Comparison of the efficacy and safety of 0.1% adapalene gel and 0.025% tretinoin cream in the treatment of childhood acanthosis nigricans.

BACKGROUND: There have been few published randomized controlled trials for the treatment of childhood acanthosis nigricans (AN) to date. OBJECTIVE: To assess the efficacy of topical 0.1% adapalene gel compared to 0.025% tretinoin cream in the treatment of childhood AN. METHODS: An 8-week, randomized, split-neck, comparative study between topical 0.1% adapalene gel and 0.025% tretinoin cream for the treatment of neck hyperpigmentation associated with AN was performed. M index measured by a narrowband reflectance spectrophotometer and both investigator's global evaluation (IGE) and parent's global evaluation (PGE) scales were used to evaluate efficacy. RESULTS: There was no statistically significant difference between 0.1% adapalene gel and 0.025% tretinoin cream in the treatment of AN-associated hyperpigmentation (P = 0.56). Mean differences in M indices between week 0 and week 8 of 0.1% adapalene and 0.025% tretinoin treatment were 24.2 ± 7.9% and 23.8 ± 8.3% improvement, respectively. Regarding treatment efficacy, 90.0% and 85.0% of participants had more than 75% improvement in IGE in 0.1% adapalene and 0.025% tretinoin treatment sides, respectively. In addition, 75.0% and 65.0% of participants had more than 75.0% improvement in PGE in 0.1% adapalene and 0.025% tretinoin treatment sides, respectively. LIMITATIONS: Lack of histopathological evaluations. CONCLUSIONS: We found no significant difference between topical 0.1% adapalene gel and 0.025% tretinoin in the treatment of AN.

The efficacy of topical 0.1% adapalene gel for use in the treatment of childhood acanthosis nigricans: a pilot study.

AIMS: To assess the degree of improvement of neck hyperpigmentation in childhood acanthosis nigricans (AN) after treatment with topical 0.1% adapalene gel and the assessment of localized tissue tolerance to the gel. SUBJECTS AND METHODS: A split comparison study of the hyperpigmentation on the neck was conducted in patients diagnosed with childhood AN. Patients were treated with topical 0.1% adapalene gel for a period of 4 weeks. The skin color of their neck was evaluated at baseline, 2 weeks and 4 weeks using a skin color chart. Skin color ratio (the skin on their necks compared with the skin on their backs) was calculated for all subjects. The investigator's global evaluation (IGE) scale and the parent's global evaluation (PGE) scale were used to assess the efficacy of the patients' treatment at the end of the 4(th) week. RESULTS: The mean skin color ratio of therapeutic side was significantly decreased from the baseline scores, at weeks 2 and 4, respectively (30.1%, 18.3%, and 12.9%, P < 0.001), with marked skin improvement at 60.7% ± 28.5%. The percentage of changes of skin color ratio was consistent with the efficacy evaluations as performed by the IGE and PGE scales. Treatment-related cutaneous irritation was minimal, predominantly in the first 2 weeks of treatment and was shown to be well-tolerated at week 4 following a modification of the treatment regimen. CONCLUSIONS: The study has shown the efficacy of topical 0.1% adapalene gel in the treatment of AN, specifically, in regards to the skin darkening with minimal cutaneous irritation.

Home-made rapid urease test compared with commercial kit for diagnosis of Helicobacter pylori infection.

OBJECTIVE: To evaluate the sensitivity and specificity of home-made rapid urease test compared with commercial kit for diagnosis of Helicobacter pylori infection. MATERIAL AND METHOD: A cross-sectional study of patients who underwent esophagogastro-duodenoscopy from June 2009 to May 2010 was carried out. Gastric biopsy specimens were taken from antrum and body of the stomach for home-made rapid urease testing, commercial kit (hpfast) urease testing, and histological study. RESULTS: One hundred and ninety nine patients were included in the present study. The sensitivity of home-made rapid urease test and hpfast were 40% and 48.5% at 1 hour and 91.4% and 91.4% at 24 hours. The specificity, positive and negative predictive value and accuracy of home-made rapid urease test vs. hpfast were 100% vs. 100%, 100% vs. 100%, 95.5% vs. 95.5% and 96.9% vs. 96.9% respectively. Furthermore 45.3% of home-made rapid urease test and 54. 7% of hpfast showed positive results within 1 hour CONCLUSION: Home-made rapid urease test has good sensitivity and specificity comparable to commercial kit for the diagnosis of H. pylori infection.

Expanding clinical spectrum of non-autoimmune hyperthyroidism due to an activating germline mutation, p.M453T, in the thyrotropin receptor gene.

OBJECTIVE: To describe clinical and genetic features of a Thai family with non-autoimmune hyperthyroidism (NAH) caused by an activating germline mutation in the thyrotropin receptor (TSHR) gene. PATIENTS: Three affected individuals from the same family (a father and his two children) were studied. Clinical and imaging findings were reviewed and compared. GENETIC ANALYSIS: Genomic DNA was extracted from peripheral blood leukocytes and mutation analysis of the entire coding sequence of the TSHR gene was performed in both children and their parents by direct DNA sequencing. RESULTS: A heterozygous germline T to C transition in exon 10 of the TSHR gene (c.1358T-->C) resulting in the substitution of methionine (ATG) by threonine (ACG) at codon 453 (p.M453T) was identified in the father and his two children. They presented with different clinical severity and variable age of onset. In addition to hyperthyroidism, ventriculomegaly and bilateral shortening of the fifth metacarpal bones and the middle phalanges of the fifth fingers were consistently found in all affected individuals. CONCLUSIONS: Ventriculomegaly and bilateral shortening of the fifth metacarpal bones and the middle phalanges of the fifth fingers might be characteristic features of NAH because of an activating TSHR germline mutation. In addition, the shortening of the middle phalanges of the fifth fingers has never been previously described, expanding the phenotypic spectrum of the disease.