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The treatment of scabies with ivermectin
140
Pearls
Journal of the American Academy of Dermatology January 1996
of wisdom
Three cases are reported of persons with urticaria and angioedema occurring after ingestion of alcohol. All other causes of chronic recurrent urticaria were excluded by history, physical examination, and extensive laboratory and allergy testing. Urticarial lesionswere reproduced with prick testingusing acetic acid, and angioedemawas reproduced after oral challenge with small amountsof purified alcohol. It is known that alcohol and acetaldehyde induce histaminereleasefrom mast cells, which is thought to be the mechanismof developmentof urticaria in thesepatients. Cluy J. CockerelI, MD
The treatment
of scabies with ivermectin
Meinking TL, Taplin D, Hermida
Skhez-Guerrero J, Colditz GA, Karlson EW, et al. N Engl J Med 1995:332: 1666-70. The authors analyzed data from the Nurses Health Study cohort during a 14-yearperiod. The study involved datafrom 87,501 womenwho were free from connective tissuediseasein June 1976. They identified 5 16 women with connective tissuediseaseand 1183 who had breast implantsof various types (846 siliconegel-filled, 170saline-filled, 67 double lumen, 14 polyurethane, and 56 of unknown type). The meanfollow-up after breastimplantation surgery was 9.9 years. Only three patients with definite connective tissuediseasehad implants. This large cohort study was unableto identify an associationbetweensiliconebreastimplantsand connective tissuedisease. COMMENT:
JL, et al. N Engl
J Med 1995:333:26-30. Ivermectin, an antihelminthic drug usedfor treatment of onchocerciasis,wasusedto treat 11 otherwisehealthy patientswith scabiesand 11patientswith scabiesandHIV infection. Of the 11 HIV-infected patients, seven had AIDS and severalhad numerousor crusted skin lesions. Ivermectin wasadministeredin a singleoral doseof 200 pg/kg. Patientswere reexaminedwith skin scrapingsfor scabiesat 2 and4 weeksafter treatment. Scabiesinfestation wascured with a singledoseof the drug in all of the otherwise healthy patients and in eight of the HIVinfected patients. Two of the HIV-infected patients requireda seconddoseof ivermectin at 2 weeksto resolve their scabies. COMMENT: Ivermectin offers an effective oral one-dose treatment for patientswith scabiesthat is resistantto topical agents.
Elkubeth A. Abel, MD
Erythema induratum with pulmonary culosis: a report of three cases
Silicone breast implants and the risk of connective tissue diseases and symptoms
tuber-
True HK. Li YD, Shun HS, et al. J Dermatol 1995;22:143-8. The authors describethree patients with documented pulmonary tuberculosiswho had clinical and histologic featuresof erythema induratum. All three casesresolved after treatment of the pulmonary tuberculosis.Whether erythema induratum is relatedto tuberculosishasbeena subjectof controversy. This report demonstratesthat there are bonafide casesin which the two diseases are truly associated. Clay J. Cocker-ell,MD
Jeffi-ey P. Callen. MD
The eosinophilia-myalgia 205 patients and results after onset
syndrome: of treatment
Hertzman PA, Clauw DJ, Kaufman Intern Med 1995;122:851-5.
status of 2 years
LD, et al. Ann
Two hundred five patientswho had eosinophilia-myalgia syndrome associatedwith L-tryptophan consumption were examined to determinethe courseof the syndrome during a 2-year period. After 18to 24 months,all symptomsexcept cognitive changeshad been alleviated in mostpatients.Nearly all physical findings improved or resolved in most patients. Only peripheral neuropathy was unchanged.Prednisonewas helpful in 79% of personswho received the drug during the acutephaseof the illness.No other treatment was consistently beneficial. There appearsto be no treatment available that is helpful in the managementof the later phaseof the syndrome. Neal S. Pemeys. MD
Malignancy-associated multicentric histiocytosis: a clinical, histological munophenotypic study
reticuloand im-
Snow IL, Muller SA. Br J Dermatol 1995; 133:7 l-6. The authorsreport four casesof malignancy-associated multicentric reticulohistiocytosis (MR). The associated
Pearls
Journal of the American Academy of Dermatology January 1996
of wisdom
Three cases are reported of persons with urticaria and angioedema occurring after ingestion of alcohol. All other causes of chronic recurrent urticaria were excluded by history, physical examination, and extensive laboratory and allergy testing. Urticarial lesionswere reproduced with prick testingusing acetic acid, and angioedemawas reproduced after oral challenge with small amountsof purified alcohol. It is known that alcohol and acetaldehyde induce histaminereleasefrom mast cells, which is thought to be the mechanismof developmentof urticaria in thesepatients. Cluy J. CockerelI, MD
The treatment
of scabies with ivermectin
Meinking TL, Taplin D, Hermida
Skhez-Guerrero J, Colditz GA, Karlson EW, et al. N Engl J Med 1995:332: 1666-70. The authors analyzed data from the Nurses Health Study cohort during a 14-yearperiod. The study involved datafrom 87,501 womenwho were free from connective tissuediseasein June 1976. They identified 5 16 women with connective tissuediseaseand 1183 who had breast implantsof various types (846 siliconegel-filled, 170saline-filled, 67 double lumen, 14 polyurethane, and 56 of unknown type). The meanfollow-up after breastimplantation surgery was 9.9 years. Only three patients with definite connective tissuediseasehad implants. This large cohort study was unableto identify an associationbetweensiliconebreastimplantsand connective tissuedisease. COMMENT:
JL, et al. N Engl
J Med 1995:333:26-30. Ivermectin, an antihelminthic drug usedfor treatment of onchocerciasis,wasusedto treat 11 otherwisehealthy patientswith scabiesand 11patientswith scabiesandHIV infection. Of the 11 HIV-infected patients, seven had AIDS and severalhad numerousor crusted skin lesions. Ivermectin wasadministeredin a singleoral doseof 200 pg/kg. Patientswere reexaminedwith skin scrapingsfor scabiesat 2 and4 weeksafter treatment. Scabiesinfestation wascured with a singledoseof the drug in all of the otherwise healthy patients and in eight of the HIVinfected patients. Two of the HIV-infected patients requireda seconddoseof ivermectin at 2 weeksto resolve their scabies. COMMENT: Ivermectin offers an effective oral one-dose treatment for patientswith scabiesthat is resistantto topical agents.
Elkubeth A. Abel, MD
Erythema induratum with pulmonary culosis: a report of three cases
Silicone breast implants and the risk of connective tissue diseases and symptoms
tuber-
True HK. Li YD, Shun HS, et al. J Dermatol 1995;22:143-8. The authors describethree patients with documented pulmonary tuberculosiswho had clinical and histologic featuresof erythema induratum. All three casesresolved after treatment of the pulmonary tuberculosis.Whether erythema induratum is relatedto tuberculosishasbeena subjectof controversy. This report demonstratesthat there are bonafide casesin which the two diseases are truly associated. Clay J. Cocker-ell,MD
Jeffi-ey P. Callen. MD
The eosinophilia-myalgia 205 patients and results after onset
syndrome: of treatment
Hertzman PA, Clauw DJ, Kaufman Intern Med 1995;122:851-5.
status of 2 years
LD, et al. Ann
Two hundred five patientswho had eosinophilia-myalgia syndrome associatedwith L-tryptophan consumption were examined to determinethe courseof the syndrome during a 2-year period. After 18to 24 months,all symptomsexcept cognitive changeshad been alleviated in mostpatients.Nearly all physical findings improved or resolved in most patients. Only peripheral neuropathy was unchanged.Prednisonewas helpful in 79% of personswho received the drug during the acutephaseof the illness.No other treatment was consistently beneficial. There appearsto be no treatment available that is helpful in the managementof the later phaseof the syndrome. Neal S. Pemeys. MD
Malignancy-associated multicentric histiocytosis: a clinical, histological munophenotypic study
reticuloand im-
Snow IL, Muller SA. Br J Dermatol 1995; 133:7 l-6. The authorsreport four casesof malignancy-associated multicentric reticulohistiocytosis (MR). The associated