Nopadon Noppakun

A clinical trial of topical terbinafine (a new allylamine antifungal) in the treatment of tinea pedis.

Twenty-three patients were enrolled in a randomized, double-blind trial of terbinafine 1% cream compared with placebo vehicle in the treatment of tinea pedis. Of the 20 patients who were evaluated for efficacy, 10 received terbinafine and 10 received placebo. Except for the terbinafine-treated patients being an average of 11 years older than the patients receiving placebo and the median duration of disease being 6 weeks longer in the placebo group, the two groups were demographically and clinically similar. Results of mycologic tests and clinical findings showed terbinafine to be significantly more effective than placebo in the treatment of tinea pedis. Significantly more terbinafine-treated patients than placebo-treated patients showed conversion to negative culture and microscopy at end of therapy and a significant reduction in scored signs and symptoms. Overall efficacy at follow-up (combined mycologic and clinical findings) was also significantly greater in the terbinafine group (78%) than in the placebo group (zero) (p less than 0.001). Unexplained elevation of liver function test results was noted in three placebo-treated patients and in one terbinafine-treated patient, but these changes were not considered clinically relevant or drug related.

Toward evidence-based practice in acne: Consensus of an Asian Working Group

Acne vulgaris is common throughout the world and often perceived by both patients and clinicians as an inconsequential disease of adolescence. In reality, however, acne is a chronic medical disease that lasts for years and causes a considerable impact on quality of life. Many patients with acne experience emotional problems due to their disease, which can lead to reduced social interactions and even a lower likelihood of employment. Little has been written specifically about acne in Asian patients in the English‐language medical published work, perhaps due to an assumption that the management of acne is the same in all populations. A group of acne experts from nine Asian countries and the USA met to review and discuss acne care within the Asia–Pacific region, focusing on evidence‐based medicine. This group developed a care algorithm using results of clinical trials as well as knowledge of practice patterns.

Detection of Leishmania siamensis DNA in Saliva by Polymerase Chain Reaction

Polymerase chain reaction was used to detect Leishmania siamensis DNA from clinical samples collected from six leishmaniasis patients during 2011-2012. The samples used in this study came from bone marrow, blood, buffy coat, saliva, urine, and tissue biopsy specimens. Saliva was a good source for L. siamensis DNA by polymerase chain reaction. L. siamensis DNA was also found in saliva of an asymptomatic case-patient. Levels of L. siamensis DNA in saliva decreased until being undetectable after treatment. These levels could be used as a marker to evaluate efficacy of the treatment. A larger study is needed to evaluate this method as a screening and survey tool to study the silent background of Leishmania infection among the at-risk population.

Frequency and characteristics of acne-related post-inflammatory hyperpigmentation

In patients with darker skin types (Fitzpatrick phototypes III–VI), acne is often accompanied by post‐inflammatory hyperpigmentation (PIH). Further, acne‐related pigmentation can pose a greater concern for the patient than the acne lesions. There has been little formal study of this acne‐related PIH. Recently, the Asian Acne Board – an international group of dermatologists with interest in acne research – made a preliminary evaluation of the frequency and characteristics of PIH in seven Asian countries. A total of 324 sequential acne subjects were evaluated for the presence of PIH. The majority (80.2%) of subjects had mild to moderate acne and there were more females than males (63.0% vs 37.0%). In this population of patients consulting a dermatologist for acne, 58.2% (188/324) had PIH. The results also showed that pigmentation problems are often long lasting: at least 1 year for more than half of subjects and 5 years or longer in 22.3%. In accordance with our clinical experience, patients reported that PIH is quite bothersome, often as bothersome or more so than the acne itself and sometimes more problematic. Excoriation was commonly reported by patients, and may represent a modifiable risk factor that could potentially be improved by patient education.

Epidermal nevus syndrome

Epidermal nevus syndrome is a group of congenital neurocutaneous disorders characterized by epidermal nevi in association with cerebral, ocular, skeletal, and sometimes cardiac and renal abnormalities. These nevi have been classified according to their predominant component. We described a child presenting with inflammatory linear verrucous epidermal nevus on the head, which is an uncommon location. He also encountered ocular and central nervous system structural disorders.

Disseminated Dermal Leishmaniasis Caused by Leishmania siamensis in a Systemic Steroid Therapy Patient

Leishmania siamensis infection was recently reported from Thailand. Clinical presentation of L. siamensis infections is generally related to human immunodeficiency virus infection. Herein, disseminated dermal L. siamensis infection in a systemic steroid therapy patient from Myanmar is described.

Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne

&NA; Scientific advances are continually improving the knowledge of acne and contributing to the refinement of treatment options; it is important for clinicians to regularly update their practice patterns to reflect current standards. The Global Alliance to Improve Outcomes in Acne is an international group of dermatologists with an interest in acne research and education that has been meeting regularly since 2001. As a group, we have continuously evaluated the literature on acne. This supplement focuses on providing relevant clinical guidance to health care practitioners managing patients with acne, with an emphasis on areas where the evidence base may be sparse or need interpretation for daily practice.

Evaluating acne‐related post‐inflammatory hyperpigmentation is a challenge even amongst experts

Post‐inflammatory hyperpigmentation (PIH) is a problematic and distressing acne sequela. The difficulty of clinically assessing and managing post‐inflammatory hyperpigmentation is especially prevalent in Asian populations. The Asian Acne Board conducted a study to evaluate concordance in diagnosis of post‐inflammatory hyperpigmentation in patients with active acne, acne scarring, and pigmentation problems. Seven dermatologists reviewed 64 anonymous clinical photographs projected onto a screen during a single session. Results showed that there were two groups of raters, those who found a high frequency of PIH and those who found a low frequency. There was significant variability in these two groups in rating the presence of PIH, with an average of 30 diagnoses (24%) difference between high‐ and low‐frequency raters. Results of severity ratings showed that while most cases of PIH were assessed as mild, there was marked variability between raters in their assessments of severity. Overall, variability in PIH diagnosis was greatest when active acne was present; in these cases, low PIH raters were more likely to report skin coloration as erythema instead of PIH. These findings uphold the importance of utilizing specific clinical criteria to improve accurate evaluation of skin color and we advocate future research into this area.

Generalized Dowling-Degos Disease: Case Reports

Dowling-Degos disease (DDD) is a rare autosomal dominant trait characterized by numerous, symmetrical, progressive and pigmented macules over the axillae, groins, face, neck, arms and trunk as well as scattered comedo-like lesions (dark dot, follicles) and pitted acneiform scars. Histopathology is diagnostic testing using a distinctive form of acanthosis, characterized by an irregular elongation of thin branching rete ridges, with a concentration of melanin at the tips. We report cases of generalized DDD in a single family with autosomal dominant penetrance. DDD can be presented in a generalized form with hypopigmented lesions instead of reticulate hyperpigmentation confined to the flexor areas. This form can be differentiated from DUH by histopathology.

Persistent erythematous linear plaque on left clavicular area

A 5-month-old female infant presented with an indurated plaque on the left clavicular area. This lesion gradually increased in size, indurations with occasionally minimal serum oozing. Despite topical antibiotic therapy, the lesion was not improved. There was no previous medical and family history of pulmonary tuberculosis. Her mother noticed this lesion developing one month after the bacille Calmette-Guerin (BCG) intradermal vaccination on the left deltoid. The reaction at this injection site occurred shortly after vaccination and left a minute hypertrophic scar (Fig. 1, red arrow). Dermatological examination revealed an erythematous, indurated linear plaque on the left clavicular area, 2.0 9 0.5 cm in size (Fig. 1, black arrow). This lesion was soft, rubbery in consistency, nontender, and 5 cm medial to the vaccination site. The lymph node was not palpable, and Darier’s sign was negative. Further physical examinations were unremarkable. A skin biopsy was performed. The histopathologic findings are shown in Figures 2 and 3. Figure 3 The granulomas were composed of epithelioid cells, foamy histiocytes and mononuclear cells (hematoxylin and eosin, high power) Figure 1 An erythematous, indurated linear plaque on the left clavicular area (black arrow) and minute hypertrophic scar from BCG vaccine (red arrow)