David L. Cram

A double-blind, vehicle-controlled study of clobetasol propionate 0.05% (Temovate) scalp application in the treatment of moderate to severe scalp psoriasis

The efficacy and safety of clobetasol propionate 0.05% scalp application was evaluated in 378 patients with moderate to severe scalp psoriasis in a double-blind vehicle-controlled parallel group study. After 2 weeks of twice-daily applications, 81% receiving active drug versus 22% receiving vehicle had clearing of 50% or greater. Complete clearing was seen in 26% with active drug and 1% with vehicle. Local side effects were primarily burning or stinging in 11% and 10% of patients treated on an active or a vehicle regimen, respectively. The morning cortisol levels of 168 patients were checked at baseline and again after 2 weeks of drug therapy. Subnormal morning plasma cortisol values were seen in 5% of the patients receiving active drug and in 5% receiving vehicle; 13% of those taking active drug versus 5% taking vehicle had a 50% or greater decrease in morning cortisol at the 2-week visit compared with baseline values. Clobetasol propionate 0.05% scalp application appears to be a safe and an effective treatment for scalp psoriasis.

The Goeckerman regimen in two psoriasis day care centers

Three hundred patients with severe psoriasis were treated with the Goeckerman regimen in two different day care centers. Each patient was personally evaluated and followed by us for a period of 1 year or longer in an effort to determine accurately clearing of the skin, side effects, and length of remission. The average duration of treatment to produce over 90% clearing of the skin was 18 days. Ninety percent of the patients remained clear for a minimum of 8 months, and 73% were clear for 1 year or longer. The average total body dosage of ultraviolet B (UVB) needed to clearing was 1.96 joules/cm2. Side effects were minimal, and there was no increase in skin cancer. The cost-effectiveness of the regimen in a day care center is comparable to psoralens and ultraviolet A (PUVA) therapy.

Psoriasis: Current advances in etiology and treatment

Psoriasis is a disease of major importance, the cause of which is unknown and treatment often difficult. However, research worldwide has intensified, and we now have an increased understanding of the events that lead to the production of a psoriatic lesion. Newer treatments and the revival of old therapies have increased the success rate in the management of this difficult disease but have also opened up new concerns regarding the safety of these modalities. This is a review of the current research on the etiology and treatment of psoriasis.

Clinical response to levamisole in thirty-nine patients with erythema multiforme: An open prospective study

Patients with erythema multiforme (EM) often have chronic or recurring oral lesions that cause intense pain and interfere with a variety of functions including eating and speech. Previous studies suggest that levamisole restores to normal the function of phagocytes and T lymphocytes, and activates the inflammatory response. In our previous double-blind study 8 of 13 patients with EM had a decrease in severity and frequency of attacks. The purpose of this open prospective study was to evaluate short-term and long-term clinical efficacy of levamisole in patients with mucocutaneous EM. Thirty-nine patients with mucocutaneous EM seen in the Oral Medicine Clinic, School of Dentistry, University of California-San Francisco, comprised our study group. Levamisole was used alone in 17 patients or in combination with prednisone in 22 patients and was given as a single dose of 150 mg/day for 3 consecutive days. Thirty-one patients showed a complete response from levamisole (alone in 13 and in combination with prednisone in 18). Four showed a partial response of signs and symptoms, and four others had no benefits from levamisole whether alone or in combination. The most common side effects from levamisole were skin rash, tiredness, weakness, myalgia, taste change, and insomnia.

Pemphigus vulgaris: A study of six cases treated with levamisole and prednisone

Six patients with pemphigus vulgaris (PV) who had been treated unsuccessfully with other modalities and who were maintained on prednisone for disease control were started on levamisole in addition to their minimum effective dose of prednisone (40 to 80 mg. daily). All patients responded within 2 to 8 weeks. The minimum effective dose range of prednisone when used with levamisole was reduced to 5 to 35 mg. daily. A temporary minor side effect occurred in only one patient. This corticosteroid-sparing, combination-drug approach for patients with PV has resulted in acceptable clinical control and diminution of the side effects that often interfere with high-dosage, long-term treatment.

Dermatological Nursing and Therapy

Dermatologic nursing is a highly specialized area of nursing that, unfortunately, usually receives scant recognition in nursing schools. Few nurses leave their training with any knowledge of the techniques involved in nursing patients with skin disease, and they must then be taught by the dermatologist or by the few nurses specifically trained in this field. The skills needed are essential especially on a dermatologic ward but are also needed in the outpatient setting. This is why a good how-to book on dermatologic nursing would be a welcome addition to our library. The book should be directed to nurses, with emphasis on the techniques that are used in caring for the hospitalized and the severely affected patient. Outpatient techniques that include ultraviolet (UV)-B and psoralen and UV-A (PUVA) would also be useful. Seville and Martin start their book admirably with a synopsis of dermatologic nursing in chapter 1 and a discussion