Stephen N. Horwitz

Naftifine cream 1% versus econazole cream 1% in the treatment of tinea cruris and tinea corporis

Data from 104 subjects with tinea cruris or tinea corporis were evaluated in this double-blind, randomized study. The subjects applied naftifine cream 1% or econazole nitrate cream 1% to affected areas twice daily for 4 weeks. After 1 week of treatment naftifine had an overall cure rate of 19% compared with 4% for econazole (p = 0.03). A difference in favor of naftifine, although not statistically significant after the first week, persisted throughout treatment. Two weeks after the end of treatment both medications had overall cure rates of approximately 80%. Three percent of the naftifine-treated subjects had side effects compared with 13% of the econazole-treated subjects. In two subjects using econazole, the side effects were severe enough to warrant discontinuation of treatment.

Double-blind comparison of 2% ketoconazole cream and placebo in the treatment of tinea versicolor

Malassezia furfur (Pityrosporum orbiculare) was confirmed by microscopic potassium hydroxide (KOH) examination in 101 patients with recurring lesions of tinea versicolor. In a double-blind comparative study, patients were randomly assigned to once-daily ketoconazole 2% or placebo cream. At the end of treatment, 98% (p less than 0.0001) of the patients using ketoconazole and 28% of those using placebo responded clinically (healed or had mild residual disease). There was an overall 84% mycologic cure rate (negative KOH at treatment end) for patients using ketoconazole 2% cream and 10% for those using placebo cream (p less than 0.0001). Ketoconazole-treated patients who were cured at the end of treatment remained cured 8 weeks later. By contrast 75% of those responding to placebo had relapsed by the 8-week follow-up visit. Follow-up after 2 years revealed that 79% (38/48) of the patients treated with ketoconazole remained clear 12 or more months.

Addition of a topically applied corticosteroid to a modified Goeckerman regimen for treatment of psoriasis: Effect on duration of remission

A double-blind parallel group study was undertaken to assess the effect of adding a topically applied corticosteroid cream to a modified Goeckerman regimen to treat patients with psoriasis. Nineteen patients with psoriasis were treated with either this regimen and hydrocortisone valerate cream or the regimen and vehicle cream. Patients were given daily treatments until their skin cleared or until twenty-eight treatments were received. They were then followed up until rebound or relapse occurred or 6 months had passed. The addition of hydrocortisone valerate cream to the modified Goeckerman regimen led to relapse after 5.9 weeks in comparison with 17.9 weeks for the control group.

Reduction of the erythema response to ultraviolet light by nonsteroidal antiinflammatory agents

SummaryThe effect of three nonsteroidal antiinflammatory agents (NSAIA) on ultraviolet B (UV-B)-induced erythema was studied in normal human volunteers. Aspirin, indomethacin, and ibuprofen were administered orally 2 h before exposure to UV-B from fluorescent sunlamps and at 4-h intervals for a total of four doses. The minimal dose of light to produce erythema (MED) was determined for each subject with and without drugs. There was a 240% increase in the mean MED when the NSAIA were given. NSAIA, given orally, can increase the threshold for UV-B-induced erythema when administered near the time of irradiation.ZusammenfassungDer Effekt von drei nicht-steroidalen antientzündlichen Substanzen (NSAIA) auf das durch Ultraviolettlicht B (UV-B) erzeugte Erythem wurde an gesunden Freiwilligen untersucht. Aspirin, Indomethazin und Ibuprofen wurden 2 h vor der UV-B-Exposition mit Fluoreszenzlampen und danach in Intervallen von 4 h insgesamt viermal oral verabreicht. Die minimale erythemerzeugende Lictosis (MED) wurde an allen Probanden mit und ohne Medikation bestimmt. Bei Verabreichung von NSAIA fand sich ein durchschnittlicher Anstieg der MED um 240%. Oral verabreichte NSAIA können die Erythemschwellendosis für UV-B erhöhen, wenn sie in kurzem zeitlichen Abstand zur Bestrahlung verabfolgt werden.

Mycosis Fungoides Treated With Acyclovir-Reply

In Reply.— We have noted the comments by Mahrle and colleagues regarding the failure of two of their patients with mycosis fungoides to respond to intravenously administered acyclovir. We do not believe that their conclusions are supported by treating only two patients. While acyclovir may not be effective for treating all patients with mycosis fungoides, there may be a population of these patients in whom this drug will be effective. We have initiated a comprehensive trial of acyclovir in patients with mycosis fungoides at 15 medical centers in the United States. The preliminary results of this trial have demonstrated benefit in some patients.