Preventing melasma recurrence: prescribing a maintenance regimen with an effective triple combination cream based on long-standing clinical severity.

BACKGROUND: The relapsing nature of melasma emphasizes the need to maintain efficacy achieved after acute treatment. OBJECTIVE: To compare clinical efficacy and safety of two 6-month Triple Combination (TC; containing fluocinolone acetonide, hydroquinone and tretinoin) maintenance regimens in subjects with moderate to severe melasma, after daily treatment up to 8 weeks. METHODS: This randomized, investigator-blinded, controlled study had a maintenance phase of 6 months. Sixteen centres in Brazil and Mexico enrolled 242 subjects 18 years or older attaining no or mild melasma after 8 weeks of daily TC applications. Subjects were randomized to receive TC in a twice weekly or tapering regimen [3/week (1st month), 2/week (2nd month), 1/week (4th month)]. Efficacy and safety measurements included median time to relapse and relapse-free rate, Global Severity Score, Melasma Area and Severity Index score (MASI), subject's assessment, quality of life questionnaire (MelasQol), and adverse events. RESULTS: The majority (78.8%) had no or mild melasma (GSS ≤ 1) at week 8 and entered maintenance phase. After 6 months, 53% of patients remained relapse-free with improved quality of life, and time to relapse was similar between groups (about 190 days). Melasma severity at study entry, not maintenance baseline, influenced relapse rate. The twice weekly regimen tended to show better effectiveness in postponing relapse in severe melasma. Both regimens were safe. CONCLUSIONS: After resolution of melasma with TC, maintenance therapy over 6 months was successful in preventing relapse in over half of the patients who entered maintenance phase. Prescribing medicines should be adapted to patients based on melasma severity.

[Lucio phenomenon. Vasculitis or occlusive vasculopathy?]. / Lucio-Phänomen. Vaskulitis oder okklusive Vaskulopathie?

Lucio's phenomenon (LP) occurs in patients with Lucio leprosy (LuL). Some interpret the cutaneous lesions and their histopathology as a thrombotic/occlusive condition, while others consider it leukocytoclastic vasculitis. The clinical similarities between the cutaneous manifestations of LP and antiphospholipid syndrome (APS) led us to investigate the relationship between these two pathological conditions. We studied the clinical, laboratory and histopathologic aspects of LuL and LP in one patient and compare these results to APS. The examination of antiphospholipid antibodies showed positive anticardiolipin (aCL) and lupus anticoagulant (LAC). The histopathological slides of cutaneous biopsies were stained by hematoxylin-eosin and Fite-Faraco. They showed the typical features of LuL, as well as thrombi, endothelial proliferation, vessel wall thickening and obliteration of the lumen. Leukocytoclastic vasculitis was not found. The clinical pattern of LuL in our case is identical to that described by Lucio and Latapi. The necrotic lesions of LP in our patient resembled APS. This suggests that LP could be considered APS secondary to LuL. Multidrug treatment for multibacillary patients (MDT-MP) was successful, with no need for thalidomide or systemic corticosteroids.

Lyme disease in Rio de Janeiro, Brazil.

Five patients living in Rio de Janeiro, Brazil, were found to have Lyme disease. These are among the first known cases in South America.

[Transient acantholytic dermatosis. Presentation of a case]. / Dermatose acantolítica transitória. Apresentação de um caso.

A case of DAT is presented and the literature is reviewed. The authors verify the limitation of the present therapeutics and they discuss the possible pathogenic mechanism. They also say that "unspecific" lesions resistant to conventional therapy, and mostly localized in the trunk of middle-aged patients may suggest the diagnosis of DAT if biopsy is performed in these cases there probably will be a higher incidence of the disease. As far as we know this is the first brazilian case of DAT reported.

Ensaio multicentrico cooperativo com a associacao do valerianato de diflucortolona com clorquinaldol. / Cooperative multicentric assay with the association of diflucortolone valerate and chlorquinaldol

Trinta e sete pesquisadores de diversas cidades brasileiras estudaram o efeito da combinacao do valerianato de diflucortolona com o clorquinaldol em 316 pacientes, num total de 44 diferentes dermatoses infectadas ou nao, em seus diversos estagios evolutivos. Devido a ocorrencia de mais de um diagnostico em alguns pacientes, foram ao todo 326 os casos tratados pela combinacao. Em sua maioria os pacientes eram portadores das diferentes formas de eczema (47,54%), tineas (12,88%) e disidrose (8,28%). Os resultados foram muito bons e bons em 94,29% dos casos, sendo que nos casos de eczema, tinea e disidrose o indice de cura foi muito bom em 89,23%, 92,85% e 81,47%, respectivamente,dos casos tratados.As reacoes colaterais observadas foram todas de carater local e temporarias e ocorreram em apenas sete dos 316 pacientes. A tolerabilidade geral foi excelente, nao tendo sido referido qualquer efeito secundario em qualquer dos pacientes tratados