The risk of psychiatric disorders in finasteride users with benign prostatic hyperplasia and androgenetic alopecia: A population-based case-control study.

BACKGROUND: There is a long-standing debate if finasteride, a medication used to treat benign prostatic hyperplasia (BPH) and androgenetic alopecia (AGA), can cause psychiatric side effects. OBJECTIVE: The goal of this large-scale population-based study was to determine whether finasteride therapy for BPH and AGA is associated with the emergence of mental health conditions. METHODS: This observational case-control study compared the data from patients with BPH who received finasteride 5 mg daily and patients with AGA who received finasteride 1 mg daily with age- and gender-matched controls. The incidence of psychological health outcomes such as depression, anxiety, neuroses, bipolar disorder, schizophrenia, psychoses and alcohol abuse within 2 years of the initiation of finasteride therapy has been evaluated and compared between the finasteride groups and controls. RESULTS: The BPH group included 307 men with a mean age of 61.5 (±17.4) years and 1218 controls. Mental health outcomes recorded in 2.3% of the patients, with no significant increase in rate when compared to controls. The AGA group consisted of 23,227 men with a mean age of 31.4 (±10.3) years and 39,444 controls. Only One percent of AGA patients developed psychiatric disorders. In comparison to controls, patients with AGA had higher rates of anxiety and depression (0.6% vs. 0.4%, p = 0.04, and 0.5% vs. 0.4%, p = 0.007, respectively). In multivariate regression models, finasteride was found as one of the risk factors for anxiety (OR 1.449, p = 0.002) and depression (OR 1.439, p = 0.003) when stratified to age, sector, socioeconomic status and comorbidities. CONCLUSIONS: According to our research, finasteride users had a very low rate of adverse mental health effects, with no increase in psychological sequelae in BPH patients and a slight increase in anxiety and depression in AGA patients.

An Update on the Cutaneous Manifestations of Darier Disease.

BACKGROUND: Knowledge about the clinical features of Darier disease, an orphan autosomal-dominant genetic disorder, is sparse and has been evaluated only in few studies. OBJECTIVES: To investigate the clinical features of a large group of patients with Darier disease, and to explore for associations between disease characteristics and severity of the disease. METHODS: Seventy-six individuals with Darier disease were evaluated utilizing a structured questionnaire-based interview, a physical examination, and a retrospective assessment of their medical records. RESULTS: The most frequent locations of lesions were hands (99%) and fingernails (93%). Wart-like lesions on the hands were more visible after soaking them in water for 5 minutes, we therefore named this phenomenon the "wet hand sign". Oral involvement was found in 43% of patients, while 48% of women and 16% of men showed genital lesions. Patients with severe Darier disease had a tenfold greater risk of developing genital lesions than those with mild disease (P = .01). Most patients (88%) in our study exhibited a combination of the four types of the disease patterns of distribution (flexural, seborrheic, nevoid, and acral). CONCLUSIONS: Documentation of disease on the hands and fingernails provides a highly sensitive means to aid in the diagnosis of Darier disease. It is important to evaluate mucosal lesions including genital and oral mucosa.

Parkinson's Disease, Melanoma, and Keratinocyte Carcinoma: A Population-Based Study.

BACKGROUND: The association between Parkinson's disease (PD) and melanoma is well recognized, but its relationship with non-melanoma skin cancers has not been studied in depth. OBJECTIVE: To assess the relationship between PD, and risk of melanoma and keratinocyte carcinoma: squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). METHODS: This historical cohort study used the data of 1.2 million adult members of a large health organization between 2000 and 2015. Individuals who were diagnosed with PD anytime between 2000 and 2010 were retrospectively followed until 8/2016 for incidence of SCC, BCC, or melanoma identified from physician diagnoses and pathology reports. RESULTS: The PD cohort included 7,727 patients (mean [SD] age = 69.9 [14.8 years]) among the 1,251,695 study population. During follow-up, a total of 4,553, 32,069, and 4,015 cases of BCC, SCC, and melanoma were identified in the study population respectively. Multivariable models revealed that older age, male sex, never smoking, and residence in southern Israel and actinic keratosis were associated with an increased risk of both BCC and SCC. PD patients in the age range 45-64 and 65-84 years at baseline had an OR of 2.11 (95% CI 1.40-3.18) and 1.52 (95% CI 1.21-1.91) for BCC respectively. Weak or no associations were calculated for melanoma or SCC. CONCLUSIONS: We report a positive relationship between PD and risk of BCC. These results should stimulate greater awareness on the part of healthcare providers to the increased risk of BCC in PD patients.

Increased Risk of Tinea Pedis and Onychomycosis Among Swimming Pool Employees in Netanya Area, Israel.

Tinea pedis and onychomycosis often co-occur in individuals. A relationship between swimming pools and tinea pedis exists; however, little research has investigated the relationship between onychomycosis, tinea pedis, and swimming pools. This study sought to examine the prevalence of tinea pedis and onychomycosis among swimming pool employees, a population that may be at risk of tinea infections. Samples were taken from 169 employees at 21 swimming pools in the Netanya area, Israel. KOH microscopy and culture was used to identify fungi. About 46 % of swimming pool employees had concurrent tinea pedis and onychomycosis, 30 % had tinea pedis only, and 6 % had onychomycosis only, compared to 10, 8, and 8 % of controls, respectively. After adjusting for age and gender, swimming pool employees were 20× more likely to have concurrent tinea pedis and onychomycosis, 15× more likely to have tinea pedis only, and 3× more likely to have onychomycosis only compared to controls. The present results are in agreement with previous research and support that swimming pools remain an important source of fungal contamination. More attention to hygienic guidelines and preventative measures may be needed in these settings.

[PURPURIC MYCOSIS FUNGOIDES].

INTRODUCTION: A 26-year-old female presented with 4-years duration of asymptomatic spots on her left leg. She was otherwise healthy. On examination several purpuric patches up to 3 cm. in diameter were found on the flexure aspect of her left leg. Histological examination revealed lymphocytic infiltrate, with mild atypia, with red blood cell extravasation and hemosiderin deposition in the papillary dermis. The clinical and histological findings were compatible with the diagnosis of early stage purpuric mycosis fungoides (MF). Purpuric form of MF is a rare form of the disease. Physician should distinguish this disease from benign forms of pigmented purpuric dermatoses.

Griseofulvin and Fluconazole Reduce Transmission of Tinea Capitis in Schoolchildren.

OBJECTIVE: We evaluated the efficacy of griseofulvin and fluconazole in reducing the potential for person-to-person transmission of tinea capitis (TC) in children. METHODS: Children with TC with positive fungal cultures were treated with griseofulvin 25 mg/kg/day (group A) or fluconazole 6 mg/kg/day (group B) for at least 21 days and up to 12 weeks until cure was achieved. Clinical and mycologic examinations occurred before treatment and on days 3, 7, 10, 14, and 21 of treatment. During each visit, mycologic examination was performed from scalp lesions of children and fingertips of medical staff and parents after a brief touch of the patient's scalp lesions. RESULTS: Ninety patients were enrolled: 48 treated with griseofulvin and 42 with fluconazole. The predominant species were Trichophyton violaceum (n = 44) and Microsporum canis (n = 41), followed by Trichophyton mentagrophytes (n = 3) and Trichophyton rubrum (n = 2). Ten days after treatment more than 75% of patients from both treatment groups were noncontagious. At day 21, all patients from group A were noncontagious and two (7%) with positive culture of M. canis from group B were still contagious. CONCLUSIONS: No statistically significant differences were found between treatment groups. Griseofulvin and fluconazole reduced the potential for disease transmission in children with TC, with griseofulvin being more effective for M. canis infections, although children with TC may be potentially contagious even after up to 3 weeks of treatment. These data should be considered regarding school attendance of children with TC.

Increased prevalence of thyroid disorders in patients with new onset alopecia areata.

BACKGROUND: Several studies have revealed a high prevalence of thyroid disorders in patients with alopecia areata. The aim of the present study was to evaluate the frequency of thyroid function abnormalities and anti-thyroid auto-antibodies in patients with new onset alopecia areata on their first visit to a community dermatology clinic. METHODS: The study included 78 patients with new onset alopecia areata who visited a community dermatology clinic between 2007 and 2011. Every patient underwent a complete medical history, physical examination and laboratory testing consisting of thyroid function tests (serum levels of free triiodothyronine, free thyroxine and thyroid stimulating hormone) and anti-thyroid auto-antibodies (thyroglobulin antibodies and thyroid peroxidase antibodies). RESULTS: The 78 patients included 46 (59%) men and 32 (41%) women, with 1.44 male : female ratio and mean age of 32.7 +/- 3.09 years. Abnormal thyroid function and anti-thyroid auto-antibodies were detected in 19 (24%) patients. Of these, 12 (15%) patients were diagnosed with subclinical hypothyroidism, one (1%) with an overt hypothyroidism, one (1%) with an overt hyperthyroidism and four (5%) with euthyroid Hashimoto's thyroiditis. CONCLUSION: The study revealed a significant association between alopecia areata and thyroid abnormalities. Screening for thyroid function and anti-thyroid auto-antibodies is advised in alopecia areata.

"Sunlight is said to be the best of disinfectants"*: the efficacy of sun exposure for reducing fungal contamination in used clothes.

BACKGROUND: Tinea pedis is a common chronic skin disease; the role of contaminated clothes as a possible source of infection or re-infection has not been fully understood. The ability of ultraviolet light to inactivate microorganisms has long been known and UV is used in many applications. OBJECTIVES: To evaluate the effectivity of sun exposure in reducing fungal contamination in used clothes. METHODS: Fifty-two contaminated socks proven by fungal culture from patients with tinea pedis were studied. The samples were divided into two groups: group A underwent sun exposure for 3 consecutive days and group B remained indoors. At the end of each day fungal cultures of the samples were performed. RESULTS: Overall, there was an increase in the percentage of negative cultures with time. The change was significantly higher in socks that were left in the sun (chi-square for linear trend = 37.449, P < 0.0001). CONCLUSIONS: Sun exposure of contaminated clothes was effective in lowering the contamination rate. This finding enhances the current trends of energy saving and environmental protection, which recommend low temperature laundry.

Treatment of tinea capitis - griseofulvin versus fluconazole - a comparative study.

OBJECTIVE: To compare the efficacy and safety of fluconazole and griseofulvin in the treatment of tinea capitis. PATIENTS AND METHODS: Patients with tinea capitis (n = 113) with positive fungal cultures entered the study. The patients were divided into four groups with different treatment regimes. Two groups received griseofulvin 15 or 25 mg/kg/day and two groups received fluconazole 4 or 6 mg/kg/day, all for up to 12 weeks. RESULTS: Griseofulvin was found to be slightly better than fluconazole. The lower doses for both griseofulvin and fluconazole required significantly longer treatment duration until mycological cure than the higher doses, independent of the fungus type. CONCLUSIONS: Since no significant difference was found between the drugs, it is suggested that the choice should be based on tolerability, availability and cost of the drugs.

Onychomycosis in psoriatic patients - rationalization of systemic treatment.

Nail changes in patients with psoriasis have been reported with varying prevalence. Onychomycosis has been reported in up to 47% of the psoriasis patients. The purpose of this study was to determine the prevalence of nail abnormalities, onychomycosis in psoriasis and response to itraconazole treatment. We evaluated 312 patients suffering from psoriasis for nail changes and onychomycosis. Patients having laboratory confirmation of onychomycosis were treated with three courses of itraconazole (400 mg day(-1) for 1 week). Of 312 patients with psoriasis, 67 (21.5%) patients had nail changes, 23 (34%) of them suffered from onychomycosis. Complete cure (clinical and mycological) was achieved in 30% of the patients with onychomycosis. The response to treatment of onychomycosis with itraconazole in psoriasis patients was found to be lower than in the general population. Considering the low response to onychomycosis systemic therapy in psoriatic patients and the potential side-effects of the treatment, the rationality of this treatment is questionable.

Iontophoretic terbinafine HCL 1.0% delivery across porcine and human nails.

BACKGROUND: Onychomycosis is a common disease. Topical treatment is usually not effective due to limitation of trans-nail delivery of antifungal drugs. Successful treatment of deep-seated nail infections remains elusive as the delivery of efficacious levels of antifungal drug to the site of action is very difficult. OBJECTIVES: To evaluate the influence of several parameters including; the effect of low electrical current, incubation time and the presence of electrolyte (NaCl or KCl) on the penetration of terbinafine through the nail plate into the nail bed, using various formulations and concentrations of terbinafine HCl. METHODS: Iontophoresis was applied across porcine and human nail in vitro to assess its efficiency in enhancing delivery of terbinafine HCl. RESULTS: In this study, we have demonstrated that an optimal electrolyte concentration (1% NaCl or KCl) is required for an effective delivery. There is a significant increase in drug delivery into the nail and into the receiving compartment in the presence of 3% DMSO. CONCLUSIONS: This study demonstrates the efficacy of iontophoresis in enhancing the trans-nail delivery of terbinafine. Clinical studies are needed to evaluate the feasibility, efficacy and safety of iontophoresis of terbinafine in onychomycosis in human.

Efficacy of a mucoadhesive patch compared with an oral solution for treatment of aphthous stomatitis.

OBJECTIVE: The purpose of this study was to evaluate the efficacy and tolerability of a mucoadhesive patch compared with a pain-relieving oral solution for the treatment of aphthous stomatitis. METHODS: Patients with active aphthous stomatitis were randomly treated either once a day with a mucoadhesive patch containing citrus oil and magnesium salts (n = 26) or three times a day with an oral solution containing benzocaine and compound benzoin tincture (n = 22). All patients were instructed to apply the medication until pain had resolved, and completed a questionnaire detailing multiple clinical parameters followed by an evaluation of the treatment. RESULTS: The mucoadhesive patch was found to be more effective than the oral solution in terms of healing time (mean +/- SD: 36.0 +/- 22.8 hours vs 134.7 +/- 57.7, p < 0.001) and pain intensity after 12 and 24 hours (3.7 +/- 2.8 vs 6.3 +/- 2.6, p = 0.003, and 2.3 +/- 2.7 vs 5.7 +/- 2.5, p < 0.001, respectively). Local adverse effects 1 hour after treatment were significantly (p < 0.01) less frequent among the mucoadhesive patch patients compared with the oral solution patients. CONCLUSIONS: The mucoadhesive patch was found to be significantly more effective and better tolerated than the oral solution in the treatment of aphthous stomatitis.

Onychomycosis: rationalization of topical treatment.

BACKGROUND: Fungal infection of the nail affects millions of people worldwide and has an estimated prevalence of more than 10% of the general population. OBJECTIVES: To determinate the prevalence of fungal infection in toenails, in order to decide the treatment policy for onychomycosis. METHODS: We evaluated 331 patients with suspected clinical toenail onychomycosis affecting at least two toenails. Mycological examination of the affected nails was performed; both the KOH test and fungal culture were used. RESULTS: Of 331 patients with suspected clinical toenail onychomycosis, 78.2% of the patients had at least three infected nails. The first toenail was the most affected. Trichophyton rubrum was by far the most common dermatophyte cultured from all samples. CONCLUSIONS: Most of the patients had at least three affected toenails. Topical treatment is not effective or practical, and systemic treatment should therefore be considered.

Treatment of moderate to severe facial seborrheic dermatitis with itraconazole: an open non-comparative study.

BACKGROUND: Seborrheic dermatitis is a common chronic disease. Malassezia yeasts have been implicated in the pathogenesis of this disease. Antifungal agents are known to be effective in the treatment of Malassezia yeast infections. OBJECTIVES: To evaluate the efficacy of itraconazole in the treatment of mild to severe facial seborrheic dermatitis. METHODS: Sixty patients with moderate to severe seborrheic dermatitis were evaluated in an open non-comparative study. Patients were treated with oral itraconazole, initially 200 mg/day for a week, followed by a maintenance therapy of a single dose of 200 mg every 2 weeks. Four clinical parameters (erythema, scaling, burning, itching) were assessed using a 0-3 score. Mycological evaluation determined the presence of Malassezia spores in the scales using a direct smear. RESULTS: At the end of the initial treatment significant improvement was reported in three clinical parameters: erythema, scaling, itching. Maintenance therapy led to only slight further improvement. Burning sensation was only mildly improved during the treatment. The quantity of Malassezia spores present in the direct smear decreased throughout the treatment period. No blood test abnormalities were found during the treatment. CONCLUSIONS: In this study initial treatment with itraconazole was beneficial in patients with moderate to severe seborrheic dermatitis.

Nail sampling in onychomycosis: comparative study of curettage from three sites of the infected nail.

BACKGROUND: Onychomycosis is a common problem. Obtaining accurate laboratory test results before treatment is important in clinical practice since the treatment of onychomycosis requires expensive oral antifungal therapy with potentially serious side-effects. The purpose of this study was to compare results of curettage technique of nail sampling in the diagnosis of onychomycosis from three different sites of the affected nail to establish the best location of sampling. PATIENTS AND METHODS: We evaluated 194 patients suffering from distal and lateral subungual onychomycosis (DLSO) and lateral subungual onychomycosis (LSO) using curettage technique. KOH examination and fungal culture were used for detection and identification of fungal infection. RESULTS: The culture sensitivity improves significantly as the location of the sample is more proximal. Trichophyton rubrum was by far the most common pathogen detected from all sampling sites. CONCLUSIONS: We found that the culture sensitivity improved as the location of the sample was more proximal. More types of pathogens were detected in samples taken from proximal parts of the affected nails.

Pseudomelanoma after Solcoderm treatment.

We describe a case of pseudomelanoma after Solcoderm treatment. Pseudomelanoma is a pathological entity describing the histological findings in cases of recurrences of a partially excised melanocytic nevus, resembling melanoma. Solcoderm is an aqueous solution containing organic and inorganic acids that destroys a lesion by tissue mummification. It has been used for the treatment of benign skin lesions. Appearance of pseudomelanoma after Solcoderm treatment stressed the controversy of the use of Solcoderm in pigmentary lesions, and that surgical removal is preferred in cases of pigmented nevi.

Low-dose isotretinoin in the treatment of acne vulgaris.

BACKGROUND: The efficacy of isotretinoin at 0.5 to 1.0 mg/kg per day in the treatment of acne is well established and considered safe, although it is sometimes not easily tolerated because of its cutaneous side effects. OBJECTIVE: The purpose of this study was to determine the efficacy of low-dose isotretinoin in the treatment of acne. METHODS: In this prospective, noncomparative, open-label study, 638 patients, both male and female, with moderate acne were enrolled and treated with isotretinoin at 20 mg/d (approximately 0.3-0.4 mg/kg per day) for 6 months. The patients were divided into two age groups: 12 to 20 and 21 to 35 years old. Patients were evaluated at 2-month intervals by means of clinical and laboratory examinations. A 4-year follow-up was also carried out. RESULTS: At the end of the treatment phase, good results were observed in 94.8% of the patients aged 12 to 20 years, and in 92.6% of the patients aged 21 to 35 years. Failure of the treatment occurred in 5.2% and 7.4% of the two groups, respectively. Twenty-one patients dropped out of the study because of lack of compliance, and another patient discontinued participation because of a laboratory side effect. During the 4-year follow-up period, relapses of the acne occurred in 3.9% of the patients aged 12 to 20 years and in 5.9% of the patients aged 21 to 35 years. Elevated serum lipid levels (up to 20% higher than the upper limit of normal value) were found in 4.2% of the patients and abnormal (

Macrolactam immunomodulators (tacrolimus and pimecrolimus): new horizons in the topical treatment of inflammatory skin diseases.

Tacrolimus and pimecrolimus are new macrolactam immunomodulators which were developed for the treatment of inflammatory skin diseases, mainly atopic dermatitis. In this article, we review the pharmacologic properties of the drugs, their side effects, and their clinical uses.

Molecular analysis of Malassezia species isolated from Israeli patients with pityriasis versicolor.

BACKGROUND: Pityriasis versicolor (PV) is a common superficial fungal infection of the skin caused by Malassezia species. The clinical significance of each of these species is not fully understood. M. furfur has long been identified as the causative agent of PV. Several recent studies suggest that M. globosa is most frequently associated with PV. OBJECTIVES: The aim of this study was to examine the prevalence of Malassezia species in affected and unaffected skin in Israeli patients with PV using a polymerase chain reaction (PCR)-based culture-independent method. METHODS: Samples were taken from affected skin of 75 patients with PV (35 females and 40 males, age range 18-65 years) who visited our outpatient clinic and from unaffected skin in 26 patients for direct microscopy and detection of Malassezia species using a PCR-based method. RESULTS: The major Malassezia species in PV was M. globosa, found in 97.3% (73 of 75) of samples from affected skin and 80.8% (21 of 26) samples of unaffected skin. M. restricta was associated with M. globosa in 1.3% (one of 75) of patients. No cases of M. furfur were detected in this study. There was no difference in the distribution of Malassezia species between affected and unaffected skin. CONCLUSION: Based on the PCR test, we have shown that M. globosa is probably most frequently associated with PV.