Rafael F. Martin-Garcia, MD
Imiquimod, an immune response modifier with potent antiviral and antitumor properties, has been reported to be effective in the
treatment of various cutaneous neoplasms. Besides stimulating the production of pro-inflammatory cytokines through Toll-like receptors
on the surface of dendritic cells of monocyte-macrophage lineage, novel antiapoptotic mechanisms have been identified.
Joseph B. Bikowski, MD; and Mitchel p. Goldman, MD
Advances continue to be made in the classification and treatment of rosacea, a chronic dermatologic syndrome. A new empiric classification
system identifies 4 rosacea subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) that may aid in more
precise diagnosis. Several new therapies have recently been approved for treatment of rosacea. Azelaic acid 15% gel is a new firsttier
topical agent proven effective in reducing inflammatory lesions and erythema. New formulations of metronidazole and sulfacetamide
10%/sulfur 5% that offer cosmetic or tolerability advantages are now available. Intense pulsed light therapy has demonstrated
effectiveness in reducing flushing, erythema, and telangiectases, with greater tolerability than existing laser systems. Other treatments
under investigation include low-dose doxycycline hyclate (which may provide greater safety than existing oral antibiotics), benzoyl
peroxide/clindamycin gel, and tacrolimus ointment (for steroid-induced rosacea). With this expanded armamentarium of medical
and light-based therapies, clinicians can now implement a multifaceted approach to treatment, crafting new treatment combinations
to address the unique and evolving features of rosacea in each individual patient.
Sandra Marchese Johnston, MD and Thomas D. Horn, MD, MBA
Warts are a common dermatologic problem. There are many treatments available. Intralesional injection of a skin test antigen has
been shown to be efficacious at eradicating all warts when only a part of one wart is injected. The aim of this study was to determine
whether injection of the combination of Candida albicans, mumps, and Trichophyton skin test antigens was more efficacious than and
as safe as single antigen injection. Seventy-one percent of subjects had resolution of their warts with the injection of the combination
of skin test antigens in this open label single arm study.
Yehuda Ullmann, MD; Oren Shoshani, MD; Lucian Fodor, MD; Yitzchak Ramon, MD; Nurit Carmi, PhD; Avi Suapk, MD; Richard Lincoln, MA and Amos Gilhar, MD
The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure
in plastic surgery. However, unpredictable partial absorption of the injected fat often necessitates repeated harvesting and
injection. Fat preservation for future re-injection is indicated to avoid repeated fat harvesting procedures. A previous study has shown
that fat obtained by suction can be preserved by freezing for at least 2 weeks. The purpose of the present study was to investigate the
effect of freezing autologous free fat for 7 months on the take of the fat graft.
Human fat obtained by suction-assisted lipectomy was centrifuged and stored in a domestic refrigerator at -18°C for 7 months. After
thawing, the fat was injected into the scalp of 10 nude mice, which served as the study group. In the control group (n = 10), fresh fat
Fifteen weeks later, the fat grafts were dissected out. Volumes, weights, and histological parameters were compared between the
groups. The injected fat survived in both the study and the control groups but the histological parameters were significantly inferior
in the frozen fat. The weight of the frozen fat was also significantly less compaired with the fresh fat. The volume of the frozen fat
was inferior but not significantly. Based on this in vivo experiment, it is suggested to refrain from using fat that has been frozen for 7
months or longer. The longest period and the optimal conditions for fat preservation shoud be further investigated.
Bruce E. Strober, MD, PhD and Shari Clark, BA
Etanercept is a self-administered medication that has FDA approval for the treatment of rheumatoid arthritis, juvenile rheumatoid
arthritis, psoriatic arthritis, and ankylosing spondylitis. Etanercept is a human fusion protein of the tumor necrosis factor receptor
(TNFR) and the Fc region of IgG1 that binds to and presumably inhibits the pro-inflammatory and pro-proliferative activity of the
tumor necrosis factor (TNF). A recent multisite, randomized, double-blind, placebo-controlled study conclusively demonstrates that
etanercept as monotherapy effectively treats patients with moderate-to-severe plaque psoriasis. This effect is dose-responsive, with
the etanercept 50 mg twice-weekly dose significantly more effective than the 25 mg twice-weekly dose in reducing the Psoriasis Area
and Severity Index (PASI) score over both 12 and 24 weeks of continuous therapy1.
Nevertheless, clinical trials do not instruct the dermatologist on how to practically integrate etanercept into a patient’s pre-existing
treatment regimen. Many psoriasis patients are already on other systemic therapies or have a medical history that necessitates a tailored
approach to their therapy. Further, in some patients, etanercept at 25 mg twice weekly is ineffective in maximally clearing a
patient of psoriasis. Below are cases that demonstrate how etanercept can be combined with other medications in order to both maximize clinical efficacy and minimize potential risk.
Infliximab was first approved by the FDA in 1998 as a treatment of moderately-to-severely active Crohn’s disease in patients who have
an inadequate response to conventional therapies, and fistulizing Crohn’s disease. In November 1999 the FDA approved it for use in
rheumatoid arthritis with methotrexate, and further expanded this indication in December 2000. It appears to be a promising agent
in the treatment of a variety of inflammatory diseases, psoriasis in particular.
A MEDLINE search was performed for “infliximab” in February of 2004, and the 1,116 articles found were reviewed. Approximately
200 articles were identified that contained references to the treatment with infliximab of skin disease, off-label uses, systemic diseases
with cutaneous manifestations, and systemic and cutaneous side effects. These articles were reviewed and their contents summarized.
Infliximab has been proven in well-controlled trial trials to ameliorate inflammatory bowel disease, rheumatoid arthritis, psoriasis, psoriatic
arthritis, and ankylosing spondylitis. Anecdotal reports report it useful in treating the cutaneous manifestations and associations
of inflammatory bowel disease, Behçet’s disease, graft versus host disease, Sjogren’s syndrome, refractory sarcoidosis, and a variety
of other conditions. Its notable side effects include an increased risk of the induction of infections (e.g., tuberculosis).
Infliximab is a very promising medication in the treatment of inflammatory dermatological conditions and should be used in larger
scale trials of more diseases.
M.E. Balañá; C. Alvarez Roger; A. V. Dugour and N. A. Kerner
Most drugs used for treatment of androgen-related dermatological disorders are not completely satisfactory in terms of clinical efficacy
and potential secondary effects. There is, therefore, a need for a new generation of specific antiandrogens. This paper focuses on
an oligonucleotide antisense pharmacological strategy. Acceptor sites were first disclosed by mapping the human Androgen Receptor
(AR) mRNA conformation using an mRNA walking approach, oligonucleotide binding, and S1 protection assays. Antisense-sensitive
regions were localized by RNAse H degradation and AR in vitro translation inhibition. Oligonucleotides were then designed and
assessed, in primary cultures of human hair dermal papillae and skin derived fibroblasts, for their capability to down-regulate AR
expression. Some of them were able to inhibit more than 60 to 80% of the AR expression. These could be a new class of antiandrogen
oligonucleotides pharmacologically active in hair and skin derived cells, suitable for the treatment of dermatological disorders.
Matthias G. H. Vey, PhD
The relationship between the fragrance industry and the dermatological community in the past has not always been perceived as one
of partnership. IFRA, the International Fragrance Association, has started a series of initiatives to underline the industry’s commitment
to market safe products that limit any unavoidable risk to the minimum while at the same time enabling the consumer to choose
from a variety of fragranced products. This article describes current projects and future initiatives.