Norma Cameli

Calcipotriol ointment in nail psoriasis: A controlled double-blind comparison with betamethasone dipropionate and salicylic acid

This double‐blind randomized study was designed to compare the efficacy and safety of calcipotriol ointment (50 μg/g) with betamethasone dipropionate (64 mg/g) and salicylic acid (0.03 g/g) ointment in the treatment of nail bed psoriasis. Fifty‐eight patients applied the given drug to the affected nails twice a day for 3–5 months, depending on clinical response. Efficacy was assessed monthly on the basis of nail thickness, measured in millimetres. Photographs of the treated nails were taken at baseline, and after 3 and 5 months. Tolerability was assessed at 3 and 5 months. In patients with fingernail psoriasis, after 3 months of treatment subungual hyperkeratosis was reduced from 2.3 ± 0.1 mm (mean ± SEM) to 1.5 ± 0.1 mm (−26.5%) in the calcipotriol group and from 2.3 ± 0.1 mm to 1.6 ± 0.1 mm (−30.4%) in the betamethasone dipropionate and salicylic acid group [not significant (NS) between treatments, analysis of variance ( ANOVA)]. After 5 months, responders showed a 49.2% reduction in hyperkeratosis in the calcipotriol group (from 2.8 ± 0.1 mm to 1.4 ± 0.2 mm) and 51.7% (from 2.1 ± 0.1 mm to 1.0 ± 0.1 mm) in the betamethasone dipropionate and salicylic acid group (P < 0.001 from baseline, NS between treatments, ANOVA). In patients with toenail psoriasis, after 3 months of treatment there was an overall reduction in hyperkeratosis from 2.6 ± 0.1 mm to 2.1 ± 0.1 mm (−20.1%) in the calcipotriol group and from 3.0 ± 0.1 mm to 2.3 ± 0.1 mm (−22.9%) in the betamethasone dipropionate and salicylic acid group (P < 0.001 from baseline, NS between treatments, ANOVA). By the end of the fifth month there was a 40.7% reduction in hyperkeratosis in the calcipotriol group (from 2.1 ± 0.1 mm to 1.2 ± 0.1 mm) and 51.9% in the betamethasone dipropionate and salicylic acid group (from 2.7 ± 0.1 mm to 1.3 ± 0.1 mm; P < 0.0001 from baseline, NS between treatments, ANOVA). The results of the study show that calcipotriol is as effective as a combination of a topical steroid with salicylic acid in the treatment of nail psoriasis and represents a safe alternative in the topical treatment of nail psoriasis.

Evaluation of the Efficacy of Acitretin Therapy for Nail Psoriasis

OBJECTIVE To evaluate the therapeutic efficacy of acitretin in patients with isolated nail psoriasis. DESIGN Open study involving 36 patients with moderate to severe nail psoriasis treated with acitretin. SETTING University-based outpatient dermatology clinic specializing in nail diseases. PATIENTS A total of 27 men and 9 women (mean age, 41 years) with nail psoriasis. INTERVENTION Therapy consisted of acitretin, 0.2 to 0.3 mg/kg/d, for 6 months. MAIN OUTCOME MEASURES Clinical evaluation, and Nail Psoriasis Severity Index (NAPSI) and modified NAPSI scores before therapy, every 2 months during therapy, and 6 months after treatment. RESULTS The mean percentage of reduction of the NAPSI score after treatment was 41%; the mean percentage of reduction of the modified NAPSI score of the target nail was 50%. Clinical evaluation at 6 months showed complete or almost complete clearing of the nail lesions in 9 patients (25%), moderate improvement in 9 (25%), mild improvement in 12 (33%), and no improvement in 6 (11%). CONCLUSION Results from low-dose acitretin therapy show NAPSI score reductions comparable with those studies evaluating biologic drugs for nail psoriasis and suggest that low-dose systemic acitretin should be considered in the treatment of nail psoriasis.

Studies on the photostability and in vitro phototoxicity of Labetalol

The purpose of this study was to obtain information on the photochemical and phototoxic properties of Labetalol, a beta-blocker drug. Preliminary information on the drug photoreactivity was achieved using a flow system with a photochemical reactor on-line with a diode array detection system. Photophysical and photochemical investigations on the drug were performed in aqueous solutions at different pH values using spectrophotometric and fluorimetric methods; the photodegradation quantum yield was found to be 2.7 x 10(-3) at pH 5.8 and 1.5 x 10(-2) at pH 11.5. Forced photodegradation of labetalol solutions under exposure to UVA--UVB radiations (xenon arc lamp) was monitored by reversed-phase liquid chromatography. The main photodegradation products were isolated and characterized by NMR and mass spectrometry; labetalol was found to give 3-amino-1-phenylbutane and salicylamide-4-carboxaldehyde as the main photoproducts. Preliminary phototoxic testings on human keratinocyte cultures were performed evaluating the viability of the cells by the neutral-red uptake assay; mutagenic and photomutagenicity tests were also carried out based on Salmonella typhimurium strains. As a result, labetalol was found to be photolabile,mainly in alkaline medium, but evidences of significant phototoxic and photomutagenic effects by the drug were not observed.

Characterization of nail matrix melanocytes with anti-PEP1, anti-PEP8, TMH-1, and HMB-45 antibodies

BACKGROUND The normal nail matrix contains quiescent melanocytes with a peculiar arrangement and behavior. OBJECTIVE Our purpose was to identify nail matrix melanocytes with antibodies that recognize melanocytic cells in tissue sections. METHODS We used the polyclonal antibodies anti-PEP1 and anti-PEP8 and the monoclonal antibody TMH-1, which recognize melanocytic enzymes, and the monoclonal antibody HMB-45, which reacts with melanoma cells and fetal melanocytes, but not with normal adult melanocytes. Nail matrix specimens were obtained from longitudinal specimens of eight white patients with ingrown toenails. Specimens from normal adult forearm skin were used as controls. RESULTS All nail specimens gave similar results. Dendritic melanocytes were more numerous in the distal than in the proximal nail matrix. They were not restricted to the basal layer, but were also found in the suprabasal layers of the nail matrix epithelium. Melanocytes were seen both a single dendritic cells among the nail matrix keratinocytes and as small clusters that appeared irregularly distributed along the length of the nail matrix. Each cluster usually consisted of three to four cells. CONCLUSION Even if normally quiescent, nail matrix melanocytes possess the key enzymes responsible for the formation of melanin. The suprabasal location of nail matrix melanocytes may be a consequence of the distribution of adhesion molecules in the nail epithelium. In fact, in the nail matrix alpha 2, alpha 3, and beta 1 integrins are not only expressed on the basal, but also on the fourth to fifth suprabasal layers, with suprabasal expression gradually decreasing from distal to proximal matrix. The behavior of nail matrix keratinocytes may cause the peculiar arrangement and behavior of nail matrix melanocytes.

Reflectance confocal microscopy of the yellow dot pattern in alopecia areata.

BACKGROUND The presence of yellow dots is a characteristic dermoscopic finding in alopecia areata. The aim of this study was to investigate the yellow dot pattern observed at dermoscopy in alopecia areata with reflectance confocal microscopy (RCM) and correlate RCM findings with pathological features. OBSERVATIONS Six patients affected by alopecia totalis entered the study. Patients were first submitted to scalp dermoscopy, which was followed by RCM examination of the same area. After RCM, a 5-mm punch biopsy specimen was also taken. Dermoscopic findings showed the yellow dot pattern in all patients, with round or polycyclic yellow-pink dots often containing miniaturized or broken hair shafts. At RCM, a Vivablock mosaic taken at the level of the spinous layer showed striking reduction of follicular adnexal structures and empty lumina containing highly refractile material corresponding to the yellow dots seen on dermoscopy. The pathological features showed that the yellow dots correspond to the dilated infundibula of the velluslike anagen and telogen follicles that characterize the chronic phase of alopecia areata. CONCLUSION The RCM study of the yellow dot pattern showed a good correlation with the dermoscopic and pathological findings and confirms that the yellow dots correspond to inefficient follicular structures that often contain hair remnants.

Itraconazole in the treatment of two young brothers with chronic mucocutaneous candidiasis

Abstract: We report on two children affected by chronic mucocutaneous candidiasis involving the mouth and all the nails who were successfully treated with itraconazole at 200 mg/day for 2 months. This therapy produced a rapid cure of both candidal nail and mouth infections. The drug was very well tolerated, and routine laboratory monitoring during treatment did not reveal any abnormalities.

Skin Needling to Enhance Depigmenting Serum Penetration in the Treatment of Melasma

Melasma is a common hypermelanotic disorder affecting the facial area which has a considerable psychological impact on the patient. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents, such as rucinol and sophora-alpha. Aims. We aim to compare the combined treatment of skin needling and depigmenting serum with that using depigmenting serum alone in the treatment of melasma, in order to evaluate the use of microneedles as a means to enhance the drugs transdermal penetration. Methods. Twenty patients were treated with combined skin needling and depigmenting serum on one side of the face and with depigmenting serum alone on the other side. The outcome was evaluated periodically for up to two months using the Melasma Area Severity Index score and the Spectrocolorimeter X-Rite 968. Results. The side with combined treatment (skin needling + depigmenting serum) presented a statistically significant reduction in MASI score and luminosity index (L) levels compared to the side treated with depigmenting serum alone, and clinical symptoms were significantly improved. Conclusions. Our study suggests the potential use of combining skin needling with rucinol and sophora-alpha compounds to achieve better results in melasma treatment compared to rucinol and sophora-alpha alone.

Nail changes in lichen planus may resemble those of yellow nail syndrome.

q 2000 British Association of Dermatologists, British Journal of Dermatology, 142, 812±851 been noted after 2 years (Fig. 1b). The patient was delighted with the success of the treatment, and no dysfunction, scarring or pigmentary changes have been reported. Pearly penile papules are smooth, dome-shaped, fleshcoloured papules which are symptomless and without pathological significance, usually occurring after puberty in a circumferential distribution on the corona and sulcus of the glans penis. They are acral angiofibromas and consist of a core of normal connective tissue covered by a centrally thin and peripherally acanthotic epidermis over a rich vascular network surrounded by dense connective tissue and a lymphocytic infiltrate. They are most readily misdiagnosed as viral warts or sebaceous hyperplasia. Despite reassurances, many patients request treatment. Previous authors have described treatment by circumcision, podophyllin, electrodesiccation and curettage and carbon dioxide laser. The latter two modalities can be successful, but they require local anaesthesia, are more time-consuming, and pigmentary change and scarring are more likely to occur compared with cryotherapy. This treatment method has been reported once before, with similarly successful results: 80±90% of lesions were removed after two treatments, with good patient tolerance and no complications. Cryotherapy offers an effective treatment modality for penile papules. Topical local anaesthesia should be available for the more nervous patient.

Preliminary comparison of fractional laser with fractional laser plus radiofrequency for the treatment of acne scars and photoaging

BACKGROUND The therapeutic approach to the treatment of acne scars and photoaging varies according to the type of lesion. Traditional carbon dioxide (CO2) laser is associated with long healing times, persistent erythema, and high risk of post‐inflammatory hyperpigmentation. Fractional laser technology, which involves the application of microscopic beams of pixilated light inducing focal zones of tissue injury surrounded by normal tissue, is currently used for the treatment of acne scars and photoaging. OBJECTIVE To compare the results obtained using CO2 fractional laser with those obtained using CO2 fractional laser plus radiofrequency for the treatment of atrophic acne scars and photoaging by means of clinical evaluation and confocal laser. MATERIALS AND METHODS Ten patients with photoaging and acne scars underwent a single treatment using both technologies. Investigators and patients evaluated the clinical effect of the treatments using digital photographs, dermatoscopy, and in vivo reflectance confocal microscopy before and immediately, 1 week, and 3 months after treatment. RESULTS AND CONCLUSION Our results underlined the high efficacy of combining CO2 laser and radiofrequency, producing better results with fewer sessions, lower risks, and fewer side effects.

Expression of integrins in human nail matrix.

Summary The aim of this study was to characterize cell‐cell and cell‐matrix interaction by evaluating the expression of different integrins in the nail matrix.