Biomedical subjects
Publications and source records attributed to S E Prawer.
We describe a previously unreported occupational dermatosis occurring in a worker employed in drywall installation and finishing. This 50-year-old man presented with bilaterally symmetrical, parallel, linear crusted erosions on his anteromedial legs after wearing drywall stilts. The pathophysiology of this condition is considered.
Forty-six subjects with hand dermatitis participated in a pilot study comparing a new semipermeable glove to a standard cotton glove. A variety of diagnoses were represented. Each subject received treatment with topical steroids and/or moisturizers and used one each of the experimental and cotton gloves for approximately one month. Physicians scored skin condition before and after treatment. Subjects evaluated skin comfort and practical aspects of using each type of glove. Thirty subjects completed the study protocol. The type of glove used had no impact on skin condition at follow up, with both groups of hands improving. Patients expressed a preference for the experimental gloves, noting improvements in skin and hand comfort, dexterity, cleanliness, and ease of use. Feedback suggested that the gloves will be well tolerated and patient compliance in using the gloves will be high. Evaluation of the gloves' value for prevention and chronic management of hand dermatitis is warranted.
The efficacy and safety of halobetasol propionate 0.05% cream, an ultra high-potency corticosteroid preparation, was evaluated in a double-blind, vehicle-controlled, paired comparison study. Patients' psoriatic lesions were evaluated before treatment and after 1 and 2 weeks of twice-daily treatment with halobetasol propionate and vehicle. Response measures (plaque elevation, erythema, scaling, and pruritus) were evaluated with a 4-point severity scale whereby the sum provided a total score. Patient self-assessment measures were obtained at the 2-week visit by categorizing his or her global responses to queries about each treatment's "effectiveness" and "overall rating." All efficacy parameters, as judged by the physician, showed statistically significant (p = 0.0001) treatment differences favoring halobetasol propionate at both week 1 and week 2 evaluations. Patient global responses for "effectiveness" and "overall rating" favored halobetasol propionate 0.05% cream over vehicle after 2 weeks of use. No systemic adverse drug effects were reported during the study. No patient was discontinued from the study because of an adverse event, and there was no evidence of skin atrophy after 2 weeks of treatment with either agent. Patient reports of "stings" or "burns" were equally distributed between the active and vehicle treatment groups. This trial demonstrates that halobetasol propionate 0.05% cream is clinically beneficial and without evidence of significant risk in the treatment of plaque psoriasis.
Severe photoaging of the skin, which may be caused by exposure to both natural and artificial ultraviolet light, ultimately results in actinic keratoses and cancer. Cancers are common on the head, neck, arms, and hands. Because of the potential for metastasis, squamous cell carcinomas generally require surgical excision and histologic examination. Although metastasis is rare with basal cell carcinoma, neglected lesions around the eyes, nose, or ears can invade bone, nerves, and cartilage and may cause death. Avoidance of sun, physical protection, and regular use of sunscreens are recommended.
Ninety psoriasis patients, who were either completely cleared of or manifested only a minimal presence of disease signs following 3-4 weeks of twice daily treatment with augmented betamethasone dipropionate (ABD) ointment 0.05%, were enrolled in this multicenter, double-blind, placebo-controlled study. The study was designed to determine if an intermittent pulse dose regimen of ABD ointment could safely and effectively maintain a remission disease status when treatment was applied in three consecutive applications 12 h apart, once a week for a maximum treatment period of 6 months. The disease of 60% of the patients in the active treatment group was successfully controlled for 6 months, while 80% of the placebo-treated patients experienced exacerbation of disease signs. No serious local or systemic treatment-related adverse experiences were reported. ABD ointment 0.05%, when applied using the intermittent treatment regimen described here, was shown to be a clinically beneficial and well-tolerated method of long-term (up to 6 months) maintenance therapy for psoriasis patients.
Superpotent topical steroids used to treat psoriasis and steroid-responsive dermatoses may produce local cutaneous side effects, including atrophy, steroid acne, perioral dermatitis, hypopigmentation, hypertrichosis and superinfections. Suppression of the hypothalamic-pituitary-adrenal axis may be one of the systemic side effects. Superpotent topical steroids should not be used under occlusion, in flexural areas, on the face and in children. The total amount used per week and the duration of treatment should be carefully monitored.
Overt iatrogenic cutaneous atrophy is easily recognized; however, the earliest signs of such an adverse event may be covert. Preatrophy is proposed as a term to describe the subtle unmasking or normally covert subpapillary vascular channels found by the use of enhanced skin surface magnification techniques. We conducted a randomized double-blind, bilaterally paired comparison clinical trial in patients with chronic plaque psoriasis treated with twice-daily (nonoccluded) superpotent topical steroids for 2 weeks. Occult reversible delicate networks of horizontally oriented vascular channels were found within and surrounding 20% (23/118) of the involved psoriatic plaques during the course of the study. The use of a hand-held magnifying lens (8X), mineral oil, a coverglass, and adequate illumination allow recognition of preatrophy. Preatrophy was more frequently found in women than in men.
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Fifty-eight patients participated in a controlled evaluation that compared a transparent film dressing (TFD [Bioclusive]) with a combination of conventional dry gauze dressing (Curity) and antibiotic ointment (Polysporin) in the treatment of fresh skin wounds following Mohs micrographic surgery. The TFD group showed a faster rate of wound contraction and reepithelialization and a shorter total healing time. The TFD was rated better with regard to comfort, ease of use, and ease of dressing removal. At six-month follow-up, the TFD group had scars that were softer, smoother, and showed less thickening and anatomic deformities. Better cosmetic appearance and greater patient acceptance were also noted with the TFD.
A study was done of extended maintenance therapy using either betamethasone dipropionate (Diprolene) in optimized vehicle (OV) (ointment) or placebo in patients with psoriasis vulgaris. Of 59 patients originally enrolled in the study, 38 assessable patients achieved clearing of at least 85% improvement from baseline with traditional betamethasone in OV twice a day for two to three weeks before intermittent pulse dosing was attempted. Thereafter, the test medication was used on weekends (three consecutive doses at 12-hour intervals) once a week. Fourteen patients (74%) of the betamethasone in OV group and four patients (21%) of the placebo group maintained a remission status for 12 weeks. Intermittent pulse dosing with betamethasone in OV seems safe and efficacious maintenance therapy in selected psoriatic patients.
A 24-month clinical trial, begun on a double-blind basis, was conducted in 153 men with discernible male pattern baldness of the crown with the use of either topically applied placebo, 2% minoxidil, or 3% minoxidil solution. After 4 months the patients using placebo were switched to 3% minoxidil solution. At 12 months, there were statistically significant increases in terminal hair growth within a 1-inch target area in those treated with 2% or 3% minoxidil solution, in comparison with baseline counts. However, there were few patients who had appreciable cosmetic restoration. At 12- and 24-month intervals, progressive regression or stabilization of the size of the bald area was noted in the majority of patients. This therapeutic or preventive effect was statistically significant. The data on actual target area hair counts suggested that the 2% minoxidil solution was equal to or more efficacious than the 3% minoxidil solution. Baseline vital signs and laboratory parameters remained essentially unchanged. Topical minoxidil was well tolerated, with no serious drug-related adverse reactions noted during the study.
Multiple clinical and laboratory evaluations, including morning plasma cortisol levels, were done in forty patients having moderate to severe psoriasis vulgaris prior to and during treatment with either betamethasone dipropionate in optimized vehicle or clobetasol-17-propionate ointment. The study was randomized, double-blind, and of parallel group design, lasting 3 weeks. Both drugs were effective (3 of 4 achieving at least 75% or more improvement). Temporary reversible suppression of the hypothalamic-pituitary-adrenal axis, as reflected by low morning plasma cortisol determinations, was found in eight of forty patients (20%). The clinician should respect the potential for superpotent topical steroids to cause laboratory evidence of adrenal suppression.
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The skin-surface touch print is a practical, easily performed and noninvasive method for obtaining a sample of infected stratum corneum or hair. This technique is particularly useful in diagnosing superficial fungal infections. With simple staining, fungal hyphae and spores can be readily visualized microscopically. This technique has been found to be as effective as the potassium hydroxide test.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Epidermodysplasia verruciformis (EV) is a rare disease characterized by the early onset and unremitting progression of wart-like lesions and frequent association of cutaneous carcinomas. We report two siblings with EV. Immunologic study of both patients demonstrated normal immunoglobulin levels, normal numbers of T-lymphocytes and B-lymphocytes, but markedly depressed in vitro blastogenic reactivity to mitogens and antigens. Cutaneous anergy to a variety of common skin test antigens was noted. These observations may reflect an inherited abnormality in immune function, or the depressed immune function may result from the viral infection of EV.