RESUMEN
BACKGROUND: Doxycycline calcium (WC2055) is a drug substance with a possible role in the treatment of acne. The objective of this study was to evaluate the safety and efficacy of three doses of doxycycline calcium tablets compared with placebo in the treatment of moderate to severe inflammatory facial acne vulgaris. METHODS: This was a randomized, double-blind, phase 2 dose-ranging study in subjects with moderate to severe inflammatory acne aged 12 years to 45 years. Subjects were randomized to receive doxycycline calcium tablets 0.6, 1.2, or 2.4 mg/kg/day or placebo, and instructed to take their tablets once daily for 12 weeks, in the evening at least 1 hour before or 2 hours after mealtime. The primary efficacy variables were the dichotomized Investigator's Global Assessment score (success or failure) at week 12 (success defined as ≥ 2 score decrease from baseline) and the absolute change from baseline to week 12 in inflammatory lesion count. RESULTS: A dose-response effect was seen with doxycycline calcium formulation in subjects with moderate to severe inflammatory acne. The highest dose-group (corresponding to approximately 2.4 mg/kg/day) showed a statistically significant difference from placebo. The dose-response effect was confirmed by logistic regression analysis for both treatment success and incidence of gastrointestinal adverse events. A limitation of this study is that safety and efficacy were only studied on moderate to severe inflammatory acne. Also, the study was not prospectively powered to show efficacy differences. CONCLUSION: Doxycycline calcium shows a dose-response effect in reducing inflammatory lesions in subjects with moderate to severe inflammatory acne.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Inflamación/tratamiento farmacológico , Acné Vulgar/patología , Adolescente , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Niño , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Doxiciclina/administración & dosificación , Doxiciclina/efectos adversos , Cara , Femenino , Humanos , Inflamación/patología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
BACKGROUND: Acitretin is an oral retinoid that is approved for the treatment of psoriasis. It is unique compared to other systemic therapies for psoriasis such as methotrexate and cyclosporine in that it is not immunosuppressive. It is, therefore, safe for use in psoriasis patients with a history of chronic infection such as HIV, hepatitis B, hepatitis C or malignancy who have a contraindication to systemic immunosuppressive therapy and require systemic therapy because topical therapy is inadequate and they are unable to commit to phototherapy. Acitretin is one of the treatments of choice for pustular psoriasis. Even though acitretin is less effective as a monotherapy for chronic plaque psoriasis, combination therapy with other agents, especially UVB or psoralen plus UVA phototherapy, can enhance efficacy. OBJECTIVE: To provide an updated review of the safety and efficacy of acitretin in the treatment for psoriasis. METHODS: Literature review of journal articles from 2008 to 2009 since the last review of acitretin evaluated medical literature from 2005 to 2008. RESULTS/CONCLUSION: Acitretin is an effective systemic therapy for psoriasis and is generally well tolerated at low doses for long-term use. If monotherapy with acitretin is inadequate, it can be used in combination with other treatments, particularly UVB phototherapy, to increase efficacy.
Asunto(s)
Acitretina/efectos adversos , Acitretina/farmacocinética , Acitretina/uso terapéutico , Queratolíticos/efectos adversos , Queratolíticos/farmacocinética , Queratolíticos/uso terapéutico , Psoriasis/tratamiento farmacológico , Acitretina/economía , Acitretina/farmacología , Interacciones Farmacológicas , Quimioterapia Combinada , Utilización de Medicamentos , Humanos , Queratolíticos/economía , Queratolíticos/farmacología , Psoriasis/economía , Psoriasis/epidemiología , Psoriasis/patologíaRESUMEN
BACKGROUND: This study compared the efficacy of a novel, topical class I synthetic, 0.10% fluocinonide corticosteroid with two other class I corticosteroids and placebo for the treatment of plaque psoriasis. METHODS: A 0.5 gram dose of fluocinonide 0.1% cream, clobetasol propionate 0.05% cream, halobetasol propionate 0.05% cream, and placebo ointment were applied to test sites on one psoriatic plaque per patient (n=5). Test sites were outlined according to the Scholtz-Dumas bioassay. Test sites were assessed by a blinded evaluator (1 = psoriasis worsened to 5 = psoriasis clear or almost clear), cleaned and medications were reapplied on days 3, 5, 7, 10 and 12. RESULTS & CONCLUSION: The three class I corticosteroid products were comparably effective, numerically and statistically, in clearing the psoriatic plaques. Upon completion of treatment, 60-80% of active-treated sites were clear or almost clear of psoriasis compared to zero with the placebo.
Asunto(s)
Clobetasol/análogos & derivados , Fluocinonida/uso terapéutico , Glucocorticoides/uso terapéutico , Psoriasis/tratamiento farmacológico , Administración Cutánea , Anciano de 80 o más Años , Bioensayo/métodos , Clobetasol/administración & dosificación , Clobetasol/uso terapéutico , Fármacos Dermatológicos/administración & dosificación , Fármacos Dermatológicos/uso terapéutico , Femenino , Fluocinonida/administración & dosificación , Glucocorticoides/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Psoriasis/patología , Índice de Severidad de la Enfermedad , Método Simple Ciego , Resultado del TratamientoRESUMEN
Delusions of parasitosis is a rare psychiatric disorder in which the patient has a fixed, false belief that he or she is infested by parasites. Even though it is a psychiatric disorder, these patients usually present to a dermatologist because they are convinced that they have a dermatologic problem. Patients with delusions of parasitosis generally reject psychiatric referral. The traditional treatment of choice for delusions of parasitosis is the antipsychotic medication pimozide (Orap, Gate Pharmaceuticals, Philadelphia, PA). The use of pimozide has been limited by its adverse effects, most notably extrapyramidal adverse effects. There is now an emerging role for atypical antipsychotics with a safer adverse effect profile in the treatment of delusions of parasitosis. However, the most challenging aspect of managing these patients may be the challenge of establishing rapport in the face of unshakable delusional ideation.
Asunto(s)
Antipsicóticos/uso terapéutico , Deluciones/tratamiento farmacológico , Enfermedades Cutáneas Parasitarias/psicología , Antipsicóticos/efectos adversos , Deluciones/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Pimozida/efectos adversos , Pimozida/uso terapéuticoRESUMEN
Many patients with skin disorders have psychologic issues associated with their chief complaints. Dermatologists who wish to help their patients with psychodermatologic conditions can greatly enhance their therapeutic armamentarium by becoming familiar with the use of a few selected psychotropic agents. This paper will review the current status and future directions of psychopharmacology for the major types of psychopathologies encountered in a dermatology practice (depression, obsessive-compulsive disorder, anxiety, and delusional disorder) with the intent of guiding dermatologists in the choice of a psychotropic agent for patients with psychologic component to their skin disorder.
Asunto(s)
Trastornos Mentales/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Enfermedades de la Piel/psicología , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/diagnósticoRESUMEN
Acitretin is a second-generation, systemic retinoid that has been approved for the treatment of psoriasis since 1997. It can be considered one of the treatments of choice for pustular and erythrodermic psoriasis. However, the efficacy of acitretin as a monotherapy for plaque psoriasis is less, although it is often used in combination therapy with other systemic psoriasis therapies, especially ultraviolet B or psoralen plus ultraviolet A phototherapy, to increase efficacy. Such combination treatments may potentially minimise toxicity by using lower doses of each of the two agents. All systemic retinoids are potent teratogens. The most common side effects are mucocutanous effects such as cheilitis and hair loss, which are dose-dependent. Acitretin is not immunosuppressive, is generally safe for long-term use and has no time limit restrictions, which makes it useful in combination therapy and for maintenance therapy.
Asunto(s)
Acitretina/administración & dosificación , Psoriasis/tratamiento farmacológico , Retinoides/administración & dosificación , Acitretina/química , Animales , Quimioterapia Combinada , Humanos , Fototerapia/métodos , Psoriasis/patología , Psoriasis/terapia , Retinoides/químicaRESUMEN
Many patients who have skin disorders have associated psychosocial issues. Psychotropic agents with improved side-effect profiles are available to allow physicians who are not psychiatrists to manage patients who have psychiatric conditions with agents that are effective, simple to administer, and generally well tolerated. Dermatologists who wish to help their patients who have psychodermatologic conditions can enhance their armamentarium by becoming familiar with the use of a few selected psychotropic agents. This article reviews the current status and future directions of psychopharmacology for the major types of psychopathologies encountered in dermatology practice.
Asunto(s)
Trastornos Mentales/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Enfermedades de la Piel/psicología , Humanos , Trastornos Mentales/complicaciones , Enfermedades de la Piel/complicacionesRESUMEN
Many patients with skin disorders have psychosocial issues associated with their chief complaints. New psychotropic agents with superior side effect profiles have become available to allow nonpsychiatric physicians to manage psychiatric patients safely with psychotropic agents that are effective, simple to administer, and well tolerated. Dermatologists who wish to help their patients with psychodermatologic conditions can greatly enhance their therapeutic armamentarium by becoming familiar with the use of a few selected psychotropic agents. This article reviews the current status and future directions of psychopharmacology for the 4 major types of psychopathologies encountered in a dermatology practice (depression, obsessive-compulsive disorder, anxiety, and delusional disorder) with the intent of guiding dermatologists in the choice of a psychotropic agent for patients with psychological component to their skin disorder.
Asunto(s)
Trastornos Mentales/complicaciones , Trastornos Mentales/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Enfermedades de la Piel/complicaciones , Trastornos de Ansiedad/tratamiento farmacológico , Trastorno Depresivo/tratamiento farmacológico , Humanos , Trastorno Obsesivo Compulsivo/tratamiento farmacológico , Esquizofrenia Paranoide/tratamiento farmacológicoRESUMEN
Atopic dermatitis, nummular dermatitis, dyshidrosis, and melasma seem to be more common in Asians, whereas psoriasis and skin cancer are less common. In addition, there are less common skin conditions that are usually seen in Asians, including Mongolian spot, nevus of Ota, nevus of Ito, Kawasaki disease, primary cutaneous amyloidosis, Kikuchi-Fujimoto disease, and LCAI. Awareness of these less common cutaneous disorders can be helpful, especially for clinicians who work in areas with a large Asian population.