Tazarotene gel, a new retinoid, for topical therapy of psoriasis: vehicle-controlled study of safety, efficacy, and duration of therapeutic effect.

BACKGROUND: Topical therapy providing initial improvement and maintenance of effect after treatment of the large majority of patients with limited, mild to moderate psoriasis is not presently available. Previous topical retinoids have generally been either ineffective or too irritating for therapy of psoriasis. OBJECTIVE: Our purpose was to evaluate a new topical retinoid, tazarotene, in the treatment of stable plaque psoriasis during treatment and posttreatment periods. METHODS: In a double-blind manner, 324 patients were randomly selected to receive tazarotene 0.1% or 0.05% gel, or vehicle control, once daily for 12 weeks and were then followed up for 12 weeks after treatment. RESULTS: Of the total, 318 patients could be evaluated. Tazarotene gels were superior (p < 0.05) to vehicle, often as early as treatment week 1, in all efficacy measures: plaque elevation, scaling, and erythema; treatment response; percentage treatment success (patients with > or = 50% improvement); and time to initial success. Efficacy was equivalent on target lesion sites (trunk or limbs and knees or elbows) and overall. A sustained therapeutic effect was observed for 12 weeks after treatment. Tazarotene gel was cosmetically acceptable. There was low systemic absorption, limiting toxicity to local irritation. CONCLUSION: Once-daily tazarotene was effective and safe as a topical monotherapy for plaque psoriasis, providing rapid reduction of signs and symptoms.

Predisposing factors in occupational skin diseases.

Work-related skin disorders do not appear randomly; they are the result of certain predisposing factors in the environment and the host. These factors can be isolated and recognized, and awareness of these factors by employers and affected employees should have a significant impact on work-related skin disease. The role of a dermatologist in providing this information is essential.

The role of atopy in occupational skin diseases.

Atopic individuals are predisposed to work-related hand eczema, predominantly on the basis of a lowered threshold for irritation. They comprise an inordinately large percentage of the more difficult and costly cases. It appears that a history of previous atopic dermatitis, rather than previous respiratory allergies, is a better prognosticator of future work-related dermatitis.

Allergic dermatitis to benzyl alcohol in an injectable solution.

Benzyl alcohol produced an allergic contact dermatitis in a 46-year-old woman. The dermatitis was characterized by erythema, palpable edema, and raised borders. It had occurred after the use of sodium tetradecyl sulfate, a sclerosing agent used for the treatment of varicose veins. This article reviews the widespread use of this preservative in a variety of injectable agents.

The role of atopy in occupational dermatoses.

Hayfever was the commonest symptom of atopy among a group of 134 individuals who had been compensated for work-related skin disease in South Carolina. A history of previous eczema and a history of wool intolerance differed significantly between the group with contact dermatitis and the group with other work-related dermatoses. The rôle of atopy figured dramatically among the more serious cases, accounting for 93% of these cases resulting in job loss.

Contact dermatitis due to endotoxin in irradiated latex gloves.

This case report describes contact dermatitis of the dyshidrotic type of the hands of a worker subjected to minor trauma. The source of the irritation was linked to bacterial endotoxin in latex gloves. Irradiated sterilized gloves and software may contain significant endotoxin levels because the irradiation does not affect endotoxin itself. The irradiation of the bacteria actually increases endotoxin levels when the bacterial count is elevated. Sweating under these gloves may enhance entry into the skin with subsequent reaction as endotoxin is water soluble.

Occupational dermatoses in South Carolina: a descriptive analysis of cost variables.

The problem of occupationally related skin disease was examined by reviewing the files of all closed cases (n = 958) of skin disease processed by the South Carolina Industrial Commission for the fiscal year (FY) of July 1, 1978, through June 30, 1979. From this population, a subset (134) was queried to obtain further personal information for an analysis of cost variables. The key findings were: (1) 82% of the sampled population were atopic; assuming a 25% frequency of atopy in the general population, the relative odds of developing occupational skin disease are 13.5 times greater if one is atopic; significant association existed between increased days lost and a history of atopy. (2) Significant associations existed between higher cost items and delayed time to see physicians, history of having a preexisting rash, and younger age.

The epidemiology of work-related skin disease in South Carolina.

Problems associated with occupationally related skin disease were examined by reviewing the charts of all closed cases of skin disease processed by the South Carolina Industrial Commission during the period of July 1, 1978, through June 30, 1979. During the review period, 958 cases occurred that accounted for costs of $142,925 and 2,100 days lost from work. Through the use of selected objective criteria, only 15% of these cases were defined as serious, but they accounted for 48% of all dollar costs and 96% of the total lost time. Similarly, with the use of a percentile approach to estimate severity, persons in the upper fifth percentile of cost elements were responsible for 68% of the total incurred fees and 77% of the lost time. Eighty-eight percent of all claimants said their hands were affected by their skin problem. Almost 13% of the claimants reported that their entire skin surface was involved. There was a significant clustering of cases from June through September among male claimants, but no seasonal incidence was observed in female claimants. We conclude that the identification of factors that characterize the small number of cases with disproportionate economic impact deserves greater attention and investigation.

Urinary monitoring for diethylstilbestrol in male chemical workers.

Between 1969 and 1972 diethylstilbestrol (DES) accounted for 25 instances of breast tenderness and enlargement in male chemical workers in a DES production area of a large chemical plant. A gas chromatographic analysis for urinary DES was performed at three spaced intervals over a 90-day work span. All full-time workers who wore air suits when necessary developed increasing levels of DES upon increasing days of exposure. At a certain range of excretion (40 micrograms/ml/24 hours) two workers became symptomatic. DES was also detected in one helper and in two individuals not directly connected with the area of known exposure. Although no federal standard for DES exists, the following evidence points to the actuality of hazardous levels of exposure: (1) there had been a persistent history of DES reactions year after year; (2) high urine levels and adverse reactions were found in workers participating in the medical studies of this evaluation; and (3) there was widespread DES contamination of buildings and equipment, extending as far away as the lunchroom in a separate building.

Allergic contact dermatitis to dimethoxane in a spin finish.

A textile worker exposed to dimethoxane in an aqueous system developed allergic contact dermatitis. Patch testing to this compound and its possible products in an aqueous system demonstrated sensitization to acetaldehyde and crotonaldehyde.

Hypervitaminosis A in a patient with alopecia receiving renal dialysis.

A patient with gradually increasing hair loss was undergoing long-term renal dialysis. Questioning revealed that her supplemental vitamin program had contained vitamin A only to that extent it was included in a portion of multivitamins taken in conventional amounts for approximately three years. Her serum vitamin A level was 140 micrograms/dL (a normal level is 20 to 80 micrograms/dL). Reports have indicated that chronic renal disease results in a state of relative hypervitaminosis A. This is compounded in renal dialysis by failure to remove vitamin A. The administration of low-dose supplemental vitamin A preparations in this select population is discussed with respect to current concepts of vitamin A metabolism in renal disease.

Bullous disease of childhood: report of a case demonstrating antibasal cell antibody.

This report describes a child with protracted bullous disease responsive only to high doses of steroids, who on immunofluorescent testing, consistently displays antibasal cell antibody. The child had been treated with penicillin a week prior to the development of the bullous disease. The etiologic possibility of this drug history in the evolution of the bullous disease is raised, with particular respect to recent reports of similar circulating antibody in drug reactions.

Hepatitis among plasma fractionation workers. An industry-wide study.

An industry-wide survey of plasm fractionation facilities in the United States was conducted during 1973-74. Hepatitis was reported among the workers with varying degrees of plasma contact at all plant sites. For each of fourteen facilities in this investigation, field inspections disclosed: (1) numerous overt instances of employee-product contact: (2) inconsistent methodologic approaches at virtually all stages of the plasma fractionation process; (3) at low level of management and employee awareness regarding the potential bio-hazard identified; and (4) disparate examples of hepatitis surveillance and prophylaxis. Our data suggests that there is a high risk of hepatitis among plasma fractionation workers and, as such, much more attention needs to be focused on the reduction of health hazards within this industry.

Endemic amebiasis in an Arkansas community.

Parasitologic, serologic, and epidemiologic studies were done during 1967 in Calion, Arkansas (population 544). Infection with Entamoeba histolytica was found to be endemic but was segregated along racial lines. Twenty-two (9.9%) black compared with only one (0.6%) white had E. histolytica demonstrated in one stool examination; only two blacks had symptoms suggestive of amebiasis. No positive amebiasis indirect hemaggulination titers were found in 135 white residents. In contrast, 41 (17.9%) blacks had positive titers. Age, sex, and geographic location were not associated with stool or seropositivity. Within the black population, clustering of stool and seropositivity occurred. Significantly higher rates of stool and seropositivity were seen in households with crowding and poor sanitation as evidenced by lack of indoor toilet facilities. The presence of contaminated water supplies did not correlate with stool or seropositivity. The probable importance of person-to-person transmission is suggested by the observed clustering of infection within households with crowding and unsanitary conditions. The absence of evidence for transmission by food or water further supports this hypothesis.

Immunologic reactions in penicillin factory workers.

One hundred sixty-nine employees of a synthetic penicillin plant participated in this study to correlate immunologic reactions, allergic symptomatology and dustiness of the work area. Statistically significant positive correlations existed among the following: (1)presence or absence of symptomatology and increasing dustiness of the work area; (2)presence or absence of symptoms and the presence or absence of benzyl-penicilloyl specific hemagglutinating antibody (BPO-specific antibody); (3)the absence, presence and level of titer of BPO-specific antibody with the dustiness of the work area. Because synthetic penicillin dust in the workroom air is able to evoke immunologic responses and produce symptoms among workers exposed to high levels, it is recommended that a reasonable air level for penicillin in factories be in the range of those demonstrated in the least symptomatic group in the study with measurements below 0.1 mg/m3.