Mycophenolate mofetil therapy for moderate to severe atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory disease of the skin that can be refractory to topical and systemic corticosteroids, phototherapy, topical immunomodulators and systemic immunosuppressive drugs. Recent studies have shown promise for the use of mycophenolate mofetil (MMF) to treat recalcitrant AD. AIM: To assess the effectiveness and adverse effects of MMF used for moderate to severe AD in a university outpatient dermatology clinic. METHODS: A retrospective chart review of 20 patient charts was conducted for patient age, gender, duration of disease, prior therapies, concomitant therapy, clinical response and adverse side-effects. RESULTS: Of the 20 patients, 17 improved within 4 weeks of starting MMF therapy. Ten patients had disease remission and were subsequently able to discontinue MMF. Seven attained satisfactory control of their AD using MMF as maintenance therapy. Overall, MMF was well tolerated, with mild headaches, gastrointestinal complaints and fatigue as the commonest side-effects. During therapy, herpes zoster developed in four patients, Staphylococcus aureus cutaneous infections in two, and herpes simplex in one. One patient discontinued MMF because of insufficient control of pruritus. CONCLUSION: MMF can be rapidly effective and well tolerated in patients with moderate to severe AD resistant to conventional therapies. The limitations of this retrospective study include no control group and a lack of a standardized scoring index to assess improvement, and the concomitant use of adjuvant therapies makes the contribution of MMF alone difficult to assess. Larger controlled studies are needed.

Wintering greater scaup as biomonitors of metal contamination in federal wildlife refuges in the Long Island region.

Tissues of greater scaup (Aythya marila mariloides) and components of their habitat (sediment, plankton, macroalgae, and invertebrates) were collected for heavy metal analysis in the winter of 1996-97 from US Department of the Interior wildlife refuges in the Long Island region. Geographic and temporal relationships between the concentration of nine metals in tissue and in habitat components were examined. In greater scaup tissues and habitat components, concentrations of As and Se were highest in Branford, Connecticut; Pb values were greatest in Oyster Bay, New York; and Hg concentrations were largest in Sandy Hook, New Jersey. Over the course of the winter, the concentration of Hg in liver increased, and concentrations of Cd, Cr, Cu, Hg, Pb, Se, and Zn in kidney decreased. Based on several criteria derived from geographic and temporal trends, metals were ranked using the apparent biomonitoring efficacy of greater scaup (As = Cr > Cu = Pb = Zn = Hg > Se = Cd > Ni). Although the seasonal migration and daily mobility of greater scaup are drawbacks to using this species as a sentinel for metal pollution, it was possible to demonstrate a relationship between geographic and temporal patterns of metals in habitat and greater scaup tissue. However, most metal concentrations in tissue were below thresholds known to adversely affect health of waterfowl.