Javier Ruiz-Esparza, MD; Julio Manuel Barba Gomez, MD and Ivan Rosales Berber, MD
Rosacea is a chronic disease characterized by redness, pimples, and thickened and inflamed skin. It affects both women and men, and does so primarily between the ages of 30 and 60. Daily interaction with other people is often embarrassing for rosacea sufferers due to the derogatory social connotations associated with the facial erythema and telangiectasia common to rosacea; this disease also often resembles acne vulgaris, which for many adults adds a further psychological burden.
Numerous oral and systemic medications, used singly or in combination, are considered the standard treatment for controlling the disease. Unfortunately, the expense, time, and effort required for its treatment are considerable.
Non-Ablative Radiofrequency (NARF) is a recent technological development that permits the use of intense heat delivered to deep dermal and subcutaneous tissues without a superficial burn.
Thermotherapy is not new in the medical field, as the use of deep heat as treatment for inflammatory conditions has had a long history in medicine. We recently reported on its effectiveness in treating active acne vulgaris1. This new technology was also tried in 3 patients with rosacea, and the preliminary results are the subject of this report.
Kenneth B. Gordon, MD and Richard Langley, MD
Alefacept is the first biologic agent approved for the treatment of chronic plaque psoriasis in the United States. Alefacept, administered
intravenously (IV) or intramuscularly (IM), was found to be well tolerated, safe, and efficacious in two pivotal phase 3 studies in
patients with moderate to severe psoriasis. Treatment with IV alefacept was associated with a median duration of off-treatment
response of 216 days (approximately 7 months). In a follow-up extension study to the phase 3 IM study, duration of therapeutic
response was also examined. Patients who achieved a ?75% reduction in baseline Psoriasis Area and Severity Index (PASI 75) with
the first course of alefacept 15 mg IM in the phase 3 study maintained a PASI 50 for a median duration of 209 days. In addition, the
extension study demonstrated that a second course of IM alefacept is safe and well tolerated in patients with psoriasis.
Stacy Smith, MD; Dan Piacquadio, MD; Vera Morhenn, MD; Deborah Atkin, MD and Richard Fitzpatrick, ND
The efficacy of photodynamic therapy (PDT) using broad area treatment with 5-aminolevulinic acid (ALA) has not been compared
to topical 5-fluorouracil (5-FU) in the treatment of actinic keratoses (AK).
The purpose of this study was to compare the efficacy and tolerability of PDT using short incubation time, broad area treatment
with ALA plus activation with either blue light or laser light to topical 5-FU in the treatment of AK of the face and scalp.
Thirty-six subjects with AK of either the face or scalp were randomized to receive either application of ALA for 1 hour followed by
activation with blue light or pulsed dye laser or topical 5-FU. Efficacy was evaluated by grading AK lesions and photoaging signs.
Tolerability was assessed by scoring crusting /erosions, erythema and stinging /burning.
Treatment with PDT using ALA plus blue light was as effective as topical 5-FU in clearing AK. PDT using ALA plus laser light was
the least effective treatment. All treatments made improvements in the signs of photoaging. Both PDT treatments were better tolerated
In conclusion, broad area PDT treatment with ALA plus activation with blue light appears to be as effective as 5–FU in the treatment
of AK. ALA plus laser light is somewhat less effective than the above therapies. Efficacy could likely be improved with further
study of laser parameters and incubation tim
Molluscum contagiosum, a viral disease of the skin, manifests as a smooth-surfaced, firm, and spherical papule with umbilication of
the vertex. It commonly presents as multiple lesions, which may be extensive in immunocompromised patients, and may mimic cutaneous
tumors in HIV co-infected patients. Infection usually persists for 6 months to 5 years before resolving naturally. Among
immune-impaired persons with HIV, infection is generally more persistent. To date, single and combination therapies for such
patients have been unsatisfactory. Recent observations from a dermatology practice in which 6 patients with HIV and molluscum
contagiosum were treated with 5-aminolevulinic acid (Levulan® Kerastick®) in conjunction with photodynamic therapy suggest clinical
benefits; i.e., substantial reduction in lesional count and severity. Additional research is mandated.
Jacob Levitt, MD, Terry Feldman, MD; Ildiko Riss, MD and On-Tai Leung, MD
The physical and chemical compatibility of desoximetasone ointment 0.25% and tacrolimus ointment 0.1%, both widely used to treat
atopic dermatitis, were determined. A 1:1 (w/w) mixture of desoximetasone ointment 0.25% (Topicort®, Taro Pharmaceuticals USA,
Inc.) and tacrolimus ointment 0.1% (Protopic®, Fujisawa Healthcare, Inc.) were prepared and stored under three different temperature/
relative humidity conditions: 25oC/60% RH; 30oC/60% RH; and 40oC/75% RH. Unmixed ointments stored under the same temperature
and humidity conditions as the mixture served as controls. Samples were evaluated at days 1, 2, 7, 14, and 28 for color, degree
of physical separation, and chemical stability via reverse-phase high performance liquid chromatography. Ranges of relative recovery
for each active ingredient for all storage conditions ((% Mixture/% Control) x 100) were 89.6 - 109.3% for tacrolimus and 99.0 - 103.4%
for desoximetasone. No significant difference in physical appearance or chromatographic profile between the mixture and controls
was observed. Therefore, we conclude that desoximetasone ointment 0.25% (Topicort®) and tacrolimus ointment 0.1% (Protopic®)
are physically and chemically compatible up to four weeks when mixed in a ratio of 1:1 (w/w).
Alan N. Elias, MD; Vandana S. Nanda, MD and Ronald J. Barr, MD
Propylthiouracil (PTU), an antithyroid thioureylene with immunomodulatory properties, has been shown to be effective in the therapy
of patients with plaque psoriasis. The mechanism of action of antithyroid thioureylenes in psoriasis remains unknown.
Propylthiouracil is a commonly used agent in the treatment of patients with Graves’ hyperthyroidism, a condition associated with elevated
levels of interleukin-12 (IL-12), which fall significantly after propylthiouracil treatment. IL-12 is believed to play a pivotal role in
the development of psoriasis. Production of IL-12 is modulated by the anti-inflammatory cytokine IL-10. The effect of PTU on IL-
12 and IL-10 levels was, therefore, studied in twelve patients with plaque psoriasis. Treatment with 300 mg of PTU daily in divided
doses for three months produced significant improvement of the PASI and histological scores in the patients. Serum IL-12 concentrations
were undetectable at baseline and did not change with treatment. IL-10 concentrations were 1.39 ± 1.49 pg /ml (mean ± SD)
at baseline, and showed no significant change after 2 weeks (1.63 ± 1.61 pg /ml and 12 weeks 1.15 ± 1.58 pg /ml of treatment with PTU.
The data suggest that the clinical improvement with patients with psoriasis treated with PTU is not due to a fall in circulating IL-12
or a rise in IL-10 concentrations. Although the drug may have effects on lesional production of these cytokines this is not reflected
in the circulating levels. It is speculated that the beneficial effect is likely mediated by an inhibitory effect on keratinocyte proliferation
or promotion of apoptosis in these proliferated keratinocytes.
Robert J. Clemons, MD; Annette Clemons-Miller, PhD; Sandra Marchese Johnson, MD; Susan K. Williamson, MA, CPC and Thomas D. Horn, MD
To compare the cost of several common modalities used to treat non-genital warts in immunocompetent patients, we identified studies
published in English using standard search strategies and evaluated the literature for the following common non-genital wart
therapies: cryotherapy with liquid nitrogen, carbon dioxide and pulsed-dye laser therapy, topical squaric acid, intralesional
bleomycin, intralesional interferon alpha injections, and intralesional immunotherapy with Candida antigens. Standard treatment
algorithms, compiled by dermatologists experienced in the treatment of patients with moderate wart burdens, were utilized
for cost-comparison analyses.
Based on the cost analysis model, the least expensive treatment option for non-genital warts were carbon dioxide laser therapy
($157) and Candida antigen injections ($190). The other treatment modalities examined ranged from $495 (bleomycin) to $1227 (interferon
alpha). Although treatment with the carbon dioxide laser therapy is the least expensive, pain and post-procedure complications
limit the use of this modality.
No abstract details for the moment.