Treatment of distal subungual onychomycosis with a topical preparation of urea, propylene glycol and lactic acid: results of a 24-week, double-blind, placebo-controlled study.

Onychomycosis is difficult to cure as this requires eradication of the primary infection and protection of new areas of growth from reinfection. A new topical treatment (K101) has been developed. The aim of this study was to assess the efficacy, safety and tolerability of K101 treatment of distal subungual onychomycosis. This was a 24-week (plus 2-week washout), multicentre, randomised, double-blind, placebo-controlled study in 493 patients with distal subungual onychomycosis (K101, n = 346; placebo, n = 147), stratified according to degree of nail involvement. More patients with ≤50% nail involvement achieved the primary endpoint (mycological cure after 26 weeks) in the K101 group (27.2%) than placebo (10.4%; P = 0.0012). Proportions for patients with 51-75% involvement were 19.1% for K101 and 7.0% for placebo (not significant). More patients applying K101 than placebo judged that their condition had improved from week 2 (P = 0.0148) to week 24 (P = 0.0004). No safety issues were identified. K101 provides early visible improvements in nail appearance and a clinically meaningful antifungal activity.

Multiple basal cell carcinoma. A clinical evaluation of risk factors.

Basal cell carcinoma (BCC) is the most common malignant skin tumour. There is evidence that the number of patients who develop more than one basal cell carcinoma (mBCC) is increasing. The aim of this study was to elucidate possible risk factors for developing mBCC. Among twelve risk factors considered, skin tumour among relatives was the strongest, with an odds ratio of 10.9 (p < 0.001). The second strongest risk factor was sunburn after the age of 60, odds ratio 4.4 (p < 0.001). The results suggest that the presence of skin tumour in the family and sunburn after age 60 are independent factors associated with mBCC. To our knowledge this has not previously been reported.

Double-blind, parallel-group comparison of terbinafine and griseofulvin in the treatment of toenail onychomycosis.

BACKGROUND: Griseofulvin has been used in the treatment of toenail onychomycosis with limited success. Evidence suggests that terbinafine may be more effective. OBJECTIVE: In a double-blind, parallel-group study we compared 250 mg/day terbinafine for 16 weeks with 500 mg/day griseofulvin for 52 weeks (or for shorter periods in cured patients) in patients with toenail onychomycosis. METHODS: Eighty-nine patients with culture-proved tinea unguium were included, and 43 in the terbinafine group and 41 in the griseofulvin group were assessable for efficacy. Patients who had not improved after 16 weeks were entered into an open study and were given 250 mg/day terbinafine for 16 weeks with the study code still blinded and were then followed up for 20 weeks. RESULTS: Terbinafine was significantly more effective than griseofulvin, with 42% being completely cured and 84% mycologically cured compared with only 2% with total cure and 45% with mycologic cure in the griseofulvin-treated group. The number of side effects was significantly lower in the terbinafine group (11%) compared with the griseofulvin group (29%). CONCLUSION: Terbinafine is significantly more effective than griseofulvin in the treatment of toenail onychomycosis.

Juvenile pemphigus vulgaris.

Pemphigus vulgaris is extremely rare in childhood. Only 35 cases of juvenile pemphigus vulgaris have been reported in the literature up until to now. During the pre-steroid era, the outcome of the disease was usually regarded as fatal. Today, the prognosis has improved because of the possibility of early diagnosis by immunofluorescent techniques, determination of antibodies against epidermal intercellular substance and early therapy with systemic steroids. A case of juvenile pemphigus vulgaris with a favourable outcome in a 13-year old girl is described.

Purified trichophytin: lymphocyte reactivity in vitro and trichophytin-induced suppression.

Three trichophytin preparations from different strains of Trichophyton mentagrophytes were produced according to the ethylene glycol method and assessed for their lymphocyte stimulation activity in vitro (LST). These trichophytin preparations showed significant variations in their effects on cord lymphocytes reactivity. The preparations also varied in their stimulation of lymphocytes from patients with dermatophytosis. Conclusions could be drawn about the immunological specificity, sensitivity and lymphocyte toxicity, which is important for the standardization of antigens. Furthermore, it was demonstrated that trichophytin-preincubated lymphocytes mediated a suppression of lymphocyte reactivity to this antigen.

The histopathogenesis of the flame figure in Wells' syndrome based on five cases.

Characteristics of Wells' syndrome are recurrent episodes of edema and erythema of sudden onset, often covering large areas of the skin. Microscopy shows marked eosinophilia and the presence of so-called flame figures. The flame figures have been considered to be either secondary to aggregates of expelled eosinophilic granules and disintergrating eosinophils, or foci of necrobiotic collagen. Our study indicates that the flame figure is secondary to disintegration of eosinophils and consists of aggregates of eosinophilic granules and nuclear fragments and not of necrobiotic collagen. We consider Wells' syndrome to be a distinctive clinical and histological reaction, which can be triggered by many different, mostly unknown factors.

Ultrastructural studies on experimental hair infections in vitro caused by Trichophyton mentagrophytes and Trichophyton rubrum.

Experimental infections with Trichophyton mentagrophytes and Trichophyton rubrum were performed on human hair in vitro and studied by conventional light microscopy, scanning (SEM) and transmission (TEM) electron microscopy. The penetrations visible by light microscopy in hair infected with T. mentagrophytes appeared at SEM as disrupted surface areas with perforating holes. T. rubrum-infected hair displayed minute perforations and less conspicuous cuticular damages seen at SEM and TEM. In both organisms multiple tiny perforating holes were observed at SEM previously unnoticed in experimental hair infections. From a morphological point of view the differences between the fungi investigated in this experimental system seem to be more of a quantitative nature than involving different mechanisms of action.

An immunohistochemical staining of epidermal Langerhans' cells in tinea cruris.

Epidermal Langerhans' cells (LC) were investigated in fresh cryostat sections of ten biopsies from patients with mycologically proven tinea cruris, using OKT6 monoclonal antibodies and avidin-biotin-immunoperoxidase. Compared to the controls, more epidermal LC and an increased number of LC in the upper half of the epidermis were found in the sections from tinea patients. In a double staining method for both OKT6-positivity and hyphae, a tendency towards a gathering of LC and fungal elements was found. The results of this study are in agreement with the theory that epidermal LC are responsible for the antigen uptake in dermatophytosis.

Brittle hair in osteogenesis imperfecta: transmission and scanning electron microscopy and mycologic assay.

The brittle hair fibres from a case of osteogenesis imperfecta were studied by scanning and transmission electron microscopy. Normal hair fibres are extremely difficult to infect with T. mentagrophytes. As a tentative assay for biochemical defects of hair fibres, experimental dermatophytic infection of the hair with T. mentagrophytes was performed. The massive growth induced suggested that the experimental fungal infection may indeed indicate a biochemical defect in the hairs from our case of osteogenesis imperfecta.