Jeffrey M. Weinberg MD, Clement J. Bottino BA, James Lindholm BA, Robin Buchholz MD
Psoriasis is a chronic skin disorder that affects approximately 2% of the US and European population. Over the last
several years, one of the major focuses in psoriasis research has been the development of biologic therapies for this disease.
The aim of these therapies is to provide selective, immunologically directed intervention with fewer side effects
than traditional therapies. The goal of this article is to update the progress of the tumor necrosis inhibitors which are
available, or under investigation, for clinical use in psoriasis: infliximab, etanercept, and adalimumab, as well as the
T-cell-targeted therapies efalizumab and alefacept (Table 1).
The skin of patients with rosacea is extremely sensitive and hyper-reactive to dietary, environmental, and topical factors.
Accordingly, the management of rosacea involves not only choosing appropriate medication and treatment for
daily skin care, but also avoiding known trigger factors. Recently, 1% metronidazole, a mainstay of topical rosacea therapy,
was reformulated in a gel vehicle that contains hydrosolubilizing agents (HSA) niacinamide, beta cyclodextrin,
and a low concentration of propylene glycol. It is designed to solubilize greater concentrations of metronidazole than
is possible in water alone while reducing the potential for irritation and barrier disruption. A 2-week study was undertaken
by the author to evaluate the effect of the new 1% metronidazole gel on the skin barrier in 25 women with mild
to moderate rosacea. Statistically significant improvement in disease severity, erythema, desquamation, and skin irritation
was noted by the investigator by the end of week 1, which continued throughout the study. After 2 weeks, subjects
noted improvements in skin condition and rosacea. Results of noninvasive assessments showed no disruption of the skin
barrier. Furthermore, there was an increasing trend in skin hydration that approached statistical significance.
Andrew A. Nelson BS, Daniel J. Pearce MD, Alan B. Fleischer Jr MD, Rajesh Balkrishnan PhD, Steven R. Feldman MD
Historically, severe psoriasis frequently required inpatient hospitalization for several weeks to reduce symptoms and prevent
morbidity and mortality. Despite declining hospitalization rates there remain patients who undergo severe, acute
psoriasis exacerbations requiring inpatient care. The majority of the literature describes the treatment of psoriasis
in the outpatient setting. We review the inherent differences between the inpatient and outpatient management of
psoriasis along several dimensions and discuss an approach to the inpatient treatment of severe psoriasis based upon
therapeutic rate of onset, efficacy, and safety. The inpatient setting benefits from and lends itself to use of rapid acting,
highly effective agents. Given the acute nature of psoriasis inpatient episodes, the risks associated with long-term use
of a treatment are far less important in inpatient setting treatment planning than they are in the outpatient setting.
Navid Bouzari MD, Keyvan Nouri MD, Hossein Tabatabai MD, Zahra Abbasi MD, Alireza Firooz MD, Yahya Dowlati MD PhD
Background: It is generally accepted that multiple laser treatments yield more effective clinical results; however, it is
not clearly known whether increasing the number of treatments would affect the incidence of adverse effect. The main
objective of the study was to assess the role of the number of treatments in the efficacy and safety of laser-assisted hair
removal in a relatively dark-skinned population.
Methods: A retrospective study of 313 consecutive laser-assisted hair removal treatments was conducted on a total of
23 patients (22 women, 1 man) with 58 anatomic areas by means of an alexandrite laser. Skin types of III and IV were
represented. The long-pulsed alexandrite system (Aphrodite, Quanta system, Italy) was used at a 755-nm wavelength
to deliver fluences ranging from 17 to 25 j/cm2 through a 10 mm spot size. The patients were divided into 4 groups
according to the number of treatments (group I ? 4, group II = 5, group III = 6, and group IV ? 7 treatments). Digital
photographs of the patients were used for hair counting. Adverse effects (hyperpigmentation, hypopigmentation, blister,
folliculitis) were questioned. The treatment was defined as successful if there was more than 50% hair reduction
and an absence of the adverse effects.
Results: There was a positive correlation between hair reduction and number of treatments (r = .402, p < .005). The
following side effects were observed: hyperpigmentation (two patients, both in group IV); hypopigmentation (one
patient in group IV) and blister (one patient in group IV); folliculitis (two patients in group III and IV). Treatment was
successful in 48.3% (28 out of 58) of the treatment sites. The success rate was 25% for ?4 treatments, and 76%, 58%,
and 15% for 5, 6, and ?7 treatments respectively (p = .002).
Conclusion: Patients who undergo more treatment sessions achieve a higher rate of hair reduction; although this may
be concomitant with an increase in the incidence of adverse effects. The benefit of more laser treatments should be balanced
with the risk of occurrence of side effects in each patient.
Sherry H. Hsiung MD, Perry Robins MD
Occlusive dressings are the foundation of wound care and have been shown to speed epithelialization and healing of
surgical sites. Many different dressings have been introduced over the years including antibacterial ointments with
gauze and adhesive, hydrocolloid bandages, and liquid adhesives. All of these have their limitations and advantages.
We introduce our experience with a new organic polymer in solvent which when applied to a wound forms a flexible
occlusive bandage. The material has been shown to have antimicrobial properties and be well-tolerated by patients.
Alan Fleischer MD, Suephy Chen MD
Objective: To examine both the short-term clinical efficacy and quality-of-life changes resulting from treatment of
rosacea with regimens that reflect the participating physicians’ standards of care while incorporating azelaic acid gel.
Design: Longitudinal, open-label, observational study.
Patients: 583 patients with mild to moderate rosacea participated in this study.
Interventions: Patients received azelaic acid gel either alone or in combination with other standard treatment for
rosacea according to each participating physician’s standards of care.
Main Outcome Measures: Change in Investigator’s Global Assessment score, measuring the severity of rosacea
symptoms, from baseline to follow-up, and change in scores on the RosaQoL?, a rosacea-related quality-of-life
instrument with 4 component measures (Overall, Emotion, Symptom, and Function) completed by patients at both
baseline and follow-up.
Results: Over the course of treatment, the mean Investigator’s Global Assessment score dropped from 3.52 to 2.10
(P < .0001). Patients who were prescribed combination therapy had significantly greater improvement than those who
were prescribed azelaic acid gel alone (P < .0001). All 4 components of the RosaQoL? also showed significant
improvement over the course of treatment, regardless of the type of therapy prescribed (P < .0001).
Conclusion: Azelaic acid gel, either alone or in combination with other medications, is efficacious in the treatment of
mild to moderate rosacea, as shown by observational data collected in the clinical setting from both treating physicians
Helen Torok MD, Susan Taylor MD, Leslie Baumann MD, Terry Jones MD, Joshua Wieder MD, Nicholas Lowe MD, Michael Jarret MD, Pheobe Rich MD, David Pariser MD, Eduardo Tschen MD, Dale Martin MD, Alan Menter MD, Jonathan Weiss
This was a 12-month extension of a randomized, investigator-blinded, multicenter, 8-week trial with triple
combination (TC) cream in facial melasma. A total of 585 patients were enrolled in the study and 569 patients
received study medication. Three hundred eighty-nine patients completed 6 months of treatment and 327 patients
completed 12 months of treatment. TC cream demonstrated a favorable safety profile: only 14 patients (2.5%)
discontinued the study due to treatment-related adverse events (AEs). The 2 cases of skin atrophy were mild and
did not lead to withdrawal. From the 23 cases of mild telangiectasia, only 2 resulted in discontinuation. All others
were transient. Results confirmed those of a previous smaller study, with both physicians and patients reporting
clinically significant improvements in melasma. By month 12, 80% of patients had lesions completely cleared or
nearly cleared. Once daily application of TC cream applied intermittently over a long period is a safe, tolerable, and
effective treatment for moderate to severe melasma of the face.
Topical imiquimod has opened an entirely new area of dermatology that previously did not exist: medical therapy for
skin cancers. While surgery will continue to play a vital role in treating more aggressive tumors and in patients who
may not be imiquimod candidates, the availability of a viable medical therapy that can be used independently or in
combination with other modalities will considerably enhance our ability to treat skin cancer successfully.
Steven Bowman MD, Michael Gold MD, Adnan Nasir MD PhD, George Vamvakias
In the treatment of mild to moderate acne vulgaris, the combination of an antibiotic and benzoyl peroxide provides
enhanced efficacy over the individual agents, with the potential to decrease the emergence of resistant strains of
P. acnes. To evaluate treatment regimens combining the daily use of a clindamycin/benzoyl peroxide gel, a tretinoin
gel, and a clindamycin gel, the current randomized, evaluator-blind study was conducted. Results demonstrate that
once-daily administration of clindamycin/benzoyl peroxide gel (combination formulation) was as effective as clindamycin/
benzoyl peroxide gel + tretinoin gel + clindamycin gel. Both of these regimens provided greater efficacy than
tretinoin + clindamycin. Treatment with clindamycin/benzoyl peroxide demonstrated a significant benefit over other
treatments at Week 2, highlighting its rapid onset of action. All regimens were safe and generally well tolerated, with
less severe peeling seen in patients who received clindamycin/benzoyl peroxide. In conclusion, the regimens that
included clindamycin/benzoyl peroxide were more effective than tretinoin + clindamycin in the treatment of acne
vulgaris, with no clinical advantage of adding tretinoin + clindamycin to once-daily clindamycin/benzoyl