Talidomida y análogos de talidomida / Thalidomide and analogous

La talidomida se introdujo en la década del 50 como droga hipnótica, sedante y antiemética, especialmente indicada en mujeres gestantes durante el primer trimestre del embarazo. Se asociaron al uso del fármaco graves anormalidades congénitas y polineuropatías, por lo que se la retiró del mercadoen los años 60. Posteriormente se comprobaron propiedades inmunomoduladoras en pacientes con eritema nudoso lepromatoso, así como también efectos antiinflamatorios como lupus eritematoso discoide, enfermedad de Behcet, úlceras aftosas en pacientes con SIDA, enfermedad crónica injerto contra huésped, mieloma múltiple y neoplasia de órganos sólidos. Actualmente, con el desarrollo de nuevos fármacos análogos de la talidomida, que conservan sus propiedades terapéuticas sin presentar teratogenicidad, su aplicación futura es más promisoria (AU)

[Minocycline]. / Minocycline.

Minocycline belongs to the second generation class of cyclines. It was synthesized in 1967 and marketed in 1972. Minocycline has an antiinfectious activity with a spectrum similar to that of other cyclines, notably against Chlamydias, Treonema and Proprionibacterium acenes. The antiinflammatory activity is associated with this antiinfectious action is greater than that of first generation cyclines with specifically a modulator effect on epidermal cytokines. The pharmokinetics of minocycline is characterized by an excellent absorption, a long half-life and an important lipophilic property inducing good tissue distribution. Clinical trials of minocycline have mainly been performed in sexually transmissible diseases and in acne, a field where randomized studies are the most frequent. These trials show that the effect of minocycline is not stronger than first generation cyclines or doxycycline, but that the action is quicker than that of tetracycline at the dose of 500 mg a day. Minocycline is also efficient in nocardiasis, mycobacteriosis, leprosy, Lyme disease, pyoderma gangrenosum, autoimmune bullous dermatitis, Carteaud disease, and prurigo. However, the effect of minocycline in these different conditions has always been evaluated in open trials with a small number of patients. The usual side effects of cyclines, i.e. digestive problems, fungal infections, are less frequent than with first generation cyclines. No photosensitivity has been demonstrated although pigmentations have been described. Dizziness is a specific side effect of minocycline. Furthermore, rare but severe side effects have been reported, including hypersensitivity syndrome, autoimmune hepatitis, and lupus. Regular indications for minocycline in dermatology are acne and three sexually transmissible diseases (mycoplasm, chlamydia, treponema). Proposed dosage is 100 mg per day in sexually transmissible disease with a reduction to 50 mg per day after 15 days in acne.

Management of pyoderma gangrenosum.

Management of pyoderma gangrenosum continues to be a therapeutic challenge, both because the low incidence of the disease makes it difficult to conduct large-scale randomized studies and because pathogenic mechanisms are not yet well defined. The selection of drugs and dosing schedules is therefore mainly guided by clinical experience.

Pyoderma gangrenosum of the penis.

Two cases of pyoderma gangrenosum involving the penis are presented. Treatment was difficult in both cases despite the use of high doses of prednisolone. In one case, the addition of thalidomide proved successful, whereas in the other, minocycline effected a cure.