An open study of efficacy and safety of long-term treatment with mometasone furoate fatty cream in the treatment of adult patients with atopic dermatitis.

BACKGROUND: Atopic dermatitis is a severe chronic skin disease often deteriorated by the presence of microorganisms and often responds well to treatment with potent corticosteroids. However, the long-term use of potent topical corticosteroids are accompanied by side-effects such as skin atrophy. OBJECTIVE: To study the effect and safety of prophylactic treatment with mometasone furoate fatty cream (contains hexylene glycol) for 6 months in patients with atopic dermatitis. RESULTS: Sixty-one of 68 (90%) patients were still free of their disease after 6 months of twice weekly treatment and only one showed possible treatment related signs of skin atrophy. The number of Staphylococcus aureus and Pityrosporum ovale were significantly reduced in cleared patients. CONCLUSIONS: Mometasone furoate fatty cream is effective and safe both for treatment and as a prophylaxis in patients with atopic dermatitis.

Pityriasis versicolor: clinical experience with Lamisil cream and Lamisil DermGel.

Pityriasis versicolor is a chronic superficial fungal disease usually located on the upper trunk, neck or upper arms. Terbinafine is an orally and topically active allylamine antifungal derivative with a broad antifungal spectrum. Several studies have documented the high activity of terbinafine (Lamisil) cream in the treatment of pityriasis versicolor, with cure rates of 79-100% after 2-4 weeks of treatment. Lamisil emulsion gel (Lamisil DermGel) is a new topical formulation that remains in the skin in high concentrations for several months after just 1 week of application. Recently, in a prospective, double-blind, placebo-controlled, randomised, parallel-group, comparative, multicentre study, we have treated patients with pityriasis versicolor with either terbinafine 1% emulsion gel (Lamisil DermGel) or placebo gel. Sixty-one patients were included, 31 in the Lamisil DermGel group and 30 in the placebo gel group. The gel was applied once daily for 7 days and the patients were followed up for 8 weeks. Twenty-eight patients in the active and 29 patients in the placebo group were evaluable for efficacy. Using the intent-to-treat efficacy analysis, 21/28 (75%) were cured in the Lamisil-DermGel-treated group compared to 4/29 (14%) in the placebo group. No side-effects were seen. In conclusion, Lamisil DermGel was well tolerated and superior to placebo in the treatment of pityriasis versicolor when applied once daily for 7 days.

An epidemic of tinea corporis caused by Trichophyton tonsurans among wrestlers in Sweden.

An epidemic of tinea corporis due to Trichophyton tonsurans among wrestlers in Sweden is described. Totally 19 patients, 14 patients from Malmö and 5 from Gothenburg, were found. The suspected source of this epidemic was from a wrestlers' team from the USA visiting Sweden in April, 1993. All patients were treated orally with either griseofulvin, fluconazole or terbinafine, and all were cured. To prevent spreading, epidemiological tracing of secondary cases is important.

Double-blind, parallel-group comparison of terbinafine and griseofulvin in the treatment of toenail onychomycosis.

BACKGROUND: Griseofulvin has been used in the treatment of toenail onychomycosis with limited success. Evidence suggests that terbinafine may be more effective. OBJECTIVE: In a double-blind, parallel-group study we compared 250 mg/day terbinafine for 16 weeks with 500 mg/day griseofulvin for 52 weeks (or for shorter periods in cured patients) in patients with toenail onychomycosis. METHODS: Eighty-nine patients with culture-proved tinea unguium were included, and 43 in the terbinafine group and 41 in the griseofulvin group were assessable for efficacy. Patients who had not improved after 16 weeks were entered into an open study and were given 250 mg/day terbinafine for 16 weeks with the study code still blinded and were then followed up for 20 weeks. RESULTS: Terbinafine was significantly more effective than griseofulvin, with 42% being completely cured and 84% mycologically cured compared with only 2% with total cure and 45% with mycologic cure in the griseofulvin-treated group. The number of side effects was significantly lower in the terbinafine group (11%) compared with the griseofulvin group (29%). CONCLUSION: Terbinafine is significantly more effective than griseofulvin in the treatment of toenail onychomycosis.

Cryosurgery of eyelid basal cell carcinomas.

One hundred and twenty-one patients have been treated for eye lid basal cell carcinomas with cryosurgery during the last 7 years. The condition resolved completely after treatment in all patients with no recurrences observed so far. Most patients have been followed for more than 2 years. Complications were few and minor. In 14 cases conjunctival overgrowth was noted. We conclude that this treatment modality is excellent, cost-effective and easily tolerated as compared with other methods.

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.

Changes in laboratory variables induced by isotretinoin treatment of acne.

During a trial of isotretinoin (0.5 mg/kg body weight/day for 3 months) in 90 patients with severe acne, the leucocyte (WBC) count, and particularly the number of neutrophils, decreased significantly. In patients with a good response the mean WBC count fell by 24% and the neutrophils by 33%, whereas in those with a poor response these variables decreased by 8% and 14%, respectively. The serum ALAT, ASAT, cholesterol and triglyceride levels increased significantly. Patients with a poor response (n = 35) received a higher dosage (0.75 mg/kg) for an additional 3 months, and during this period there was a further decrease in the WBC and neutrophil counts and an increase in the triglyceride level. In the other patients, who initially responded well, the dosage was decreased to 0.1 or 0 mg/kg during the second 3-month period, which resulted in reversion of the laboratory variables to the pre-treatment levels. The observed changes were clearly both dose-dependent and reversible.

Treatment of recurrent genital herpes simplex infections with oral acyclovir.

A total of 113 patients with recurrent genital herpes were enrolled in a multicentre cross-over study. Two consecutive recurrences were treated with either oral acyclovir 200 mg or matching placebo five times daily for five days. Acyclovir significantly reduced the time to crusting and healing and the duration of new lesions and symptoms. Acyclovir was not found to have any clinically significant effect on the haematological or biochemical parameters measured, or to have caused adverse events and was well tolerated. Early self-initiated treatment may abort a recurrent attack of genital herpes without progression to the ulcerative or crusting stage.

Long-term ketoconazole treatment of chronic acral dermatophyte infections.

Ketoconazole 200-400 mg was given once daily for a maximum period of 12 months to 31 patients with chronic (mean duration, 12 years) dermatophyte infections of the hands and/or feet. Griseofulvin had previously been withdrawn due to intolerance or lack of effect. All skin and nail infections improved clinically. Fifty percent of the patients with skin infections and 26% of those with nail infections became clinically clear and culture-negative. Six months later, relapses had occurred in 8 of 12 patients (67%) with cleared skin lesions, and in 2 of 5 (40%) with cleared nail infections. Ketoconazole was discontinued in one patient due to headache and in another due to asymptomatic transient elevation of hepatic laboratory tests. Ketoconazole is an alternative when a replacement for griseofulvin is required, provided the degree of disability justifies the risk of drug toxicity.

An epidemic of scabies with unusual features and treatment resistance in a nursing home.

An epidemic of scabies affecting elderly patients on one ward of a nursing home is described. The outbreak was characterized by a high degree of contagion and treatment resistance among patients suffering from malignant diseases and receiving immunosuppressive therapy. The clinical picture was unusual, with papules surmounted by scabies burrows and a high percentage of persistent nodular lesions. The origin of the outbreak was probably a patient with an exfoliative psoriasis, treated with an aromatic retinoid and potent topical corticosteroids. In view of the high recurrence rate, follow-up may be advisable especially in elderly patients.

Oral lichen planus: hypersensitivity to dental restoration material.

67 patients with oral lichen planus of the atrophic-erosive or reticular plaque type were examined. Dental amalgam in contact with mucosal lesions was present in 64 patients, and gold fillings in 33. Patch testing with a standard procedure was performed with components of dental fillings. 11 patients (16%) reacted to at least one of the mercury compounds compared to 8% in a reference group. Most positive reactions were caused by elemental mercury and ammoniated mercury. No patient reacted to gold or copper. Readings at days 10-14 did not increase the number of responders. 13 patients were patch tested with palladium; all were negative. It is not clear whether in the mercury-positive patients allergy to dental amalgam is a causative or aggravating factor, or merely on epiphenomenon.

Severe oral lichen planus: remission and maintenance with vitamin A analogues.

Twenty-five patients with chronic oral lichen planus, usually of the atrophic-erosive type, were treated for 2 months with Etretinate 0.6 mg/kg b.w./day, followed for 4 months by Etretinate 0.3 mg/kg/day, or 0.1% Tretinoin in an adhesive base. Complete resolution or improvement was seen in 85% of the lesions after first treatment. The number of patients with oral soreness and pain was significantly reduced (p less than 0.001). During the second treatment, the improvement was maintained or even increased in about 70% of the patients, irrespective of the mode of treatment. Treatment was discontinued in one patient owing to moderately increased serum transaminase levels. The number of drug-related drop-outs was significantly lower than in a previous study utilizing an etretinate dose of about 1 mg/kg/day (p less than 0.05). Other adverse effects were minor and tolerable. Retinoids offer an effective mode of therapy for severe oral lichen planus.

Hyperkeratotic dermatitis of the palms.

Thirty two adult patients who presented with a sharply marginated, hyperkeratotic dermatitis of the palms (HDP), but with no skin lesions elsewhere, have been re-examined approximately 10 years later. Topical treatments had had limited effect. The morphological appearance and localization had remained unchanged, except in two individuals who were free from symptoms. One had developed psoriasis. The incidence of atopic disease and psoriasis in first degree relatives did not differ from that in control subjects. Mycological cultures and patch tests were negative. Serum IgE was normal. Skin biopsies in nine patients all revealed a chronic spongiotic dermatitis.

Severe oral lichen planus: treatment with an aromatic retinoid (etretinate).

A double-blind study of twenty-eight patients with severe oral lichen planus treated with etretinate (75 mg daily) or a placebo for 2 months, showed that the oral retinoid had a marked beneficial effect. Nine non-responders who had received only placebo then entered an open cross-over study and they responded well to etretinate. Etretinate thus provided effective symptomatic relief for severe oral lichen planus, but side-effects were common, and six patients stopped treatment because of them.