Topical meclocycline sulfosalicylate, benzoyl peroxide, and a combination of the two in the treatment of acne vulgaris.

One hundred and six patients with acne vulgaris of the face were treated for 10 weeks with either topical meclocycline sulfosalicylate, topical benzoyl peroxide or both preparations. A randomized, double-blind parallel group study was used. Benzoyl peroxide proved more effective than meclocycline in reducing acne lesion counts, while local side effects were more common in the benzoyl peroxide-treated patients. The combined treatment was of intermediate efficacy with fewer local side effects.

Urostomy appliances and stoma care routines. The relation to peristomal skin complications.

The aim of the study was to describe types of appliances and stoma care routines and evaluate their relation to peristomal skin complications. Sixty-six patients with a cutaneous uretero-ileostomy were interviewed and the peristomal skin was assessed according to Classification of Peristomal Skin (CPS). The results show a conservatism regarding the types of appliance and the stoma care routines. More than half of the patients used the same product at follow-up as they were initially fitted with three to 14 years earlier. The routines adopted by the patients were often inadequate, resulting in skin complications. Continuous exposure of the skin to urine by creation of a too wide opening in the face-plate and infrequent changing of the appliance resulted in development of pseudoverrucose skin lesions.

Local status of the urinary stoma--the relation to peristomal skin complications.

Sixty-six patients with uretero-ileostomy were investigated with special regards to local status of the urinary stoma, i.e. stomal site, length, size/shape, and peristomal skin. Each variable was defined. In reports from other centres there has been a lack of definitions making it difficult to compare results from different studies. One fifth of our patients had inadequately located stomas and 85% had stomas shorter than 1 cm. The peristomal skin status was assessed according to CPS, Classification of Peristomal Skin. Eight per cent of the patients exhibited severe erythematous/erosive lesions and one fifth pseudoverrucose lesions. The relation between skin lesions and local status of the urinary stoma was analyzed. Patients with inadequately located stomas were more likely to show severe erythematous/erosive lesions and there was a tendency towards patients with stomas shorter than 1 cm, more frequently exhibiting pseudoverrucose lesions.

Classification of peristomal skin changes in patients with urostomy.

Peristomal skin lesions in patients with ileal conduit urinary diversion have been reported in frequencies ranging from none to occurrence in 100% of patients. In previous studies skin lesions often are referred to in unspecific terms, which has made it impossible to compare results with those of other studies. Thus a classification of peristomal skin (CPS) has been developed on the basis of macroscopic peristomal findings. It defines what can be accepted as ordinary findings, as well as two different types of skin lesions, erythematous-erosive and pseudoverrucous. Each of these is divided into two subgroups. Such a classification is a prerequisite for a meaningful comparison of the type, incidence, and severity of skin lesions in different groups; it also may allow a more reliable clinical evaluation of new ostomy appliances and skin care products. In addition, CPS may also facilitate communication among professionals who are responsible for the care of ostomy patients.

Multicenter clinical evaluation of a hydrocolloid dressing for leg ulcers.

The need for a moist environment for the normal healing process led to the development of occlusive dressings. Results from this study support the contention that a moist wound environment is favorable to the healing process in humans as well as in animal models. Hydrocolloid dressings are effective in the practical daily management of chronic and even refractive ulcerations of the lower extremities and offer a time-saving treatment alternative with a high degree of patient acceptability.

Coagulation and fibrinolytic systems during the course of erysipelas and necrotizing fasciitis and the effect of heparin.

Necrotizing fasciitis (NF) is a grave infection of the skin leading to gangrene of the integument and often having a complicated and prolonged course. Studies on blood coagulation and fibrinolysis were done in 15 patients with NF and compared with 5 cases of erysipelas (E). In both conditions local fibrin deposition occurred initially in their course, but it was quantitatively more pronounced in NF than in E. Fibrinolysis decreased and stayed low at the site of NF up to 5 months (median) after discharge from hospital. Fibrinogen and activities of several plasma serine proteinases modifying coagulation were increased during the course of both diseases and even at the follow-up. Factor XII was decreased during the first week in E but a transient drop was present in NF only on days 3 and 4. The treatment of NF consists of high doses of appropriate antibiotics instituted early in its course. A beneficial effect of 300-500 IU heparin/kg/day was suggested from this open study. The hard induration preceding the appearance of skin gangrene was inhibited, if heparin was given early in the course of NF. We conclude that the enhanced fibrin deposition and vascular occlusions in the skin are the basis for most complications present in NF.

Impact of topical clindamycin and systemic tetracycline on the skin and colon microflora in patients with acne vulgaris.

In a double-blind study on 20 patients with acne vulgaris, 10 patients were treated with topical clindamycin and 10 patients with oral tetracycline for eight weeks. The skin and colon microflora were determined before, during and up to eight weeks after treatment. All patients improved markedly to the same extent. Topical clindamycin caused no changes in the colon flora, whereas oral tetracycline significantly suppressed the numbers of colon bacteria and four patients were colonized by new tetracycline resistant bacteria. In patients receiving tetracycline, 40% of the skin bacteria became resistant during therapy, while the corresponding figure for clindamycin was 60%. The skin flora was normalized in most patients after the treatment had stopped.

Blood coagulation and fibrinolytic systems in patients with erysipelas and necrotizing fasciitis.

Necrotizing fasciitis (NF) is a skin infection caused by a group A streptococci, resulting in an erythematous lesion with cyanosis and vesicles or bullae leading to gangrene. The condition is prostrating and often accompanied with cerebral confusion. A table of diagnostic scores is given to differentiate initial symptoms and signs of NF from erysipelas (E). Assays of blood coagulation and fibrinolysis together with routine laboratory examinations were made in 12 patients with NF on admission to the hospital and they were compared with similar analyses of 5 patients with E. The NF and E patients showed increased levels of fibrinogen, factor V and factor VIII as well as positive ethanol gelation test, which hypercoagulability as did also decrease antithrombin III and increased levels of fibrinopeptide A. Slightly increased levels of fibrinogen degradation products were also noted. The Hageman factor was low in E compared to NF. In both conditions fibrin formation seems to be enhanced, most probably more extensively in NF. General signs of secondary fibrinolysis were less conspicuous. It is possible that the Hageman factor is activated to modulate the inflammatory response differently in E than in NE.

An improved quantitative method for the study of fibrinolysis in the skin as exemplified in patients with leukocytoclastic vasculitis and erysipelas.

The activity of plasminogen activator has been measured in tissue sections with the aid of a modified Todd technique. Frozen skin biopsies were sectioned and the tissue covered with fibrin-plasminogen film. After incubation at 37 degrees C fibrinolysis was studied for a period of 30 min and was graded into six exponentially increasing steps. During this period, grades were linear with the llogarithm of time of incubation. The rate of fibrinolysis is a measure of the activity of the plasminogen activator and is expressed by the slope of the linear regression of grades versus the ogarithm of time; the value of the slope is proportional to the common logarithm of the activity of the plasminogen activator present in the section. Using urokinase as a specific plasminogen activator, the same linear expression was shown with time, indicating the validity of our grading and experimental system. Eleven healthy subjects served as controls to 6 patients with leukocytoclastic vasculitis and 4 patients with erysipelas and 4 with necrotizing fascilitis. The controls showed values similar to the non-involved skin in the patients. The activity was higher in the arm than in the thigh sites. The activity in the thighs was lower in women than in men. A decrease in the plasminogen activator activity was found in the three disorders.

Photokinetic microassay of adenylate kinase using the firefly luciferase reaction.

A new rapid photokinetic method is described for determining the activity of adenylate kinase (ATP:AMP phosphotranspherase, EC 2.7.4.3) in 0.1--5.0 micrograms of freeze-dried tissue. This represents a weight range far below that obtainable by fine-needle biopsy. The reaction 2 ADP in equilibrium with AMP + ATP was employed and the ATP formed assayed with firefly luciferase as light yielder. The light emission was recorded on a multi-channel scaler. The adenylate kinase activities found in tissues of mice were in the same range as previously described in a study using fluorometric microassay.

Treatment of scabies with disulfiram and benzyl benzoate emulsion: a controlled study.

In a double-blind study, 38 adults with scabies were treated with the scabicide Tenutex (a proprietary aqueous emulsion containing 0.5% DDT, 2% disulfiram and 22.5% benzyl benzoate) and 42 patients were treated with a similar emulsion lacking DDT. The treatment consisted of a single whole-body (except for the head) application which was washed off after 24 hours. When examined 3 weeks later, both groups were completely cured. Thereafter, a further 35 patients took part in an open trial with the DDT-free Tenutex emulsion and all patients were cured, irrespective of whether the treatments were administered by skilled personnel or by themselves at home. It is concluded that for the treatment of scabies in Sweden, the most commonly used preparation, Tenutex, can be replaced, without risk of loss of efficacy, by an emulsion containing 2% disulfiram and 22.5% benzyl benzoate, i.e. Tenutex without DDT.

Percutaneous absorption of DDT from a parasiticide used for treatment of scabies.

Moderately to markedly increased plasma concentrations of DDT and its major metabolite DDE were found in 3 boys 4, 7 and 9 years of age and also in a 50-year-old woman who, because of suspected or proven scabies infection, had all repeatedly received between 7 and 200 applications of Tenutex (a DDT-containing scabicide) during recent years. Normal values were found in 4 untreated children and in 2 children who had been treated with Tenutex four and three times respectively. In 9 adults there was no significant increase in the plasma concentrations of DDT and DDE after a single 24-hour treatment with Tenutex. These results indicate that DDT, a known constituent of the scabicide Tenutex, can be percutaneously absorbed and lead to measurably increased plasma concentrations after repeated application, especially in children.