Thomas D. Regan MD, Dawn Lewis MD, Scott A. Norton MD MPH
Objective: Although numerous taste studies have compared the palatability of antibiotic suspensions,1-6 few have
compared the palatability of corticosteroid suspensions.7,8 Therefore, we compared the taste of 8 commonly prescribed
liquid corticosteroid suspensions with the intent to help guide prescribing practices and improve patient compliance.
Methods: We conducted a randomized, double-blind study using 31 adult volunteers ages 24 to 57. All volunteers were
asked to sample 8 different pediatric corticosteroid suspensions and to rate the palatability of their taste and aftertaste.
The mean scores for each sample were then compared.
Results: The 8 suspensions fell into 2 groups based on their taste scores: one group with relatively high scores or more
acceptable tastes (Orapred, Pediapred, and a dexamethasone suspension) and a second group with relatively low scores
or less acceptable tastes (a prednisone suspension and 4 cherry-flavored prednisolone suspensions).
Conclusions: The results demonstrate a significant difference in palatability between corticosteroid suspensions. Not
only will this new information help clinicians choose between otherwise equivalent corticosteroid suspensions but,
given the importance children place on taste, may improve compliance as well.
Scott Fretzin MD, Jeffrey Crowley MD, Loretta Jones FNP-C, Melodie Young MSN RN ANP-C, Jeffrey Sobell MD
Hand and foot psoriasis can appear in a plaque-type or pustular-type form. Any form of psoriasis that occurs on the hands
and feet can have a debilitating effect on the patient’s daily functions. Here we present a case series of patients with plaqueor
pustular-type hand and foot psoriasis whose conditions were successfully managed with the biologic agent efalizumab.
In many of these patients, the disease was refractory to multiple systemic psoriasis treatments. Treatment with efalizumab was
effective and well-tolerated, with few adverse events. Many of the patients described here reported an improvement in both
their physical functioning and health-related quality of life. The efficacy of efalizumab in treating these cases of hand and
foot psoriasis suggests that it may provide therapeutic benefit.
Michael M. Sachse MD, Amor Khachemoune MD CWS, Kjetil K. Guldbakke MD, Michael Kirschfink DVM PhD
Hereditary angioedema (HAE) is a rare autosomal dominant disorder caused by a C1-inhibitor deficiency. It is characterized
by potentially life-threatening recurrent episodes of angioedema of the skin and mucosa. Several recent studies have further
elucidated the immunology of HAE implicating bradykinin, the key mediator of the contact system. This article reviews the
pathophysiology, subtypes, and clinical features of HAE. Therapeutic approaches for various clinical situations (emergency
and prophylactic regimens) are also discussed.
Katherine Holcomb MD, Jeffrey M. Weinberg MD
Varicella-zoster virus is the causal agent of varicella and herpes zoster in humans. Herpes zoster results from reactivation of
latent varicella-zoster virus (VZV) within the sensory ganglia. The incidence and severity of herpes zoster increase with
advancing age. More than half of all persons in whom herpes zoster develops are older than 60 years. The most frequent debilitating
complication is postherpetic neuralgia, a neuropathic pain syndrome that persists or develops after the dermatomal rash
has healed and can be prolonged and disabling. There are many limitations of current therapies for herpes zoster and postherpetic
neuralgia. A live attenuated VZV vaccine has been developed and recently approved by the FDA for the prevention of
herpes zoster in individuals 60 years of age and older. In a randomized, double-blind, placebo-controlled trial with 38,546
patients 60 years of age or older, the use of the zoster vaccine reduced the burden of illness due to herpes zoster by 61.1%
(P<.001), reduced the incidence of postherpetic neuralgia by 66.5% (P<.001), and reduced the incidence of herpes zoster by
51.3% (P<.001). In this review, we will discuss the history of the use of the varicella vaccine in children, and the subsequent
development of the new zoster vaccine.
William R. Levis MD, Aton M. Holzer MD, Leonard L. Kaplan PhD
Background: CD4 T cell counts are recognized as the standard method for monitoring HIV-seropositive patients and, along
with viral load, are clinically important as indicators for initiating highly active antiretrovival therapy (HAART). Skin
reaction scores following topical application of diphenylcyclopropenone (DPC) also demonstrate diagnostic utility as
a functional measure of immune competence.
Methods: We used low sensitizing doses of DPC in 40 patients applied in a non-volatile, non-irritating topical delivery
system to assess immune competence in 40 HIV-seropositive subjects with a range of CD4 T cell counts. Standardized patch
test reading scores were used, with 2+ or greater scores (erythema and induration) indicative of a positive response. The patch
test scores were then compared with CD4 counts.
Results: Application of DPC in concentrations of 0.4% and 0.2% successfully resulted in 90% sensitivity skin reaction scores
in subjects with >300 CD4 T cells/microL, following a single 0.1 mL application to the inner aspect of the arm. Lower DPC
concentrations of 0.1% and 0.05% were too low for initial sensitization reactions. Three subjects with CD4 counts between
150 and 300 cells/microL showed positive skin reactions indicating that this DPC test gives the clinician information on
cellular immunity beyond the CD4 count.
Conclusion: We conclude that a single topical application of DPC at concentrations between 0.2% and 0.4% can serve as a
measure of immune competence in HIV-seropositive patients. As a functional measure of immunocompetence, this DPC test
provides information beyond a CD4 count, which is particularly relevant to HIV-positive subjects with CD4 counts between 200 and 350 cells/microL.
Jennifer C. Filip BA, Whitney P. Bowe BS, Joseph M. DiRienzo PhD, Alla Volgina MSc, David J. Margolis MD PhD
We report the in vitro inhibition of Propionibacterium acnes (P. acnes) by a bacteriocin-like inhibitory substance (BLIS-like
substance) produced by Streptococcus salivarius (S. salivarius). Bacteriocins are proteinaceous substances produced by bacteria
that are capable of inhibiting the growth of similar bacterial strains. Unlike classical antibiotics, they have a relatively
narrow spectrum of killing activity, resulting in a reduction in the intensity of selection for resistance. These findings suggest
that BLIS may potentially be used for its anti-P. acnes activity in the treatment of acne.
Aimee L. Leonard MD, C. William Hanke MD
Poly-L-lactic acid is a biodegradable synthetic polymer used in an injectable form for subcutaneous volume restoration.
Volumetric correction following subcutaneous and deep dermal injection of poly-L-lactic acid is thought to occur through
a foreign body tissue response leading to increased production of fibroblasts and subsequent neocollagenesis. Despite the
growing popularity and use of this material, there has been a scarcity of published information describing proper injection
technique, and many practitioners remain unfamiliar with its use. Appropriate injection technique is critical since incorrect
placement of the material can lead to long-lasting unintended results. We present a protocol for successful injection of
poly-L-lactic acid into the submalar and buccal regions.
Gholamhosein Ghaffarpour MD, Shadi Mazloomi MD, Razieh Soltani-Arabshahi MD, Seyed Kamran Soltani Arabshahi MD
Background: Oral isotretinoin is an established effective therapy for acne. No published data is available on the
efficacy and side effects of this drug in Iranian patients.
Patients and Methods: A total of 132 acne patients with a mean age of 22.9±6.2 years were treated with oral
isotretinoin (Roaccutane) and followed-up from 1999 through 2005. Each patient was started with a dose of 0.75 mg/kg
per day until all active lesions healed, followed by a maintenance dose of 20 mg/kg per day for one more month.
Laboratory tests were done at monthly intervals. Evaluation of clinical response was based on Leeds technique. Patients
were followed-up for a mean period of 4.4 years.
Results: Most of the patients had severe nodulocystic acne involving both trunk and face. Treatment was continued for
6.6±2.5 months with a cumulative dose of 111.5 mg/kg±33.9. The mean final improvement rate was 96.7% (95% CI,
84.9% to 108.5%). There was no correlation between improvement rate and age, sex, duration of acne, length of
treatment, or cumulative dose. Side effects were generally mild and treated conservatively. In the follow-up, period
18.35% experienced relapse after a mean interval of 1.28 years, 9.17% required a second course of isotretinoin, and only
one case needed 3 courses of treatment.
Conclusion: Isotretinoin is an effective and safe treatment for acne in Iranian patients. Starting treatment with a high
dose and modifying the length of treatment based on the therapeutic response in each patient, might lead to a rapid and good response rate with minimal side effects.
Paula Bellot-Rojas MD, Rosalinda Posadas-Sanchez MSc, Nacu Caracas-Portilla MD, Jose Zamora-Gonzalez MSc, Guillermo Cardoso-Saldaña PhD, Fermin Jurado-Santacruz MD, Carlos Posadas-Romero MD
Background: Acanthosis nigricans (AN) is a skin condition commonly present on the neck of obese subjects. Obesity is
often accompanied by insulin resistance and/or hyperinsulinemia. Metformin and rosiglitazone are 2 pharmacologic agents
useful in conditions characterized by insulin resistance.
Objective: The aim of our study was to compare the efficacy of metformin versus rosiglitazone on AN lesions of the neck as
well as their effects on metabolic and anthropometric variables.
Methods: This 12-week randomized, open-label pilot study involved overweight or obese subjects with AN treat with either
metformin (n=14) or rosiglitazone (n=13).
Results: Only the rosiglitazone group showed a significant reduction in insulin levels. No effect on the severity of AN was
observed, but modest improvements of skin texture occurred in both treatment groups.
Conclusions: Metformin and rosiglitazone were well-tolerated. Although efficacy on skin lesions was very modest, their use
in acanthotic subjects might be useful during longer treatment periods.