Search PubMed⌕ Search

Biomedical subjects

A D Katsambas

Publications and source records attributed to A D Katsambas.

15 recordsLinked to original sources
PubMed2003

A randomized trial of amorolfine 5% solution nail lacquer in association with itraconazole pulse therapy compared with itraconazole alone in the treatment of Candida fingernail onychomycosis.

BACKGROUND: Treatment failures and relapses are not uncommon in onychomycosis. Therefore, it is worthwhile to consider the combination of systemic and topical antifungals to improve the cure rates further and to reduce the duration of systemic treatment. OBJECTIVES: To evaluate and compare itraconazole pulse therapy combined with amorolfine with itraconazole alone in the treatment of Candida fingernail onychomycosis. METHODS: Ninety patients with moderate to severe Candida fingernail onychomycosis were randomized into two treatment groups of 45 subjects each. Group 1 received itraconazole pulse therapy for 2 months and applied amorolfine 5% solution nail lacquer for 6 months, while group 2 received monotherapy with three pulses of itraconazole. The primary efficacy criterion was the result of mycological examination at 3 months. The secondary criterion was the combined mycological and clinical response at 9 months. A pharmacoeconomic analysis was also performed to compare the cost-effectiveness of combined therapy vs. monotherapy. RESULTS: Eighty-five patients were analysed (73 women and 12 men, mean +/- SD age 44.2 +/- 12.9 years). Patients had a mean +/- SD of 3.64 +/- 2.0 nails involved and 228.6 +/- 148.0 mm2 of their nail surface diseased. The mean duration of onychomycosis was 11 months. Paronychial involvement was evident in 71 patients. C. albicans was isolated in 85 cases, C. parapsilosis in three and other Candida species in two cases. Side-effects were uncommon and in only one case led to withdrawal. At the 3-month visit, mycological cure was seen in 32 (74%) of 43 patients in group 1 and in 25 (60%) of 42 patients in group 2. At the 9-month visit, a global cure was seen in 40 patients (93%) in group 1 and in 34 patients (81%) in group 2. Statistical analysis showed no statistically significant difference (P > 0.1) between the two treatment groups. The cost per cure ratio was 1.63 and 1.70euro for groups 1 and 2, respectively. CONCLUSIONS: The combination of amorolfine and oral itraconazole, which interfere with different steps of ergosterol synthesis, exhibited substantial synergy. Compared with oral itraconazole alone, the combination achieved greater mycological cure and increased total cure rate. However, no statistically significant difference was documented for this number of observations. Combination treatment with amorolfine and two pulses of itraconazole is at least as safe and effective as three pulses of itraconazole, with a lower cost per patient. In our opinion, the addition of amorolfine to oral itraconazole pulse therapy is of value in the treatment of moderate to severe Candida fingernail onychomycosis.

Administration, Cutaneous↗
PubMed2002

Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte.

BACKGROUND: Poikiloderma of the face and neck (Civatte) is a rather common, indolent, chronic dermatosis, most often affecting menopausal females. Cumulative excessive sun exposure, a phototoxic or a photoallergic reaction, hormonal changes of menopause and genetic factors have all been incriminated in its obscure aetiopathogenesis. OBJECTIVE: To evaluate the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte (PC). METHODS: Thirty-two patients (24 females and eight males, age range 38-74 years) with PC were patch tested with the European standard series and the fragrance series, and were photopatch tested with the photoallergens series. Additionally, photo-testing with a monochromator was performed. RESULTS: Thirteen of 32 patients (40.62%) had one or more positive reactions to allergens of the standard series. Eight patients (25%) had positive reactions to fragrance mix and/or Balsam of Peru, which are included in the standard series, or to allergens of the fragrance series. Nickel sulphate was the single most common cause of contact sensitization (18.75%) among our patients. Ninety-seven subjects, who were patch tested with the standard series for suspected allergic contact dermatitis of the face and/or neck, served as age, sex and site controls. Of these, nine (9.27%) had one or more positive reactions to fragrance compounds. Statistical analysis showed a statistically significant difference in the frequency of positive reactions to fragrances between the PC group and the control group (chi2 value = 3.91, P < 0.05). In contrast, none of the PC patients had a positive photopatch test for the allergens included in the photoallergens series. The estimated minimal erythemal dose for the PC group was in all cases within normal limits for all wavelengths of ultraviolet (UV) radiation examined. CONCLUSIONS: Contact sensitization, mostly to perfume ingredients, may develop in PC, possibly playing a pathogenetic part, at least in a subset of patients. Despite negative results of photopatch testing, an allergic photo-contact reaction cannot be definitely excluded. PC seems not to be a photosensitivity disorder of the type of chronic actinic dermatitis. UV radiation-induced dermal connective tissue changes are the predominant histological feature of PC, leading to telangiectasia due to loss of vascular support. Reticular pigmentation may result from a delayed hypersensitivity reaction to perfume and/or cosmetic ingredients. Patch testing with the standard series and avoidance of documented allergens may be of value in patients with PC.

Adult↗
PubMed2002

Epidermolysis bullosa acquisita: treatment with intravenous immunoglobulins.

Epidermolysis bullosa acquisita (EBA) is a rare autoimmune bullous disorder that is often difficult to treat. Few cases have been reported and therapy consists mainly of combinations of systemic steroids, immunosuppressants and, recently, administration of intravenous human immunoglobulin (IVIg). We describe a case of EBA in which our therapeutic choices were limited due to the patient's poor general condition, including extensive infection of the lesions and a history of pulmonary tuberculosis. The patient was treated with IVIg at a dose of 400 mg/kg per day for 5 consecutive days every 4 weeks. The treatment was well tolerated and the results were satisfactory. It seems that IVIg, due to its possible immunomodulatory mode of action, can be an efficacious therapeutic agent in this rare autoimmune disease.

Adult↗
PubMed2002

Polymorphous light eruption.

Polymorphous light eruption (PLE) is a common idiopathic photosensitivity disorder with an estimated prevalence of 10-20%. It is characterized by an intermittent skin reaction to ultraviolet (UV) radiation exposure, consisting of non-scarring pruritic erythematous papules, vesicles or plaques that develop on light-exposed skin. Despite the different morphology in different individuals, the eruption tends to have a monomorphous presentation in any single subject. The histopathological features of PLE are distinct and comprise a perivascular lymphocytic infiltrate in the dermis, subepidermal oedema and variable epidermal changes. The pathogenesis of PLE is not well known, but findings suggest that it is a delayed-type hypersensitivity reaction to one or more UV-modified cutaneous antigens. The principal action of PLE is mainly in the UVA region, although some subjects exhibit sensitivity to UVB alone or to both UVA and UVB radiation at the same time. Preventive measures in PLE include the regular use of photoprotective methods combined with graduated exposures to natural sunlight. The induction of immune tolerance by phototherapy and photochemotherapy are useful prophylactic methods in moderate to severe cases. The role of systemic agents in the management of PLE is under investigation. This article reviews the epidemiological, pathogenetic and clinical aspects of PLE and discusses recent advances in the diagnostic approach and management of this condition.

Diagnosis, Differential↗
PubMed2001

An epidemiological study of syphilis incognito, an emerging public health problem in Greece.

BACKGROUND: Syphilis incognito is a subtype of latent syphilis (early or late) characterized by no signs or symptoms of primary or secondary syphilis and diagnosed by positive serologic results for syphilis during routine screening. OBJECTIVE: To study the epidemiological characteristics, causes, and implications of syphilis incognito in Greece. PATIENTS AND METHODS: All new adult patients diagnosed as having syphilis in Andreas Sygros Hospital for Skin and Venereal Diseases, Athens, Greece, from 1989 through 1996 were studied prospectively and retrospectively (history, physical examination, serologic tests, cerebrospinal fluid examination, and imaging) to determine the stage of their disease. The epidemiological, clinical, and serologic characteristics of patients with syphilis incognito were recorded and analyzed. RESULTS: During the 8-year period, 711 new syphilis cases were detected; of these, 480 cases (67.5%) fulfilled the definition criteria of syphilis incognito. The male-female ratio was 1.8:1. Patients with syphilis incognito were most commonly heterosexual, had a median socioeconomic status, and were aged 20 to 39 years, and their conditions were diagnosed during routine screening for syphilis (prenatal care, hospital admission, or blood donation). However, the number of syphilis incognito cases appeared to decline during the period studied. CONCLUSIONS: The incidence of syphilis in Greece has decreased dramatically, following the trends in western Europe. The most common form of syphilis is syphilis incognito, affecting adults who are older and have a higher socioeconomic status than those in the past. Improved hygiene and wide use of antibiotics that minimize or abolish symptoms of early disease may have contributed to the frequency of syphilis incognito in recent years. Screening of asymptomatic persons, especially those at high risk, should continue and be reenforced to prevent the devastating consequences of unrecognized and untreated syphilis.

Adolescent↗
PubMed1999

Topical retinoids in the treatment of aging of the skin.

Aging of the skin is a complex phenomenon resulting from the interaction of several intrinsic and extrinsic factors [1]. Due to the cosmetic disfigurement it produces and its psychological impact, especially to women, aging of the skin has become an issue of great social significance and concern. Intrinsic aging is an inevitable, genetically programmed process, the underlying mechanisms of which remain largely unknown. No prevention or effective treatment is currently available [1]. Among extrinsic influences (wind, heat, cigarette smoke, chemicals, etc.), ultraviolet radiation appears to be the single most important factor associated with aging of the skin [2]. Photoaging refers to gross and microscopic cutaneous changes induced by cumulative exposure to ultraviolet radiation (UVR). These changes are superimposed on the background of intrinsic aging [2]. Increased recreational sun exposure, including excessive sunbathing, the depletion of stratospheric ozone, the use of UVR in the treatment of various skin diseases, are some of the causes that have led to increased prevalence of photoaging during the last decades. The clinical importance of photoaging lies mostly on the potential for the development of precancerous lesions or skin cancer [3]. In contrast to intrinsic aging, photodamage can be prevented by sun avoidance and proper sun protection [2]. Furthermore, overwhelming clinical and histological evidence indicate that skin changes of photoaging can be reversed by the use of topical retinoids [4].

Administration, Topical↗
PubMed1999

Acne neonatorum: a study of 22 cases.

BACKGROUND: Acne is not uncommon in the neonatal period. Acne neonatorum is characterized by a mainly facial eruption of inflammatory and noninflammatory lesions. It is most commonly mild and transient. Hyperactivity of sebaceous glands, stimulated by neonatal androgens, has been implicated as the underlying pathogenetic mechanism. MATERIALS AND METHODS: All patients diagnosed with acne neonatorum in "A. Sygros" Hospital, Athens, Greece, during the years 1993-1996, were evaluated clinically and epidemiologically. Histologic examination and smears for Propionibacterium acnes and Pityrosporum ovale were performed in selected cases. RESULTS: Of the 22 patients studied, 18 were male (81.8%) and 4 were female. The mean age at onset was 3 weeks and the mean duration of the disease was 4 months. Papules and pustules were the most frequent types of lesions (72.7%), followed by comedones only (22.7%). The cheeks were the most common site of predilection (81.8%). A family history of acne was reported in only three patients. Histologic examination showed hyperplastic sebaceous glands with keratin-plugged orifices. Smears for P. ovale were negative. CONCLUSIONS: Our findings are consistent with previous experience, although inflammatory lesions were encountered more often than previously reported. Hereditary factors did not seem to play a significant role in our series. Topical treatment hastened the resolution of this self-limited condition. Recalcitrant cases warrant investigation for underlying androgen excess.

Acne Vulgaris↗
PubMed1998

Why and when the treatment of acne fails. What to do.

The majority of acne patients show a good response to the proper acne treatment. However, a small percentage not exceeding 10-15% do not respond as satisfactorily as expected. The main reason for the treatment failure is the poor patient compliance. In order to improve the patient compliance the strategy for the treatment of acne has to be carefully planned and includes the following: discussion before treatment; give clear instructions; explain the rhythm of improvement; explain the role of cosmetics; explain the role of sunbathing; explain the expected side effects. It has to be emphasized that all acne cases can be adequately controlled if the relationship between doctor and patient has been built on trust and confidence, maximizing the patient compliance.

Acne Vulgaris↗
PubMed1982

Pellagra: "A reappraisal".

A brief review of the epidemiological history of pellagra is attempted. In Europe and North America Pellagra is practically eradicated at the present time. However, in mediterranean countries, with much sunlight, cases of the disease are sporadically seen. Nevertheless, in countries with a low nutritional level Pellagra still exists as endemic form. In Athens, Greece, the last decade 1971-1981, 56 new cases of Pellagra were studied. A short analysis of the above cases concerning mainly the real cause of the disease is presented. Moreover, the more recent aspects concerning the aetiological factors responsible for the appearance of Pellagra, with special emphasis to vitamins, is reported.

Alcoholism↗