Minocycline-induced hyperpigmentation: rapid resolution after 755nm alexandrite picosecond laser treatment.

Minocycline-induced pigmentation (MIP) is an infrequent complication of minocycline therapy, with four subtypes each with distinct clinical features and histologic staining patterns. MIP may resolve following discontinuation of minocycline therapy or it may persist indefinitely. A 64-year-old Caucasian male presented with a 6 month history of progressive blue-gray facial pigmentation distributed symmetrically over his face. One session utilizing a 755 nm picosecond Alexandrite laser resulted in immediate and significant clearance of the pigment in all treated areas. Long-term follow-up at 2 years revealed no recurrence of the MIP.

Systemic Allergic Contact Dermatitis After Formaldehyde-Containing Influenza Vaccination.

BACKGROUND: Systemic contact dermatitis occurs when a patient sensitized to an allergen topically is systemically reexposed to the allergen and develops a cutaneous eruption. OBJECTIVE: To report the case of a 48-year-old male who developed explosive dermatitis following injection of a formaldehyde-containing influenza vaccine and was subsequently shown to be strongly positive to formaldehyde and formaldehyde-releasing allergens by patch testing, as well as to review the literature for similar cases. METHODS: A PubMed search was made using the following search terms: systemic contact dermatitis, formaldehyde, influenza, and vaccine. RESULTS: A review of the literature revealed 2 cases of systemic contact dermatitis from formaldehyde derived from aspartame and 1 case from a thimerosal-containing influenza vaccine. No cases caused by formaldehyde in influenza or other vaccines were found. CONCLUSION: This case highlights the importance of considering systemic allergic contact dermatitis in any patient presenting with dermatitis following injection of a formaldehyde-containing vaccine.

The controversial role of vitamin D in the skin: immunosuppression vs. photoprotection.

Vitamin D is produced in the skin by ultraviolet (UV) B radiation (290-320 nm). The active metabolite 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] is made systemically by hydroxylation of vitamin D in the liver and the kidney, but also locally in the epidermis, which suggests that 1,25(OH)(2)D(3) may have important functions in the skin. 1,25(OH)(2)D(3) has opposing effects: it can mimic immunosuppressive effects caused by UV irradiation in some models, or reverse UV-induced DNA damage and immunosuppression in other models. 1,25(OH)(2)D(3) exerts effects on Langerhans cells that are characteristic of those associated with UV radiation (UVR)-induced suppression of contact hypersensitivity, and topical application of the vitamin D analogue calcipotriene suppresses contact hypersensitivity in human subjects to a similar extent as UVR. However, 1,25(OH)(2)D(3) decreases DNA damage both in vitro when added to human skin cells in culture before and after UVR, and in vivo when applied to mouse skin after UVR. Furthermore, topical 1,25(OH)(2)D(3) applied to mouse skin after UVR reversed the immunosuppressive effect of UVR in a contact hypersensitivity model. This review will discuss the role of 1,25(OH)(2)D(3) as either a mediator of UVR-induced immune suppression or as a photoprotective molecule against UVR-induced DNA damage and immune suppression.

Topically applied 1,25-dihydroxyvitamin D3 enhances the suppressive activity of CD4+CD25+ cells in the draining lymph nodes.

The immunomodulatory effects of vitamin D have been described following chronic oral administration to mice or supplementation of cell cultures with 1,25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3)), the active form of vitamin D. In this study, topically applied 1,25(OH)(2)D(3), enhanced the suppressive capacity of CD4(+)CD25(+) cells from the draining lymph nodes. The effects of topical 1,25(OH)(2)D(3) were compared with those of UVB irradiation, which is the environmental factor required for 1,25(OH)(2)D(3) production in skin. CD4(+) cells from the skin-draining lymph nodes (SDLN) of either 1,25(OH)(2)D(3)-treated or UVB-irradiated mice had reduced capacity to proliferate to Ags presented in vitro, and could suppress Ag-specific immune responses upon adoptive transfer into naive mice. This regulation was lost upon removal of CD4(+)CD25(+) cells. Furthermore, purified CD4(+)CD25(+) cells from the SDLN of 1,25(OH)(2)D(3)-treated or UVB-irradiated mice compared with equal numbers of CD4(+)CD25(+) cells from control mice had increased capacity to suppress immune responses in both in vitro and in vivo assay systems. Following the sensitization of recipient mice with OVA, the proportion of CD4(+)Foxp3(+) cells of donor origin significantly increased in recipients of CD4(+)CD25(+) cells from the SDLN of 1,25(OH)(2)D(3)-treated mice, indicating that these regulatory T cells can expand in vivo with antigenic stimulation. These studies suggest that 1,25(OH)(2)D(3) may be an important mediator by which UVB-irradiation exerts some of its immunomodulatory effects.

Physician perceptions of sexual dysfunction related to benign prostatic hyperplasia (BPH) symptoms and sexual side effects related to BPH medications.

In a large-scale epidemiology study, 50% of aging men reported erectile dysfunction (ED) or ejaculatory dysfunction (EjD), with lower urinary tract symptoms (LUTS) an independent risk factor for each of these conditions. In light of the shift from urologists (UROs) to primary care/internal medicine physicians (PCPs) for the initial management of men with LUTS associated with benign prostatic hyperplasia (BPH), a survey was conducted to assess the perceptions of UROs and PCPs regarding sexual dysfunction (SD) in men with LUTS/BPH and the effects of BPH treatments (alpha(1)-adrenergic receptor antagonists (alpha-blockers) and 5alpha-reductase inhibitors (5ARIs)) on sexual function. The survey was mailed to 7500 UROs and 2500 PCPs, with 1275 (13%) surveys returned (1087 by UROs, 177 by PCPs and 11 by other specialty). Alpha-blocker monotherapy was the most common medication prescribed by both UROs (56%) and PCPs (47%). UROs estimated that 19% of their patients with LUTS/BPH experienced SD owing to their symptoms compared with the estimate of 27% by PCPs. UROs estimated that 19% of their patients experienced SD owing to their BPH medication compared with the PCP estimate of 24%. The incidence of EjD owing to BPH medications estimated by UROs (32%) was higher than that estimated by PCPs (22%); the rate of ED estimated by PCPs (34%) was higher than that estimated by UROs (23%). UROs were more aware than PCPs of the specific sexual side effects caused by alpha-blockers versus 5ARIs. These results suggest that physicians are underestimating the prevalence of SD in men with LUTS/BPH. As men with LUTS/BPH are at increased risk for SD, physicians should be especially cognizant of BPH treatment-related sexual side effects.

Efficacy and safety of alfuzosin 10 mg once daily in the treatment of symptomatic benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common disorder in ageing men. Patients with BPH often present with bothersome irritative and obstructive lower urinary tract symptoms -- urgency, frequency, nocturia, feeling of insufficient bladder emptying and weak or intermittent flow. alpha(1)-Blockers are the most frequently prescribed oral medications for the first-line treatment of the symptoms associated with BPH. Alfuzosin is a uroselective alpha(1)-blocker that relaxes the smooth muscle of the bladder neck and prostate gland to alleviate BPH symptoms. A pooled analysis of three phase III trials confirmed that treatment with alfuzosin 10 mg q.d. significantly improves the peak urinary flow rate and symptom severity compared with placebo treatment. Unlike some other alpha(1)-blockers, alfuzosin 10 mg q.d. is associated with a low incidence of sexual and vasodilatory side effects. Based on the clinical trials reviewed, alfuzosin 10 mg q.d. is an effective and well-tolerated treatment for the urinary symptoms associated with BPH.

GERD management. Strategies recommended for primary care practice.

Primary care physicians are on the front lines in the treatment of gastroesophageal reflux disease. Therefore, they need the most current information available regarding how to achieve the best outcomes possible. Much clinical evidence indicates that when prescribed for initial and maintenance therapy, the proton pump inhibitors are effective for symptom relief and cost-effective in maintaining remission. In this article, Drs Kuritzky and Rodney discuss several step management strategies that could well be "just what the doctor ordered."

Atherosclerotic vascular disease: management of angina in the office setting.

A discussion of primary care issues related to the management of angina in the office setting is warranted because of recent developments. These developments include new pharmacotherapies, recent insights into the pathophysiology of angina, and increased recognition of the role of the diseased endothelium in sequelae of coronary artery disease.