Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa.

BACKGROUND: Antibiotics are often used to treat hidradenitis, but only topical clindamycin has been shown to be effective in a randomized controlled trial. The paucity of these trials may be the result of difficulties in disease assessment. OBJECTIVE: We compare topical clindamycin with systemic tetracycline in the treatment of hidradenitis suppurativa, and study clinical disease assessment. METHODS: A total of 46 patients with stage 1 or 2 hidradenitis suppurativa were treated in a double-blind, double dummy controlled trial. RESULTS: No significant difference was found between the two types of treatment. Patients' global assessment of disease was significantly worse than physician's assessment in 3 of 5 evaluations (P = .0096 to .015), but the correlation between patients' and physicians' assessments was satisfactory after only one visit (rs = .761 to .895). Soreness was the key factor in patients' overall assessment of the disease. CONCLUSION: Systemic therapy with tetracyclines did not show better results than topical therapy with clindamycin. Subjective factors, particularly soreness, appear to be a key factor in patients' assessment of the disease and should, therefore, be included as an outcome variable in future therapy studies.

The bacteriology of hidradenitis suppurativa.

BACKGROUND: Bacteria have been suggested as a possible cause of hidradenitis. Different species have been found in several small studies, and particularly the presence of Streptococcus milleri has been linked to disease activity. OBJECTIVE: To investigate the possible role of bacteria in hidradenitis. METHODS: Cultures of active lesions and serological analysis of circulating IgG antibodies were studied in 41 patients. RESULTS: Bacteria were found in 49% (20/41) of all lesions: Staphylococcus aureus, 8; S. milleri, 1; Staphylococcus epidermidis, 11; Staphylococcus hominis, 1. Corynebacterium spp., Acinetobacter and Lactobacillus spp. were found once each and considered as contaminants. Patients in whom S. aureus was found had a shorter duration of disease (mean 1.7 vs. 9.7 years for sterile lesions). No other significant correlations were found between location of disease or antibody response and the bacterial species found. CONCLUSION: S. milleri appears to be an unusual pathogen, and bacteria are only found in approximately 50% of all active hidradenitis lesions. It is suggested that S. aureus may play a temporary role in the early phase of the disease, but additional longitudinal studies of cohorts of patients are needed to clarify this point.

Toxic epidermal necrolysis and erythema multiforme following therapy with terbinafine.

We report two cases with severe skin reactions following oral terbinafine (Lamisil) therapy. The first case was a 49-year-old woman with onychomycosis of the toe nails. She had suffered from diabetes for 3 years, but it was well controlled on insulin. Five days after start of terbinafine 250 mg once daily she developed erythema. The treatment was continued for 2 days, but the skin eruption progressed, and a clinical diagnosis of toxic epidermal necrolysis was confirmed histologically. The second case was a 51-year-old woman with dermatomycosis on the right foot. She developed a papular eruption in the second week after taking terbinafine 250 mg once daily. Despite this eruption she continued treatment for 6 days. Generalized erythema multiforme developed in the following days. Terbinafine is a recently introduced efficacious fungicidal drug. This is the first report of toxic epidermal necrolysis following terbinafine.

[HIV-positive persons in a Danish provincial region 1985-1990]. / HIV-antistofpositive i et dansk provinsområde 1985-1990.

From January 1985 to July 1990 a total of 128 HIV-infected persons were examined in the Clinics for Infectious Diseases and Dermato-Venereology at Odense University Hospital which covers a provincial region of Denmark. Clinical and demographic data were recorded regarding their initial contact with the hospital. About 1/2 (47%) were homosexual men and these were seen primarily during the first and last years of the observation period. Approximately 1/4 (27%) were intravenous drug users (15% of these were women), and about 1/5 (18%) had become infected by heterosexual relations. Half of these were women and these were seen mostly during the latter half of the observation period. The majority (81%) were clinically healthy at the time of the initial contact with the hospital. Eight patients (6%) had developed AIDS. It is noteworthy that during the last year of the observation period, there was a great increase in the number of homosexuals with compromised health and low CD4-cell count. This tendency could not be demonstrated for the other groups. In general, at the beginning of the observation period, a very uniform group of homosexual men was observed. Most of these had become HIV-infected in Denmark. They were healthy and with good immunological function and in the age group 25-49 years. During the subsequent years, a more varied group of patients was observed. The risk behaviour was different, the percentage of women greater and there was greater variation in age, health status and CD4-count.(ABSTRACT TRUNCATED AT 250 WORDS)

Bioactive and inactive forms of tumor necrosis factor-alpha in spinal fluid from patients with meningitis.

Twenty-four patients, including 12 with meningitis, were admitted with meningeal symptoms and fever. Their serum and spinal fluid tumor necrosis factor-alpha (TNF alpha) levels were determined by ELISA. TNF alpha immunoreactivity was found in spinal fluid of 10 meningitis patients and one nonmeningitis patient, whereas 7 sera, 5 from meningitis patients, contained TNF alpha. Levels were significantly higher in spinal fluids than in serum samples, and the TNF alpha bioactivity of spinal fluids and sera was considerably below predictions based on ELISA measurements. Gel filtration chromatography demonstrated the presence of both polymeric (greater than 200 kDa) and oligomeric (10-40 kDa) TNF alpha in spinal fluid. Significant bioactivity was obtained only from samples containing oligomeric cytokine. In agreement with previous in vitro findings, these results strongly indicate that bioactive TNF alpha oligomers form inactive polymers and monomers, which could contribute to the observed in vivo discrepancies between immunoreactive and bioactive protein. Finally, the data support the concept of local central nervous system production of TNF alpha in meningitis.