Subject(s)
Carcinosarcoma/diagnosis , Head and Neck Neoplasms/diagnosis , Scalp , Skin Neoplasms/diagnosis , Aged, 80 and over , Carcinosarcoma/pathology , Carcinosarcoma/radiotherapy , Carcinosarcoma/surgery , Combined Modality Therapy , Diagnosis, Differential , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/radiotherapy , Head and Neck Neoplasms/surgery , Humans , Male , Skin Neoplasms/pathology , Skin Neoplasms/radiotherapy , Skin Neoplasms/surgeryABSTRACT
PURPOSE: To access the efficacy of spironolactone and topical retinoids in the treatment of female cyclical acne. METHODS: A retrospective chart review on 41 female patients age 19-57 years old with cyclical acne was performed. Patients were examined over the course of 2 to 102 months while taking 50 to 200 mg of spironolactone and topical tretinoin 0.025% or adapalene 0.1% cream. All were diagnosed with acne rated mild to severe, prior to treatment, and were started on an initial dose of 50 mg po daily. If significant improvement was not seen within the first 3-6 months, the dose was either held or increased in 25 mg increments every 3 months. Patients on oral and topical antibiotics, as well as patients on photodynamic therapy were excluded from the study. The response to treatment was rated on a 0-4 scale with 0 being no response and 4 corresponding to clear skin. RESULTS: One patient (2.4%) had no response to treatment. This patient was only on 50 mg po daily for only 2 months. Only 5 (12.2%) patients had minimal response to treatment and 9 (22.0%), 12 (29.3%), and 14 (34.1%) had a good, excellent, or clear response respectively. The study showed 26 (63.4%) women on treatment with spironolactone and topical retinoids had an excellent or clear outcome, and 35 (85.4%) were considered to have a good, excellent, or clear response. CONCLUSION: The addition of spironolactone to topical retinoid treatment suggests a superior response to retinoids alone in clearance of female adult cyclical acne.
Subject(s)
Acne Vulgaris/drug therapy , Naphthalenes/therapeutic use , Spironolactone/therapeutic use , Tretinoin/therapeutic use , Acne Vulgaris/pathology , Adapalene , Administration, Cutaneous , Adult , Dermatologic Agents/administration & dosage , Dermatologic Agents/therapeutic use , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Humans , Middle Aged , Naphthalenes/administration & dosage , Retrospective Studies , Severity of Illness Index , Spironolactone/administration & dosage , Treatment Outcome , Tretinoin/administration & dosage , Young AdultABSTRACT
TNF-α inhibitors, including adalimumab, are increasingly used in the management of inflammatory cutaneous, gastrointestinal, and rheumatologic diseases. An untoward class effect of these medications is the development of new-onset psoriasis, particularly in patients treated for rheumatologic diseases without any personal or family history of cutaneous psoriasis. We report two patients that developed cutaneous and histologic changes consistent with psoriasis while receiving treatment with adalimumab for inflammatory arthridities: one patient with Crohn disease and ankylosing spondylitis who tolerated adalimumab for 15 months before developing psoriasis and another patient with rheumatoid arthritis who developed psoriasis 3 years after starting adalimumab. Both patients experienced rapid resolution of their psoriasis after discontinuation of adalimumab.
