Discordant results with pimecrolimus 1% cream in the treatment of plasma cell balanitis.

Plasma cell balanitis of Zoon is a chronic, benign, inflammatory dermatosis of the glans penis and prepuce. The exact aetiology is unknown. The treatments described to date have provided only partially successful results. Recently, several reports of plasma cell balanitis successfully treated with calcineurin inhibitors have been published. We report 3 cases of plasma cell balanitis refractory to several treatments with steroids and antifungals treated with pimecrolimus 1% cream applied twice daily: 1 patient had a complete resolution, 1 patient had a marked response but relapsed during the treatment and the last patient had a partial response due to the development of a side effect that precociously required to stop the treatment. One patient referred a slight pruritus after the first applications of the cream that spontaneously disappeared after a few minutes. Additional experiences are needed to determine if topical pimecrolimus is an effective and safe treatment for plasma cell balanitis.

An open randomized study to compare narrow band UVB, topical pimecrolimus and topical tacrolimus in the treatment of vitiligo.

Vitiligo is an acquired loss of pigmentation and its treatment remains very difficult up to date. Narrow band ultraviolet B (NB-UVB) and topical immunomodulators are included among the most innovative approaches to vitiligo. We evaluated the efficacy and tolerability of NB-UVB, topical pimecrolimus and tacrolimus in the treatment of vitiligo. Adult patients with chronic and stable vitiligo refractory to conventional therapies were enrolled in an open parallel groups study. The patients were scheduled on the basis of a computer-generated randomization into three groups: 13 patients received NB-UVB phototherapy 3 times a week, 15 patients were treated with pimecrolimus 1% cream b.i.d. and 16 patients applied tacrolimus 0.1% ointment b.i.d. All three treatment regimens were performed for 24 weeks. At baseline and every three weeks for the whole period of therapy the patients were examined through digital photographs and, at the end of the study, based on the percentage of repigmentation, treatment outcome was classified as "absent" (0), "slight" (< 25%), mild (25-49%), "moderate" (50-74%), and "excellent" (> 75%). During the whole period of the study, possible side effects were recorded. The response to treatments varied according to the anatomical location of the lesions. No statistically significant differences in repigmentation for any anatomical site were recorded with the three treatments. The best results were obtained for lesions of the face with pimecrolimus cream and tacrolimus ointment and of the neck with NB-UVB. Statistically significant differences in repigmentation between photo-exposed and covered skin areas were recorded although the patients were asked to avoid direct UV exposition and to apply a very high protection sun screen on vitiligo lesions. All three treatments should be considered as a good option in the treatment of vitiligo. NB-UVB irradiation may represent the optimal choice in generalized vitiligo with topical immunomodulators in localized vitiligo.

A randomized double-blind study to investigate the clinical efficacy of adding a non-migrating antimicrobial to a special silk fabric in the treatment of atopic dermatitis.

BACKGROUND: A randomized, double-blind study designed to compare the efficacy of DermaSilk versus a sleeve of similar structure but minus the AEM 5772/5 antimicrobial finish in the treatment of atopic dermatitis (AD). OBJECTIVE: To evaluate the clinical effect of adding an antimicrobial finish to knitted silk garments on eczema severity and on pruritus in patients with AD. METHODS: Thirty patients aged between 3 and 31 years (mean 14.2 +/- 7.7) were enrolled. The inclusion criterion was that the patients presented with active AD with eczematous lesions located on the arms without any sign of infection. Each participant was given a set of 4 pairs of knitted silk tubular sleeves marked with seams of different colours. Only one colour was treated with AEGIS AEM 5772/5. This information was unknown to both the clinicians and the patients/parents. At baseline (T0) and after 7 (T7), 14 (T14), 21 (T21) and 28 (T28) days, the patients were evaluated using the following methods: photographic assessment, local modified SCORAD index adapted for only the arm, and parent/patient assessment of pruritus measured with a visual analogue scale. RESULTS: The mean local SCORAD index of both the DermaSilk- and the unmodified-silk-covered arms decreased significantly between baseline (T0) and the end of study (T28). However, while the Derma-Silk group showed a constant decrease each week, the unmodified-silk group showed a significant decrease only in the first 2 weeks of the study. Also the decrease in pruritus values between T0 and T28 was greater for the DermaSilk group. CONCLUSIONS: This study demonstrates the importance of including the AEM 5772/5 finish to the specially knitted silk for a long-term improvement of atopic eczema symptoms.

Efficacy, tolerability, impact on quality of life and sebostatic activity of three topical preparations for the treatment of mild to moderate facial acne vulgaris.

BACKGROUND: Acne is treated according to the clinical observations and pathophysiologically relevant mechanisms, such as hyper-keratinization, seborrhea and bacterial proliferation. In mild and moderate forms of inflammatory acne, topical antimicrobials are recommended as a monotherapy or in combination with topical retinoids. The aim of this study was to compare the clinical effectiveness, tolerability, impact on quality of life and effect on sebum excretion of three antimicrobial preparations: clindamycin phosphate, benzoyl peroxide and a combination of clindamycin phosphate plus benzoyl peroxide. METHODS: In total, 240 patients were randomized into treatment groups for an 8-week study. Every two weeks the patients were evaluated using the following methods: photography, the Global Acne Grading System, sebumetric evaluation, and the Acne-Specific Quality of Life questionnaire. In addition, 80 healthy controls were enrolled for the sebumetric evaluation. RESULTS: A significant improvement in acne and the quality of life was observed for all three therapies at the end of the study. The sebum excretion results for the three treatment groups displayed significant and unpredictable variation, whereas the controls groups exhibited no significant variation. The three treatments were well tolerated. CONCLUSIONS: The efficacy of the three antimicrobial preparations likely results from their anti-inflammatory and bacteriostatic activities. In contrast, seborrhoea seems to be minimally impacted.

Pruritus in chronic plaque psoriasis: a questionnaire-based study of 230 Italian patients.

In the past, several textbooks defined psoriasis as a non-pruritic dermatosis, but the most recent data in the literature emphasizes the high frequency of pruritus in psoriasis and its impact on the quality of life of patients with psoriasis. Aim of this study was to explore the sensory and affective dimensions of pruritus as well as to assess the impact of itch on quality of life and to evaluate the influence of lifestyles, habits, and various anti-pruritic therapies on pruritus in a large group of psoriatic subjects. The structured Yosipovitch itch questionnaire was given to 240 psoriatic patients. 230 patients returned a complete and detailed questionnaire. Pruritus was referred to by 80% of the patients. Psoriasis area and severity index (PASI) was significantly higher in itching-patients (P=0.04). In half of the patients, itching appeared daily, particularly in the evening. Significant aggravating factors of pruritus were stress, skin dryness, hot water, sweating, elevated ambient temperature, exercise, abundant meals, bad moods, lying position, and contact with clothes. Cold water is the only factor that showed to significantly relieve the pruritus. Anti-pruritic therapies had limited effect. Pruritus is a common, bothersome, and poorly responsive symptom in patients with psoriasis.