Between a rock and a hard place: management of systemic lupus erythematosus and porphyria cutanea tarda.

Porphyria cutanea tarda (PCT), the most common porphyria, is a rare photodermatosis characterized by fragile, hemorrhagic bullae and erosions with associated milia, hyperpigmentation, and hypertrichosis. SLE is a systemic connective tissue disease with approximately 80% of those affected manifesting cutaneous findings. These include malar and discoid rashes, photosensitivity, bullae, oral ulcerations, as well as a variety of other nonspecific findings. In this case, we illustrate a rare but established association between these two pathologic entities, and the resulting therapeutic challenge in treating a patient with both conditions. The concurrence of these two diseases poses therapeutic challenges with a paucity of evidence-based recommendations. Management with low dose weekly antimalarial therapy may be the appropriate middle ground in effectively treating the two co-morbid conditions especially in a patient with other underlying systemic conditions.

Six week evaluation of the potential for topical desoximetasone 0.25% spray to induce photoallergic skin reaction.

PURPOSE: Desoximetasone 0.25% topical spray is a novel formulation that has not been tested or approved for safety and efficacy. The primary objective was to determine the potential of desoximetasone 0.25 and 0.05% topical sprays, as well as a vehicle to induce photoallergic skin reaction after repeated topical application and irradiation to the skin using a controlled photopatch testing procedure. MATERIALS AND METHODS: 53 subjects completed the study, each with six application sites (two of each treatment), three of which were irradiated and three non-irradiated, for an induction period of three weeks and then challenge period at week 6. RESULTS: Desoximetasone 0.25 and 0.05%, as well as vehicle showed no evidence of potential to induce photosensitization. There was statistically significantly greater irritation at the vehicle irradiated site in comparison to the irradiated treatment area of desoximetasone 0.25% (p = .005) and the irradiated treatment area of desoximetasone 0.05% (p = .008). CONCLUSION: Our results suggest that regular treatment with desoximetasone 0.25 and 0.05% spray, followed by UV light exposure does not induce photosensitization or photo-irritation. These findings increase confidence for the use of this topical spray in eczema or psoriasis patients who may also be receiving UV light therapy and may contribute to the clinical management of these patients.

4-Day evaluation of the irritation potential of topical desoximetasone 0.25% and 0.05% spray on light-exposed skin.

PURPOSE: The safety and potential side effects of desoximetasone 0.25% and 0.05% sprays have not previously been studied. The primary objective of this study was to determine the irritation potential of desoximetasone 0.25%, 0.05% and vehicle sprays in response to irradiation. MATERIALS AND METHODS: Thirty-four subjects were enrolled in the study, each with three study treatments (desoximetasone 0.25%, 0.05% topical sprays and vehicle) were applied to two sites each on the back of every subject, with half of the sites irradiated with filtered UV light. Dermal reactions at the test sites were evaluated using a visual scale with corresponding numerical scores that rated the degree of erythema and oedema. RESULTS: Desoximetasone 0.25%, 0.05%, and vehicle caused no detectable signs of phototoxicity when examined on days 3 and 4. Mean scores of desoximetasone 0.25%, 0.05% and vehicle to non-irradiated treatment areas showed no signs of irritation. CONCLUSIONS: Our results suggest that regular application of desoximetasone 0.25% and 0.05% topical sprays do not induce photosensitization or photoirritation. The safety of this topical spray may help with clinical management of patients using topical corticosteroids while also receiving therapeutic UV light exposure. Thus, patients can use desoximetasone sprays without concerns of side effects due to therapeutic light or sun exposure.

Age-related changes in male forearm skin-to-fat tissue dielectric constant at 300 MHz.

Prior research suggests that tissue dielectric constant (TDC) values are useful to assess localized skin water in females for early diagnosing breast cancer treatment-related lymphoedema and TDC values in young adults have shown gender differences. However, no TDC data are available for older males nor have ageing effects been studied despite known shifts in water state and other skin age-related changes. Thus our goals were to (i) characterize TDC values at various skin depths in young and older males, (ii) determine the dependence of these values on body composition parameters and (iii) establish inter-arm TDC ratios for use as normal male reference values. TDC measurements were made to depths of 0·5, 1·5, 2·5 and 5·0 mm bilaterally on volar forearm skin in 60 males in three groups of 20 that had mean ages ± SD of 24·0 ± 0·9, 40·0 ± 12·9 and 71·0 ± 8·0 years. Total body fat and water percentages were determined via bioimpedance at 50 KHz. Results showed that (i) for all age groups TDC values decreased with increasing depth, (ii) TDC values were not statistically different among age groups except at a depth of 0·5 mm, (iii) TDC values were highly negatively correlated with total body fat and (iv) inter-arm ratios varied little among age groups and depths. It is concluded that (i) age-related larger TDC values at only the shallowest depth is consistent with skin water shifting state from bound to more mobile in the oldest group and (ii) inter-arm ratios at any depth provide a basis to test for unilateral oedema.

Skin indentation firmness and tissue dielectric constant assessed in face, neck, and arm skin of young healthy women.

PURPOSE: Our goal was to test the hypothesis that skin firmness correlates with skin hydration. METHODS: Dermal water was assessed by tissue dielectric constant (TDC) at 0.5 mm (TDC0.5 ) and 2.5 mm (TDC2.5 ) depths on four face sites and two arm sites of 35 women (25.0 ± 1.6 years). Firmness was determined by force (mN) to indent skin to 0.3 mm (F0.3 ) and 1.3 mm (F1.3 ). RESULTS: F0.3 was similar among face sites (avg = 16.2 ± 7.2 mN) but F1.3 varied (avg = 32.5 ± 4.1 mN). TDC2.5 was similar among face sites (avg = 37.7 ± 4.2) but TDC0.5 varied (avg = 36.2 ± 4.8). F1.3 of arm sites was similar (avg = 60.2 ± 18.6 mN) and both greater than F1.3 of neck (28.3 ± 7.1 mN) and face. Regression analysis showed a near-zero correlation between forces and TDC at all sites. CONCLUSION: The near-zero correlation may be due to low skin interstitial hydraulic resistance to mobile water movement in healthy young skin. If true, then conditions in which dermal hydraulic conductance is reduced as in lymphedematous, diabetic, or aged skin are more likely show the hypothesized relationship. Our findings provide normalized reference values and suggest that such persons are an important population to study to test for a possible skin water-indentation force relationship and its utilization for early diagnosis.