Found on the net / Encontrados en la red

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****** DATA-MÉDICOS **********
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ENCONTRADOS EN LA RED
FOUND ON THE NET
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****** DERMAGIC-EXPRESS No.56 *******
****** 02 JUNIO DE 1.999 ***********
02 JUNE 1.999
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EDITORIAL ESPAÑOL:
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Hola a todos, DERMAGIC con ustedes de nuevo. La semana pasada di un paseíto por la WEB en búsqueda de información dermatológica de interés para todos.

Selecciones estas 28 referencias de los años 97, 98 y 99. Espero las disfruten.

Saludos a todos !!!

Próxima edición: MELANOMA Y VACUNAS,

Dr. José Lapenta R.,,,

EDITORIAL ENGLISH:
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Hello to all, DERMAGIC with you again. Last week I went for a little walk for the WEB in search of dermatológic information of interest for all.

I Select these 28 references of the years 97, 98 and 99. I hope you enjoy it.

Greetings to ALL, !!

Next edition: MELANOMA AND VACCINE

Dr. José Lapenta R.,,,

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DERMAGIC/EXPRESS(56)
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ENCONTRADOS EN LA RED / FOUND ON THE NET
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1.) FDA Approves Lidoderm For Postherpetic Neuralgia Pain
2.) ADA MEETING: Organ Transplant Patients At High Risk For Developing Skin Cancer
3.) Hylaform Approved In Australia For Correction Of Facial Wrinkles, Depressed Scars
4.) Neoral Study Visually Confirms Efficacy In Severe, Recalcitrant, Plaque Psoriasis
5.) FDA Approves Panretin Gel For AIDS-Related Kaposi's Sarcoma
6.) Severe Shingles Pain Relieved With Anti-Convulsant Drug Gabapentin
7.) WORLD AIDS CONFERENCE: Panretin Acts As An Anti-Tumour Agent In Kaposi's Sarcoma Treatment
8.) Famvir Prevents Herpes Outbreaks During Laser Skin Resurfacing
9.) FDA Clears Cryosurgical Treatment For Verruca Plana
10.) Researchers Identify Substance Which Protects Against UV Skin Damage
11.) Erbium-YAG Laser -- The New Wunderkind In Skin Rejuvenation
12.) Ultrapotent Topical Corticosteroid Treatment of Childhood Genital Lichen Sclerosus
13.) The Use of Sucralfate Suspension in the Treatment of Oral and Genital
Ulceration of Behçet Disease A Randomized, Placebo-Controlled, Double-blind Study
14.) Anti--Fodrin Antibodies in Sjögren Syndrome and Lupus Erythematosus
15.) Turbo-PUVA: Dihydroxyacetone-Enhanced Photochemotherapy for Psoriasis A Pilot Study
16.) Systemic Toxicity Following Administration of Sirolimus (Formerly Rapamycin) for Psoriasis
17.) Bullous Systemic Lupus Erythematosus With Autoantibodies Recognizing Multiple Skin Basement Membrane Components, Bullous Pemphigoid Antigen 1, Laminin-5, Laminin-6, and Type VII Collagen
18.) Comparison of Erbium:YAG and Carbon Dioxide Lasers in Resurfacing of Facial Rhytides
19.) The Drug for the Turn of the Millennium?
20.) Association of the Köbner Phenomenon With Disease Activity and Therapeutic Responsiveness in Vitiligo Vulgaris
21.) Vitiligo Antibodies Are Not Directed to Tyrosinase
22.) Efficacy of Erbium:YAG Laser Ablation in Darier Disease and Hailey-Hailey Disease
23.) Pulse Dosing of Thioguanine in Recalcitrant Psoriasis
24.) Why Does Carbon Dioxide Resurfacing Work? A Review
25.) Prognostic factor analysis in mycosis fungoides/Sézary syndrome
26.) Finasteride in the treatment of men with frontal male pattern hair loss
27.) Mycophenolate mofetil: A new therapeutic option in the treatment of blistering autoimmune diseases
28.) A comparison of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea
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1.) FDA Approves Lidoderm For Postherpetic Neuralgia Pain
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CHADDS FORD, PA -- March 22, 1999 -- The United States Food and Drug Administration has approved Endo Pharmaceuticals Inc.'s Lidoderm(R) (lidocaine patch 5%) to treat the pain associated with postherpetic neuralgia (PHN), a complication of shingles (herpes zoster) that affects approximately 200,000 Americans.

Lidoderm, a patch dermal delivery system, is the first FDA-approved product with an indication specifically for the treatment of pain associated with PHN.

Postherpetic neuralgia results from nerve injury or damage during an outbreak of shingles, a reactivation of the herpes zoster virus that causes chicken pox. PHN causes chronic, often excruciating pain that persists for months or even years in the sensory nerves where the shingles eruption occurred. PHN has long been considered a difficult to treat pain condition.

"This product is revolutionary in the treatment of postherpetic neuralgia, a condition that often prevents patients from leading normal lives," said Dr. Bradley Galer, director of clinical studies, Institute for Education and Research in Pain and Palliative Care, and co-director, Nerve Pain Disorders Clinic, Beth Israel Medical Center in New York. "Lidoderm significantly relieves the majority of patients' pain without any serious side effects. In addition, it is unique in its method of treating pain: it is a topical agent that is applied directly to the painful skin and acts locally in the damaged, painful nerves underlying the skin without producing any clinically meaningful blood levels of lidocaine."

Lidoderm is composed of an adhesive material containing 5% lidocaine that is applied to a non-woven polyester felt backing. When applied to intact skin, Lidoderm provides dermal analgesia by the release of lidocaine from the patch into the epidermal and dermal layers of the skin. The patch provides analgesic action, reducing pain at the damaged and dysfunctional nerves, without the complete loss of sensation or numbness. The size of the patch is 10 cm x 14 cm.

Approximately one million patients contract shingles annually in the U.S. Almost all shingles patients experience pain and as many as 20 percent develop long-term pain. The elderly are the most likely to develop PHN -- over half of shingles patients over age 60 and 75 percent of patients over age 70 experience long-term pain.

"The Lidoderm patch is effective and very well tolerated," said Michael Rowbotham, M.D., associate professor, neurology and anesthesia, School of Medicine, University of California, San Francisco. "The elderly population that typically develops postherpetic neuralgia is susceptible to lowered blood pressure, constipation, sleepiness and forgetfulness from some current treatments."

Lidoderm was approved based upon clinical trials of PHN patients comparing treatment with Lidoderm to treatment with placebo patch and no treatment. Trial results demonstrate that Lidoderm performed statistically better than placebo patch or no treatment in terms of pain intensity, daily average pain relief and patient's preference of treatment.

During or immediately after treatment with Lidoderm the skin at the site of treatment may develop erythema or edema or may be the locus of abnormal sensation. These reactions are generally mild and transient. Allergic and anaphylactoid reactions associated with lidocaine, although rare, can occur. Lidoderm should be used with caution in patients with a history of drug sensitivities.

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2.) ADA MEETING: Organ Transplant Patients At High Risk For Developing Skin Cancer
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NEW ORLEANS, LA -- March 22, 1999 -- Each year, more and more people are enjoying a new lease on life with the increase of organ transplant surgeries. But studies find that organ transplant patients are more susceptible to developing skin cancer following surgery and need to take extra precautions to avoid prolonged sun exposure and monitor their skin for any signs of change.

Speaking this weekend at the American Academy of Dermatology's 57th annual meeting in New Orleans, dermatologist Clark Otley, MD, Mayo Clinic, discussed the high occurrence of skin cancer in transplant patients and the need to educate patients on the risk of developing skin cancer following transplant surgery.

"Approximately 35 percent to 70 percent of organ transplant patients develop skin cancer within 20 years following transplant surgery, depending on geographic location," Dr. Otley said. "Even more alarming is that some long-term transplant patients actually die from skin cancer."

While many factors such as ozone depletion, immunosuppression due to heavy doses of post-surgical medication, human papillomavirus (HPV) -- the virus that causes warts -- and a steady rise in melanoma over the years contribute to whether or not an organ transplant patient will develop skin cancer, past sun exposure is one of the main risk factors. Dr. Otley finds that lighter skin patients with a history of sun damage are more susceptible to developing skin cancer following transplant surgery than darker skinned patients.

"Prior sun damage combined with immunosuppression is a recipe for disaster," Dr. Otley said. "We're seeing patients with hundreds of skin cancers developing per year following transplant surgery. This can ruin a person's quality of life."

Although all transplant recipients are at greater risk for developing skin cancer than the general population, skin cancer is more prevalent in heart transplant patients than kidney transplant patients. A study published in the January 1999 issue of the Journal of the American Academy of Dermatology tracking the incidence of skin cancer in Australian heart transplant patients concluded that heart transplant patients traditionally require higher doses of immunosuppression agents compared with other solid organ transplants.

Skin cancer is classified into three categories -- basal cell carcinoma, squamous cell carcinoma and malignant melanoma. While 80 percent of the estimated one million new cases of skin cancer that will be diagnosed in the United States each year will be basal cell carcinoma, research finds that squamous cell carcinoma is much more prevalent in transplant recipients.

"Squamous cell carcinoma poses a significant threat to transplant patients because this type of cancer can metastasise, or spread to other parts of the body and can be quite aggressive in immunosuppressed patients" Dr. Otley explained.

The American Academy of Dermatology estimates that 1,200 people died of squamous cell carcinoma in 1998.

For patients with rampant skin cancer following an organ transplant, chemoprevention, or using chemicals to prevent the growth of new skin cancers, with oral retinoids has proven effective in studies.

"Acetretin, which is actually an oral medication that is effective in treating psoriasis, seems to prevent the growth of new skin cancers in patients that experience an aggressive growth of skin cancers following transplant surgery," Dr. Otley said. "This allows us to try to treat the existing cancers with traditional therapies."

Dr. Otley recommends that transplant patients follow the American Academy of Dermatology's sun protection guidelines, including avoiding outdoor activities between 10 a.m. and 4 p.m. when the sun's rays are the strongest, seeking shade whenever possible, wearing a broad spectrum sunscreen with a Sun Protection Factor (SPF) of at least 15, and wearing sun protective clothing. Dr. Otley advises transplant patients to learn to perform frequent skin self-examinations and report any suspicious changes in moles or new lesions to their dermatologist.

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3.) Hylaform Approved In Australia For Correction Of Facial Wrinkles, Depressed Scars
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RIDGEFIELD, NJ -- March 18, 1999 -- The Australian Therapeutic Goods Administration has approved Biomatrix, Inc.'s Hylaform(R), an injectable treatment for the correction of facial wrinkles and depressed scars.

Hylaform, based on Biomatrix' patented hylan B gel technology, has distinguished itself competitively because of its unique physical properties and because it is made of a polysaccharide molecule (hyaluronan) which is a component of the human body. As a result, Hylaform was the first product of its kind world-wide to be approved for medical use without a skin test.

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4.) Neoral Study Visually Confirms Efficacy In Severe, Recalcitrant, Plaque Psoriasis
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EAST HANOVER, NJ -- March 22, 1999 -- The first study to visually document the efficacy of Novartis Pharmaceuticals Corp.'s Neoral(R) (cyclosporine for microemulsion) in severe, recalcitrant, plaque psoriasis confirms that the product effectively relieves signs and symptoms of this inflammatory skin disease such as pain, itching, scaling and irritation.

Psoriasis is a skin disorder characterised by raised lesions, thickening of the outer layer of the skin (epidermis), itching, silver-white scaling and inflammation. The study is being presented this week at the 1999 annual meeting of the American Academy of Dermatology (AAD).

"Although numerous studies support Neoral as an effective monotherapy for severe, recalcitrant, plaque psoriasis, this study is the first to visually document the corresponding improvements in the skin," said Jerome Shupack, M.D., professor of clinical dermatology at New York University School of Medicine and clinical investigator. "The study found that some patients experienced clearing of the skin after only two weeks and most showed substantial improvement by the study's completion."

The study was conducted by M. Lebwohl, M.D. of Mount Sinai Medical Center, J. Shupack, M.D. of New York University and A. Gottlieb, M.D. of the University of Medicine and Dentistry of New Jersey.

The researchers started the 15 study participants on the recommended dose of 2.5 mg/kg/day, and dose adjustments were made according to clinical response to a maximum dose of 4 mg/kg/day. Adverse reactions reported were mild and manageable and were consistent with the known side effect profile of cyclosporine. Methods used to assess the efficacy of Neoral in this 16-week study included photographing the participants and using the Psoriasis Area and Severity Index (PASI), a method of determining the extent and severity of psoriasis.

Some studies indicate that abnormalities in the immune system may exacerbate psoriasis. Cyclosporine, the active ingredient in Neoral, selectively inhibits the underlying activity, slowing the abnormally rapid skin turnover and reducing inflammation.

The effectiveness of Neoral in the treatment of severe, recalcitrant, plaque psoriasis has been evaluated in nine clinical studies involving a total of 770 cyclosporine treated patients. Results of previous cyclosporine clinical trials indicated remission (defined as 75 percent based on the PASI) was achieved in 51 percent of patients after eight weeks and in 79 percent of patients after 12 weeks.

Neoral is indicated for treatment of adult, nonimmunocompromised patients with severe (such as extensive and/or disabling), recalcitrant, plaque psoriasis who have failed to respond to at least one systemic therapy or for whom other systemic therapies are contraindicated or intolerable. Neoral is also indicated for prevention of organ rejection in kidney, liver and heart transplant recipients and treatment of severe, active rheumatoid arthritis.

The initial recommended dose of Neoral for psoriasis should be 2.5 mg/kg/day. This initial dose is lower than that recommended for transplant patients and should be divided and taken twice daily. Only physicians with experience in management of systemic immunosuppressive therapy should prescribe Neoral.

Neoral is contraindicated in patients with hypersensitivity to cyclosporine or to any ingredients of the formulation. Psoriasis patients with abnormal renal function, uncontrolled hypertension or malignancies should not receive Neoral. Neoral in recommended doses can cause systemic hypertension and nephrotoxicity. In the majority of cases, these changes were reversible after dose reduction. It is also contraindicated in patients being treated with other systemic immunosuppressive therapies or coal tar.

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5.) FDA Approves Panretin Gel For AIDS-Related Kaposi's Sarcoma
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SAN DIEGO, CA -- Feb. 3, 1999 -- The United States Food and Drug Administration has approved Ligand Pharmaceuticals Inc.'s Panretin(R) gel (alitretinoin) 0.1% for the topical treatment of cutaneous lesions of patients with AIDS-related Kaposi's sarcoma (KS).

"Panretin gel is the first patient-applied treatment for AIDS-related KS and represents a significant new option to the traditional management of this disease," said Steven Miles, M.D., associate professor of medicine, UCLA C.A.R.E. Center, and a leading clinical investigator in the Panretin gel trials. "Panretin gel offers patients a self-administered, non-invasive alternative to currently available therapies."

Patients may apply Panretin gel to their KS skin lesions in the privacy of their homes twice a day or as instructed by their physicians. This application regimen is expected to save patients significant time and money compared to other therapies, which require periodic visits to the doctor's office, clinic or hospital and the administration of the treatment by a doctor or nurse (collectively called collateral costs).

FDA clearance followed a review by its oncologic drugs advisory committee on Nov. 16, 1998, at which the committee recommended Panretin gel approval in a series of eight to one votes. In making that recommendation, the committee reviewed data from two Phase III clinical trials: one conducted internationally at 22 sites in Europe, Australia and the U.S., and one conducted at 35 sites in North America. These two trials plus earlier human studies included 385 patients.

Final results of the North American trial, which were released in December 1997, demonstrated that 35 percent of patients treated with Panretin gel experienced complete or partial response compared to 16 percent of patients applying vehicle gel.

Both Phase III trials were designed to evaluate safety and efficacy of Panretin gel in patients with cutaneous AIDS-related KS. Protocols for the trials called for patients to be treated with either Panretin gel or vehicle gel, applied two to four times daily to KS skin lesions for at least 12 weeks. Patients were assessed at two, four, eight and 12 weeks. Responses were defined using AIDS Clinical Trials Group (ACTG) criteria as applied to topical therapy of designated KS index lesions. After 12 weeks, qualifying patients could continue treatment with open-label Panretin gel.

In clinical trials to date, Panretin gel was generally well tolerated. Side effects were primarily mild to moderate and included in most patients erythema (redness) or skin irritation occurring nearly exclusively at the application site. Skin toxicity, including more intense erythema, edema (swelling) and vesiculation (blistering), caused only seven percent of the patients to withdraw from the studies.

In both studies, responses occurred in patients with a wide range of baseline CD4+ lymphocyte counts, including patients with CD4+ lymphocyte counts less than 50 cells/mm3. Nearly all patients received concomitant combination antiretroviral therapy.

KS is the most frequent malignancy seen in AIDS patients and is often characterised by multi-focal, widespread lesions at the onset of illness and may involve the skin, oral mucosa, lymph nodes and visceral organs, such as the lung and gastrointestinal tract. The company estimates that between 30,000 and 50,000 patients in the U.S. and Western Europe, where Ligand intends to be the primary marketer for Panretin gel, are affected by the disease.

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6.) Severe Shingles Pain Relieved With Anti-Convulsant Drug Gabapentin
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CHICAGO, IL -- Dec. 2, 1998 -- In a clinical trial of a new type of drug to relieve severe, chronic pain caused by nerve damage, the anti-convulsant medicine gabapentin has provided significant relief from the aching, burning, tearing pain that some shingles patients suffer for years after other symptoms subside.

Shingles, caused by the virus Herpes zoster, results from the reactivation of the chickenpox virus and attacks more than a million people in the United States each year. While the shingles rash and pain eventually subside in most people, about 10 to 15 percent experience continued severe pain known as postherpetic neuralgia, or PHN, which can last years, and often the rest of an older patient's life.

The shingles clinical trial was reported in today's issue of the Journal of the American Medical Association by University of California San Francisco neurologist Michael Rowbotham, MD, and colleagues at the Rehabilitation Institute of Chicago, Oregon Health Sciences University and Parke-Davis Pharmaceutical Research, which funded the study.

Soon after gabapentin came into use in 1995 to treat epilepsy, physicians noted its pain-relieving powers. Tricyclic antidepressants are the principal drug used to treat PHN pain, but they don't work for more than half of those who try them and many cannot tolerate their side effects, which include decreased blood pressure, constipation and forgetfulness, Rowbotham said. Most PHN sufferers are elderly, making these side effects particularly unacceptable. In contrast, gabapentin appears to be at least as effective as tricyclic antidepressants and gabapentin's side effects are often better tolerated, the researchers found.

"Gabapentin appears to affect a completely different aspect of the nerve cell circuitry involved in chronic pain than do opioids [morphine-like drugs] and tricyclic antidepressants, the main drugs currently used to treat severe nerve damage pain," Rowbotham said. "This report should help physicians become more aware of the effective treatments available for chronic neuropathic pain. It will give more choice in what can be used to relieve pain, particularly for the elderly. And it should also inspire pharmaceutical companies to look for new treatments that are effective and well tolerated."

The eight-week clinical trial involved a total of 229 PHN sufferers. Patients were asked to rate the effect of gabapentin or a matching placebo on their pain, mood and level of sleep interference. Adverse side effects were also monitored. On a self-reporting 10-point pain scale, patients treated with gabapentin reported an average drop in pain of about one third -- 6.3 to 4.2 points, while the patients treated with placebo noted almost no change in their pain. Adverse effects were minor and well tolerated, consisting mainly of sleepiness and dizziness. Particularly important, serious cardiovascular side effects were not found.

Although the mechanism of action of gabapentin remains uncertain, evidence suggests that it affects a particular type of calcium channel in pain-transmitting nerve cells of the spinal cord, Rowbotham said. What is already apparent is that gabapentin does not affect the same nerve pathways that opioids or tricyclics do, making it a new kind of drug for pain.

"This is the first non-opioid medication in at least a decade to be proven a first-line therapy for neuropathic pain," he said. "This is exciting, and an important step forward in allowing people with chronic pain to choose from a broad range of medications that each have a potential to control their pain."

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7.) WORLD AIDS CONFERENCE: Panretin Acts As An Anti-Tumour Agent In Kaposi's Sarcoma Treatment
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GENEVA, SWITZERLAND -- June 30, 1998 -- Two separate scientific presentations at the 12th international AIDS Conference in Geneva reported that Ligand Pharmaceuticals Inc.'s Panretin(R) capsules (alitretinoin) act as an anti-tumour agent in the treatment of AIDS-related Kaposi's sarcoma (KS).

Researchers observed a response rate of nearly 40 percent among patients receiving the drug. The studies' conclusions also suggest that patient responses to Panretin capsules occurred independent of baseline CD4+ counts, concurrent antiretroviral therapy and prior treatment for AIDS-related KS.

The Company's first NDA, submitted for Panretin gel (alitretinoin) 0.1% for the topical treatment of AIDS-related KS, was submitted in May 1998.

Final results of a phase II, multicentre, open-label trial, presented today by James Thommes, M.D., principle investigator and medical director, Pacific Oaks Research in Los Angeles, indicate a 39 percent (22 of 57 patients) overall response rate based on an intent-to-treat analysis and a 62 percent (21 of 34 patients) response for all protocol-defined evaluable patients. Fifty-seven male patients with biopsy-proven KS at five study sites were enrolled in the investigation. They received orally-administered Panretin capsules daily in doses ranging from 60 mg/m2/day to 140 mg/m2/day. The median duration of treatment was 15 weeks. For the 22 responders, two patients relapsed and 20 were still responding as of the database cut-off for the study.

The median baseline CD4+ count among all patients was 219 cells/mm3. Eighty-nine percent of patients were taking three or more antiretroviral agents (ARV), with 94 percent of these receiving a protease inhibitor. Side effects for Panretin capsule-treated patients were generally noted as mild to moderate by study investigators and included headache, hypertriglyeridemia, dry skin and rash.

"What we found most encouraging in the continued analysis of these data is that Panretin capsules appear to have a significant effect in patients whose AIDS-related KS persists, regardless of their treatment with advanced antiretroviral therapy," Dr. Thommes said. "The drug also had positive results among patients who had undergone prior anti-KS chemotherapy and patients for whom chemotherapy had previously failed."

Fifty-six percent (32 of 57) of patients in the study had received prior chemotherapy for KS. Response to Panretin capsules was seen in five of seven patients who were refractory to prior chemotherapy for KS.

A second Phase II study conducted under the sponsorship of the National Cancer Institute's AIDS Malignancy Consortium (AMC) showed that treatment with Panretin capsules resulted in a significant number of clinical responses in patients with extensive disease, low baseline CD4+ counts and prior treatment with systemic chemotherapy. An overall response rate of 37 percent was seen in this study of 66 patients.

"The need for oral KS therapy has been well established," said Alvin Friedman-Kien, M.D., clinical investigator, New York University Ronald O. Perelman department of dermatology. "Although additional investigations are expected, Panretin capsules have shown significant response rates in a range of patients with KS. We are very encouraged by the drug's strong anti-tumour effect in patients whose AIDS-related KS did not respond to the concurrent use of three- and four-drug antiretroviral therapies.

"Panretin capsules also appear to cause a regression of disease in patients with whom who we have exhausted all other therapies, even aggressive cytotoxic regimes."

Seventy-one percent of patients had received prior therapy for KS, including 29 patients who had experienced local treatment and 45 who had undergone systemic chemotherapy or immunotherapy. Side effects of Panretin capsules included headache, elevated triglycerides and alopecia.

Participants in the AMC study, as in the Ligand study, received Panretin capsules (alitretinoin) administered once daily at doses increasing from 60 mg/m2/day to 140 mg/m2/day. Study participants had to have biopsy-proven KS associated with AIDS, and at least five or six skin lesions that were assessed as indicator lesions every two weeks for response. The protocol-defined evaluation period was 16 weeks. Response rates for both trials of Panretin capsules were determined by applying the standard AIDS Clinical Trials Group (ACTG) criteria.

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8.) Famvir Prevents Herpes Outbreaks During Laser Skin Resurfacing
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LOS ANGELES, CA -- May 4, 1998 -- Up to 10 percent of laser skin resurfacing patients experience an outbreak of herpes lesions on the face that can lead to severe and permanent scarring and disfiguration. According to a study presented this weekend at the annual meeting of the American Society for Aesthetic Plastic Surgery, SmithKline Beecham's Famvir(R) (famciclovir) almost completely eliminates reactivation of the herpes simplex virus during laser resurfacing of facial skin.

Studies have shown that 60-80 percent of people harbour latent (dormant) herpes virus, although most people aren't even aware they have been infected with herpes. A single seven-day regimen of Famvir during laser skin resurfacing may be enough to prevent the herpes virus from reactivating during this procedure.

More than 154,000 laser skin resurfacing procedures took place in 1997, making it one of the most common cosmetic procedures. Laser skin resurfacing, also referred to as laser peel, is a relatively new alternative to chemical peels and older dermabrasion procedures. It is used to eliminate small wrinkles and/or reduce the depth and prominence of larger ones, especially around the mouth and eyes and is also effective in treating facial scars or areas of uneven pigmentation. Often the surgery is performed in conjunction with another cosmetic procedure, such as a facelift or eyelid surgery.

The procedure, however, can reactivate latent herpes simplex virus, causing an infection that may be severe and cover large areas of the face. Patients often experience an unusually severe burning pain, accompanied by the blistering lesions typical of herpes. The infection may ultimately spread to all areas of the face and can result in permanent scarring and disfiguration.

"An outbreak of herpes on the face has long been a serious complication associated with laser resurfacing. This procedure involves the stimulation of highly sensitive nerves that can trigger a herpes recurrence, even if a person hasn't had an outbreak for several years or has never had a recognisable outbreak," said Simeon Wall, M.D., the study's lead author. "The results from our study indicate that the risk of herpes reactivation is almost entirely eliminated if patients are given Famvir a few days before and after the surgery is performed.

"In the same way that prophylactic [preventive] antibiotics are administered during other cosmetic surgeries, physicians should consider Famvir during laser skin resurfacing for all patients."

A retrospective study compared rates of herpes simplex virus (HSV) reactivation in 121 patients treated with Famvir to those in 127 other patients who received no antiviral treatment. Patients received Famvir twice a day, beginning one or two days before resurfacing and continuing for five days afterward. Famvir-treated patients who reported having had a recent herpes outbreak (either oral or genital) received 250 mg twice daily and patients who did not report any recent outbreaks received 125 mg twice daily.

Of the patients who received no antiviral therapy, 12 (9.4 percent) experienced a herpes outbreak within one week of surgery. In comparison, only one patient treated with Famvir experienced reactivation -- this patient had received the lower dose of medication. Interestingly, none of the patients who received the higher dose of the medication and had reported a prior history of herpes outbreaks experienced a recurrence.

"Laser skin resurfacing is a relatively new procedure that is becoming more and more popular, but many physicians and patients don't know about the potential for herpes reactivation. It is important that physicians who conduct this procedure recognise the benefit of preventive treatment with antivirals such as Famvir," Dr. Wall said. "In addition to laser resurfacing patients, preventive treatment with Famvir may also prove to be useful for patients undergoing other surgical procedures on the face or mouth."

Famvir is currently indicated for the treatment or suppression of recurrent genital herpes and for the treatment of acute herpes zoster (shingles) in immunocompetent individuals. It is also being studied for treatment of a number of other infections caused by the human herpes virus in both immunocompetent and immunocompromised individuals.

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9.) FDA Clears Cryosurgical Treatment For Verruca Plana
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LEHIGH VALLEY, PA -- January 21, 1998 -- STC Technologies, Inc. has received clearance from the FDA to market its Histofreezer(R) Cryosurgical Wart Treatment for verruca plana. Verruca plana is a small, flesh-coloured, flat topped lesion that commonly occurs on the face, neck, and back of hands of children and young adults.

Histofreezer is indicated for the treatment of verruca vulgaris (common warts), verruca plantaris (plantar warts), HPV (genital lesions), acrochordon (skin tags), molluscum contagiosum, seborrhoeic keratosis, and now, verruca plana. In the removal of benign skin lesions, Histofreezer has been shown to be an effective and economical alternative to liquid nitrogen.

Histofreezer units are available in 5 mm, 40 applicator kits or 2 mm, 50 applicator kits. Each kit contains a CPT code manual, a Material Safety Data Sheet (MSDS) and a complete set of instructions. Histofreezer may be stored at room temperature and has a four-year shelf life from date of manufacture.

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10.) Researchers Identify Substance Which Protects Against UV Skin Damage
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BOSTON, MA -- November 18, 1997 -- A substance called pTpT enhances a skin cell's natural ability to repair DNA damage from ultraviolet (UV) radiation, according to researchers from the Boston University School of Medicine. The finding suggests the possibility topical agents could eventually be created which not only induce tanning, but also lower the risk of skin cancer.

Their discovery was reported in the Nov. 11, 1997 issue of the Proceedings of the National Academy of Sciences.

According to co-author Barbara Gilchrest, MD, chair of the department of dermatology and professor of dermatology at the Boston University School of Medicine, the study extends the finding, reported in Nature in December 1994, that pTpT promotes tanning by inducing melanocytes (skin pigment cells) to produce melanin.

"Tanning is the body's natural response to UV damage, so that the cell's DNA is protected from further UV radiation," she said. "Since we knew that pTpT could induce the tanning response, we reasoned that it might also protect against UV light in other ways. Our study confirms that hypothesis."

The scientists irradiated normal skin cells (keratinocytes and fibroblasts) with damaging doses of UV light, then measured how well the damage was repaired and how well the cells survived. They then compared the results in otherwise identical cells that had been pre-treated with pTpT. The plain cells exhibited the normal response to UV damage and eventually began to repair the damaged DNA. But the pTpT-treated cells repaired the DNA much faster.

"Not only does pTpT induce tanning, but it primes the cell to protect itself by enhancing DNA repair capacity," Gilchrest explained.

Although more research is needed, Gilchrest believes pTpT may have clinical applications one day. "A skin tanning lotion containing a pTpT-like substance would not only produce a tan, but in addition treated skin might be innately better able to deal with whatever UV damage it might encounter," she said. "With this substance, we could lower the overall risk of skin cancer."

Approximately one million people in the United States develop skin cancer every year and more than 40,000 develop melanoma, the most deadly form of skin cancer. Roughly 9,300 Americans each year die from some form of skin cancer.

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11.) Erbium-YAG Laser -- The New Wunderkind In Skin Rejuvenation
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SCHAUMBURG, IL -- November 3, 1997 -- Recent studies show the new high-powered erbium (Er):YAG laser provides significant improvement with less redness, rapid healing and minimum complications in patients with mild to moderate wrinkling and scarring.

Different from other lasers used for skin resurfacing, the Er-YAG system produces laser energy in a wavelength that gently penetrates the skin, is readily absorbed by water (a major component of tissue cells) and scatters the heat effects of the laser light. These unique properties allow dermatologic surgeons to remove thin layers of skin tissue with exquisite precision while minimizing damage to surrounding skin.

In a recent article in Dermatologic Surgery Journal, co-author David Goldberg, MD, chief of dermatologic surgery at the New Jersey Medical School in Newark, concluded the new pulsed Er-YAG laser system may optimally fulfill the basic requirements for skin rejuvenation as it safely and effectively obtains the desired cosmetic results.

"These features of the Er-YAG laser provide for both fine, superficial resurfacing of the skin, as well as controlled large superficial tissue removal," he said. "Of great excitement is the erbium laser's role in rejuvenating body areas like the neck and hands, which were difficult to treat with other laser systems."

In particular, skin laser experts nationwide are finding the most favorable results from the Er-YAG are observed in patients who have superficial to moderate facial wrinkles, mild surface scars and melasma, a skin discoloration commonly associated with pregnancy in females.

Based on clinical experience involving 150 subjects who had undergone resurfacing procedures using the Er-YAG short-pulsed system, Tina Alster, MD, director of the Washington Institute of Dermatologic Laser Surgery, reported this new technology is ideal for younger patients in their late 30s who don't have severe signs of photoaging or for patients who can't deal with a prolonged recovery period.

"Instead of jumping into the deep end of the pool, many patients prefer to begin treatment with the erbium laser because it effectively improves fine lines and wrinkles, atrophic scars and overall skin tone and color while offering the advantages of reduced redness, decreased side effects and less downtime for recovery," she said.

According to Dr. Alster, current studies suggest that the Er-YAG could fill the therapeutic gap that exists between medium depth chemical peels and C02 laser treatment. Dr. Alster added if further studies support the high benefit:risk ratio predicted by early reports erbium lasers will be here to stay.

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12.) Ultrapotent Topical Corticosteroid Treatment of Childhood Genital Lichen Sclerosus
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Maria C. Garzon, MD; Amy S. Paller, MD

Objective: To observe the clinical effects of short-term application of ultrapotent topical corticosteroid on symptomatic genital lesions of lichen sclerosus in pediatric patients.

Design: Case series of 10 prepubertal girls with genital lichen sclerosus. Ultrapotent topical corticosteroids were applied twice daily for 6 to 8 weeks and patients were reexamined at completion of treatment. Long-term follow-up over 6 months to 3 years.

Setting: Pediatric dermatology clinic (referral center).

Patients: Ten prepubertal girls with typical clinical features of genital and/or perianal lichen sclerosus.

Intervention: Topical ultrapotent corticosteroid ointment was applied sparingly to affected areas for 6 to 8 weeks.

Main Outcome Measure: Improvement of erythema, whitening erosions, and atrophy. Subjective improvement of symptoms.

Results: All patients showed partial or total subsistence of signs and symptoms of lichen sclerosus. Frequency and severity of recurrences varied, but patients responded within a few days to reapplication of ultrapotent topical corticosteroid. No significant adverse effects were noted after the initial 6- to 8-week course of therapy or during the 6-month to 3-year follow-up period.

Conclusion: A 6- to 8-week course of ultrapotent topical corticosteroid is a safe and effective treatment for genital lichen sclerosus in pediatric patients.

Arch Dermatol. 1999;135:525-528

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13.) The Use of Sucralfate Suspension in the Treatment of Oral and Genital Ulceration of Behçet Disease A Randomized, Placebo-Controlled, Double-blind Study
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Erkan Alpsoy, MD; Hanife Er, MD; Cicek Durusoy, MD; Ertan Yilmaz, MD

Objective: To determine the efficacy of topically applied sucralfate suspension in the treatment of oral and genital ulceration of Behçet disease.

Design and Setting: A randomized, placebo-controlled, double-blind study at a university referral center.

Patients: Forty patients with Behçet disease were included in the study.

Intervention: Patients were given topical sucralfate or placebo 4 times a day for 3 months and examined clinically at biweekly intervals.

Main Outcomes Measures: For each lesion, the mean frequency, healing time, and pain were evaluated during the pretreatment, treatment, and follow-up periods. No patients were given any concurrent disease-specific or immunosuppressive topical and systemic drugs during the 9-month study period.

Results: Of the 40 patients included in the study, the results in 30 patients (16 patients treated with sucralfate and 14 patients treated with placebo, ranging in age from 16 to 52 years [mean ± SD age, 34.3 ± 8.1 years]) were evaluable for efficacy. Treatment with sucralfate decreased significantly the mean frequency, healing time, and pain of oral ulceration and healing time and pain of genital ulceration compared with the pretreatment period. The effectiveness of sucralfate on the frequency and healing time of oral ulceration continued during the posttreatment period. In the placebo group, no significant difference was found in measured parameters of oral and genital ulceration except the pain of the oral ulceration between the pretreatment and treatment periods.

Conclusion: Our results showed that topical sucralfate suspension is an easy, safe, inexpensive, and effective treatment for oral and genital ulceration in patients with Behçet disease.

Arch Dermatol. 1999;135:529-532

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14.) Anti--Fodrin Antibodies in Sjögren Syndrome and Lupus Erythematosus
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Takahiro Watanabe, MD, PhD; Tetsuya Tsuchida, MD, PhD; Naoko Kanda, MD, PhD; Katsunori Mori, MD; Yoshio Hayashi, MD, PhD; Kunihiko Tamaki, MD

Objectives: To investigate the prevalence of anti--fodrin antibody in patients with Sjögren syndrome (SS), lupus erythematosus (LE), or both and the association of this antibody with other clinical manifestations.

Design: A study of screening and diagnostic tests. Mean follow-up was 152 months (range, 4-572 months).

Setting: A university hospital associated with a research laboratory in Tokyo, Japan.

Patients: Nine patients with primary SS, 15 patients with SS secondary to LE, and 44 patients with LE alone.

Main Outcome Measures: Frequencies of clinical and laboratory findings, including anti--fodrin antibody.

Results: Anti--fodrin antibody was more commonly detected in patients with primary (7/9; P<.001) and secondary (9/15; P<.001) SS than in those with LE alone (3/44). When patients with primary and secondary SS were combined and compared with those with LE alone, the sensitivity of anti--fodrin antibody was 67%, specificity was 93%, and both positive and negative predictive values were 84%. The presence of anti--fodrin antibody was associated with pernio, hyperglobulinemia, rheumatoid factor positivity, and the presence of anti-SS-B (La) antibody (P<.01) but not with annular erythema, photosensitivity, vasculitis, or renal disorder.

Conclusions: Although anti--fodrin antibody was detected in patients with SS and in those with LE, it seemed to be more valuable for the diagnosis of SS than was anti-SS-A (Ro) because anti--fodrin was much less prevalent in patients with LE alone. It may be possible to consider this novel autoantibody as pathophysiologically associated with some extraglandular manifestations characteristically seen in patients with SS.

Arch Dermatol. 1999;135:535-539

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15.) Turbo-PUVA: Dihydroxyacetone-Enhanced Photochemotherapy for Psoriasis A Pilot Study
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Charles R. Taylor, MD; Chartchai Kwangsukstith, MD; Joanne Wimberly, MPA; N. Kollias, PhD; R. Rox Anderson, MD

Background: Dihydroxyacetone (DHA), a colorless sugar in "sunless" tanning lotions, binds to stratum corneum to form a UV-A-protective brown pigment. Bound DHA polymer is shed faster from hyperproliferative skin sites such as psoriatic plaques. We tested the hypothesis that selective shedding of DHA pigment during psoralen-UV-A (PUVA) treatment of psoriasis may allow higher UV-A doses, thus accelerating clearing while protecting uninvolved skin. Concurrent use of lactic acid was investigated as an aid in removing scale and residual DHA from psoriatic plaques. Observations: Thirty psoriatic patients with more than 20% body surface area involvement were recruited. The 6 PUVA study groups were (1) standard American style, (2) American style plus lactic acid, (3) DHA-PUVA or "topical ultraviolet-resisting barrier to optimize PUVA" (Turbo-PUVA), (4) Turbo-PUVA with lactic acid, (5) European style, and (6) European style plus DHA. Combinations of lactic acid and European-style treatment were not studied. Each subject received up to 30 oral PUVA treatments twice weekly 3 days apart. The DHA-PUVA groups used 15% DHA lotion twice weekly. Lactic acid groups used 7% lotion daily except on treatment days. Psoriasis area and severity index scores were recorded weekly. Turbo-PUVA allowed higher UV-A exposures with minimal burns, showed faster clearing, and required fewer treatments for 90% clearing (P<.001).

Conclusions: Protection of uninvolved skin by DHA during PUVA treatment allows higher UV-A exposures to be tolerated, demonstrates faster clearing, and requires fewer treatments to clear psoriasis. By reducing the total body dose received, Turbo-PUVA may also reduce long-term risks.

Arch Dermatol. 1999;135:540-544

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16.) Systemic Toxicity Following Administration of Sirolimus (FormerlyRapamycin) for Psoriasis association of Capillary Leak Syndrome With Apoptosis of Lesional Lymphocytes
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Mariana J. Kaplan, MD; Charles N. Ellis, MD; Zsuzsanna Bata-Csorgo, MD; Ross S. Kaplan, MD; Judith L. Endres, BS; David A. Fox, MD

Background: Sirolimus (formerly rapamycin) is an immunosuppressive agent that interferes with T-cell activation. After 2 individuals with psoriasis developed a capillary leak syndrome following treatment with oral sirolimus, lesional skin cells and activated peripheral blood cells were analyzed for induction of apoptosis.

Observations: A keratome skin specimen from 1 patient with sirolimus-induced capillary leak syndrome had a 2.3-fold increase in percentage of apoptotic cells (to 48%) compared with an unaffected sirolimus-treated patient with psoriasis (21%). Activated peripheral blood T cells from patients with psoriasis tended to exhibit greater spontaneous or dexamethasone-induced apoptosis than did normal T cells, particularly in the presence of sirolimus.

Conclusions: Severe adverse effects of sirolimus include fever, anemia, and capillary leak syndrome. These symptoms may be the result of drug-induced apoptosis of lesional leukocytes, especially activated T lymphocytes, and possibly release of inflammatory mediators. Because patients with severe psoriasis may develop capillary leak from various systemic therapies, clinical monitoring is advisable for patients with inflammatory diseases who are treated with immune modulators.

Arch Dermatol. 1999;135:553-557

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17.) Bullous Systemic Lupus Erythematosus With Autoantibodies Recognizing Multiple Skin Basement Membrane Components, Bullous Pemphigoid Antigen 1, Laminin-5, Laminin-6, and Type VII Collagen
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Lawrence S. Chan, MD; Jean-Christophe Lapiere, MD; Mei Chen, PhD; Tom Traczyk, BS; Anthony J. Mancini, MD; Amy S. Paller, MD; David T. Woodley, MD; M. Peter Marinkovich, MD

Background: Bullous systemic lupus erythematosus is a generalized subepidermal blistering skin eruption in patients suffering from systemic lupus erythematosus. Type VII collagen was initially identified as the target antigen.

Observation: We studied an unusual patient who had bullous systemic lupus erythematosus. The patient fulfilled the criteria of systemic lupus with an antinuclear antibody titer of 1:5120. Immunopathological testing revealed in vivo deposition of all IgG subclasses, secretory IgA1, and both light chains at the patient's skin basement membrane. The in vivo-bound IgG and IgA were localized at the hemidesmosomes and lamina densa. The patient's IgG and IgA circulating autoantibodies labeled both the epidermal roof and the dermal floor of salt-split skin and recognized the hemidesmosomal protein BP230 as well as the full-length native form and the recombinant noncollagenous domain 1 of type VII collagen (anchoring fibril). In addition, the patient's IgG autoantibodies recognized the anchoring filament proteins laminin-5 and laminin-6 (3 chain and 2 chain).

Conclusions: We conclude that patients with bullous systemic lupus erythematosus may have autoantibodies to multiple basement membrane components critical for epidermal-dermal junctional adhesion. Possible pathogenic mechanisms in this patient's clinical diseases include provocation of organ-specific disease (bullous disease) by systemic autoimmunity (lupus) and the "epitope spreading" immune phenomenon.

Arch Dermatol. 1999;135:569-573

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18.) Comparison of Erbium:YAG and Carbon Dioxide Lasers in Resurfacing of Facial Rhytides
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Khalil A. Khatri, MD; Victor Ross, MD; Joop M. Grevelink, MD, PhD; Cynthia M. Magro, MD; R. Rox Anderson, MD

Objective: To compare the efficacy, adverse effects, and histological findings of erbium:YAG (Er:YAG) and carbon dioxide (CO2) laser treatment in removing facial rhytides.

Design: An intervention study of 21 subjects with facial rhytides. All participants were followed up for 6 months. The end points of the study were wrinkle improvement and duration of adverse effects.

Setting: Academic referral center.

Subjects: Nineteen female and 2 male volunteers with skin type I to III and wrinkle class I to III participated in the study.

Intervention: In all subjects, 1 side of the face was treated with a CO2 laser and other side with an Er:YAG laser. Skin biopsies were performed in 6 subjects before treatment and immediately, 1 day, 2 days, and 6 months after treatment. Observations were recorded by subjects, investigators, and a blinded panel of experts.

Main Outcome Measures: Improvement in wrinkles and severity and duration of adverse effects.

Results: The CO2 laser-treated side had relatively better wrinkle improvement when evaluating all subjects (P<.03). However, in subjects receiving more than 5 passes of Er:YAG laser, improvement scores were not significantly different from those for 2 to 3 passes of CO2 laser treatment. Posttreatment erythema was noted at 2 weeks in 14 subjects (67%) on the Er:YAG laser-treated side and 20 subjects (95%) on the CO2 laser-treated side. The frequency of erythema was significantly less after Er:YAG laser treatment at 2 (P=.001) and 8 (P=.03) weeks. Hypopigmentation was seen in 1 Er:YAG-treated (5%) and 9 CO2-treated (43%) sides (², P<.05). Histological evaluation showed residual thermal damage of up to 50 µm on the Er:YAG-treated side and up to 200 µm on the CO2-treated side.

Conclusions: Erbium:YAG laser is safe and effective in removing facial rhytides. Subjects treated with Er:YAG laser recover more quickly from the procedure than those receiving CO2 laser treament.

Arch Dermatol. 1999;135:391-397

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19.) The Drug for the Turn of the Millennium?
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Thomas Ruzicka, MD; Till Assmann, MD; Bernhard Homey, MD

Background: Tacrolimus has been shown to be a powerful suppressor of the immune system. It was introduced into clinical use to prevent allograft rejection and is now routinely used in kidney, liver, and heart transplantation. Recently, 2 double-blind multicenter studies demonstrated the therapeutic efficacy of topical and systemic tacrolimus in the inflammatory skin diseases atopic dermatitis and psoriasis.

Data Source: MEDLINE was searched for relevant publications and combined with our own clinical, in vitro, and in vivo studies.

Study Selection: All studies dealing with tacrolimus and dermatology were reviewed. Data Extraction: Publications with clinically relevant data were included in this review.

Conclusions: Topical tacrolimus is a safe and effective therapeutic agent that may open a new era in the treatment of inflammatory skin diseases, particularly for patients with atopic dermatitis. Before its full potential in dermatology can be assessed, more clinical experience in treating children and comparison with the criterion standard of anti-inflammatory therapy, glucocorticosteroids, are needed.

Arch Dermatol. 1999;135:574-580

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20.) Association of the Köbner Phenomenon With Disease Activity and Therapeutic Responsiveness in Vitiligo Vulgaris
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M. D. Njoo, MD; P. K. Das, MSc, PhD; J. D. Bos, MD, PhD; W. Westerhof, MD, PhD

Objective: To investigate the association between the experimentally induced Köbner phenomenon (KP-e) and the Köbner phenomenon by history (KP-h), disease activity, and therapeutic responsiveness in vitiligo vulgaris.

Design: Cohort study.

Setting: An outpatient clinic.

Patients: Sixty-one consecutive patients with vitiligo vulgaris.

Intervention: Three months after a standardized epidermodermal injury was induced, the KP-e was evaluated. For 1 year, UV-B (311 nm) therapy or topical fluticasone propionate plus UV-A therapy was given, depending on the severity of depigmentation.

Main Outcome Measures: The presence or absence of the KP-e and the KP-h disease activity as scored on a 6-point scale from -1 to +4 (vitiligo disease activity [VIDA] score) and therapy-induced repigmentation grade.

Results: Nineteen (31%) of the patients had a positive KP-h, whereas 37 (61%) showed a positive KP-e (P<.001). The VIDA score did not always predict a positive KP-e, although patients with a positive KP-e had a higher mean VIDA score (VIDA score of 1.6) than did patients with a negative KP-e (VIDA score of 0.5) (P<.001). The responsiveness to UV-B (311 nm) therapy among KP-e-positive or KP-e-negative patients was not significantly different (P=.66). However, KP-e-positive patients who were treated with fluticasone propionate plus UV-A showed a better response than did KP-e-negative patients (P=.01). Among patients responding to both therapies, VIDA scores were significantly decreased (P<.001) compared with VIDA scores before therapy.

Conclusion: The KP-e may function well as a clinical factor to assess present disease activity and may also predict the responsiveness to fluticasone propionate plus UV-A therapy but not to UV-B (311 nm) therapy.

Arch Dermatol. 1999;135:407-413

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21.) Vitiligo Antibodies Are Not Directed to Tyrosinase
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Zhong Xie, MD, PhD; Dunlu Chen, MD; Diane Jiao, MD; Jean-Claude Bystryn, MD

Background: Patients with vitiligo have a markedly increased incidence of antibodies to melanocytes, referred to as vitiligo antibodies. Antibodies to tyrosinase have been reported in some patients with vitiligo, suggesting that vitiligo antibodies may be directed to this enzyme. However, there is considerable controversy as to the frequency with which these antibodies occur, and, hence, about their relevance to the pathogenesis of vitiligo. The frequency with which antityrosinase antibodies occur in vitiligo is critical to evaluate their potential role in the pathogenesis of this disease.

Objective: To examine the prevalence of antibodies to tyrosinase in a large group of patients with vitiligo.

Design: We examined the incidence of antibodies to enzymatically and immunologically active tyrosinase in patients with and without vitiligo.

Setting: Outpatient clinic in referral center.

Patients: The study was conducted on serum samples obtained from 54 patients with active (n=40) and inactive (n=14) uncomplicated vitiligo and from 52 age- and sex-matched individuals without vitiligo.

Main Outcome Measure: Presence in the serum of antibodies to enzymatically and/or immunologically active tyrosinase.

Results: By immunoblotting, 20 patients (50%) with active vitiligo, 9 of those (64.3%) with inactive vitiligo, and 29 control individuals (55.8%) had antibodies to an antigen that comigrated with tyrosinase. However, by immunoprecipitation DOPA stain and by sandwich enzyme-linked immunosorbent assay, none of the vitiligo or control individuals had antibodies to tyrosinase, even though both assays easily detected control antityrosinase antibodies.

Conclusion: These results indicate that while antibodies to an antigen(s) that comigrates with tyrosinase are common in patients with or without vitiligo, vitiligo antibodies are not directed to tyrosinase.

Arch Dermatol. 1999;135:417-422

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22.) Efficacy of Erbium:YAG Laser Ablation in Darier Disease and Hailey-Hailey Disease
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Christian Beier, MD; Roland Kaufmann, MD

Background: Among different surgical approaches, dermabrasion and carbon dioxide laser vaporization have been used to treat Hailey-Hailey disease (HHD) (familial benign chronic pemphigus) and Darier disease (DD) (keratosis follicularis), with various results. Because of the erbium:YAG laser's unique absorption characteristics in tissue water, erbium:YAG laser ablation combines the advantages of both techniques, avoiding thermal injury of vaporization and also allowing selectively deeper tissue removal in the follicular lesions of DD. Therefore, good results should be expected in both types of acantholytic disorders.

Observations: Four patients (2 with HHD and 2 with DD) with different affected areas were treated with laser ablation. During a follow-up period ranging from 8 to 20 months, complete remission was achieved in 3 patients-2 with DD and 1 with HHD-and significant improvement was achieved in 1 patient with HHD. Histological examination of control biopsy specimens after ablation in 1 patient with DD revealed no signs of the disease and only a slight fibrosis in the papillary dermis.

Conclusions: Erbium:YAG laser ablation effectively removes lesions of both HHD and DD and can also yield excellent long-term results in chronic, recalcitrant cases.

Arch Dermatol. 1999;135:423-427

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23.) Pulse Dosing of Thioguanine in Recalcitrant Psoriasis
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Nancy G. Silvis, MD; Norman Levine, MD

Background: Patients with severe psoriasis may be unresponsive to or unable to tolerate the adverse effects of traditional therapy. Thioguanine has been used to treat psoriasis, but experience is limited. Most previous studies have used daily therapy and have demonstrated significant hematologic abnormalities.

Objective: To reduce the adverse effects of traditional thioguanine therapy, our study patients were treated with thioguanine with a pulse-dosing schedule of 2 to 3 times per week.

Observations: Marked improvement of recalcitrant psoriasis was noted in 10 (71%) of 14 patients receiving thioguanine therapy using a pulse-dosing schedule. Maintenance dosage ranged from 120 mg twice a week to 160 mg 3 times a week. Adverse effects were minimal.

Conclusions: Thioguanine therapy is an effective treatment for recalcitrant psoriasis. A dosing schedule of 2 or 3 times per week is recommended to minimize the potential adverse effects. Routine laboratory follow-up is suggested to screen for potential adverse effects, with special attention to bone marrow suppression.

Arch Dermatol. 1999;135:433-437

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24.) Why Does Carbon Dioxide Resurfacing Work? A Review
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E. Victor Ross, MD; Joseph R. McKinlay, MD; R. Rox Anderson, MD

Despite the unquestionable efficacy of carbon dioxide laser skin resurfacing, mechanisms for cosmetic enhancement remain poorly characterized. Histological studies have provided some insight into the cascade of events from initial laser impact to final skin rejuvenation. However, there are few comprehensive studies of gross and microscopic wound healing. Additionally, the literature is fragmented; excellent individual articles appear in journals from widely disparate disciplines. For example, some reports relevant to laser skin resurfacing are "sequestered" in the engineering literature. This article is intended to update the physician on laser skin resurfacing based on the broadest review of the current literature. It proceeds from a discussion of initial laser-tissue interactions, such as collagen denaturation, to examination of long-term biological sequlae. At some cost to scientific rigor, mathematical models describing laser-tissue interactions are not presented.

Arch Dermatol. 1999;135:444-454

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25.) Prognostic factor analysis in mycosis fungoides/Sézary syndrome
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Eleni Diamandidou, MDa Maria Colome, MDb Luis Fayad, MDa Madeleine Duvic, MDc Razelle Kurzrock, MDa Houston, Texas
Background: The influence of prognostic factors on survival in patients with mycosis fungoides/Sézary syndrome (MF/SS) is less well described than for other lymphomas.

Objective: Our purpose was to evaluate the prognostic value of diverse clinicopathologic and laboratory characteristics in patients with MF/SS. Methods: All 115 patients with MF/SS seen at the Mycosis Fungoides clinic at M. D. Anderson Cancer Center during the study period who had slides available for pathologic review were analyzed. Univariate and multivariate methodologies were used.

Results: Age ( 60 years; P = .0002), advanced stage (P < 10-5), tumor (T3) stage disease (P 10-5), lymphadenopathy (P = .006), bone marrow infiltration (P = .03), high lactate dehydrogenase (LDH; P = .0002), high 2-microglobulin (> 2 mg/L; P = .009), and transformation to large-cell lymphoma (P = .004) were significant prognostic factors in the univariate analysis and correlated with a poorer survival. The outcome of patients staged as IIB was significantly worse than that of those staged as I or IIA or III (P < .001) and was comparable to that of the patients staged as IV (P = .8). In the multivariate analysis, the factors selected include stage (I to IIA and III vs IIB and IV; P < .0001), LDH (P = .006), and age ( 60 vs < 60 years; P = .02). The actuarial median survival of patients with advanced stage, high LDH, or age 60 years or more was 2.5 to 3.5 years, whereas that of patients without any of these parameters was more than 13 years.

Conclusion: Our results suggest that patients with MF/SS who are staged as IIB or IV, who have a high LDH, or who are 60 years of age or older have an aggressive course and poor survival. (J Am Acad Dermatol 1999;40:914-24.)

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25.) Finasteride in the treatment of men with frontal male pattern hair loss
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James Leyden, MDa Frank Dunlap, MDb Bruce Miller, MDc Peter Winters, MDd Mark Lebwohl, MDe David Hecker, MDe Stephen Kraus, MDf Hilary Baldwin, MDg Alan Shalita, MDh Zoe Draelos, MDi Michael Markou, DOj Diane Thiboutot, MDk Marvin Rapaport, MDl Sewon Kang, MDm Timothy Kelly, MDj David Pariser, MDn Guy Webster, MDo Maria Hordinsky, MDp Robert Rietschel, MDq H. Irving Katz, MDr Lisa Terranellas Sharon Bestt Elizabeth Round, PhDs Joanne Waldstreicher, MDs Philadelphia and Hershey, Pennsylvania; Tucson, Arizona; Portland, Oregon; Indianapolis, Indiana; New York and Brooklyn, New York; Atlanta, Georgia; Paramus and Rahway, New Jersey; Winston-Salem, North Carolina; Palm Harbor, Florida; Beverly Hills, California; Ann Arbor, Michigan; Norfolk, Virginia; Minneapolis and Fridley, Minnesota; and New Orleans, Louisiana

Background: Finasteride, a specific inhibitor of type II 5-reductase, decreases serum and scalp dihydrotestosterone and has been shown to be effective in men with vertex male pattern hair loss.

Objective: This study evaluated the efficacy of finasteride 1 mg/day in men with frontal (anterior/mid) scalp hair thinning.

Methods: This was a 1-year, double-blind, placebo-controlled study followed by a 1-year open extension. Efficacy was assessed by hair counts (1 cm2 circular area), patient and investigator assessments, and global photographic review.

Results: There was a significant increase in hair count in the frontal scalp of finasteride-treated patients (P < .001), as well as significant improvements in patient, investigator, and global photographic assessments. Efficacy was maintained or improved throughout the second year of the study. Finasteride was generally well tolerated.

Conclusion: In men with hair loss in the anterior/mid area of the scalp, finasteride 1 mg/day slowed hair loss and increased hair growth. (J Am Acad Dermatol 1999;40:930-7.)

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26.) Mycophenolate mofetil: A new therapeutic option in the treatment of blistering autoimmune diseases
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Marcella Grundmann-Kollmann, MDa Hans Christian Korting, MDb Stefanie Behrens, MDa Peter Kaskel, MDa Ulrike Leiter, MDa Gertraud Krähn, MDa Martina Kerscher, MDa Ralf Uwe Peter, MDa Ulm and Munich, Germany

Background: Mycophenolate mofetil (MMF), an ester of mycophenolic acid (MPA), was approved by the Food and Drug Administration in 1995 and is currently primarily indicated for the prophylaxis of rejection in renal transplant patients. The drug seems also to be of value in the treatment of psoriasis and rheumatic arthritis. Recently there have been 6 reported cases of successful treatment of blistering autoimmune diseases with MMF in combination with high dose prednisone therapy.

Objective: On the basis of these reports we administered this new treatment regimen to several patients with blistering autoimmune diseases. Besides using a combination of MMF and high-dose prednisone we wanted to evaluate whether MMF monotherapy is also effective in the treatment of blistering autoimmune diseases.

Methods: We administered MMF to 5 patients who had severe pemphigus vulgaris or bullous pemphigoid. Two patients received MMF in combination with high-dose prednisone therapy and 3 patients received MMF monotherapy. To our knowledge, this is the first report of successful treatment of pemphigus vulgaris and bullous pemphigoid with MMF monotherapy.

Results: All patients were completely free of symptoms within 8 to 11 weeks of therapy. Patients who had received MMF monotherapy responded as well to treatment as those who received a combination of MMF and high-dose prednisone.

Conclusion: Our experiences strongly suggest that MMF monotherapy may be effective for patients even with severe pemphigus vulgaris and bullous pemphigoid. In addition, MMF monotherapy, at least over the short term, offers the advantage of fewer side effects in comparison to immunosuppressive combination therapy and was well tolerated by our patients. (J Am Acad Dermatol 1999;40:957-60.)

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27.) A comparison of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea
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Stuart Maddin, MD, FRCPC Vancouver, British Columbia, Canada

Background: Although it is important for physicians to have sufficient clinical data on which to base treatment decisions, little comparative data exist regarding newer treatment modalities for rosacea.

Objective: The goal of the study was to compare the efficacy and safety of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea. Parameters of patient satisfaction to treatment were also assessed.

Methods: Forty patients with the clinical manifestation of symmetric facial rosacea were investigated in this single-center, double-blind, randomized, contralateral split-face comparison clinical trial.

Results: After 15 weeks of treatment, both azelaic acid and metronidazole induced significant, albeit equal reductions in the number of inflammatory lesions (pustules and papules). A significantly higher physician rating of global improvement was achieved with azelaic acid. Changes in the rosacea signs and symptoms of dryness, burning, telangiectasia, and itching were equal between treatments. A reduction in erythema tended toward significance with azelaic acid at week 15. A trace amount of stinging on application was noted with azelaic acid; however, such discomfort did not appear to concern patients because their overall impression of azelaic acid was superior to that of metronidazole.

Conclusion: Azelaic acid 20% cream provides an effective and safe alternative to metro-nidazole 0.75% cream with the added benefit of increased patient satisfaction.

(J Am Acad Dermatol 1999;40:961-5.)

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DATA-MÉDICOS/DERMAGIC-EXPRESS No (56) 02/06/99 DR. JOSÉ LAPENTA R.
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