Double blind clinical trial in a series of 115 patients with seborrheic dermatitis: prevention of relapses using a topical modulator of Toll like receptor 2.

AIM: Seborrheic dermatitis is a chronic inflammatory disease aggravated by Malassezia species. Toll-like receptors (TLR) are part of innate immune system that can be activated by yeasts. Previous studies showed that an association of Umbelliferae extract with a lipid (TLR2-Regul™) decreases the IL-8 expression in human skin in contact with M. furfur. The aim of this study was to assess the activity of a topical formulated with TLR2-Regul™ in the prevention of seborrheic dermatitis (SD) relapses. METHODS: Immune-competent SD adult patients were treated for SD (topical imidazoles or steroids). Cleared patients were randomized and received a topical containing TLR2-Regul™ (A) or its vehicle (B). Erythema, scales and pruritus were assessed during two months. RESULTS: The study included 115 patients, mean age 43.4, sex ratio m/f 1.5. At week 4 the relapse rate was 26% (N.=15) in group A and 43% (N.=25) in group B. At W8 the relapse rate was 21% (N.=12) in group A and 40% (N.=23) (P=0.0309). CONCLUSION: In this series of 115 adults with seborrheic dermatitis, patients treated with a topical containing TLR-Regul™ showed a significantly less relapse rate compared with the excipient group (P<0.05). TLR modulation could represent a new therapeutic approach in the prevention of seborrheic dermatitis relapses.

Radiotherapy of skin carcinomas of the pinna: a study of 115 lesions in 108 patients.

BACKGROUND: The possibility of treating skin carcinomas of the pinna with radiotherapy is somewhat under discussion and scarcely known. Therefore the aim of the study was to evaluate the effectiveness and safety of dermatologic radiotherapy in a series of patients affected by basal or squamous cell carcinoma of the pinna. METHODS: A retrospective study was performed on 108 patients affected by 115 carcinomas of the pinna (99 basal cell carcinomas, 16 squamous cell carcinomas) without involvement of the external auditory canal. Radiotherapy was performed with kilovoltage techniques (55-120 kV) and the total doses administered ranged from 45 to 70 Gy (105 Gy in one case only), with different fractionations. RESULTS: The mean follow-up was 28.80 months. Complete remission was obtained in 111 lesions (96.52%) and partial remission in one (0.87%), as evaluated 1 month after the end of radiotherapy. No response was observed in two lesions (1.74%). The response was not evaluable in one lesion (0.87%). During follow up a relapse was observed in 12 lesions (all basal cell carcinomas): nine central and three marginal to the irradiation field. The 5-year cure-rate from the end of radiotherapy was 78%. The cosmetic results were evaluated as good or acceptable in 88.28% of lesions. No complications nor sequelae to the treatment were observed. CONCLUSIONS: The results obtained confirm the possibility of treating epithelial skin neoplasms of the pinna with dermatologic radiotherapy, which can afford high-remission percentages without damaging cartilaginous tissue.

Results and side effects of dermatologic radiotherapy: a retrospective study of irradiated cutaneous epithelial neoplasms.

BACKGROUND: Ionizing radiation therapy has a well-defined role among several therapeutic options available for the management of cutaneous neoplasms. However, many dermatologists today are not aware of its potential. OBJECTIVE: Our purpose was to evaluate the effectiveness and safety of radiotherapy in a large series of patients with primary malignant epithelial neoplasms (PMENs), who had been subjected to radiotherapy between 1982 and 1995. METHODS: A retrospective study was performed on 1188 patients with a total of 2002 PMENs that had been treated by contact, superficial, and intermediate x-ray therapy. RESULTS: Complete remission was obtained in 98.7% of the irradiated lesions. The 5-year cure rate was 90.73%. Cosmetic results were evaluated as "good" or "acceptable" in 84.01% of the treated lesions. Acute complications occurred in 1.94% and chronic complications in 0.34%. To date, neither radio-induced skin neoplasms nor late stochastic effects have been observed. CONCLUSION: This study confirms that dermatologic radiotherapy is an effective and reliable form of treatment of PMENs and has a favorable cure rate/toxicity ratio.

Intracavitary contact X-ray therapy of oral HIV-associated Kaposi's sarcoma.

A retrospective study was performed to assess the efficacy and low mucosal toxicity of intracavitary contact X-ray therapy (ICRT), a proposed treatment of small/medium sized lesions of oral HIV-associated Kaposi's sarcoma (HIV-KS). Twenty-six patients with histologically confirmed oral HIV-KS underwent ICRT in the period 1986-1995. No patient received antiblastic or interferon therapy during the radiotherapy or follow-up periods. ICRT was performed according to the usual technical modalities of contact X-ray therapy, but the end of the source of ionizing radiations was introduced into the oral cavity. The total doses administered ranged from 10 to 50 Gy per field, in one or two weekly fractions of 5 Gy each. The follow-up ranged from 1 to 44 months (mean 7.5 months). Complete remission was obtained in 20 cases (76.92%), partial remission in 6 (23.08%) and relapse in one case (3.84%). Pain was relieved in all cases. Mucosal reaction was mild and did not result in any interruption of treatment. Our data suggest that ICRT is an effective and well tolerated treatment. It can be used in the management of oral HIV-KS instead of external radiotherapy, provided that the size and the location of the lesions and the conformation of the palate are suitable to this technique.