Mycophenolic acid for psoriasis. A review of pharmacology, long-term efficacy, and safety.

In previous studies of up to 2 years' duration, mycophenolic acid has been shown to be an effective psoriasis suppressant. As the result of questions raised regarding the possible immunosuppressive and carcinogenic potentials of the drug, in addition to its apparent acute gastrointestinal side effects, widespread clinical trials were discontinued in 1977. We were given the unique opportunity of continuing to administer the drug on a compassionate-use basis to 85 patients for up to 13 years. In this review we report continued efficacy without dose escalation. Gastrointestinal side effects, prominent in the early years of the study, became infrequent. Although 11.6% of the patients developed uncomplicated zoster, no clinical evidence of immunosuppression was noted. The seven malignant neoplasms that arose in six of the patients were not unusual considering the age of the study population. Six patients died of conditions believed to be unrelated to drug therapy. We continue to believe that mycophenolic acid is an effective drug for the treatment of moderate to severe psoriasis and that the risks of its long-term administration are acceptable. With appropriate clinical and laboratory monitoring it can be given safely to patients who cannot take methotrexate and who may not be candidates for PUVA, retinoids, or other systemic chemotherapy.

The role of cosmetics in postadolescent acne.

The role of cosmetics in the induction and perpetuation of adult acne has been debated. This study reports the effects of a cosmetic regimen consisting of six formulations of low predicted acnegenic potential on the course of mild postadolescent acne in ten young women. No increase in activity of disease as measured by comedo and inflammatory papule counts was noted in these subjects; on the contrary, a decreasing trend in the total number of comedones and papules was noted throughout the cosmetic use period of the study. The premarketing "in-use" testing of cosmetic formulations intended for use by the postadolescent consumer with mild acne is suggested.

Cimetidine-induced xerosis and asteatotic dermatitis.

Cimetidine, a histamine H2-receptor antagonist, has previously been shown to have antiandrogenic activity in animals and to decrease the sebum excretion rate in humans. Two patients had generalized xerosis and asteatotic dermatitis that developed while they were receiving cimetidine therapy and resolved when cimetidine therapy was discontinued. We postulate that this skin change is related to the antiandrogenic properties of the drug and its effect on the sebum secretion rate.

The phototoxic effects of benoxaprofen and their management and prevention.

During clinical trials with benoxaprofen, some patients noted burning and stinging in the skin when exposed to light and some developed onycholysis. A four-part prospective study was undertaken. During the first part of the study it was demonstrated that (1) benoxaprofen is associated with a hypersensitivity to long wave-length ultraviolet light (UVA). During the remaining three parts of the study, patients were exposed to very high doses of UVA light in order to try to induce a photosensitivity response. These studies demonstrated that (2) the symptoms of burning and stinging in the skin and signs of erythema and induration after very high-dose UVA exposure (30 Joule) may be prevented by the prophylactic application of a factor 15 sunscreen; (3) exposure to sunlight is required for the development of onycholysis in patients on benoxaprofen; and (4) the development of onycholysis was prevented by the regular use of a nail polish containing sunscreen. A commercially available, colored, opaque nail polish also would be expected to provide protection from onycholysis.

The keratitis, ichthyosis, and deafness (KID) syndrome.

We describe here a patient with ichthyosis, keratitis, deafness, and recalcitrant cutaneous bacterial and fungal infections, who was previously described as having hereditary hypohidrotic ectodermal dysplasia. Similarly affected patients described in the literature have the following features in common: (1) a distinctive ichthyosis characterized by a fine dry scale, follicular hyperkeratotic spines, and a reticulated pattern of hyperkeratosis on the palms and soles; (2) a vascularizing keratitis that results in notable visual impairment; and (3) neurosensory deafness. One half of the affected patients also display frequent, severe cutaneous infections. We suggest that the name "the KID syndrome" to emphasize the characteristic features of the syndrome-keratitis, ichthyosis, and deafness.

Systemic lupus erythematosus: association with psoralen--ultraviolet-A treatment of psoriasis.

Systemic lupus erythematosus (SLE) developed in as 23-year-old woman with psoriasis during treatment with psoralen-ultraviolet-A (PUVA). The connective tissue disease was characterized by an erythematous rash, hair loss, nephritis, splenomegaly, seizures, and coma. Serum antinuclear antibodies were present in high titer, and hypocomplementemia developed. Antibodies to native or ultraviolet-irradiated DNA were not demonstrated. While the association of psoriasis and lupus may have been fortuitous, the temporal relationships suggest that PUVA treatment in this case may have been of pathogenetic importance in the development of the connective tissue disease.

Angioendothelioma: report of an unusual case in an American black.

Angioendothelioma is a rare malignant vascular tumor occurring on the face or scalp in an elderly individual or in an area of antecedent radiotherapy or chronic lymphedema. We are reporting the second fully documented case of angioendothelioma occurring in a black patient. The case is also of interest because initially the tumor mimicked kerion, both clinically and histopathologically.