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Topical erythromycin preparations
620
Journal of the American Academy of Dermatology
Correspondence
REFERENCES I. Enzinger FM, Weiss SW. Tumores primifivos de nervios perifedcos. In: Enzinger FM, Weiss SW, eds. Tumores de tejidos blanos. Buenos Aires, Bogota, Caracas: Ed Med Panamedcana, 1985:623-68. 2. Alvira MM, Mandybur TI, Menefee MG. Light microscopic and ultrastructural observations of metastasizing malignant epithelioid schwannoma. Cancer 1976;38: 1977. 3. Elder DE, Ainsworth AM, Goldman LI, et al. Malignant melanoma schwannoma. In: Ackerman AB, ed. Pathology of malignant melanoma. New York: Masson Publishing USA, Inc., 1981:251-61. 4. Janzer RC, Makek MD. Intraoral malignant meIanotic schwannoma. Arch Pathol Lab Med 1983;107:298-301. 5. Diaz Perez JL, Burgos J, Alfaro A, et al. Schwannoma maligno melanotieo. Estudio ultrastructural. Actas Dermosif 1979;70:455-66. 6. Conley J, Lattes R, Orr W. Desmoplastic malignant melanoma: a rare variant of spindle cell melanoma. Cancer 1971 ;28:914-36. 7. Frolow GR, Shapiro L, Brownstein MH. Desmoplastic malignant melanoma. Arch Dermatol 1975; 111:753-4. 8. Aguade PP, Ferrando J, Bombi TA, et al. Melanoma desmoplastico. Med Cutan Ibero Lat Am 1977;2:77-92. 9. Batsakis JG, Bauer R, Regezi JA, et al. Desmoplastic melanoma of the maxillary alveolus. J Oral Surg 1979;37:107-9. 10. Valensi QJ. Desmoplastic malignant melanoma. A report of two additional cases. Cancer 1977;39:286-92.
Topical erythromycin preparations To the Editor: In our article, "Contact Allergen Alternatives" (J AM ACAD DERMATOL 1986;14:951), Dr. Adams and I mention the fact that although Ilotycin ophthalmic ointment is still available, Ilotycin ointment is not. It should be emphasized that the erythromycin in Ilotycin ointment was erythromycin base and that there have been no reports of allergic contact dermatitis to topical erythromycin base. All reports on delayed hypersensitivity to topical erythromycin have been either to the sulfate or stearate, but not to topical erythromycin base itself. 1.2 We reported that pharmacies can make up erythromycin ointment and that the shelf life o f such a preparation is indefinite. 3 However, I have recently learned that most pharmacies do not customarily stock erythromycin base powder. The tendency, therefore, is for pharmacists to triturate tablets and incorporate the resultant substances (with excipients) into the petrolatum. Such a procedure does not usually result in cosmetically or pharmaceutically acceptable ointment. Tablets containing erythromycin in dry form, marketed by various companies, have a shelf life of no
more than 3 years.* Obviously, the addition of such materials into ointments would not result in indefinitely prolonged shelf life of the antibiotic? The use of hydrophilic ointment as a vehicle for erythromycin has been suggested. 4 However, hydrophilic ointment contains 37% water and there are reports that an aqueous media inactivates erythromycin quite rapidly.5,t Recently I have been investigating the use of 2% erythromycin base ointment in a special vegetable oil base (E-Solve-2 ointment; Syosset Laboratories, Inc., Syosset, NY 11791). Thus far, E-Solve ointment has proved to be effective for impetigo and other infected dermatoses. It also can be used in pustular acne because it is nongreasy and has proved to be noncomedogenic.
A. A. Fisher, M.D. 45-15 48th St., Woodside, L.I., NY 11377 *Personal communicationFDA (on file) 8/21/1986. tTeehnical Bulletin #75-A102. AbbottLabs., Chicago, IL 60084.
REFERENCES 1. Fisher AA. Erythromycin "free base"--a nonsensitizing topical antibiotic for infected dermatoses and acne vulgaffs. Cuffs 1977;20:17-35. 2. Fisher AA. Is topical eryt.hromycin base non-allergenic? (Letter to Editor). Contact Dermatitis 1983;9.'243. 3. Adams RM, Fisher AA. Contact allergen alternatives: 1986. J AM AC_~DDERMATOL1986;14:951-69. 4. Mills OH, Kligman AM. Topically applied erythromycin in rosacea [letter to Editor]. Arch Dermatol 1976;112: 553. 5. United States Pharmacopeia, 21st revision. Rockville, MD: The United States Pharmacopeial Convention, Inc., 1980:756.
Leprosy and psoriasis To the Editor: To contend, as does Dr. Glickman (J AM ACAD DERMATOL 1986;14:863-6), in his article "Lepra, Psora, Psoriasis," that the disorder we now refer to as psoriasis was not distinguished from leprosy (i.e., Hansen's disease) until modem times does not accord with what Daniel Turner ~ wrote in 1726. What we know as psoriasis appears in Part 1, Chapter II (pp. 7-49) Of the Leprosy of the Greeks, whereas Hansen's disease occupies Chapter I (pp. 1-7)~ Of the Lep-
rosy of the Arabians. Not only does Tumer's description (pp. 32-41) of the ease of " a young gentlewoman, comely and of a slender make, about eighteen or nineteen years of age" fit perfectly with our conception of psoriasis:
Journal of the American Academy of Dermatology
Correspondence
REFERENCES I. Enzinger FM, Weiss SW. Tumores primifivos de nervios perifedcos. In: Enzinger FM, Weiss SW, eds. Tumores de tejidos blanos. Buenos Aires, Bogota, Caracas: Ed Med Panamedcana, 1985:623-68. 2. Alvira MM, Mandybur TI, Menefee MG. Light microscopic and ultrastructural observations of metastasizing malignant epithelioid schwannoma. Cancer 1976;38: 1977. 3. Elder DE, Ainsworth AM, Goldman LI, et al. Malignant melanoma schwannoma. In: Ackerman AB, ed. Pathology of malignant melanoma. New York: Masson Publishing USA, Inc., 1981:251-61. 4. Janzer RC, Makek MD. Intraoral malignant meIanotic schwannoma. Arch Pathol Lab Med 1983;107:298-301. 5. Diaz Perez JL, Burgos J, Alfaro A, et al. Schwannoma maligno melanotieo. Estudio ultrastructural. Actas Dermosif 1979;70:455-66. 6. Conley J, Lattes R, Orr W. Desmoplastic malignant melanoma: a rare variant of spindle cell melanoma. Cancer 1971 ;28:914-36. 7. Frolow GR, Shapiro L, Brownstein MH. Desmoplastic malignant melanoma. Arch Dermatol 1975; 111:753-4. 8. Aguade PP, Ferrando J, Bombi TA, et al. Melanoma desmoplastico. Med Cutan Ibero Lat Am 1977;2:77-92. 9. Batsakis JG, Bauer R, Regezi JA, et al. Desmoplastic melanoma of the maxillary alveolus. J Oral Surg 1979;37:107-9. 10. Valensi QJ. Desmoplastic malignant melanoma. A report of two additional cases. Cancer 1977;39:286-92.
Topical erythromycin preparations To the Editor: In our article, "Contact Allergen Alternatives" (J AM ACAD DERMATOL 1986;14:951), Dr. Adams and I mention the fact that although Ilotycin ophthalmic ointment is still available, Ilotycin ointment is not. It should be emphasized that the erythromycin in Ilotycin ointment was erythromycin base and that there have been no reports of allergic contact dermatitis to topical erythromycin base. All reports on delayed hypersensitivity to topical erythromycin have been either to the sulfate or stearate, but not to topical erythromycin base itself. 1.2 We reported that pharmacies can make up erythromycin ointment and that the shelf life o f such a preparation is indefinite. 3 However, I have recently learned that most pharmacies do not customarily stock erythromycin base powder. The tendency, therefore, is for pharmacists to triturate tablets and incorporate the resultant substances (with excipients) into the petrolatum. Such a procedure does not usually result in cosmetically or pharmaceutically acceptable ointment. Tablets containing erythromycin in dry form, marketed by various companies, have a shelf life of no
more than 3 years.* Obviously, the addition of such materials into ointments would not result in indefinitely prolonged shelf life of the antibiotic? The use of hydrophilic ointment as a vehicle for erythromycin has been suggested. 4 However, hydrophilic ointment contains 37% water and there are reports that an aqueous media inactivates erythromycin quite rapidly.5,t Recently I have been investigating the use of 2% erythromycin base ointment in a special vegetable oil base (E-Solve-2 ointment; Syosset Laboratories, Inc., Syosset, NY 11791). Thus far, E-Solve ointment has proved to be effective for impetigo and other infected dermatoses. It also can be used in pustular acne because it is nongreasy and has proved to be noncomedogenic.
A. A. Fisher, M.D. 45-15 48th St., Woodside, L.I., NY 11377 *Personal communicationFDA (on file) 8/21/1986. tTeehnical Bulletin #75-A102. AbbottLabs., Chicago, IL 60084.
REFERENCES 1. Fisher AA. Erythromycin "free base"--a nonsensitizing topical antibiotic for infected dermatoses and acne vulgaffs. Cuffs 1977;20:17-35. 2. Fisher AA. Is topical eryt.hromycin base non-allergenic? (Letter to Editor). Contact Dermatitis 1983;9.'243. 3. Adams RM, Fisher AA. Contact allergen alternatives: 1986. J AM AC_~DDERMATOL1986;14:951-69. 4. Mills OH, Kligman AM. Topically applied erythromycin in rosacea [letter to Editor]. Arch Dermatol 1976;112: 553. 5. United States Pharmacopeia, 21st revision. Rockville, MD: The United States Pharmacopeial Convention, Inc., 1980:756.
Leprosy and psoriasis To the Editor: To contend, as does Dr. Glickman (J AM ACAD DERMATOL 1986;14:863-6), in his article "Lepra, Psora, Psoriasis," that the disorder we now refer to as psoriasis was not distinguished from leprosy (i.e., Hansen's disease) until modem times does not accord with what Daniel Turner ~ wrote in 1726. What we know as psoriasis appears in Part 1, Chapter II (pp. 7-49) Of the Leprosy of the Greeks, whereas Hansen's disease occupies Chapter I (pp. 1-7)~ Of the Lep-
rosy of the Arabians. Not only does Tumer's description (pp. 32-41) of the ease of " a young gentlewoman, comely and of a slender make, about eighteen or nineteen years of age" fit perfectly with our conception of psoriasis: