A combination therapy of calcipotriol cream and PUVA reduces the UVA dose and improves the response of psoriasis vulgaris.

BACKGROUND: The addition of calcipotriol ointment to PUVA therapy for psoriasis vulgaris results in a lower total UVA dose and a faster onset of response. The addition of calcipotriol cream to PUVA, however, has not been studied. OBJECTIVE: To investigate whether combining calcipotriol cream with PUVA therapy has a UVA sparing effect. METHODS: We performed a randomized, multicentre, vehicle-controlled, double-blind, 12-week comparative study including 120 patients with psoriasis covering 20-50% body surface area. The study consisted of a washout phase followed by a 10-week treatment phase. PUVA therapy three times weekly was added within 1 week after randomization. Efficacy was assessed by the Psoriasis Area and Severity Index (PASI). RESULTS: At baseline the mean PASI scores were 17.5 and 19.2 in the calcipotriol and vehicle (placebo) groups, respectively. At the end of treatment, the mean PASI scores were 2.65 and 7.03 (p<0.01), respectively. A reduction in PASI score >90% was observed in 69% of the patients in the calcipotriol-treated group and in 36.4% of the patients in the vehicle group (p<0.01). CONCLUSION: Calcipotriol cream plus PUVA clearly reduces the cumulative dose of UVA and improves the response of psoriasis vulgaris to PUVA.

Evaluation of clinical efficacy and safety of adapalene 0.1% gel versus tretinoin 0.025% gel in the treatment of acne vulgaris, with particular reference to the onset of action and impact on quality of life.

A randomized, multicentre, investigator-masked study was conducted in 105 patients with mild to moderate acne vulgaris to compare the efficacy and safety of adapalene 0.1% gel with tretinoin 0.025% gel after three months of treatment, with particular emphasis on reduction in inflammatory lesion counts after one week of treatment and impact on quality of life. In terms of efficacy, adapalene gel was found to be superior to tretinoin gel after one week of treatment, with respect to reduction in inflammatory lesion counts (32% vs. 17%, respectively; P = 0.001), total lesion counts (28% vs. 22%, respectively; P = 0.042) and global severity grade (28% vs. 16%, respectively; P = 0.001). No significant difference between the two treatments was found after 12 weeks of treatment for any of these variables. Evaluation of facial skin tolerance parameters showed significant differences between the two treatments in favour of adapalene for dryness, erythema, immediate and persistent burning and pruritus for at least one time point. One patient in the adapalene group and three patients in the tretinoin group experienced medical events which lead to discontinuation of treatment (skin irritation; NS). Quality of life scores improved more rapidly in the adapalene group than in the tretinoin group, with significant differences (P < 0.05) appearing at week 1 for questions related to problems with partners, close friends or relatives and to skin symptoms. There was also a significantly greater improvement in social and leisure activity in the adapalene group at week 12. Adapalene 0.1% gel reduced inflammatory and total lesion counts more rapidly than tretinoin 0.025% gel, and was also better tolerated. These differences appear to result in an earlier and greater quality of life improvement for the patients receiving adapalene.

Green hair.

Green hair is an unusual dermatologic condition usually due to the deposition of copper from exogenous sources. We report the cases of two patients who presented to our clinic with green discoloration of their hair. This pigmentation of hair has generally been reported in patients with blond hair as a consequence of increased concentrations of copper in domestic or swimming pool water. Although an increased copper content of the affected hair seems to be a prerequisite, other predisposing factors have to be present for this situation to occur. These include previous hair damage (mechanical, sun exposure, bleaching, dyeing, waving), frequent contact with chlorinated water, or use of alkaline shampoos. Several options for treatment have been described for this problem, including application of hot vegetable oil, hydrogen peroxide, edetic acid- or D-penicillamine-containing shampoos, or hydroxyethyl diphosphonic acid.

[Multiple familial trichodiscoma]. / Tricodiscomas múltiples familiares.

Trichodiscomas are hamartomas of the pilar apparatus, and have been described alone or associated to other benign proliferations of the pilar complex. Two familial cases of trichodiscomas not associated to pilar alterations or systemic manifestations are described.

Embolismo por cristais de colesterol / Embolism by cholesterol crystals

Os autores apresentam um caso de embolia cutânea por cristais de colesterol. Após revisäo da literatura discutem sua paratogênese, clínica, histopatologia e prognóstico; sugerem que em caso de aparecimento súbito de livedo reticular, o diagnóstico da embolia cutânea por cristais de colesterol deve ser cogitado

Cutaneous malakoplakia. Report of a case.

A case of cutaneous malakoplakia in a 44-year-old women under immunosuppressive therapy after renal transplantation for nephrosclerosis is reported. A nodular lesion with inflammatory signs appeared on her right buttock. Histopathology showed a dermal infiltrate with histiocytes containing Michaelis-Gutmann bodies. Electron microscopy showed Michaelis-Gutmann bodies with concentric laminar structure ('target' appearance). Tissue culture revealed Escherichia coli growth. Lesions recurred on surrounding skin and left buttock after excision. Clofazimine treatment resulted in total remission.

[Primary nodular amyloidosis of the tongue]. / Amiloidosis nodular primaria de la lengua.

Two cases of nodular primary amyloidosis of the tongue are reported. A review of the literature is made.

[Localized cutaneous infantile myofibromatosis. Apropos of a congenital self-limiting case]. / Miofibromatosis infantil cutánea localizada. A propósito de un caso congénito autorresolutivo.

A case of a 8 year girl presenting a congenital tumoral lesion of the lumbar region is reported. Histologically a hamartomatous fibromatosis was found. A review of the literature was made. The final diagnosis was solitary infantile myofibromatosis, cutaneous type (peculiar form of congenital generalized fibromatosis, also named infantile myofibromatosis). Probably this variety is less rare than thought, because biopsies of apparently benign superficial lesions on children are not usually performed.

[PUVA therapy: long-term degenerative effects. I. Histological changes observed after PUVA therapy]. / PUVA terapia: efectos degenerativos a largo plazo. I. Alteraciones histológicas observadas después de la PUVA terapia.

The authors studied PUVA induced histological alterations in a group of 7 patients compared with 6 control subjects of same age. The epidermal alterations were unprominent: a few necrotic keratinocytes and hyperpigmentation of basal layer melanocytes with a lentiginous pattern. Basement PAS positive membrane was in some cases desestructured, but this was reversible. In the papillary dermis there was homogenization and partial or total destruction of orceinophilic vertical fibers, these phenomena were also reversible. PUVA therapy induced aging of the skin which is dose related and depends also of the patients age. No phenomena of precancerous dysplasia were observed.

[Pre-remission syndrome in flat warts. Report of 2 cases]. / Síndrome de preextinción de las verrugas planas. Aportación de dos casos.

Two cases of flat warts spontaneous regression syndrome are reported, with description of the histopathologic features. Immunologic mechanism which intervene in the processus are reviewed.

[PUVA therapy: long-term degenerative effects. II. Study of ultrastructural changes in the skin induced by PUVA therapy]. / PUVA terapia: efectos degenerativos a largo plazo. II. Estudio de las alteraciones ultraestructurales ocasionadas por la PUVA terapia en la piel.

The authors studied PUVA induced ultrastructural alterations in a group of 7 patients compared with 6 control subjects of same age. Hyperactivity of melanocytes was observed in all patients. Elastic fibers showed vacuolisation age and dose related. There was a reduplication of the basal layer of dermal capillaries and increased pinocytosis of endothelial cells, age and dose related also. The authors conclude that PUVA therapy induced alterations are degenerative; the target is located in deep dermis (capillaries and elastic fibers). No alterations of keratinocytes nor precancerous epithelial dysplasia was found. This confirms that UVA radiation is less aggressive for keratinocytes than UVB.