A comparison of the efficacy and tolerability of topical agents used in facial Demodex treatment.

BACKGROUND: Demodex spp. is the most common ectoparasite in humans. This parasite is believed to play a role in the etiology of many dermatological and ocular disorders. AIM: The aim of this study was to compare the efficacy and tolerability of the sulfur-sodium sulfacetamide combination, crotamiton, and permethrin, which are three topical agents commonly used in Demodex treatment. METHODS: A total of 28 patients with primary demodicosis and 44 patients with Rosacea + Demodex were included in the study. The pretreatment and post-treatment Demodex spp. counts, patient satisfaction, and erythema decrease rates were compared. RESULTS: Analysis of the efficacy of these topical agents on Demodex revealed that all three significantly decreased the number of parasites. The patient satisfaction was higher in the sodium acetamide group than the 10% crotamiton and 5% permethrin groups, and clinical evaluation (erythema/ papulopustules and white plugs) was better in the sodium acetamide group than the other groups but no statistically significant difference was found in terms of patient satisfaction and clinical evaluation. CONCLUSION: The sulfur-sodium combination, crotamiton, and permethrin are the three agents commonly used in the treatment of Demodex spp. and all significantly decreased the Demodex count. The three agents were similar in terms of tolerability. Our study needs to be supported with others on larger patient series.

Urolithiasis as an extraarticular manifestation of ankylosing spondylitis.

Ankylosing spondylitis (AS) affects sacroiliac and axial joints as well as extraarticular organs, such as the eye, lung, bowel, and heart. Although examples of renal involvement in AS, such as IgA nephropathy, amyloidosis, and glomerulonephritis, have been reported, it has not been emphasized that urolithiasis is frequently formed in the clinical course of AS. Growing evidence indicates that urolithiasis may be observed in AS patients and is more frequent than other extraarticular features. In this review, we will discuss frequency and predictors of AS-related urolithiasis and summarize the possible underlying genetic and biochemical mechanisms. We believe an increased awareness of urolithiasis as a complication of AS will encourage future studies that will shed light on disease mechanisms and preventative therapies.

The use of sodium sulfacetamide in dermatology.

Sodium sulfacetamide is effective in the management of a variety of inflammatory facial dermatoses and often is used in combination with sulfur for a synergistic effect. Adverse effects from sodium sulfacetamide are rare and generally are limited to mild application-site reactions. This agent is contraindicated in any patient with known hypersensitivity to sulfonamides.

Toxic epidermal necrolysis caused by over the counter eyedrops.

We present a case of a 15-year-old boy who developed toxic epidermal necrolysis (TEN) from sulfacetamide eyedrops. He presented with conjunctival injection and an erythematous rash that rapidly progressed to epidermal necrosis of over 30% of his body. A skin biopsy revealed an acute lichenoid reaction pattern consistent with TEN. After 22 days in hospital, he was left with significant scarring to his eyes, mouth and anogenital areas. An extensive search for an infective aetiology was negative. Previously exposed to bactrim tablets, he used Bleph-10 eyedrops 3 days before admission to hospital. The patient had a strong family history of sulphur allergy. The onset of TEN after topical administration of medication has been reported rarely in the literature. This case highlights the need for a thorough medication history that includes topical preparations.

Sulfur and calcific keratopathy associated with retinal detachment surgery and vitrectomy.

We report an unusual case of extensive sulfur and calcium deposition in the cornea after retinal detachment surgery, vitrectomy, and use of topical sulfacetamide. There were no signs of anterior segment ischemia and intraocular silicone oil was not used. Light and electron microscopic examination and x-ray energy dispersive analysis are described. A possible mechanism for the pathogenesis of this condition is presented.

Erythema multiforme after use of topical sulfacetamide.

An 8-year-old boy developed erythema multiforme major after topical administration of sodium sulfacetamide for conjunctivitis. He had received systemic treatment with trimethoprim-sulfamethoxazole four months previously without evidence of drug allergy. There was no history of recent exposure to other drugs or evidence of herpes simplex or Mycoplasma infection. After 12 days of treatment with erythromycin ointment, 1% prednisolone eyedrops, systemic prednisone, and intravenous nafcillin, the patient's condition improved dramatically. A slit-lamp examination showed only superficial punctate keratitis. Two months later his visual acuity had improved from 20/200 bilaterally to R.E.: 20/40 and L.E.: 20/30.