European S1 guidelines on the management of lichen planus: a cooperation of the European Dermatology Forum with the European Academy of Dermatology and Venereology.

Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, hair, nails and mucous membranes. Although there is a broad clinical spectrum of lichen planus manifestations, the skin and oral cavity remain the major sites of involvement. A group of European dermatologists with a long-standing interest and expertise in lichen planus has sought to define therapeutic guidelines for the management of patients with LP. The clinical features, diagnosis and possible medications that clinicians can use, in order to control the disease, will be reviewed in this manuscript. The revised final version of the lichen planus guideline was passed on to the European Dermatology Forum (EDF) for a final consensus with the European Academy of Dermatology and Venereology (EADV).

Treatment of vitiligo with narrowband-UVB (TL01) combined with tacrolimus ointment (0.1%) vs. placebo ointment, a randomized right/left double-blind comparative study.

BACKGROUND: Only a few, small double-blind clinical trials have been reported for the treatment of vitiligo. Narrowband-ultraviolet B (NB-UVB) is an established form of treatment for this condition. Tacrolimus ointment is assumed to have an effect in some patients. OBJECTIVES: To assess the additive effect of tacrolimus ointment (0.1%) once daily in vitiligo patients treated with NB-UVB. METHODS: In a randomized double-blind trial, patients with stable symmetrical vitiligo were treated half-side with tacrolimus ointment (0.1%) and half-side with placebo ointment. Whole body NB-UVB was given twice or thrice weekly for at least 3 months. As a morphometric device, Visitrak(TM) was used to measure the area of the vitiligo target lesions. RESULTS: Of 40 patients, 27 had a better effect on the tacrolimus side. The degree of improvement was significantly better on the tacrolimus side (P = 0.005). The median reduction in the target lesion areas was 42.1% on the tacrolimus side and 29% on the placebo side. There was a correlation between the effect and the number of topical tacrolimus applications (P = 0.044), but there was no correlation with the number of UV treatments given; neither any significance of gender, age, skin type, duration of disease, familial occurrence of vitiligo nor presence of other autoimmune disease or atopy was observed. We found a significant reduction in the patients' subjective disease impact during the treatment period (P < 0.001). CONCLUSION: According to this study, the combination of NB-UVB and tacrolimus ointment (0.1%) is more effective than UV treatment alone in patients with vitiligo. The effect is tacrolimus total dose-dependent.

Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patients.

OBJECTIVE: In this study the safety and efficacy of imiquimod 5% cream for the treatments of actinic keratoses in kidney, heart and liver transplant recipients is evaluated. BACKGROUND: Growing populations of organ transplant recipients face increased risk of developing actinic keratosis (AK) and skin cancer secondary to continuous systemic immunosuppressive therapy. Imiquimod 5% cream is an effective option for the treatment of AK, but the safety of topical immune stimulation in immunocompromised patients has not been widely evaluated. METHODS: A total of 43 patients in six European transplant centres applied two sachets of topical imiquimod or vehicle cream three times per week to a 100 cm(2) field. Dosing continued for 16 weeks regardless of lesion clearance. Patients were assessed for safety variables that included adverse events, local skin reactions, laboratory results, vital signs, dosage of immunosuppressive medication and indication of graft rejection. A blinded independent expert committee was responsible for safety monitoring and final safety assessment. RESULTS: No graft rejections or trends for a deterioration of graft function were detected. No meaningful trends were observed in laboratory results. Among patients randomized to imiquimod, the complete clearance rate was 62.1% (18/29); for vehicle patients, the complete clearance rate was 0% (0/14). Clinical clearance was confirmed histologically in all cases. CONCLUSIONS: Imiquimod appears to be a safe alternative for the treatment of multiple actinic keratoses in patients with solid organ transplants. Efficacy was within the range previously observed in nontransplanted populations.

Narrowband UVB therapy for vitiligo: does the repigmentation last?

BACKGROUND: Since 1997, a number of trials have shown promising results in treating generalized vitiligo with narrowband ultraviolet B (UVB) both in adults and children. However, there is little knowledge concerning the duration and permanency of the treatment-induced repigmentation. OBJECTIVE: Our main objective was to perform a follow-up trial of successfully treated patients receiving narrowband UVB for generalized vitiligo. METHODS: We have investigated to what degree the treatment-induced repigmentation remains stable for up to 2 years post-treatment. We performed an initial open trial including 31 patients with generalized vitiligo. They received narrowband UVB thrice weekly for up to 12 months. Patients experiencing > 75% repigmentation were defined responders and were included in the follow-up trial. Responders were followed every 6 months for up to 2 years after cessation of treatment. We observed the pigmentation status and registered any changes indicating loss of pigmentation and relapse. RESULTS: Eleven of the 31 treated patients were included in the follow-up trial. Six patients had relapse and five patients had stable response 24 months after cessation of treatment. Four out of six relapses were within 6 months post-treatment. CONCLUSION: In our study population of 31 patients with generalized vitiligo, five patients (16%) experienced > 75% stable repigmentation 2 years after cessation of a treatment programme of up to 1 years narrowband UVB therapy.

Biological therapies in the systemic management of psoriasis: International Consensus Conference.

Psoriasis is a chronic, immune-mediated disorder that usually requires long-term treatment for control. Approximately 25% of patients have moderate to severe disease and require phototherapy, systemic therapy or both. Despite the availability of numerous therapeutic options, the long-term management of psoriasis can be complicated by treatment-related limitations. With advances in molecular research and technology, several biological therapies are in various stages of development and approval for psoriasis. Biological therapies are designed to modulate key steps in the pathogenesis of psoriasis. Collectively, biologicals have been evaluated in thousands of patients with psoriasis and have demonstrated significant benefit with favourable safety and tolerability profiles. The limitations of current psoriasis therapies, the value of biological therapies for psoriasis, and guidance regarding the incorporation of biological therapies into clinical practice are discussed.

Chemotherapy for giardiasis: randomized clinical trial of bacitracin, bacitracin zinc, and a combination of bacitracin zinc with neomycin.

This study describes a prospective, randomized, clinical trial in patients infected with the protozoa Giardia lamblia. Patients received a 10-day treatment with twice a day doses of either 120,000 U (USP) of bacitracin zinc, 120,000 U (USP) of bacitracin, 120,000 U (USP) of neomycin, or 60,000 U (USP) of bacitracin zinc and 60,000 U (USP) of neomycin. At the first assessment (day 11), all 21 subjects (100%) treated with bacitracin zinc had ceased to show Giardia parasites in their stools compared with 19 (95%) of 20 receiving bacitracin, 20 (90.9%) of 22 subjects receiving neomycin, and 17 (89.5%) of 19 subjects receiving bacitracin zinc plus neomycin. During the two-week follow up period, one (5.3%) of the 19 subjects examined who received bacitracin zinc experienced a recurrence compared with one (6.7%) of 15 receiving bacitracin, one (5.0%) of 20 receiving neomycin, and 0 (0%) of 14 receiving the combination treatment. Final cure rates of 94.7% for bacitracin zinc, 87.5% for bacitracin, 86.4% for neomycin, and 87.5% for bacitracin zinc plus neomycin were obtained. No synergistic activity was noted between bacitracin zinc and neomycin. Side effects were generally limited to nausea, abdominal discomfort, and diarrhea in a small number of patients.

Phenoxymethylpenicillin two or three times daily for tonsillitis with beta-haemolytic streptococci group A: a blinded, randomized and controlled clinical study.

In relation to compliance problems it was investigated whether phenoxymethylpenicillin dosed twice or 3 times daily was equally effective in tonsillitis due to beta-haemolytic streptococci group A. In a randomized, controlled and single blind multicentre study 206 patients older than 5 years with a positive culture of group A streptococci were treated with phenoxymethylpenicillin for 7 days. 101 patients received the daily dosage divided in 2 doses and 105 patients divided in 3 doses a day. The cure rate (a combination of bacteriological and clinical cure) was 82.0% in the 2-dosage regimen, and 88.2% in the 3-dosage regimen. The difference was not statistically significant. In conclusion, phenoxymethylpenicillin dosed 2 or 3 times daily seems to be equally effective in tonsillitis due to group A streptococci.

Phenoxymethylpenicillin two or three times daily in bacterial upper respiratory tract infections: a blinded, randomized and controlled clinical study.

In relation to compliance problems it was investigated whether phenoxymethylpenicillin dosed 2 or 3 times daily was equally effective in bacterial upper respiratory infections. In a randomized, controlled and single blind clinical trial, 131 patients with otitis media, sinusitis and tonsillitis were treated with phenoxymethylpenicillin. 71 received the daily dose twice a day and 60 patients received the daily dose 3 times a day. The dose was adjusted for diagnoses and age. Clinical cure was the endpoint for treatment success. In the 2-dosage group 78.6% had full effect of the treatment and 86.2% had full effect in the 3-dosage group. There was no statistically significant difference. In conclusion phenoxymethylpenicillin dosed 2 or 3 times daily seems to be equally effective in bacterial upper respiratory infection.

The immunology of contact dermatitis. A review with special reference to the pathophysiology of eczema.

This review summarizes current knowledge of the pathophysiological events which lie behind the development of contact dermatitis. The clinical distinction between allergic and irritant eczema is discussed. New observations are evaluated on our understanding of how allergic and irritant eczema may in many respects be similar, evolving through common physiological pathways of immune inflammation.

Natural and Chang liver cell cytotoxic studies of methotrexate-treated psoriatic patients with liver cirrhosis.

Forty patients with psoriasis were investigated for unspecific and specific lymphocyte cytotoxicity in order to evaluate the significance for liver cell damage in methotrexate-treated (MTX) patients. We found no difference between psoriasis patients with regard to cytotoxicity. We also observed a normal proliferation of lymphocytes after stimulation with tuberculin and phytohemagglutinin.