Double blind clinical trial in a series of 115 patients with seborrheic dermatitis: prevention of relapses using a topical modulator of Toll like receptor 2.

AIM: Seborrheic dermatitis is a chronic inflammatory disease aggravated by Malassezia species. Toll-like receptors (TLR) are part of innate immune system that can be activated by yeasts. Previous studies showed that an association of Umbelliferae extract with a lipid (TLR2-Regul™) decreases the IL-8 expression in human skin in contact with M. furfur. The aim of this study was to assess the activity of a topical formulated with TLR2-Regul™ in the prevention of seborrheic dermatitis (SD) relapses. METHODS: Immune-competent SD adult patients were treated for SD (topical imidazoles or steroids). Cleared patients were randomized and received a topical containing TLR2-Regul™ (A) or its vehicle (B). Erythema, scales and pruritus were assessed during two months. RESULTS: The study included 115 patients, mean age 43.4, sex ratio m/f 1.5. At week 4 the relapse rate was 26% (N.=15) in group A and 43% (N.=25) in group B. At W8 the relapse rate was 21% (N.=12) in group A and 40% (N.=23) (P=0.0309). CONCLUSION: In this series of 115 adults with seborrheic dermatitis, patients treated with a topical containing TLR-Regul™ showed a significantly less relapse rate compared with the excipient group (P<0.05). TLR modulation could represent a new therapeutic approach in the prevention of seborrheic dermatitis relapses.

Effects of resource constraint on health care services.

Starting with the duty of Governments to provide adequate resources for the establishment and development of health services, this paper draws on experiences in four developed countries to illustrate the problems and their outcomes. The examples chosen demonstrate the contrast in philosophies and approach to resource allocation for health care.

Informed consent in medical treatment: conflict or consensus.

The author reviews the legal theory and practice of the requirements for informed consent. He uses a discussion of relevant cases and judgements from courts in the UK, USA, Australia and Malaysia to illustrate apparently conflicting attitudes exemplified by these cases. From this he aims to form some consensus in their application to everyday practice.

Chlamydia pneumoniae infection in asthmatic patients.

This study was conducted on 30 asthmatic patients and 10 healthy controls. They were subjected to complete history talking, thorough clinical examination, and assessment of their ventilatory functions before and after bronchodilator. Two specimens were obtained from each patients, bronchoalveolar lavage and serum samples. Chlamydia pneumoniae antigens and antibodies (IgG and IgM) were detected using microimmunoflourescence technique. Samples giving positive results for C. pneumoniae antigen were examined for apoptosis. A significant correlation between asthma and C. pnumoniae was found especially in moderate and severe, long standing, steroid dependent asthma. In addition there was a significant difference between cases and controls regarding specific IgG and IgM. An association of C. pneumoniae with forced expiratory volume 1 (FEVI) was found. In addition C. pneumoniae was found to induce inhibition of programmed cell death. On conclusion, C. pneumoniae infection is associated with severe long standing asthma, and may be an important factor in acute exacerbation of asthma.

Assessment of the water content of the stratum corneum using a sorption-desorption test.

BACKGROUND/AIM: Various instruments based on electrical properties of the skin are currently used to assess the stratum corneum (SC) hydration state or water holding capacity. However, no direct relation with the quantity of water measured is provided. The objective of the present study was to calibrate the Corneometer, a device displaying electrical-capacitance-related values (which reflect the skin hydration state), and the amount and behaviour of the water taken up by the outer part of the SC during a sorption-desorption test. METHODS: The experiment was performed on the ventral forearms of 20 healthy volunteers after a rest in an environmentally controlled room. Corneometer and transepidermal water loss (TEWL) values were measured at intervals over the desorption process. The areas under the TEWL-versus-time curve provided the absolute amounts of residual sorbed water. RESULTS: The decrease kinetics of both signals after subtraction of prehydration values were very similar and bi-exponential, both showing a rapid, then a slower phase. The absolute amount of water taken up by the SC (hygroscopicity) and the two desorption rates were obtained. The Corneometer values were mono-exponentially related to the amount of water remaining within the SC. This allowed the in vivo calibration of the Corneometer in terms of absolute amount of water over the desorption range. CONCLUSION: The method may be used to calibrate in vivo other electrical devices aimed at assessing SC hydration during a sorption-desorption test. It may also provide new ways to measure SC water uptake and water holding capacity following application of products.