Efficacy of erythromycin for psoriasis vulgaris.

Psoriasis is characterised by the presence of neutrophil overactivation and overproduction of interleukin (IL)-6 and IL-8 from keratinocytes. It is now clear that macrolide antibiotics have anti-inflammatory effects, such as inhibition of IL-6, IL-8 and tumour necrosis factor-alpha, perhaps by suppressing the transcription factor nuclear factor-kappaB or activator protein-1, and reduction of neutrophil activity. It is thus possible that macrolides might be a candidate for adjunctive treatment of psoriasis. In this study, we investigated the effectiveness of treatment with the macrolide antibiotic, erythromycin, for skin lesions and pruritus of patients with psoriasis. In total, 60 patients with psoriasis, especially pruritic psoriasis, were included. This was an open-label study and the analysis was on an intention-to-treat basis. Oral macrolide antibiotics and topical corticosteroids were given to the study group of 36 patients. The control group (24 patients) were treated only with topical corticosteroids. After a 4-week treatment period, scores on the Psoriasis Area and Severity Index (PASI) at baseline and at the end of the treatment, and the effectiveness in reducing itching were compared within and between both groups. Although there was no statistically significant difference between the baseline mean PASI of the two groups (P=0.81), there was a statistically significant difference between the mean PASI of the two groups at the end of the treatment (P=0.023, 95% confidence interval: - 3.45 to - 0.27). The comparison of the mean difference in PASI yielded a statistically significant difference (P=0.03, 95% confidence interval 0.73-3.55). Our study suggests that macrolides could be used as one of the adjunctive therapies for psoriasis vulgaris.

Penile pyoderma gangrenosum.

Pyoderma gangrenosum is a rare ulcerating inflammatory skin disease. Genital involvement has been rarely reported. We report a 24-year-old man with penile pyoderma gangrenosum who was treated with systemic corticosteroids.

Protein C and protein S activities in Behçet's disease as risk factors of thrombosis.

BACKGROUND: In Behçet's disease (BD), there is a marked increase in vascular complications. Approximately 30% of patients with BD suffer from thrombosis of the arteries and veins, varices, aneurysms, and thrombophlebitis of superficial or deep veins. Protein C and Protein S are major inhibitors of coagulation, and it is well known that the deficiency of Protein C and Protein S causes thrombotic disorders. METHODS: Protein C and Protein S activities were measured in 23 patients with BD and in a control group consisting of 23 age- and sex-matched healthy volunteers. Patients who had received anticoagulant or oral contraceptive drugs, or who had liver disease or active thrombosis, were not included in the study. RESULTS: Of the 23 patients with BD (age, 13-55 years), the mean Protein S activities (94.2 +/- 11.3%) were slightly lower than the means of the control group (109.1 +/- 8.4%), but not statistically significant differences could be demonstrated (p > 0.05). Compared with the means of the control group (103.5 +/- 6.9%), the Protein C activities were not lower in BD (106.3 +/- 8.4%). No statistical difference was determined. CONCLUSIONS: Protein C and Protein S deficiencies are not a probable cause of thrombotic manifestations in BD. We do not recommend the measurement of these activities routinely in BD unless thrombosis is the major and primary manifestation of BD.

Itraconazole therapy in lymphocutaneous sporotrichosis: a case report and review of the literature.

A 24-year-old white man had a six-month history of nontender nodules on the dorsal aspect of the right hand. The lesions were diagnosed as lymphocutaneous sporotrichosis based on clinical appearance, histopathologic examinations, and fungal culture. Therapy with itraconazole was started. Considerable improvement was recorded after two months, when all of the lesions diminished in size and were no longer nodular in appearance.