Successfully treated superficial basal cell carcinomas with ingenol mebutate 0.05% gel: Report of twenty cases.

Surgery is the therapy of choice in the guidelines to treat basal cell carcinomas (BCCs) but a variety of non-surgical options are available. The objective of this study is to evaluate the efficacy and safety of ingenol mebutate 0.05% gel for the treatment of superficial BCCs. We accepted twenty patients with superficial BCCs on the body and we treated them once daily for two consecutive days with ingenol mebutate 0.05% gel. We examined the lesions at the screening visit and after four days from the gel application to describe the local skin reaction due to the therapy. Then we followed the patients after two and six months from the first visit. All the lesions were clinically and dermoscopically documented with a digital camera and we used the LSR (local skin reaction) grading scale based on a 0-4 numerical index of severity with specific clinical parameters and a characteristic photographic image for each rating, to assess the local side effects related to the therapy.

Improvement of psoriatic onychodystrophy by a water-soluble nail lacquer.

BACKGROUND: There is a strong need for effective products, simple to use and safe for a chronic use in the management of nail psoriasis. Recently, a non-drug, water-soluble nail lacquer became available, containing hydroxypropyl chitosan (HPCH), horsetail extract (Equisetum arvense) and methylsulphonyl-methane (DMSO(2)). This product was effective in strengthening the nails and reducing fragility and roughness in brittle nails. A clinical trial was performed to verify whether this product was able to improve nail psoriatic signs and appearance. PATIENTS AND METHODS: Thirty adult patients affected by mild to moderate symmetric psoriasis of the matrix and/or of the nail bed in at least one fingernail diagnosed more than 6 months before screening and with negative mycology findings were recruited. The nail lacquer was applied once daily on the affected fingernails of the left hand for 24 consecutive weeks. The right hand was used as control. The extent and severity of nail psoriasis was assessed on a target fingernail by means of the recently proposed Nail Psoriasis Severity Index (NAPSI) score. The value at baseline was 2.83 (+/- 0.99). At the end of treatment, the patients judged the treatment effect and their willing to continue product application. Adverse events were carefully recorded. RESULTS: Overall, 28 patients were included in the efficacy analysis. At the end of treatment, results showed a 72% reduction in pitting, 66% reduction in leukonychia, 63% reduction in onycholysis and a reduction of 65% in NAPSI score compared to baseline, respectively. No changes were observed in the untreated nails. Patients' treatment evaluation was classified as very satisfying or good by 78.6% of patients. The acceptability of the treatment was excellent in all patients both for the easiness and for the organoleptic characteristics of the product and 75% of them decided to continue the application after the end of the study. No adverse reactions were reported. CONCLUSION: In our experience, the new water-soluble nail lacquer proved to be effective in decreasing signs and symptoms of nail dystrophy in psoriatic patients. The effect was particularly evident on NAPSI and on pitting. The product was very well accepted by the patients.

Nadolol to treat aggression and psychiatric symptomatology in chronic psychiatric inpatients: a double-blind, placebo-controlled study.

BACKGROUND: Considerable evidence indicates that the lipophilic beta-blocker propranolol is useful in treating organically based aggression. This study looked at the efficacy of a more hydrophilic beta-blocker, nadolol, to treat aggression in chronic psychiatric inpatients. METHOD: Forty-one chronic psychiatric inpatients with an average of one aggressive outburst per week (defined by the Overt Aggression Scale [OAS]) were entered into a double-blind, placebo-controlled study lasting 17 weeks. The OAS was used to track aggression on a per-incident basis, while the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impressions scale (CGI) were used to track clinical status. RESULTS: Nadolol subjects showed a significant decline in frequency of aggression compared with controls (p = .026) and a significant decline in the BPRS total score (p = .007) and in the subfactors "hostility and suspicion," "negative symptoms," and "signs of hyperarousal/tension." There was no significant change in CGI "severity of illness" ratings between groups, although the nadolol group was significantly improved from baseline at every subsequent time period while the placebo group was unchanged throughout the study. CONCLUSION: Nadolol is of significant benefit in the treatment of aggression in chronic psychiatric inpatients. This drug does penetrate the brain over time, but the success of a drug whose primary locus of action is peripheral may implicate a bimodal mechanism of action, i.e., a role for the CNS and the soma in the maintenance of aggression.

Depression during treatment with beta-blockers: results from a double-blind placebo-controlled study.

Depressive symptoms were rated during a double-blind placebo-controlled trial of nadolol for chronic aggression. Depressive symptoms were not significantly different in nadolol and placebo groups during any phase of the drug trial.

Open trial effects of beta-blockers on speech and social behaviors in 8 autistic adults.

We began open trials of beta-blockers, as adjunctive medication, in eight consecutive autistic adults. The immediate result across all patients was a rapid diminution in aggressivity (Ratey et al., 1987). As time on the drug increased, subtler changes in speech and socialization emerged. While results of open trials must be interpreted with caution, these changes were significant and lasting. We speculate that these effects may be the result of a lessening of the autistic individual's state of hyperarousal. As the individual becomes less anxious, defensive and dearousing behaviors are relinquished and more social and adaptive behaviors appear. There is a concomitant improvement in language, though it is unclear whether lost skills are recouped or new ones developed. Further research is indicated.

Autism: the treatment of aggressive behaviors.

Eight consecutive cases of adults with the diagnosis of early infantile autism and who were treated with a betablocker are presented. Each had been on various and multiple drug, educational, and behavioral regimens to help control aggressive and self-abusive behavior. Most had been institutionalized from an early age, and a broad range of IQs and speech capacities are represented. Results show the betablockers to have a remarkable effect potentiating measurable diminution in previously intractable aggressive behavior and in many cases the decrease or withdrawal of their neuroleptic.

Beta-adrenergic blockers for the control of aggressive behaviors in patients with chronic schizophrenia.

The authors conducted a chart review to determine the effect of beta blockers on chronic assaultiveness in seven patients with chronic schizophrenia. Six of the patients showed improvement. Four of the seven showed a greater than 70% decrease in actual assaults.

Beta-blockers in the severely and profoundly mentally retarded.

The authors present data from four different institutions from open clinical trials of propranolol in 19 mentally retarded patients with IQs less than 50. When customary forms of treatment had failed, propranolol was initiated. A table showing changes in the patients' behavior is included. Twelve patients demonstrated a pronounced improvement in self-abusive and aggressive behavior, four made moderate gains, and three were considered unchanged. The authors postulate that at least some aspects of the behavioral improvement were due to the peripheral anxiolytic action of the beta-blockers. Contrary to other reports of using higher doses (greater than 520 mg/day range), the authors used a mean dose of 120 mg/day and consider the duration of time spent on the medication as a crucial factor in its effectiveness.

Nadolol as a treatment for akathisia.

The authors present three cases of patients with neuroleptic-induced akathisia who were successfully treated with nadolol, a peripherally acting beta blocker. They discuss the potential implications of this finding.