Imiquimod 5% cream is a safe and effective self-applied treatment for anogenital warts--results of an open-label, multicentre Phase IIIB trial.

Our objective was to determine the efficacy and safety of imiquimod 5% cream in the treatment of external genital/perianal warts in an open-label Phase IIIB trial. Patients applied imiquimod 5% cream 3 times per week, for up to 16 weeks. Those who cleared their warts were monitored during a 6-month follow-up period. If their warts recurred, or new warts developed during this time, patients could be re-treated for up to 16 additional weeks. Patients who experienced partial clearance during the initial treatment period entered an extended treatment period of up to an additional 16 weeks. A total of 943 patients from 114 clinic sites in 20 countries participated in this study. Complete clinical clearance was observed in 451/943 (47.8%) patients (intent-to-treat (ITT) analysis) during the initial treatment period, with clearance in an additional 52 (5.5%) patients during the extended treatment period beyond 16 weeks. The overall clearance rate for the combined treatment periods was 53.3%. In a treatment failure analysis, the overall clearance rate was 65.5%; a greater proportion of female patients (75.5%) experienced complete clearance than male patients (56.9%). Low recurrence rates, of 8.8% and 23.0%, were observed at the end of the 3- and 6-month follow-up periods, respectively. The sustained clearance rates (patients who cleared during treatment and remained clear at the end of the follow-up period) after 3 and 6 months were 41.6% and 33.0% (ITT analysis), respectively. Local erythema occurred in 67% of patients. In the majority of patients local skin reactions were of mild to moderate severity. In conclusion, imiquimod 5% cream is an effective self-applied treatment for external genital/perianal warts when applied for up to 16 weeks and is well tolerated for up to 32 weeks.

[Skin diseases among refugees and immigrants. Four exotic case reports]. / Hudsygdomme hos flygtninge og indvandrere. Fire eksotiske eksempler.

The influx of immigrants from outside the Western world, has led to a wider spectrum of dermatological diseases seen by doctors in Denmark. We present four case histories, in which the disease was brought to Denmark from the patient's land of origin. Tropical diseases may present as a skin disease as such, or a generalised disease with skin manifestations, the commonest signs being ulcers, papules, exanthema, changes in pigmentation, and itching.

[Drug-induced exanthemas]. / Medikamentelle eksantemer.

This article briefly reviews potential mucocutaneous adverse reactions to medicaments, with special attention to the commonest used drugs in Denmark. More than 70 different adverse events are associated with the intake of various drugs, which means that, irrespective of the presentation and morphology of the exanthema, a drug-induced eruption should always be considered a possibility.

The dermatoscopic ABCD rule does not improve diagnostic accuracy of malignant melanoma.

The dermatoscopic ABCD rule has been suggested to improve diagnostic performance regarding cutaneous malignant melanoma. Using this rule, a total dermatoscopy score is calculated from the presence of various dermatoscopic elements. A total dermatoscopy score above 4.75 signifies possible and 5.45 probable melanoma. We compared the diagnostic accuracy of dermatoscopy with and without the use of the ABCD rule. Furthermore, receiver operating characteristic analysis was performed for the ABCD rule. The area under the receiver operating characteristic curve was 0.854 (range 0.777-0.906) demonstrating that in 85.4% of the cases, cutaneous malignant melanomas were rated higher than the non-melanoma skin lesions. Sensitivity for the melanoma diagnosis was higher for simple dermatoscopy than when the ABCD rule was used (p<0.05). There was no difference in specificity when a total dermatoscopy score of 4.75 was used as cut-off point, but specificity was lower for simple dermatoscopy than when the total dermatoscopy score of 5.45 was used. Diagnostic accuracy was higher for simple dermatoscopy than for the ABCD rule (p<0.01). In conclusion, the dermatoscopic ABCD rule was not superior to simple dermatoscopy, and fewer malignant melanomas were identified with this rule.

Direct or referral microscopy of vaginal wet smear for bacterial vaginosis: experience from an STD clinic.

A new wet smear diagnostic criterion for bacterial vaginosis was applied to 124 consecutive female patients attending an STD clinic located in the centre of Copenhagen. Bacterial vaginosis was detected in 54 (44%) women, making bacterial vaginosis the most prevalent pathological condition encountered. A total of 47 (87%) of the women were symptomatic. Concomitant genital infections were found in 13 (24%) of these women, most often as vulvo-vaginal candidiasis. A correct microscopic diagnosis could also be obtained by sending the vaginal smear to the local microbiologist for rehydration and phase contrast microscopy. It is suggested that the previously described vaginal wet smear criteria are used in place of Amsel's criteria for routine diagnosis of bacterial vaginosis.

[Dementia paralytica is still seen in Denmark]. / Dementia paralytica forekommer stadig i Danmark.

Two cases of neurosyphilis are presented. Both patients had developed a paranoid psychosis and needed admission to a psychiatric department. In both cases relevant treatment resulted in improvement of both the dementia and the psychotic condition, though the patients were left with some degree of dementia at follow up. Both patients had a symptom-free interval lasting several years. It still remains important to take WR, when investigating the cause of dementia, and when dealing with patients admitted to neurological and psychiatric departments with an uncertain diagnosis.

Clinical and dermatoscopic diagnosis of malignant melanoma. Assessed by expert and non-expert groups.

We investigated the nosographic and diagnostic probabilities and likelihood ratios of dermatoscopy in order to evaluate the method's role in decision-making regarding melanoma. Clinical slides and dermatoscopic photos were obtained from 232 patients referred for dermatoscopy. Four dermatoscopy "experts" and 5 "non-experts" assessed the slides. Diagnoses were compared with histopathology. Sensitivity of the clinical assessments was 0.78 vs. 0.69 ("experts" vs. "non-experts"), sensitivity of dermatoscopy assessment was 0.83 vs. 0.69 (p = 0.04). The expert group demonstrated increased specificity (from 0.89 to 0.94) when applying dermatoscopy compared with clinical assessment alone (p=0.03). Positive likelihood ratios were doubled in the "expert group" and the negative likelihood ratios improved 25% with dermatoscopy compared with clinical assessment.

[Investigation of malignant melanoma in an "open house" setting]. / Undersøgelse for malignt melanom ved et "åbent hus"-arrangement.

Individuals with a self-evaluated risk of malignant melanoma were invited to an "open house" where trained dermatologists examined suspected lesions. The attendants filled in a short questionnaire relating to skin cancer risk factors. Persons with skin changes suspected for malignancy were referred for excision in the dermatological department. The clinical evaluation included dermatoscopy. Nine hundred and eleven individuals attended. Among 16 individuals referred for excision one malignant melanoma, one lentigo maligna melanoma and two in situ melanomas were histologically verified. Furthermore, 21 basal cell carcinomas were identified clinically. The most frequent clinical diagnoses were melanocytic naevi and seborrhoic keratoses.