A randomized controlled trial of R-salbutamol for topical treatment of discoid lupus erythematosus.

BACKGROUND: In a recent open pilot trial, R-salbutamol sulphate, a well-known molecule with anti-inflammatory effects, was tested successfully on patients with therapy-resistant discoid lupus erythematosus (DLE). OBJECTIVES: To compare the efficacy and safety of R-salbutamol cream 0.5% vs. placebo on DLE lesions in a multicentre, double-blinded, randomized, placebo-controlled phase II trial. METHODS: Thirty-seven patients with at least one newly developed DLE lesion were randomized - 19 to the R-salbutamol cream 0.5% and 18 to placebo - and treated twice daily for 8 weeks. Efficacy was evaluated through scores of erythema, scaling/hypertrophy and induration as well as pain and itching; general improvement scored by the investigator and global improvement scored by patients' assessment were also evaluated. RESULTS: The mean area under the curve of improvement for scaling/hypertrophy, pain, itching and global patient assessment was significantly better for the actively treated patients as compared with placebo (scaling/hypertrophy, P = 0.0262; pain, P = 0.0238; itching, P = 0.0135; global patient assessment, P = 0.045). Moreover, the percentage of patients without induration was significantly higher in the active group compared with the placebo group (P = 0.013), and a statistically significantly greater decrease in the size of the lesional area was also seen in the overall analysis of the R-salbutamol-treated patients (P = 0.0197). No serious adverse events were reported. CONCLUSIONS: Application of R-salbutamol cream 0.5% was safe and well tolerated. Statistically significant effects were seen on scaling/hypertrophy, induration, pain and itching as well as patient global assessment, suggesting that R-salbutamol could be a promising new topical therapy alternative for DLE.

Dermal glycosaminoglycans characterise the primary irritant dermatitis in psoriatics and healthy individuals.

Primary irritant dermatitis includes an inflammatory process of connective tissue which is of general interest. For the first time this process has been characterised biochemically in humans by following the dermal changes in the concentration of hydroxyproline and four glycosaminoglycans. In healthy individuals (n = 7) and in psoriatics (n = 8) the changes were rather similar. Only dermatan sulphate showed a tendency towards an abnormal response in the psoriatics. In both groups the deviations from the pre-irritant condition clearly distinguished the response of irritant dermatitis from that of the wound healing process: (1) the concentration of hyaluronic acid decreased by the third day and remained so until by the sixth day, (2) after a decrease on the third day the concentration of dermatan sulphate returned to the initial value by the sixth day, (3 and 4) the concentration of chondroitin 4/6-sulphate and heparan sulphate increased continuously from the third to the sixth day, and (5) the concentration of hydroxyproline remained constant throughout the period of investigation.

Dermatan sulphate in urine reflects the extent of skin affection in psoriasis.

The investigation included 15 psoriatic patients and 14 healthy controls. By using a simple method based on susceptibility to chondroitinases the excretion of dermatan sulphate, chondroitin-4/6-sulphate and heparan sulphate in the psoriatics was found to be increased with 104, 62 and 47% from uronic acid mean excretions of 1.97, 6.37 and 5.10 mumol/24 h, respectively. The excretion of hydroxyproline was not increased. In both groups the excretion of hyaluronic acid was insignificant. The absolute increase in the excretion of a major skin component like dermatan sulphate was exceeded by the excretion of chondroitin-4/6-sulphate and heparan sulphate which are both small components of skin. This indicates a comparatively high turnover of those two fractions in psoriatic lesions. The fact, that only the excretion of dermatan sulphate correlated with the fraction of skin surface involved in the psoriatic disease, indicated an important origin of this fraction, as well as the possibility of dermatan sulphate as a means of following dermal metabolism.

Wound dressing after skin planing.

A variety of dressings have been used following skin planing. Compresses are difficult to apply and simple bandages stick tight and are hard to remove. The Department of Dermatology has for several years used Collagen film, but this film is no longer commercially available. After 12 patients with acne scars underwent skin planing, synthetic polyurethanefilm (Omiderm) was applied for 7 days, with good results.

Bullous pyoderma gangrenosum in association with myeloid leukaemia.

The case is presented of a patient with busulfan (Myleran) treated myeloid leukaemia, who developed bullous pyoderma gangrenosum. Skin symptoms appeared at the time when treatment was discontinued due to signs of bone marrow depression. The pyoderma disappeared following treatment with systemic steroid.

Metal sensitivity in patients treated for tibial fractures with plates of stainless steel.

In three patients a local dermatitis developed 3-3 1/2 months after tibial osteosynthesis with plates and screws of stainless steel 316 L (AO). Two of the patients had a positive patch test for chromium (and cobalt) and one for nickel. Infection was not indicated and it is suggested that the dermatitis was caused by a metallic sensitivity. The skin affection disappeared after removal of the metal.

Skin reactions to a urea-containing cream.

Patch tests with a cream (Calmuril) containing 10% urea were performed on 79 patients with eczematous skin disease; seven (9.9%) had positive tests. Patch tests with the ingredients of the cream were negative. It is suggested that the positive patch test reactions are toxic, due to hypertonicity and acidity of the cream.

Porphyria variegata treated with cyproterone acetate and ethinyl estradiol.

The cyclical use of cyproterone acetate and ethinyl estradiol successfully prevented attacks of abdominal pain in a 30-year-old woman suffering from porphyria variegata. Blistering still appeared following light exposure, but possibly to a lesser degree.

Porphyria variegata: failure of chloroquin treatment.

A 27-year-old woman affected by porphyria variegata was treated with chloroquin for 1 1/2 years without any clinical improvement. Urinary excretion of porphyrins was not convincingly altered during treatment.

Argon laser treatment of cutaneous vascular lesions in connective tissue diseases.

Two patients with juvenile dermatomyositis, 5 with chronic discoid lupus erythematosus, and one with Rothmund-Thomson's Syndrome were treated for their teleangiectasias of the face with argon laser. The results were highly satisfactory with an almost normal appearance of treated skin in 4 patients. Two patients showed satisfactory results with 60-70% blanching, while 2 patients showed some improvement, but not a completely cosmetically satisfactory result. The most impressive results were in the patients with juvenile dermatomyositis and Rothmund-Thomson's Syndrome. The only side effects observed were a slight scarring and an insignificant pigmentation. No patient displayed any signs of disease activation.

The sulphate content of dermal and urinary glycosaminoglycans in psoriatics with increased excretion and increased dermal content of glycosaminoglycans.

The investigation included 17 psoriatics and 19 healthy controls. The content of sulphate per disaccharide unit (sulphate/uronic acid ratio) was measured in the sulphated glycosaminoglycans (GAGs) isolated from urine and dermal biopsies of the gluteal region. Biopsies were taken from both involved and uninvolved skin of the psoriatics. Perfectly normal sulphate/uronic acid ratios were found in the involved and uninvolved skin as well as in the urine of the psoriatics. A close and positive correlation between the sulphate/uronic acid ratio of the sulphated GAGs in the affected and unaffected skin of the psoriatics was discovered. The results are discussed in relation to earlier findings on the same specimens which shows that the concentration of sulphated GAGs in the psoriatic lesions is increased (28%) as is the urinary excretion of sulphated GAG in the same patients (62%).

Paired observations of sulphate/uronic acid ratios in glycosaminoglycans of human dermis and urine.

Using methods which have been described earlier in detail [23] the sulphate/uronic acid molar ratio of glycosaminoglycans was determined in corresponding specimens of skin and urine obtained from 14 healthy adults. The method of dermis was provided with an electrophoretic separation that made it possible to determine the ratio of the sulphate subfraction without increasing the weight of the biopsies. The sulphate/uronic acid ratios were uninfluenced by age and were exactly equal in males and females whether measured in total glycosaminoglycans of dermis (0 X 51 +/- 0 X 11, means +/- SD), in the sulphated subfraction of dermal glycosaminoglycans (1 X 17 +/- 0 X 25) or in urinary glycosaminoglycans (0 X 96 +/- 0 X 15). The latter ratio was surprisingly high and the significance of this was discussed. Furthermore an inverse relationship between the urinary ratio and the ratio of sulphated glycosaminoglycans of dermis was found. However the exact nature of this relationship remains to be explained. The results demonstrate the applicability of a method that can be used on small biopsies without ethical obstacles and make it possible to discover pathological conditions.

Determination of hyaluronic acid, dermatan sulphate, heparan sulphate and chondroitin 4/6 sulphate in human dermis, and a material of reference.

Using a new method based on electrophoresis and enzymatic digestion with chondroitinase AC small skin biopsies of 15 healthy individuals were assayed for qualitative and quantitative content of glycosaminoglycans. The content of collagen was measured as hydroxyproline. The following results were obtained: (1) The mean substance content and standard deviation of hyaluronic acid, dermatan sulphate, heparan sulphate chondroitin 4 or 6 sulphate and hydroxyproline in dried defatted tissue is presented. (2) There is a negative correlation with age for hyaluronic acid and no correlation with age for any of the other glycosaminoglycans or the hydroxyproline. (3) The sex has no major influence on any of the quantities measured. (4) The observed substance content of water in wet tissue is presented.

Pivampicillin compared with erythromycin for treating women with genital Chlamydia trachomatis infection.

In a randomised single blind study, pivampicillin was compared with erythromycin in women with urogenital Chlamydia trachomatis infections. The pivampicillin dosage was 700 mg twice a day and the erythromycin dosage 500 mg twice a day for seven days. Follow up took place on days 7 and 14 after the start of treatment. All 26 women treated with pivampicillin were culture negative for chlamydiae at the first and second follow up visits. All 23 women who received erythromycin were culture negative at the first follow up visit, but one was culture positive at the second follow up visit. Gastrointestinal side effects were recorded in five patients receiving pivampicillin and in nine receiving erythromycin. Two patients receiving erythromycin were withdrawn from treatment because of gastrointestinal disturbances, compared with none receiving pivampicillin.

Pivampicillin in treating genital infection with Chlamydia trachomatis.

Pivampicillin was used to treat urogenital colonisation with Chlamydia trachomatis in 41 women and 24 men who yielded chlamydiae but not gonococci. They were treated for 10 days. All but one patient gave negative chlamydia cultures 10 days after the start of treatment, and all 65 patients gave negative results at the second examination seven days later. Ten days of treatment with pivampicillin seems to be the optimum to eradicate C trachomatis from the lower genital tract in man.