Steven E. Prawer

Interferon therapy for condylomata acuminata.

Current therapy for condylomata acuminata (genital warts) is not consistently effective. Therefore, we conducted a randomized, double-blind trial to compare interferon alpha-2b with placebo in the treatment of this disorder. Our rationale was that interferon has both antiproliferative and antiviral properties. The placebo or interferon (1 X 10(6) IU) was injected directly into one to three warts three times weekly for three weeks. The injections were well tolerated by both groups of patients. The side effects of fever, chills, myalgia, headache, fatigue, and leukopenia occurred more commonly in the interferon group than in the placebo group, but such effects rarely disrupted daily routines. Only 13 of 296 patients (4 percent) discontinued therapy because of side effects (11 in the interferon group and 2 in the placebo group). Twenty-six other patients were excluded from analysis because of a loss to follow-up or other deviations from protocol, thus leaving 257 patients in the final evaluation. At one week after the completion of therapy, interferon had produced a large and significantly greater reduction in mean wart area (a 62.4 percent decrease), as compared with placebo (a 1.2 percent increase in mean area) (P less than 0.001). At the conclusion of the study (13 weeks after the completion of therapy), the mean wart area was still decreased 39.9 percent below the initial size in the interferon group, whereas it had increased by 46 percent over base-line measurements in the placebo group (P less than 0.001). At the same time, all treated warts had completely cleared in 36 percent of the interferon recipients and in 17 percent of the placebo recipients (P less than 0.001), whereas treated warts progressed in 13 percent of the interferon recipients and in 50 percent of the placebo recipients (P less than 0.001). We conclude that injection of interferon alpha-2b directly into genital warts appears to be an effective and fairly well-tolerated form of therapy.

A double-blind evaluation of topical capsaicin in pruritic psoriasis

BACKGROUND Substance P, an undecapeptide neurotransmitter, has been implicated in the pathophysiology of psoriasis and pruritus. OBJECTIVE Safety and efficacy of topical capsaicin, a potent substance P depletor, were evaluated in patients with pruritic psoriasis. METHODS Patients applied capsaicin 0.025% cream (n = 98) or vehicle (n = 99) four times a day for 6 weeks in this double-blind study. Efficacy was based on a physicians global evaluation and a combined psoriasis severity score including scaling, thickness, erythema, and pruritus. RESULTS Capsaicin-treated patients demonstrated significantly greater improvement in global evaluation (p = 0.024 after 4 weeks and p = 0.030 after 6 weeks) and in pruritus relief (p = 0.002 and p = 0.060, respectively), as well as a significantly greater reduction in combined psoriasis severity scores (p = 0.030 and p = 0.036, respectively). The most frequently reported side effect in both treatment groups was a transient burning sensation at application sites. CONCLUSION Topically applied capsaicin effectively treats pruritic psoriasis, a finding that supports a role for substance P in this disorder.

Tretinoin emollient cream: a new therapy for photodamaged skin.

BACKGROUND Tretinoin administered topically in 0.1% concentration has been shown to improve the wrinkling and irregular pigmentation of photoaged skin. OBJECTIVE The purpose of this study was to assess the safety and efficacy of various concentrations of tretinoin in a new emollient cream base in the treatment of photoaged skin. METHODS Three concentrations of tretinoin (0.05%, 0.01%, and 0.001%) in a new emollient cream formulation were compared with vehicle in a 24-week, double-blind, randomized, multicenter study of 296 subjects with photodamaged facial skin. RESULTS Tretinoin emollient cream 0.05% gave a significantly better global response to therapy than vehicle (p less than 0.001), with 68% of subjects exhibiting improvement at the end of therapy, compared with 43% of subjects in the vehicle group. An excellent or good response was found in 26% of subjects treated with tretinoin emollient cream 0.05% versus 11% of vehicle-treated subjects. Fine wrinkling, mottled hyperpigmentation, and roughness were more improved in subjects who received tretinoin emollient cream 0.05% than in vehicle-treated subjects (p less than 0.05). No significant difference was found between vehicle and tretinoin emollient cream 0.01% or 0.001%. Histologic examination showed increases in epidermal and granular layer thickness, decreased melanin content and compaction of the stratum corneum after therapy with tretinoin emollient cream 0.05% or 0.01%. Mild to moderate skin reactions, such as erythema, peeling, and burning, were the most common side effects and, although most prevalent in the group using the 0.05% concentration, generally did not limit tretinoin use. CONCLUSION Tretinoin emollient cream 0.05% appears to be safe and effective in the treatment of photodamaged skin.

Superpotent topical steroid treatment of psoriasis vulgaris—clinical efficacy and adrenal function

Multiple clinical and laboratory evaluations, including morning plasma cortisol levels, were done in forty patients having moderate to severe psoriasis vulgaris prior to and during treatment with either betamethasone dipropionate in optimized vehicle or clobetasol-17-propionate ointment. The study was randomized, double-blind, and of parallel group design, lasting 3 weeks. Both drugs were effective (3 of 4 achieving at least 75% or more improvement). Temporary reversible suppression of the hypothalamic-pituitary-adrenal axis, as reflected by low morning plasma cortisol determinations, was found in eight of forty patients (20%). The clinician should respect the potential for superpotent topical steroids to cause laboratory evidence of adrenal suppression.

Long-term efficacy of topical minoxidil in male pattern baldness

A 24-month clinical trial, begun on a double-blind basis, was conducted in 153 men with discernible male pattern baldness of the crown with the use of either topically applied placebo, 2% minoxidil, or 3% minoxidil solution. After 4 months the patients using placebo were switched to 3% minoxidil solution. At 12 months, there were statistically significant increases in terminal hair growth within a 1-inch target area in those treated with 2% or 3% minoxidil solution, in comparison with baseline counts. However, there were few patients who had appreciable cosmetic restoration. At 12- and 24-month intervals, progressive regression or stabilization of the size of the bald area was noted in the majority of patients. This therapeutic or preventive effect was statistically significant. The data on actual target area hair counts suggested that the 2% minoxidil solution was equal to or more efficacious than the 3% minoxidil solution. Baseline vital signs and laboratory parameters remained essentially unchanged. Topical minoxidil was well tolerated, with no serious drug-related adverse reactions noted during the study.

Bowenoid papulosis of the penis. Demonstration of intranuclear viral-like particles.

Intranuclear viral-like particles are reported in a case of Bowenoid papules of the penis.

Preatrophy: Covert sign of thinned skin

Overt iatrogenic cutaneous atrophy is easily recognized; however, the earliest signs of such an adverse event may be covert. Preatrophy is proposed as a term to describe the subtle unmasking or normally covert subpapillary vascular channels found by the use of enhanced skin surface magnification techniques. We conducted a randomized double-blind, bilaterally paired comparison clinical trial in patients with chronic plaque psoriasis treated with twice-daily (nonoccluded) superpotent topical steroids for 2 weeks. Occult reversible delicate networks of horizontally oriented vascular channels were found within and surrounding 20% (23/118) of the involved psoriatic plaques during the course of the study. The use of a hand-held magnifying lens (8X), mineral oil, a coverglass, and adequate illumination allow recognition of preatrophy. Preatrophy was more frequently found in women than in men.

Comparison of Therapeutic Efficacy of Two Different Preparations of Fluocinonide Cream in the Treatment of Psoriasis Vulgaris

SummaryA randomised, prospective double-blind bilateral comparative clinical trial of the safety and efficacy of 2 preparations of fluocinonide 0.05% cream in psoriasis vulgaris was completed. By both objective and subjective measures, ‘Lidex’ cream demonstrated significantly greater reduction in erythema, induration, scale and overall severity in psoriatic activity than ‘Vasoderm’ cream.

A three-dimensional photography system for dermatologic diagnosis.

Dermatology is a visual specialty, Three-dimensional photography was used in our study to capture significant morphologic detail not present in ordinary two-dimensional photographs. Using three-dimensional photographs, texture and depth assessment are readily apparent, Three-dimensional photography enhances the real life morphologic changes of dermatologic patients. This can greatly assist in the confidence and accuracy in diagnosing of dermatologic conditions at a distance.