Treatment of tinea cruris with topical terbinafine.

Twenty-three patients were enrolled in a randomized, double-blind trial of terbinafine 1% cream versus its vehicle (placebo) in the treatment of tinea cruris. One patient had a negative initial culture and was excluded, and two patients were dropouts, one because of poor study compliance (terbinafine) and one because of an adverse event (placebo). Twenty patients were examined for efficacy of treatment (9 terbinafine-treated, 11 placebo-treated). Both groups were similar in age, sex, duration of disease, prior therapy, size and location of lesion, infecting organism, and predisposing factors. Terbinafine 1% cream was more effective than vehicle cream in the reduction of the signs and symptoms of tinea cruris. In addition, there was a higher conversion rate to negative culture and normal microscopy findings in the terbinafine-treated group. Clinical results combined with evaluation of mycologic tests at end of therapy showed terbinafine to be a rapid and significantly more effective treatment for tinea cruris than placebo (78% vs 18% cure rate, respectively). Follow-up cure rates confirmed these findings (89% and 18%, respectively). No significant adverse events occurred during terbinafine treatment.

Immunoenzyme techniques in dermatopathology.

The advantages and disadvantages of the immunofluorescence and immunoperoxidase techniques and an introductory description of the major variations of the basic immunoperoxidase method are discussed. The ability to identify intermediate filaments, T and B lymphocyte cell markers, S-100 proteins, myelin basic protein, and carcinoembryonic antigen in tissue sections can assist the dermatopathologist in classifying undifferentiated or histologically similar-appearing tumors. A systematic approach to the diagnosis of a majority of these tumors with the use of immunoenzyme staining is provided.

Comparative trial of a two-dosage schedule of ketoconazole 2% cream for the treatment of tinea pedis.

Sixty-two patients with mycologically confirmed tinea pedis received two different treatment regimens of ketoconazole 2% cream on a randomized double-blind basis for 1 month with weekly evaluations. A 4-week posttreatment follow-up permitted an assessment of recurrence or improvement. After 1 month of treatment, 90% of the patients treated once daily responded clinically, in comparison with 83% of those treated twice daily. The cure rate was 63% for the once-daily and 60% for the twice-daily group. This rate substantially improved at follow-up (77% and 73%, respectively). One patient from each group discontinued therapy for an adverse reaction. On the basis of both clinical and mycologic assessments, topical treatment with ketoconazole 2% cream was effective as a once-daily therapy.

A multicenter double-blind evaluation of ketoconazole in the treatment of dermatomycoses.

A multicenter double-blind study was conducted on the use of ketoconazole and griseofulvin for the treatment of dermatomycoses. Of one hundred thirty cases (one hundred twenty-seven patients) for which efficacy data were available, sixty-six were treated with a single daily dose of 200 mg ketoconazole, and sixty-four were treated with a single daily dose of 250 mg griseofulvin for periods of two to sixteen weeks. The proportion of remissions observed with ketoconazole (61 percent) was significantly greater (p = 0.02) than that observed with griseofulvin (39 percent). The proportion of relapses within two months was significantly less (p less than 0.01) in the ketoconazole group (9 percent) than in the griseofulvin group (43 percent). The frequency and severity of side effects were comparable in the two groups.

Melanoma in the dermatologist's office.

Data about melanomas seen in a private dermatologist's office during a fifteen year period were evaluated as to size, location, stage, and histologic level of the lesions, and sex and survival of the patients. Forty-three melanomas were seen in forty-one patients. Only four patients (9 percent) died as a result of their melanomas. All patients were at clinical stage 1 of the disease. Thirty-two lesions were smaller than 1.6 cm. Twenty-four (56 percent) of the lesions were of the superficial spreading type. Apparently, patients with melanomas seek advice at a dermatologist's office when their disease is at an earlier stage of development than do patients generally seen in other types of medical settings. A plea is made to examine patients yearly for pigmented lesions. The number of melanomas seen per 10,000 patient-visits rose during the fifteen year period.

Fixed drug eruptions to tetracyclines.

We observed 11 cases of fixed drug eruption to tetracyclines. Two cases were in a mother and her adult son, and two patients experienced fading of their lesions while continuing to take 1 g of the drug per day. Several patients were cross-reactive to different salts.

Collagen disease in children. A review of 71 cases.

Seventy-one children with the diagnosis of systemic lupus erythematosus (SLE) (39 cases), dermatomyositis (25 cases), or scleroderma (7 cases) were studied retrospectively. The children with SLE were much sicker than those with the other two diseases and were found to have a poorer prognosis than adults with SLE. In general, the earlier the age of onset, the poorer the prognosis. Early gastrointestinal bleeding, abnormal renal findings, and cardiac abnormalities heralded early death from SLE. The peak incidence of SLE near the time of puberty suggests hormonal influence on this disorder in children. Survival rates and morbidity improved as the treatment improved. Corticosteroids were the main therapeutic agents. The patients with scleroderma also received varying doses of vitamin E, penicillamine, chloroquine hydrochloride, and salicylates. The antimetabolites were used to treat SLE starting in the late 1960s.

Hormonal dependency in Darier disease.

Variation in the severity of keratosis follicularis relative to states of homonal change was noted in eight women with the disease. Observations included frequent onset near puberty, puberty, exacerbation during menses, and improvement while patients are pregnant or on oral contraceptive agents. It is proposed that states of relative estrogen excess are associated with quiescence of this skin disorder. In support of this hypothesis, three postpubertal women with Darier desease were observed to undergo significant improvement with the use of estrogen-dominant birth control pills.

PIP: 8 women with keratosis follicularis (Darier disease) were studied. The severity of the disorder varied in relation to changes in the subjects' hormonal status. The condition often 1st manifested itself near the onset of puberty and continued without interruption for many years. Menstruation aggravated the disorder. Treatment of 3 patients with estrogen-dominant oral contraceptives markedly improved the condition. The findings suggest that states of relative estrogen excess ameliorate keratosis follicularis.

Norwegian scabies: occurrence in a patient undergoing immunosuppression.

Norwegian scabies is rare yet distinctive. The majority of reported cases have been in patients with relatively small group of diseases, including Down syndrome and lepromatous leprosy. A case occurred in a patient on long-term immunosuppressive therapy following a kidney transplant. Altered host factors appear to be the prime determinants in the pathogenesis of the disease.