Stuart Maddin

A comparison of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea ☆ ☆☆ ★

BACKGROUND Although it is important for physicians to have sufficient clinical data on which to base treatment decisions, little comparative data exist regarding newer treatment modalities for rosacea. OBJECTIVE The goal of the study was to compare the efficacy and safety of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea. Parameters of patient satisfaction to treatment were also assessed. METHODS Forty patients with the clinical manifestation of symmetric facial rosacea were investigated in this single-center, double-blind, randomized, contralateral split-face comparison clinical trial. RESULTS After 15 weeks of treatment, both azelaic acid and metronidazole induced significant, albeit equal reductions in the number of inflammatory lesions (pustules and papules). A significantly higher physician rating of global improvement was achieved with azelaic acid. Changes in the rosacea signs and symptoms of dryness, burning, telangiectasia, and itching were equal between treatments. A reduction in erythema tended toward significance with azelaic acid at week 15. A trace amount of stinging on application was noted with azelaic acid; however, such discomfort did not appear to concern patients because their overall impression of azelaic acid was superior to that of metronidazole. CONCLUSION Azelaic acid 20% cream provides an effective and safe alternative to metronidazole 0.75% cream with the added benefit of increased patient satisfaction.

Alclometasone Dipropionate in Psoriasis: A Clinical Study

In a parallel group design, and using a ‘blind evaluator’ technique, alclometasone cream 0·05% and clobetasone butyrate cream 0·5% applied twice a day for 21 days were compared in thirty-one patients presenting with psoriasis. Erythema, induration and scaling were assessed at the start of treatment. Seven, 14 and 21 days later, effects of the two treatments were assessed and recorded together with the physicians global evaluation of overall improvement. Both drugs had similar beneficial effects on the clinical signs. No adverse experience was reported and the overall results indicate that alclometasone and clobetasone have comparable efficacy and safety.

What is new in therapeutics

Dermatologists in Western Europe and North America presently have available approximately 400 drugs that can be used topically or systemically for the treatment of patients with skin disease and, each year, five or six new agents with skin disease treatment potential make their appearance. Since the late 60s and early 70s, we are also fortunate in having devices available to us that are both safe and effective for the treatment of hitherto recalcitrant disease. The major emphasis today in dermatology should include the matter of the safety and efficacy of drugs that are now being made available by the various regulatory agencies both in Western Europe and in North America. With the introduction of these new therapeutic agents, we are now being faced with new molecules that are not only therapeutically more specific (and if used properly, are safe), but which place much more demand upon the physician to be aware of the side effects. The physician also has to be aware of the laboratory procedures that should be carried out at baseline and during therapy, as well as the possibility of drug interactions in order to give the patients as much protection as possible from any untoward side effects.

DERM/PHARM. Drug data base for dermatologists.

DERM/PHARM (drugs used in dermatology) is computerized data base that presents drug profiles on the more than 300 drugs used for the treatment of skin disease. This data base can be accessed through DERM/INFONET by members of the American Academy of Dermatology. This data base will be maintained by the Task Force on DERM/PHARM of the Committee on Biomedical Communications of the American Academy of Dermatology.

Efficacy and safety of antihistamines in allergic skin disorders

Background For patients with urticaria, H1‐antihistamines remain the gold standard medical treatment of choice. They act by blocking H1 receptors on the vascular endothelial cell surface. Newer, non‐sedating antihistamines such as loratadine also act to some extent by blocking the release of histamine from mast cells, basophils and human skin tissue.