The long-term safety and efficacy of cyclosporin in severe refractory atopic dermatitis: a comparison of two dosage regimens

An open, randomized trial was performed to determine the optimal dosage schedule with regard to the efficacy and safety of cyclosporin in severe atopic dermatitis. The study also provided clinical experience with regard to the efficacy and safety of long-term cyclosporin treatment. During a 2-month dose-finding period, 78 patients with severe, long-standing atopic dermatitis received cyclosporin at a dose of either 5 mg/kg per day, decreasing to 3 mg/kg per day (Group A), or 3 mg/kg per day, increasing to 5 mg/kg per day (Group B), Patients were maintained on their optimal dose for a further 10 months. Patients in Group A showed a significantly greater improvement in efficacy parameters over the first 2 weeks than with patients in Group B, but as the dose was decreased in Group A and increased in Group B, these differences were minimized. After 1 year, cyclosporin showed an efficacy of 59.8% in Group A and 51.7% in Group B, assessed by a severity score. Assessed in terms of an area score, these figures were 48.7% and 40%, respectively. Cyclosporin demonstrated a good safety profile during long-term treatment and was generally well tolerated. The lower starting dosage was not associated with higher dropout rates. This study showed no differences in efficacy or adverse events between the two dosage schedules in long-term treatment.

A comparison of 2 weeks of terbinafine 250 mg/day with 4 weeks of itraconazole 100 mg/day in plantar-type tinea pedis

This double-blind, parallel group study compared a 2-week course of terbinafine 250 mg/day with a 4-week course of itraconazole 100 mg/day. A total of 190 patients were enrolled, of whom 129 were evaluable for efficacy. At week 8, 69% of patients treated with terbinafine were classified as effectively treated (mycological cure, and clinical assessment total score < or = 2) vs. 67% in the itraconazole group. At week 16, however, the rating for effective treatment increased to 71% of the terbinafine group, but decreased to 55% of the itraconazole group. This difference was of borderline statistical significance (P = 0.06). The results of this study demonstrate that both drugs can be used safely, and that 2 weeks' treatment with terbinafine 250 mg daily is as effective as 4 weeks' treatment with itraconazole 100 mg daily, but with fewer long-term relapses.

Porphyria cutanea tarda in a patient with AIDS

A 53-yr-old man, known to have had AIDS for 6 months, developed the clinical signs and symptoms of porphyria cutanea tarda (PCT) preceding deterioration of his illness. Urinary porphyrin analysis confirmed the diagnosis of PCT. At the time the cutaneous blistering and scars developed, he was taking zidovudine and fluconazole. Reviewing the literature suggested that association of the two disorders is not purely coincidental. Anaemia, due to chronic immune activation and therapeutic options in the light of AIDS, could play an important role in the development of PCT. We recommend analysing the urine for porphyrins in HIV-positive patients who have chronic photosensitivity of the skin.

A randomized treatment duration-finding study of terbinafine in onychomycosis

Terbinafine is an allylamine antifungal compound shown to be effective in the oral treatment of onychomycosis. Because of the fungicidal activity of the drug, a shorter duration of treatment, compared with the currently used oral treatment modalities, can be expected in onychomycosis of the toenail. In the present randomized study, the efficacy of oral terbinafine treatment (250 mg/day) was assessed for periods of 6, 12, and 24 weeks. All patients were followed for up to 48 weeks after starting treatment. Of the 120 patients with toenail onychomycosis who entered the study, 98 were evaluable for efficacy. The involvement of the toenails was assessed both clinically and mycologically throughout the study. Evaluation at 24 weeks showed that complete cure of toenail onychomycosis was achieved in 67% of patients treated for 6 weeks, 82% treated for 12 weeks, and 85% treated for 24 weeks. At the end of a further 24 weeks of follow-up, cure rates were 40%, 71% and 79%, respectively. The adverse effects of terbinafine were mostly mild-to-moderate gastrointestinal symptoms. Three patients discontinued treatment because of side-effects. In conclusion, oral treatment with terbinafine is effective and generally well tolerated in patients with onychomycosis. Our results demonstrate that, for toenail onychomycosis, a treatment period of 12 weeks is sufficient.

[Group treatment of psoriasis with the duo formula]

Group treatment for and by psoriasis patients was the subject of a trial. For 12 sessions over a period of 3 months, a fellow sufferer as co-helper cooperated with a professional specialist as co-worker according to the so-called duo formula. When the results were compared with those in a control group, the patients showed a change in the dimensions examined, as well as in their illness behaviour and insight into the value of problem-solving in groups. Therefore, it is recommended that dermatologist/co-helper teams be instructed for group treatment of chronic skin diseases, because this method stimulates self-activity in patients.

Pseudomonic acid, a new antibiotic for topical therapy

Pseudomonic acid, a new wide-spectrum antimicrobial agent, was evaluated as a 2% formulation in a cream. Animal studies showed that this formulation was just capable of penetrating the skin. When administered parenterally to animals, pseudomonic acid was converted to inactive metabolites that were quickly eliminated from the body. When pseudomonic acid was applied as a cream to human skin, no sensitization was observed. In an open clinical study, sixty-eight patients with skin infections (mostly superficial conditions such as impetigo, infected eczema, folliculitis, or balanitis) applied pseudomonic acid cream three times a day for 5 days. In fifty patients the infections completely cleared within 2 days of the end of therapy, and considerable clinical improvement was noted in sixteen more. One patient stopped the treatment prematurely due to local burning pain, and one patient could not be evaluated clinically.

Group therapy of psoriasis. Duo formula group treatment (DFGT) as an example

Between 1978 and 1982 an experiment on group treatment for and by psoriasis sufferers was conducted, based on a pyramid of previous investigations since 1968. Each group was facilitated by a duo consisting of a fellow sufferer and a physician, both having trained together. The subjects practiced the procedure described, directed toward self-care and mutual aid facilitated and supported by the duo, in a series of ten 2-hour weekly sessions. A pretest/posttest control group design was used. Comparing the results of the quantitative analysis of the experimental groups with those of the control groups, the experimental groups showed significant change. The results of the qualitative analysis showed that decrease of anxiety correlated with mastering of the skills involved. The key element affecting outcome was the balance in cooperation within the duo, the expertise of the patient lying in his personal experience of the condition, and the expertise of the physician in his knowledge and skills. One of the method's main characteristics was the intrinsic complementarity of the duo partners.

Intermittent topical treatment of psoriasis with betamethasone dipropionate 0.05 percent cream

Seventy-three patients with psoriasis were treated in an open multicenter study with betamethasone dipropionate 0.05 percent cream (twice daily application for four days) alternated with the cream base (twice daily application for three days). The therapeutic response at the end of the treatment period of three weeks was very satisfactory: 39 patients had marked improvement or recovery, 16 patients had moderate improvement, and 14 patients had slight improvement. These results did not differ from those of a study on continuous treatment with betamethasone dipropionate cream in the treatment of psoriasis. Side effects (folliculitis) were only noted in one patient.

Comparative study of triamcinolone acetonide and hydrocortisone 17-butyrate in rosacea with special regard to the rebound phenomenon

The clinical efficacy and the rebound phenomenon were studied in a left-right double-blind trial comparing triamcinolone acetonide (TA) and hydrocortisone 17-butyrate (HC 17-B, Locoid). The trial comprised 19 patients with rosacea-like dermatitis of whom 7 did not receive treatment and 12 were pretreated with betamethasone valerate (BMV). Tetracyclince was given all the time as additional treatment. Clinically there was no significant difference between TA and HC 17-B. No rebound phenomenon was observed. If corticosteroids are to be used at all in rosacea or resoacea-like dermatitis, preference is given to HC 17-B.

Livedo racemosa-like photosensitivity reaction during quinidine Durettes medication

Two patients on quinidine Durettes medication developed a photosensitive reaction 48 h after sun exposure. The reaction started with a pronounced oedema, followed by a reticulate daik blue discolouration; purpura developed in the discoloured areas. Patch tests and photo patch tests with quinidine sulphate and with quinidine Durettes were negative. As yet it has not been decided whether the quinidine or another constituent of the quinidine Durettes has caused the reaction.