Photoprotection by sunscreens.

Ultraviolet (UV) radiation is an etiologic factor for the development of nonmelanoma skin cancers and also possibly melanoma. The American Academy of Dermatology currently recommends the daily use of sunscreens with a sun protection factor (SPF) of 15 or above. The SPF numerical rating is an in vivo, standardized measure of sunscreen efficacy. SPF assessment predominantly reflects the ability of a product to screen UVB radiation. The physical and biologic properties of UVA radiation are relevant as UVA contributes to photoimmunosuppression and photocarcinogenesis. An ideal sunscreen assessment system would address both UVB and UVA protection. However, the SPF rating should continue to serve as the major determinant of sunscreen efficacy.

Ulcerating plantar keratoderma in association with systemic lupus erythematosus.

This report highlights the finding of ulcerative plantar keratoderma in two patients with systemic lupus erythematosus (SLE). Both patients suffered from painful plantar ulcerations and fissures; in one patient there was diffuse desquamation over the entire plantar surface, while the other patient's lesions were focal and accentuated over weight-bearing surfaces. Other etiologies for keratoderma including papulosquamoua disease, contact dermatitis, tinea and primary keratodermas were excluded. Both patients were resistant to multiple topical therapies including super-potent topical corticosteroids, vitamin D analogues and retinoids, but did report moderate relief with hydrocolloid dressings applied over super-potent topical corticosteroids and pressure off-loading measures. Lupus-associated keratoderma can be recurrent and recalcitrant to treatment, often necessitating aggressive therapy and particular attention to advanced wound care methodologies. While not a specific cutaneous sign of lupus, it should be recognized as a cause for considerable morbidity.

Lupus profundus: not a benign disease.

Lupus profundus is an unusual clinical variant of cutaneous lupus erythematosus that has previously been described as a benign disease that follows a mild course. This report describes the extent of disease and associated comorbidities in patients with severe lupus profundus and systemic lupus erythematosus. Four cases of lupus profundus are reviewed and their associated systemic disease complications are highlighted. All four patients fulfilled at least four of the 11 criteria for systemic lupus erythematosus. One patient suffered from severe facial disfigurement and Parry-Romberg syndrome. Two patients developed nonhealing ulcers on the scalp. All four patients had scarring alopecia as well as depressed areas over large areas of their body surfaces. All patients were resistant to conservative therapy, and required long-term aggressive therapy. Clinical depression secondary to disfigurement was a major problem in three patients. Extensive lupus profundus may be associated with more serious systemic disease and warrants aggressive treatment early on to prevent permanent disfigurement and its resultant psychological consequences.

Narrow-band ultraviolet B is a useful and well-tolerated treatment for vitiligo.

BACKGROUND: The treatment of vitiligo remains a challenge. OBJECTIVE: The purpose of this article is to review our results and experience with narrow-band ultraviolet (UV) B phototherapy for vitiligo. METHODS: This is a retrospective analysis of our experience and results with patients with vitiligo who were treated with narrow-band UVB between November 1998 and November 1999. Narrow-band UVB phototherapy was given as monotherapy 3 times a week. The starting dose was 280 mJ/cm(2), with 15% dose increments at each subsequent treatment. RESULTS: Seven patients were able to be evaluated for the purposes of this analysis. Their ages ranged from 19 to 59 years (mean, 37.6 years). Three patients had Fitzpatrick skin phototype IV and V, and 4 had phototypes II and III. Five of the 7 patients achieved more than 75% repigmentation with a mean of 19 treatments; the mean duration of disease was 13 months. The remaining two patients had 50% and 40% repigmentation after 46 and 48 treatments, respectively. Their mean duration of disease was 132 months. Adverse effects were mild erythema and pruritus. CONCLUSION: This treatment protocol resulted in rapid repigmentation in many patients, including those with skin phototypes IV and V. In accordance with previous studies, this report indicates that narrow-band UVB is a useful and well-tolerated therapy for vitiligo.

Diltiazem-associated photodistributed hyperpigmentation: a review of 4 cases.

BACKGROUND: Diltiazem hydrochloride is a widely used calcium channel blocking agent. While a few cases of diltiazem-associated photosensitivity have been reported, no cases of photodistributed hyperpigmentation are known. OBSERVATION: Four cases of photodistributed hyperpigmentation associated with the long-acting formulation of diltiazem hydrochloride (Cardizem CD) are presented. All patients were African American women, with a mean age of 62 years. The mean duration of diltiazem administration prior to the development of hyperpigmentation was 8 months. The hyperpigmentation was slate-gray and reticulated. Phototesting during diltiazem therapy revealed a decreased minimal erythema dose to UV-A in 1 patient. Histopathologic examination showed lichenoid dermatitis with prominent pigmentary incontinence. Electron microscopic examination of the tissue revealed multiple melanosome complexes. Discontinuation of diltiazem therapy resulted in the gradual resolution of the hyperpigmentation. CONCLUSIONS: Long-term administration of diltiazem may be associated with characteristic reticulated, slate-gray hyperpigmentation on sun-exposed areas. Discontinuation of the therapy results in resolution of the eruption.