Mutilating acrodermatitis continua (Hallopeau's acrodermatitis).
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Acrodermatitis↗
Biomedical subjects
N J Lowe
Publications and source records attributed to N J Lowe.
Generalized pustular psoriasis precipitated by lithium carbonate.
Precipitation of generalized pustular psoriasis was manifested in a patient with previously stable psoriasis vulgaris following lithium carbonate therapy for manic-depressive psychosis. Methotrexate toxicity was observed during the acute stage of the illness, and photochemotherapy was the successful treatment. Further pustulation occurred when lithium carbonate therapy was reintroduced.
Adult↗
Effects of topical prostaglandin E analogue on normal hairless mouse epidermal DNA synthesis.
The in vivo topical effects of a synthetic analogue of prostaglandin E2 (15(S)-15-methyl PGE2 methyl ester [PGE2 analogue]), have been studied on the epidermis of hairless mice. One microgram of the PGE2 analogue increased DNA synthesis significantly by 5 hr, a maximum increase of 390% was reached by 12 hr, and DNA synthesis returned to control levels by 24 hr. Twenty micrograms of the PGE2 analogue reduced epidermal DNA synthesis for 12 hr after application, DNA synthesis was increased at 24 hr, returning to control levels by 48 hr. One hundred micrograms of topical PGE2 had no significant effect on epidermal DNA synthesis over 48 hr, but 1 mug of intradermal PGE2 increased DNA synthesis by 160% at 24 hr. These results suggest that topical 15(S)-15-methyl PGE2 methyl ester is biologically active compared with PGE2.
Administration, Topical↗
Anti-inflammatory properties of a prostaglandin antagonist, a corticosteroid and indomethacin in experimental contact dermatitis.
The topical effects of N0164 (a phenyl phosphonate derivative which is a partially selective antagonist of prostagladin E2), indomethacin and triamcinolone acetonide have been shown to reduce the erythema and ear weight gain from inflammation induced by experimental contact allergic eczema. Oxazolone sensitized Swiss Webster mice were used, ear erythema and ear weights being used as a measure of the anti-inflammatory response to the drugs. N0164 was also shown to have systemic anti-inflammatory activity after intraperitoneal injection.
Administration, Topical↗
Essential fatty acid deficient hairless mouse: a model of chronic epidermal hyperproliferation.
Epidermal DNA synthesis has been shown to be increased approximately three-fold in hairless mice that were fed a diet deficient in essential fatty acids (EFA deficient) for 65 days, compared with animals fed a standard diet. Autoradiographic labelling indices showed a 330% increase in the EFA deficient mice over controls. The animals developed evidence of a diffuse thickening, scalping and loss of elasticity of the skin after 40 days on the EFA deficient diet. Histologically, the epiderma of the EFA deficient animals showed acanthosis, hypergranulosis, hyperkeratosis and increased intracellular epidermal spaces. Increased mitotic indices were found with Feulgen staining. This is further evidence that deficiencies of essential fatty acids are associated with disturbance of normal epidermal cell proliferation and control of keratinization. A single application of topical 0.1% betamethasone valerate to EFA deficient mice reduced the epidermal DNA synthesis to that of normal diet mice. Ten percent linoleic acid topically over 2 weeks also returned epidermal DNA synthesis to normal levels.
Animals↗
Essential fatty acid deficient hairless mouse: the effects of topical agents on the epidermis.
Essential fatty acid deficient (EFA deficient) hairless mice were used to test the ability of topical agents to reduce the high epidermal DNA synthesis and acanthosis present in EFA deficiency. An established therapeutic agent known to be effective in psoriasis (betamethasone 17-valerate) significantly reduced the epidermal DNA synthesis, mitotic count and epidermal cell thickness. Linoleic acid reduced DNA synthesis and returned epidermal histology towards that of normal skin. Prostaglandin E2 analogue (15 (S)-15-methyl PGE2 methyl ester) reduced epidermal DNA synthesis both in treated and distant skin sites. Prostaglandin E2 was less effective than the analogue but slightly reduced epidermal DNA synthesis and thickness. Prostaglandin F2alpha had no obvious effect on the epidermis. Chlorambucil reduced epidermal DNA synthesis and thickness. Vitamin A acid increased DNA synthesis and epidermal cell thickness but reduced the hyperkeratosis of EFA deficiency. A rapid epidermal cell transit was found in EFA deficient mice, approximately three times faster than in normal mouse epidermis.
Administration, Topical↗
HL-A antigens in lichen planus.
A study of fifty-seven patients with lichen planus showed a significant increase in the frequency of HL-A3 (54% compared with 29.7% in a control population). It is likely that there is a gene in the HL-A chromosomal region increasing the susceptibility to lichen planus. No correlation was found between HL-A3 and age of onset, sex, and presence or absence of mucosal lesions.
Genetic Linkage↗
Carbohydrate metabolism in lichen planus.
A study of forty patients with active lichen planus and a negative family history for diabetes showed that 42% had unequivocally abnormal oral glucose tolerance. The pattern of insulin response to glucose is similar to that seen in typical mild maturity-onset diabetes. There was no association between the presence of glucose intolerance and the duration or type of lesions. None of the patients with glucose intolerance had demonstrable islet-cell antibodies.
Adult↗
Peutz-Jeghers syndrome with pigmented oral papillomas.
The association of cutaneous and mucosal pigmentation with gastrointestinal polyposis has been well-described as the Peutz-Jeghers syndrome. A case is described of a patient who has evidence of gastrointestinal polyposis, diffuse and circumscribed macular hyperpigmentation, a nasal polyp, and the additional features of buccal mucosal pigmented papillomas.
Adult↗
Pityriasis lichenoides et varioliformis acuta and suspected cardiomyopathy.
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Acute Disease↗
Adverse effects of retinoids.
Oral retinoids, synthetic derivatives of vitamin A, have been used in the treatment of various dermatoses over the last decade. The most useful drugs have been isotretinoin (13-cis-retinoic acid) for nodulocystic acne and etretinate for psoriasis vulgaris. Retinoids are also effective in the treatment of papulosquamous dermatoses other than psoriasis (i.e. inherited disorders of keratinisation), cutaneous T-cell lymphoma and in chemotherapy and chemoprevention of cancer. However, systemic administration of these compounds is frequently associated with mucocutaneous side effects, liver toxicity and abnormalities of serum lipid profiles, which might be related to an increased risk of coronary heart disease. Of particular concern is the teratogenic effect of all retinoids, which limits their use in women of child-bearing potential. Chronic toxicities from long term therapy with retinoids may result in skeletal abnormalities, usually mimicking diffuse idiopathic hyperostosis syndrome. Furthermore, the chronic use of retinoids in children may inhibit their growth due to premature epiphyseal closure. In contrast to other side effects of retinoids which are dose dependent and reversible upon withdrawal of the drug, it seems unlikely that bone abnormalities will resolve after discontinuation of the medication. In view of the wide spectrum of toxicities, treatment with retinoids requires appropriate selection of patients, careful consideration of the benefit to risk ratio for each individual, periodic monitoring of clinical response and laboratory tests. Clinicians should use special management techniques in order to prevent or minimize slide effects. Extensive investigations are currently being conducted in an attempt to develop new retinoids which will improve the therapeutic efficacy and reduce unwanted reactions.
Humans↗
Azelaic acid 20% cream in the treatment of facial hyperpigmentation in darker-skinned patients.
This multicenter, randomized, double-masked, parallel-group study assessed the efficacy, safety, and tolerability of azelaic acid 20% cream compared with those of its vehicle for the treatment of facial hyperpigmentation in darker-skinned patients (phototypes IV to VI). Following a 24-week treatment period, azelaic acid produced significantly greater decreases in pigmentary intensity than did vehicle as measured by both an investigator's subjective scale (P = 0.021) and a chromometer analysis (P = 0.039). There was a significantly greater global improvement with azelaic acid than with vehicle at week 24 (P = 0.008). Azelaic acid produced a slightly but significantly greater amount of burning (weeks 4 and 12, P < or = 0.046) and stinging (week 4, P = 0.002) than did vehicle. At the end of the study, more patients treated with azelaic acid than with vehicle reported having much smoother skin and being very satisfied or satisfied with their treatment. Also, more patients treated with azelaic acid than with vehicle rated their medication as being more effective or the same as past treatments. Thus azelaic acid is an effective and well-tolerated treatment for hyperpigmentation in darker-skinned patients.
Adult↗
Azelaic acid and glycolic acid combination therapy for facial hyperpigmentation in darker-skinned patients: a clinical comparison with hydroquinone.
This multicenter, randomized, double-masked, parallel-group, 24-week clinical study compared the efficacy of the combination of azelaic acid 20% cream and glycolic acid 15% or 20% lotion with hydroquinone 4% in the treatment of facial hyperpigmentation in darker-skinned patients. At week 24, overall improvement and reduction in lesion area, pigmentary intensity, and disease severity were comparable in the two treatment groups. At some visits, patients treated with an azelaic/glycolic acid combination had slightly greater levels of peeling, burning, stinging, or dryness than did patients treated with hydroquinone, although scores for cutaneous signs and symptoms were always low. The present study demonstrated that the combination of azelaic acid 20% cream and glycolic acid 15% or 20% lotion was as effective as hydroquinone 4% cream in the treatment of hyperpigmentation in darker-skinned patients, with only a slightly higher rate of mild local irritation. These findings suggest that the addition of glycolic acid to azelaic acid treatment for hyperpigmentation is an appropriate alternative in selected darker-skinned patients.
Dermatologic Agents↗
Photo(chemo)therapy: general principles.
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Clinical Trials as Topic↗