Photodynamic therapy plus topical retinoids in Darier's disease.

Darier's disease is a rare, genetically determined, chronic disorder of keratinization. Characterized clinically by a symmetrical eruption of hypercheratotic papules with predilection for the seborrhoeic areas of the body. Many treatments have been suggested: emollients, topical retinoids, dermoabrasion, topical steroids and intermittent courses of oral antibiotics. Systemic retinoids are usually the treatment of choice. We present a small case series of patients treated with PDT and topical retinoids with good results. This therapeutic modality could represent an alternative to systemic retinoid treatment.

Insufficient knowledge among psoriasis patients can represent a barrier to participation in decision-making.

Patient participation in treatment decisions can have positive effects on patient satisfaction, compliance and health outcomes. The objectives of this study were to examine attitudes of psoriasis patients regarding participation in treatment decisions and to evaluate the effect of a decision-aid for discussing treatment options. A "quasi experiment" was conducted in a large dermatological hospital in Italy: a questionnaire evaluating the decision-making process and treatment knowledge was self-completed by 231 consecutive psoriasis patients after routine clinical practice and by a second sample of 171 patients exposed to a decision-board. In routine clinical practice 67.9% of patients wanted to be involved in decision-making, 28.4% wanted to leave decisions entirely to the doctor and 3.7% preferred making decisions alone. 17.9% and 25.3% of the control and decision-board group had good knowledge. At multivariate analysis good knowledge increased the likelihood of preferring an active role (risk ratio (RR) = 2.21; 95% confidence interval (CI) 1.3-3.9; p = 0.006). The decision-board only marginally improved patient knowledge and doctor-patient communication. In conclusion, large proportions of psoriasis patients want to participate in decision-making, but insufficient patient knowledge can represent a barrier.

Medium- versus high-dose ultraviolet A1 therapy for urticaria pigmentosa: a pilot study.

BACKGROUND: There is currently no definitive cure for urticaria pigmentosa (UP). Psoralen plus ultraviolet A therapy is efficacious in alleviating symptoms and reducing cutaneous lesions. OBJECTIVE: The purpose of this study was to assess the effect of ultraviolet A1 (UVA1) in adult patients with UP and to compare the effectiveness of high-dose (130 J/cm(2)/day for 10 days) and medium-dose (60 J/cm(2)/day for 15 days) UVA1 radiation. METHODS: Ten and 12 adult patients with UP were treated with high-dose or medium-dose UVA1, respectively. The number of skin lesions and dermal mast cells, the presence of Darier's sign, the intensity of pruritus, and quality of life measures were evaluated before, at the end of treatment, and 2 and 6 months later. RESULTS: Baseline characteristics were similar among the 2 groups of patients. In the majority of patients, the number of lesions was not significantly reduced. However, the number of mast cells in lesional skin decreased markedly in most patients by the end of treatment, and it remained low for the whole study period. Pruritus and quality of life improved considerably by the end of treatment, and the improvement was maintained during the 6-month follow up. No significant differences were observed between patients receiving high- or medium-dose UVA1. CONCLUSIONS: UVA1 phototherapy ameliorates both objective and subjective symptoms of adult patients with UP and induces long-term remission in most cases. Medium-dose UVA1 appears at least as effective as high-dose UVA1.