Long-term efficacy and safety of tacalcitol ointment in patients with chronic plaque psoriasis.

BACKGROUND: As psoriasis patients often require continuous treatment optimal therapy has to provide efficacy and a good safety profile over the long term. OBJECTIVES: The aim of this multicentre study was to assess the efficacy, safety and tolerability of tacalcitol (4 microg g(-1)) ointment (Curatoderm, Hermal, Reinbek, Germany) applied once daily over a treatment period of 18 months. PATIENTS AND METHODS: Efficacy parameters were Psoriasis Area Severity Index (PASI), based on summed scores of erythema, infiltration and scaling and total body surface involvement (TBI). Safety assessment included serum levels of calcium, parathyroid hormone, calcitonin, 1,25-dihydroxy vitamin D3 (calcitriol); urinary calcium, creatinine, calcium/creatinine ratio in spot and 24-h urine and urinary alpha(1)-microglobulin. A group of 304 patients with chronic plaque psoriasis, covering between 7% and 20% of the body surface area was included for the initial treatment phase of 3 months. Of the 257 patients who completed the initial 3 months, 197 patients continued in a second treatment phase of 15 months. RESULTS: Tacalcitol treatment proved to be effective in reducing the severity of psoriasis and maintained therapeutic response over the study period. The median PASI fell from 9.5 to 4 .6 at month 3 and to 3.25 at month 18 (P < 0.0001). The median improvement in TBI was 30% at month 3 and 50% at month 18. In no patient was there any relevant disturbance of calcium homeostasis. There were no significant changes in mean values of serum calcium, parathyroid hormone and calcitriol. Additionally no significant changes in 24-h urinary excretion evaluation were observed. There was no correlation between levels of serum calcium or urinary calcium and amount of tacalcitol ointment used, even in the patients requiring the largest amounts of ointment (up to 13 g day(-1) and up to 20% of body area affected). Treatment was generally well tolerated and there were no serious or unexpected adverse events reported. However, discontinuation of treatment as a result of skin irritation was seen in 5.9% of patients. The greatest frequency of cutaneous side-effects occurred during initial treatment and the incidence decreased markedly as the treatment was well-tolerated with continued use. CONCLUSIONS: Tacalcitol ointment once daily was demonstrated to be efficacious, safe and well tolerated in the long-term control of plaque psoriasis in patients with up to 20% body surface involvement.

Topical tacalcitol treatment for psoriasis.

Multiple studies have shown the benefit of topical tacalcitol treatment for chronic plaque psoriasis. Tacalcitol ointment 4 micrograms/g is efficacious and well tolerated as both monotherapy and in combination with other treatments such as ultraviolet light therapy. It can be used all over the body including the face and scalp.

Successful treatment of severe psoriasis with basiliximab, an interleukin-2 receptor monoclonal antibody.

T-cell mediated inflammation plays an important role in the aetiology of psoriasis. We describe a case of severe recalcitrant psoriasis responding well to combined cyclosporin and basiliximab (Simulect(R) Novartis Pharmaceuticals UK Ltd), an interleukin-2 receptor (IL-2R; CD25) chimeric monoclonal antibody.

Two cases of primary hyperparathyroidism associated with primary cutaneous lymphoma.

Primary hyperparathyroidism has been described previously in association with malignancy, but to our knowledge has not been reported in association with primary cutaneous lymphoma. We report two cases of parathyroid adenoma with primary cutaneous lymphoma, the first in a 42-year-old woman with CD30-negative cutaneous large cell lymphoma, and the second in a 67-year-old man with mycosis fungoides and CD30-positive anaplastic large cell lymphoma.

Digital teledermatology for skin tumours: a preliminary assessment using a receiver operating characteristics (ROC) analysis.

A low-cost store-and-forward teledermatology system using digital images for the remote diagnosis and management of skin tumours was evaluated. Two hospitals participated in the trial. Patients were seen face to face at one hospital, and had their images and clinical history viewed remotely by a different dermatologist at a second hospital. A preliminary receiver operating characteristics (ROC) analysis revealed clinical agreement between the teledermatologist and face-to-face dermatologist in 93% of cases in terms of their assessment of the benign/malignant nature of the lesions. Sensitivity of the judgements was 88% and specificity was 80%. These preliminary findings indicate the potential for remote management of skin tumours using a low-cost system in the National Health Service.

Allelic heterogeneity of dominant and recessive COL7A1 mutations underlying epidermolysis bullosa pruriginosa.

The inherited mechanobullous disease, dystrophic epidermolysis bullosa, is caused by type VII collagen gene (COL7A1) mutations. We studied six unrelated patients with a distinct clinical subtype of this disease, epidermolysis bullosa pruriginosa, characterized by pruritus, excoriated prurigo nodules, and skin fragility. Mutation analysis using polymerase chain reaction amplification of genomic DNA, heteroduplex analysis and direct nucleotide sequencing demonstrated pathogenetic COL7A1 mutations in each case. Four patients had a glycine substitution mutation on one COL7A1 allele (G1791E, G2242R, G2369S, and G2713R), a fifth was a compound heterozygote for a splice site mutation (5532 + 1G-to-A) and a single base pair deletion (7786delG), and a sixth patient was heterozygous for an out-of-frame deletion mutation (6863del16). This study shows that the molecular pathology in patients with the distinctive clinical features of epidermolysis bullosa pruriginosa is heterogeneous and suggests that other factors, in addition to the inherent COL7A1 mutation(s), may be responsible for an epidermolysis bullosa pruriginosa phenotype.

Teledermatology--high technology or not?

As an alternative to attending a conventional dermatology clinic, patients had a high-resolution conventional photographic image taken by a professional medical photographer. The photographic images were viewed by a dermatologist together with referral details from the general practitioner and any other relevant information from the patient's notes. From the images, a dermatological diagnosis was derived and a management plan for each patient instituted. After treatment, histological assessment of the tumours allowed diagnostic accuracy to be determined. The preliminary diagnostic accuracy (71%) was greater than that of the referring general practitioners (49%). However, when the diagnostic ability of the method to detect the nature of malignant lesions was examined, telemedicine was able to detect malignancies in 94% of cases compared with only 70% detected by general practitioners. The results of the present study indicate that teledermatology is achievable using a low-technology, low-cost approach.

Subacute cutaneous lupus erythematosus: two cases of delayed diagnosis.

Two cases of subacute cutaneous lupus erythematosus are described. Features which delayed diagnosis are discussed. The potential clinical and histopathological overlap between this condition and erythema multiforme is emphasized, drawing attention to the histological features which allow distinction. The possibility that some cases of Rowell's syndrome may be manifestations of subacute lupus erythematosus is discussed.

Latex glove allergy among hospital employees: a study in the north-west of England.

The frequency of use and duration of wearing latex gloves among hospital employees has increased due to concerns about AIDS and hepatitis. In many countries there is increased consciousness about latex sensitization. In the UK, the Medical Device Agency has been monitoring latex allergy for a number of years but has not found any conclusive evidence of any significant problem. We report following a detailed questionnaire study in two hospitals in the north-west of England. A total of 1,827 members of staff were questioned about latex allergy at work. One hundred and twenty-four (7%) of these hospital employees had experienced symptoms strongly suggestive of latex allergy. Of this group, 56 had a-RAST test (IgE specific to latex), which was positive in seven (12.5%). There was a history of atopy in 31%, and a family history of atopy in 17% of the individuals. As a result of the study it was found that 17% (21 of the affected individuals) had already changed their working practice by using latex-free gloves. We were able to increase awareness of latex allergy within the hospitals. Both individuals and health care organizations need to be aware of the problem and hospital organizations should encourage staff to seek guidance to address the problem and, if necessary, to take appropriate measures to improve working practices. Practical guidelines are given with regard to identifying the problem and glove use for hospital staff.

Digital imaging and teledermatology: educational and diagnostic applications of a portable digital imaging system for the trainee dermatologist.

Teledermatology is no longer a futuristic curiosity; several general practices across the UK are now preparing to be electronically linked to other medical services for the purposes of referral and telediagnosis. Further, digital imaging in dermatology has been the subject of considerable research in recent years, largely because of its application to telemedicine. Indeed in the UK, geographically isolated general practices in North Powys have already demonstrated the effective delivery of dermatological expertise through a video-conferencing link to a consultant dermatologist at Aberystwyth Hospital, thereby reducing the need for patients or the consultant to travel long distances.

A portable digital imaging system in dermatology: diagnostic and educational applications.

Digital photographs were taken by a trainee dermatologist of the presenting lesions of 100 unselected, consecutive new patients. For the 38 patients presenting with rashes there was clinical disagreement in only four cases (10%). For the 62 patients with tumours there was clinical disagreement in three cases (3.8%). In a further three cases both clinicians agreed on a differential diagnosis which was subsequently disproved by histological findings and clinical progress. The study demonstrated that an affordable, low-resolution, fixed-focus digital camera with close-up lenses could provide diagnostically useful images suitable for telediagnosis in dermatology.