Advances in HIV treatment and treatment toxicities.

Among the different classes and complexities of antiretroviral regimens, maximal viral suppression, sustained durability, increased CD4 count, decreased evolving resistance, and fewer side effects combined with increased compliance resulting in decreased morbidity and mortality remain the goals of therapy. Serial viral load measurements help best guide the direction of therapy. According to the CDC 20% fewer people died of HIV in 1998 compared to 1997 in the United States. HAART, although expensive (sometimes exceeding $20,000 per year), is not readily available to 95% of the estimated 36 million HIV-infected people in the world. HAART therapy commonly consists of two NRTIs and a protease inhibitor, but other combination regimens exist. The disadvantage of HAART therapy is that antiretroviral agents are not virucidal, thus eradication with these drug cocktails cannot be achieved. When HAART therapy is stopped, viral loads return to pre-treatment levels. New drug classes under investigation may completely prevent fusion between the HIV virus and healthy cells. For now, the epidemic can only be controlled with good public awareness, such as education, condom use, or abstinence. Because a cure does not seem immediately foreseeable, an effective prophylactic vaccine may afford protection. Defined treatment regimens exist for occupational postexposure prophylaxis. Ultimately, an expert in the field should be involved in manipulating drug regimens; however, dermatologists remain an integral part of the health care team because most HIV patients experience cutaneous manifestations related either to their HIV or to their drug therapy.     

Vitiligo treatment demystified: a flowchart for stratified treatment approaches

The recent publication by Anbar et al. in the April issue of this journal, delineating and prioritizing treatment options for vitiligo, is both timely and significant. First and foremost, this work brings to the forefront the important message that vitiligo truly is a treatable disease. All too often, patients refrain from seeking treatment as public opinion dictates that vitiligo is not an important disease, there are no effective treatments available, and insurance will not cover attempts to treat. By providing clear guidelines of treatments to be considered, practicing physicians seeing an occasional vitiligo patient will be more readily inclined to explore the possibilities currently available for enhancing the quality of life of this patient group.     

Melanoma treatment update

Except for high-dose interferon as adjuvant therapy in stage III disease, little success has emerged over the last 20 years for metastatic melanoma. Recent advances in melanoma biology suggest that disarming oncogenic mechanisms in melanoma may be an attractive approach to therapy. For instance, sustained expression of Bcl2 has been associated with an increased resistance to apoptosis, and recently, anti-sense-mediated reduction of Bcl2 levels was shown to chemosensitize patients to dacarbazine, dimethyl triazino imidazole carboxomide, or DTIC. Likewise, the identification of activating mutations in the RAS signaling pathway, including the NRAS and BRAF genes, opens up new therapeutic options for RAS and RAF inhibitors. A more thorough understanding of melanoma biology and tumor immunology will undoubtedly yield new promise for patients with advanced disease.     

Vitiligo nonsurgical treatment: a review of latest treatment researches

Vitiligo is a common depigmenting acquired disorder affecting about 1–2% of the world population, regardless of race, ethnic background, or gender. It is characterized by the appearance of milky white maculae because of a loss of melanocytes. The disfiguring nature of vitiligo causes high psychosocial morbidity. This is especially pronounced in populations with darker skin tone, likely because of the marked contrast. A variety of nonsurgical treatment regimens are currently employed in vitiligo. We reviewed the latest studies carried out on different nonsurgical treatment modalities used in vitiligo. All nonsurgical treatment aid to repigment or depigmentation the skin, however, many of them require a prolonged treatment course and may yield minimal results as well as carry unwanted side effects. There is a need for further research into the causes of vitiligo and into discovering better treatments.     

Vitiligo treatment update

Vitiligo is a common depigmenting disease that can affect the skin and mucosal surfaces. Various treatments have been used over the years with varying repigmentation rates. This review looks at the evidence of commonly used therapies for vitiligo.     

Lyme borreliosis treatment

ABSTRACT:  Lyme borreliosis is the most common human tick-borne illness in the Northern Hemisphere. The causative agent is the spirochete Borrelia burgdorferi species complex, and the hard-shell ticks of the genus Ixodes is responsible for pathogen transmission from animals to humans. The incidence of the disease is increasing year by year and although lyme disease is not fatal, it can affect the skin, heart, nervous, and musculoskeletal system with an impairment of quality of life. The appropriate diagnosis of lyme disease should be promptly treated by antibiotics to prevent late stage of the disease. The choice of antibiotics depends on many factors such as the stage of the disease, the drug efficacy, adverse effects, type of delivery, duration of treatment, and cost. Treatment failure occurs as a result of many reasons, re-infection is possible. The recommended treatment schedule in the Czech Republic is presented.     

Antiviral treatment regimens

The availability and use of effective antiretroviral combination therapies has dramatically decreased the morbidity and mortality of HIV infection. Almost complete suppression of viral replication by antiretroviral therapy prevents disease progression and development of resistance, as well as leading to both regression of HIV-associated symptoms and clinically relevant immune reconstitution. More than 20 antiretroviral substances in four classes have been approved. As a result of the broad therapeutic options, HIV infection can be better treated. Although a high number of combinations can be conceived, only a small number is actually applicable. The decisions to start, monitor and change therapy have become even more difficult. The indication for treatment, the selection of the most suitable therapy for an individual, the counseling of the patient, and the monitoring of the success of treatment demand a high level of knowledge and experience. Virologic failures of modern antiretroviral therapy regimens are rare in adherent patients.     

A combination of nonoperative treatment modalities used for treatment of keloids

Keloid is one abnormal wound healing that occurs commonly in predisposed individuals. Many treatment modalities have been tried, either alone or in variety, including surgical removal, laser therapy, radiation therapy, silicone cream or gel application, cryosurgery, and intralesional injection of various agents. These treatment options have been practiced with largely transient and limited success. In the present study, the present authors prospectively assessed the efficacy of combination methods of the treatment of recalcitrant keloid. One hundred fifty‐one sites of keloids in 122 patients were chosen, age of patients varied between 15 and 60 years, size of scar more than 2 cm² with pain, itch, or other discomfort, and duration of more than 2 years. Keloids were treated with combination methods of lasers and ³²P radiation on originating scars. One hundred eleven of 151 evaluated sites scored “excellence” and 40 belonged to “effectiveness”. These patients demonstrated local control and have remained free of local recurrence for more than 2 years. In addition, there were only 21 and 32 sites with pigmentation and depigmentation, respectively. Over the past 5 years, we established a treatment protocol combining laser with ³²P‐patch contact brachyradiotherapy, which represents a safe and effective option in the treatment of keloids.     

Matching physicians’ treatment recommendations to patients’ treatment preferences is associated with improvement in treatment satisfaction

Background Dissatisfaction with treatment is common among those with psoriasis. While incorporating patients’ preferences into the process of treatment decision‐making may improve satisfaction, this relationship has not been clearly established. Objective To assess the extent to which matching physicians’ treatment recommendations to patients’ treatment preferences is associated with improvement in treatment satisfaction in patients with moderate‐to‐severe psoriasis. Methods This prospective cohort study design examined change from baseline to 3‐month follow‐up in four subscales of an established measure of treatment satisfaction. Separate multivariate regression models investigated the association of change in these subscale scores with an index measuring the match between physicians’ treatment recommendations and patients’ treatment preferences at the initial study visit. Results A closer match between physicians’ recommendations and patients’ preferences was associated with greater improvement in treatment satisfaction over time in each of the four subscales: effectiveness (β = 0.53, P < 0.001), side‐effects (β = 0.25, P = 0.009), convenience (β = 0.78, P < 0.001) and global satisfaction (β = 0.49, P < 0.001). Adjusted models explained as much as 76% of the variation in change in treatment satisfaction subscales over 3 months. Conclusions Further efforts to incorporate patients’ preferences in treatment decision‐making appear justified given the strength of independent associations between preference matching and improved treatment satisfaction and the extent to which our models explained variation in this relationship. An approach based on preference matching shows promise for increasing satisfaction in the management of other chronic diseases.     

着色芽生菌病的治疗进展

着色芽生菌病是暗色真菌引起的感染性疾病中最为常见的一种。患者多是通过外伤将病原菌接种于机体而导致皮肤及皮下感染。该病治疗困难且易复发,至今仍无治疗的金标准。目前多采用手术疗法、物理疗法(CO_2激光、冷冻治疗)、化学疗法及联合疗法等,光动力、免疫调节剂等新的治疗手段和方法也应用于临床。本文就目前该病的治疗进展进行综述。     

Tetracycline and minocycline treatment

The effect of 1,000 mg of tetracycline hydrochloride and 200 mg of minocycline hydrochloride on Propionibacterium acnes levels and skin-surface lipid levels was measured in 15 patients with acne. Minocycline produced a significantly greater reduction in the P acnes counts that persisted even up to three weeks after discontinuation of the minocycline therapy, in contrast to the return of P acnes to baseline counts within three weeks after discontinuation of tetracycline therapy. A similar persistence of effect for reduction of skin-surface free fatty acid levels and clinical lesions was also seen with minocycline therapy.