES 1. Burge S, Wilkinson J. Darier-White disease: a review of the clinical features in 163 patients. J Am Acad Dermatol 1992;27:40-50. 2. Hashimoto K, Fujiwara K, Tada J, Harada M, Setoyama
3. 4. 5. 6.
M, Eto H. Desmosomal dissolution in Grover’s disease, Hailey-Hailey’s disease and Darier’s disease. J Cutan Pathol 1995;22:488-501. Dicken C, Bauer E, et al. Isotretinoin treatment of Darier’s disease. J Am Acad Dermatol 1982;6:721-6. Weinstein GD. Tazarotene gel: efficacy and safety in plaque psoriasis. J Am Acad Dermatol 1997;37:S33-8. Marks R. Clinical safety of tazarotene in the treatment of plaque psoriasis. J Am Acad Dermatol 1997;37:S25-32. Abramowicz M. Two new retinoids for psoriasis. Med Lett 1997;39:105-6.
Treatment of primary anetoderma with colchicine Ralph P. Braun, MD, Luca Borradori, MD, Pierre Chavaz, MD, Isabelle Masouyé, MD, Lars French, MD, and Jean-Hilaire Saurat, MD Geneva/Lausanne, Switzerland
Primary anetoderma is rare and has been classified into two types, inflammatory (JadassohnPellizari), and noninflammatory (SchwenningerBuzzi). Secondary forms of anetoderma may occur during the course of various disorders, including syphilis,1 tuberculosis,2 Borrelia infection,3 urticaria pigmentosa,4 lupus erythematosus,5 and the antiphospholipid syndrome.6 Numerous therapeutic approaches have been proposed, but the results have frequently been disappointing. We describe a patient with primary inflammatory anetoderma whose inflammatory component responded to colchicine.
Fig. 1. Atrophic flabby saclike lesions on lower back.
CASE REPORT A 30-year-old man had a 5-year history of well-circumscribed patches that first occurred on the trunk and then slowly spread to the extremities. The patient was otherwise in good health and his past and family history were unremarkable. Examination revealed areas of atrophic, flabby saclike lesions on the chest, lower back (Fig. 1), upper arms, and legs. The lesions initially appeared as 7 to 10 mm red inflammatory macules and progressively became papular, saclike lesions with loss From the Department of Dermatology, Professorial Unit, University Hospital Geneva and DHURDV. Reprint requests: R. P. Braun, MD, Department of Dermatology, University Hospital Geneva, 24, rue Micheli-du-Crest, CH 1211 Geneva 14, Switzerland. J Am Acad Dermatol 1998;38:1002-3. Copyright © 1998 by the American Academy of Dermatology, Inc. 0190-9622/98/$5.00 + 0 16/54/90023
of dermal substance. The rest of the physical examination, including ocular fundi, was normal. No abnormal scarring was observed and skin extensibility was not increased. A biopsy specimen of an early inflammatory lesion showed a perivascular lymphocytic cell infiltrate and a neutrophil interstitial infiltrate between the collagen fibers in the papillary and middle dermis. Sections stained with orcein did not reveal a loss of elastic tissue fibers. In contrast, a second specimen taken from a saclike area showed a loss of elastic fibers in the papillary and middle dermis. Direct immunofluorescence of lesional skin was negative in both specimens. A search for systemic, autoimmune,5 infectious, and metabolic disorders, as well as screening for bone abnormalities and cardiovascular disorders2 was negative. The patient was given oral colchicine, 1 mg daily. Within 2 weeks,
Brief communications 1001
Tazarotene gel for Darier’s disease Craig G. Burkhart, MSPH, MD,a and Craig N. Burkhartb Sylvania and Toledo, Ohio
Darier’s disease is inherited in an autosomal dominant fashion.1 Nevertheless, half of affected persons have no family history of the condition. Darier’s disease presents with scattered, greasy, keratotic papules on the face, neck, chest, back, and extremities that coalesce forming plaques. It is exacerbated by heat and sweating, and usually worsened by exposure to sunlight.1 The cause of the distorted keratinization is dissolution of desmosomal plaque proteins, specifically, desmoplakin I and II, plakoglobin, and desmoglein.2 The result of this defect is a deficiency in the tonofilament/desmosome attachment, leading to tonofilament clumping and vesicle formation. Because oral isotretinoin is effective in this condition,3 the From the Department of Medicine, Medical College of Ohio,a the Department of Medicine, Ohio University College of Osteopathic Medicine,a and the Department of Biology, University of Toledo.b Reprint requests: Craig G. Burkhart, 5600 Monroe St., Suite 106B, Sylvania, OH 43560. J Am Acad Dermatol 1998;38:1001-2. Copyright © 1998 by the American Academy of Dermatology, Inc. 0190-9622/98/$5.00 + 0 16/54/90028
new topical acetylenic retinoid tazarotene was tried in a patient. CASE REPORT A 45-year-old white woman had Darier’s disease since childhood involving her scalp, face, neck, seborrheic areas of the trunk, and flexures of her extremities. She had been treated with topical steroids, various antibiotics, and topical retinoic acid with discouraging results. Tazarotene 0.05% gel was applied to her skin lesions once daily in the morning, followed by an afternoon application of a weak topical steroid cream to allay the dryness and irritation of the acidic retinoid. Within 6 weeks improvement was noted, and by 3 months, results superior to all former therapies were achieved. After 12 weeks, therapy was continued on alternate days to maintain improvement and diminish skin irritation. DISCUSSION
Tazarotene modulates abnormal keratinocyte differentiation and proliferation, and decreases inflammation in psoriasis.4 Although slightly irri-
Journal of the American Academy of Dermatology June 1998
1002 Brief communications tating, it has minimal systemic side effects.5 The drug is not recommended for use in pregnancy.6 In our patient, tazarotene gel appeared to be effective in the treatment of Darier’s disease. Further evaluation appears warranted. REFERENCES 1. Burge S, Wilkinson J. Darier-White disease: a review of the clinical features in 163 patients. J Am Acad Dermatol 1992;27:40-50. 2. Hashimoto K, Fujiwara K, Tada J, Harada M, Setoyama
3. 4. 5. 6.
M, Eto H. Desmosomal dissolution in Grover’s disease, Hailey-Hailey’s disease and Darier’s disease. J Cutan Pathol 1995;22:488-501. Dicken C, Bauer E, et al. Isotretinoin treatment of Darier’s disease. J Am Acad Dermatol 1982;6:721-6. Weinstein GD. Tazarotene gel: efficacy and safety in plaque psoriasis. J Am Acad Dermatol 1997;37:S33-8. Marks R. Clinical safety of tazarotene in the treatment of plaque psoriasis. J Am Acad Dermatol 1997;37:S25-32. Abramowicz M. Two new retinoids for psoriasis. Med Lett 1997;39:105-6.
Treatment of primary anetoderma with colchicine Ralph P. Braun, MD, Luca Borradori, MD, Pierre Chavaz, MD, Isabelle Masouyé, MD, Lars French, MD, and Jean-Hilaire Saurat, MD Geneva/Lausanne, Switzerland
Primary anetoderma is rare and has been classified into two types, inflammatory (JadassohnPellizari), and noninflammatory (SchwenningerBuzzi). Secondary forms of anetoderma may occur during the course of various disorders, including syphilis,1 tuberculosis,2 Borrelia infection,3 urticaria pigmentosa,4 lupus erythematosus,5 and the antiphospholipid syndrome.6 Numerous therapeutic approaches have been proposed, but the results have frequently been disappointing. We describe a patient with primary inflammatory anetoderma whose inflammatory component responded to colchicine.
Fig. 1. Atrophic flabby saclike lesions on lower back.
CASE REPORT A 30-year-old man had a 5-year history of well-circumscribed patches that first occurred on the trunk and then slowly spread to the extremities. The patient was otherwise in good health and his past and family history were unremarkable. Examination revealed areas of atrophic, flabby saclike lesions on the chest, lower back (Fig. 1), upper arms, and legs. The lesions initially appeared as 7 to 10 mm red inflammatory macules and progressively became papular, saclike lesions with loss From the Department of Dermatology, Professorial Unit, University Hospital Geneva and DHURDV. Reprint requests: R. P. Braun, MD, Department of Dermatology, University Hospital Geneva, 24, rue Micheli-du-Crest, CH 1211 Geneva 14, Switzerland. J Am Acad Dermatol 1998;38:1002-3. Copyright © 1998 by the American Academy of Dermatology, Inc. 0190-9622/98/$5.00 + 0 16/54/90023
of dermal substance. The rest of the physical examination, including ocular fundi, was normal. No abnormal scarring was observed and skin extensibility was not increased. A biopsy specimen of an early inflammatory lesion showed a perivascular lymphocytic cell infiltrate and a neutrophil interstitial infiltrate between the collagen fibers in the papillary and middle dermis. Sections stained with orcein did not reveal a loss of elastic tissue fibers. In contrast, a second specimen taken from a saclike area showed a loss of elastic fibers in the papillary and middle dermis. Direct immunofluorescence of lesional skin was negative in both specimens. A search for systemic, autoimmune,5 infectious, and metabolic disorders, as well as screening for bone abnormalities and cardiovascular disorders2 was negative. The patient was given oral colchicine, 1 mg daily. Within 2 weeks,