Low dose of acyclovir may be an effective treatment against pityriasis rosea: a random investigator-blind clinical trial on 64 patients.

BACKGROUND: Pityriasis rosea (PR) is a papulosquamous disease with an unknown aetiology, but recently the role of two herpes viruses human herpes virus 6 and human herpes virus 7 was defined as being the aetiology of PR. OBJECTIVE: The aim of this study was to compare a low dose (400 mg five times a day for a week) anti-viral agent, acyclovir, with follow-up protocol for the treatment of PR. METHODS: A randomized, investigator-blind, prospective, 4-week study was designed. Sixty-four patients with PR presenting at the outpatient clinic were randomly allocated to acyclovir (400 mg five times a day for 1 week) or follow-up group. Fifty-four of them completed the period of study and their clinical responses such as improvement rate of erythema, and scaling and occurrence of complications were evaluated by two dermatologists using weekly photographic records. RESULTS: Statistically, acyclovir was more effective than follow-up in reducing erythema at the end of the first, second, third and fourth week of treatment. Although the decrease in scaling was higher in the acyclovir group at the end of the first, second and third week of treatment, there was no statistical significance between two groups at the end of fourth week of treatment in the both groups. CONCLUSIONS: According to our study, acyclovir may be more effective than follow-up in reducing erythema and shortening of duration of PR even in lower doses than was applied in previous studies. So given the safety of acyclovir, we suggest to our colleagues to consider this treatment when facing a patient suffering from this conundrum, at least in extensive or having pruritus ones.

An unusually large squamous cell carcinoma mass arising from the lower lip.

Squamous cell carcinoma (SCC) of the lip is a relatively common malignancy of the head and neck region. Tumor thickness, grading, and perineural invasion are significant prognostic indicators. We report an 81-year-old, otherwise healthy woman presenting with a huge friable mass originating from her lower lip. The lesion had started as a small papule 8 years before. It later became eroded and ulcerative and transformed into a slow growing, flesh-colored mass that began interfering with her speaking and eating. Radiologic studies showed no evidence of bone involvement. The lesion was diagnosed histopathologically as squamous cell carcinoma. The patient was advised to undertake palliative treatment such as surgery or chemotherapy, but she refused any intervention.

Efficacy of sulfasalazine in the treatment of generalized lichen planus: randomized double-blinded clinical trial on 52 patients.

BACKGROUND: Oral sulfasalazine has been reported to be effective in patients with idiopathic cutaneous lichen planus (LP). OBJECTIVES: Our purpose was to evaluate the efficacy of this drug in the treatment of generalized cutaneous lichen planus (GLP). In this study, we evaluated the effectiveness of the anti-inflammatory drug sulfasalazine for the treatment of GLP. METHODS: A total of 52 patients with GLP presenting at the outpatient clinic were enrolled in this double-blind, randomized, placebo-controlled, prospective study. Of these patients, 44 completed the period of study. The patients were randomly divided into two groups. One group received placebo and the other was given sulfasalazine maximum 2.5 g/day. The patients were evaluated at the third and sixth weeks of treatment for improvement rate and occurrence of complications. RESULTS: After 6 weeks of treatment, the rate of cutaneous lesions improvement was 9.6% (two patients) in the placebo group and 82.6% (19 patients) in the sulfasalazine group. The improvement rate of pruritus was 14.3% in the placebo group and 91.3% in the sulfasalazine group. Side-effects which were mild and tolerable were detected in 30.7% of patients, but three patients left the study because of side effects. Most of the reported side-effects included gastrointestinal upset and headache. CONCLUSIONS: Statistically, sulfasalazine was more effective than placebo in reducing cutaneous lesions and improving pruritus after 6 weeks of treatment. According to our study, sulfasalazine is a relatively safe and effective treatment option and may be an alternative therapy for the treatment of generalized lichen planus.

Self-inflicted non-healing genital ulcer: a rare form of factitious disorder.

Dermatitis artefacta is a factitious dermatological disorder with many forms of presentation that may occur on any part of the body. A diagnosis of dermatitis artefacta is often reached after rigorous and repeated investigations. Here we present the case of a 49-year-old single man complaining of a 4- month history of ulceration on the dorsal surface of the glans penis. In view of the unusual appearance of the lesion and the negative findings from clinical investigations, a diagnosis of dermatitis artefacta was made and the patient was referred for psychiatric evaluation. He was started on 20 mg/day of citalopram and titrated up to 40 mg/day by the 4th week, leading to complete remission in the following weeks. Thus, although rare, artefactual dermatitis should be considered in the differential diagnosis of unusual penile lesions.

Aloe vera in dermatology: a brief review.

Aloe vera Linne or aloe barbadensis Miller is a succulent from the Aloe family (400 different species), a tropical plant which is easily grown in hot and dry climates and widely distributed in Asia, Africa and other tropical areas. The use of aloe vera is being promoted for a large variety of conditions. The aim of this systematic review was to summarize all dermatology-oriented in vitro and in vivo experiments and clinical trials on aloe vera preparations. Extensive literature search were carried out to identify all in vitro and in vivo studies as well as clinical trials on the subject. Data were extracted from these in a predefined standardized manner. Forty studies were located. The results suggest that oral administration of aloe vera in mice is effective on wound healing, can decrease the number and size of papillomas and reduce the incidence of tumors and leishmania parasitemia by >90% in the liver, spleen, and bone marrow. Topical application of aloe vera is not an effective prevention for radiation-induced injuries and has no sunburn or suntan protection. It can be effective for genital herpes, psoriasis, human papilloma virus, seborrheic dermatitis, aphthous stomatitis, xerosis, lichen planus, frostbite, burn, wound healing and inflammation. It can also be used as a biological vehicle and an anti-microbial and antifungal agent and also as a candidate for photodynamic therapy of some kinds of cancer. Even though there are some promising results with the use of aloe vera for diverse dermatologic conditions, clinical effectiveness of oral and topical aloe vera is not sufficiently and meticulously explored as yet.