Urbà González

Therapeutic interventions for vitiligo

BACKGROUND Current treatments for vitiligo, a common pigmentary disorder affecting around 1% of the worlds population, are largely unsatisfactory. OBJECTIVE We sought to report a Cochrane review of all interventions for the treatment of vitiligo. METHODS We systematically searched a range of databases for randomized controlled trials. At least two reviewers independently assessed study eligibility, methodological quality, and extracted data. RESULTS Nineteen trials were included. We found moderate evidence of the benefit of topical steroids. Our search uncovered limited to moderate evidence for various types and regimens of phototherapy (ultraviolet [UV] A and UVB) used alone or in combination with oral and topical treatments. Topical khellin combined with UVA should be questioned in view of the lack of available evidence of benefit. There is limited evidence of the benefit of topical tacrolimus and topical calcipotriol used in conjunction with UV light, and for oral ginkgo biloba, and thin split-thickness grafts. LIMITATIONS Studies generally were poorly designed and reported. CONCLUSIONS Variations in study design and different outcome measures limit the evidence for the different therapeutic options. The best evidence from individual trials showed short-term benefit from topical steroids and various forms of UV light with topical preparations. Long-term follow-up and patient-centered outcomes should be incorporated in study design and psychologic interventions need more attention.

Designing and Reporting Clinical Trials on Treatments for Cutaneous Leishmaniasis

Cutaneous leishmaniasis is considered to be one of the most neglected and serious parasitic infectious skin diseases in many developing countries. We have assessed the design and reporting of randomized, controlled trials evaluating treatments included in 2 Cochrane systematic reviews on cutaneous leishmaniasis. The analysis of the methodological quality identified some potential bias that can make it difficult to determine whether truly effective therapies exist for this disease. We found important weaknesses in the adequacy and transparency of randomization, loss of participants, causative Leishmania species, outcome measures, and follow-up times. Given these distorting effects on the evidence base, we propose guidelines for authors who wish to conduct clinical trials aimed at the development of effective therapies in cutaneous leishmaniasis. The recommendations in this report will hopefully deserve the attention of the World Health Organization and assist in the planning and prioritization of global strategies for improving the interpretation and replication of clinical research on cutaneous leishmaniasis.

Systemic antifungal therapy for tinea capitis in children: An abridged Cochrane Review

Background: The comparative efficacy and safety profiles of systemic antifungal drugs for tinea capitis in children remain unclear. Objective: We sought to assess the effects of systemic antifungal drugs for tinea capitis in children. Methods: We used standard Cochrane methodological procedures. Results: We included 25 randomized controlled trials with 4449 participants. Terbinafine and griseofulvin had similar effects for children with mixed Trichophyton and Microsporum infections (risk ratio 1.08, 95% confidence interval 0.94‐1.24). Terbinafine was better than griseofulvin for complete cure of T tonsurans infections (risk ratio 1.47, 95% confidence interval 1.22‐1.77); griseofulvin was better than terbinafine for complete cure of infections caused solely by Microsporum species (risk ratio 0.68, 95% confidence interval 0.53‐0.86). Compared with griseofulvin or terbinafine, itraconazole and fluconazole had similar effects against Trichophyton infections. Limitations: All included studies were at unclear or high risk of bias. Lower quality evidence resulted in a lower confidence in the estimate of effect. Significant clinical heterogeneity existed across studies. Conclusions: Griseofulvin or terbinafine are both effective; terbinafine is more effective for T tonsurans and griseofulvin for M canis infections. Itraconazole and fluconazole are alternative but not optimal choices for Trichophyton infections. Optimal regimens of antifungal agents need further studies.

Vaccines for preventing cutaneous leishmaniasis

This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate if vaccination with each of the different available vaccines reduces the occurrence of cutaneous leishmaniasis (CL) in endemic regions 1 Vaccines for preventing cutaneous leishmaniasis (Protocol) Copyright