Michael D. Zanolli

Neutrophilic vascular reactions

Dermatologic diseases are classified most commonly by morphology, by pathogenesis, or by etiology. Nontraditional classifications may be useful in terms of providing a reassessment of traditional views about disease interrelationships. This review of dermatoses characterized by neutrophilic infiltrates and dermal vessel changes reveals evidence suggesting that these dermatoses result from immune complex-mediated, neutrophil-induced dermal vessel damage. Therapeutic approaches to these heretofore unlinked dermatoses are remarkably similar.

Double-blind treatment of seborrheic dermatitis with 2% ketoconazole cream

Thirty-seven patients with seborrheic dermatitis were treated topically with a 2% ketoconazole cream or its vehicle control in a double-blind study. The subjects were studied for numbers of Malassezia ovalis (Pityrosporum ovale) cells in their scalp scale; changes in numbers of yeast cells and morphology of M. ovalis were tabulated along with clinical assessment of improvement. The 2% ketoconazole cream, but not the placebo cream, reduced the numbers of viable yeast cells on the scalp. The clinical effect of 2% ketoconazole cream was good (75%-95% improvement) or better in eighteen of twenty subjects; the placebo cream produced good results in only three of seventeen subjects treated. Results of this study are consistent with the view that M. ovalis plays a central role in the pathogenesis of seborrheic dermatitis.

Phototherapy treatment of psoriasis today.

The use of the various forms of phototherapy remains an essential treatment option for psoriasis vulgaris. Expertise concerning the mechanisms involved with the actions of therapeutic ultraviolet light and the proper delivery of office-based treatments resides within the specialty of dermatology. New therapies for the treatment of moderate to severe psoriasis will soon become available which have specific actions on the cutaneous immune system. A better understanding of the known mechanisms of action for ultraviolet light therapy makes it appropriate to include this area of treatment with new biologic agents. Photochemotherapy and various forms for delivery of narrow band ultraviolet B can be used as treatments, either as monotherapy or in combination with other agents, to effectively treat moderate and severe psoriasis.

Tanning facility compliance with state and federal regulations in North Carolina: A poor performance

BACKGROUND Little is known about the compliance of commercial tanning facilities with regulations governing their operation. We inspected some tanning parlors to assess the degree to which they follow federal and North Carolina state regulations. METHODS An inspection of 32 tanning facilities was conducted between March and May 1991 as part of an ongoing effort to educate tanning parlor operators and proprietors about UV light safety. Compliance with each of 21 distinct state and federal requirements was recorded for each facility. RESULTS Only 1 of 32 facilities was in complete compliance with both state and federal regulations. The number of infractions ranged from none to 21 (mean [+/- SD] 7.1 +/- 4.1). Nineteen percent of facilities had timers that were not within the required +/- 10% accuracy level. Twenty-two percent also had timers that did not meet Code of Federal Regulations standards. The estimated proportion of the total light output in the UVB spectrum ranged from 0.5% to 5.0% (mean 4.25% +/- 0.95%). CONCLUSIONS These limited data suggest that many commercial tanning establishments are not uniformly compliant with regulations. Although we cannot extrapolate these findings to other states, we anticipate that facilities in states with less rigorous regulations than North Carolina have similar or inferior safety profiles.

Experience in treating recalcitrant scalp psoriasis with automated shampooing and debridement

We report the cumulative clinical experience and financial implications of treating severe scalp psoriasis in an outpatient phototherapy center by means of an automated scalp debridement unit. Benefits of this approach included increased patient and staff satisfaction, enhanced response of recalcitrant scalp psoriasis, and detection of scalp dermatoses mimicking psoriasis.