Efficacy and Safety of Methotrexate in Combination with Mini Pulse Doses of Methylprednisolone in Severe Alopecia Areata. The Vietnamese Experience.

BACKGROUND: Treatment of severe alopecia areata remains very difficult, especially in alopecia areata totalis and alopecia areata universalis. Methotrexate is known to be effective in the treatment of severe and chronic autoimmune disorders. OBJECTIVE: To assess the effectiveness and safety of MTX in combination with mini pulse dose of methylprednisolone in the treatment of severe alopecia areata. PATIENTS AND METHODS: The open, uncontrolled study compared pre-treatment and after-treatment. Thirty-eight patients (age 16-64) with severity AA (SALT score > 50 %) visiting National hospital of Dermatology and Venereology from April-2004 to September-2015 were enrolled. All patients received oral methylprednisolone 24mg/day for 3 consecutive days of a week in combination with oral MTX 7,5 mg weekly. This regimen is maintained up to 12 weeks and follow-up until to 6 months. RESULTS: After 6 months, 60.5% of patients show complete hair growth (good response) and 18.4% shows the medium response. There is a significant SALT score reduction: mean baseline SALT score 84.39 ± 17.03 compared to mean post-treatment SALT score 24.19 ± 29.42. Good clinical improvement noted in after 3 months. We do not observe any side- effects related to oral MTX and oral methylprednisolone, and no patients had to withdrawal treatment due to side- effects. CONCLUSION: Combination Methotrexate and mini pulse dose of methylprednisolone are effective and safe in treatment severity alopecia areata.

Early Treatment with Imiquimod 5% Cream of Periungual Warts in Vietnam: The Poorer, the Better.

AIM: To evaluate the efficacy of imiquimod 5% in periungual wart treatment. MATERIAL AND METHODS: A group of 40 patients were recruited to apply imiquimod 5 % cream once daily for 5 consecutive days per week in 8 weeks. They were classified into 3 levels: Mild (the total lesion area ≤ 25 mm2), moderate (25 mm2 50 mm2). The outcome was evaluated at the 4th and the 8th week. The result was graded as excellent (complete clearance), good (≥ 50% clearance) and poor (< 50% clearance). RESULTS: The total area of the wart lesion got decreased significantly from the beginning to the 4th and the 8th week (36.7 mm2 vs 16.8 mm2, p = 0.0001 and 16.8 mm2 vs 8.8 mm2, p = 0.01). The complete clearance rate at the 4th week was lower than that at the 8th week significantly (22.5% vs 72.5%, p = 0.04). The clearance rate of patients suffering severe warts was lower significantly than that of mild/moderate patients (82.8% vs 45.5%, p = 0.03). The duration of the disease in people who responded completely to imiquimod was shorter than that of patients partially responded (10.2 ± 14.1 months vs 22.3 ± 14.3 months, p = 0.02). Adverse effects were not common, mild and local only. Recurrence rate after 6 months of follow up was 3.5%. CONCLUSION: In conclusion, Imiquimod 5% cream is a safe and effective drug in the treatment of periungual warts.

Superantigens of Staphylococcus Aureus Colonization in Atopic Dermatitis and Treatment Efficacy of Oral Cefuroxim in Vietnamese Patients.

BACKGROUND: Atopic dermatitis (AD) is a common, chronic, relapsing, genetically determined inflammatory skin disorder. Staphylococcus aureus (S. aureus) plays an important role in the pathogenesis of AD. Atopic skin is susceptible to infection with S. aureus. AIM: This study was aimed to compare the skin S. aureus colonisation status and its secretion of superantigens in adult AD and healthy subjects and to evaluate the efficacy of two treatment regimens (oral cefuroxime plus topical betamethasone dipropionate 0.05% versus topical betamethasone dipropionate 0.05%) in AD patients. METHODS: A group of 128 AD and 40 healthy subjects were recruited in this study and treatment efficacy was assessed by the SCORAD score. RESULTS: S. aureus was found in skin lesions in 83.8% of AD patients while only 37.5% of healthy subjects possessed this kind of bacteria in the external nares (p < 0.001). Superantigen production was more common in S. aureus strains isolated from AD than the control group (58.6% versus 6.6%, p = 0.0006) and staphylococcal enterotoxin B was predominant (88.89%). 68 AD patients who had positive cultures with S. aureus were included in a clinical therapeutic trial. The isolated bacteria were all sensitive to cefuroxime. Patients were randomised to receive either oral cefuroxime 500 mg b.i.d. Plus topical betamethasone dipropionate 0.05% twice daily for 2 weeks (so-called group 1, 36 patients) or only topical betamethasone dipropionate 0.05% twice daily for 2 weeks (so-called group 2, 32 patients). The mean SCORAD scores of group 1 at baseline and after 1 and 2 weeks of treatment were 44.61, 26.69 and 16.61, respectively. The corresponding values for group 2 were 43.03, 32.53 and 23.41, respectively. CONCLUSION: The reduction in SCORAD scores was significantly higher in group 1 than group 2 in comparison to the baseline value of each study group (p = 0.003 after 1 week and p < 0.001 at the end of treatment).

The Effectiveness of Oral Mini-Pulse Methylprednisolonein - the Treatment of Alopecia Areata in Vietnam.

BACKGROUND: Systemic corticosteroid is used to treat alopecia areata, but it is associated with side effects. Mini-pulse therapy is thought to be effective but able to reduce side effects. AIM: The study aimed to evaluate the effectiveness of oral mini-pulse methylprednisolone in the treatment of alopecia areata. METHODS: Patients received methylprednisolone 16 mg orally for 2 consecutive days every week. RESULTS: After 3 months, among patients, 40% recovered well, and 55.6% recovered fairly. After 6 months, 82.2% recovered well, 17.8% recovered fairly. No adverse events were detected, and the recurrence rate was low (2.2%). CONCLUSION: Oral mini-pulse methylprednisolone therapy is an effective and safe therapeutic option for alopecia areata without side effects, and the time of the treatment is short.