Twice-daily dosing of loracarbef 15 mg/kg versus 30 mg/kg in the treatment of children with acute sinusitis.

Loracarbef is an oral synthetic beta-lactam antibiotic of the carbacephem class. The aim of this study was to compare the efficacy and safety of loracarbef 15 mg/kg versus 30 mg/kg in children with acute sinusitis. A randomized, parallel-group, clinical study was conducted. Fifty-eight children aged 5-12 years with acute sinusitis were divided into two groups, which received either loracarbef 15 mg/kg/day or 30 mg/kg/day orally, divided in two doses for 10 days. Clinical examination, anterior rhinoscopy and sinus radiographs were performed at the beginning of treatment. Clinical evaluation was repeated in a second session, 0-2 days after the final dose, and in a third session, 30 days after the beginning of the treatment. Sinus X-rays were repeated selectively in the second session and in all patients in the third session. Nineteen of 29 (65.5%) patients in the 15 mg/kg/day group and 26 of 29 (89.6%) in the 30 mg/kg/day group were characterized as completely or clinically cured at the end of the study. In conclusion, a statistically significant difference between the two treatment groups was shown with better results in the 30 mg/kg group. Despite the slight difference in adverse events between the two groups (with fewer adverse events in the 15 mg/kg group), we recommend that if loracarbef is chosen as initial therapy in acute sinusitis, a regimen of 30 mg/kg/day in two doses is followed.

Calcipotriol monotherapy versus calcipotriol plus UVA1 versus calcipotriol plus narrow-band UVB in the treatment of psoriasis.

The purpose of this study was to evaluate the efficacy of calcipotriol ointment as monotherapy versus calcipotriol in combination with narrow-band ultraviolet (UV)-B or UVA1 phototherapy and to determine whether calcipotriol in combination with UVA1 is an alternative to calcipotriol with narrow-band UVB phototherapy. Forty-five patients with plaque psoriasis were divided into three treatment groups with no significant differences in Psoriasis Area and Severity Index (PASI) scores, mean age, sex or skin type. The total duration of the treatment was 3 months. Regarding PASI score, psoriasis regression was statistically significant between the groups. The response to UVA1 and narrow band UVB with calcipotriol was superior to calcipotriol monotherapy. UVA1 phototherapy with calcipotriol could be an alternative to narrow-band UVB phototherapy with calcipotriol.

Improvement of otitis media with effusion after treatment of asthma with leukotriene antagonists in children with co-existing disease.

Otitis media with effusion (OME) is a common pediatric disease and there is great controversy concerning its management. Mechanical, medical and surgical treatments have not proven adequate in resolving the disease and serve mainly to manage complications. Leukotriene inhibitors are new drugs that have been approved recently for the treatment of asthma in children. The aim of this study was to evaluate the impact of leukotriene inhibitor therapy for asthma on the clinical course of OME in children with co-existing disease. Fifty children with bilateral OME and asthma, divided equally into two groups, were studied. The children in the first group were treated with budesonide and terbutaline inhalers together with the leukotriene inhibitor montelukast, whereas the children in the second group were treated with the inhalers alone. Duration of treatment was 30 days. Pneumatic otoscopy, tympanometry and pure-tone audiometry were performed at the beginning and at the end of treatment. Fifteen (60%) of the children receiving inhalers and montelukast and nine (36%) of those receiving only inhalers were found free of OME after 30 days of therapy. Thus, it may be concluded that a statistically significant beneficial effect on the clinical course of OME resulted from the addition of montelukast to the treatment of children with co-existing asthma and OME. Given that no medication has been shown to be effective in OME therapy, further investigation of the possible effects of leukotriene inhibitors is warranted.

Objective biophysical findings in patients with sensitive skin.

The term sensitive skin has been used to describe a clinical phenomenon of hyperreactivity of the human skin, which develops exaggerated reactions when exposed to external factors. The aim of this study was to determine objective biophysical findings in patients with sensitive skin compared to those individuals with nonsensitive skin. Thirty-two patients with sensitive skin and 30 healthy volunteers with nonsensitive skin were studied. The testing methods included in vivo and in vitro tests: epicutaneous testing (Patch tests); measurement of sebum and hydration of the skin; alkali resistance test; stinging test with lactic acid; reaction to aqueous solution of methyl nicotinate 0.5%, 1.4% and acetyl-b-methylcholine chloride 1:1000; pH measurement; dermographism; and measurement of total and specific IgE. Significant results were observed in the measurement of sebum (p < 0.01) and hydration (p < 0.05) of the skin, in the alkali resistance test (p < 0.05), in the vascular reaction to methyl nicotinate (p < 0.01) and to acetyl-b-methylcholine chloride (p < 0.01) and in the skin response to allergens of the European standard (p < 0.01) and cosmetic series (p < 0.05). In addition, the subjective findings of stinging test produced significant results (p < 0.001) as was anticipated. Patients with sensitive skin possess very dry skin with low fatness, which leads to a disturbance of the protective skin barrier function. They also present a hyperreaction of the skin blood vessels, increased transcutaneous penetration of water-soluble chemicals, enhanced immune responsiveness, significant decrease of alkali resistance and a heightened neurosensory stimulation.

Psychiatric factors in patients with sensitive skin.

The term sensitive skin has been used to describe a clinical phenomenon of skin hyperreactivity induced after exposure to different external factors. The diagnosis is mainly based on patient's self-assessment because of the lack of objective clinical signs of the disease. The aim of this study was to investigate psychiatric factors in patients with sensitive skin and to estimate the possible need for psychological intervention to these patients. Thirty-seven patients with sensitive skin and 38 individuals with nonsensitive skin were studied. The psychometric instruments used were the Symptom Checklist-90 (SCL-90) and the Delusions-Symptoms-States Inventory/states of Anxiety and Depression (DSSI/sAD). Statistically significant differences in subjects with sensitive skin compared to those with nonsensitive skin were observed in the SCL-90 subscales of somatization, phobic anxiety, hostility, interpersonal sensitivity and the DSSI/sAD subscale of anxiety. Our findings suggest that somatization, anxiety, phobic anxiety, hostility and interpersonal sensitivity symptoms may be associated with hypersensitivity of human skin. Psychological factors should be taken into consideration in the treatment of patients with sensitive skin.

Successful treatment of genital and facial psoriasis with tacrolimus ointment 0.1%.

Tacrolimus is an immunomodulatory agent that inhibits the activation and maturation of T-cells and blocks transcriptional activation of several cytokine genes. It also interferes with the function of Langerhans cells, basophil cells and mast cells. Recent studies have demonstrated the efficacy of topical tacrolimus in inflammatory skin disorders. Our objective was to assess the efficacy of topical treatment with tacrolimus ointment 0.1% in patients with psoriasis on the anogenital region and the face. Included in the study were 10 patients with a long-standing history of genital and facial psoriasis, partially controlled with periodic use of topical corticosteroids. Tacrolimus ointment 0.1% was applied twice daily for 10 days. The patients were followed-up every 3 weeks for a total period of 12 weeks. The severity of psoriasis was evaluated in all patients at baseline (day 0) and at the end of weeks 3, 6, 9 and 12. Clinical severity of erythema, scaling, infiltration and lesional extent were graded using a 0-3 scale indicating none, mild, moderate and severe expression, at baseline and at follow-ups. An overall severity score of 0 (clear), 1-4 (mild), 5-8 (moderate) or 9-12 (severe) was then assigned to each patient by adding the scores for the above parameters. On each visit, every patient was evaluated clinically. The decision to reapply the drug was determined by the clinical response of each patient at each visit. At the end of the study, patients also assessed efficacy, safety and tolerance after topical application of tacrolimus ointment using a 0-5 scale for each parameter: A marked improvement was noticed in all patients at the end of the first week without drug-related adverse effects. There were 15 recurrences during the 12-week period in all patients. In conclusion, tacrolimus ointment 0.1% seems to represent a safe new option for the treatment of genital and facial psoriasis. Further studies are probably needed to specify the therapeutic dosage and maintenance therapy

Is itraconazole the treatment of choice in Microsporum canis tinea capitis?

Mycotic scalp infection caused by Microsporum canis is the most dominant cause of tinea capitis in Greece. Griseofulvin has been the gold standard for the treatment of tinea capitis, but it is unavailable in our country. In this study, we evaluated 111 children with M. canis tinea capitis that were treated with itraconazole. Eighty-one of them were treated with itraconazole capsule pulse therapy (group A) and 30 (group B) were treated with oral suspension administered in continuous regimen. Twenty-one patients, all from group A, were lost to follow-up, probably due to the length of this regimen. In all patients that made up the study protocol, complete cure was achieved within seven pulses for group A and 12 weeks for group B. No significant side effects to lead to the cessation of therapy were recorded. Laboratory investigations were performed in 32 randomly chosen patients and were within normal ranges. The response to therapy did not appear to depend upon the formulation administered (capsules versus suspension). Using the pulse regimen, we also believe that it is necessary to individualize the number of pulses administered according to the clinical response. In conclusion, itraconazole proved safe and effective in our study, providing an ideal alternative to griseofulvin.

Identification of human papillomavirus DNA in melanoma biopsy specimens of Greek population.

The aim of this retrospective study was to evaluate melanoma biopsy specimens from the Greek population living in the prefecture of Larissa for the presence of human papillomavirus (HPV) DNA and to determine the possible relationship between HPV and clinical outcome in these patients. Twenty-eight melanoma biopsy specimens, 20 from primary cutaneous melanoma and eight from melanoma metastasis were obtained from 28 patients. The biopsy samples were formalin-fixed and paraffin wax-embedded. The control group consisted of three junctional melanocytic nevi, histologically confirmed, and three punch biopsies from normal skin that were obtained from six healthy individuals. The presence and types of HPV DNA were assessed by the amplification of a fragment of the LI region by consensus primer polymerase chain reaction (PCR) combined with restriction fragment length polymorphism analysis (RFLPA). In each biopsy specimen that was evaluated, HPV 6, HPV 11, HPV 16 and HPV 18 positive controls from genital HPV lesions were included. Five of 28 (17.85%) biopsy melanoma specimens were positive for HPV DNA. Conversely, HPV was not detected in any of the biopsy specimens of the control group (0/6). HPV viral type 16 was found in two samples and HPV 6 DNA in three. Our results regarding the possible relationship between melanoma and HPV DNA were not statistically significant (p > 0.05). These findings suggest that ultraviolet sun exposure remains the main cause of melanoma in our region. The role of cutaneous HPV infection in the pathogenesis of melanoma remains elusive.

Evaluation of cytokine serum levels in patients with plaque-type psoriasis.

Psoriasis is a chronic debilitating cutaneous disorder that affects both sexes and appears clinically as inflamed, edematous skin lesions covered with a silvery white scale. Strong evidence suggests that immune mechanisms are implicated in its pathogenesis, such as persistent activation of T-lymphocytes, excessive proliferation of keratinocytes and reactivation of proto-oncogenes and other elements. Additionally, several recent studies have demonstrated that cytokines play a significant role in the pathogenesis of the disease, as they can be found in the affected skin of psoriatic patients. In this study we evaluated levels of circulating cytokines in the serum of 45 Greek psoriatic patients before initiation of treatment and compared the results with those in 45 healthy volunteers. According to our findings interleukin (IL)-2, IL-10, IL-12 and tumor necrosis factor-alpha (TNF-alpha) levels were statistically significantly elevated in the serum of psoriatic patients before therapy compared with those of controls. IL-6 serum levels did not differ between psoriatic patients and healthy volunteers. Conversely, interferon-gammaserum levels of psoriatic patients were statistically significantly lower than those of healthy volunteers.

Oral administration of cyclosporin A in patients with severe alopecia areata.

Alopecia areata is a chronic, nonscarring hair loss condition with an unpredictable course that may cause emotional stress in affected patients. Regarding its pathogenesis, the most accepted theory is that alopecia areata is a T-cell-mediated autoimmune condition that is most likely to occur in genetically predisposed individuals. Cyclosporin A is an immunosuppressive agent that has provided new approaches in the treatment of autoimmune diseases. Hypertrichosis, one of the common side effects of orally administered cyclosporin A, encouraged a number of investigators to use the drug in the treatment of alopecia areata, but the reports on this subject have been controversial. We present a small series of patients with severe alopecia areata treated systemically with cyclosporin A at a dose of 3-5 mg/kg for 6 months as well as their 3-month follow-up after cessation of the drug.

Increasing incidence of melanoma in central Greece: a retrospective epidemiological study.

The increasing incidence of melanoma in the general population during the last few decades has provoked a great deal of research, aiming to identify the possible relationship between old and new etiological factors involved in the pathogenesis of this tumor. The aim of the study was to evaluate the incidence of melanoma in central Greece, especially in the prefecture of Larissa from January 1988 to December 1998. Data were collected from the General Hospital of Larissa. Seventy-one cases of melanoma were studied (41 females, 30 males). The incidence increased from 1.36/100,000 patients during the first year of the study (1988) to 5.2/100,000 patients in the last year of the study (1998). The patients'skin types were: type 12.8%, type II 52.1%, type III 45.1%. The median age of patients was 61.9 years, 61.4 years in female and 62.5 years in male patients. Concerning their occupation, farmers accounted for 56.3%. Melanomas were most frequently located on head and neck (36.6%), extremities (30.98%) and trunk (11.3%). Superficial spreading melanomas were observed in 44% of the patients and nodular melanomas in 20%. In conclusion. there was a rapid increase in the incidence of melanoma in our region especially during the last 3 years.

Acrokeratosis verruciformis of Hopf (Hopf disease): case report and review of the literature.

Acrokeratosis verruciformis of Hopf is an autosomal dominant genodermatosis usually presenting with multiple planar wart-like lesions, typically observed on the dorsum of the hands and feet. The disease is very rare and the pathogenesis remains unknown. Considerable controversy surrounds the nature and relationship of acrokeratosis and Darier disease and whether they are manifestations of one genetic abnormality. We describe the case of a 19-year-old man seen in our clinic with skin-coloured, flat, warty papules localized to the dorsum of the hands and feet. Both clinical and histological findings were compatible with acrokeratosis verruciformis. We also review the disease, particularly its relation with Darier disease and therapeutical options.

Pustular impetigo with good response to clarithromycin.

Impetigo is a contagious superficial pyogenic infection of the skin caused by Staphylococcus aureus and/or by group A Streptococcus. Two main clinical forms are recognized: bullous impetigo and non-bullous impetigo. We present an unusual case of pustular impetigo in a 35-year-old man. The pustules were localized symmetrically in the groin and the patient was successfully treated with clarithromycin. In bullous impetigo, exfoliative toxins produced by Staphylococcus aureus are accepted as the basis for the bulla formation just below the stratum granulosum. Although clarithromycin is considered to be a second-choice therapy for bullous impetigo, it was highly effective in our case.