Acute and maintenance treatment of atopic dermatitis in children – two comparative studies with fluticasone propionate (0.05%) cream

BACKGROUND

Two multicentre, randomised, parallel group, double-blind, comparative studies in children (2-14 yr) evaluated fluticasone propionate (FP) 0.05% cream for both acute and maintenance treatment of moderate to severe atopic dermatitis (AD).

METHODS

One study compared FP with hydrocortisone (HC) 1% cream (FP 70, HC 67) and the other with hydrocortisone butyrate (HCB) 0.1% cream (FP 67, HCB 62). Treatments were applied twice daily, for 2-4 weeks until the AD was stabilised, and thereafter intermittently ('as required') for up to 12 weeks.

RESULTS

The primary outcome measure, Total AD Score, recorded at the end of the acute and maintenance phases, was significantly lower (indicating improvements in disease severity) following treatment with FP compared with either HC or HCB (acute phase difference vs. HC, -2.39, 95%CI -3.47, -1.31; p<0.001 and vs. HCB, -1.25, 95%CI -2.46, -0.05; p=0.042) and (maintenance phase difference vs. HC, -1.88, 95%CI -3.20, -0.56; p=0.006 and vs. HCB, -1.39, 95%CI -2.72, -0.05; p=0.042). In both studies treatments were equally well tolerated with no visible signs of skin atrophy.

CONCLUSION

In both the acute and longer term management of AD in children, FP demonstrated a high level of efficacy and maintenance of disease control with a tolerability similar to HC 1%, a lower potency corticosteroid.

Cutaneous recall reactions with systemic fluorouracil

5-Fluorouracil is used extensively to treat actinic keratoses as there is selective excessive uptake of 5-fluorouracil in rapidly dividing cells, thus causing inflammation in lesional skin. We report 2 cases of inflammation occurring on clinically normal skin after fluorouracil had been administered parenterally for carcinoma of the oesophagogastric junction and lower third of the oesophagus, respectively. In the first case, actinic keratoses had previously been treated with topical fluorouracil and in the second case, although there were no previous actinic keratoses, there was a high degree of previous solar exposure of the affected areas. In each case, there was a good response to topical steroid application. No recurrence was experienced on further doses of systemic fluorouracil when the skin was treated prophylactically with topical steroids. Recognition of these reactions is important if unnecessary discontinuation of chemotherapeutic drugs is to be avoided as a result of fear of allergic drug reactions.

Twice-daily vs. once-daily inpatient dithranol for psoriasis

The aim of this study was to compare the efficacy and tolerability of twice-daily vs. once-daily regimes of dithranol (anthralin) in Lassar's paste. Over a 4-year period, 61 inpatients with stable plaque psoriasis gave informed consent and entered a randomized controlled trial, having twice or once-daily application of dithranol in Lassar's paste as part of otherwise standard Ingram's regime. Primary outcome measurements were time required in hospital, nursing time, changes in total body surface area affected by psoriasis and thickness of a target plaque and in some patients, an assessment of the recurrence of psoriasis. Doctors were blinded as to the regime being used. At entry, mean patient age, lesional surface area and target plaque thickness were comparable in both groups and no patient had received systemic therapy in the preceding 3 months. Forty-two patients completed the study, two (11%) in the twice-daily group withdrawing due to skin irritation or 'burning'. Mean lesional surface area and target plaque thickness were similar in both groups at hospital discharge. Mean (+/- SD) time spent in hospital was not significantly different in each group, being 13.3 (+/- 6.2) days and 13.9 (+/- 4.5) days for the twice-daily and once-daily groups, respectively (P = 0.36). Duration of hospitalization did not correlate with surface area or plaque thickness on admission. Mean (+/- SD) nursing time spent on treatment was significantly greater in the twice-daily group, at 0.82 (+/- 0.33) hours per day compared with 0.51(+/- 0.25) hours per day in the once-daily group. Relapse rate at 6 months was not different between the two groups.

Polymorphic eruption of pregnancy developing in the puerperium

Polymorphic eruption of pregnancy is an uncommon disorder, usually developing in the third trimester and rapidly resolving in the first few weeks postpartum. It has been suggested that multiple pregnancy and excessive weight gain are associated features. We report a patient with the clinical and histological features of polymorphic eruption of pregnancy, whose rash developed 4 weeks after delivery of a singleton pregnancy. An unusual feature of this case was the occurrence of the rash on the face. We discuss this case with respect to the recent literature.

Clinical measurement of dimensions of basal cell carcinoma: effect of waiting for elective surgery

Fifty well-defined basal cell carcinomas (BCCs) on the face, outside the central T, were studied to establish change in size between initial assessment and surgery. The major and minor diameters were measured at presentation and when the patients attended for elective excision 21-155 days later (mean 70). The median change in major diameter was an increase of 0.5 mm (range - 3 to + 4, P < 0.05). The median change in area was 4.71 mm2 (range - 54 to + 64, P < 0.05). Although there is a statistically significant increase in major diameter and area, it was small in clinical terms. The major axis increased by > 1 mm in 8% of cases. In no case was treatment or completeness of excision compromised by waiting. A mean delay of 10 weeks between review and surgery does not appear to compromise the outcome of treatment of BCC in patients with well-defined BCCs of the face outside the central T.