Suzanne Bruce

Herpesvirus-like DNA sequences in non-Kaposi's sarcoma skin lesions of transplant patients

Herpesvirus-like DNA sequences (KSHV) have been reported to be associated with various forms of Kaposis sarcoma (KS). To determine if KSHV was associated with other proliferative skin lesions from non-AIDS immunocompromised patients, 33 skin lesions (basal cell carcinomas, squamous cell carcinomas, actinic keratoses, verruca vulgaris, atypical squamous proliferations, and seborrhoeic keratosis) from 4 organ-transplant patients receiving immunosuppressive therapy were tested for KSHV by PCR. KSHV sequences were detected in 82% of these skin lesions. Our results suggest that KSHV is associated with lesions other than KS in non-AIDS immunocompromised patients, and may also be involved in the pathogenesis of the various forms of proliferative skin lesions from organ-transplant patients.

Effect of a Low-Fat Diet on the Incidence of Actinic Keratosis

BACKGROUND Actinic keratoses are premalignant lesions and are a sensitive and important manifestation of sun-induced skin damage. Studies in animals have shown that dietary fat influences the incidence of sun-induced skin cancer, but the effect of diet on the incidence of actinic keratosis in humans is not known. METHODS We randomly assigned 76 patients with nonmelanoma skin cancer either to continue their usual diet (control group) or to eat a diet with 20 percent of total caloric intake as fat (dietary-intervention group). For 24 months, the patients were examined for the presence of new actinic keratoses by physicians unaware of their assigned diets. RESULTS At base line, the mean (+/- SD) percentage of caloric intake as fat was 40 +/- 4 percent in the control group and 39 +/- 3 percent in the dietary-intervention group. After 4 months of dietary therapy the percentage of calories as fat had decreased to 21 percent in the dietary-intervention group, and it remained below this level throughout the 24-month study period. The percentage of calories as fat in the control group did not fall below 36 percent at any time. The cumulative number of new actinic keratoses per patient from months 4 through 24 was 10 +/- 13 in the control group and 3 +/- 7 in the dietary-intervention group (P = 0.001). CONCLUSIONS In patients with a history of nonmelanoma skin cancer, a low-fat diet reduces the incidence of actinic keratosis.

Comparative study of calcipotriene (MC 903) ointment and fluocinonide ointment in the treatment of psoriasis

BACKGROUND The topical vitamin D analogue calcipotriene has been reported to be an effective treatment for patients with psoriasis. Comparative studies with topical steroids are informative in judging this new therapy. OBJECTIVE The purpose of this study was to evaluate the efficacy and safety of calcipotriene ointment 0.005% versus fluocinonide ointment 0.05% in the treatment of plaque psoriasis. METHODS This study was a randomized, double-blind, parallel-group, active-controlled trial in adults who had at least mild overall disease severity and plaque elevation of at least moderate severity. Treatments were applied twice daily for 6 weeks, and subjects were evaluated at weeks 0, 2, 4, and 6. Subjects were graded on a 9-point scale (0 to 8) for scaling, erythema, plaque elevation, and for overall disease severity. A physicians global assessment of improvement/worsening was performed at every visit. RESULTS A total of 114 subjects were enrolled at six study sites. Ninety-nine subjects completed the trial. Mean scores for signs of scaling and plaque elevation in calcipotriene-treated subjects were significantly lower by week 2 than in the fluocinonide-treated subjects. These scores continued to be significantly lower than fluocinonide through week 6 (p < 0.05). Mean scores for erythema in calcipotriene-treated subjects were significantly lower than those in fluocinonide-treated subjects at weeks 4 and 6 (p < 0.05). Both the physicians global assessment and overall disease severity showed statistically significant treatment differences in favor of calcipotriene at week 4 (p < 0.05). This superior efficacy continued through week 6. Treatment-related adverse events were observed in 12 calcipotriene-treated subjects and 5 fluocinonide-treated subjects; all were considered minor. CONCLUSION Calcipotriene was superior to fluocinonide in the treatment of plaque psoriasis.

Urticaria: Clinical efficacy of cetirizine in comparison with hydroxyzine and placebo

Chronic urticaria is a problem for both physician and patient. In an effort to avoid the risks associated with corticosteroid treatment, many first-generation H1-receptor antagonists have been tried and found to induce undesirable levels of sedation when given in amounts sufficient to control urticaria. Cetirizine, a pharmacologically active oxidized metabolite of hydroxyzine, was developed to provide selective H1-receptor inhibition without depression of the central nervous system. In a 4-week, multicenter, double-blind, placebo-controlled safety and efficacy study, cetirizine, in a once-a-day dose (5 to 20 mg), was equivalent in efficacy to hydroxyzine in divided doses (25 to 75 mg/day). The incidence of somnolence in the cetirizine group was not significantly different from that of the placebo group. However, in the hydroxyzine group, the incidence of somnolence was significantly higher than that in the placebo group (p = 0.001). The results of this study demonstrate that cetirizine has a greater safety margin over the older parent drug hydroxyzine.

Topical methyl-aminolevulinate photodynamic therapy using red light-emitting diode light for treatment of multiple actinic keratoses: A randomized, double-blind, placebo-controlled study

BACKGROUND The use of light-emitting diode light offers practical advantages in photodynamic therapy (PDT) with topical methyl-aminolevulinate (MAL) for management of actinic keratoses (AK). OBJECTIVE We sought to evaluate the efficacy of MAL PDT using red light-emitting diode light. METHODS We conducted a multicenter, double-blind, randomized study. A total of 49 patients with 363 AK lesions had 16.8% MAL cream applied under occlusion for 3 hours, and 47 patients with 360 AK lesions had vehicle cream similarly applied. The lesions were then illuminated (630 nm, light dose 37 J/cm2) with repeated treatment 1 week later. Complete lesion and patient (all lesions showing complete response) response rates were evaluated 3 months after last treatment. RESULTS MAL PDT was superior (P<.0001) to vehicle PDT with respect to lesion complete response (86.2% vs 52.2%, odds ratio 6.9 [95% confidence interval 4.7-10.3]) and patient complete response (59.2% vs 14.9%, odds ratio 13.2 [95% confidence interval 4.1-43.1]). LIMITATIONS The study population may not be representative of all patients with AK. CONCLUSION MAL PDT using red light-emitting diode light is an appropriate treatment alternative for multiple AK lesions.

Early detection of skin cancer: Racial/ethnic differences in behaviors and attitudes

Data from 384 individuals participating in a worksite skin cancer screening program were used to assess racial/ethnic differences in attitudes toward and practice of prevention and early detection of skin cancer. Caucasians and Hispanics were more likely than African Americans to report having used a sunscreen during the past year. Caucasians performed skin self-examination more frequently than Hispanics, but African Americans did not differ in their frequency of skin self-examination from the other two groups. African Americans and Hispanics reported that they would be less likely than Caucasians to seek immediate follow-up care for suspicious skin lesions. Both similarities and differences were found in a variety of health belief variables across the three groups. These findings suggest a need for intensified efforts at primary and secondary prevention of skin cancer among African Americans.

Treatment of Melasma Using a Novel 1,927-nm Fractional Thulium Fiber Laser: A Pilot Study

BACKGROUND A 1,927‐nm wavelength was recently added to the 1,550‐nm erbium‐doped fiber laser. This wavelength possesses a higher absorption coefficient for water than the 1,550‐nm, conferring greater ability to target epidermal processes such as dyschromia. OBJECTIVE To evaluate the efficacy and safety of a novel 1,927‐nm fractional thulium fiber laser in the treatment of melasma. METHODS Fourteen patients underwent three to four laser treatments (at 4‐week intervals) at pulse energies of 10 to 20 mJ and total densities of 252 to 784 microscopic treatment zones per cm2 (6–8 passes) using a 1,927‐nm thulium fiber laser. Three blinded assessors and the patients evaluated clinical improvement of treatment areas at 1‐, 3‐, and 6‐month follow‐ups. Side effects were assessed, and pain was scored using a visual analog scale (0–10). RESULTS A statistically significant 51% reduction in MASI score was observed at 1‐month post 3 to 4 laser treatments. A 33% (p = .06) and 34% (p = .07) reduction in Melasma Area and Severity Index score was observed at the 3‐ and 6‐month follow‐up visits, respectively. Skin responses observed after treatment were moderate erythema and mild edema. No scarring or postinflammatory hyper‐ or hypopigmentation was observed. CONCLUSION The 1,927‐nm fractional thulium fiber laser is a safe, effective treatment for melasma.

Laser eradication of pigmented lesions: a review.

BACKGROUND Pigmented lesions include solar lentigines, seborrheic keratoses, dermatosis papulosa nigra, ephelides, café‐au‐lait macules, nevus spilus, Beckers nevus, postinflammatory hyperpigmentation, melasma, nevocellular nevi, congenital nevi, junctional and compound melanocytic nevi, nevus of Ota and Ito, Horis nevus, and blue nevi. Advances in laser technology have resulted in the ability to treat pigmented lesions with greater safety and efficacy. OBJECTIVE To review the literature on the use of cutaneous laser treatments for pigmented lesions using Medline. RESULTS The literature cited the use of various lasers to treat pigmented lesions, including argon, carbon dioxide, erbium‐doped yttrium aluminum garnet, Q‐switched, long‐pulsed ruby, alexandrite, diode, and fractional lasers. For each lesion, we describe the efficacy of laser treatments, treatment intervals, and settings used for a variety of diagnoses. CONCLUSION The treatment of pigmented lesions continues to evolve as new laser technology emerges and improvements in existing devices are made. The ability to treat pigmented lesions with greater efficacy and safety has resulted from recent advances in laser technology. The authors have indicated no significant interest with commercial supporters.

Cutaneous sarcoidosis in a patient with philadelphia-positive chronic myelogenous leukemia treated with interferon-α

A patient with Philadelphia‐positive (Ph+) chronic myelogenous leukemia (CML) was diagnosed with cutaneous sarcoidosis after treatment with interferon‐alpha (IFN‐α). Following IFN‐α dose reduction, the skin lesions disappeared. Few cases of sarcoidosis associated with IFN treatment have been reported, and only in one patient with pre‐existing CML. Our patient was unique in that (1) the sarcoidosis was induced by the IFN‐α treatment alone, (2) it developed de novo, and (3) it was confined to the skin. Am. J. Hematol. 58:80–81, 1998.

Intralesional interferon-α and zidovudine in epidemic Kaposi's sarcoma

Background: Kaposis sarcoma (KS) is the most common neoplasm in patients with acquired immunodeficiency syndrome (AIDS). To date, no therapy has proved to be consistently effective. Objective: The purpose of this study was to evaluate the efficacy of intralesional interferon- α in patients with epidemic KS who were taking zidovudine. Methods: Up to five lesions in each of 14 patients entered into the study were injected with 1 million U of interferon- α three times weekly for 6 weeks. Sterile water was used as a placebo control. The median zidovudine dose was 500 mg/day. The median CD4 count was 23/ μ l. Results: Of 14 patients evaluated, 13 of 14 (93%) showed a clinical complete response (CR) or partial response (PR) to therapy. Of 54 lesions injected, 41 (76%) showed a CR and 5 (9%) showed a PR, which resulted in an overall response rate of 85%. Conclusion: Intralesional interferon- α produced a high response rate in injected lesions of KS, but it failed to demonstrate superior efficacy over the placebo.