Terfenadine in chronic urticaria: a comparison with clemastine and placebo.

Terfenadine, a new specific and peripherally acting antihistamine, was compared with clemastine and placebo in a prospective, randomized, double-blind, double-dummy, crossover study of the treatment of chronic urticaria. Sixty patients with chronic urticaria participated in this multicenter trial. The treatment time was two weeks per drug treatment, totalling six weeks. Terfenadine proved more effective than clemastine and was associated with significantly less sedation. Few adverse reactions were noted.

The pros and cons of an oral treatment of dermatomycosis.

The advantages and disadvantages of oral treatment of dermatomycosis is discussed, particularly with regard to griseofulvin and ketoconazole as examples. The advantages versus topical treatment are better efficacy, better compliance, and oral treatment is possibly more economical. Disadvantages are toxicity, development of resistant strains, interaction with other drugs and time- and cost consuming regular supervision of the patients.

Reproducibility of clinical trials of topical glucocorticosteroids.

Clinical trials of topical glucocorticosteroids employ a variety of evaluating methods. This makes it difficult to assess the relative strengths of the products without resorting to direct comparative trials between them. We propose a standardized evaluation system for this class of pharmaceuticals that can easily be adopted by any competent dermatologist. Its use would facilitate evaluation of new topical glucocorticosteroids.

Double-blind comparison of a zinc pyrithione shampoo and its shampoo base in the treatment of tinea versicolor.

A zinc pyrithione shampoo was compared with its shampoo base in the treatment of tinea versicolor. Forty patients with tinea versicolor were included in the study. The condition in twenty patients treated with the zinc pyrithione shampoo cleared; the condition in the remaining twenty patients treated with the shampoo base did not. No side effects were noted in any of the patients.

A comparative study of dithranol cream, 0.25% and 0.1%, and dithranol ointment 0.25% in the treatment of psoriasis.

A trial was carried out in 60 patients with relatively stable psoriasis to compare the effectiveness, tolerance and cosmetic properties of dithranol in a cream base (0.1% and 0.25%) or in the form of a soft paraffin ointment (0.25%). Patients were assigned at random to receive treatment with one or other of the three formulations, applied once daily, over a period of 4 weeks. Assessments were made initially and after 2 and 4 weeks of induration, redness, scaling and pruritus and during the trial of staining of clothes and linen, skin discolouration and burning. There was no significant difference in effect between dithranol cream 0.25% and dithranol ointment 0.25%, while both showed a better effect than dithranol cream 0.1% (p less than 0.05). The dithranol cream preparations were significantly better (p less than 0.05) than dithranol ointment 0.25% regarding all the cosmetic variables after 2 as well as after 4-weeks' treatment. The same applied to the patients' overall evaluation of the cosmetic acceptability. Three patients in the dithranol ointment group were considered as treatment failures. One of them refused to continue with the treatment due to burning and another due to burning and staining.

Treatment of dermatomycoses with topical tioconazole and miconazole.

A total of 60 patients with proven fungal infection of the skin took part in a single-blind comparative study of the efficacy, toleration and safety of tioconazole base 1% w/w and miconazole nitrate 2% creams applied twice daily for 14 days to patients with pityriasis versicolor and for 28 days to patients with dermatophyte and yeast infections. Overall assessment of the patients reviewed at the end of treatment showed that 23 of 30 patients (77%) treated with tioconazole and 19 of 30 patients (63%) treated with miconazole were clinically and mycologically cured. Tioconazole cured 80% (8 of 10) and miconazole cured 38% (5 of 13) of the infections with Trichophyton rubrum, which are the most frequent ones. At long-term follow-up, approximately 6 weeks later, results in both treatment groups were comparable. 20 of the 23 patients (87%) cured by tioconazole and 18 of the 19 patients (95%) cured by miconazole remained free from infection. Both creams were easy to apply and there were no reports of staining. No side effects were recorded during the study.

A double-blind trial of budesonide and betamethasone- 17,21-dipropionate in psoriasis.

A double-blind trial was carried out to compare the effectiveness of budesonide, a non-halogenated steroid, and betamethasone-17,21-dipropionate in the treatment of psoriasis. One group of 40 hospitalized patients was treated with both preparations under occlusive dressings. The evaluation was done as a left-right comparison within each patient. These patients were treated for 1 week, with evaluations on Days 3 and 7. Another series of 79 out-patients was divided into two groups, either group being treated with one of the two preparations. These were treated for 2 weeks, with evaluations after 1 and 2 weeks. Itching, scaling, erythema and induration were recorded on a 5-point scale. A preference was stated for the best result. Statistically significant results favouring the budesonide ointment were obtained, both with and without occlusion.

Experimental infections in rabbits and humans with Pityrosporum orbiculare and P. ovale.

The purpose of this investigation was to produce experimental tinea versicolor in rabbits and humans with Pityrosporum orbiculare and P. ovale. P. orbiculare and P. ovale were inoculated, with and without occlusion, on the inside of the ear in 10 male rabbits and on the upper arm in 10 patients with a history of tinea versicolor, and in 3 healthy volunteers. After 1 week tinea versicolor-like lesions were produced with both P. orbiculare and P. ovale in 8 of 10 rabbits. Likewise experimental infections, similar to those found clinically in tinea versicolor, were seen, after 1 week, in 5 patients with a history of tinea versicolor and in the 3 healthy volunteers. Two of 5 patients inoculated for only 4 days showed identical but less pronounced lesions. Experimental infections could only be produced with occlusion. Microscopically short hyphae and transformation between round and oval forms were seen in both P. orbiculare and P. ovale. This investigation adds to the identity of P. orbiculare and P. ovale and also to the identity of these 2 fungi and the fungus seen in tinea versicolor. Spontaneous healing and the fact that experimental infections were produced only under occlusion illustrates the importance of predisposing factors in tinea versicolor.

Ro 11-1430, a new retinoic acid derivative for the topical treatment of acne.

The clinical efficacy and tolerance of a new retinoic acid derivative, Ro 11-1430, in the treatment of acne vulgaris have been compared with those of tretinoin in a double-blind trial with 60 patients during 8 weeks. The efficacy of both drugs was good. Tretinoin showed a tendency to give better effect but this was not statistically significant. However, tolerance of the new derivative was better. 48 of the patients were treated with Ro 11-1430 for another 3 months with good effect and tolerance. In a long-term study, 32 patients with previous irritation of tretinoin have been treated with Ro 11-1430 between 1.5 and 17 months with good tolerance.

The atopic thigh: a "starting-school' symptom?

In a retrospective survey of 1112 patients with atopic dermatitis we found that the age of onset of lesions localized to the lower gluteal and posterior femoral regions reached its peak at the age of 7 to 8 years. We speculated that this is due to sweat retention caused by prolonged sitting when these predisposed individuals start school.

Solubility of antimycotics: a problem in in vitro experiments.

An investigation of how miconazole nitrate dissolved in dimethylformamide in initial concentrations of 1,000, 500, and 100 microgram/ml may alter its concentration with storage time, is presented. The determination of miconazole nitrate was performed with high pressure liquid chromatography. After 8 hours the 1,000 microgram/ml solution was milky and the concentration of miconazole had fallen significantly. It was concluded that test agar plates or agar tubes must be made with freshly prepared and clear stock solutions, otherwise false MIC's may be obtained.

[Comparative double-blind study on ciclopiroxolamine cream and placebo cream in dermatophytoses (author's transl)]. / Doppelblind-Vergleichsstudie mit Ciclopiroxolamin-Creme und Plazebo-Creme bei Dermatophytosen.

In a controlled double-blind study involving 60 patients with dermatophytosis, cream containing 1% 6-cyclohexyl-1-hydroxy-4-methyl-2(1H)-pyridone, 2-aminoethanol salt (ciclopiroxolamine, Cic, Hoe 296, Batrafen cream) was compared with vehicle as to effectiveness and tolerability. Each treatment was applied to 30 patients, the compounds being assigned at random to be used for 21 days per patient. Assessed on clinical, cultural and microscopical findings. Cic cream proved to be significantly more effective than vehicle. Under the application of Cic cream, all (100%) of the cultures and native preparations became free of fungi (negative), whereas with vehicle only 27% and 23% negative cultures and native preparations, respectively, were obtained. The skin symptoms showed significantly more improvement with Cic cream than with vehicle. All 60 patients completed the study. No side effects occurred.

The antimycotic activity in vitro of five diols.

The antimycotic activity of ethane-1,2-diol, propane-1,2-diol, butane-1,3-diol, pentane-1,5-diol, and hexane-2,5-diol in vitro against Pityrosporum orbiculare, Candida albicans, Trichophyton rubrum, T. mentagrophytes var. interdigitale and Epidermophyton floccosum was studied. Ethane-1,2-diol had the lowest activity (MIC of 40-100 g 1(-1)), and hexane-2,5-diol the highest activity (MIC of 10-40 g 1(-1)). Among, the higher diols there can be both effective antifungal agents and substances with a lower risk of allergic and irritative skin reactions than propane-1,2-diol.

Antimycotic activity of propane-1,2-diol (propylene glycol).

Propane-1,2-diol in concentrations of 30-90 g/l was found to inhibit in vitro the growth of Pityrosporum orbiculare, Candida albicans, Trichophyton rubrum, T. mentagrophytes var. interdigitale, and Epidermophyton floccosum. These results are discussed in relation to the management of fungal skin diseases.

An open trial of the effect of a zinc pyrithione shampoo in tinea versicolor.

The effect of zinc pyrithione 1 percent, incorporated in a shampoo, has been tested in an open trial of twenty patients with tinea versicolor. The period of treatment was two weeks, and eighteen patients returned for follow-up visits two weeks after the last day of treatment. All of these patients were cured of tinea versicolor clinically, under Wood's light, and microscopically. No side effects were noticed in any of the patients and the patients found the shampoo cosmetically acceptable.