An in vivo study to evaluate the influence of oil blotting paper on the efficacy of sunscreen.

BACKGROUND: Ultraviolet radiation (UVR) is a major cause of photoaging and photocarcinogenesis. An appropriate application of sunscreen can effectively protect UV damage but cause unpleasant skin oiliness. Oil blotting paper is commonly used to reduce oiliness in some parts of the world although its influence on the efficacy of sunscreen has not been carefully investigated. OBJECTIVE: To evaluate the efficacy of sunscreen after applying oil blotting paper. MATERIALS AND METHODS: Measurement of oiliness and sunscreen efficacy was compared before and after the use of oil blotting paper in 11 healthy volunteers, 10 females, and 1 male. Specifically, 3 zones on each subject's back were exposed to UVR from a solar simulator, that is, 1) no sunscreen, 2) sunscreen (organic sunscreen at 2 mg/cm2 SPF 30) left on for 30 minutes, and 3) sunscreen left on for 30 minutes followed by application of oil blotting paper. Skin oiliness was also compared before and after oil blotting using a sebumeter. All areas were phototested for the comparison of the minimal erythema dose (MED) and sun protection factor (SPF). RESULTS: The averaged MED of our subjects is 4.3 standard erythema doses (SED) in the unprotected area. The averaged MED was decreased after oil blotting from 89.8 SED to 59.8 SED. The SPF was also decreased from 20.70 to 13.99. CONCLUSIONS: Application of oil blotting paper significantly reduces the efficacy of organic sunscreen.

Prevalence, risk factors, and mortality outcome in the drug reaction with eosinophilia and systemic symptoms patients with cardiac involvement.

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous drug reaction that can affect multiple internal organ systems. Cardiac involvement in DRESS syndrome (CiDs) is uncommon but can be life-threatening. OBJECTIVE: To determine the prevalence, risk factors, and mortality outcome of CiDs. MATERIAL AND METHODS: Forty-one patients who were diagnosed with probable and definite DRESS syndrome according to the RegiSCAR criteria were recruited. Cardiac involvement was evaluated by two independent cardiologists. RESULTS: The cardiac involvement was found in 8/41 (19.5%) patients. Specifically, myocardial involvement was found in five patients, while three patients had pericardial involvement. The majority of culprit drugs were antibiotics followed by anti-epileptic medications. The hemoglobin and albumin levels were significantly lower in the patients with CiDs when compared to the patients without CiDs (P-value = 0.005 for both factors). The mortality rate at 30 and 90 days was significantly higher among CiDs patients, that is, 3/8 (37.5%) versus 2/28 (6.1%); P-value = 0.02 and 4/8 (50.0%) versus 2/33 (6.1%); P-value = 0.002 respectively. CONCLUSION: Our study showed the prevalence of CiDs was as high as 19.5% with high mortality rate. We suggest a thorough cardiac evaluation in all DRESS patients with RegiSCAR score ≥4. The patients with CiDs had significantly lower hemoglobin and albumin levels, which might imply poor health condition, when compared to those without CiDs.

The treatment of keloids and hypertrophic scars with intralesional bleomycin in skin of color.

Intralesional injection with corticosteroid remains the mainstay of therapy for hypertrophic scars and keloids, however some lesions are unresponsive or may result in skin atrophy. Intralesional bleomycin injection is an alternative therapy that has been widely reported. In order to compare the effectiveness and safety of bleomycin for the treatment of keloids and hypertrophic scars in skin of color population, Fitzpatrick skin type III to V patients with keloids or hypertrophic scars were randomized into two groups. Group A was treated monthly with intralesional triamcinolone acetonide (10 mg/mL), while group B with intralesional bleomycin (1 mg/mL) for three consecutive months. Evaluation of the treatment was performed using "Patient and Observer Scar Assessment Scale" (POSAS), self-rated patient satisfaction score, photography, and ultrasonography. Two patients had their bleomycin blood levels monitored. Twenty-six patients with keloids or hypertrophic scars were recruited. The clinical improvement as assessed by the POSAS was not statistically significant. In terms of patients satisfaction score, one half of both groups reported a very good improvement. Photographic as well as ultrasonographic evaluation showed no difference between the two groups. Bleomycin was found to enter the blood circulation in a very small amount. The major side effect was hyperpigmentation. There was no skin atrophy detected in this study. Intralesional bleomycin is a safe and effective treatment for keloids and hypertrophic scars. The treatment is comparable to intralesional triamcinolone. Unfortunately, hyperpigmentation was the major side effect in darker skin type.

The Effect of Food Avoidance in Adult Patients with Chronic Idiopathic Urticaria.

BACKGROUND: Recent findings show food allergy is rarely the cause of chronic urticaria. However; reports showed up to 5% of chronic idiopathic urticaria (CIU) was food induced urticaria (FIU) and the remission rate with food avoidance in CIU was varied. According to recent studies, skin prick test (SPT) is not a gold standard for investigating the culprit food allergen in CIU. The clinical response for food avoidance is still unclear. OBJECTIVE: The purpose of the present study is to investigate the association of food allergen and SP7 the clinical response after positive food avoidance in adult Thai patients with CIU. MATERIAL AND METHOD: We conducted a prospective study that included 76 patients, who presented with CIU at the Division of Dermatology, Department of Medicine, Phramongkutklao Hospital, between September 1, 2009 and May 31, 2010. Personal data, general physical examination, and detailed history were obtained. Twenty food allergens were used to perform SPT at the allergy clinic. The positive food allergens were enrolled to avoid the culprit food allergens for two to four weeks and evaluated the clinical response. RESULTS: Fifty-one of 76 patients (67.1%) gave history compatible with FIU. Shrimp (54.9%) and fish (49.0%) were the two most commonly suspected allergens by the patients. Fifteen of 76 patients (19.7%) had positive SPT In comparison to the SPT negative group in terms of clinical severity and effect on their daily lives, there was no significant difference. We then matched the SPT results with the patient's history. Five of 76 (6.6%) patients had results of SPT matching the patients' history. The five allergens in these patients were fish, milk, tomato, shrimp, and yeast. Fifty-one of 76 (67.1%) patients had negative SPT results but the patients suspected that certain foods were the cause of their urticaria. Fifteen of 76 (19.7%) patients had positive SPT results but the patients had never suspected any food allergen. Among these SPT positive patients, 13 food allergens were the culprits, the first three most common SPT allergens in this group were peanut, oyster and tomato. Upon SPT positive food avoidance, 12 of 15 (80%) SPT+ patients had significant improvement of symptom score in term of clinical severity and effect on their daily lives. CONCLUSION: Although SPT still yielded a low sensitivity for the diagnosis of FIU, the present study showed a very good response by food avoidance in patients who were SPT positive.

Linear atrophoderma of moulin: a case report and review of the literature.

Linear atrophoderma of Moulin (LAM) is a rare dermatosis in childhood and early adolescence. The exact etiology of LAM is still obscure. Several treatment modalities were reported but none was consistently successful. We report a case of LAM in which a favorable outcome was obtained with topical calcipotriol. The relevant literature is also reviewed.

Effect of combination of 1064 nm Q-switched Nd:YAG and fractional carbon dioxide lasers for treating exogenous ochronosis.

We describe three cases of exogenous ochronosis of the malar areas due to long-term application of skin-lightening agents for melasma, effectively treated by combination of Q-switched Nd:YAG and the fractional carbon dioxide lasers. None of these lasers has been reported to be used to effectively treat ochronosis before. The Q-switched Nd:YAG laser is capable of disintegrating dermal ochronotic fibers, thereby facilitating their phagocytosis and elimination via lymphatics. The fractional carbon dioxide laser is believed to assist transepidermal elimination of the onchronotic material. We believe successful treatment of ochronosis is possible when both mechanisms are applied.

Topical 5% tranexamic acid for the treatment of melasma in Asians: a double-blind randomized controlled clinical trial.

BACKGROUND: Topical tranexamic acid has been claimed to lighten melasma without serious adverse effects. However, controlled studies assessing the efficacy and safety of topical tranexamic acid (TA) for the treatment of melasma is limited. OBJECTIVE: To assess in a double blind, randomized, prospective study, the efficacy of topical 5% tranexamic acid versus vehicle for treatment of melasma. METHODS: Twenty-three women with bilateral epidermal melasma enrolled in a split-face trial lasting 12 weeks. Patients blindly applied topical 5% tranexamic acid and its vehicle, to the designated sides of the face twice daily in addition to the assigned sunscreen each morning. Pigmentation and erythema were measured objectively using a mexameter and Melasma Area and Severity Index (MASI), in addition to physician and patient global assessments. RESULTS: Twenty-one patients completed the study. Eighteen out of twenty-three patients (78.2%) showed decrease in the melanin index on either or both sides of the face by the end of 12 weeks compared to baseline. The MASI scores were also significantly reduced on both tested sides. However, lightening of pigmentation induced by TA gel was neither superior nor different (p > 0.05) compared to its vehicle although erythema was significant on the TA-applied site (p < 0.05). CONCLUSIONS: Although lightening of pigmentation was obtained, the results were not significant between the two regimens. However, topical TA produced erythema.

A randomized control study of the prevention of hyperpigmentation post Q-switched Nd:YAG laser treatment of Hori nevus using topical fucidic acid plus betamethasone valerate cream versus fucidic acid cream.

BACKGROUND: Post-inflammatory hyperpigmentation (PIH) after laser treatment of Hori nevus remains problematic. Prevention and treatment of PIH have limited success. OBJECTIVE: To study the effects on hyperpigmentation using topical antibiotic alone versus combined antibiotic and betamethasone/valerate after 1064 nm Q-switched Nd:YAG laser treatment of Hori nevus. METHOD: Twenty-five cases of Hori nevus treated with Q-switched Nd:YAG laser randomly applied topical fucidic acid (control group) or fucidic acid plus betamethasone/valerate (study group) on assigned cheek immediately post laser for 2 weeks. Pigmentation was measured using the mexameter as melanin index (MI) and erythema index (EI), at baseline, 2nd and 4th weeks. Photographic evaluation and patient global assessment were done at the 4th week. RESULTS: Twenty-three cases completed the study. No patient developed side effect from either creams. The comparison of M and E-indexes of the control versus the study group revealed no significant difference. However, there was a uniform increase of M index of the control group compared to the study group. CONCLUSION: Applying topical corticosteroid immediately after laser treatment decreased pigmentation. Although not statistically significant, there was a tendency for lightening. Future studies are needed with more patients, duration of follow-ups and histological studies to assess pigmentary changes.

Drug eruptions at five institutes in Bangkok.

The study was performed in five hospitals in Bangkok for a period of one year. All in- and outpatients who developed drug eruption from January to December 2001 were enrolled into the study. Physical examinations and complete history-taking were performed by one of the authors. A skin biopsy was done to confirm the diagnosis in every suspected case. Oral challenge test was performed to obtain a definite diagnosis only in some patients with informed consent. Among 212 patients, the most common causative drugs were antimicrobial agents with cephalosporin group in the highest rank. Maculopapular rash was the most common type of drug eruption followed by urticaria and photosensitivity reaction. It was concluded that antimicrobial agents were the predominant causative agents and maculopapular eruption was the most frequent clinical manifestation. New kinds of antimicrobial agents, anti-inflammatory drugs and lipid lowering agents could cause various patterns of drug eruption.