Barry A. Solomon

Fluconazole for the treatment of tinea capitis in children.

Fluconazole, a water soluble bis-triazole, is a highly selective inhibitor of fungal cytochrome P450 and sterol 14-alpha demethylation. It has good bioavailability, low protein binding, and a long half-life. After oral administration it rapidly distributes to the subcutaneous tissues and epidermis, where it accumulates. Favorable results have been obtained with fluconazole in the treatment of various systemic mycoses, candidiasis, and dermatophyte infections. We studied the efficacy of fluconazole in the treatment of tinea capitis in children.

Quality of care : Issue or oversight in health care reform ?

BACKGROUND Health care reform is not dead but merely on hiatus. The vehicle for the reform is managed care, in particular health maintenance organizations (HMOs). HMOs employ primary care physicians as gatekeepers to act as regulators and points of entry into the health care system. It is through these gatekeepers that most dermatologic care is rendered. OBJECTIVE Our purpose was to assess (1) the level of dermatology training of family practice physicians compared with dermatologists and (2) the impact on the delivery of quality dermatology services. METHODS a national study of university residency programs was undertaken. Twenty color Kodachromes of typical cutaneous diseases were analyzed by the two physician groups. A questionnaire was used to evaluate the average formal dermatology training received, the number of primary dermatology patients examined by family practitioners, the correct response rates to the questions, and the dermatologic procedures performed by family practitioners. A total of 723 family practice physicians and 443 dermatologists responded. RESULTS Our results indicate that, in comparison to dermatologists, primary care physicians significantly are deficient in their ability to recognize common and serious dermatoses. CONCLUSION this study provides data emphasizing the need for reevaluation of the dermatology curriculum in medical schools and family practice residencies. Most important, it suggests that direct access to dermatologists provides better quality of care to members of HMOs and hence indirectly is most cost effective for the provision of dermatology services.

Neonatal lupus erythematosus: Discordant disease expression of U1RNP-positive antibodies in fraternal twins—Is this a subset of neonatal lupus erythematosus or a new distinct syndrome?

Neonatal lupus erythematosus (NLE) is an uncommon disease that is manifested by cutaneous lesions, cardiac conduction defects, or both, that appear in utero or shortly after birth. In approximately 95% of patients, anti-Ro antibody (Ro[SS-A]) has been identified and has become the serologic marker for NLE. Since 1987 there have been four reported cases of Ro- and anti-La antibody (La[SS-B])-negative, U1RNP antibody-positive, NLE. Our affected twin, as well as all other infants with U1RNP-positive NLE, had cutaneous lesions similar to those in Ro-positive NLE, although they lacked systemic abnormalities, including cardiac conduction defects. HLA typing of mothers with infants with U1RNP-positive NLE revealed the presence of HLA-DR4, DQw1, or DQw3 phenotypes. Our typing confirms these findings. As with Ro-positive NLE, no distinct HLA associations were demonstrated in the infants. Unlike Ro-positive mothers, all mothers with a U1RNP-positive infant with NLE had connective tissue disease at the time of the diagnosis and had a different spectrum of disease. We describe the clinical, serologic, and immunogenetic findings in the first reported case of U1RNP-positive NLE in dizygotic twins in whom the NLE disease expression was discordant.

Effects of detergents on acne

A cne vulgaris is a disease that affects more than 17 million people, all of whom can benefit from medical care.* Over the past several years, excellent progress has been made in developing effective topical and oral preparations to treat acne; nevertheless, advice regarding skin hygiene and care is a mandatory component to any effective acne therapeutic regimen. The goals of such counseling for the acne patient are:

Modification of neutrophil functions by naftifine

Naftifine (NF), a topical antimycotic agent, is highly active in vitro and in vivo against a wide range of pathogenic fungi. NF inhibits human polymorphonuclear leucocyte (PMN) chemotaxis. Following stimulation with zymosan‐activated serum. 85–97% of the PMNs exhibited detectable membrane ruffling and polarity. In contrast, NF‐treated PMNs did not exhibit such chemotactic factor‐induced shape changes. We also analysed the effect of NF on PMN superoxide anion (O2−) and chemiluminescence (CL) production, as a measure of respiratory burst activity. Stimulation of PMNs pre‐incubated with NF (37°C for 30 min at 1–150 μg/ml) hy FMLP, PMA and zymosan resulted in a dose‐dependent inhibition in PMN CL. Doses of NF which depressed chemotaxis, inhibited CL and diminished O2− production in a statistically significant manner (P<0.05–0.001). In conclusion, NF alters membrane‐related responses in PMNs, and this alteration may be associated with a change in PMN morphology. Binding of NF to PMN membrane sterol, with a subsequent alteration in membrane configuration, is the most likely cause of the inhibition of PMN function. The data collectively document biochemical and morphological differences between control and NF‐treated PMNs as determined by stimulus‐specific CL and O2− generation and membrane shape change. Such differences may account, in part, for its efficacy in inflammatory fungal skin diseases.

Disorders of sweat glands: hyperhidrosis: unapproved treatments.

Hyperhidrosis is a disorder of excessive sweating beyond the amount needed to cool down an elevated body temperature. The quantitative assessment of excessive sweat can be performed with the starch-iodine test 1 or gravimetry. 2 Hyperhidrosis can be categorized as generalized, localized, or emotional. Generalized and some forms of localized hyperhidrosis usually occur secondary to an underlying cause, and should be treated accordingly. 3 Emotional stimuli can provoke hyperhidrosis of the palms, soles, and axillae; this chapter will focus on the treatments for emotional hyperhidrosis. Topicals Antiperspirants are the first line of therapy; they are inexpensive with minimal, if any, side effects. The most effective topical agents for use on the palms, soles, and the axillae are solutions of aluminum chloride hexahydrate in anhydrous alcohol (Drysol, 25%, and Xerac AC, 6.25%, Person and Covey Inc; CertainDri, Numark Labs; Maxim 12.5%). The action of aluminum salts on the eccrine duct and method of their nocturnal application

Effect of naftifine on neutrophil adhesion.

Effective methods of fungal treatment involve reduction in fungal infections and host inflammatory responses. Naftifine (NF), a topical antifungal agent, is highly active in vitro and in vivo against a wide range of pathogenic fungi. Additionally NF has been shown to inhibit polymorphonuclear leukocyte (PMN) chemotaxis and respiratory burst activity in an irreversible dose-dependent and time-dependent manner. Since leukocyte adherence to endothelia is believed to be one of the initial crucial events in the recruitment of circulating leukocytes to the site of inflammation, we have investigated the in vitro effect of NF on PMN adherence to nylon fiber, BSA-coated glass chamber or polystyrene, and endothelial monolayers via three adherence assays. All three assays demonstrated a statistically significant reduction (p < 0.01-0.001) in PMN adherence to the respective media. In particular, NF (at 30-60 micrograms/ml) significantly inhibited PMN adherence to endothelial monolayers (p < 0.01) as measured spectrophotometrically by the uptake of rose bengal stain. Therefore, NF inhibits PMN adherence to endothelia in our in vitro model system. This inhibition may constitute part of the anti-inflammatory effect of NF.

Parallel scanning of auditory and visual information

Two experiments involving memory retrieval of auditorilv and visually presented materials were performed. In Experiment I, subjects were presented with memory sets of 1, 2, or 4 stimuli and then with a test item to be classified as belonging or not belonging to the memory set. In Condition 1, each memory stimulus was a single, auditorily presented letter. In Condition 2, each memory stimulus was a visually presented letter. In Conditions 3 and 4, each memory stimulus was a pair of letters, one presented visually and the other auditorily. Mean reaction time (RT) for the classification task increased as a function of number of memory stimuli at equal rates for all four conditions. This was interpreted as evidence for a parallel scanning process in Conditions 3 and 4 where the auditory item and visual item of each memory stimulus pair can be scanned simultaneously. Experiment II compared memory retrieval for a simultaneous condition in which auditory and visual memory items were presented as pairs with a sequential condition in which mixed auditory-visual memory sets were presented one item at a time. RTs were shorter for the simultaneous condition. This was interpreted as evidence that parallel scanning may depend upon memory input parameters.