Jung-Min Park

Propranolol, doxycycline and combination therapy for the treatment of rosacea

Doxycycline is the standard systemic treatment for rosacea. Recently, there have been a few reports on β‐adrenergic blockers such as nadolol, carvedilol and propranolol for suppressing flushing reactions in rosacea. To our knowledge, there are no comparative studies of propranolol and doxycycline, and combination therapy using both. The aim of this study was to investigate and compare the efficacy and safety of monotherapy of propranolol, doxycycline and combination therapy. A total of 78 patients who visited Pusan National University Hospital and were diagnosed with rosacea were included in this study. Among them, 28 patients were in the propranolol group, 22 the doxycycline group and 28 the combination group. We investigated the patient global assessment (PGA), investigator global assessment (IGA), assessment of rosacea clinical score (ARCS) and adverse effects. Improvement in PGA and IGA scores from baseline was noted in all groups, and the combination therapy was found to be the most effective during the entire period, but this was statistically insignificant. The reduction rate of ARCS during the treatment period was also highest in the combination group (57.4%), followed by the doxycycline group (52.2%) and the propranolol group (51.0%). Three patients in the combination group had mild and transient gastrointestinal disturbances but there was no significant difference from the other groups. We conclude that the combination therapy of doxycycline and propranolol is effective and safe treatment for rosacea and successful for reducing both flushing and papulation in particular.

Is narrowband ultraviolet B monotherapy effective in the treatment of pityriasis lichenoides

Pityriasis lichenoides (PL) is a self‐limiting papulosquamous disease that may persist for years and is associated with a high relapse rate. To date, few comparative studies have investigated the efficacy of narrowband ultraviolet B (NB‐UVB) phototherapy and other therapies in the treatment of PL.

Efficacy and Safety of Calcipotriol/Betamethasone Dipropionate Ointment for the Treatment of Trachyonychia: An Open-Label Study.

Background Despite efforts to treat trachyonychia, there is no promising treatment modality. Objective This study evaluated the efficacy and safety of calcipotriol plus betamethasone dipropionate ointment on trachyonychia. Methods A total of 39 patients with 432 nails affected by trachyonychia were enrolled. All patients applied calcipotriol/betamethasone ointment once daily without occlusion for 6 months. Outcome measures were assessed by physicians global assessment (degree of roughness: 0, clear; 1, mild; 2, moderate; 3, marked; 4, severe) at all time points. Results After 6 months of therapy, 98.6% (426/432) of nails showed significant clinical improvement; 4.2% were completely free from nail lesions. The mean physician global assessment score decreased significantly from 3.5 to 1.7 points (p< 0.05). No serious side effects were reported, except mild pruritus and erythema in 2 patients. Conclusion This is the first study to prospectively evaluate the efficacy and safety of calcipotriol/betamethasone ointment for the treatment of trachyonychia. The results indicate topical calcipotriol/betamethasone is an effective and safe treatment for symptom improvement of trachyonychia.

The use of dermatoscopy to monitor therapeutic response of Bowen disease: a dermatoscopic pathological study.

Background  Dermatoscopy is a noninvasive technique that can be helpful in the diagnosis of pigmented and nonpigmented skin tumours. The dermatoscopic evaluation of Bowen disease (BD) improves diagnostic accuracy.

Efficacy and safety of pregabalin for the treatment of chronic pruritus in Korea

Dear Editor, Pregabalin is one of the antiepileptic drugs used for the treatment of neuropathic pain. Recently, the efficacy of gabapentin, which has a similar structure to pregabalin, in the treatment of chronic pruritus has been demonstrated. The authors aimed to evaluate the efficacy and safety of pregabalin for the treatment of chronic pruritus. This study was conducted on dermatological outpatients diagnosed with generalized chronic pruritus of unknown etiology of more than 6 weeks’ duration from March 2008 to May 2010. Patients with specific cutaneous or systemic disease except secondary cutaneous disease due to pruritus (such as lichen simplex chronicus or prurigo nodularis), and patients to whom oral or topical corticosteroid had been administrated within 4 weeks or antihistamine within 7 days prior to treatment were excluded. Pregabalin 75 mg was administrated p.o. twice a day for 8 weeks regardless of meals, and the subjects were not allowed to take any other medications during the treatment. The study was approved by the Ethics Committee of Pusan National University Hospital, and voluntary informed consent in written form was obtained from all the participants. Patients visited the hospital in the first, second, fourth and eighth week after the first visit, and the researcher determined the degree of pruritus by asking the patients to mark their current intensity of pruritus using a 100-mm Visual Analog Scale (VAS). The patients were made to rate the overall satisfaction of the efficacy of the experimental drug on a scale of 0–4 at the end of the experiment. A paired Student’s t-test was used for statistical analysis on VAS change during the treatment period. A total of 22 subjects completed the experiment and six subjects dropped out (five patients voluntarily withdrawn and one patient withdrawn because of adverse effect). The patients who completed the experiment were aged 42–69 years (mean ± standard deviation, 56 ± 13.65), and the sex distribution was 13 men and nine women. The average duration of pruritus was 86 ± 78 months. Baseline VAS was 6.95, and 5.41 after 1 week, 4.95 after 2 weeks, 4.68 after 4 weeks and 4.82 after 8 weeks. Compared with the initiation of treatment, there was a significant decrease (P < 0.05) of VAS after 4 weeks of the treatment (Fig. 1). However, there was no difference of VAS between 4 and 8 weeks, and from this we can assume that the pregabalin shows maximum antipruritic efficacy at 4 weeks and can be used as maintenance therapy thereafter. Eight patients (36.8%) expressed relatively high satisfaction with VAS ratings of 3 or 4, though seven patients (31.8%) revealed no response (Fig. 2). There was no significant clinical difference between responders and non-responders, and the patients with high satisfaction showed improvement of their skin manifestations along with the reduction of pruritus (data not shown). The safety assessment showed one patient with constipation and one patient with heartburn. Although there was no serious adverse reaction, one patient reported vertigo and dropped out. There were no complaints of any somnolence, peripheral edema, headache or weight gain. Both gabapentin and pregabalin are c-aminobutyric acid analogs, and they elicit pharmacological effects by binding to the a2d-subunit of voltage-dependent calcium channels, which suppress release of neurotransmitters such as glutamate and contribute to antineuropathic itch. These drugs also inhibit the calcitonin