Calcipotriol and betamethasone dipropionate for the treatment of psoriasis: a 52-week study.

Psoriasis is a common skin disease affecting 1%-3% of the world's population with significant impacts on quality of life. There is a great need for therapies that are efficacious and safe, not only for the short-term, but also for long-term management. Dovobet/ Daivobet/ Taclonex is a product combining two molecules, calcipotriol and betamethasone dipropionate, that may offer psoriatic patients with an option for maintenance therapy. The efficacy and safety of this combined formulation when used over a 4-week period is well documented. A recent publication in the British Journal of Dermatology discusses the safety of this product when used for 52 weeks.

Actinic prurigo: clinical features and HLA associations in a Canadian Inuit population.

BACKGROUND: Actinic prurigo (AP) is an idiopathic familial photodermatitis. AP of the Inuit is rarely reported and poorly characterized. OBJECTIVE: Our purpose was to examine the clinical features and HLA associations of AP in an Inuit population. METHODS: Thirty-seven Inuit subjects with AP were administered a questionnaire and underwent a cutaneous examination. Other causes of photosensitivity were excluded. HLA class I typing was performed by polymerase chain reaction and sequence-specific primers and class II typing by polymerase chain reaction and sequence-specific oligonucleotide probes. RESULTS: Subjects were 81.1% female, 67.6% had a family history of photosensitivity, and all experienced seasonal variation. The average age at onset of photosensitivity was 29 years, and only 27% had a trend toward improvement in photosensitivity. Involvement of eyes and nonexposed skin was reported in 62.2% and 18.9% of subjects, respectively. Physical examination revealed involvement of the face (64.9%), lip (32.4%), ear (13.5%), and dorsal aspect of the hand (24.3%). HLA-DRB1*14 was present in 51.2% of subjects and 26.2% of controls (P =.022, odds ratio = 2.975). This is a previously unreported HLA association. CONCLUSION: AP in the Inuit is a seasonal, pruritic photodermatitis, often commencing in adulthood and worsening over time. A novel association with HLA-DRB1*14 has been discovered. Overall, this novel HLA association, the absence of HLA associations previously reported in non-Inuit populations, and clinical distinguishing features support the concept that AP in the Inuit may have a distinct immunopathogenic basis that translates into a different phenotype. It also raises the question of whether AP in the Inuit is a distinct photosensitivity disorder specific to this group that has been genetically isolated because of geographic and cultural seclusion.

Towards non-invasive screening of skin lesions by near-infrared spectroscopy.

A noninvasive tool for skin tumor diagnosis would be a useful clinical adjunct. The purpose of this study was to determine whether near-infrared spectroscopy can be used to noninvasively characterize skin lesions. In vivo visible- and near-infrared spectra (400--2500 nm) of skin neoplasms (actinic keratoses, basal cell carcinomas, banal common acquired melanocytic nevi, dysplastic melanocytic nevi, actinic lentigines, and seborrheic keratoses) were collected by placing a fiberoptic probe on the skin. Paired t tests, repeated measures analysis of variance and linear discriminant analysis were used to determine whether significant spectral differences existed and whether spectra could be classified according to lesion type. Paired t tests showed significant differences (p < 0.05) between normal skin and skin lesions in several areas of the near-infrared spectrum. In addition, significant differences were found between the lesion groups by analysis of variance. Linear discriminant analysis classified spectra from benign lesions compared with premalignant or malignant lesions with high accuracy. Near-infrared spectroscopy is a promising noninvasive technique for the screening of skin lesions.

Comparative irritancy study among retinoid creams and gels.

BACKGROUND: Topical retinoids, although very useful in dermatology, may be irritating to some patients. OBJECTIVE: There are a number of topical retinoids available in Canada, and the objective of the present study was to evaluate the irritancy potential in humans of retinoid gels and creams presently available in Canada. METHODS: Thirty healthy adults were administered 10 products (five creams, three gels, petrolatum, and sodium lauryl sulfate (SLS) 0.1% w/v) for up to 21 consecutive days. RESULTS: Early termination of patching due to irritation was required for the tretinoin creams and gels and SLS more frequently and earlier in the study than for adapalene and petrolatum (p =.001). Statistically significant, among-group differences were noted in the severity of irritation at each day and for the cumulative score for both the creams and the gels (p =.0001), in favour of adapalene over the tretinoin products. CONCLUSION: By several measures, adapalene cream and gel were less irritating upon multiple dosing than various tretinoin creams and gels.

Psoriatic arthritis and myopathy.

We describe a patient with psoriatic arthritis and a myopathy. The myopathy did not follow the time course of topical steroid treatment, nor did the patient display any features of hypercorticolism or local steroid excess. No evidence was found to support the diagnosis of polymyositis. Psoriatic myopathy is an uncommonly described condition. Steroid induced myopathy shares some nonspecific features with psoriatic myopathy, but can be differentiated by the clinical response to cessation of steroid therapy. Myalgia and 24 h urine creatine elevation are 2 features not previously described in association with psoriatic myopathy. The latter appears to correlate with muscle weakness and may be useful in following the course of this disease.

Darier's disease and Kaposi's varicelliform eruption.

Kapos's varicelliform eruption usually occurs in persons with active skin disease of various types; however, in atopic dermatitis the condition may occur when the underlying disease is inactive. Two cases of widespread herpes simplex infection associated with Darier's disease are reported. In both cases, infection occurred in the absence of preexisting Darier skin lesions. In one case there was no previous history of Darier's disease. The infection occurred in the third trimester of pregnancy, but it did not appear to affect the infant or the placenta. In the second case, the Darier's disease was in remission at the time of onset of the virus infection.

Immunopathologic study of herpes gestationis in mother and infant.

In vivo bound C3 was demonstrated by immunofluorescence in lesions of both maternal and infant skin in an immunopathologic study of herpes gestationis. Immunoglobulins and other complement components of both classical and alternative pathways were not found. The serum was also negative for circulating antibody to basement membrane of skin. Maternal serum had a factor present that was able to deposit C3 from fresh normal serum onto the basement membrane zone of skin. Hemolytic complement titrations showed a decrease of CH50 levels in serum of both classical and alternative pathways in the mother and the classical pathway in the infant, with a decrease of C2 and C4 in both. To our knowledge, this is the first reportof a decrease in serum complements in herpes gestationis and indicates that complement may not be activated locally.