Roland S. Medansky

Dermatopsychosomatics: classification, physiology, and therapeutic approaches.

Psychosomatic dermatology is practiced in some manner by every dermatologist. In spite of this, there has been a virtual void in the literature from the middle 1950s until the present time. The relationship to physiologic phenomena, as well as a classification of psychosomatic dermatology, is reviewed. Dermatologic patients are divided into three groups: the primary group in which the emotional disorder is the primary disease and the cutaneous disorder merely part of its expression; the secondary group in which the basic cause is organic but does not affect the person emotionally in various degrees; and the collaborative group in which the organic causes and emotional disorders combine in different degrees to cause the skin disorder. This paper discusses anxiety and depression along with methods of dermatologic psychosomatic therapy consisting of antianxiety drugs, especially the benzodiazepines, antidepressants, hypnosis, behavior therapy, and the doctor/patient rapport. We conclude that one of the objectives for every dermatologist is to treat the entire patient-the psyche along with the soma.

A double-blind, vehicle-controlled study of clobetasol propionate 0.05% (Temovate) scalp application in the treatment of moderate to severe scalp psoriasis

The efficacy and safety of clobetasol propionate 0.05% scalp application was evaluated in 378 patients with moderate to severe scalp psoriasis in a double-blind vehicle-controlled parallel group study. After 2 weeks of twice-daily applications, 81% receiving active drug versus 22% receiving vehicle had clearing of 50% or greater. Complete clearing was seen in 26% with active drug and 1% with vehicle. Local side effects were primarily burning or stinging in 11% and 10% of patients treated on an active or a vehicle regimen, respectively. The morning cortisol levels of 168 patients were checked at baseline and again after 2 weeks of drug therapy. Subnormal morning plasma cortisol values were seen in 5% of the patients receiving active drug and in 5% receiving vehicle; 13% of those taking active drug versus 5% taking vehicle had a 50% or greater decrease in morning cortisol at the 2-week visit compared with baseline values. Clobetasol propionate 0.05% scalp application appears to be a safe and an effective treatment for scalp psoriasis.

Once‐Daily Naftifine Cream 1% in the Treatment of Tinea Cruris and Tinea Corporis

Seventy patients with tinea cruris or tinea corporis were treated with naftifine cream 1% or vehicle once daily (or 4 weeks in this double‐blind, randomized study. After two weeks, the patients using naftifine had a significantly higher mycologic cure rate than the vehicle‐treated patients (79% vs. 31 %, p < 0.001), and they showed significantly better resolution of signs and symptoms. Statistically significant differences favoring naftifine over its vehicle were found throughout the treatment period and 2 weeks posttreatment.

Diflorasone diacetate cream in an optimized vehicle versus fluocinonide cream for the treatment of psoriasis

The effectiveness and safety of diflorasone diacetate 0.05% in an optimized cream vehicle (Psorcon Cream) and fluocinonide 0.05% cream (Lidex Cream) in the management of moderate-to-severe psoriasis was compared in a double-blind multicenter 2-week study enrolling 100 patients. A randomized bilateral-paired comparison study design was used. The efficacy results showed that the mean total scores (erythema, scaling, and induration) were significantly lower for diflorasone diacetate-treated sites than for the comparable fluocinonide-treated sites at days 7 and 14 (P < 0.001). The comparative evaluations made by the investigators were also more favorable for diflorasone diacetate-treated sites than for fluocinonide-treated sites at day 14 (P < 0.001), and the global evaluations of effectiveness done by the investigators favored the diflorasone diacetate-treated sites (P < 0.001). More patients rated the improvement in their diflorasone diacetate-treated sites superior to that in their fluocinonide-treated sit...

Clobetasol Propionate Ointment Once Daily Versus Fluocinonide Ointment Three Times Daily in Psoriasis

Most topical corticosteroids are applied two to four times daily. This practice is based on custom, not pharmacokinetics. One study^ in psoriatic patients has shown that a class II compound applied once daily was not as effective as a three-times-daily regimen of the same drug, but the once-daily results were still impressive, especially in mild-to-moderate psoriasis. Another study has demonstrated equivalent efficacy for a class II steroid applied once daily and a three-times-daily application of a class III steroid.^ The class I topical steroid, clobetasol propionate (probably the most potent available), not surprisingly has been shown to be more effective than the popular class II compound, fluocinonide, in both eczema and psoriasis when each was applied three times daily.^ This study was designed to compare the efficacy and safety of class I clobetasol propionate 0.05% ointment once daily with class II fluocinonide 0.05% ointment thrice daily.