A case of Darier''s disease successfully treated with topical tacrolimus

Tacrolimus is a macrolide that inhibits T-cell activation. The most extensive experience with topical tacrolimus has been in treating atopic dermatitis but it has been used in various skin diseases, including Hailey-Hailey disease, with encouraging results. We report a case of extensive Darier's disease successfully treated with topical tacrolimus, after suspension of oral isotretrinoin due to major depression.     

The unmet treatment need for moderate to severe psoriasis: results of a survey and chart review

BACKGROUND: Conventional systemic therapies and phototherapy for psoriasis are limited by safety concerns that may preclude long-term treatment with these agents. OBJECTIVES: To estimate the unmet need for safe and effective treatments for psoriasis. METHODS: A survey was conducted at three psoriasis outpatient clinics in Europe. Male and female patients of any age with psoriasis requiring more than topical treatment were eligible to participate in the survey. Patient data were obtained from patients' answers to a questionnaire as well as by a chart review of each participating patient. The survey questionnaire addressed various aspects of psoriasis, including demographics and disease characteristics, treatment history, pre-existing medical conditions, and patient satisfaction with treatments received. RESULTS: A total of 301 patients participated in the survey, with approximately 100 patients from each centre. Nearly 90% of patients had received at least one systemic therapy or phototherapy for psoriasis, with 39% of patients receiving three or more. Ultraviolet B (UVB), methotrexate, psoralen plus ultraviolet A (PUVA), retinoids and cyclosporin were the most commonly used agents. Inadequate response, reported by patients as no change or worsening of disease with treatment, ranged from 10% to 50%. Contraindications to conventional systemic therapies were reported by 9-22% of patients. A substantial number of patients (42%) were not satisfied with these therapies. CONCLUSIONS: This survey highlights the unmet need for safe and effective therapies for moderate to severe psoriasis.     

Recommendations for the topical treatment of psoriasis

Several topical treatments are available for patients with psoriasis. Although individualization of the treatment remains important, there is a need for treatment recommendations to identify the best treatment out of the available treatments and to help with improvement in treatment compliance. In this communication we give our views on the assessment of severity of psoriasis. We provide recommendations for selection of treatments, reconciling the clearance phase and the long‐term management. Finally, we provide recommendations for the treatment of particular localizations: the scalp and psoriasis at sensitive sites.     

Determination of isotretinoin or etretinate and their major metabolites in human blood by reversed-phase high-performance liquid chromatography

A method is described for the quantitative analysis of isotretinoin and its 4-oxo metabolite, or of etretinate and its principal metabolites, in human blood in the range 10-2000 ng/ml. Following a simple one-step extraction, the compounds are determined by reversed-phase high-performance liquid chromatography (HPLC) with gradient elution and detection at 365 nm. This highly specific method separates the cis and trans isomers of the parent compounds and their metabolites. Examples are given of the application of this method to clinical studies of these two therapeutically important retinoids.     

孔源性视网膜脱离患者视网膜下液维A酸含量的分析

采用高效液相色谱法研究 5 6例孔源性视网膜脱离患者的视网膜下液 (SRF)及血清维A酸的含量 ,并观察部分患者服用维生素A对其的影响。结果示 ,患者SRF中维A酸的含量与增殖性玻璃体视网膜病变 (PVR)程度、视网膜脱离范围和术前服用维生素A的天数呈正相关 (r1=0 .85 1,P <0 .0 0 ;r2 =0 .4 5 2 ,P <0 .0 1;r3=0 .4 3 1,P <0 .0 5 ) ;血清维A酸的含量与眼部病变无关 ;SRF中维A酸在口服维生素服药第 4d时显著增高。结果表明视网膜脱离后 ,色素上皮和神经上皮之间代谢关系发生紊乱 ,造成维A酸循环利用障碍。服用维生素A有利于阻止PVR的发生和发展。     

Dietary retinoids and carotenoids in rodent models of mammary tumorigenesis

In this review of the scientific literature the relationship between retinoids, carotenoids, and mammary carcinogenesis is examined. Several retinoids have shown promise as chemopreventive agents against chemically induced mammary carcinogenesis in mice and especially in rats. The most promising retinoids are retinyl acetate (RA) and N-(4-hydroxyphenyl)retinamide (4-HPR, fenretinide). In rats, dietary administration of these retinoids reduced tumor incidence and multiplicity, and increased the latency of DMBA or MNU-induced mammary cancers. In mice, 4-HPR reduced the number of hyperplastic alveolar nodules and the number of tumors in MTV- and MTV+ mice, respectively. Among retinoids, 4-HPR is at present the most promising analogue, due to its ability to concentrate in the mammary gland. The combination of 4-HPR with tamoxifen not only is more effective in suppressing breast cancer than either agent alone, but also inhibits the appearance of subsequent cancers following the surgical removal of the first tumor. These studies suggest that retinoids, like tamoxifen, may be applicable to the prevention of contralateral breast cancer in women who underwent breast cancer surgery. It is also becoming evident that differentiation therapy and chemoprevention can become attractive alternative approaches to intensive cytotoxic chemotherapy. The role of carotenoids in the prevention of mammary carcinogenesis, however, is ambiguous. Poor absorption and low levels of carotenoids that reach the target tissues complicate interpretation of data in rodent models of mammary carcinogenesis. Very few animal studies are presently available in which purified carotenoids were found effective against mammary carcinogenesis. These results do not justify undertaking clinical evaluation of individual carotenoids against breast cancer at this time.     

Effects of Synthetic Retinoids on the Growth of Bacteria and Their Susceptibility to Antibiotics

Summary

In patients treated with oral retinoids the recovery of Propionibacterium acnes and other anaerobic bacteria in the skin is markedly reduced, whereas an increased colonization of the skin and a significant rise in the incidence of cutaneous staphylococcal infections are observed. Since very little is known about the effects of retinoids on bacteria, in the present study we investigated the influence of 4 retinoids (isotretinoin, etretinate, arotinoid ethyl ester, arotinoid sultane) in 15 different concentrations on the growth of 10 Gram-positive and Gram-negative bacteria in vitro and on their susceptibility to 10 antibiotics.

It was found that all retinoids were not capable of affecting either the growth of bacteria or their susceptibility to antibiotics. It seems reasonable, therefore, to assume that the retinoid-induced changes in cutaneous bacterial flora in vivo are due to mechanisms other than to the direct action of these compounds on bacteria.