Clobetasol propionate cream versus halcinonide cream in psoriasis.
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Biomedical subjects
Publications and source records attributed to C N Ellis.
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We prospectively analyzed radiographic skeletal surveys of eight patients who received etretinate therapy for psoriasis at doses ranging from 0.5 to 1.2 mg/kg/day for 6-18 months. Although subtle skeletal changes could have been obscured by some of our patients' other radiographic abnormalities, no bony changes that could be attributed to etretinate were detected in any of these patients.
We encountered a patient with continual skin peeling syndrome, a rare disorder in which generalized, noninflammatory exfoliation of the stratum corneum occurs. Although scaling occurred spontaneously in our patient, he was also able to manually peel sheets of skin without bleeding or pain. Histologically, there was separation of corneocytes above the granular cell layer. Ultrastructural examination revealed an unusual type of intracellular cleavage, in which the plasma membrane of the "peeling" cell remained firmly adherent to the underlying cell while the upper part of the cell exfoliated. Unique intercellular electron-dense globular deposits were localized to the stratum corneum.
Findings from an eight-week fish oil-supplemented diet given to 13 psoriatic patients demonstrated that eicosapentaenoic acid (20:5,n3 [EPA]) and docosahexaenoic acid (22:6,n3 [DCHA]) are rapidly incorporated into the sera, neutrophils, and epidermis of participating patients, and that the incorporation of EPA and DCHA into epidermal lipids increased with weeks of supplementation with minimal alteration of arachidonic acid (AA) in the epidermal lipids. Global clinical evaluation showed that eight patients demonstrated mild to moderate improvement in their psoriatic lesions. Improved clinical response correlated with high EPA/DCHA ratios attained in epidermal tissue specimens. These findings underscore the need for further investigations into the role of dietary n3 fatty acids, particularly the possibility of pentaenoic acid as a potential protective agent and/or therapeutic adjunct for the clinical management of psoriasis.
A case of miliaria crystallina occurring with isotretinoin therapy in a patient with lamellar ichthyosis is described. To our knowledge, the association of miliaria crystallina with isotretinoin therapy has not been previously reported.
In a double-blind study, 20 patients with oral lichen planus were treated twice daily with 0.1% isotretinoin gel or the vehicle alone for two months. Subsequently, patients who used the placebo received the active preparation for another two months. Patients treated with the active medication displayed significantly greater improvement than patients receiving the placebo. Patients who were treated initially with the placebo showed statistically significant improvement after receiving the topical isotretinoin treatment for two months. Side effects from using the gel were primarily a transient burning sensation or irritation on initial application.
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We monitored the antibody-dependent cell-mediated cytotoxicity of polymorphonuclear leukocytes from 14 patients with psoriasis before and during etretinate therapy. Neutrophils obtained from the patients with psoriasis at pretherapy demonstrated significantly greater cytotoxic activity than control cells. After four weeks of etretinate therapy, the cytotoxicity of neutrophils from the psoriatic patients decreased significantly and was no longer significantly different from the control value (at a 1:1 effector-to-target ratio). The decline in neutrophil cytotoxicity preceded significant clearing of our patients' psoriasis. The reduction in the antibody-dependent cell-mediated cytotoxicity of polymorphonuclear leukocytes from patients with psoriasis occurs early during therapy and may represent one of the mechanisms of action of etretinate.
Vitamin A and its synthetic congeners are known to produce a variety of skeletal abnormalities in patients on prolonged treatment with these medications. Two patients are described who developed posterior longitudinal ligament ossification following treatment with the synthetic retinoid 13-cis-retinoic acid. In both cases, this finding became apparent after other retinoid-induced skeletal abnormalities were observed and was less marked than the ossification of the anterior longitudinal ligament. Although spinal cord compression did not occur in our patients, patients on long-term retinoid therapy should be carefully observed for this complication.
Two hundred eight patients completed a 12-week, multicenter, double-blind, controlled study comparing a 2% erythromycin ointment to its vehicle. Patients were evaluated by inflammatory lesion counts and Cook acne severity grade at the initial visit and at weeks 2, 4, 8, 10, and 12. The 2% erythromycin ointment proved to be statistically more effective than the vehicle in reducing lesion counts and acne severity grade at weeks 4, 8, 10, and 12. The ointment caused few side effects and was well tolerated by most patients.
Using a Boyden chamber technic, we measured the directed chemotaxis of polymorphonuclear leukocytes obtained from control subjects or psoriasis patients when the leukocytes were placed in sera obtained from control subjects or psoriasis patients. The samples from patients were obtained before therapy and after 2 and 4 weeks of etretinate administration. Compared with control sera, the sera from seven untreated psoriasis patients significantly enhanced the chemotaxis of polymorphonuclear leukocytes from control subjects toward a chemotaxin (p less than 0.05). After 4 weeks of etretinate therapy, the chemotaxis-stimulating ability of the sera from psoriasis patients was no longer significantly greater than that of the control sera. This decline in the chemotaxis-stimulating activity of our patients' sera preceded significant clearing of their psoriasis. The levels of circulating etretinate in the blood of our patients could not account for the reduction. Etretinate therapy had no apparent direct effect on the chemotactic activity of polymorphonuclear leukocytes from the psoriasis patients but may act in part by reducing the inflammatory effects of psoriatic sera.
Seven patients underwent retrospective radiographic examination 10 to 16 months after high dose isotretinoin therapy for severe cystic acne. One patient, who received the highest isotretinoin dose (approximately twice the average dose taken by the remaining patients), had multiple small hyperostoses of the thoracic spine and tarsi navicular. These findings were identical to the skeletal changes known to occur during retinoid administration. Prospective studies are needed to ascertain the risk of developing hyperostoses during isotretinoin therapy for acne at the lower doses currently employed. In this preliminary study, clinically significant hyperostoses were not a late sequela of high dose isotretinoin treatment for acne.
An atypical case of pemphigus vulgaris that presented with vesiculobullous pustular lesions on the feet and hands is discussed. The initial clinical diagnosis was dyshidrotic eczema. Other unusual manifestations of pemphigus vulgaris are briefly reviewed.
A patient with both pili torti and leukonychia had a family history indicating dominant inheritance for the nail changes. However, no relatives had hair abnormalities. The authors briefly review both of these unusual entities.
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A 9-year-old girl had the insidious development of lethargy, gingival erosions, and follicular hyperkeratosis with perifollicular hemorrhage. A dietary history disclosed that she consumed only one kind of sandwich and beverage and took no other foods. A skin biopsy specimen was consistent with the diagnosis of scurvy, and marked improvement occurred with ascorbic acid therapy. Although it is an uncommon disorder in the United States, scurvy may occur in persons with prolonged and peculiar dietary habits.
Minoxidil, a potent peripheral vasodilator used orally for refractory hypertension, has produced hypertrichosis. To determine the efficacy and safety of 1% or 5% topical minoxidil for the stimulation of scalp hair regrowth, we studied fifteen normotensive patients, five with androgenic alopecia and ten with alopecia areata diagnosed clinically and by biopsy, for 12 months. Three of five patients with androgenic alopecia using 5% minoxidil for 12 months noted hair regrowth, ranging from minimally observable hair to an appreciable restoration of larger, pigmented, terminal hair in one patient. Among the patients with androgenic alopecia, regrowth response corresponded to the serum minoxidil blood levels. None of the patients with alopecia areata receiving either 1% or 5% minoxidil noted hair regrowth despite comparable minoxidil blood levels. Improved local absorption of topical minoxidil solution may promote hair regrowth in androgenic alopecia.