Oral terbinafine in the treatment of multi-site seborrhoic dermatitis: a multicenter, double-blind placebo-controlled study.

Seborrheic dermatitis (SD) is a common disorder for which no satisfactory curative treatment exists. Preliminary studies suggest that terbinafine may be effective. The efficacy and tolerability of oral terbinafine was evaluated in multi-site SD in a randomized, double-blind, placebo-controlled study. For this purpose, 174 adult patients with SD lesions involving >or=3 skin areas, each causing >or=2 moderate/severe symptoms according to a pre-defined clinical score, were classified according to the localization of lesions: patients with lesions predominantly involving non-exposed skin areas, such as scalp and hairline and sternum and/or interscapular area (Population A, n=83) or patients with lesions in exposed sites, mainly the face (Population B, n=91). Patients were randomized to oral terbinafine (250 mg/day ) (n=86) or matching placebo (n=88), each given for 6 weeks. Primary efficacy variable was the response rate, defined as >or=50% decrease in baseline total clinical score without rescue medication intake after 6 weeks of treatment. The main secondary assessments were: subject's global assessment of relief and proportion of patients satisfied with treatment. Recurrence rate was assessed in responder patients during a 4-week treatment-free period. In Population A the response rate after 6 weeks of treatment was significantly higher with terbinafine (70% vs 45.4%; p=0.03) and so was the proportion of patients who reported relief (75% vs 41%; p=0.007) and who were satisfied (66% vs 40%; p=0.02). No significant differences were recorded in Population B. Adverse events occurred in 11.5% of terbinafine patients and 8% of placebo patients. One patient discontinued treatment with terbinafine because of adverse events (mild tachycardia and insomnia). In conclusion, our results show that terbinafine is significantly more effective than placebo in reducing the severity of SD lesions in nonexposed sites. Clinical trials comparing terbinafine to standard treatment regimens in different types of patients with SD are warranted.

In vitro effects of ultraviolet A on histamine release from human basophils.

BACKGROUND: As long-wave ultraviolet (UV) radiation penetrates the dermis, connective tissue cellular components and circulating blood cells can be possible targets for solar UVA. Basophils, involved in the effector phase of the inflammatory response, play a part in skin diseases such as chronic urticaria, psoriasis, atopic dermatitis, fixed drug eruption, allergic contact dermatitis, urticaria pigmentosa, systemic sclerosis and bullous pemphigoid. OBJECTIVE: The evaluation of the in vitro effect of UVA on histamine release from human basophils. METHODS: Basophils from healthy human volunteers were irradiated, respectively, with UVA at doses of 2.5, 5, 7.5, 10, 20 and 50 J/cm2 and then incubated with an anti-IgE serum. A fluorimetric technique was employed to determine histamine release from samples: (i) incubated with 2% HClO4 (complete lysis of basophils); (ii) irradiated with increasing doses of UVA; and (iii) unirradiated (controls). RESULTS: Histamine release was: 100% for HClO4 incubated basophils, 30% for unirradiated and anti-IgE incubated cells (controls) and 27%, 24%, 34%, 41%, 60% and 70% for basophils irradiated with UVA doses, respectively, of 2.5, 5, 7.5, 10, 20 and 50 J/cm2 and incubated with anti-IgE. Histamine releasability from irradiated samples was statistically significant (P < 0.05), in comparison with controls, at UVA doses equal to 5, 10, 20 and 50 J/cm2. CONCLUSIONS: UVA exerts, at least in vitro, a biphasic dose-dependent action on histamine release from human basophils incubated with an anti-IgE serum: at the lowest irradiation doses (< 5 J/cm2) it exerts an inhibitory effect and at the highest doses (> or = 10 J/cm2) histamine release increases significantly.

Phaeomelanin versus eumelanin as a chemical indicator of ultraviolet sensitivity in fair-skinned subjects at high risk for melanoma: a pilot study.

It is now generally agreed that solar exposure is a major external factor in the causation of cutaneous melanoma in light skinned populations with red hair and a marked susceptibility to the acute effects of ultraviolet (UV) radiation. In the present study, we investigated the existence of a possible relationship between hair melanin composition and minimal erythema dose (MED), as an indicator of UV sensitivity, in a group of 15 healthy red-haired subjects aged 20-46 years. In spite of comparable skin and hair colour, marked variations were observed in the MED values as well as in the hair melanin composition. Phaeomelanin levels varied in the range 0.026-0.53% w/w and were generally comparable to or higher than eumelanin levels (0.042-0.17% w/w). No significant relationship was found between MED values and phaeomelanin, eumelanin or total melanin (eumelanin plus phaeomelanin) content. Notably, however, a gross positive correlation was found between the eumelanin/phaeomelanin ratio and the MED values. These results would suggest that a high UV sensitivity is associated with high phaeomelanin and low eumelanin levels, and point to the eumelanin/phaeomelanin ratio as a novel chemical parameter that could be used for predicting individuals at high risk for skin cancer and melanoma.

Dose-dependent visible effect on mice Langerhans cell membrane markers.

Ultraviolet B and psoralen plus UVA treatment induce antigenic and enzymatic changes in Langerhans cells (LC). The aim of this study was to investigate the visible (VIS) effect on mice LC surface markers. As visible source, a slide projector equipped with a 150-W tungsten lamp, emitting between 400 and 740 nm (maximum at 580 nm) was used. Mice (BALB/c and C3H) were divided into groups, each irradiated with visible single fixed doses (ranging from 10 to 1000 J/cm2). The mice backs were shaved before irradiation. Skin biopsies obtained immediately after irradiation were processed for immunofluorescence and electron microscopy. Immunofluorescent studies showed: 1) a complete depletion of LC membrane markers at a dose of 700 J/cm2; 2) no effect at visible doses ranging between 0 and 75 J/cm2; 3) a dose-dependent effect with doses between 100 and 700 J/cm2. Electron microscopy revealed no cellular damage of LC at the visible doses administered.

Peptide T in the treatment of severe psoriasis.

We investigated the effect of treatment with peptide T on severe psoriasis in 5 patients. Within 2 months, peptide T led to complete remission of all lesions in 1 patient and to good improvement in 3 others. In 1 patient, no effect was observed.

Effect of nicotinic acid administration on serum levels of bilirubin and iron in patients with porphyria cutanea tarda.

Nicotinic acid (NA) administration in Gilbert's syndrome (GS) patients promotes an increment of bilirubin and of total iron serum levels, dependent on a defective hepatic bilitranslocase function and on a haemolytic effect of NA. In porphyria cutanea tarda (PCT): (1) the effect of nicotinic acid on bilirubinaemia is superimposable to that in controls; (2) a well documented disturbance of iron metabolism occurs; (3) but relationship between bilirubin and iron under NA load has never been investigated. The administration of 5.9 mumol/kg body weight of NA to 12 PCT patients, 10 GS subjects and nine healthy volunteers of comparable age resulted in: (1) normal behaviour of bilirubin parameters in PCT but higher bilirubinaemic values in GS subjects; (2) normal values of serum iron in GS subjects, but higher baseline values and lower sideraemic effect of nicotinic acid in PCT patients; (3) a normal NA half-life in PCT and enhanced in GS subjects. These findings confirm a defective bilirubin uptake and excretion by the liver of GS subjects with a normal iron metabolism. On the contrary, in our PCT patients a normal clearance of bilirubin occurs, but a complex disturbance of iron metabolism is well evident in baseline conditions as well as after NA administration. The latter being probably the consequence of an enhanced excretion of iron extraproduced by the haemolytic effect of NA.

Tyrosinemia type II in two cases previously reported as Richner-Hanhart syndrome.

Two sibs with palmo-plantar keratosis and dendritic corneal opacities, previously described as suffering from Richner-Hanhart syndrome by other authors, about 25 years ago, showed increased plasma and urine tyrosine levels. Their neurological and mental features were within normal limits. A comprehensive review of the literature showed a total of 47 cases of fully documented tyrosinemia type II; 8 more patients also had the clinical features of the disease, but aminoacidemia had never been observed. The importance of early diagnosis is stressed, since a low tyrosine-phenylalanine diet dramatically improves the symptoms and may prevent mental retardation.

Inadequate effect of helium-neon laser on venous leg ulcers.

A study to determine whether laser radiation of low-power photon density would really affect the healing of venous leg ulcers in man was performed. The ulcers were irradiated 6 d per wk with a helium-neon laser (wavelength 632.8 nm). Energy densities of 1 J/cm2 (16 patients) and 4 J/cm2 (17 patients) were administered daily. The control group (28 patients) received only antiseptic local compresses as treatment. No statistically significant difference between the laser-treated group and the control group was found. It was concluded that helium-neon laser radiation has no advantages over standard local treatments, at least with the dosage schedules and protocols employed.

A novel assocation between HLA and disease: porphyria cutanea tarda and HLA-AW32.

An association between porphyria cutanea tarda and HLA-AW32 has been put into evidence in a group of 28 unrelated patients. A relative risk of 3.09, with a chi 2 of 4.55 (p less than 0.05) was found, using a 148-member panel of controls.