Patient-reported outcomes from a multicenter, randomized, vehicle-controlled clinical study of MAS063DP (Atopiclair) in the management of mild-to-moderate atopic dermatitis in adults.

BACKGROUND: MAS063DP (Atopiclair) is a topical cream approved for symptomatic relief in the treatment of atopic and contact dermatitis. METHODS: This was a multicenter, randomized, double-blind, vehicle-controlled study in adults with mild-moderate atopic dermatitis. Patients were given MAS063DP or vehicle (2:1) three times per day to areas affected by atopic dermatitis for up to 50 days. A patient global assessment change from baseline was determined at days 8, 22, 36, and 50. Patient total body pruritus (visual analog scale) and patient opinion on treatment acceptability were also assessed. RESULTS: A total of 218 patients (active: n = 145, vehicle: n = 73) were enrolled. At Day 22, 77% of patients on MAS063DP had a patient global assessment of good improvement or better versus 21% on vehicle (p<0.0001, chi-squared test). Similarly, more patients had improvement in itch over their total body on MAS063DP than on vehicle (p<0.0001). CONCLUSION: MAS063DP treatment results in patient-perceived improvements in mild-moderate atopic dermatitis.

Imiquimod as an antiaging agent.

BACKGROUND: Topical imiquimod therapy has proven to be effective for a variety of infectious, neoplastic, and inflammatory dermatologic diseases. Several published reports have validated the benefit of imiquimod therapy for actinic keratoses and superficial melanoma and nonmelanoma skin cancers. There is, however, limited evidence demonstrating the use of topical imiquimod application as an antiaging treatment. OBJECTIVES: We examined the effectiveness of imiquimod 5% cream in the treatment of photoaging by evaluating pretreatment and posttreatment biopsy specimens and documenting the histologic changes. METHODS: This study represents an extension of an earlier project in our department in which patients with biopsy-proven lesions of lentigo maligna (LM) were recruited from a university dermatology service, a hospital, and referrals from private practitioners for an open-labeled efficacy trial with daily topical application of 5% imiquimod for 3 months. Biopsy of clinically affected skin was carried out on all patients before and after treatment. Using a semiquantitative method, biopsy specimens were analyzed for changes in the dermal collagen table (solar elastosis vs papillary dermal fibroplasia). Additional parameters analyzed included epidermal changes (atrophy vs acanthosis, melanin content, and hypergranulosis) and inflammatory effects (epidermal and dermal cell populations along with presence of pigment incontinence). Variables were compared using paired Wilcoxan rank sums. RESULTS: Of 26 evaluable patients who completed 3 months of daily application, 24 (>92.3%) showed a significant increase in papillary dermal fibroplasia (P < .0001) with associated reduction in solar elastosis (P = .0036). Other noteworthy findings were restoration of normal epidermal thickness (P = .0073) and melanization (P < .0001). LIMITATIONS: This study only evaluates the effect of imiquimod in the lesional skin of LM. It is not known whether the results are applicable to nonlesional, photoaged skin. CONCLUSION: Topical imiquimod appears to induce reparative changes to the epidermis and the dermal collagen table in chronically sun-damaged skin associated with LM, indicating its potential use as an antiaging treatment. These findings need to be confirmed in photodamaged skin not associated with LM.

Cutaneous diseases in Native Americans.

Native Americans have a rich and complex heritage and culture. Although the genetic pool has changed with increasing integration with other Americans with different ancestry, there are important conditions that are unique to Native Americans, the most prominent example being actinic prurigo. The scientific literature dealing with Native American skin conditions is sparse and more studies are needed to understand more fully cutaneous disease in Native Americans.

Erythema migrans and the differential diagnosis of annular erythema.

The diagnosis of Lyme disease (LD) or Lyme borreliosis is often based on the recognition of erythema migrans (EM) because its clinical appearance precedes systemic manifestations of the disease and the antibody response. The clinical basis and variable presentation of EM leave room for diagnostic error and, as a consequence, potential long-term repercussions such as rheumatic, cardiac, ophthalmic, or neurologic complications. Most cases are reported in the Northcentral and Northeastern states. In areas where LD is not endemic, the differential diagnosis of annular erythema may not list EM highly, although all the features of a lesion may fit the typical description of EM. Therefore, a complete understanding of LD and its clinical presentation are key in making a diagnosis, especially in areas with low incidence. We present a hypothetical case report of EM from Oklahoma, a state with low incidence of LD, for the purposes of review of this entity and the differential diagnosis of annular erythema.