Homoeopathic remedies in dermatology: a systematic review of controlled clinical trials.

BACKGROUND: Homoeopathic therapies are routinely used for the management of skin diseases. However, there is a lack of evidence-based data on their effectiveness. OBJECTIVES: To assess the evidence for the efficacy of homoeopathic treatments in dermatology. METHODS: We designed a systematic review of the controlled clinical trials (January 1962-April 2011) investigating homoeopathic therapies for the treatment of cutaneous diseases. We collected data from MEDLINE, PubMed, Current Contents, HomInform (Glasgow), reference lists, specialist textbooks and contacts with homoeopathic manufacturers. There was no restriction on language. Subsets were defined according to treated skin disease/condition. For each subset, two reviewers extracted data for information on study quality, type of remedy, population and outcomes. RESULTS: After an extensive search, we isolated a very limited number of trials investigating homoeopathic treatments for cutaneous diseases. Overall, of the 12 trials with interpretable results, nine trials indicated no positive effects of homoeopathy. The three trials showing a positive effect were of low methodological quality. CONCLUSIONS: Reviewed trials of homoeopathic treatments for cutaneous diseases were highly variable in methods and quality. We did not find sufficient evidence from these studies that homoeopathy is clearly efficacious for any single dermatological condition.

Epidermal kinetic alterations required to generate the psoriatic phenotype: a reappraisal.

OBJECTIVES: Although there have been major advances in understanding immunopathogenesis of psoriasis, the basic processes causing psoriatic morphology remain to be identified. MATERIALS AND METHODS: Our group has designed a systematic review of studies (1962-2009) on keratinocyte kinetics in psoriasis. We obtained data from MEDLINE, PubMed, Current Contents, reference lists and specialist textbooks. A general equation for evolution of the differentiated epidermis has been analysed. Necessary conditions for observed qualitative change in homeostasis between normal skin and established psoriatic lesions were determined. RESULTS AND DISCUSSION: Increase in the number of cell divisions (or imbalance in symmetric division rates of committed progenitor cells) and/or decrease in physiological apoptosis in the germinative compartment, together with feedback loops that limit thickening of the skin, are required to generate psoriatic morphology, that is, to increase the absolute size but decrease relative size of the differentiated cell compartment with respect to the germinative compartment.

Curettage treatment for molluscum contagiosum: a follow-up survey study.

BACKGROUND: Although curettage is commonly used to treat molluscum contagiosum, prospective studies on its effectiveness are lacking. OBJECTIVES: To evaluate prospectively the efficacy of curettage in the treatment of molluscum contagiosum and to identify the risk factors associated with treatment failure. METHODS: A systematic 2-month follow-up survey study was carried out on 73 patients treated by curettage for molluscum contagiosum. RESULTS: Treatment of molluscum contagiosum by curettage was associated with a high risk of treatment failure at week 4 (42/64, 66%) and at week 8 (25/55, 45%). Risk factors for treatment failure at week 4 and 8 were the number of lesions at day 0 (P < 0.001), the number of involved anatomical sites (P < 0.001) and concomitant atopic dermatitis (P = 0.038 and P < 0.001, at weeks 4 and 8, respectively). CONCLUSIONS: The main risk factor for treatment failure is lesion number, underlining the importance of the early detection of the lesions or, alternatively, emphasizing the need for therapeutic options other than curettage in patients with numerous lesions.

Origin of threshold behaviour in psoriatic skin.

The mechanisms that lead to the psoriatic morphology are not fully elucidated. Several lines of evidence suggest that the positive feedback between keratinocytes and immunocytes plays a key role in the development of the lesions. On the other hand, little information is available on the negative regulatory controls that maintain a new homoeostasis level in psoriatic skin. We suggest here that the interplay of these two contrary feedbacks is likely to entail a hysteresis effect and that psoriasis is likely to be interpreted as a critical phenomenon characterized by a catastrophic shift of the skin from a normal to a hyperplastic state.

Black Skin Dermatology Online, from the project to the website: a needed collaboration between North and South.

BACKGROUND: Whereas teledermatology is an emerging discipline, to date, no teledermatology service has been developed, which is specifically dedicated to black skins. OBJECTIVES: To create and develop a teledermatology service that provides a complete range of communication, information, telediagnosis and teaching services. METHODS: A multilingual clinical description of the lesion was provided for each photograph using a five-level disease classification from the 10th revised International Classification of Diseases. In parallel, a usability study to assess and improve the functionality of the platform was also conducted. RESULTS: A web prototype has been developed which integrates image acquisition, submission, clinical description, translation as well as validation, security and data protection aspects and almost 2000 images were obtained from which 600 have been integrated in the 'store and forward' telemedicine system (http://www.black-skin.org). Initial usability tests with native French medical students show good perceived usefulness, perceived usability and internal consistency (Cronbach's alpha = 0.80 and 0.84). CONCLUSION: The Black Skin project (North and South collaboration project) offers possibilities for continuous medical education (pedagogical cases), teleteaching (educational quiz) or asking for a second opinion ('Ask a specialist' item).

Efficacy of tetracyclines in the treatment of acne vulgaris: a review.

BACKGROUND: Oral tetracyclines are routinely used for the management of inflammatory acne. However, there is a lack of evidence-based data on their relative effectiveness and appropriate dosages. OBJECTIVES: To assess the relative effectiveness and the optimal dosage of tetracyclines for the treatment of inflammatory acne. METHODS: We designed a systematic review of the clinical trials (1962-2006) investigating oral tetracyclines for the treatment of inflammatory acne. We obtained data from MEDLINE, PubMed, Current Contents, reference lists and specialist textbooks. RESULTS: There was substantial heterogeneity in the design of the trials. We identified only seven randomized trials which were set up to compare the efficacy of tetracyclines in reducing acne lesion counts. These showed no evidence of superiority of one tetracycline over another. Overall, there was also no significant difference between the available tetracyclines in terms of improvement in inflammatory (32 trials, P=0.898) and noninflammatory (23 trials, P=0.429) lesions. In the range of investigated dosages, the antibiotic dosage had no impact on efficacy in inflammatory (P=0.609) and noninflammatory (P=0.654) lesions. There was no decrease in efficacy during the study period. CONCLUSIONS: There is insufficient evidence to support one tetracycline rather than another in terms of efficacy. In the range of investigated dosages, the antibiotic dosage seems to have no impact on efficacy. Despite increased resistance to antibiotics, oral tetracycline formulations displayed no change in efficacy during the study period. Further studies are, however, required to determine if the anti-inflammatory properties of tetracyclines are sufficient in managing acne.

Treatment of axillary hyperhidrosis with botulinum toxin type A reconstituted in lidocaine or in normal saline: a randomized, side-by-side, double-blind study.

BACKGROUND: Botulinum toxin type A represents a safe and effective treatment for primary axillary hyperhidrosis. One of the most troublesome disadvantages associated with this therapy is pain at the injection sites. Reconstitution of botulinum toxin A in a solution of lidocaine could be an easy alternative procedure to reduce the discomfort associated with those injections. However, the current recommendations are that botulinum toxin A should be reconstituted in normal saline. OBJECTIVES: To compare the efficacy and tolerance profile of saline-diluted botulinum toxin A and lidocaine-diluted botulinum toxin A in patients with axillary hyperhidrosis. METHODS: In a double-blind, side-by-side, controlled, randomized clinical trial, 29 patients were injected with 100 mouse units of botulinum toxin A (Botox); Allergan Pharmaceuticals Ireland, Westport, Ireland) reconstituted in lidocaine into one axilla and with the same dosage of the toxin, reconstituted in an equal volume of saline, into the other axilla. The patients were followed up for 8 months. Quantification of sweat production was performed by iodine-starch tests and by the patients' own rating of sweating. The intensity of pain associated with the botulinum toxin intracutaneous injections was self-assessed by the patients and was evaluated using a 100-mm visual analogue scale. RESULTS: Botulinum toxin A diluted in normal saline and botulinum toxin A diluted in lidocaine were similarly effective in terms of control of onset of sweat production, duration of effect and subjective percentage of mean decrease in sweating. Both treatments were well tolerated, and there were no lasting or severe adverse effects. However, the mean +/- SD pain score during the procedure was significantly lower in the axillae treated with lidocaine-reconstituted botulinum toxin than in the axillae treated with saline-reconstituted botulinum toxin (29.3 +/- 20.1 vs. 47.5 +/- 24.0; P = 0.0027). CONCLUSIONS: Short- and long-term results show the equal effectiveness of botulinum toxin A reconstituted in saline or in lidocaine. However, because injections of botulinum toxin A reconstituted in lidocaine are associated with significantly reduced pain, lidocaine-reconstituted botulinum toxin A may be preferable for treating axillary hyperhidrosis.