Epilation of upper lip hirsutism with a eutectic mixture of lidocaine and prilocaine used as a topical anesthetic.

Twenty-one patients were included in a double-blind, placebo-controlled, cross-over study with a eutectic mixture of lidocaine and prilocaine (EMLA). EMLA or placebo was placed on the upper lip for 1 hour; diathermy was then performed for 10 minutes. The pain caused by diathermy was evaluated by the patients and the cosmetologist on a four-point scale. The results of the investigation showed that there was significantly less pain after application of 5 gm of EMLA cream on the upper lip than after application of placebo, assessed both by the patient and by the cosmetologist. Eighteen of 20 patients preferred EMLA (p less than 0.0001). Local reactions were few and mild.

Treatment of lichen planus with acitretin. A double-blind, placebo-controlled study in 65 patients.

Sixty-five patients with lichen planus were included in a multicenter trial of acitretin. At the end of an 8-week placebo-controlled, double-blind phase, a significantly higher number of patients treated with 30 mg/day acitretin (64%) showed remission or marked improvement compared with placebo (13%). Furthermore, during the subsequent 8-week open phase, 83% of previously placebo-treated patients responded favorably to acitretin therapy. Typical retinoid adverse reactions were present in all patients on active drug. Laboratory studies did not show any clinically significant changes. This study shows that acitretin is an effective and acceptable therapy for severe cases of lichen planus.

The development of the patch testing procedure and working for consistency.

Patch testing is a necessary tool to investigate contact dermatitis, which has developed alongside the increased knowledge of contact sensitivity in the past 100 years. The history of patch testing, the current state of the art with its problems, and future prospects are discussed.

A double-blind comparison of acitretin and etretinate in the treatment of severe psoriasis. Results of a Nordic multicentre study.

Acitretin, the free acid of etretinate, is less lipophilic and has a much shorter terminal half-life than the parent compound. The present double-blind, randomized study compared the therapeutic effectiveness and the tolerability of acitretin (n = 127) and etretinate (n = 41) in psoriasis. Patients were treated with 40 mg daily for the first 4 weeks and with an individually adjusted dose for the subsequent 8 weeks. The average daily doses of acitretin (0.54 mg/kg/day) and etretinate (0.65 mg/kg/day) were similar. The PASI (Psoriasis Area and Severity Index) scores improved in parallel in the 2 treatment groups. At the completion of the study, the PASI score improvement was 75.8% for acitretin and 70.8% for etretinate. Both acitretin and etretinate resulted in mucocutaneous side effects. Assessments of tolerability by investigators and patients showed a statistically significant difference in favour of etretinate. These results demonstrate that acitretin and etretinate have similar therapeutic effectiveness in psoriasis. Although the tolerance to acitretin was lower than to etretinate, acitretin offers the important advantage of a much shorter period of potential teratogenicity and is, therefore, to be preferred in women of childbearing potential.

Terfenadine in the treatment of chronic idiopathic urticaria and atopic dermatitis.

The use of the nonsedating antihistamine terfenadine (60 mg twice daily) in the treatment of chronic idiopathic urticaria and contact urticaria associated with atopic dermatitis was assessed. In patients with chronic idiopathic urticaria, terfenadine was found to be as effective as the traditional antihistamine clemastine in reducing the number of wheals and the severity of itch, without causing drowsiness. A separate study showed terfenadine to be of value in some patients with atopic dermatitis and a history of contact urticaria.

Kathon CG reactivity in 1396 consecutively patch tested patients in the Copenhagen area.

In 1396 consecutively patch tested patients 18 (1.3%) reacted to Kathon CG. Relevance was established in 4 of the 18 patients. The frequency of positive reactions to Kathon CG in eczema patients seems to have been stable in Denmark during the period 1983 to 1988.

Routine patch testing with paraben esters.

Paraben esters are the most widely used preservatives in cosmetics and topical medicaments. Their sensitization potential is low, based on both experimental and human experience. A paraben mixture is included in the ICDRG standard series, and in patch test studies, approximately 1% of eczema patients react to it. The present study confirms this frequency in 8020 patients patch tested consecutively. Testing with the individual paraben esters was employed as confirmation, which makes it unlikely that the excited skin syndrome is a significant problem in this context. It remains undetermined whether the present paraben mixture is the optimal patch test material for diagnosing paraben sensitivity.

Recurrent genital herpes on the buttocks: "herpes disciformis".

We report a clinical variety of recurrent genital herpes on the buttocks of seven women ranging in age from thirty-four to eighty-one years. The lesions had recurred for one to nine years and had produced a characteristic cicatricial rounded area within the S2 to S3 dermatomes on one buttock. Herpes disciformis is believed to be an anatomical variant of the common genital herpes infection. We have only noted it in middle-aged or older women with no history of genital herpes.

Domoprednate, a new nonhalogenated topical steroid: comparison to hydrocortisone butyrate.

Thirty-nine patients with mainly psoriasis vulgaris and atopic dermatitis were treated for 4 weeks with 0.1% domoprednate and hydrocortisone butyrate ointment according to a right-left, randomized design. Various assessments of efficacy only revealed marginal, but statistically insignificant differences. Patients' preferences for one of the two treatment favored domoprednate in 20 cases and hydrocortisone butyrate in 12 cases; 6 cases were ties (p greater than 0.2). The efficacy of domoprednate, a new, nonhalogenated topical steroid, is evidently at least of the same order as that of the hydrocortisone butyrate, and the tolerance of the two ointments is equally good.

Is it possible to work with pao ferro (Machaerium scleroxylum, Tul.)?

Pao ferro (Machaerium scleroxylum), used as a rosewood substitute, is a strong sensitizer capable of causing acute outbreaks of allergic and irritant dermatitis in workers not previously exposed to it. This, however, has not prevented furniture factories from using the product. Apparently, most workers develop tolerance to the wood.

Topical metronidazole in the treatment of rosacea.

One percent metronidazole in an emollient cream base was compared with 250 mg oral tetracycline taken twice daily for the treatment of seventy-five patients with rosacea. After eight weeks of treatment there was no statistically significant difference between the results of the two treatments. Tetracycline did have a more rapid onset of effect on papules and pustules. Both treatments were well tolerated.

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.

Rehabilitation in hand eczema.

The difference between medical and social prognosis in hand eczema is stressed. Rehabilitation may be a fashionable word, but a change of job may result in a lower social standing and the eczema may persist. Job change should never be considered unless extensive patch testing has been performed. The decision also depends on age, nature of allergen, actual trade and occupation, a personal history of atopy and some personal factors. Some guidelines are given.

Patch test sensitivity to Kathon CG.

Among 1511 consecutive patients patch tested with Kathon CG at 100 ppm active ingredient, 13 (0.8%) gave a positive reaction. Use test with a lotion containing Kathon CG (8.6 ppm) revealed no reaction in 11 patients with a positive patch test. It is concluded that a positive patch test reaction to 100 ppm does not initiate eczema after use of products preserved with Kathon CG in the low concentrations (3-15 ppm) used in final products.

Anthralin stick (Anthraderm) in the treatment of mosaic warts.

Thirty patients having mosaic warts of the soles for 2 years (range 3 months-6 years) were treated daily with a wax-based anthralin stick supplemented by weekly paring. Six patients dropped out, because they failed to appear for follow-up. Of the remaining patients 17/24 cleared, whereas the warts persisted in 7/24. Although the trial was an open study, this result can hardly be explained by placebo effect since mosaic warts are notoriously resistant to treatment.