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Notes: Melasma is a cosmetic problem that sometimes causes great emotional suffering. The two most important causative factors are sunlight and genetic predisposition. Moreover, natural and synthetic estrogens, the use of certain drugs and the use of cosmetics with certain components have been implicated as etiologic factors. For the treatment of melasma, the elimination of the factors that are associated with the abnormality of pigmentation, is essential (discontinuation of birth control pills, avoidance of sun exposure). From the many medications that have been used in the treatment of melasma, Hydroquinone alone at a concentration of 2-5%, or in combination with tretinoin or tretinoin and corticosteroids, is now the most widely used preparations. New phenolic compounds and Azelaic acid are also used. Medium depth chemical peeling alone or in combination with other bleaching agents has also been tried with success in some cases. Finally, the use of lasers is discussed.

Notes: In this study we have evaluated the use of blue light (peak at 415 nm) and a mixed blue and red light (peaks at 415 and 660 nm) in the treatment of acne vulgaris. One hundred and seven patients with mild to moderate acne vulgaris were randomized into four treatment groups: blue light, mixed blue and red light, cool white light and 5% benzoyl peroxide cream. Subjects in the phototherapy groups used portable light sources and irradiation was carried out daily for 15 min. Comparative assessment between the three light sources was made in an observer-blinded fashion, but this could not be achieved for the use of benzoyl peroxide. Assessments were performed every 4 weeks. After 12 weeks of active treatment a mean improvement of 76% (95% confidence interval 66–87) in inflammatory lesions was achieved by the combined blue–red light phototherapy; this was significantly superior to that achieved by blue light (at weeks 4 and 8 but not week 12), benzoyl peroxide (at weeks 8 and 12) or white light (at each assessment). The final mean improvement in comedones by using blue–red light was 58% (95% confidence interval 45–71), again better than that achieved by the other active treatments used, although the differences did not reach significant levels. We have found that phototherapy with mixed blue–red light, probably by combining antibacterial and anti-inflammatory action, is an effective means of treating acne vulgaris of mild to moderate severity, with no significant short-term adverse effects.

Notes: Background Topical application of isotretinoin and adapalene has proved effective in treating acne vulgaris. Both drugs demonstrate therapeutic advantages and less irritancy over tretinoin, the most widely used treatment for acne. They both act as retinoid agonists, but differ in their affinity profile for nuclear and cytosolic retinoic acid receptors. Objectives To compare the efficacy and tolerability of adapalene gel 0·1% and isotretinoin gel 0·05% in the treatment of acne vulgaris of the face, in a randomized open-label clinical trial. Methods Eighty patients were enrolled and were instructed to apply adapalene gel 0·1% or isotretinoin gel 0·05% once daily over a 12-week treatment period. Efficacy determination included noninflammatory and inflammatory lesion counts by the investigator and global evaluation of improvement. Cutaneous tolerance was assessed by determining erythema, scaling and burning with pruritus. Results Adapalene and isotretinoin gels were highly effective in treating facial acne. Adapalene gel produced greater reductions in noninflammatory and inflammatory lesion counts than did isotretinoin gel, but differences between treatments were not statistically significant. Adapalene gel was significantly better tolerated than isotretinoin gel during the whole treatment period. Conclusions The two gels studied demonstrated comparable efficacy. When adapalene and isotretinoin were compared, significantly lower skin irritation was noted with adapalene, indicating that adapalene may begin a new era of treatment with low-irritant retinoids.

Notes: Sixty patients (aged 12–30 years) were enrolled in a 12-week, double-blind, randomized study to compare the efficacy of clindamycin phosphate 1% topical solution with oral tetracycline for the treatment of moderate acne. Forty-four patients (22 in each group) were evaluable. All patients experienced significant reductions in numbers of pustules, papules and inflamed nodules, and there were no significant differences between the two groups. Both treatment regimens were well tolerated, and no systemic side-effects were reported. Topical clindamycin phosphate 1% is considered a safe and effective alternative to oral tetracycline for the treatment of moderate acne vulgaris.

Notes: Psoriasis is a chronic, immune-mediated disorder that usually requires long-term treatment for control. Approximately 25% of patients have moderate to severe disease and require phototherapy, systemic therapy or both. Despite the availability of numerous therapeutic options, the long-term management of psoriasis can be complicated by treatment-related limitations. With advances in molecular research and technology, several biological therapies are in various stages of development and approval for psoriasis. Biological therapies are designed to modulate key steps in the pathogenesis of psoriasis. Collectively, biologicals have been evaluated in thousands of patients with psoriasis and have demonstrated significant benefit with favourable safety and tolerability profiles. The limitations of current psoriasis therapies, the value of biological therapies for psoriasis, and guidance regarding the incorporation of biological therapies into clinical practice are discussed.

Notes: Summary Background There is evidence that a T-helper (Th) 2 cytokine pattern dominates in the peripheral blood as well as in tissue of patients with Sézary syndrome (SS), and that the malignant clone is of Th2 phenotype. However, there are conflicting studies on the cytokine pattern in the peripheral blood in different stages of cutaneous T-cell lymphoma (CTCL). Objectives To examine, by means of flow cytometry (FC), the Th1/Th2 cytokine profile [cytoplasmic interferon (IFN)-γ/interleukin (IL)-4] in peripheral blood T cells from patients with mycosis fungoides (MF) and SS, the most common forms of CTCL, and to correlate their expression with clinical stage, clonality and T-cell immunophenotype changes in order to evaluate their relevance in CTCL progression. Methods We investigated by FC the percentage of CD3+ T cells expressing cytoplasmic IFN-γ and IL-4 after stimulation in blood specimens of 43 CTCL patients (32 stage I–II and 11 stage III–IV), eight of whom were erythrodermic. Next, we compared cytoplasmic IFN-γ and IL-4 expression between patients of different stages and controls, and correlated our findings to T-cell receptor (TCR)-γ gene rearrangement, used as a marker of clonality, and changes in T-cell immunophenotype (CD4+, CD8+, CD4+/CD7–, CD4+/CD25+) and natural killer cells. Polymerase chain reaction amplification of the TCR-γ gene was performed in 41 blood and 26 skin specimens. We also examined the cytokine expression pattern in patients with erythrodermic MF and SS. Results A significantly higher frequency of CD3+/IL-4+ T cells was found in late (III–IV) compared with early (I–II) CTCL patients (P = 0·002) or controls (P 〈 0·001). There were significant positive correlations between the percentages of CD3+/IL-4+ and the percentages of CD3+/CD4+ T cells (r = 0·385, P = 0·05), CD4+/CD7– T cells (r = 0·335, P 〈 0·05) and CD4+/CD25+ T cells (r = 0·433, P = 0·01); there was a negative correlation between the percentages of CD3+/IL-4+ and CD3+/CD8+ T cells (r = −0·463, P = 0·005) and a positive correlation between the percentages of CD3+/IFN-γ+ and CD3+/CD8+ T cells (r = 0·368, P = 0·02). Increased percentages of CD3+/IL-4+, CD3+/CD4+ and CD4+/CD7– T lymphocytes were associated with the presence of clonality (P = 0·025, P 〈 0·001 and P = 0·0031, respectively). All independent variables showed a statistically significant difference between SS and erythrodermic MF patients, or controls, apart from cytoplasmic IL-4, which was high both in erythrodermic MF and SS patients compared with controls (P = 0·003 and P = 0·008, respectively). In multiple regression logistic analysis, the probability of belonging to advanced CTCL stages was associated only with increased cytoplasmic IL-4 (P = 0·007, odds ratio 1·13, 95% confidence interval 1·033–1·229). Conclusions Increased T-cell cytoplasmic IL-4 is more frequent in late CTCL stages, correlates with T-cell immunophenotype changes found in advanced disease and is associated with clonality. Increased cytoplasmic IL-4 is frequent both in erythrodermic MF and SS patients, in contrast to other variables found increased only in SS, suggesting that IL-4 may be an early indicator of disease progression. Moreover, our results show that increased cytoplasmic IL-4 is the sole predictor of advanced CTCL disease and confirm the relevance of FC determination of IL-4 in the routine evaluation of CTCL cases.

Notes: : The administration of phenylalanine (Phe) combined with UVA exposure was found to be effective in treating vitiligo. Twenty-one patients with vitiligo were divided in two groups: eleven patients were treated with oral L-Phe in a dose of 100 mg/kg body weight and with UVA exposure and ten patients were treated with oral L-Phe in a dose of 100 mg/kg body weight and with UVA exposure. In addition, in the second group, a cream containing 10% L-Phe was applied to the vitiliginous areas. The best results occurred in the second group. No side effects were found in either group.

Notes: Forty-five patients with tinea corporis or tinea cruris were treated with oral itraconazole 100 mg daily for 15 days. At the end of the 15-day treatment, 80% of the patients were healed or had markedly improved. At the first follow-up visit, 2 weeks after stopping therapy, 80% of patients were considered responders. An additional follow-up visit another month later (i. e. 6 weeks post-treatment) showed that 32 of 41 patients had responded (78%). Overall, the mycological cure rate (culture and microscopy negative) was somewhat lower than the clinical response rate. Only three patients reported minor side effects (7%). Nausea was reported by two patients and an urticarial reaction was seen in one patient after 8 days treatment. This latter patient discontinued therapy because of the adverse experience. It is concluded that itraconazole, given at a daily dose of 100 mg for 15 days, is effective in the treatment of tinea corporis and tinea cruris. Response rates at the last visit (6 weeks post-therapy) remained at the same satisfactory levels as at the first follow-up visit (2 weeks post-therapy), even though treatment was stopped after 2 weeks. Itraconazole appears to be well tolerated by patients. These results, both in terms of efficacy and side effects, are in line with results reported by other investigators. The fact that the mycological cure rates were somewhat lower than the clinical response rates had apparently no influence on the relapse rate at 6 weeks follow-up post-therapy.