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This Month in Archives of Dermatology
Arch Dermatol. 2004;140:785.
Effect of a 1-Week Treatment With 0.5% Topical Fluorouracil on Occurrence of Actinic Keratosis After Cryosurgery
Treatment of actinic keratoses (AKs) is recommended because of the potential of these lesions to evolve into invasive squamous cell carcinoma. Therapeutic options include chemical destruction, such as with 5-fluorouracil, or physical destruction, such as with cryosurgery, curettage, or electrosurgery. In this prospective, multicenter, randomized, double-blind, vehicle-controlled clinical trial, Jorizzo et al demonstrate that pretreatment with a 1-week course of 0.5% fluorouracil before cryosurgery significantly reduced the proportion of patients with AKs at 6 months following therapy compared with patients receiving cryosurgery alone. This serial treatment may reduce the need for long-term retreatment for AKs.
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Effects of a Superpotent Melanotropic Peptide in Combination With Solar UV Radiation on Tanning of the Skin in Human Volunteers
The melanocortins are a family of peptide hormones that induce pigmentation by interaction with melanocortin 1 receptors in the epidermis.  -Melanocyte stimulating hormone (-MSH) is the primary pigmentary hormone in the skin. Using a superpotent derivative of -MSH, melanotan-1 (MT-1), Dorr et al examine whether MT-1 could be safely combined with small amounts of UV-B from a solar stimulator and demonstrate a marked enhancement of skin tanning. Thus, MT-1 in combination with minimal sun exposure should provide the cosmetic benefits of a tan without the need for substantial solar exposure and its inherent risks.
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Thalidomide Treatment for Prurigo Nodularis in Human Immunodeficiency Virus–Infected Subjects: Efficacy and Risk of Neuropathy
Prurigo nodularis (PN) is a chronic, intensely itchy condition characterized clinically by discrete hyperkeratotic nodules primarily on the extensor surfaces of the extremities. Standard therapies, such as antihistamines, UV phototherapy, and topical and systemic corticosteroids, may prove ineffective or problematic in human immunodeficiency virus (HIV)–seropositive patients. Thalidomide has been used to treat refractory PN in non–HIV-infected subjects, and in this prospective study, Maurer et al demonstrate its safety and efficacy in treating PN in HIV-seropositive patients. The significant number of patients who developed treatment-associated peripheral neuropathy in this setting emphasizes the need for careful neurologic assessment during the course of therapy.
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Poor Prognosis of Arthritis-Associated Pyoderma Gangrenosum
Pyoderma gangrenosum (PG) is an idiopathic, rare, destructive, necrotizing skin disease characterized by noninfectious ulcers that most commonly affect the lower extremities. Approximately 50% of patients with PG have an associated systemic disease, including various types of arthritis. In this retrospective review, Charles et al compare a series of patients with lower extremity ulcers of PG confined to the skin with patients with PG associated with arthritis (PGA). The ulcers of patients with PGA appeared to be more refractory to treatment than the ulcers of patients with PG alone.
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Response of Ulcerated Perineal Hemangiomas of Infancy to Becaplermin Gel, a Recombinant Human Platelet-Derived Growth Factor
Infantile hemangiomas are the most common benign tumor of childhood, and ulcerations are the most common complication. Such ulcerations represent a therapeutic challenge for which no single treatment has been demonstrated to be uniformly effective. Becaplermin gel is a recombinant human platelet-derived growth factor-BB gel that is currently approved in the United States for the treatment of lower extremity diabetic neuropathic ulcers. Becaplermin gel has also been reported useful in treating pressure ulcers. In this open study on 8 patients with ulcerated perineal hemangiomas of infancy, Metz et al demonstrate the safety and efficacy of of this medication for this painful complication.
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A, Ulcerated hemangioma worsening in patient 1 despite wound care and intralesional steroids. B, Lesion appearance 19 days after starting treatment with 0.01% becaplermin gel.
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(SEE ARTICLE)
SECTION EDITOR: ROBIN L. TRAVERS, MD
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