Baruch Kaplan

Modified Topical Photodynamic Therapy of Superficial Skin Tumors, Utilizing Aminolevulinic Acid, Penetration Enhancers, Red Light, and Hypertherntia

background. Photodynamic therapy (PDT) is a noninvasive selective therapy for a specific group of skin tumors. objective. In this study we used a modified topical medication in which ethyleneamine tetra acetic acid (EDTA) and dimethyl‐sulphoxid (DMSO) were added to 5‐aminolevulinic acid 20% (ALA) followed by exposure to a novel high output light source emitting red and infrared irradiation. methods. ALA 20%‐EDTA 2%‐DMSO 2% in a water in oil cream base was applied to the tumors. After 12 hours the tumor was exposed to red (585–720 nm; 150 mW/cm2) and near infrared irradiation (1.25–1.6 mm; 50 mW/cm2) for 10–15 minutes by the VersaLight incoherent filtered light source. results. Complete responses were achieved after one to three ALA‐PDT treatments in 26/31 lesions of superficial or small nodular basal cell carcinoma (BCC) (84%), and in four of five in superficial squamous cell carcinoma (SCC) (80%). Complete clearance was achieved in one patient with Bowens disease of the penis. conclusions. Topical PDT utilizing ALA 20%‐EDTA 2%‐DMSO 2% as the photosensitizer and VersaLight as the light source is a noninvasive, nearly painless treatment with excellent therapeutic and cosmetic results. Our data show the efficiency of this therapy for patients with certain subtypes of BCC, SCC, and Bowens disease.© 1998 by the American Society for Dermato‐logic Surgery, Inc.

TREATMENT OF PYODERMA GANGRENOSUM WITH CLOFAZIMINE

We report a case of pyoderma gangrenosum in a 80‐year‐old woman suffering from ulcerative colitis and treated with clofazimine. Significant improvement was evident within 5 days following commencement of therapy, complete healing occurred after only 4 weeks of treatment.

Tumescent anesthesia for dermatologic surgery. Cosmetic and noncosmetic procedures.

background. Tumescent anesthesia was originally described by Klein and Lillis for liposuction surgery. Its extension to many other interventions in dermatologic surgery (cosmetic and non‐cosmetic) has provided a significant contribution in the performance of safe, ambulatory, and simplified procedures. objectives. To demonstrate the validity of the technique in various procedures. methods. Over the course of 1 year all large reconstruction or cosmetic surgery was performed using tumescent anesthesia. In a total of 242 cases performed, the advantages and disadvantages of the procedure were analyzed. results. Tumescent anesthesia was found to be very effective in achieving adequate anesthesia for performance of the reconstructive or cosmetic procedures. Good patient compliance was achieved with no serious sequelae. conclusion. Tumescent anesthesia is one the most substantial progressions in the field of cosmetic and reconstructive surgery, with advantages that by far outnumber the few disadvantages.© 1998 by the American Society for Dermatologic Surgery, Inc.

Comparison of room temperature and warmed local anesthetic solution for tumescent liposuction : A randomized double-blind study

background The tumescent technique of local anesthesia has been accepted as the standard of care for liposuction surgery. Large volumes of a dilute solution of lidocaine, epinephrine, sodium bicarbonate, and triamcinolone are infused into the subcutaneous fat. The technique eliminates the need for general anesthesia and provides greater safety and improved esthetic results. objective A study was designed to evaluate the benefit of wanning of the local anesthetic to 40°C prior to infiltration and thus to determine whether warming provides improved patient comfort. methods A double‐blind randomized cross‐over study was performed in 16 patients undergoing outpatient tumescent liposuction. Pain scores were determined using a visual analog pain scale. results The mean pain score was significantly lower for areas treated with the 40°C warmed solution. conclusion Warming of local anesthetic solution for tumescent liposuction significantly reduces pain as perceived by the patient and is recommended in all tumescent liposuction surgery.

Wells' syndrome: report of a case and review of the literature

A 17‐year‐old woman presented with pruritic papules and plaque wheals on the upper and lower extremities, back, chest, and abdomen, which had appeared 4 months previously. Previous medical history revealed two surgical operations for ovarian cysts (the latter was 2 weeks prior to admittance to the hospital). There was family (brother) but no personal history of atopy, with no known drug allergies. A prior biopsy demonstrated urticaria.

Factitial Dermatitis Induced by Application of Garlic

tender, dome-shaped granular ttimor believed to be an infected kerato-acanthoma,^ The biopsy specimen, however, showed features consistent with condyloma latum. The V,D,R,L, was strongly reactive, and the FTA-ABs were reactive, as well. The patient received two intramuscular injections of benzathine penicillin 2,4 MU 1 week apart. One month later, only slight postinflammatory hyperpigmentation was evident. The V,D,R,L, titer was 1:16 1 month later and 1:4 6 months later,

Toenail abnormalities and onychomycosis in chronic venous insufficiency of the legs : should we treat?

Background  Toenail manifestations of chronic venous insufficiency (CVI) may often mimic the nail changes of onychomycosis. The current study aims to determine the frequency of toenails deformations in patients with CVI, onychomycosis prevalence among deformed toenails and the outcome of itraconazole treatment.

Itraconazole versus ketoconazole in the treatment of tinea versicolor

Tinea versicolor is a chronic superficial infection of the skin, caused by Malassezia furfur. The disease is recurrent and hard to eradicate with topical antifungal agents. In this study we compared the efficacy, safety and tolerability of three regimens of oral treatment for tinea versicolor: itraconazole 200 mg/day for 1 week, itraconazole 100 mg/ day for 2 weeks and ketoconazole 800 mg in 2 weekly doses of 400 mg. We randomly assigned 105 patients with extensive tinea versicolor to receive each of the three regimens and followed the patients for 16 weeks (a longer period than usual). At every visit, we checked the presence of tinea versicolor by direct KOH preparation and Woods lamp, and the presence of signs and symptoms of infection were recorded. Of the 105 patients, 89 completed the study, and no major side-effects were noted with any of the treatment regimens. Our results show that there were no significant differences in efficacy (cure rate), safety and tolerability between the three treatment r...

Open randomized comparison of different itraconazole regimens for the treatment of onychomycosis

Aims: This study aimed to compare the efficacy of four different itraconazole regimens in the treatment of toenail onychomycosis caused by dermatophytes.Methods: The four treatment regimens were: 3 months and 4 months of continuous treatment (200 mg/day of itraconazole) vs 3 months and 4 months of pulse therapy (400 mg/day of itraconazole for 1 week every month). The follow-up period was for 48 weeks after the end of treatment.Results: A total of 66 patients completed the study. Only three patients (4.5%) had reversible abnormal liver function tests. No significant difference in cure rates was noted between the pulse and the continuous treatment regimens during the follow-up period. At 12 and 24 weeks after the end of treatment, more patients in the 4-month treatment groups were cured compared with the 3-month treatment groups. However, at the end of the follow-up period the cure rates levelled among the four different regimens.Conclusion: Itraconazole, in each of the regimens tested, proved to be efficie...

Pellagra complicating Crohn's disease

A 20-year-old woman had a 6-month history of an apparent photosensitivity eruption that was refractory to topical steroid treatment. The patient had had Crohns disease since 11 years of age with intermittent exacerbations. Examination revealed mildly erythematous plaques with thin atrophic wrinkling and fine scale on the bridge of the nose, both sides of the mouth, sides of the neck, extensor aspects of the forearms and shins, and on the dorsal aspects of the hands and feet. They were sharply demarcated by a dark-brown, hyperpigmented zone. Abdominal examination disclosed hyperactive peristalsis. The neurologic examination revealed mild disturbances in immediate and midterm memory. Barium meal and follow-through x-ray revealed extensive involvement of the small intestine with many stenotic segments. A biopsy specimen taken from the rim of a plaque on the left arm showed psoriasiform epidermal hyperplasia, spongiosis, parakeratosis, and a few neutrophils in the stratum corneum. Laboratory tests showed low serum levels of iron (41 #g/d0, zinc (65 #g/d1), carotene (32 gg/dl), folate (2.6 ng/ml), a low serum iron binding capacity (141 #g/dl), and a high fecal fat excretion (9.3 gin/day). Levels of vitamin Btz, magnesium, copper, as well as coagulation function tests and repeated urine samples for porphyrins and amino acids were all normal or negative. The patient was treated with nicotinic acid, B complex, and an adequate nutritional dietary regimen; prompt cutaneous and neurologic improvement was noted.