Adapalene 0.1% gel for the treatment of acne vulgaris: its superiority compared to tretinoin 0.025% cream in skin tolerance and patient preference.

One hundred patients with acne vulgaris applied adapalene (Differin) 0.1% gel to one side of their face and tretinoin 0.025% cream to the other once a day for 4 weeks; the side of application was determined by randomization code. Patient tolerance (assessed as the side of the face least irritated by drug application) was recorded weekly and patient preference (assessed as the preparation more easily spread, absorbed more quickly, smelled better, felt best on the skin and least greasy to the feel) at completion of the study. The investigator measured skin irritation weekly, scoring erythema, skin dryness, desquamation and burning/stinging on a 10-point scale. After each week of treatment, 64-68% of patients found adapalene 0.1% gel more tolerable than tretinoin 0.025% cream (P < 0.05). At study completion, 65% of patients preferred adapalene 0.1% gel over tretinoin 0.025% cream (P = 0.003). An overall assessment showed adapalene 0.1% gel was significantly less irritating to the skin in terms of producing erythema, dryness, desquamation and burning/stinging, at Visits 2, 3 and 4 (P < 0.02). Thirty-two patients experienced mild to moderately severe adverse events; three had adverse events considered to be drug related (two with skin discomfort; one with skin dryness). One patient stopped using the study drugs because of dry skin. This study showed that a majority of patients preferred adapalene 0.1% gel over tretinoin 0.025% cream and that it caused significantly less skin irritation.

Adapalene 0.1% gel has low skin irritation potential even when applied immediately after washing.

The purpose of this study was to evaluate the difference, if any, in facial skin tolerance of adapalene 0.1% gel applied immediately after washing, compared to delayed application as recommended for the other topical retinoids: tretinoin and isotretinoin. Twenty-five acne patients with mild to moderate acne vulgaris were included in this intra individual randomized comparison study where adapalene 0.1% gel was applied immediately after washing on one half of the face and 20-30 min after washing on the contralateral half-face, for 22 consecutive days. No difference between the two regimens was detected by the investigator or by 21 of the 22 patients who completed the study. It was concluded that application of adapalene gel 0.1% is well tolerated even when applied immediately after washing.

Adeno-associated virus Rep78 inhibits oncogenic transformation of primary human keratinocytes by a human papillomavirus type 16-ras chimeric.

Seroepidemiologic studies demonstrate that adeno-associated virus (AAV) infection is negatively associated with cervical cancer. This inverse association may be due to an ability of AAV to inhibit the role of human papillomavirus (HPV) in cervical carcinogenesis. In support of this hypothesis AAV has been demonstrated to inhibit several papillomavirus types, including bovine papillomavirus type 1 and human papillomaviruses types 16 and 18 (HPV-16/18) in tissue culture. The AAV-encoded Rep78 protein was responsible for this inhibition. These previous studies, however, were largely carried out in immortalized mouse fibroblasts. This cell type is likely not to be the most accurate model cell type for studying HPV-associated cervical carcinogenesis. In this study it is demonstrated that AAV Rep78 protein inhibits oncogenic transformation of freshly explanted primary human foreskin keratinocytes by an HPV-16/ras chimeric genome. Such cells are the natural host cell type for HPV-16/18 infection. It is also demonstrated that the HPV-16 P97 promoter is specifically inhibited by Rep78 in a transient CAT assay. These data further extend our knowledge of the AAV-papillomavirus interaction and provide a model for investigating the negative association of AAV with cervical cancer.

The comparative efficacy of benzoyl peroxide 5%/erythromycin 3% gel and erythromycin 4%/zinc 1.2% solution in the treatment of acne vulgaris.

This randomized 10-week study compared the efficacy of benzoyl peroxide 5%/erythromycin 3% gel with erythromycin 4%/zinc 1.2% solution in 72 acne vulgaris patients. Physician global evaluations were significantly more improved (P < or = 0.05) in the benzoyl peroxide 5%/erythromycin 3% gel treatment group compared to erythromycin 4%/zinc 1.2% solution at week 2 and at each subsequent biweekly clinical visit. Inflammatory lesions (papules/pustules) were significantly more reduced (P < or = 0.005) in the benzoyl peroxide 5%/erythromycin 3% gel treatment group than the erythromycin 4%/zinc 1.2% solution at weeks 4 and 10. Comedones were significantly more reduced (P < or = 0.001) in the benzoyl peroxide 5%/erythromycin 3% gel treatment group than in the erythromycin 4%/zinc 1.2% solution group at weeks 8 and 10. Patient efficacy evaluations significantly (P < or = 0.001) favoured benzoyl peroxide 5%/erythromycin 3% gel to erythromycin 4%/zinc 1.2% solution.

Pemphigus vulgaris antigen lacks biochemical properties characteristic of classical cadherins.

Pemphigus vulgaris antigen (PVA) is a member of the desmoglein subfamily of the cadherin supergene family. PVA has homology to the classical cadherins (e.g., E-cadherin), both in its extracellular and cytoplasmic domains. Classical cadherins possess certain well-defined and characteristic biochemical properties of both domains. The cytoplasmic domain binds alpha-, beta-, and gamma-catenins. The extracellular domain is protected by calcium from degradation by trypsin. In this study we show that PVA does not share these characteristic biochemical features. Immunoprecipitation of E-cadherin and PVA from human keratinocytes shows that under the same conditions in which the catenins co-precipitate with E-cadherin, only plakoglobin (which co-migrates with gamma-catenin) co-precipitates with PVA. Treatment of keratinocytes with 0.01% trypsin in 1 mM calcium (T/C) does not degrade the extracellular region of E-cadherin, but does partially degrade that of PVA. This increased T/C susceptibility of PVA is not due to its cytoplasmic domain, as the same sensitivity of the extracellular domain of PVA to T/C was observed in L cell clones transfected with a chimeric cDNA that encoded for the extracellular domain of PVA and the cytoplasmic domain of E-cadherin. These data demonstrate that although the desmogleins and classical cadherins share striking amino acid homologies in both the cytoplasmic and extracellular domains, they do not exhibit identical biochemical properties and, by extension, may not subserve identical cell biologic functions.

Recurrence of pemphigus vulgaris associated with interleukin 2 therapy.

BACKGROUND: Immunotherapy with recombinant interleukin 2 may result in regression of metastatic cancer, particularly malignant melanoma and renal cell carcinoma. OBSERVATIONS: We describe a patient who received interleukin 2 immunotherapy for metastatic renal cell carcinoma. After his second course of treatment, he developed a recurrence of pemphigus vulgaris that had been in remission for 10 years. CONCLUSIONS: Interleukin 2 therapy may be associated with recurrence of an autoimmune disease, perhaps because of its ability to stimulate autoantibody production.

Iatrogenic contamination of multidose vials in simulated use. A reassessment of current patient injection technique.

An investigation of the potential spread of iatrogenic infections through contaminated multidose vials was performed. Contamination of a multidose vial was hypothesized to occur after a single syringe is used to inject an infected patient with medication, and the same syringe subsequently is used to withdraw additional medication from the multidose vial. If the contaminated multidose vial is used for another patient, an iatrogenic infection may be spread. Laboratory study of this injection technique found that viral plaque-forming units could be transmitted to a multidose vial in this manner. A survey of 100 fellows of the American Academy of Dermatology from the United States found that 24% of the respondents used this potentially unsafe procedure. The potential for iatrogenic spread of the human immunodeficiency virus and hepatitis B virus is described. Recommendations to avoid patient infection are made.

Modern treatment approaches to vitiligo.

Vitiligo is a common disorder for which treatment is frequently difficult and disappointing. The current medical and surgical treatment options are reviewed and fully discussed. Several recently developed therapeutic modalities that may be useful options in the future are described.

A surgical treatment for vitiligo: autologous cultured-epithelial grafts.

Medical treatment of vitiligo has been disappointing; therefore surgical treatments using autologous grafts have been tried. We investigated a new technique in which normally pigmented epidermal cells from a vitiligo patient were cultured on a collagen-coated membrane in MCDB-153, a media that supports melanocytes and keratinocytes. The cell/collagen-coated membrane was used to cover a superficially dermabraded vitiliginous area. Clinical repigmentation, though incomplete, was evident in three of four patients in 4 weeks. Immunofluorescence and electron microscopy were performed on the grafted areas (involved and uninvolved controls). These studies demonstrate the reappearance of melanocytes and melanosomes within the grafted area. All three patients who were successfully repigmented retained their pigment at 1 year follow-up. Further investigation of this promising treatment for vitiligo is warranted.

Suicide of AIDS patients in Texas: a preliminary report.

The incidence of suicide in patients with the diagnosis of acquired immunodeficiency syndrome (AIDS) in the state of Texas during the period between January 1986 and August 1987 was determined. AIDS patients were found to have a rate of suicide higher than expected when compared to the general population. The results of this study document this trend which has important implications in the care of the growing number of patients with AIDS.