Oscar E. Araujo

Toxic epidermal necrolysis: A review

This article reviews the many facets of toxic epidermal necrolysis. Emphasis is placed on the importance of early diagnosis, burn unit placement, supportive care, and avoidance of systemic steroids. Discussion also includes other therapeutic options and the pathophysiology of the disease.

The Interferons and Their Use in Condyloma Acuminata

There are three naturally occurring interferons: Alfa, beta, and gamma. Alfa, derived from lymphoblastic tissue, is approved by the Food and Drug Administration for the treatment of condyloma acuminata (genital or venereal warts). Genital warts are caused by human papillomaviruses, of which more than 50 subtypes have been described. Traditional therapies have centered on destruction of the lesions by either cytotoxic or physical modalities. Intralesional interferon exerts its antiviral effects on infected cells without causing damage to the surrounding tissue. In general, success rates with intralesional interferon alfa are comparable to traditional modalities. There is also evidence that interferon alfa might be particularly useful in the treatment of lesions that have failed to respond to other modalities.

STEVENS-JOHNSON SYNDROME

The clinical manifestations, including variations, of the Stevens-Johnson syndrome (SJS) are reviewed. Lesions of the skin, eye, and mucous membranes are described and discussed. The potential complications and therapeutic approaches are outlined. Finally, the review discusses the controversy over the use of systemic corticosteroids in this syndrome.

Griseofulvin: A New Look at an Old Drug:

Griseofulvin is the oral antifungal agent of choice for the treatment of dermatophytoses. This article reviews the history, pharmacokinetics, adverse reactions traditional therapeutic applications of griseofulvin. In addition, reports since 1960 of the use of the drug in the treatment of Raynauds phenomenon, progressive systemic sclerosis, lichen planus, mycosis fungoides, herpes zoster, eosinophilic fasciitis molluscum contagiosum are discussed, noting the varying degree of therapeutic success.

Phenytoin hypersensitivity syndrome

The clinical manifestations of the phenytoin hypersensitivity syndrome are reviewed. The main symptoms of cutaneous eruptions, hepatitis, lymphadenopathy, as well as other manifestations, are described and discussed. Proposed theories as to the specific etiology of the syndrome are outlined. Finally, the review discusses the course, prognosis, and potential complications of the syndrome along with suggested therapeutic approaches.

Toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a life-threatening condition in which the epidermis blisters and peels in large sheets. The clinical syndrome and diagnosis are reviewed. Current treatment and prevention of complications are discussed. The key to low morbidity and mortality in TEN is early intervention. Physicians should be knowledgeable about TEN and the appearance of the skin in its initial presentation.

Vitamin D Therapy in Psoriasis

The use of vitamin D3 in the treatment of psoriasis is discussed with emphasis on positive and negative results of many clinical trials. Investigations indicate that treatment with topical vitamin D3 provides consistently more rapid clinical improvement than its oral counterpart, with no reported adverse effects. Studies have shown that 68 of 83 patients exhibited significant improvement of their psoriatic lesions with the topical application of vitamin D3 analogs, including 1,24-dihydroxycholecalciferol, calcitriol, and MC 903. Clinical trials involving 35 patients treated with oral vitamin D3 analogs resulted in moderate improvement in 24 of the patients. Adverse effects can be minimized by bedtime dosing and possibly the use of new noncalciotropic analogs. Vitamin D3 analogs appear to provide one more promising treatment option for psoriasis.

Effect of Topically Applied Flurbiprofen on Ultraviolet-Induced Erythema

The effect of flurbiprofen, a nonsteroidal anti-inflammatory agent, on ultraviolet B-induced erythema was studied in normal volunteers. The effect of various concentrations as well as the effect of multiple applications were evaluated at 4, 8, and 24 hours after irradiation with three MEDs of ultraviolet B. Repeated applications of flurbiprofen during the four- and eight-hour periods following ultraviolet B exposure did not increase the blanching response obtained following a single treatment. A concentration dependent effect of flurbiprofen on blanching was observed with suppression of erythema increasing with increasing concentration of flurbiprofen up to 3%. Further increase in concentration up to 5% offered no added advantage. Significant differences in blanching were also observed at different postirradiation time periods. No cutaneous or systemic complications were reported during the entire study.

Current topical corticosteroid preparations

A brief review of the development, desirability, potency, and side effects of topical corticosteroids is presented. Because of potential sensitizing agents present in vehicles delivering corticosteroids and because new products are constantly being marketed, a detailed listing of single and combination products, as well as the constituents of their vehicles, has been compiled to aid the practicing physician.

Drug-Induced Photosensitivity: A Clinical Review

Objective: To provide an overview of drug-induced phototoxic and photoallergy reactions, the mechanism involved, and the most common classes of drugs causing these reactions. Data Source: Pertinent English-language literature (1987–1993). Study Selection: Representative articles documenting mechanisms and types of drug-induced photosensitivity reactions, as well as treatment options. Data Extraction: Data were extracted only from articles that documented relevant and substantive information backed by clinical studies. Data Synthesis: Drug-induced photosensitivity can be acute or chronic. The chromophore that absorbs the radiation and activates the process of photosensitivity results in color within the longer ultraviolet wavelength. The primary classes of drugs causing phototoxic reactions include nonsteroidal antiinflammatory drugs, thiazide diuretics, tetracycline, and quinolone antibiotics, tricyclic antidepressants, and amiodarone. Those causing photoallergic reactions include antihistamines, thiazide diuretics, sulfonamides, griseofulvin, sulfonylurea hypoglycemic agents, benzocaine, and coal tar preparations. Conclusions: The importance of understanding the mechanism of photosensitivity is stressed as well as the difficulty in determining whether a phototoxic or photoallergic reaction has occurred. Established classes of each type of photosensitivity are identified and the importance of recognizing treatment options is emphasized. Patients prone to photosensitizing reactions should be advised concerning how to manage these problems.