A pilot methodology study for the photographic assessment of post-inflammatory hyperpigmentation in patients treated with tretinoin.

BACKGROUND: Post-inflammatory hyperpigmentation (PIH) is a common occurrence in patients with acne vulgaris, particularly in those with skin of colour. AIMS: A previous study has demonstrated the benefit of tretinoin (retinoic acid) in the treatment of PIH; however, there is currently no standard protocol to evaluate change in PIH following treatment. Based on these findings, we performed a pilot, exploratory, blinded, intraindividual-controlled methodology study that consisted of a photographic assessment protocol with facial mapping. MATERIALS AND METHODS: The study was based on a secondary analysis of a phase 4, community-based trial of 544 acne patients who were treated with tretinoin gel microsphere 0.04% or 0.1%. Only patients with Fitzpatrick types III-V (skin of colour) were included in the study; subjects with Fitzpatrick skin type VI were excluded because the photographic assessment did not allow for proper evaluation. RESULTS: Despite the small number of subjects evaluated (n=25), the results revealed consistent assessment of improvement in PIH between two independent graders (weighted κ=0.84). CONCLUSION: Further study with a larger population is recommended to validate the accuracy of this method.

A multicenter dose-escalation trial with denileukin diftitox (ONTAK, DAB(389)IL-2) in patients with severe psoriasis.

BACKGROUND: Denileukin diftitox, a fusion protein targeting both malignant and normal activated lymphocytes, has been shown previously to have antipsoriatic activity. However, the ideal dosing regimen for treating psoriasis was not established. OBJECTIVE: We examined the safety and efficacy of denileukin diftitox in patients with severe plaque-type psoriasis. METHODS: This was a cohort dose-escalation trial. Patients were administered denileukin diftitox on 3 consecutive days every other week. Patients were evaluated for toxicity, improvement in psoriasis, immunogenicity, and serum levels. RESULTS: Thirty-five patients were treated at 3 dose levels. Eight patients had a 50% decrease or more in Psoriasis Area and Severity Index score from baseline (0/10 at 0.5 microg/kg per day, 1/10 at 1.5 microg/kg per day, and 7/15 at 5 microg/kg per day). Adverse events primarily consisted of constitutional events and skin reactions. CONCLUSIONS: The potential antipsoriatic activity of denileukin diftitox demonstrated in this study was comparable to that observed in other psoriasis studies with this agent. However, this dosing regimen was better tolerated than the dosing regimen used in the last study with denileukin diftitox in psoriasis patients.

A newly formulated topical triple-antibiotic ointment minimizes scarring.

A randomized study of polymyxin B sulfate-bacitracin zinc-neomycin sulfate versus simple gauze-type dressings in dermabrasion wounds assessed the effects that each treatment had on scarring. Each of three uniform dermabrasion wounds created on the upper backs of 70 subjects was treated concurrently with a triple-antibiotic ointment (polymyxin B-bacitracin-neomycin), a double antibiotic (polymyxin B-bacitracin), or a simple, non-occlusive, gauze-type dressing, twice daily for up to 14 days. Pigmentary changes and textural changes (scarring) appearing after healing at the skin surface test sites were compared to adjacent normal skin at 45 and 90 days post-dermabrasion. These changes were graded visually utilizing fluorescent light, long-wave ultraviolet light, and by clinical color photography. The triple-antibiotic ointment was superior to simple gauze-type dressing alone in minimizing the scarring observed in dermabrasion wounds. The benefit of this new ointment was more pronounced in its effect on pigmentary changes.

Photosensitivity as the presenting illness in four patients with human immunodeficiency viral infection.

BACKGROUND: A multitude of skin lesions have been reported in individuals with human immunodeficiency virus (HIV) infection. Some of them, eg, severe seborrheic dermatitis and herpes zoster infections, may predate the onset of the diagnostic criteria for the acquired immunodeficiency syndrome and may actually raise the suspicion of HIV infection in healthy-appearing individuals. We have recently evaluated four individuals who presented with a severe idiopathic photosensitivity of eczematous morphologic features who eventuated in a diagnosis of HIV seropositivity. Four individuals who presented with an eczematous eruption of sun-exposed skin were referred to the Environmental Dermatology Unit of Columbia-Presbyterian Medical Center (New York, NY) for evaluation of possible photosensitive disease. They were examined and underwent photobiological testing (minimal erythema dose testing and photopatch testing) to confirm and classify their suspected photosensitivity. OBSERVATIONS: All four patients fulfilled the criteria for chronic actinic dermatitis, a rare idiopathic photosensitivity characterized by debilitating, unremitting dermatitis with eczematous or lymphomalike histologic features and reproduction of lesions by small quantities of mid-wave UV-B radiation (290 to 320 nm). All four individuals were HIV seropositive and CD4 counts were markedly suppressed in all four. The photosensitivity predated the finding of seropositivity and the diagnosis of acquired immunodeficiency syndrome in all four patients. CONCLUSION: The presentation of healthy-appearing individuals with photodistributed dermatitis of unknown cause should alert the physician to the possibility of HIV infection.

Open-label study of the safety and efficacy of naftifine hydrochloride 1 percent gel in patients with distal subungual onychomycosis of the fingers.

Optimal topical therapy for distal subungual onychomycosis is not available. An open-label study was performed to determine the safety and efficacy of naftifine hydrochloride (Naftin) 1 percent gel in patients with this disorder of the fingers. Ten patients with culture-proven distal subungual onychomycosis were treated twice daily for six months with naftifine hydrochloride 1 percent gel. At monthly intervals, the target nail was trimmed, the nail bed debrided, and global clinical assessment recorded. Following months three, six, and eight (two months after treatment), the target nail underwent evaluation with potassium hydroxide wet mount and fungal culture. After six months of therapy, eight of ten patients showed negative results of fungal culture and eight of ten patients showed clinical improvement. Adverse effects were minimal and included mild peeling in two patients and mild fissuring with transient fingertip numbness in one patient.

Open-label study of the safety and efficacy of Fungoid tincture in patients with distal subungual onychomycosis of the toes.

Onychomycosis is the most frequent cause of nail diseases. An open-label study has been conducted to evaluate the safety and efficacy of Fungoid Tincture, a topical antifungal agent approved by the Food and Drug Administration for the treatment of onychomycosis of the toes. Ten patients with culture-proven distal subungual onychomycosis were treated twice daily for twelve months with topical Fungoid Tincture. Another ten patients with the same condition were treated with the vehicle alone. At monthly intervals, the target nail was trimmed, the nail bed debrided, and global clinical assessment recorded. After twelve months of therapy, all patients applying Fungoid Tincture showed negative findings on fungal culture. The vehicle alone benefitted several patients, and may have antifungal activity. Adverse effects were minimal, with mild peeling occurring in seven patients and erythema noted in one.

Longitudinal pigmented nail bands.

In this article, we have discussed the possible causes of a longitudinal pigmented nail band. A thorough history, physical examination, and, when indicated, biopsy of the origin of the band should reassure the patient with a benign lesion and direct further treatment of a patient with a malignant or potentially malignant lesion.

Nail disorders in children.

The spectrum of nail abnormalities that may be seen in the pediatric population is discussed in this article. Developmental abnormalities, both hereditary and congenital, are discussed. Acquired nail abnormalities that may be similar to those seen in adults are also described.

Congenital malalignment of the great toenails.

Congenital malalignment of the great toenails is a disorder in which malalignment of the nail matrix results in angular lateral nail plate growth. The consequence is onychodystrophy, which may progress to onychogryphosis and chronic ingrown toenails. There has been debate as to whether the condition is inherited or acquired in utero secondary to improper fetal positioning. A 6-year-old boy and his father, both of whom have this disorder, are discussed.