Sebum composition: a comparison of thin-layer chromatography and infrared reflectance spectroscopy.

Thin-layer chromatography and infrared reflectance spectroscopy were compared as methods for measuring sebum composition. Solutions of varying known concentrations of free fatty acids and triglycerides were analyzed by both methods. Skin surface lipid samples were similarly analyzed. Infrared spectroscopy produced more variable data than thin-layer chromatography with photodensitometry. This was particularly true at low concentrations of free fatty acids. It is concluded that thin-layer chromatography with photodensitometry is a more accurate method for the measurement of sebum composition.

In vitro effect of isotretinoin on monocyte chemotaxis.

The effect of isotretinoin on the chemotaxis of human monocytes was studied in an in vitro system using a Nucleopore chamber. The chemoattractant used was zymosan-activated serum. Inhibition of monocyte chemotaxis was achieved with isotretinoin in concentrations of 1 X 10(-3) M and 5 X 10(-4) M. It is felt that the improvement seen in patients with inflammatory skin diseases such as cystic acne and acne conglobata who are treated with isotretinoin may in part be a result of this anti-inflammatory action.

Comparison of a salicylic acid cleanser and a benzoyl peroxide wash in the treatment of acne vulgaris.

A four-week crossover study to compare the efficacy of an acne cleanser containing 2% salicylic acid with that of a 10% benzoyl peroxide wash was conducted in 30 patients with acne vulgaris. The results demonstrated that only patients treated with the salicylic acid cleanser had a significant reduction in comedones. Patients treated with the salicylic acid cleanser for the first two weeks showed a significant improvement in acne, but worsened during benzoyl peroxide therapy over the following two weeks. In contrast, patients initially treated with the benzoyl peroxide wash for the first two weeks continued to improve with salicylic acid cleanser over the next two weeks.

High-dose tetracycline therapy in severe acne.

High daily doses of tetracycline (in most instances 2,000 mg) were administered over periods of 3 to 33 months to 31 patients suffering from unusually severe, disfiguring, and treatment-resistant forms of acne (papulopustular, cystic, and conglobated). The acne cleared in 14 patients, improved greatly in 13, improved only insignificantly in 3, and failed to improve in 1. Side-effects occurred in 15 of the 31 patients but necessitated cessation of treatment in only three.

Effect of isotretinoin on serum levels of precursor and peripherally derived androgens in patients with acne.

Sebaceous glands are stimulated by androgens and can convert them to more active forms. Isotretinoin, however, has a profound inhibitory effect on sebaceous gland size and function. This study evaluated the effect of isotretinoin on serum levels of precursor and tissue-derived androgens. Twenty-four subjects (15 men and nine women) were treated for 20 weeks with 1 mg/kg/d of isotretinoin. Serum samples were obtained at baseline, 8, 16, and 24 weeks, and assayed for precursor androgens--total testosterone (TT), free testosterone (free T), dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEA-S); and tissue androgens--dihydrotestosterone (DHT), and its metabolite, 3 alpha-androstanediol glucuronide (3 alpha-diol G). Isotretinoin had no meaningful effects on precursor androgens, except for producing an elevation of free T in women. In contrast, isotretinoin produced depressions in the serum levels of DHT and 3 alpha-diol G in women and in 3 alpha-diol G in men. These decreases are believed to be the result, rather than the cause, of a reduction in the size of the sebaceous glands: The magnitude of the observed decreases may represent the amount of tissue-derived androgens that sebaceous glands normally contribute to the circulating pool.

Oral zinc therapy of acne. Absorption and clinical effect.

In a double-blind controlled comparison that lasted eight weeks, tablets of zinc sulfate monohydrate, 411 mg total daily dosage, and a lactose placebo were administered orally to 22 male subjects with moderate acne. At the same time, levels of zinc were determined in serum and urine. There were no statistically significant differences in the lesion counts (papules, pustules, open comedones, and closed comedones) in the zinc-treated and lactose-treated cases, despite evidence in serum and urine of absorption of zinc. The data from this study indicate that oral zinc therapy has no early clinical effect on male patients with moderate acne.

Acne vulgaris. Pathogenesis and treatment.

Acne vulgaris is a multifactorial disease involving abnormalities in follicular keratinization, sebum production, proliferation of Propionibacterium acnes, and inflammation. Treatment is directed toward reversing these underlying pathogenic factors. Therapeutic options include topical comedolytics, topical and systemic antibiotics, hormonal manipulations, and oral retinoids.

Isotretinoin dosing: past, present, and future trends.

Isotretinoin is the treatment of choice for severe nodulocystic acne. It represents the sole agent that effectively addresses all of the pathophysiological factors in the production of acne. Dosing recommendations are based on European trials that included patients with nonacne skin disease, which requires higher doses of isotretinoin for clearance. In this article, the authors relate their extensive experience with dosing regimens for acne as well as discuss recommendations for length of therapy.

Isotretinoin revisited.

Isotretinoin (13-cis-retinoic acid) remains the drug of choice for treatment of severe, recalcitrant nodulocystic acne that is unresponsive to conventional therapy, including oral antibiotics. The drug has been shown to produce dramatic clearing of lesions and prolonged remissions. The length of remission may be dependent on both the dosage used and the duration of therapy. Since fetal malformations have been observed in infants born of mothers taking isotretinoin during pregnancy, it is mandatory to prevent women who are pregnant or may become pregnant during treatment from taking isotretinoin. Because the half-life of isotretinoin is ten to twenty hours, and because it is eliminated from the body rapidly enough, women may become pregnant one month after discontinuation of therapy without an increased risk of birth defects. Common side effects of the drug include mucocutaneous reactions, serum lipid alterations, eye irritation, and myalgias. Less commonly observed are hyperostoses and exuberant granulation tissue, and rarely, pseudotumor cerebri. Recommendations for substantially reducing or eliminating these effects are made.

Tazarotene gel is safe and effective in the treatment of acne vulgaris: a multicenter, double-blind, vehicle-controlled study.

Retinoids reverse the abnormal pattern of keratinization seen in acne vulgaris. Tazarotene is the first of a novel family of topical receptor-selective acetylenic retinoids. This study evaluates the safety and efficacy of topical tazarotene 0.1% and 0.05% gels, in comparison to vehicle gel, applied once daily for 12 weeks, in the treatment of mild-to-moderate facial acne vulgaris. A total of 446 patients with facial acne vulgaris were enrolled, and 375 patients, ranging in age from 14 to 44 years, were evaluable in this multicenter, double-blind, randomized study. In comparison to vehicle gel, treatment with tazarotene 0.1% gel resulted in significantly greater reductions in noninflammatory and total lesion counts at all follow-up visits, and inflammatory lesion counts at Week 12. Tazarotene 0.05% gel resulted in significantly greater reductions in noninflammatory and total lesion counts than vehicle gel at Weeks 8 and 12. At Week 12, treatment success rates were 68% and 51% for tazarotene 0.1% and 0.05%, respectively (40% for vehicle gel). Tazarotene gel was an effective, safe, and generally well-tolerated therapy for the treatment of acne vulgaris.

Multicentre double-blind clinical trials of ciclopirox olamine cream 1% in the treatment of tinea corporis and tinea cruris.

In separate multicentre, randomized, double-blind clinical trials, 1% ciclopirox olamine cream was compared with its cream vehicle and with 1% clotrimazole cream as treatment for tinea corporis and tinea cruris. Patients who demonstrated clinical and mycological findings consistent with the diagnoses of tinea corporis or tinea cruris were included in the study. Clinical and mycological evaluations were made pretreatment, at the end of each of the four weeks of treatment, and weekly for the two weeks immediately following cessation of treatment. In both studies, use of ciclopirox olamine cream resulted in demonstrable improvements after the first week of therapy and in complete clinical and mycological clearing in two thirds of the patients at the end of the treatment period. These results were maintained through the two-week drug-free observation period that followed the end of treatment. Statistically, the results with ciclopirox olamine cream were significantly better than those with the vehicle and were equivalent to those with clotrimazole cream. All treatments were well tolerated.

Neurotoxic reaction to lindane in an HIV-seropositive patient. An old medication's new problem.

Scabies is a common infestation for patients of all ages throughout the world. One of the standard therapies for scabies is 1% lindane lotion. Lindane has been associated with neurotoxic reactions, specifically seizures. We describe a case of a middle-aged adult man with human immunodeficiency virus (HIV) infection who was found to have typical scabies and was treated with a single topical application of lindane. Two hours after the application, the patient experienced a new-onset generalized seizure. We believe that the triad of HIV infection, medications that reduce seizure thresholds, and percutaneous absorption factors, in the aggregate, induced the seizure. We believe that lindane should not be prescribed for patients with HIV infection.