Treatment of tinea imbricata: a randomized clinical trial using griseofulvin, terbinafine, itraconazole and fluconazole.

BACKGROUND: Griseofulvin has been the mainstay of treatment for tinea imbricata (TI) for decades; however, there have been few reports of efficacy of newer antifungals in the treatment of this condition. Many patients with TI have several obstacles to treatment due to their remote geographical locations and the primitive nature of their societies. OBJECTIVES: The aim of this study was to compare the efficacy of itraconazole, terbinafine and fluconazole with that of griseofulvin after 4 weeks of therapy. METHODS: Patients aged 12-76 years with the clinical diagnosis of TI were randomly assigned to one of four treatment groups: griseofulvin 500 mg twice daily for 4 weeks, terbinafine 250 mg daily for 4 weeks, itraconazole 200 mg twice daily for 1 week or fluconazole 200 mg once weekly for 4 weeks. Disease activity was monitored weekly. Laboratory measurements included monitoring complete blood count and liver function enzymes. Fifty-nine patients were included in the efficacy analysis: 13 in the fluconazole group, 15 in the griseofulvin group, 12 in the terbinafine group and 19 in the itraconazole group. RESULTS: Significant remission was achieved in the terbinafine and griseofulvin groups, lasting up to 8 weeks after cessation of therapy. The fluconazole group experienced no significant remission, and remission was of short duration in the itraconazole group. No adverse events were reported, and non-compliance with medications or follow-up was the only reason for removal from the study. CONCLUSIONS: Griseofulvin and terbinafine are effective in the treatment of TI. The decision of whether to treat at all and which medication to choose depends greatly on the extent of involvement, the social situation, and the availability of resources such as laboratory testing and follow-up.

Azithromycin for the treatment of acne.

BACKGROUND: Acne affects a large number of young adults, including women, who often present with facial as well as truncal involvement. Systemic antimicrobial agents currently used for the reduction of inflammatory papules and cysts require frequent administration and are sometimes associated with uncomfortable side-effects contributing to a decrease in compliance. METHODS: Ninety-nine episodes of inflammatory acne in 79 patients treated with oral antimicrobial agents were studied retrospectively over a period of 46 weeks. Patients were treated with tetracycline, erythromycin, minocycline, and doxycycline, the most commonly prescribed oral antimicrobials used to treat acne. Individuals that were unable to tolerate this therapy or had failed conventional therapy were treated with the azalide antibiotic azithromycin, given in a single oral 250-mg dose three times a week. The other agents were administered daily in divided doses as is current practice. Patients were also on topical care. RESULTS: The efficacy and reported side-effects were examined for all agents. Significant improvement was noted in 4 weeks. All agents were effective in reducing inflammatory lesions and improving acne. Azithromycin produced a slightly higher percentage of patients with a greater than 80% reduction in their inflammatory acne lesions (85.7%) vs. an average of 77.1% for all other agents. All differences observed were not statistically significant. CONCLUSIONS: The results show that azithromycin is a safe and effective alternative in the treatment of inflammatory acne with few side-effects and good compliance, and suggest the need for further investigation with a clinical trial that will compare the long-term efficacy and tolerability.

Neurologic symptoms posing as dapsone-induced polyneuropathy in two patients with dermatitis herpetiformis.

The clinical picture of neuropathy caused by dapsone is usually progressive muscle weakness and wasting, most often involving distal muscles of the extremities. Two patients with neurologic symptoms following the use of dapsone for dermatitis herpetiformis are reported. Both patients had normal motor conduction velocities, and negative results on physical examination of muscle wasting. We conclude that their clinical presentation was not due to dapsone-induced neuropathy. A discussion and a review of cases of this unusual effect of dapsone are included.

Residents' corner: cryosurgery of clear cell acanthoma.

A case is presented of an epidermal tumor occurring in an 84-year-old male which had been treated for many years as a chronic dermatitis. Following histologic confirmation of clear cell acanthoma, cryosurgery was attempted, resulting in a complete resolution of the tumor with no recurrence at 6 months.

Flagellate pigmentation from intrapleural bleomycin. A light microscopy and electron microscopy study.

A case is presented of a 65-year-old white man with left pleural mesothelioma treated with a single intrapleural instillation of bleomycin for cavitary sclerosis. One month later the patient developed pigmented flagellate streaks on his arms and chest wall. To our knowledge, this is the first case in the literature showing these typical pigmentary changes in which a single small dose of bleomycin acted as an intrapleural sclerosing agent.