Preventing melasma recurrence: prescribing a maintenance regimen with an effective triple combination cream based on long-standing clinical severity.

BACKGROUND: The relapsing nature of melasma emphasizes the need to maintain efficacy achieved after acute treatment. OBJECTIVE: To compare clinical efficacy and safety of two 6-month Triple Combination (TC; containing fluocinolone acetonide, hydroquinone and tretinoin) maintenance regimens in subjects with moderate to severe melasma, after daily treatment up to 8 weeks. METHODS: This randomized, investigator-blinded, controlled study had a maintenance phase of 6 months. Sixteen centres in Brazil and Mexico enrolled 242 subjects 18 years or older attaining no or mild melasma after 8 weeks of daily TC applications. Subjects were randomized to receive TC in a twice weekly or tapering regimen [3/week (1st month), 2/week (2nd month), 1/week (4th month)]. Efficacy and safety measurements included median time to relapse and relapse-free rate, Global Severity Score, Melasma Area and Severity Index score (MASI), subject's assessment, quality of life questionnaire (MelasQol), and adverse events. RESULTS: The majority (78.8%) had no or mild melasma (GSS ≤ 1) at week 8 and entered maintenance phase. After 6 months, 53% of patients remained relapse-free with improved quality of life, and time to relapse was similar between groups (about 190 days). Melasma severity at study entry, not maintenance baseline, influenced relapse rate. The twice weekly regimen tended to show better effectiveness in postponing relapse in severe melasma. Both regimens were safe. CONCLUSIONS: After resolution of melasma with TC, maintenance therapy over 6 months was successful in preventing relapse in over half of the patients who entered maintenance phase. Prescribing medicines should be adapted to patients based on melasma severity.

Palmar basal cell carcinoma: case report and literature review.

BACKGROUND: Although basal cell carcinoma (BCC) is the most common tumor of the skin, its occurrence on the palm is very rare. Only eight cases not associated with the basal cell nevus syndrome having been reported in the world literature so far. Among these eight cases, one was associated with epidermolysis bullosa dystrophica and another with previous trauma to the site of the appearance of the lesion. OBJECTIVE: The authors report a case of palmar BCC due to its rare occurrence on that site. The case is not associated with any predisposing factors such as basal cell nevus syndrome, trauma, or preexistent dermatosis. METHODS: An incisional biopsy was performed into the border of the palmar ulcer. The histopathologic findings of the fragment, stained by hematoxylin and eosin, were characteristic of BCC. RESULTS: Following surgical removal of the lesion, there was complete healing and the patient has presented no signs of relapse after 3 years of clinical follow-up. CONCLUSION: Palmar BCC not associated with the basal cell nevus syndrome or any other predisposing condition is very rare. Nevertheless, when facing an ulcerated lesion on the palm, BCC should be considered as a diagnostic possibility.

Eosinophilic and neutrophilic spongiosis: clues to the diagnosis of immunobullous diseases and other inflammatory disorders.

When eosinophils or neutrophils are found within the epidermis in concert with edema, the pattern is known as eosinophilic or neutrophilic spongiosis. Although eosinophilic spongiosis has been accepted as a clue to the diagnosis of blistering disorders for some time, the fact that either pattern can serve as a clue to the diagnosis of a variety of disorders, including immunobullous diseases, is less widely known. Herein, we review the types of inflammatory skin diseases, including spongiotic dermatitides, subepidermal vesicular dermatitides, intraepidermal vesicular dermatitides, and perivascular or diffuse dermatitides, that display intraepidermal eosinophils and neutrophils. We also review the known mechanisms that explain in part why intraepidermal granulocytes are commonly found in this diverse group of skin diseases.