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M Lebwohl

Publications and source records attributed to M Lebwohl.

At least 91 records · Page 5Linked to original sources
PubMed1998

Clinical efficacy and safety of tazarotene: optimizing clinical results.

Tazarotene is the first topical retinoid demonstrated to be both effective and tolerable in the treatment of psoriasis. The clinical efficacy and safety of topical tazarotene have been investigated in vehicle-controlled and active-controlled studies. Ongoing studies are evaluating its use in combination with other antipsoriasis medications. Tazarotene has been demonstrated to be significantly more effective than vehicle, and comparable in efficacy to fluocinonide 0.05%, but with a more sustained therapeutic effect after treatment is stopped. Its adverse effects consist primarily of mild to moderate local irritation with no reports of treatment-related systemic adverse effects. Combining tazarotene with a mid- to high-potency corticosteroid gives greater efficacy with fewer adverse effects than either agent used alone. The use of tazarotene in combination with phototherapy or calcipotriene is currently being investigated. Overall, topical tazarotene is a highly useful addition to the array of options available for the topical treatment of mild to moderate plaque psoriasis.

Administration, Topical↗
PubMed1997

Effectiveness of norgestimate and ethinyl estradiol in treating moderate acne vulgaris.

BACKGROUND: An excess of androgen is believed to contribute to development of acne in some patients. Because oral contraceptives (OCs) may reduce the active androgen level, hormonal therapy with OCs has been used successfully to treat patients with acne, although this treatment has previously not been studied in placebo-controlled trials. OBJECTIVE: Our purpose was to evaluate the efficacy of a triphasic, combination OC (ORTHO TRI-CYCLEN [Ortho-McNeil Pharmaceutical, Raritan, N.J.], norgestimate/ethinyl estradiol) compared with placebo in the treatment of moderate acne vulgaris. METHODS: Two hundred fifty-seven healthy female subjects, 15 to 49 years of age with moderate acne vulgaris, were enrolled in a multicenter, randomized, double-blind, placebo-controlled clinical trial. Each month for 6 months, subjects received either 3 consecutive weeks of the OC (i.e., tablets containing a fixed dose of ethinyl estradiol [0.035 mg] and increasing doses of norgestimate [0.180 mg, 0.215 mg, 0.250 mg]) followed by 7 days of inactive drug or placebo (color-matched tablets). Efficacy was assessed by facial acne lesion counts, an investigator's global assessment, a subject's self-assessment, and an analysis of within-cycle variation (cycle 6) in lesion counts. RESULTS: Of the 160 subjects in whom efficacy could be evaluated, the OC group showed a statistically significantly greater improvement than the placebo group for all primary efficacy measures. The mean decrease in inflammatory lesion count from baseline to cycle 6 was 11.8 (62.0%) versus 7.6 (38.6%) (p = 0.0001), and the mean decrease in total lesion count was 29.1 (53.1%) versus 14.1 (26.8%) (p = 0.0001) in the OC and placebo groups, respectively. In the investigator's global assessment, 93.7% of the active treatment group versus 65.4% of the placebo group were rated as improved at the end of the study (p < 0.001). Six of the seven secondary efficacy measures (total comedones, open comedones, closed comedones, papules, pustules, and the subject's self-assessment of study treatment) were also significantly more favorable in the OC group compared with the placebo group. CONCLUSION: An OC containing 0.035 mg of ethinyl estradiol combined with the triphasic regimen of norgestimate is a safe and effective treatment of moderate acne vulgaris in women with no known contraindication to OC therapy.

Acne Vulgaris↗
PubMed1997

Interactions between calcipotriene and ultraviolet light.

BACKGROUND: Calcipotriene is often used with UVB or PUVA, but interactions between UV radiation and calcipotriene have not been examined extensively. OBJECTIVE: Our purpose was to examine interactions between calcipotriene and UV light. METHODS: Minimal erythema doses (MEDs) were determined with UVB and immediate pigment darkening was measured for UVA. The effect of calcipotriene ointment applied before phototesting was examined. Thick and thin applications of calcipotrience were compared. Calcipotriene ointment was applied to a small area on the skin before phototherapy. Patients received either UVB, PUVA, UVA, or no phototherapy. After phototherapy, the ointment was collected and assayed by reverse-phase, high-performance liquid chromatography. RESULTS: MEDs for UVB and immediate pigment darkening for UVA were unaffected by calcipotriene. Thick application of calcipotriene, however, increased the MED, UVA caused substantial reductions in the concentration of detectable calcipotriene. CONCLUSION: When used in conjunction with PUVA, calcipotriene should be applied after exposure to UVA.

Calcitriol↗
PubMed1997

Identification of possible reactive oxygen species involved in ultraviolet radiation-induced oxidative DNA damage.

We have previously demonstrated that each region of the ultraviolet (UV) spectrum (UVA, UVB, and UVC) induces the formation of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo) in purified calf thymus DNA and HeLa cells in a fluence-dependent manner. In the present study, we further characterize the possible reactive oxygen species (ROS) that are involved in the induction of 8-oxodGuo by UV radiation. Sodium azide, a singlet oxygen (1O2) scavenger though its quenching effect on HO. was also reported, inhibited 8-oxodGuo production in calf thymus DNA exposed to UVA, UVB, or UVC in a concentration-dependent fashion with maximal quenching effect of over 90% at a concentration of 10 mM. Catalase, at a concentration of 50 U/ml, reduced the yields of UVA- and UVB-induced 8-oxodGuo formation by approximately 50%, but had little effect on UVC-induced 8-oxodGuo production. In contrast, 50 U/ml of superoxide dismutase (SOD) did not affect induction of 8-oxodGuo by any portion of the UV spectrum. Hydroxyl radical (HO.) scavengers mannitol and dimethylsulfoxide (DMSO) moderately reduced the levels of 8-oxodGuo induced by UVA and UVB, but not those by UVC. Instead, mannitol and DMSO enhanced the formation of 8-oxodGuo induced by UVC. These results suggest that certain types of ROS are involved in UV-induced 8-oxodGuo formation with 1O2 playing the predominant role throughout the UV spectrum. Except for UVC, other ROS such as hydrogen peroxide (H2O2) and HO. may also be involved in UVA- and UVB-induced oxidative DNA damage. Superoxide anion appears not to participate in UV-induced oxidation of guanosine in calf thymus DNA, as SOD did not display any quenching effects.

Catalase↗
PubMed1997

Topical calcipotriene in combination with UVB phototherapy for psoriasis.

A total of 20 patients with symmetric plaque-type psoriasis were recruited for a controlled, investigator-blinded, right-left study. None of the patients had used any therapy other than emollients for 2 months prior to starting in the trial. All patients had a negative antinuclear antibody. By history, all patients had previously improved upon exposure to sunlight or ultraviolet light. Two symmetrical sites of equal severity were selected as target areas. Each patient was treated on one side with mineral oil twice daily and on the opposite side with calcipotriene 0.005% ointment twice daily. The investigator was blinded as to which site received which topical treatment. Both sides were treated with equal doses of ultraviolet B (UVB) three times weekly in graduated suberythemogenic doses. Ultraviolet B radiation was emitted by a group of 6-ft fluorescent bulbs (Light Sources FS72 T12 UVB HO) in a standard phototherapy unit. The above regimen was continued for a total of 12 weeks. The severity of psoriasis in the target sites was rated by the examiner at baseline and at weekly intervals for the 12 weeks of study. Target sites were rated by severity of erythema, scaling, plaque elevation, and pruritus, with each of these parameters being assigned a score on a four-point scale: 0, clear; 1, mild; 2, moderate; 3, severe. The four scores were added together to arrive at a total severity score for each of the target sites. Statistical analysis was performed using the paired t test, P values less than 0.05 were considered statistically significant. Eleven of the 20 patients (55%) showed a greater decrease in the severity of their psoriasis with UVB plus calcipotriene compared with UVB plus mineral oil. The difference in severity scores between the two groups was statistically significant as early as week 1 (P < 0.05). The difference between the UVB and calcipotriene group versus the UVB and mineral oil group peaked between weeks 3 and 6. The differences then decreased but remained statistically significant through to week 12 (Fig. 1). There were no instances of local cutaneous irritation, but mild photosensitivity occurred symmetrically on both sides in three patients.

Calcitriol↗
PubMed1997

Induction of 8-oxo-7,8-dihydro-2'-deoxyguanosine by ultraviolet radiation in calf thymus DNA and HeLa cells.

The levels of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo) in purified calf thymus DNA and HeLa cells were measured following exposure to either UVC, UVB or UVA wavelengths. This DNA damage was quantitated using HPLC coupled with an electrochemical detector. The 8-oxodGuo was induced in purified DNA in a linear dose-dependent fashion by each portion of the UV spectrum at yields of 100, 0.46 and 0.16 8-oxodGuo per 10(5) 2'-deoxyguanosine (dGuo) per kJ/m2 for UVC, UVB and UVA, respectively. However, the amount of 8-oxodGuo in HeLa cells irradiated with these UV sources decreased to approximately 2.0, 0.013 and 0.0034 8-oxodGuo per 10(5) dGuo per kJ/m2, respectively. In contrast, the levels of cyclobutyl pyrimidine dimers were similar in both irradiated DNA and cells. Therefore, 8-oxodGuo is induced in cells exposed to wavelengths throughout the UV spectrum although it appears that protective precesses exist within cells that reduce the UV-induced formation of this oxidative DNA damage. Cell survival was also measured and the number of dimers or 8-oxodGuo per genome per lethal event determined. These calculations are consistent with the conclusion that dimers play a major role in cell lethality for UVC- or UVB-irradiated cells but only a minor role in cells exposed to UVA wavelengths. In addition, it was found that the relative yield of 8-oxodGuo to dimers increased nearly 1000-fold in both UVA-irradiated cells and DNA compared with cells subjected to either UVC or UVB. These results are supportive of the hypothesis that 8-oxodGuo, and possible other forms of oxidative damage, play an important role in the induction of biological effects caused by wavelengths in the UVA portion of the solar spectrum.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed1997

Pustular and erythrodermic psoriasis complicated by acute respiratory distress syndrome.

BACKGROUND: The pustular and erythrodermic types of psoriasis have been associated with a number of systemic complications, including congestive heart failure and pneumonia. Acute respiratory distress syndrome (ARDS) refers to acute noncardiogenic pulmonary edema with hypoxemia of various causes and has been attributed to pulmonary capillary leak. Recently, 4 cases of generalized pustular or erythrodermic psoriasis have been described associated with a pulmonary capillary leak syndrome. OBSERVATIONS: We describe 2 additional patients, 1 with pustular and erythrodermic psoriasis and 1 with erythrodermic psoriasis; who developed ARDS. Radiographic findings, pulmonary capillary wedge pressures, echocardiograms, and, in one case, an open lung biopsy specimen, were consistent with the diagnosis of ARDS. In neither case could we document any of the common causes of acute respiratory failure. CONCLUSIONS: Generalized pustular and erythrodermic psoriasis may be complicated by ARDS. The pathogenesis of this complication is unclear, but proinflammatory cytokines may be involved.

Adult↗
PubMed1997

Topical application of calcipotriene and corticosteroids: combination regimens.

BACKGROUND: Side effects of topical corticosteroids limit their long-term use. Calcipotriene/calcipotriol (Dovonex/Daivonex) ointment is not associated with any of the side effects of corticosteroids and has been shown to thicken the skin in contrast to the cutaneous atrophy caused by topical steroids. OBJECTIVE: We attempted to determine whether the addition of calcipotriene to a regimen of topical steroids results in an improved benefit/risk ratio. METHODS: Published and unpublished data on combination regimens were reviewed. RESULTS: In long-term regimens for psoriasis, substituting calcipotriene for topical corticosteroids may result in a steroid-sparing effect. Conversely, topical corticosteroids may suppress the development of local cutaneous irritation that occurs in patients treated with calcipotriene ointment. CONCLUSION: Psoriasis regimens combining calcipotriene ointment with superpotent steroids such as halobetasol ointment can result in greater improvement and fewer side effects.

Administration, Cutaneous↗
PubMed1997

Lyme disease.

Explore the source record for details and available documents.

Erythema Chronicum Migrans↗
PubMed1996

Efficacy and safety of fluticasone propionate ointment, 0.005%, in the treatment of eczema.

The clinical efficacy and safety of fluticasone propionate ointment, 0.005%, were compared with those of its vehicle in the treatment of moderate-to-severe eczema of long duration in two multicenter, double-blind, vehicle-controlled, randomized studies. One of the two study medications (up to 100 gm/week) was applied topically to the affected areas of the body twice daily for up to four consecutive weeks. Drug efficacy was measured in terms of three variables: the physician's gross assessment of clinical response of the target lesion, severity scores of individual signs and symptoms, and the patient's subjective assessment of treatment effects. Efficacy and safety were evaluated after seven, fourteen, twenty-one, and twenty-eight days of treatment. The total number of patients in the two studies was 372 (203 in study 1 and 169 in study 2). Fluticasone propionate ointment, 0.005%, was more effective than vehicle at all postbaseline visits in both studies (study 1 P < or = 0.015, study 2 P < or = 0.018). In study 1, approximately 80% of the patients on fluticasone were rated as cleared, excellent, or good by the investigators at treatment endpoint, compared with 38% of those receiving vehicle. In study 2, the sum of 80% of the fluticasone-treated patients was rated as cleared, excellent, or good by the investigators at the end of the study, compared with 34% of those receiving vehicle. The beneficial effect of fluticasone ointment, 0.005%, was early and sustained and was particularly noticeable for pruritus, erythema, and skin thickening. In study 1, no drug-related adverse events were reported in the fluticasone group. Four patients (4.3%) in the vehicle group experienced a total of four drug-related adverse events. The most common was burning/stinging, reported by two patients. In study 2, two patients (2.4%) in the fluticasone-treated group and three (4.1%) in the vehicle group reported a total of five drug-related adverse events, the most common event being pruritus (fluticasone group one patient, vehicle group two patients). These findings show that fluticasone propionate ointment, 0.005%, applied twice daily, is therapeutically superior to the vehicle and is well tolerated.

Administration, Topical↗
PubMed1996

Pseudoxanthoma elasticum and pregnancy.

Reports of complications of pseudoxanthoma elasticum occurring during pregnancy have dissuaded some women with the disorder from attempting to conceive for fear of exacerbating the disease. The actual risks of serious complications during pregnancy, however, may be overstated. We report a 40-year-old woman with pseudoxanthoma elasticum who delivered a healthy male infant after an uneventful pregnancy. At the time of delivery, the placenta was noted to be heavily calcified. The effects of pregnancy on pseudoxanthoma elasticum and the effects of maternal pseudoxanthoma elasticum on a developing fetus are reviewed, with a review of the relevant medical literature.

Adult↗
PubMed1995

New cutaneous manifestations of systemic diseases.

In recent years, especially with the advent of acquired immunodeficiency syndrome, new skin disorders associated with systemic disease have been described in the literature. Eosinophilic folliculitis and pruritic papules of human immunodeficiency virus (HIV) infection are clinically similar lesions that respond to phototherapy. Bacillary angiomatosis, another HIV-related skin disease that is caused by a pleomorphic gram-negative organism, resembles Kaposi's sarcoma clinically but is curable if treated early with antibiotics. Toxic strep syndrome, a scarlatiniform, desquamative eruption associated with hypotension, fever and multiorgan system dysfunction, is caused by group A streptococcal soft tissue infection. Paraneoplastic pemphigus, a recently characterized autoimmune vesicular eruption, produces painful mucocutaneous ulcerations in patients with an occult neoplasm, such as chronic lymphocytic leukemia or malignant lymphoma.

Cat-Scratch Disease↗