EDITORIAL ESPANOL:

====================

Hola a todos, DERMAGIC con ustedes de nuevo. La semana pasada di un paseito 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.

Próxima edición: MELANOMA Y VACUNAS, 

Hola amigos DERMÁGICOS, allí va la segunda parte de la revisión sobre LUPUS ERITEMATOSO SISTÉMICO, el tema es muy amplio y seleccione las mejores de los años 97-99. y se actualizo 2024 haciendo énfasis en el tratamiento.

Saludos,,,

Dr. José Lapenta R.,,,

 EDITORIAL ENGLISH:

===================

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. 

Next edition: MELANOMA AND VACCINE

Greetings,,,

Dr. José Lapenta R. 

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ENCONTRADOS EN LA RED / FOUND IN 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

=====================================================================

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

=====================================================================

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. 

=====================================================================

3.) Hylaform Approved In Australia For Correction Of Facial Wrinkles,

Depressed Scars

=====================================================================

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. 

=====================================================================

4.) Neoral Study Visually Confirms Efficacy In Severe, Recalcitrant, Plaque

Psoriasis 

=====================================================================

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.

=====================================================================

5.) FDA Approves Panretin Gel For AIDS-Related Kaposi's Sarcoma

=====================================================================

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. 

=====================================================================

6.) Severe Shingles Pain Relieved With Anti-Convulsant Drug Gabapentin 

=====================================================================

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." 

=====================================================================

7.) WORLD AIDS CONFERENCE: Panretin Acts As An Anti-Tumour Agent In

Kaposi's Sarcoma Treatment

=====================================================================

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.

=====================================================================

8.) Famvir Prevents Herpes Outbreaks During Laser Skin Resurfacing

=====================================================================

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.

=====================================================================

9.) FDA Clears Cryosurgical Treatment For Verruca Plana 

=====================================================================

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. 

=====================================================================

10.) Researchers Identify Substance Which Protects Against UV Skin Damage

=====================================================================

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. 

=====================================================================

11.) Erbium-YAG Laser -- The New Wunderkind In Skin Rejuvenation

=====================================================================

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. 

=====================================================================

12.) Ultrapotent Topical Corticosteroid Treatment of Childhood Genital Lichen Sclerosus 

=====================================================================

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

=====================================================================

13.) The Use of Sucralfate Suspension in the Treatment of Oral and Genital Ulceration of Behçet Disease A Randomized, Placebo-Controlled, Double-blind Study

=====================================================================

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

=====================================================================

14.) Anti--Fodrin Antibodies in Sjögren Syndrome and Lupus Erythematosus 

=====================================================================

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

=====================================================================

15.) Turbo-PUVA: Dihydroxyacetone-Enhanced Photochemotherapy for Psoriasis 

A Pilot Study 

=====================================================================

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

=====================================================================

16.) Systemic Toxicity Following Administration of Sirolimus (FormerlyRapamycin) for Psoriasis association of Capillary Leak Syndrome With Apoptosis of Lesional Lymphocytes 

=====================================================================

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 

=====================================================================

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 

=====================================================================

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

=====================================================================

18.) Comparison of Erbium:YAG and Carbon Dioxide Lasers in Resurfacing of

Facial Rhytides 

=====================================================================

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 

=====================================================================

19.) The Drug for the Turn of the Millennium? 

=====================================================================

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 

=====================================================================

20.) Association of the Köbner Phenomenon With Disease Activity and

Therapeutic Responsiveness in Vitiligo Vulgaris 

=====================================================================

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

=====================================================================

21.) Vitiligo Antibodies Are Not Directed to Tyrosinase 

=====================================================================

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

=====================================================================

22.) Efficacy of Erbium:YAG Laser Ablation in Darier Disease and

Hailey-Hailey Disease 

=====================================================================

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

=====================================================================

23.) Pulse Dosing of Thioguanine in Recalcitrant Psoriasis 

=====================================================================

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

=====================================================================

24.) Why Does Carbon Dioxide Resurfacing Work? A Review 

=====================================================================

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

=====================================================================

25.) Prognostic factor analysis in mycosis fungoides/Sézary syndrome

=====================================================================

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.) 

=====================================================================

25.) Finasteride in the treatment of men with frontal male pattern hair loss

=====================================================================

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 (59) 02/06/99 DR. JOSE LAPENTA R. 

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Produced by Dr. José Lapenta R. Dermatologist
Venezuela 1.998-2.024

Producido por Dr. José Lapenta R. Dermatólogo Venezuela 1.998-2.0024

Tlf: 0414-2976087 - 04127766810