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PubMedDate not supplied

Gold therapy in arthritis treatment.

The purpose of this article is to familiarize primary care providers with the use of gold salts in the treatment of rheumatoid arthritis. Gold salts used carefully can be very effective in controlling the disease when used in conjunction with other anti-inflammatory medicines. Side effects of gold therapy can be potentially dangerous; but used cautiously, gold can be of great value in the treatment of rheumatoid arthritis. The dosage schedule of gold salts described in this article is the current method of administering gold salts. The side effects--dermatological, hematological, and renal are described, and the parameters that need to be followed are also included. The flow sheet in the article can be used by health care providers as a part of the medical record in which lab results and amount of gold can be kept current. The article also emphasizes that a nurse practitioner should be aware of the emotional and financial status of the patient.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Microcirculation and oral contraceptives].

A microvascular "condition" associated with the contraceptive Pill does exist; it explains in those "priviledged" women certain functional symptoms and minor venous incidence such as telangiectasia. We still have to prove the direct and particular relation. Documents and statistics are few and far between ; the reasons for this are the difficulty in obtaining them, the pharmaceutical form, and individual vascular response. A regional investigation was carried out over four years in a homogenous population shows only four cases of telangiectasia. Clinical and experimental facts enable us to discuss the pathogeny. Excessive permeability and capillaro-venular neogenesis are at its basis and, mutatis mutandis, we can compare gravid histangiopathy and functional histangiopathy of the Pill, there being no fibrinoid necrosis. We are able to observe under capillaroscopy the same phenomenon in the base of the nail, as in the ocular conjunctiva: this stems from excessive permeability and its effects of interstitial constriction on the microvessels when the lymphatic drainage is flooded. Corrective treatment is possible.

Animals↗
PubMed1996

[The use of low doses of sodium aurothiomalate in the treatment of rheumatoid arthritis. Current trends in basic therapy].

We studied 20 patients suffering from rheumatoid arthritis treated with small doses of sodium aurothiomalate (20 mg/month, seldom 40 mg/month) for a mean time of 6.1 years (range 2.7-10.6). 16 subjects were women and 4 men; their mean age was 58 years (range 35-77). 9 patients (45%) were affected by seropositive RA; the mean duration of disease was 1.5 years (range 0.3-7.3). 14 patients achieved the grade 1 of disease activity, evaluated by Mallya and Mace's (1981) criteria: 9 subjects after 3-9 months and 5 subjects after 2-5 years. The mean length of this remission state was 4.3 years (range 0.9-9.9). Side dermatological effects (skin rashes, pruritus, exfoliative dermatitis) were observed in 3 patients (15%); 1 patient (5%) was withdrawn from the study. We have discussed the numerous advantages of low doses of sodium aurothiomalate monotherapy, although this therapy has to be employed only in patients selected by prognostic features. Moreover we briefly mention the actual opinions in R.A. therapy that discuss the traditional pyramidal approach in favour of more aggressive therapy with combination of various disease-modifying drugs in many R.A. patients.

Adult↗
PubMed1976

Comparison of allergic aspermatogenesis with that induced by vasectomy. I. In vivo studies in the guinea-pig.

Groups of male and female guinea-pigs were immunized with homologous epdidymal sperm in Freund's complete adjuvant (FCA) and skin tested at weekly intervals with a heat-treated extract of the sperm or with PPD. In females, the skin response to both antigens was similar to that to any standard protein antigen. In males, the response to sperm extract varied with the induced auto-immune orchitis, reaching a maximum immediately after testis lesion was most severe and as recovery was beginning (shown histologically): the response to PPD was decreased at 1 week after immunization, but subsequently was similar to that in females. Skin tests on guinea-pigs 8 months after bilateral vasectomy (when both ends of vasa were ligated), showed no evidence of delayed hypersensitivity to sperm, although there was marked histological evidence of reduced spermatognesis, due to back pressure atrophy.

Animals↗
PubMed2006

The MORE trial: effectiveness of adapalene gel 0.1% in real-world dermatology practices.

Effective treatment of acne often involves combination therapy. Topical retinoids are effective when used in combination with topical and/or oral antibiotics, and recent guidelines from the Global Alliance to Improve Outcomes in Acne recommend retinoids as part of initial and maintenance therapies. The Measuring Acne Outcomes in a Real-World Experience (MORE) trial evaluated the effectiveness, tolerability, and acceptability of adapalene gel 0.1% in combination with other acne treatments for subjects with moderate to moderately severe acne, either as an initial combination regimen for subjects not treated at baseline or as add-on therapy for patients already treated for acne. Of 1979 subjects aged 12 years or older who were enrolled, 1662 completed the 12-week assessment using adapalene gel 0.1% once daily for 12 weeks according to protocol. Adherence to therapy was high for both the initial combination and add-on therapies with adapalene gel 0.1%. Significant reductions in acne lesions were seen as early as week 6 and were even more pronounced by week 12 (P < .001 vs baseline for all lesion types at both weeks 6 and 12). A majority of investigators rated adapalene gel 0.1% superior to other acne treatments they had prescribed, and the success rate also was high based on the Investigator Global Assessment. The MORE trial confirms that adapalene gel 0.1% is effective in clearing both inflammatory and noninflammatory acne lesions in patients with moderate to moderately severe acne.

Acne Vulgaris↗
PubMed2006

Rising educational debt levels in recent dermatology trainees and effects on career choices.

BACKGROUND: Educational debt levels are outpacing inflation. OBJECTIVE: To determine whether debt levels influence career choices of graduating dermatology residents. METHODS: Anonymous surveys of graduating dermatology residents. RESULTS: The presence of debt was associated negatively with pursuing fellowship training in 1999 and 2004 (P < .05) but did not affect choices about entering solo practice or job dissatisfaction levels. LIMITATIONS: This study relies on self-reported data, and some surveys were incomplete. CONCLUSION: Debt levels do not appear to significantly influence the career choices of dermatology residents.

Adult↗
PubMed2007

Incorporating photodynamic therapy into a medical and cosmetic dermatology practice.

Effective in the treatment of a growing variety of skin conditions, photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) is rising rapidly in popularity among both practitioners and patients, despite the fact that many applications are not yet cleared by the Food and Drug Administration. Because of its versatility, safety, efficacy, cosmetic benefits, and potential financial advantages, ALA-PDT may soon be a mainstay in many clinical settings. This article provides an overview of this easy-to-use treatment modality and a guide to implementing ALA-PDT into practice, including pretreatment and post-treatment protocols and guidelines for managing side effects.

Dermatology↗
PubMed2000

Adverse effects of herbal drugs in dermatology.

Herbal treatments are becoming increasingly popular, and are often used for dermatological conditions. Thus dermatologists should know about their potential to cause adverse events. This review is aimed at addressing this area in a semisystematic fashion. Some agents, particularly Chinese herbal creams, have been shown repeatedly to be adulterated with corticosteroids. Virtually all herbal remedies can cause allergic reactions and several can be responsible for photosensitization. Some herbal medicines, in particular Ayurvedic remedies, contain arsenic or mercury that can produce typical skin lesions. Other popular remedies that can cause dermatological side-effects include St John's Wort, kava, aloe vera, eucalyptus, camphor, henna and yohimbine. Finally, there are some herbal treatments used specifically for dermatological conditions, e.g. Chinese oral herbal remedies for atopic eczema, which have the potential to cause systemic adverse effects. It is concluded that adverse effects of herbal medicines are an important albeit neglected subject in dermatology, which deserves further systematic investigation.

Complementary Therapies↗
PubMed1998

A prospective evaluation of dermatological side-effects during alpha-interferon therapy for chronic viral hepatitis.

OBJECTIVE: Alpha-interferon therapy may occasionally account for immune-mediated phenomena. This study was conducted in an attempt to investigate the incidence of the development of immune-mediated dermatological diseases during alpha-interferon therapy in patients with chronic viral hepatitis. The latter has not been evaluated prospectively, whereas most of the previous studies examined small numbers of interferon treated patients or consisted of case reports. DESIGN: A prospective case-control study. SETTING: A tertiary referral centre. PARTICIPANTS: One hundred and twenty consecutive patients with chronic viral hepatitis (67 with hepatitis B, 45 with hepatitis C, six with both hepatitis viruses, and two with delta hepatitis) were evaluated during a course of alpha-interferon therapy. In addition, 120 consecutive patients with chronic liver diseases (disease control group), who had never received alpha-interferon therapy, were evaluated during the period of the study (at least for 12 months). INTERVENTIONS: Recombinant alpha-interferon at a dose of 4.5 or 5 million units subcutaneously (s.c.) three times per week for 6 to 12 months was administered to patients with hepatitis B. The patients with chronic hepatitis C were treated with 3 million units s.c. three times per week for 12 to 18 months. The patients with chronic hepatitis B and C infections received 4.5 million units for 6 months, and then 3 million units for an additional 6 to 12 months. Finally, the patients with chronic delta hepatitis received 5 million units for 1 year or more. MAIN OUTCOME MEASURES: To assess prospectively the incidence of these dermatological disorders during alpha-interferon therapy and to estimate if there is any relationship between their development and the clinical, laboratory or other characteristics of the patients with chronic hepatitis. RESULTS: Three to 6 months after the initiation of alpha-interferon three patients with chronic viral hepatitis (two with hepatitis C and one with hepatitis B) developed lichen planus, whereas one patient with hepatitis C developed relapsing aphthous stomatitis. The development of these disorders was significantly associated only with the presence of antinuclear antibodies before the initiation of alpha-interferon (P=0.000000). None of the patients from the disease control group had such a manifestation during the follow-up. Lichen planus resolved after the end of therapy in all of them. In contrast, therapy was discontinued in the patient who developed aphthous stomatitis, owing to the painful lesions. CONCLUSIONS: This study demonstrated that alpha-interferon may rarely (3.3%) induce immune-mediated dermatological disorders, especially lichen planus. The development of these disorders may reflect a subclinical or covert autoimmune background of patients, as suggested by the presence, although in low titres, of antinuclear antibodies. However, when lichen planus developed, it was mild, did not require the discontinuation of therapy and resolved after alpha-interferon administration had ceased.

Adult↗