A Hydroquinone Solution in the Treatment of Melasma

ABSTRACT: Two versions of a 3% hydroquinone solution in a hydroalcoholic solution were tested in 46 patients with melasma. The more effective of the two solutions tested, Formula A, was found to produce improvement in 88% of the patients, with moderate to marked improvement in 36% of them with minimal side effects. The usage of a sunscreen agent seems to be necessary for therapeutic efficacy.     

Photochemotherapy in the treatment of psoriasis

This article describes the satisfactory clinical improvement obtained in the majority of a group of 72 patients with psoriasis of various types as a result of the oral and/or topical administration of 8–methoxypsoralen followed by long wavelength ultraviolet irradiation. The irradiation source used was that of conventional longwave UV fluorescent tubes mounted in a specially constructed cubicle. Until such time as the long term effect of this form of photochemotherapy on the cell has been evaluated and the most appropriate regime worked out, it would seem to be important to restrict the amount of irradiation used to that required to produce acceptable maintained clinical improvement.     

Solar urticaria: treatment with PUVA and mediator inhibitors

Several therapeutic regimes for solar urticaria were evaluated. A short course of PUVA therapy produced a marked increase in the minimal dose of radiation required to produce urticaria in the six patients treated. This objective evidence of improvement was supported by the patients' reports of greatly increased tolerance to sun-exposure. Chlorpheniramine, an antihistamine, produced a slight increase in the minimal dose of radiation necessary to produce urticaria but its effectiveness was limited by side-effects. Indomethacin, an inhibitor of prostaglandin synthetase, produced no beneficial effect.     

Angiosarcoma arising in sclerodermatous skin

We report a case of cutaneous angiosarcoma in a 77-year-old female patient with systemic sclerosis. The tumor developed around a large telangiectasia in the left temporal region. Later on, extensive asymptomatic redness and edema with several nodules over the whole left side of the face developed. Since the conservative therapy failed to produce any improvement, a diagnostic skin biopsy was performed. The pathohistological diagnosis was moderately differentiated angiosarcoma. The patient was treated with a combination of chemotherapy and electron beam irradiation. Despite a notable cutaneous improvement, the control check-up revealed the presence of metastases of the lung and liver. This is the first report of cutaneous angiosarcoma occurring in sclerodermatous skin. The possible pathogenesis of this rare tumorogenic transformation of soft tissues is discussed.     

Clofazimine (B663, Geigy) in Leprosy Reactions

Ten Solomon Island patients with troublesome leprosy reactions were treated with clofazimine in an uncontrolled clinical trial. In every case benefit resulted to the patient in one or more of the following ways: clofazimine had the ability to suppress reactions; to replace cortico-steroid therapy; to cover the effect of increasing the dosage of dapsone; and to produce clinical improvement without serious side effects.     

Reduction of environmental mites improved atopic dermatitis patients with positive mite-patch tests.

During a series of studies on the involvement of house dust mite antigens in 183 cases of atopic dermatitis, we observed an improvement in two patients following the removal of mites from their environment by means of a thorough housecleaning and replacement of the mattress. Both patients manifested the typical clinical skin lesions of atopic dermatitis and had similar laboratory findings. Although the serum IgE concentrations and specific IgE to Dermatophagoides pteronyssinus and Dermatophagoides farinae were each relatively low, the results of patch tests with these antigens were positive. Thus, a regimen aimed at reducing the presence of house dust mites can produce clinical improvement in a subset of patients with atopic dermatitis who show contact hypersensitivity to mite antigens on skin testing, but negative results on IgE (RAST; radioallergosorbent technique) testing.     

A comparison of the effectiveness of topical tetracycline, benzoyl-peroxide gel and oral oxytetracycline in the treatment of acne

A proprietary topical tetracycline preparation (Topicycline) was compared with an alcohol-based 5% benzoyl-peroxide gel and with oral oxytetracycline (250 mg twice daily) using a randomized group-comparative double-blind study in 69 patients with mild to moderate acne. Facial acne grades improved significantly in all three treatment groups over the 12-week study period but chest acne grades did not change significantly and only oxytetracycline produced a significant improvement in back grade. All three treatment groups produced a significant reduction in facial inflamed and non-inflamed lesions apart from oxytetracycline which failed to produce a significant reduction in inflamed lesions. However, there were no overall significant differences between the three treatment groups either in improvement of acne grade or in reduction of inflamed and non-inflamed lesions. We conclude that topical tetracycline is as effective as either 5% benzoyl-peroxide gel or 250 mg oxytetracycline twice daily in the treatment of mild to moderate acne.     

Topical cyclosporin in oral lichen planus: a controlled, randomized, prospective trial

The published studies of topical cyclosporin (CyA) therapy in chronic oral lichen planus (OLP) have shown conflicting results. We report an investigator-blinded study of 13 patients with OLP, who were randomly assigned to treatment with CyA (500 mg as a swish-and-spit medication for 5 min three times daily) or a corticosteroid oral paste (triamcinolone acetonide). The duration of treatment was 6 weeks. Thereafter, patients on corticosteroid therapy were treated with CyA. Only slight, transient clinical improvement was observed in both groups after 6 weeks of treatment, compared with baseline. No significant differences could be demonstrated between the two groups. CyA therapy following corticosteroid treatment did not produce any further clinical improvement. During follow-up of the disease for up to 1 year after treatment, neither the CyA nor the corticosteroid group exhibited long-term improvement in disease activity. Contradictory results from earlier reports are discussed.     

Subcorneal Pustular Dermatosis Treated with Phototherapy

A 12-year-old boy had a 5-year history of recurrent generalized dermatoses with scales, crusts, and pustules. Histologic findings showed subcorneal blisters filled with polymorphonuclear leukocytes typical of subcorneal pustular dermatosis. Dapsone and prednisolone with a topical fluocinolone acetonide did not produce improvement. The skin lesions cleared completely after 11 exposures of UV-B three times a week. After 8 months of follow-up, there has been no recurrence.     

Novel technique to treat melasma in Chinese: The combination of 2940-nm fractional Er:YAG and 1064-nm Q-switched Nd:YAG laser

Melasma is one of the most common pigmented lesions in Chinese women. Although topical therapies are the mainstay treatment, lasers are being used increasingly to treat pigmented lesions. Laser treatment of melasma is however still controversial. This is because lasers have not been able to produce complete clearance of melasma and recurrence rates are high. Laser treatments also cause complications such as hypopigmentation and post-inflammatory hyperpigmentation. In this article, we report on a novel technique using a combination of fractional 2940-nm Er:YAG and 1064-nm Q-switched Nd:YAG lasers. We achieved a rapid improvement in two cases of melasma in Chinese type III skin. The improvement was seen rapidly within a month of treatment. Follow-up at 6 months showed sustained results with no complications. This novel technique is able to safely confer excellent and sustained clearance within a short treatment time.     

Drug-induced bullous pemphigoid: cases triggered by intravenous iodine and etanercept

Bullous pemphigoid (BP) is one of the most common acquired immunobullous diseases. Rarely, the development of BP is attributed to drug exposure. We present two cases of BP, one triggered by intravenous iodine, and one associated with etanercept treatment in a patient with psoriasis; the first time, to our knowledge, that either of these associations has been reported. The recognition of occasional cases of drug-induced BP such as ours, with timely cessation of the offending agent, may produce rapid clinical improvement with decreased exposure to potent immunosuppressive therapy.     

Laser therapy of freckles and lentigines with quasi-continuous,frequency-doubled,Nd:YAG (532 nm) laser in Fitzpatrick skin type IV: a 24-month follow-up

BACKGROUND : Newly developed lasers produce excellent results with minimal complications compared with traditional treatments for freckles and lentigines. OBJECTIVES : To assess the efficacy and safety of the frequency-doubled Nd:YAG (532 nm) laser in the treatment of freckles and lentigines in type IV skin. PATIENTS AND METHODS : Twenty adult patients (14 with freckles and six with lentigines) were subjected to a variable number of treatments with a minimum 4-week interval until no additional improvement occurred or > 75% improvement was obvious. Patients manifesting > 50% improvement were followed up once every 3 months for 24 months. The rest were regarded as treatment failures and not followed up. RESULTS : Sixteen (80%) of 20 patients (freckles, n = 10; lentigines, n = 6) manifested more than 50% improvement. They were irradiated between three and eight times with a 4-12-week interval. Complications included hypopigmentation (25%), mild textural changes (15%) and hyperpigmentation (10%). All these were mild and resolved within 2-6 months. Of 10 patients with freckles followed up for 24 months, four (40%) patients showed partial recurrence. However, all the patients maintained > 50% improvement. None of the patients with lentigines showed recurrence. CONCLUSION : The quasi-continuous, frequency-doubled Nd:YAG (532 nm) laser safely and effectively treats freckles and lentigines in Fitzpatrick skin type IV.     

An assessment of the effect of photo-chemotherapy (PUVA) and UV-B phototherapy in the treatment of psoriasis

We have shown that it is possible to produce a satisfactory clinical response with a low UV-A dosage regime in approximately one-third of patients with widespread chronic psoriasis. UV-B phototherapy is as effective initially, but the improvement is not as well maintained as that resulting from photochemotherapy (PUVA). However, in view of the probability that unwanted side effects of PUVA are related to the amount of UV-A irradiation administered, it would seem appropriate to restrict the use of the higher dosage regimes to selected patients and to those who have not responded to an initial low dosage regime or to UV-B phototherapy.     

Hyalinosis cutis et mucosae: a 30 year follow up of a female patient

Hyalinosis cutis et mucosae is an inherited disease, characterized by deposition of a hyaline-like substance in the dermis and internal organs. In the present study, we report a 30 year follow up in a female patient with hyalinosis cutis et mucosae treated using dermabrasion and oral retinoids. In our opinion, the lesion on uncovered body areas should be corrected as soon as possible to enable a normal psychophysical development. The lesions on skin and oral mucosa may be successfully removed without remission with dermabrasion in early childhood. In addition, oral retinoids in adulthood may produce some improvement.     

Glycolic acid peel in disseminated facial verrucae

Facial warts are a common cause of cosmetic concern and also affect the self-esteem of the affected patients. These are benign skin papillomas caused by human papillomavirus infections. Warts affecting the face are mainly due to HPV-3 and HPV-10. Destructive and caustic agents used for the treatment can produce scarring at these site, hence should be used with care. Earlier, glycolic acid alone as well as in combination with salicylic acid in gel base formulation have been used to treat facial recalcitrant wart with good results. We used glycolic acid peel in aqueous base with dramatic improvement     

Isotretinoin treatment of acne and related disorders: an update

In the one year since isotretinoin has been available in the United States for the treatment of severe, recalcitrant, nodulocystic acne, there has been extensive clinical verification of the reports of its dramatic efficacy in the treatment of this troublesome disease. Proper selection of patients, as well as treatment with adequate doses of drug for 3 to 5 months, will most often result in significant clinical improvement or total clearing. Although dosages of less than 1 mg/kg/day may produce a nearly equivalent degree of improvement with somewhat fewer or less severe side effects, the recommended daily dose remains 1 mg/kg/day because lower dosages are associated with more frequent relapses. In severe cases, the daily dosage may be increased to 2 mg/kg/day. Teratogenicity, elevation of serum triglycerides, liver function abnormalities, pancreatitis, and pseudotumor cerebri may all be associated with isotretinoin therapy and require close monitoring of the patient.     

Stripping operations of the parva and magna saphenous veins. Long-term study in relation to pre- and postoperative dysfunction

BACKGROUND AND OBJECTIVE: Little data is available on the log-term effects of stripping the greater and lesser saphenous veins in combination with pre- and post-operative function tests. The goal of this study was to record the long-term course after surgery based on the function data. PATIENTS/METHODS: Drain-off capability was measured preoperatively and postoperatively by light reflection rheography in 203 patients (58 men, 145 women) between 17 and 79 years. Questionnaires were used about 9 years after surgery to determine the nature of the post-operative complaints. RESULTS: Nine years after surgery 58% of the patients still had no discomfort, and 78% had fewer problems with venous ulcers. About 60% reported improvement of swelling and skin changes. The results tended to be better in men. Freedom of complaints was longer-lasting where venous drainage had been good before surgery. CONCLUSIONS: Stripping operations can produce long-lasting improvement of venous ulceration and the above-mentioned complaints in a high percentage of patients.     

Ketanserin in the treatment of systemic sclerosis: a double-blind controlled trial

In a randomized, double-blind study, the selective and specific S2-serotonergic receptor antagonist, ketanserin was compared with placebo in 24 patients with systemic sclerosis. Following a 6-week placebo washout period, patients were randomly allocated to receive ketanserin or placebo for 6 months. Ketanserin failed to produce a greater improvement than placebo in functional and objective clinical signs and symptoms as well as in most subjective assessments. However, in a global rating by the physician ketanserin was superior to placebo. No difference in the frequency or severity of side-effects was found. The results cast doubt on the hypothesis that serotonin may be a major contributing factor in the pathophysiology of systemic sclerosis.     

Is Erythromycin an Effective Treatment for Chronic Bullous Disease of Childhood? A National Survey of Members of the British Society for Paediatric Dermatology

Abstract:  Chronic bullous disease of childhood is the commonest acquired blistering disorder of children. Erythromycin has been reported to be beneficial for this condition. A three question survey was e-mailed to all members of the British Society for Paediatric Dermatology to assess the incidence, preferred treatments and experience of oral erythromycin in treating chronic bullous disease of childhood. A second, more detailed questionnaire was sent to members who had used erythromycin. Forty patients were reported to have been treated over the previous 2 years. The preferred treatment was dapsone. Erythromycin alone had been used in five children as first-line oral treatment. In three of these patients the initial improvement was graded as either "good" or "complete resolution." This benefit was only sustained in one child, with the other two relapsing between 4 and 12 weeks. In a further eight children, erythromycin had been used with other oral agents. In five of these children, erythromycin was associated with long-term benefit. These results suggest that erythromycin is unlikely to produce sustained improvement in chronic bullous disease of childhood when used as a sole first-line agent. However, erythromycin can cause an initial improvement, which may be useful whilst awaiting results of diagnostic tests and may confer benefit when used with other systemic treatments.     

Short-contact anthralin therapy for psoriasis using an aqueous cream formulation

A pilot study of five patients was conducted using an aqueous anthralin cream (Drithocreme) and demonstrated that between twenty and forty minutes was an effective contact time to produce an improvement in induration of psoriatic plaques. In a further, bilateral controlled study, the anthralin cream was used to treat twenty patients with symmetrical chronic plaque psoriasis. The cream was applied to one side of the body overnight and then to the other side in the morning. Thirty minutes later it was washed off both sides in a bath or shower. The results indicated that both overnight and short-contact treatment were equally effective, and the short-contact treatment reduced staining and irritation.