Modern topical glucocorticoids and anti-infectives for superinfected atopic eczema: do prednicarbate and didecyldimethylammoniumchloride form a rational combination?

The addition of an anti-infective to a topical glucocorticoid preparation for superinfected atopic eczema is still controversial. To address this question in the context of the topical glucocorticoids of the non-halogenated double-ester type 0.25% prednicarbate cream was compared to the identical preparation incorporating the same amount of the disinfectant didecyldimethylammoniumchloride in patients suffering from atopic eczema carrying Staphylococcus aureus at a density of more than 10(6) colony-forming units per cm2. One of the preparations was used twice daily over 5 days according to a random plan in a blind fashion. Thereafter treatment was based on either prednicarbate cream or the corresponding vehicle according to clinical needs. Clinical and microbiological evaluation were scheduled for days 0, 6 and 34. Various clinical parameters were addressed individually as well as over all improvement using scores. A total of 143 patients was recruited. The patients of both groups improved rapidly with respect to clinical and microbiological findings. Essentially, there was no difference between the groups. Hence, the addition of an anti-infective to a topical prednicarbate preparation is not to be generally recommended.

Treatment of tinea unguium with medium and high doses of ultramicrosize griseofulvin compared with that with itraconazole.

Toenail tinea is a very recalcitrant dermatosis. Griseofulvin at > or = 500 mg/day is the current medication of choice, but it is minimally successful. In a controlled open trial ultramicrosize griseofulvin (UMSG) at doses of 660 and 990 mg/day was compared with itraconazole at 100 mg/day in 109 patients. At 4-week intervals, the patients were evaluated for their clinical and mycological statuses and adverse reactions. Treatment was given for up to 18 months. Compliance was checked by tablet counting. Response (cure, partial cure, marked improvement) was analyzed by the intent-to-treat method. Cured and partially cured patients were followed up. Except for one early dropout, the toenails (mean, 6 to 7) were involved. Cure or partial cure was found in 6% (UMSG at 660 mg), 14% (UMSG at 990 mg), and 19% (itraconazole at 100 mg) of patients (P = 0.2097); marked improvement was found in 36, 44, and 39% of patients in the three treatment groups, respectively. Most patients had to be treated for 18 months. Failure was related to short medication periods (adverse drug reactions, dropout). While stable cure was not obtained with UMSG at 660 mg, the higher dose of UMSG and itraconazole gave stable cures in the other patients. Side effects of nausea, diarrhea, and headache were found in 20, 26, and 11 patients, respectively (P = 0.0028), and the numbers in whom medication had to be discontinued differed, too (P = 0.0137). While there was no major difference with glutamic-pyruvic transaminase and gamma-GT, total and low-density lipoprotein cholesterol levels declined slightly in the itraconazole group (P = 0.0357 and P = 0.0639, respectively, at 3 months). More than 70% of the patients had an average compliance of > or = 90%; four patients (two dropouts) were poor compliers. In conclusion, it appears questionable whether griseofulvin can continue to be considered the "gold standard" in the treatment of toenail tinea. At present, itraconazole at 100 mg shows better efficacy and is better tolerated.

Comparative efficacy and safety of bifonazole 1% cream and the corresponding base preparation in the treatment of seborrhoeic dermatitis.

Seborrhoeic dermatitis is a common entity that conventionally is difficult to treat. Recently, topical ketoconazole has been proven successful. To determine if other azoles, and in particular the more modern ones, are also helpful in this condition, a double-blind multicentre randomized controlled trial was performed in patients suffering from seborrhoeic dermatitis involving individuals 16 years and older without human immunodeficiency virus (HIV) infection. One hundred patients were enrolled and treated according to a random plan with either bifonazole 1% cream or the corresponding vehicle once daily for 4 weeks. All patients were evaluated at the beginning of the study, as well as after 2 and 4 weeks, i.e. the treatment period proper, and after 6 weeks of follow-up. Clinical evaluation was based on scores of 0-3 for the following parameters: erythema, papules, infiltration, scaling, itch. In addition, mycological evaluation was performed using adequate contact plates for quantitative determination of Malassezia furfur. In the end, 92 patients were at least partially evaluable. In general, the verum preparation tended to be more efficacious, e.g. the score for erythema amounted to 0.75 after 4 weeks as compared with 0.88 in the control group, the baseline values being 2.18 and 2.04 respectively. With itch, the corresponding figures were 0.17 and 0.33 as compared with 1.42 and 1.38 before treatment. While in statistical terms there was significant difference in these parameters, such a difference was demonstrated by clinical judgement at follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical efficacy and tolerability of saperconazole for tinea of glabrous skin. A report on four cases.

In a randomized controlled trial three different treatment protocols with the new broad-spectrum peroral antifungal saperconazole were evaluated. The treatment regimens were as follows: 100 mg per day for 7 days, 200 mg per day for 7 days, 100 mg per day for 14 days. Of four assessable cases of dermatophytosis of glabrous skin treated with one of these three therapeutic regimens, one was cured. In this patient, however, the dermatophytosis relapsed after the end of the observation period, but due to a different microorganism. While partial improvement was seen in the other cases definite cure was not obtained. No adverse events were recorded.

Cultural evidence for a bullous type of tinea pedis.

Maceration, hyperkeratosis and vesicles are well known as typical clinical correlates of dermatophyte infection of the feet. It seems, however, still to be controversial whether bullae also belong to the clinical spectrum. In a 48-year-old female Trichophyton rubrum could be cultured from the fluid obtained by aspiration of an interdigital bulla. In another case Trichophyton mentagrophytes could be isolated from the interdigital space but not from a bulla found on the sole, microscopic investigation, however, being positive. This emphasizes the hypothesis that blisters found on the foot can be due to dermatophytes.

Dermatophytosis in children and adolescents: epidemiological, clinical, and microbiological aspects changing with age.

During a four year period, a total of 84 cases of dermatophytosis were seen in patients from 0 to 17 years of age attending our out-patient department. The sex distribution was about equal in preadolescents. Males predominated among adolescents. A peak incidence at early school age was due to cases of tinea capitis, mainly caused by Microsporum canis. A peak among adolescents was due to cases of tinea pedis, mainly caused by Trichophyton rubrum. In general, patients with Trichophyton rubrum infections were older than those with other types of dermatophytosis (p less than 0.05). Dermatophytosis due to Microsporum canis was most frequently seen in January and in September (p less than 0.01). Although onychomycosis due to dermatophytes was a comparatively rare disease, it did occur within all age subgroups. Entities which were very frequent in former times and which have become rare during the last decades, such as tinea capitis due to Trichophyton schönleinii, still contribute to the spectrum of dermatophytosis in childhood.

[Cultural protection of a bullous form of Tinea pedis]. / Kulturelle Sicherung einer bullösen Form der Tinea pedis.

While maceration, hyperkeratosis and vesicles are well known as typical clinical correlates of dermatophyte infection of the feet it seems to be still controversial if bullae also belong to the clinical spectre. In a 48-year-old female Trichophyton rubrum could be cultured from the fluid obtained by aspiration of an interdigital bulla. In another case Trichophyton mentagrophytes could be isolated from the interdigital space but not from a bulla found on the sole microscopic investigation, however, being positive. This backs the hypothesis that blisters found on the foot can be due to the local presence of dermatophytes.

Influence of skin cleansing preparation acidity on skin surface properties.

Synopsis Two long-term trials were conducted each over eight weeks to compare the effect of the regular application of skin cleansing preparations of pH 5.5 and pH 8.5 and pH 5.5 and pH 7.0 respectively on the surface pH, roughness and transepidermal water loss (TEWL) of normal human forehead and forearm skin. Both trials were based on a cross-over design: five healthy volunteers started with a pH 5.5 preparation and switched to the other after four weeks, five additional volunteers used the preparations in the opposite order. While the skin surface pH was markedly lower in those individuals using the pH 5.5 preparation at each examination, as compared to those using the pH 8.5 or pH 7.0 preparation, no such difference could be established with respect to skin roughness and TEWL. Hence the skin irritancy of a cleansing preparation does not seem to be linked to its pH within the pH ranges tested.

[Dermatomycoses as occupational diseases. The causative agents, sources of infection and the involved occupations]. / Dermatomykosen als Berufskrankheiten. Erreger, Infektionsquellen und betroffene Berufe.

Fungal diseases of the skin can be occupational dermatoses. This applies in particular to diseases due to microorganisms acquired from animals. A discussion of the relationship between occupation and disease, however, is not only pertinent in regards to dermatophytoses due to zoophilic fungi but also with those due to geophilic and--to a certain extent--even anthropophilic ones. The same is true of candidiasis. The present review deals with the various standpoints concerning the role of occupation in the development of cutaneous mycoses. In addition casuistic evidence for the various types disease, is compiled and discussed.

Dermatophytoses as occupational dermatoses in industrialized countries. Report on two cases from Munich.

Although interest in dermatophytoses as occupational dermatoses nowadays focuses on developing countries, pertinent cases are still also seen in industrialized countries. Two recent cases from Munich are reported in which Trichophyton verrucosum had been acquired by a cattle farmer and Microsporum canis by a veterinary surgeon from a pet cat.

Liposome encapsulation improves efficacy of betamethasone dipropionate in atopic eczema but not in psoriasis vulgaris.

The effect of a liposomal preparation of beta-methasone dipropionate (0.039%, BDP) has been compared to that of a commercial propylene glycol-gel containing 0.064% BDP in a double-blind, randomized, paired trial lasting 14 d in 10 patients with atopic eczema and 10 patients with psoriasis vulgaris. In eczema, the liposome preparation tended to reduce erythema and scaling more than the conventional gel, the difference in the latter parameter being significant on Day 7. There was greater improvement of psoriasis on the side treated with the reference gel. Hence, liposome encapsulation of BDP may increase the antiinflammatory action but not the antiproliferative effect. Since inhibition of mitotic activity is linked to the atrophogenicity of topical corticosteroids, the results suggest that liposome encapsulation may improve the benefit-risk ratio in eczema.

[Intrafamilial transmission of Trichophyton verrucosum to a newborn]. / Innerfamiliäre Ubertragung von Trichophyton verrucosum auf ein Neugeborenes.

At the age of 4 weeks a suckling developed discoid erythema with scales and a few pustules at the face. Previously, his father having contact with cattle as a farmer had fallen ill from tinea barbae. In both cases Trichophyton verrucosum could be detected by culture. Dermatophytosis in sucklings has recently more often been reported about in the literature. This, however, does not apply to Tr. verrucosum infections.

[Eruptive histiocytoma and xanthoma disseminatum as manifestations of the same disease?]. / Eruptive Histiozytome und Xanthoma disseminatum als Manifestationsformen derselben Erkrankung?

Xanthoma disseminatum, generalized eruptive histiocytoma, juvenile xanthogranuloma and Hand-Schüller-Christian disease are considered to be separate nosologic entities, but it can be difficult to differentiate them and establish the correct diagnosis in a given case. In this paper, the case of a young man is presented who showed lesions resembling those of generalized eruptive histiocytoma early in the course of disease while the lesions later showed typical signs of xanthoma disseminatum.