ABSTRACT
BACKGROUND: Substance P, an undecapeptide neurotransmitter, has been implicated in the pathophysiology of psoriasis and pruritus. OBJECTIVE: Safety and efficacy of topical capsaicin, a potent substance P depletor, were evaluated in patients with pruritic psoriasis. METHODS: Patients applied capsaicin 0.025% cream (n = 98) or vehicle (n = 99) four times a day for 6 weeks in this double-blind study. Efficacy was based on a physician's global evaluation and a combined psoriasis severity score including scaling, thickness, erythema, and pruritus. RESULTS: Capsaicin-treated patients demonstrated significantly greater improvement in global evaluation (p = 0.024 after 4 weeks and p = 0.030 after 6 weeks) and in pruritus relief (p = 0.002 and p = 0.060, respectively), as well as a significantly greater reduction in combined psoriasis severity scores (p = 0.030 and p = 0.036, respectively). The most frequently reported side effect in both treatment groups was a transient burning sensation at application sites. CONCLUSION: Topically applied capsaicin effectively treats pruritic psoriasis, a finding that supports a role for substance P in this disorder.
Subject(s)
Capsaicin/administration & dosage , Psoriasis/drug therapy , Administration, Topical , Adolescent , Adult , Aged , Double-Blind Method , Female , Humans , Male , Middle Aged , Pruritus/drug therapy , Pruritus/metabolism , Psoriasis/metabolism , Substance P/metabolismABSTRACT
Seventy patients with tinea cruris or tinea corporis were treated with naftifine cream 1% or vehicle once daily for 4 weeks in this double-blind, randomized study. After two weeks, the patients using naftifine had a significantly higher mycologic cure rate than the vehicle-treated patients (79% vs. 31%, p less than 0.001), and they showed significantly better resolution of signs and symptoms. Statistically significantly differences favoring naftifine over its vehicle were found throughout the treatment period and 2 weeks posttreatment.
Subject(s)
Allylamine/therapeutic use , Amines/therapeutic use , Antifungal Agents/therapeutic use , Tinea/drug therapy , Adolescent , Adult , Aged , Allylamine/administration & dosage , Allylamine/analogs & derivatives , Antifungal Agents/administration & dosage , Double-Blind Method , Female , Groin , Humans , Male , Middle Aged , Ointments , Random AllocationABSTRACT
Although screening for melanoma/skin cancer is theoretically of value, few data are available to evaluate its effectiveness or the value of a visual exam by a dermatologist as a cancer screening tool. From the 2560 persons screened for melanoma/skin cancer in Massachusetts in 1986 and 1987, the authors followed the positive screenees to determine their final diagnosis. The authors obtained information on 85% of these persons, and found nine malignant melanomas, 91 non-melanoma skin cancers, 39 dysplastic nevi, and three congenital nevi. The sensitivity of the visual exam by a dermatologist was 89% to 97% and the predictive value positive was 35% to 75% for skin cancer. The authors conclude that the yield of screening is equivalent to that of other major cancer screening efforts and that the sensitivity and predictive value of the visual examination by the dermatologist is appropriate for a cancer screening tool.
Subject(s)
Mass Screening/methods , Melanoma/epidemiology , Skin Neoplasms/epidemiology , Carcinoma in Situ/epidemiology , Female , Male , Massachusetts/epidemiology , Physical Examination , Predictive Value of Tests , PrevalenceABSTRACT
In a multicenter, evaluator-blind, parallel group study of 244 patients with moderate to severe psoriasis, a once-daily application of a new formulation of beta-methasone dipropionate 0.05% cream, augmented formulation (AF), and a twice-daily application of fluocinonide 0.05% cream were compared, with respect to safety and efficacy. Results significantly favored betamethasone dipropionate AF over fluocinonide, as indicated by improvements in signs of erythema, induration, and scaling, as well as the physicians' and patients' global evaluations of response after 14 days of treatment. As a result of adverse experiences, treatment had to be discontinued in three patients on fluocinonide. No patient on betamethasone dipropionate AF had to discontinue treatment.
Subject(s)
Betamethasone/analogs & derivatives , Psoriasis/drug therapy , Administration, Topical , Adolescent , Adult , Aged , Aged, 80 and over , Betamethasone/administration & dosage , Betamethasone/adverse effects , Betamethasone/therapeutic use , Double-Blind Method , Female , Fluocinonide/adverse effects , Fluocinonide/therapeutic use , Humans , Male , Middle Aged , Randomized Controlled Trials as TopicABSTRACT
Treatment of common warts with topical keratolytic solutions is generally estimated to result in cure rates of 60% to 80% in 12 weeks. Problems with keratolytic solutions include irritation of surrounding normal skin and poor patient compliance. A product containing 26% salicylic acid in a novel polyacrylic vehicle was evaluated in 27 patients and found to cure or provide much improvement in 22 (81%) after only two weeks of treatment. This rapid response was accompanied by a low incidence of irritation. The results of this study suggest that high-potency salicylic acid promotes prompt resolution of warts, which may enhance patient compliance.
Subject(s)
Salicylates/therapeutic use , Warts/drug therapy , Administration, Topical , Adolescent , Adult , Female , Humans , Male , Pharmaceutical Vehicles , Salicylates/administration & dosageABSTRACT
The safety and efficacy of SCH 370 (1 percent clotrimazole/0.05 percent betamethasone dipropionate) cream was compared with each of its individual components in 331 patients with tinea cruris or tinea corporis. The study was a multicentered, randomized, double-blind, parallel-groups design. The patients received one of three treatments applied twice a day for two weeks and returned for a follow-up visit two weeks after the last application. Total signs and symptoms scores of infections were evaluated at baseline, once between days three to five, and after weeks one, two, and four. Culture and potassium hydroxide preparations were done at baseline and weeks two and four. SCH 370 cream demonstrated more rapid therapeutic activity than the antifungal agent alone, resulting in significantly better clinical results in early treatment and in midtreatment. As expected with a steroid, betamethasone dipropionate achieved relief of inflammatory signs and symptoms early in the course of treatment, but SCH 370 was superior from one week on in the patients with tinea cruris and at post-treatment in the patients with tinea corporis. Mycologically, SCH 370 cream and clotrimazole were comparable at the end of the study and results were significantly better than those for betamethasone dipropionate. All three treatments were safe with no reports of unexpected or serious adverse experiences.
Subject(s)
Betamethasone/analogs & derivatives , Clotrimazole/administration & dosage , Imidazoles/administration & dosage , Tinea/drug therapy , Adult , Betamethasone/administration & dosage , Clinical Trials as Topic , Double-Blind Method , Drug Combinations , Female , Follow-Up Studies , Humans , Male , Middle Aged , Ointments , Random AllocationABSTRACT
A multicenter double-blind study was conducted on the use of ketoconazole and griseofulvin for the treatment of dermatomycoses. Of one hundred thirty cases (one hundred twenty-seven patients) for which efficacy data were available, sixty-six were treated with a single daily dose of 200 mg ketoconazole, and sixty-four were treated with a single daily dose of 250 mg griseofulvin for periods of two to sixteen weeks. The proportion of remissions observed with ketoconazole (61 percent) was significantly greater (p = 0.02) than that observed with griseofulvin (39 percent). The proportion of relapses within two months was significantly less (p less than 0.01) in the ketoconazole group (9 percent) than in the griseofulvin group (43 percent). The frequency and severity of side effects were comparable in the two groups.
