Clinical efficacy and safety comparison of adapalene gel and tretinoin gel in the treatment of acne vulgaris: Europe and U.S. multicenter trials

BACKGROUND

Adapalene is a new chemical entity that exhibits tretinoin-like activities in the terminal differentiation process.

OBJECTIVE

We evaluated a dose range effect of two concentrations of adapalene gel as acne treatment and compared adapalene 0.1% gel with tretinoin 0.025% gel in the treatment of acne patients in two large multicenter studies.

METHODS

Multicenter, investigator-masked, parallel group studies including 89 acne patients in the dose range study and 591 patients in the concurrent controlled studies were conducted.

RESULTS

Adapalene gel 0.1% was significantly more effective in treating acne lesions than 0.03% adapalene gel. Adapalene gel 0.1% was significantly more effective than 0.025% or tretinoin gel in one study and of the same effectiveness in the other study. Adapalene gel was always better tolerated than tretinoin gel.

CONCLUSION

Adapalene 0.1% gel is a safe and effective treatment of acne vulgaris.

[Oxiconazole cream versus ketoconazole cream. A prospective, randomized, double-blind, multicenter study in the treatment of inguinocrural dermatophytoses]

INTRODUCTION

The aim of this study was to compare oxiconazole, 1 p. 100 cream, with ketoconazole, 2 p. 100 cream, applied once-daily, in the treatment of tinea cruris.

PATIENTS AND METHODS

A prospective, randomized, double-blind trial was performed in 8 dermatology departments on two parallel groups in patients having this type of mycosis confirmed by mycological examination.

RESULTS

The efficacy was analyzed in 66 out of the 79 patients included in the study (36 patients treated with oxiconazole, 30 with ketoconazole). At Day 14, a first assessment was made and 77.1 p. 100 of the patients treated with oxiconazole had been cured; this result was significantly better (p < 0.05) than that obtained with ketoconazole (51.7 p. 100 of cured patients). At Day 21, after a further week of treatment, both treatments were efficient with statistically non-different results between the two groups: 97.2 p. 100 of the patients treated with oxiconazole, versus 86.7 p. 100 with ketoconazole. Thus, a greater rapidity of action of oxiconazole was observed. No correlation was detected between the ratio of cured patients and the duration of the mycosis. The safety was assessed in 74 patients. No adverse effects were reported for the patients treated with oxiconazole, whereas 9 patients treated with ketoconazole experienced contact sensitization reactions and irritant skin reactions due to the application of the product. The difference between the two groups of treatment was statistically greatly significant (p < 0.001). Furthermore, acceptance of the drug on the part of the patient was better (p < 0.05) with oxiconazole.

DISCUSSION

After 3 weeks of topical treatment oxiconazole has revealed itself to be as efficient as ketoconazole, but it seems more rapidly efficient and better tolerated than ketoconazole.

Psoriasis and birdshot chorioretinopathy: response to aromatic retinoids

Birdshot chorioretinopathy, also known as vitiliginous chorioretinitis, is a rare and serious retinochoroidopathy. We describe a case in a patient with long-standing typical psoriasis. To our knowledge this association has not been previously reported in the dermatologic literature. Both psoriasis and chorioretinitis appeared to respond to aromatic retinoids. The incidence of birdshot chorioretinopathy in patients with psoriasis should be assessed.

Influence of age and sun exposure on the biophysical properties of the human skin: an in vivo study

The physical properties of the skin were measured by using noninvasive methods on 72 people displaying various levels of solar elastosis on the neck. The physical parameters measured were the skin extensibility, the elastic recovery, the skin colour, the skin thickness and the electrical conductance. The correlation between the above parameters, the clinical grades of elastosis and the chronological age of each subject were studied using two different statistical approaches. They both showed that elastotic skin is less elastic, dryer, darker, more erythematous and less yellowish than the nonexposed skin. The similarities and differences between the properties of elastotic skin and purely chronologically aged skin are discussed.

[Essential fatty acids and the skin]

Metabolism of the essential fatty acids (AGE) in an organism leads to synthesis of eicosanoids, which have various biological properties. Linoleic acid plays an important part in maintenance of epidermal integrity by intervening in the cohesion of the stratum corneum and in prevention of transepidermal water loss. Metabolites of arachidonic acid (mostly those obtained by the lipoxygenase pathway) are important agents in causing many inflammatory skin reactions concurrent with development of skin diseases such as psoriasis and atopic dermatitis. Pharmacological and dietetic control of the metabolism of arachidonic acid is a new and interesting therapeutic concept in the care of skin diseases. Also, fish oil, which is rich in linoleic acid and poor in arachidonic acid, seems to be useful in basal treatment of psoriasis. The value of evening primrose oil, which is rich in gamma-linoleic acid, in the treatment of atopic dermatitis is discussed.

Xeroderma pigmentosum and refractory anaemia in two first cousins

We report two first cousins with xeroderma pigmentosum who developed a refractory anaemia with excess of blasts which resulted in their deaths.

Benefit of progressively increasing doses during the initial treatment with acitretin in psoriasis

The purpose of this double-blind study was to compare the therapeutic effects of a low initial dosage of acitretin, increased at 2-week intervals (group 1: 10, 30, 50 mg/day) with a high initial dosage decreased at similar intervals (group 3: 50, 30, 10 mg/day) and with a constant dosage (group 2: 30 mg/day) in 66 patients (47 men and 19 women) with severe psoriasis. At the end of the double-blind phase, the mean percent improvement, calculated by the Psoriasis Area and Severity Index score, was as follows: 62.7% in group 1, 55.9% in group 2 and 67.1% in group 3. The double-blind phase of 6 weeks was followed by an open phase of 6 weeks, during which the patients were treated either with 10, 30 or 50 mg/day, according to the therapeutic response. At the end of treatment (12 weeks), a mean improvement of more than 80% was obtained in all three groups. Hypervitaminosis A signs and symptoms were observed in all patients. The frequency and severity of these adverse reactions were shown to be dose-dependent. This study shows that a low dose progressively increased is advisable because of similar activity and better acceptability.

Eosinophilic pustular folliculitis (Ofuji's disease): efficacy of isotretinoin

The case of a 30-year-old man with a 6-year history of eosinophilic pustular folliculitis (EPF) is reported. Isotretinoin (1 mg/kg/day) led to a dramatic improvement of all the lesions within 2 weeks. The withdrawal of the drug was followed by a recurrence after 10 days of the papulopustular, follicular and pruritic lesions. Reintroduction of isotretinoin was successful. The benefits of isotretinoin in the treatment of EPF have, to the best of our knowledge, never been reported previously. The mechanisms underlying this efficacy may involve the inhibition of the eosinophilic chemotactic factors thought to be present in sebaceous lipids and in the stratum corneum of patients suffering from EPF.

Collagen biosynthesis and isomorphism in a case of Ehlers-Danlos syndrome type VI

Collagen metabolism was studied in fibroblasts grown from a skin biopsy specimen of a patient who presented the striking clinical features of Ehlers-Danlos syndrome and, in particular, hyperextensibility of the skin, hypermobility of the joints, and kyphoscoliosis. A reduction in lysine hydroxylation, characteristic of Ehlers-Danlos Type VI, was observed after labelling of the collagen with 14C-proline and 3H-lysine. Other modifications in the collagen metabolism of fibroblast cultures were noted, including an increase in collagen and total protein synthesis, and an increase in both the Type I and Type III collagen. The percentage of Type III collagen was, however, lower than in the control fibroblasts. The results point out the complexity of collagen disturbances in Ehlers-Danlos Type VI.

Single nodule on the glans penis: metastatic lesion from an unusual carcinoma of the prostate

An inflammatory nodule developed on the glans penis of a 79-year-old man. Histological examination confirmed the diagnosis of metastasis from a carcinoma of the prostate. This case is of interest in view of the rarity of this metastatic localization and the very unusual microscopic pattern of the primary cancer (epidermoid carcinoma).

Severe erosive lichen planus and polycythemia vera in an adolescent

Erosive lichen planus developed in a 12-year-old adolescent also presenting polycythemia vera (Vaquez' disease). Though a casual association cannot be excluded, the rarity of the two diseases in children suggests a pathogenetic link, possibly involving an abnormal hematologic stem cell line.

[Gonococcal and nongonococcal urethritis in the male. Apropos of 100 cases treated with doxycycline polyphosphate]

After pointing out the epidemiological significance of sexually transmitted diseases, the authors report results in 100 male patients given doxycycline polyphosphate during 2 weeks for urethritis. Ten patients had post-gonococcal urethritis and twenty others had persistent urethritis afer a first treatment had failed. The association Chlamydia trachomatis-Staphylococcus albus was the most common bacteriologic finding. Staphylococcus aureus and Neisseria gonorrhea were demonstrated in 24 and 12 cases respectively. Ureaplasma urealyticum was found in only four instances. Clinical and bacteriological results show that doxycycline polyphosphate was effective in 92 out of 100 cases. Circumstances of the eight failures are analyzed specifically. Clinical tolerance was excellent in every case. Following confrontation with recent data from the literature, these results lead the authors to conclude that gonococcal and non-gonococcal urethritis is an indication of choice for doxycycline polyphosphate.

[Should thalidomide be rehabilitated?]

Thalidomide (alpha-N-phtalimido-glutarimide) was withdrawn from sale in 1961 since it was held responsible for the birth of hundreds of phocomelus children. Despite this teratogenic potential, thalidomide remains a useful tool in the treatment of erythema nodosum leprosum, as well as in discoid lupus erythematosus when antimalarial drugs are ineffective or contraindicated. In addition, good results have been reported in several diseases such as actinic prurigo, polymorphous light eruption, Behçet syndrome, Weber-Christian disease, prurigo nodularis, pyoderma gangrenosum and ulcerative colitis. The mechanism of action is under debate but it is likely that thalidomide has immunomodulating properties by controlling T-suppressor lymphocytes, and anti-inflammatory effects, particularly an inhibition of neutrophil chemotaxis. Several attempts at synthesis of effective thalidomide derivatives devoid of teratogenic effects are ongoing.

Small bowel deposition of crystals associated with the use of clofazimine (Lamprene) in the treatment of prurigo nodularis

A 46-year-old woman with widespread prurigo nodularis was treated with 300 mg clofazimine a day for six months. Ten months after stopping the drug she complained of weight loss and gastrointestinal side effects which were shortly improved by a gluten-free diet, but relapsed one year later. At laparotomy, all tissues were stained bright orange-yellow, and histological examination showed crystals deposited in the chorion of intestinal villi and in the mesenteric lymph nodes.

[Verrucous carcinoma. Apropos of a case report with palpebral localization]

The authors present a case of "verrucous carcinoma" of the eyelid. Such a location never seems to have been described in the literature. As the histological features of the tumor are highly differentiated the exact diagnosis can be ascertained, only upon examination of a large biopsy specimen or of the operative specimen. Clinical, histological and evolutional features are recalled. The therapeutic means of curing this locally malignant and potentially recurrent lesion are discussed. In most cases, recovery depends on early treatment, particularly on surgery.

[Stewart-Treves syndrome. 2 cases with an ultrastructural study]

The authors present an ultrastructural study of two cases of Stewart-Treves syndrome in elderly women. Under light microscopy, the dermal and hypodermal proliferations showed vascular features which were more clearly preceptible in the second case than in the first. Ultrastructural studies showed, in the first case, clefts containing erythrocytes and surrounded by neoplastic cells which were linked by zonulae adherentes. A rudimentary form of basal membrane was also noted, with an exterior lining of pericyte-like cells. In the second case, typical capillary vessels were bordered by endothelial cells containing a few pinocytotic vesicles and microfilaments, in contact by zonulae adherentes. The walls of these vessels consisted of a clearly defined membrane lined with pericytes, and constituting, in some areas, an anastomotic network due to the swelling of the endothelial cells. Ultrastructural study suggests an angiosarcomatous origin of these lesions. Finally, the article includes a review of the literature.

[Acute dermatomyositis in the development of a nevocarcinoma of the great toe]

A case of acute Unverricht-Wagner dermatomyositis occurring two years after amputation of a great toe for malignant melanoma graded stage IV in Clark's classification is reported. A review of the literature found only six previous reports of dermatomyositis associated with malignant melanoma.

[Exudative enteropathy caused by clofazimine: apropos of a case]

The authors report a case of a forty-six year old woman suffering from generalized prurigo nodularis. This dermatosis was associated with a cellular immunodeficiency; therefore a clofazimine therapy 300 mg/a day was instituted for six months. Ten months after the cessation of the clofazimine therapy, there appeared a malabsorption syndrome that was temporarily improved by gluten--free diet the real etiology was only ascertained during laparotomy, when masses of crystals in the small intestine mucosa as well as in mesenteric lymph nodes were observed. Therefore when it is necessary to prescribe clofazimine to take advantage of become its immunoregulating properties, it must always become in mind that an intestinal complication may ensue: this is well recognized in articles appearing in journals devoted to leprosy.

[Hormonotherapy in acute, idiopathic hirsutism, and seborrheic alopecia (author's transl)]

It has been established that, through skin responds to circulating androgens, it can also produce androgens from precursors. Therapy can address either of the two following physiopathological steps: the secretory step can be countered by replacement or suppressive therapy which is now fairly well mastered; the target-organ step opens new possibilities concerning receptor abnormalities and receptor control. The medical literature was reviewed for data on hormonal therapy for women with acne, idiopathic hirsutism and seborrheic alopecia, three conditions which are usually only partially improved by cosmetic treatment.

[Montgomery xanthomatosis (author's transl)]

A typical case of Montgomery xanthomatosis is reported by the authors. Out of this case and of a hundred other ones gathered from the literature, they outline the main features of the disease. It is revealed as being stereotyped and particularly the prognosis is usually good. Whether the ultra structural study may show Langerhans corpuscules or not, it brings us a material to the discussing of border-line cases (xanthomatosis with diabetes insipidus, Hand-Schüller-Christian disease with cutaneous lesions similar to Montgomery's.

[Cutaneous manifestations of mediterranean periodic disease. Concerning an observation. Review of the literature (author's transl)]

Méditerranean Periodic Disease is frequently encountered in non-aschenazic Jews and in Armenians. Aside from the classic triad of pseudo-palustral febrile crises, paroxysms of abdominal and articular pain, and a biological syndrome of inflammation; cutaneous manifestations were noted in 25 to 35% of the cases according to various authors. The most commonly encountered lesions consisted of erysipel-like plaques and subcutaneous nodules. We observed the case of a 47 years old Armenian male, afflicted with Mediterranean Periodic Disease for 30 years in which the dermatologic symptoms are quite classic aside from a vitiligo having progressively appeared since 15 years. Possibly a coincidental association, but to the best of our knowledge, which has not as yet been reported.

[The association tretinoin-erythromycin base: a new topical treatment for acne. Results of a multicentric trial on 347 cases (authors transl)]

A multicentric trial involving ten dermatological departments was conducted to evaluate the efficacy and tollerance of ANTIBIO-ABEREL (an association of Tretinoin and Erythromycin base) in 347 patients with persistant acne. Complete healing or considerable improvement was obtained in 85% of cases. This new treatment was active against both inflammatory lesions (papules and pustules) and retentional elements (microcysts and open comedones). It was also rapidly active, as very favorable results were obtained in ten weeks or less, in more than half of the cases. The tolerance was remarkable (less than 1% of cases had to interrupt treatment). This product represents an important progress as compared to Tretinoin alone. No other local or systemic therapy, especially long term antibiotherapy, is required.

[Clinical trial of Pulvo 47 Neomycin in the treatment of leg ulcer (author's transl)]

Pulva 47 Neomycine was tested in 30 patients suffering from a leg ulcer, 11 of those were surinfected. Half the ulcers dated back over 6 months. The would preparation included a careful cleaning with a permanganate or dakin's solution. In most of the cases, the product was applied on a once a day basis during an average period of 30 days. In 12 patients, the severity of the infection needed an additional antibiotherapy administered orally. The results were expressed in relation to the activity on the infection and wound healing. In 28 patients, the signs of infection disappeared completely. The wound healing effect was very satisfying in 22 patients (19 of them had varicose or post-phlebitis ulcers). The value of the results is independent on the date of onset and on the area of the lesions. The tolerance was good; only 4 patients suffered from itching after the application of the compound. It is mainly through his wound healing effect that Pulvo 47 Neomycine represents a progress compared to other similar specialties.

[Multicentric clinical trial of a new combination of a broad spectrum antimycotic and a dermocorticoid (author's transl)]

After having reviewed the conditions of use of an antimycotic-corticoid combination, the authors are reporting their clinical results on 183 patients of a new drug combining econazole and triamcinolon. This clinical trial demonstrates that the own activity of each component of the combination is entirely maintained, and that the new combination shows an original interest in the treatment of all inflammatory dermatomycoses, as well as inflammatory supra-infected dermatoses.

[Crosti's reticulosis. Report on three cases, one with ultrastructural study (author's transl)]

Crosti's reticulosis is defined as a peculiar form of well-circumscribed, slow developing lymphomas in adults, with a malignant histological picture. Three cases with typical dorsal localisation according to Crosti's first description are reported and the cardinal features of this type of tumour are recalled. One observation includes an ultrastructural study which confirms the malignant nature of histiocytes in this disease. Localisation in back seems not to be exclusive and a study of 32 cases of the literature about other localised cutaneous reticulum cell lymphomas show them similar to Crosti's reticulosis-which authorizes their classification, as was proposed by Thiers in a single group of slow developing circumscribed reticuloses.

[Cutaneous periarteritis nodosa. Critical study about 4 cases (author's transl)]

Cutaneous form of periarteritis nodosa. Four personal cases are added to 70 cases of the previous literature. The clinical and biological picture of the cutaneous form of P.A.N. are different from the systemic one by the lack of visceral involvement and a noteworthy good long-term prognosis. Venous (superficial thrombophlebitis) and distal arterial involvement in some cases, raise doubts about diagnosis and classification. The solution is in an accurate definition of the diagnostic clues and specially of the histopathological ones.