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Biomedical subjects

R S Stern

Publications and source records attributed to R S Stern.

At least 163 records · Page 9Linked to original sources
PubMed1983

The Koebner (isomorphic) response in psoriasis. Associations with early age at onset and multiple previous therapies.

Among 1,253 patients with psoriasis who were enrolled in a study of photochemotherapy, 33% had a history of a Koebner response (KR) at the site of physical trauma. The early onset of psoriasis and previous treatment with multiple types of therapy were each independently associated with the KR. Among patients with both onset before age 15 years and previous treatment with four or more types of therapy, 75% reported the KR, compared with only 5% of patients with onset after age 30 years and no previous therapy. At the time of enrollment in the photochemotherapy study, the history of the KR was not associated with worsening, the duration of psoriasis, or the extent of skin surface involved. Patients with the KR may manifest their disease earlier in life or may be more prone to flare after any type of treatment.

Adolescent↗
PubMed1983

Imipramine and brief therapists-aided exposure in agoraphobics having self-exposure homework.

Forty-five chronic agoraphobics were randomly assigned to treatment by placebo or imipramine in doses up to 200 mg/day for 28 weeks. All patients also had systematic self-exposure homework with an instruction manual. In addition, half of each drug group had therapist-aided exposure and half had therapist-aided relaxation, each totalling three hours. Patients in both drug groups improved substantially and maintained their gains for one year of follow-up. Imipramine had no significant therapeutic effect despite satisfactory plasma levels and significant drug side effects. Patients' low initial Hamilton depression scores might explain the absence of any drug effect. Antidepressants may be ineffective for agoraphobics who have normal mood. Brief therapist-aided exposure improved phobias and panics to a significant but limited extent, and is a useful adjuvant to self-exposure homework, which can be a powerful therapeutic agency by itself.

Adult↗
PubMed1983

Coal tar phototoxicity: kinetics and exposure parameters.

We examined two manifestations of coal tar phototoxicity: delayed erythema and skin pain (tar smarts) by quantifying the amount (dose) of UVA and exposure conditions required to induce these phenomena in normal human skin. The minimal UVA dose required to induce delayed erythema (minimal phototoxic dose or MPD) and the minimal UVA dose required to induce an immediate smarting reaction (minimal smarting dose or MSD) were recorded in 32 subjects in a variety of settings. A log-log dose-response model described the relation between the interval of time tar was left on the skin and lowering of MPD. We examined 4 different methods of tar removal and showed that several methods using more than water alone were equally effective--judging by resultant phototoxicity. The time between tar removal and UVA irradiation is important. Even 30 min was sufficient for the MPD to increase from 3.77 +/- 1.55 to 6.1 +/- 4.0 J/cm2 (p less than 0.02). The smarting reaction shows a similar dependence on the time interval between tar removal and exposure. The mean MSD was less than the mean MPD at all times tested. Both manifestations of coal tar phototoxicity, reduced delayed erythema threshold and susceptibility to the smarting reaction, persisted at least 30 h after tar removal.

Adult↗
PubMed1983

The PUVA lentigo: an analysis of predisposing factors.

Pigmented macules appearing in sun-protected sites of psoriatic patients treated chronically with oral methoxsalen photochemotherapy (PUVA) have been characterized as a lentiginous proliferation of relatively large, sometimes cytologically atypical, melanocytes (i.e., PUVA lentigines). In 1380 psoriatic adults followed prospectively, PUVA lentigines of any degree (slight, moderate, or extensive) were noted on the buttocks of 53% of patients at the most recent examination (an average of 5.7 years after starting PUVA). The frequency of moderate or extensive buttock lentigines at the most recent examination was positively associated with a greater number of PUVA treatments, an older age at starting PUVA, and male sex, and negatively associated with skin types V and VI. Moderate or extensive buttock lentigines were present in 17% of 693 patients who had not had PUVA for 1-2 years or longer. According to a regression analysis, the persistence of buttock lentigines was related in greatest measure to the total number of PUVA treatments received and was relatively independent of the time interval from the last PUVA treatment to the most recent examination or to "other" UV radiation therapy (predominantly UVB) received after PUVA was discontinued. Until the long-term course of PUVA lentigines is known, individuals who develop "fixed" pigmented lesions while on PUVA should be monitored continually for melanocytic dysplasias, including melanoma.

Adult↗
PubMed1983

Low-intensity selective UV phototherapy. A clinical trial in outpatient therapy for psoriasis.

A UV source of low-intensity output with peak effective emission in the 300 to 320-nm range, termed low-intensity selective UV phototherapy (LISUP), is being advocated for home phototherapy for psoriasis. Twenty patients with plaque-type psoriasis were treated three times a week as outpatients with this unit; the results were compared with those found in a similar group of 20 outpatients treated previously three times a week with a proved and effective protocol using erythemogenic exposures to a conventional UV-B source. Emollients were the only topical agents used during therapy. Eight patients had clearing and five others showed improvement with LISUP. Eighteen patients had clearing and one showed improvement with the UV-B protocol. We found LISUP less frequently effective when used three times a week in clearing plaque-type psoriasis. Therefore, we recommend a trial of this unit before purchase by the patient.

Adult↗
PubMed1983

Treatment of pityriasis rosea with UV radiation.

Twenty patients with symptomatic and extensive pityriasis rosea were treated with unilateral UV-B phototherapy in a bilateral comparison study. Five consecutive daily erythemogenic exposures resulted in substantially decreased pruritus and extent of disease greater than that on the untreated side in approximately 50% of the patients. Therapy seems to be most beneficial to patients receiving treatment within the first week of the eruption.

Female↗
PubMed1983

Adverse drug reactions.

Explore the source record for details and available documents.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1982

Methotrexate used for psoriasis and the risk of noncutaneous or cutaneous malignancy.

Using case-control methods, we separately evaluated the risk of noncutaneous and cutaneous malignancy associated with exposure to methotrexate as it is used in the treatment of severe psoriasis. An analysis of 26 cases of noncutaneous cancer and 104 matched controls revealed no association between the development of noncutaneous malignancy and exposure to methotrexate (relative risk = 0.96; upper bound 95% confidence interval = 2.0). An analysis of 80 cases of nonmelanoma skin cancer and 297 matched controls revealed a relative risk of 1.2 for the development of cutaneous malignancy among those with exposure to methotrexate (upper bound 95% confidence interval = 1.9). Our data suggest that methotrexate, as it is used in the treatment of severe psoriasis, does not increase the risk of noncutaneous or cutaneous malignancy.

Adult↗
PubMed1982

Combined methotrexate--ultraviolet B therapy in the treatment of psoriasis.

Twenty-six patients with extensive psoriasis were treated with a 3-week course of methotrexate followed by a combination of ultraviolet B (UVB) therapy and methotrexate. A plaque of psoriasis was shielded during UV therapy to serve as a control. When lesions cleared to less than 5% of body involvement, the methotrexate was stopped and UVB therapy alone was used as maintenance therapy. This protocol achieved clearance of disease in all twenty-six patients in a mean of 7 (+/- 1.5) weeks, with twelve (+/- 4.0) exposures to UVB therapy and a final UVB radiation dose at clearance of 320 (+/- 157) mjoules/cm2. The mean total dose of methotrexate was 112 mg (range, 75 mg-165 mg). At the time of clearing, the shielded area had a decrease in sealing and thickness in twenty-two patients but was free of psoriasis in only four patients. In a preliminary study we were unable to reproduce a methotrexate recall of UV-induced erythema. The combination therapy of methotrexate and UVB allows for clearing of psoriasis at relatively low doses of UVB and methotrexate, and thus may reduce the long-term cumulative toxicity of both agents.

Adult↗
PubMed1982

Anxiety management training for anxiety states: positive compared with negative self-statements.

Twelve patients complaining of chronic free-floating anxiety, usually also with panic attacks, were assigned at random to treatment by six hour-long sessions of anxiety-management training, either with positive or with negative self-statements, given over six weeks. Patients in both treatment conditions improved, with a small trend favouring positive over negative self-instruction, especially at follow-up. It is unclear how much self-instruction, rather than therapeutic attention or mere passage of time, accounted for the bulk of the modest improvement obtained.

Adolescent↗
PubMed1982

Polymorphous light eruption: a common reaction uncommonly recognized.

Polymorphous light eruption (PMLE) is usually considered to be an uncommon complaint, although the prevalence in the general population has not been studied. In a survey of 271 apparently healthy subjects, 10% gave a history consistent with a diagnosis of PMLE. The clinical characteristics in the survey cases of PMLE were similar in most respects to those of patients presenting to a clinic with this disorder. However, there was one notable exception, in that there was a striking difference between the clinic and survey cases in the amount of sunlight required to trigger the eruption. Clinic patients required a mean exposure of 30 min as compared with over 3 h in the survey cases. These findings suggest that PMLE is a common disorder but that many individuals have a high threshold of response to sunlight exposure.

Adolescent↗
PubMed1982

Clinical features of pruritus among patients undergoing maintenance hemodialysis.

Patients undergoing maintenance hemodialysis were asked to complete a questionnaire to define further the nature of uremic pruritus. Of the 237 respondents, 87 (37%) reported "prolonged bothersome itchiness" at the time surveyed, and an additional 97 (41%), not affected at that time, had experienced this problem in the past. Of the 184 patients who reported pruritus in either the past or present, discomfort occurred only during or soon after dialysis in 46 (25%) patients and was most severe at those times in an additional 78 (42%) patients. Topical emollients and orally administered antipruritic agents provided relief in only 33 (18%) and 31 (17%) patients, respectively. These data provide the first statistical basis for certain clinical impressions concerning uremic pruritus and suggest it is not as common among patients who are undergoing dialysis as has been previously implied.

Adult↗
PubMed1982

Long-term continuation of psoralen and ultraviolet-A treatment of psoriasis.

We studied the continued reliance on psoralen and ultraviolet-A (PUVA) radiation in 1,172 patients. After an average treatment period of 1.8 years, 937 (80%) patients were still receiving PUVA therapy or planned to use PUVA if their psoriasis flare. We defined both groups as patients who continue to rely on PUVA. Patients with the most extensive disease were least likely to continue receiving therapy. Among 1,079 patients with less than 70% involvement, 890 (82%) patients continued to rely on PUVA after 1.8 years. Factors associated with decreased continuation in this group included the following: age older than 60 years, fair or poor general health, multiple previous hospitalizations for treatment of psoriasis, and unusual reactions to sun exposure. Thus, the ability of PUVA to meet long-term treatment needs varies according to demographic and certain disease factors.

Adolescent↗
PubMed1981

Effect of methoxsalen photochemotherapy on cost of treatment for psoriasis. An example of technological assessment.

In 1974 a new therapy that employs methoxsalen and ultraviolet A irradiation (PUVA) was introduced as an outpatient treatment for severe psoriasis. To study the effect of this therapy on the cost of treatment, we documented for 1,320 patients two major components of cost--hospitalization and PUVA treatments. When the one-year period before initiation of PUVA therapy was compared with a one-year period after initiation of PUVA therapy, average hospital days per person per year declined 77% (5.1 vs 1.2). This decrease in hospitalization was most notable among patients who continued to use PUVA therapy. Largely offsetting the reduction in cost from reduced hospitalization was the cost of PUVA treatments. Our data confirm the previously known effectiveness of PUVA therapy, and they provide no support for the hypothesis that PUVA substantially increases the cost of treating patients with severe psoriasis.

Ambulatory Care↗