A randomized, double-blinded, placebo-controlled trial of pseudocatalase cream and narrowband ultraviolet B in the treatment of vitiligo.

BACKGROUND: Pseudocatalase cream in conjunction with narrowband ultraviolet B (NB-UVB) has previously been reported to result in repigmentation of vitiliginous skin. OBJECTIVES: The purpose of this 24-week, double-blind, placebo-controlled, randomized, single-centre trial was to assess the efficacy of pseudocatalase cream and NB-UVB vs. placebo and NB-UVB for the treatment of vitiligo. METHODS: Patients with active vitiligo on their face and/or hands applied either pseudocatalase cream or placebo to their whole body, twice daily for 24 weeks. NB-UVB therapy was administered three times a week for the duration of the trial. Efficacy was assessed primarily by digital image analysis of photographs. RESULTS: Thirty-two patients were randomized to either the pseudocatalase arm (n = 14) or placebo (n = 18). Between-group analysis did not show a statistically significant improvement in percentage area affected in the pseudocatalase cream group when compared with placebo. However, a statistically significant improvement was found within each group by week 12, which was maintained throughout the study. CONCLUSIONS: NB-UVB treatment is a moderately effective treatment for vitiligo. Pseudocatalase cream does not appear to add any incremental benefit to NB-UVB alone.

Lichenoid reaction to hepatitis B vaccination.

Liver disease is now a well recognized association with lichen planus. Recent reports suggest that the hepatitis viruses may play a central role in this association. The present report describes a case of a lichenoid reaction to hepatitis B vaccination, which has only been rarely documented previously. A 16-year-old male developed a widespread pruritic erythematous eruption 5 weeks after receiving his second dose of hepatitis B vaccine. The eruption evolved to produce strikingly blue macules before spontaneously disappearing. A skin biopsy showed an intense lichenoid reaction. The hepatitis B surface antigen component of the vaccine is probably responsible for this reaction as well as for other rare immunologically mediated reactions to hepatitis B vaccination. These reactions may provide insight into the pathogenesis of the cutaneous features of natural hepatitis B infection.

Merkel cell carcinoma with a desmoplastic portion.

Merkel cell carcinoma of the skin usually has a trabecular, intermediate-cell or small-cell pattern of differentiation. We report the case of a 66-year-old man who developed a progressive multinodular plaque that showed a prominent desmoplastic component on preliminary biopsy. Immunohistochemical and ultrastructural studies and the final surgical specimen confirmed that the tumor was a Merkel cell carcinoma. The presence of desmoplasia may mask the diagnosis of Merkel cell carcinoma.

Recurrent cutaneous erythralgia and arthralgia.

Two cases are reported of Vietnamese men who presented in young adult life with recurrent, painful, erythematous patches (which we have termed "erythralgia") over and adjacent to joints and accompanied by marked constitutional symptoms of malaise and lethargy, arthralgia and in one patient, fever. In the other, from the onset of the disease there were nodules over the bony prominences and in the interphalangeal regions of the fingers. The duration of the disease was over 12 years, the duration of each episode without therapy was one week and the interval between episodes was one to two weeks. In addition the patients showed a raised ESR and peripheral neutrophil leucocytosis of over 70%. There was a rapid response, within hours, to non-steroidal anti-inflammatory agents. Skin biopsies taken at varying stages of the disease episode failed to demonstrate neutrophils thereby failing to satisfy one major criterion of Sweet's Syndrome. Direct immunofluorescence studies were negative. Biopsy of the nodules did not show rheumatoid pathology. The serum rheumatoid factor was negative. Investigations failed to demonstrate any recognised pattern of cutaneous or rheumatologic disease; infections such as borreliosis were excluded. Both patients showed evidence of past hepatitis B infection. As recurrent painful cutaneous erythema is an uncommon phenomenon in dermatology except where the patient is suffering from recurrent cellulitis of the lower limbs, the patients reported here exhibit a pattern of disease not previously described.

Skin reactions to diltiazem.

A survey of Australian dermatologists was conducted into skin reactions observed to diltiazem. These have included: erythema multiforme, subcorneal pustular dermatosis, photosensitive erythroderma, macular exanthem, allergic vasculitis and urticarial vasculitis. The range of clinical and histopathological features are described. A review of the literature is presented. Photosensitive erythroderma and urticarial vasculitis have not, to our knowledge, been reported in the literature previously.

Unilateral facial actinic elastotic plaque--a new clinical variant of actinic elastosis.

The case is reported of an 82-year old woman with a four month history of an erythematous indurated plaque on the left cheek. Light and electron microscopy demonstrated the presence of solar elastosis alone. We believe that this is a new clinical variant of solar elastosis. The spectrum of cutaneous actinic damage is reviewed.