Calcitriol shows greater persistence of treatment effect than betamethasone dipropionate in topical psoriasis therapy.

OBJECTIVE: To establish the efficacy and duration of remission post-treatment of calcitriol 3 micro g/g ointment in comparison with betamethasone dipropionate 0.05% ointment. METHODS: A randomized, multicentre trial was conducted in 258 adult patients with chronic plaque psoriasis. Calcitriol 3 microg/g ointment or betamethasone dipropionate 0.05% ointment was applied twice daily for 6 weeks or until complete clearance of lesions. Patients whose psoriasis cleared or were significantly improved and did not require treatment continuation at treatment endpoint were contacted over the following 8 weeks to determine whether relapse had occurred. RESULTS: Both treatments were efficacious; improvement in psoriasis or clearance of lesions (residual erythema was allowed) was recorded for 79% and 82% of patients receiving calcitriol or betamethasone dipropionate, respectively. Global improvement and global severity scores at treatment endpoint showed statistically significant differences in favour of betamethasone dipropionate (p<0.05); however, the absolute reduction in mean PASI (psoriasis area and severity index) was comparable between the groups. A statistically significantly (p<0.01) higher proportion of responders remained in remission (no worsening of the disease warranting new treatment) following calcitriol therapy (48%) than betamethasone therapy (25%). This is of potential importance to patients, physicians and healthcare suppliers. CONCLUSION: Twice-daily applications of either calcitriol 3 microg/g ointment or betamethasone dipropionate 0.05% ointment can be used to good effect in the treatment of chronic plaque psoriasis. However, the beneficial effect is likely to persist for longer following calcitriol treatment.

Monitoring levels of preservative sensitivity in Europe. A 10-year overview (1991-2000).

A 10-year multicentre analysis of the frequency of sensitivity to common preservatives collected in 16 centres in 11 countries has shown stable but persisting high levels of sensitivity to formaldehyde and 5-chloro-2-methyl-4-isothiazolin-3-one + 2-methyl-4-isothiazolin-3-one (MCI/MI). It has also revealed a significant increase in the level of reactivity to methyldibromoglutaronitrile (MDBGN) from 0.7% in 1991 to 3.5% in 2000. The current high level of sensitivity to MDBGN requires an urgent safety re-evaluation and risk assessment update along with consideration of immediate lowering of use concentrations, especially in leave-on products.

Azelastine tablets in the treatment of chronic idiopathic urticaria. Phase iii, randomised, double-blind, placebo and active controlled multicentric clinical trial.

This trial was designed to study the efficacy and tolerability of azelastine in controlling symptoms of chronic idiopathic urticaria, using ebastine as validation group. Fifty-two adult patients were randomised to receive azelastine (4 mg), ebastine (10 mg) or 18 placebo for 21 days. Patients were required to visit the investigating physicians on three different occasions (days 0, 7 and 21). On each of these three study days, investigators assessed itching, wheals and erythema, based on a 4-point scale, and quality of life using a visual-analogue scale and subscale 9 of the Short Form 36 (SF-36) Health Survey. Patients entered daily assessments of itching on diary cards also using a 4-point scale. Furthermore, investigators assessed global efficacy and tolerability of the study medication on day 21 or upon premature discontinuation of the trial. Side effects and compliance were evaluated on each visit. A statistically significant reduction in itching was found for both active treatments compared with placebo. These improvements, which were statistically significant already after 1 day of treatment, continued over the course of 3 weeks. Additionally, both azelastine and ebastine were effective in improving symptoms such as wheals and erythema when compared to placebo. The quality-of-life parameters were unaffected by either treatment. Taste perversion (2 cases) and somnolence (1 case) were the only adverse drug reactions of azelastine. Ebastine, however, seemed to cause more often and more severe symptoms such as fatigue, sleepiness and asthenia. Global assessments of efficacy and tolerability performed by the investigators, also favoured azelastine. In conclusion, both azelastine and ebastine are effective and safe drugs, able to control symptoms of chronic idiopathic urticaria since the first day of treatment, and along a period of 3 weeks.

Rolipram inhibits staphylococcal enterotoxin B-mediated induction of the human skin-homing receptor on T lymphocytes.

The cutaneous lymphocyte-associated antigen defines T lymphocytes with cutaneous tropism under inflammatory conditions. Bacterial infections participate in cutaneous inflammations, such as atopic dermatitis or psoriasis. Bacterial superantigens, such as staphylococcal enterotoxin B, can activate peripheral blood mononuclear cells to induce effector T cells bearing the T cell skin homing receptor cutaneous lymphocyte-associated antigen via enhancement of interleukin-12 production. We have identified and characterized the anti-inflammatory effects of different phosphodiesterase inhibitors on this system. Our data indicate that the selective type 4 phosphodiesterase inhibitor rolipram inhibits the Staphylococcal enterotoxin B-mediated generation of cutaneous lymphocyte-associated antigen positive CD3+ cells from peripheral blood mononuclear cells by reducing interleukin-12 production in a concentration-dependent manner. Conversely, type 3 phosphodiesterase or type 5 phosphodiesterase selective inhibitors were not effective. The rolipram inhibitory effect was on interleukin-12 production, as exogenously added interleukin-12 could revert rolipram suppression. These results suggest that selective type 4 phosphodiesterase inhibition may have beneficial effects on T cell mediated skin inflammatory processes characterized by the presence of bacterial infections, that are thought to exacerbate ongoing skin inflammation.

Contact dermatitis: clinical review of 800 patients tested using the standard European series.

The results of the use of the European Standard Series on 800 patients suffering from Contact Dermatitis, including occupational Dermatosis is reported. This work also attempts to provide insight into the interests and difficulties of carrying out an epidemiological study in an Allergy Centre and Immunology Clinic. All the patients underwent a Patch Test following the guidelines laid out by the International Contact Dermatitis Research Group. The results of the patch tests were positive in 462 patients (57.7%) and negative in 338 cases (42.3%). The agents responsible for the symptoms in our study were as follows: metals (33%), parafenilen-diamine (13.9%), cobalt (13.3%), perfumes (5.5%), benzocaine (5.4%) and potassium dichromate (5.4%). In this study 72 patients were verified to have Occupational Dermatosis, corresponding mainly to the following occupational sectors: metal industry workers, hairdressers and bakers and pastry makers.

[Bacteremia of cutaneous origin]. / Bacteriemia de origen cutáneo.

558 episodes of bacteremia were detected in our medical center during a 2-year period. 17 of them (3%) were of cutaneous origin. 12 cases were community-acquired and 5 were hospital-acquired. The patients median age was of 65 years. 15 patients had a baseline disease, the most frequent being diabetes mellitus and neoplastic disease. The most common bacteria isolated were group A beta-hemolytic Streptococcus, Staphylococcus aureus, and Escherichia coli; 2 patients had multibacterial episodes. Decubitus ulcer and cellulitis were the most frequently associated skin disease. Global mortality was of 47% and was sepsis related in 29% of the cases. Death prognosis factors were old age, diabetes mellitus, gram-negative causal bacteria, nonappropriate antibiotic therapy, low index of clinical suspicion.

[Allergenicity degree and sensitization percentage of minoxidil in experimental animals]. / Demostración del grado de alergenicidad y porcentaje de sensibilización del minoxidil en animales de experimentación.

The maximization test of Magnusson Kligman was performed in 25 Hartley guinea pigs with minoxidil. The results concluded that minoxidil has a very low capacity of sensitization. This results confirmed in the animal test, the low incidence of contact dermatitis, among the customers using minoxidil topical solutions.

[The quenching phenomenon or antigenic extinction]. / El fenómeno de quenching o extinción antigénica.

The new concept of "quenching" is exposed for its diffusion and Knowledge. This phenomenon occurs in nature, industry and in clinic dermatology. Doctors working in contact dermatitis suffer contradictions and paradoxic reactions due to "quenching situations". Most important bibliography on this theme is commented.

[Urticaria. Generalities]. / Urticaria. Generalidades.

This is an update article in urticaria. Its content try to summarize in few words all the practical knowledge that we have of these diseases "up to now". An exhaustive reference of the bibliography is avoided although the revision has been done indeed. We feel that if such is necessary in some papers, do difficult the reading in others like this, exclusively conceived for teaching.

Turpentine: an attempt to explain sensitization to this allergen in Spain.

On turpentine being removed from the standard international series, and seeing that the % of positives in Spain were high, the Spanish group decided to study chromatographically the components of turpentine in order to know which of these components is present in the highest proportion. Various samples of turpentine are studied and the results are shown.

[Sensitization to metals in children]. / Sensibilización a metales en niños.

Patch tests with Nickel sulphate, cobalt chloride, bichromate and mercury, were performed in 100 randomized children. Twenty children reacted with allergic positive responses 11 were positive to mercury. Nine to Nickel sulphate. The youngest was a girl of eight months of age, allergic to nickel sulphate and suffering contact dermatitis in the ear lobes, produced by the ear rings that she had brought from her first week of life. Mercury has been the strongest metal in the infancy examined. Biggest incidence of responses are in kids between six and eight years old.

Ethylene oxide dermatitis.

A case of contact dermatitis produced on the face of patient after the application of an oxygen mask is described. This paper includes the results of epicutaneous tests, the identification of the possible etiological agent and chromatographic analysis of the samples sterilized by ethylene oxide.