One-week therapy with twice-daily butenafine 1% cream versus vehicle in the treatment of tinea pedis: a multicenter, double-blind trial.

BACKGROUND: Butenafine hydrochloride, a benzylamine derivative with potent antifungal activity, has been used in Japan to treat superficial fungal diseases. OBJECTIVE: We evaluated the safety and efficacy of twice-daily butenafine versus its vehicle in the treatment of interdigital tinea pedis in a multicenter, randomized, double-blind, parallel-group trial. METHODS: A total of 402 patients with interdigital tinea pedis and a positive potassium hydroxide examination were enrolled. Of the 271 patients who had culture-confirmed tinea pedis and were assessed for efficacy, 132 applied butenafine and 139 applied vehicle twice daily for 1 week. Patients were assessed for mycologic cure, effective treatment, overall cure, and mycologic/clinical cure. RESULTS: The rates of all four end points were significantly higher with butenafine than with vehicle 5 weeks after treatment ended. Rates of mycologic cure and effective treatment with butenafine were significantly higher than with vehicle at cessation of treatment. Adverse events to treatment occurred in less than 1% of patients treated with butenafine and 2% of patients who applied vehicle. CONCLUSION: Butenafine applied twice daily for 1 week is highly effective in treating interdigital tinea pedis.

Transient acantholytic dermatosis induced by recombinant human interleukin 4.

BACKGROUND: Interleukin 4 is one of many cytokines under investigation about its possible role in the pathogenesis and treatment of disease. Transient acantholytic dermatosis is of uncertain origin. It has not previously been linked to drug ingestion and is generally not believed to have an immunologic basis. OBJECTIVE: Our purpose was to describe the clinical characteristics and histologic features of a cutaneous eruption caused by interleukin 4. METHODS: Three patients in whom an eruption developed after they received intravenous recombinant human interleukin 4 were examined and biopsy specimens were evaluated. RESULTS: These patients had a pruritic papulovesicular eruption that was consistent, both clinically and histologically, with transient acantholytic dermatosis. None of the other conditions believed to precipitate transient acantholytic dermatosis was present in our patients. CONCLUSIONS: This is the first report of a cutaneous side effect of interleukin 4. This may be antibody-mediated or related to increased production of tissue-type plasminogen activator.

Widespread bullous fixed drug eruption mimicking toxic epidermal necrolysis.

This paper is written to heighten awareness of the presence of the most severe form of fixed drug eruption. Two patients with a widespread bullous form of fixed drug eruption (FDE) were initially given the diagnosis of toxic epidermal necrolysis (TEN). Both gave a history of a previous widespread eruption from the responsible drug, each had biopsies consistent with fixed drug eruption, and most importantly, both had an uncomplicated course, with complete cutaneous reepithelialization within 10 days. These observations suggest that widespread bullous fixed drug eruption may portend a more favorable prognosis than TEN, thus stressing the potential importance of distinguishing the two diseases. A review of fixed drug eruption and possible means of differentiating the widespread bullous form from TEN are discussed.

Androgenetic alopecia treated with topical minoxidil.

A randomized double-blind trial of topical minoxidil was carried out during a 12-month period in 56 patients with male pattern baldness. Subjects were randomly assigned to treatment with either 2% minoxidil solution, 3% minoxidil solution, or placebo. The placebo group was switched to 3% minoxidil after the first 4 months. Subjects using the 2% and 3% solutions of minoxidil showed a significant change in terminal and indeterminate hair counts (p less than 0.05) from the placebo group at 4 months. A progressive decrease in vellus hair counts with a concomitant increase in both indeterminate and terminal hair counts was noted during the 12-month period, suggesting that minoxidil applied topically partially reverses the balding phenomenon.

Female androgenic alopecia. The 3 alpha,17 beta-androstanediol glucuronide/sex hormone binding globulin ratio as a possible marker for female pattern baldness.

Twenty-five women fulfilling the criteria for female alopecia, of either the male pattern baldness type or female pattern baldness type, were evaluated for hormone markers to delineate the clinical baldness patterns. Women with a marked increase in the 3 alpha,17 beta-androstanediol glucuronide/sex hormone binding globulin ratio and low serum sex hormone binding globulin were noted to have female pattern baldness. This pattern of baldness may represent hair loss from the influence of minimal androgen excess on genetically sensitive hair bulbs in the absence of other signs of maximal androgen excess, including hirsutism, acne, or virilism.

Modified topical steroid therapy for the treatment of oral mucous membrane pemphigoid.

A modified approach to the treatment of two patients with oral mucous membrane pemphigoid, using an adaptation of a custom fluoride carrier, is described. The method provided for occlusive topical steroid therapy, overcoming many of the obstacles to such treatment for oral lesions. Response was excellent, with no adverse local or systemic effects. Further clinical trials to determine the applicability of this form of therapy in the treatment of patients with a number of infectious, ulcerative, and vesiculobullous oral diseases appear warranted.

Topical minoxidil therapy in hereditary androgenetic alopecia.

A randomized double-blind trial of topical minoxidil therapy was carried out on 56 patients with hereditary male pattern baldness. The subjects selected were required to have a discernible balding patch, a minimum of 2.5 cm in diameter on the vertex of the head where the hairs could be counted and photographed. Minoxidil, 1.0 mL, was applied twice a day to the scalp beginning at the balding vertex and spreading centrifugally around the scalp. Cosmetically acceptable hair growth was achieved in 18 patients (32%). The most notable indicators for regrowth of hair were the number of indeterminate hairs initially present, the duration of baldness, and the size of the balding area. No serious systemic or cutaneous side effects were noted.

A new topical antifungal drug: tioconazole.

Following 4 weeks of treatment, 32 of 35 tioconazole treated patients (91.4%) and 29 of 34 miconazole treated patients (85.3%) achieved clinical and mycologic cures. At follow-up four weeks after completion of treatment, 29 of 31 tioconazole treated patients (93.5%) and 25 of 28 miconazole treated patients (89.3%) remained cured. There was no significant difference between clinical, mycologic or clinical plus mycologic response to the two medications. The 96.2% positive culture correlation in this study is attributed to the selection of multiple culture sites.

Acroangiodermatitis of Mali.

We have presented a case of acroangiodermatitis, a rare and sometimes asymptomatic disorder which may signal the presence of an arteriovenous malformation. We have discussed the histologic differentiation from Kaposi's sarcoma.

Alopecia totalis in a chimpanzee.

A case of alopecia totalis in a chimpanzee is reported. The disease was probably due to an autoimmune phenomenon and was successfully treated with immunosuppressive therapy. However, possible side-effects outweighed benefits.

Griseofulvin in the treatment of three cases of oral erosive lichen planus.

We report three cases of erosive oral lichen planus treated with griseofulvin, 500 mg. twice a day. Subjective improvement was noticed in 3 weeks by two patients and at 6 weeks by the third patient. Objective improvement, however, was delayed and became apparent at 6 to 10 weeks. Continued improvement or remission without exacerbation was noted in all patients. There were no significant hematologic, hepatic, or other side effects in any patient, and complete blood count and blood chemistries remained normal at 1-month as well as 6-month intervals during therapy. All patients did, however, report mild, transient gastrointestinal discomfort during the first 2 days of therapy, and one patient mentioned a mild headache. These remitted after approximately 2 to 4 days. We believe that these preliminary findings warrant additional trials of griseofulvin therapy in the treatment of severely symptomatic oral lichen planus. The adverse effects of this agent appear considerably less than those of systemic steroids.

Hyperkeratotic mycosis fungoides restricted to the palms.

The case of a 45-year-old Latin American man, who presented to the Dermatology Clinic with a 6-month history of hyperkeratotic lesions confined to the palms and the palmar aspects of the digits of both hands, is discussed. Biopsy of these lesions revealed the classic histologic findings of mycosis fungoides. The clinical and histologic differential diagnosis of mycosis fungoides is considered.

Bowenoid papules of the genitalia. A case progressing to Bowen's disease.

We report a case of an older man with bowenoid papulosis of the genitalia progressing to a plaque of carcinoma in situ. The case also demonstrates a progressive eruption of bowenoid papules over a 10-year period.