Abbas Rasi MD, Ashkan Heshmatzade Behzadi MD, Siamak Davoudi MD, Parviz Rafizadeh MD, Yasamin Honarbakhsh MD, Mahsa Mehran MD, Pirouz Piran MD, Nasir Dehghan MD
Introduction: Response to different antimicrobial agents supports the infection hypothesis for lichen planus (LP). There are individual
case reports describing the improvement of LP with oral metronidazole treatment in patients with concomitant intestinal amebiasis
or giardiasis. There are two small studies that reported metronidazole might be effective in some patients with idiopathic LP who
did not have concomitant protozoal infections of the intestinal or genital tracts. The authors performed an open trial to evaluate the
effectiveness of metronidazole, as a single treatment, on different forms of LP.
Patients and Methods: A total of 49 patients, 24 male and 25 female, were selected from the dermatology outpatient clinic with
a diagnosis of LP in one of its forms. Metronidazole was administered at 250 mg every eight hours daily without any concomitant
therapy. Patients were examined at baseline and at days 21, 42, 63, 84 of treatment, and the follow-up period was three months. The
authors used SPSS software (Version 15) for data analysis.
Results: A total of 20 (40.82%) skin lesions had complete response (CR) to treatment by metronidazole, 16 (32.65%) had relative
healing (PR) and 13 (26.53%) did not improve (NR). The overall treatment response (CR +PR) of LP skin lesions was 73.47 percent in
this study. In mucosal involvement, the overall treatment response was 66.6 percent, and finally the overall treatment response for
itching was obtained in 75 percent of the cases.
Conclusion: Based on the authors’ findings, metronidazole can be an alternative therapy in treatment of LP, and is a safe agent to
Mahmoud F. Abdel Hamed, Hassan A. Hussein, Nivine A. Helmy, Mohamed L. Elsaiea,
Background: Ichthyosis is a disorder of keratinization characterized by diffuse uniform and persistent scales resulting from abnormal
epidermal differentiation or metabolism. The identification of steroid sulfatase (STS) as the cause of X-linked ichthyosis (XLI) points to
the importance of this enzyme in skin desquamation. Fluorescent in situ hybridization (FISH) analysis is a good diagnostic technique
with which to detect a common deletion of the STS gene.
Objective: In this study, the authors set out to detect the X-linked type of ichthyosis, diagnosed by detection of STS gene deletions
among Egyptian males.
Methodology: Egyptian males complaining of X-linked ichthyosis were clinically examined, evaluating pedigree analysis of the family,
cytogenetic studies using G-banding technique and FISH using locus specific probe for stereoid sulfatase (STS) gene which is
located at chromosome Xp22.3.
Results: Of patients, 11.11 percent had nocturnal enuresis and 33.33 percent showed STS gene deletion by FISH analysis.
Conclusion: This study underlines a difficulty in diagnosing X-linked ichthyosis on the clinical features or familial pedigree analysis in
Egypt and the importance of cytogenetic and molecular cytogenetic studies for diagnosis. FISH analysis is a good, reliable and rapid
diagnostic tool with which to detect STS gene deletion. Since FISH will not detect partial deletion or point mutations, the authors
recommend further molecular studies to reach the proper diagnosis of X-linked ichthyosis.
Jeffrey M. Weinberg MD and Stephen K. Tyring MD PhD
Staphylococcus aureus (S. aureus) is the leading cause of nosocomial infections and responsible for more than 11 million skin and
soft tissue infections annually. Impetigo is a common skin infection and the most common bacterial skin infection in children aged
two to five years. The emergence of S. aureus isolates resistant to commonly utilized antibacterials for skin infections (β-lactams,
erythromycin, fluoroquinolones and mupirocin) makes successful treatment an ongoing challenge. To treat skin infections such as
impetigo, antibacterials with a short dosing schedule and low propensity to develop resistance should be used. In 2007, retapamulin
was the first agent for human use approved in the pleuromutilin class of antibacterials in the United States (U.S.), and is the first topical
antibacterial indicated to treat impetigo in over 20 years. In vitro, retapamulin is highly potent against S. aureus and has a lower
propensity to develop resistance than mupirocin. In clinical studies, the convenient five-day b.i.d. (twice-daily) dosing of retapamulin
is highly effective against impetigo due to methicillin- susceptible S. aureus and Streptococcus pyogenes and may play an important
role in limiting the development of resistance against systemic agents.
Gulsum Gencoglan MD, Murat Tosun PhD, Oner Gencoglan MD
Wound healing is a complex process, and the role of retinoids in wounds is confusing and controversial. In this study, the authors
aimed to evaluate the role of oral isotretinoin on mast cells, collagen production and remodeling in the wound healing process. In the
first group 2 mg/kg/day isotretinoin dissolved in sunflower oil were administrated for 28 days. In the second group, only sunflower
oil was administered. At the end of first week, four incisions were made on rats’ back. In the seventh (group 1a and 2a), fourteenth
(group 1b and 2b) and twenty-first (group 1c and 2c) days, the skin biopsies were taken from around of the incision areas from both
groups. The authors revealed that isotretinoin administration permanently accelerates mast cell accumulation parallel to days in the
wound area. The histological features of wound healing in isotretinoin administered rats were faster and better than the group 2.
Fernanda Aguiar Santos Vilela MD, Sueli Carneiro MD PhD, Marcia Ramos-e-Silva MD PhD
Scleroderma is a disease that affects the microvasculature and the connective tissue. These alterations produce fibrosis and blood
vessel occlusion. Its cause is still unknown, although the exaggerated synthesis of collagens I and IV, detected in skin and vessels,
may be related to genetic, immunologic and, less frequently, exogenous factors as inhalation of silica and polyvinyl chloride. There is
a localized and a systemic form, which affects both adults and children.
The treatment of the localized form, also called morphea, is still controversial, and, in this article, the authors will discuss the main
agents that were found to improve the lesions and symptoms.
Norashikin Shamsudin MRC P and Alan B. Fleischer Jr. MD
Background: A topical comparison in a randomized controlled trial (RCT) should correctly be termed a vehicle rather than a placebo
as the vehicle in a dermatologic drug product enhances delivery and efficacy of the active compound.
Objectives: To conduct a systematic review of RCTs involving topical drugs published in the Archives of Dermatology, Journal of
the American Academy of Dermatology and British Journal of Dermatology for correct classification of studies as vehicle versus
Methods: RCTs involving topical drugs published in the Archives of Dermatology, Journal of the American Academy of Dermatology
and British Journal of Dermatology from January 1999 to November 2008 were identified through PubMed, supplemented by citation
lists from the individual journals’ web pages. Only original studies that involved using a topical control or used the term topical “vehicle”
or “placebo” were selected. The studies were examined for correct classification as vehicle-controlled, the year of publication,
country of origin, sample size, funding source and nature of study center.
Results: Out of 132, 64 (49%) correctly classified their studies as vehicle-controlled. Pharmaceutical-funded studies (55%, P=0.01)
were significantly associated with the use of correct classification.
Limitations: As only three peer-reviewed dermatology journals were studied, findings may not be generalized to other dermatology
journals and other types of publications.
Conclusion: This systematic review highlights a common pitfall in the reporting of studies of topical dermatology drugs.
Rebecca G. Pomerantz BA, Ezra D. Mirvish BA, Larisa J. Geskin MD
Cutaneous toxicities are the most common adverse effects of antineoplastic therapy with epidermal growth factor receptor (EGFR)
inhibitors. Skin reactions to this class of agents usually present as papular and/or pustular follicular eruptions developing within two
weeks of treatment onset. Other manifestations include generalized xerosis and pruritis, as well as abnormalities of the hair and nails.
For most EGFR inhibitors, the incidence and severity of cutaneous toxicity are associated with clinical benefit. At the same time,
cutaneous toxic effects may detract substantially from health-related quality of life, leading to interruption, discontinuation or dose reduction
of EGFR inhibitor therapy in significantly affected patients. Current recommendations for treatment of EGFR inhibitor-induced
eruptions are based primarily on anecdotal evidence from published case series and physicians’ own experiences, and include antibiotics,
corticosteroids and retinoids. Randomized controlled trials are needed to enable the development of evidence-based paradigms
for the treatment of EGFR inhibitor-induced skin eruptions.
Lilla Landeck MD, Sonja Sabath,a Swen Malte John MD, Guenther Gediga PhD, Nanna Y. Schurer MD
Chitosan is a deacetylated derivate (≥50%) of chitin, to which antimicrobial properties have been assigned. As bacterial resistances
to antibiotics are increasing, alternative treatments have been gaining in importance. In the present study, the authors investigated
the antimicrobial effect of a chitosan-containing spray in a randomized, double blind, placebo controlled clinical trial at the department
of dermatology of the University of Osnabrueck. Twenty-nine healthy volunteers applied a chitosan-containing (1% concentration,
low molecular chitosan, degree of deacetylation 87%) spray and a chitosan-free control (vehicle only) spray to the left and right foot
respectively for five days. Before and after treatment swabs were taken for microbiological analysis. Bacterial count of the chitosan
treated areas showed a significant decrease (P<0.001) compared to those areas treated with the chitosan-free spray. Thus, chitosan
might serve as an alternative local antimicrobial agent in the future.
Xiao Yang MD, Oliver A. Perez MD, Joseph C. English III MD
Background: The current medical therapies for perniosis are diverse. The agents used have produced variable results and lack evidence-based data.
Objective: To determine outcomes of patients with perniosis treated with hydroxychloroquine.
Methods: In this retrospective study, patients with a diagnosis of perniosis treated with hydroxychloroquine were analyzed for dosage required, subjective improvement in signs and symptoms, and adverse drug reactions.
Results: Hydroxychloroquine resulted in improvement of symptoms in four of five patients. Review of the literature has revealed 12
out of 51 cases have responded to hydroxychloroquine alone or in combination with other therapies.
Conclusion: Hydroxychloroquine is a relatively safe, well tolerated alternative therapy for the treatment of perniosis and should be
considered as part of the initial management. Additional data are needed to further evaluate this drug in a prospective manner and in
a larger population of patients.
Soloman Shockman MD, Kapila V. Paghdal MD PharmD, George Cohen MDb
Keloids and hypertrophic scars are abnormal responses to wound healing. In general, keloids may exhibit proliferative growth beyond
the margins of the scar and will remain persistent; whereas hypertrophic scars will stay contained to the original wound and may
regress over time. The authors will discuss the five different types of keloid: post-incisional, ear lobe, spontaneous, acne keloidalis
nuchae (AKN) and sessile. Many medical and surgical modalities have been studied in the treatment of these two entities, ranging
from silicone sheets, intralesional corticosteroid injections, cryosurgery, ligation, 5- fluorouracil, Allium cepa (onion) extract, lasers, imiquimod, interferon-α and intralesional verapamil and surgical excision. This review will discuss the pathogenesis, types and treatments
for keloids and hypertrophic scars.
Jordan B. Slutsky MD, Richard A. F. Clark MD, Alexander A. Remedios MD, Peter A. Klein MD
Background: There is a long history of using topical coal tar for the treatment of psoriasis and atopic dermatitis (AD).
Objective: To review the literature on coal tar and its derivatives, without the use of ultraviolet light, for the treatment of psoriasis
Methods: MEDLINE/PubMed and Cochrane Database of Systematic Reviews literature searches were performed to identify randomized
controlled trials and clinical trials of topical coal tar for the treatment of psoriasis or AD. Studies were graded according to
a modified version of Sackett’s criteria for clinical evidence and evaluated to determine if they support or do not support the use of
coal tar therapy.
Results: Twenty-five studies meeting the authors’ search criteria were identified, only two of which were placebo-controlled. The
majority (21, or 84%) supported the use of coal tar products in the treatment of psoriasis or AD, while four (16%) did not support the
use of coal tar products.
Conclusion: Most studies support the use of coal tar products, although their level of evidence is not strong. Topical coal tar was
found to be efficacious in the treatment of psoriasis in two placebo-controlled trials. Coal tar products appear to be therapeutic in
psoriasis and AD, are well tolerated with few side effects, and are cost-effective. Staining and odor are deterrents to coal tar therapy.
Large, randomized, double-blind, placebo-controlled studies with precise point estimates of treatment effect are needed to establish
the efficacy of coal tar preparations.
Marco Toscani MD, Giuseppe Curinga MD, Emilio Trignano MD, Giovanni Bistoni MD, Antonio Rusciani MD PhDc
One limiting factor of hair transplantation is the amount of hair available in the patient donor scalp. Several techniques have been
proposed as steel punches, multiblade knives, FUE (follicular unit extract) and single-strip harvesting.
The authors introduce a modified surgical scalpel with a No. 10 blade to minimize side effects. This scalpel is folded at 120-degree
angle and allows the incision to be parallel to the hair follicles and help the surgeon to avoid resection of the hair during dissection.
The authors propose this modified scalpel as a new ideal instrument for removing the donor area in hair transplantation.
Bahar F. Firoz, MD MPH, Leonard H. Goldberg MD, Tracy Katz MD, Arash Kimyai-Asadi MD, Paul M. Friedman MD
Reconstruction of the scalp after Mohs surgery can pose dilemmas for the dermatologic surgeon, especially for extensive tumors.
The authors present a unique technique for removing large in-situ epidermal tumors of the scalp during Mohs surgery in four patients.
Although invasive tumor was removed with a standard No. 15 scalpel, the extensive epidermal component of the tumor was
removed through the mid-dermis using the flexible scalpel. This technique allowed the superficial defect to heal by second intention.
The results showed minimal scarring and hair regrowth in what could have been large defects requiring complex reconstruction.
Clinical Trial Review is a JDD department designed to provide physicians with information on drugs undergoing clinical testing. It is our goal to
inform the reader of the status of select drug trials relevant to the practice of dermatology before this information is available through standard
channels. To participate in or learn more about these and additional trials, visit www.clinicaltrials.gov.
News, Views and Reviews provides focused updates, topic reviews and editorials concerning the latest developments in dermatologic therapy.
Pipeline Previews brings to you information on the newest drugs and medical products as they become available to the dermatological
community. This department may include additional information from the manufacturers, plus reports from physicians who wish to share
their clinical experience with these new products. In addition, we will inform our readers about the latest drugs receiving Food and Drug
Administration (FDA) approval. We trust you will find this information beneficial to your practice and research.