Comparison of single dose 400 mg versus 10-day 200 mg daily dose ketoconazole in the treatment of tinea versicolor.

One hundred and twenty patients were entered into a randomized controlled trial comparing a 400 mg single dose of ketoconazole with a 10-day 200 mg daily dose. The trial was carried out to determine (i) whether the single dose regimen may be effective in tropical conditions such as exist in the Philippines where the relative humidity ranges from 74% to 77% at temperatures of 69-73 degrees F, and (ii) whether a 400 mg single dose of ketoconazole is as effective as the standard 10-day 200 mg daily dose. The patients had a moderate degree of infection (25%-50% body surface area using the rule of nines), confirmed by both KOH and Wood's light examinations. They had no topical treatment for 2 weeks and no systemic antifungal intake for at least 1 month prior to the study. Pregnant patients and patients with a history of liver disease were excluded from the study. One hundred and twenty patients were given either Regimen A (two 200 mg tablets as a single dose) or Regimen B (one 200 mg tablet daily for 10 days). Follow-ups were carried out 10 days and 1 month after completion of each treatment regimen, at which point both KOH and Wood's light examinations were repeated. Mycologic cures were defined as both examinations being negative; treatment failures as either one or both examinations remaining positive. Considering the low doses used and the relative safety record of ketoconazole in previous studies, blood examinations including liver enzyme determinations were deemed unnecessary. Fisher's exact test was used to determine the statistical difference between the two regimens at a level of significance of 0.05.

Survey of skin lesions in the Filipino elderly.

One hundred elderly Filipino patients, aged 60 and over were surveyed to identify past and present skin complaints, and the dermatologic findings on a total cutaneous examination. All patients were consulting at the dermatology clinical of a teaching hospital in the Philippines. The elderly were keen to recall past hypersensitivity reactions because of their dramatic symptoms. The most common dermatologic problem prompting consultation was lichen simplex chronicus. Although the population size was limited, dermatoses in the Filipino elderly were not uncommon, and they were also subject to the stigmata of aging. Similarities and differences to two American surveys are noted.

Additional markers for the type I reactional states of borderline leprosy.

The histological course of reaction in borderline leprosy has been described by Ridley and Radia. They are dermal edema, dilatation of the lymphatics, swelling of the granulomas, changes in the concentration and distribution of lymphocytes and giant cells, maturity of the histiocytes, and presence of neutrophils. New markers for the condition are spongiosis of the epidermal and follicular epithelium with exocytosis of mononuclear cells, parakeratosis, focal interface changes with occasional individual cell necrosis of keratinocytes, and lastly, follicular mucinosis. Recognition of this reaction is vital in the prevention of deformities secondary to nerve damage.

Multiple cutaneous metastases from breast carcinoma.

A case of breast carcinoma presenting as cutaneous metastases on sites other than the anterior chest wall is reported. Multiple nodules, in numbers (reaching 900) not previously reported, were widely distributed, even to the thighs and pelvic region, which are areas not previously reported as sites of cutaneous metastases from breast carcinoma. This patient's case is further characterized by an adenocarcinoma pattern in the presenting skin lesions and a thirty-five months' survival time from the appearance of the cutaneous metastases. We emphasize the need to remove excisional biopsy specimens of unexplained skin nodules. Breast carcinoma is the most common internal malignant primary tumor in women.