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Journal: The Journal of dermatological treatment


Abstract Background: Recently, tranexamic acid (TNA) containing oral medication has gained public attention, claiming for whitening effects. Objective: This study was performed to evaluate the clinical efficacy and safety of oral TNA as an adjuvant to intense pulsed light (IPL) and laser treatment in melasma. Methods: A total of 51 patients were included in the study. Patients who have been on oral TNA during IPL and laser treatments (group A) and those who were treated with only IPL and laser (group B) were analyzed (from winter to summer). Modified melasma area and severity index (mMASI) scores were blindly evaluated by two investigators using digital photographs taken at each visit. Results: The mean modified MASI score decreased from 11.33 ± 7.07 to 6.21 ± 5.04 in group A and from 11.70 ± 6.72 to 8.93 ± 5.89 in group B (baseline vs. 2 weeks after the last treatment, p = 0.005). Modified MASI score right before and after IPL were more reduced in group A. No serious adverse effects were reported up to 8 months of oral TNA medication. Conclusion: Oral TNA may improve clinical efficacy in light- or laser-based melasma treatment especially during the period of relative high sun exposure without serious adverse effects.

Concepts: Clinical trial, Ultraviolet, Light, Laser, Stimulated emission, Effectiveness, Infrared, Intense pulsed light


Abstract Background: Keratosis pilaris (KP) is a very common disorder; yet, very few treatment options are available. Objectives: To evaluate the efficacy of long-pulsed 1064-nm Nd:YAG laser for the treatment of KP. Materials and methods: Eighteen patients with untreated KP on the upper outer arms were enrolled in a randomized clinical trial. One arm was treated with long-pulsed 1064-nm Nd:YAG laser at 30 msec pulse width and fluence of 34 J/cm(2), while the contralateral arm served as control. Patients received three consecutive treatments at 4-week intervals. Three blinded dermatologists assessed digital photographs using a quartile grading system to separately rate global improvement, erythema and the number of keratotic papules. Results: Seventeen patients completed the study. There were statistically significant improvements in global assessment, erythema and the number of keratotic papules at 4 weeks after the last treatment (p < 0.05). All patients also stated that their lesions improved and were satisfied with the laser treatment. Conclusion: Long-pulsed 1064-nm Nd:YAG laser has been shown to improve KP in Thai patients compared with control after three treatment sessions.

Concepts: Better, Clinical trial, Improve, Randomized controlled trial, Laser, Clinical research, Keratosis pilaris, Laser hair removal


Abstract The Goeckerman regimen, consisting of the application of crude coal tar combined with exposure to ultraviolet radiation, was formulated in 1925 for the treatment of psoriasis. While some centers have adapted the Goeckerman regimen for the treatment of eczema, there are no published reports of its efficacy in this condition. Here, we explain how the Goeckerman regimen has been modified for use in an eczema population at the University of California San Francisco (UCSF). We reviewed the treatment records of eczema patients treated with the modified Goeckerman regimen over a 6-year period at UCSF. We found that the Goeckerman regimen was effective in treating patients with severe baseline disease, inducing a mean remission period of 7.2 months. The treatment was tolerated well with mild folliculitis and occasional ultraviolet B phototoxicity noted as the only adverse reactions. Since the use of Goeckerman as a treatment for severe eczema is both effective and safe, it should be considered an excellent alternative or adjunct to the systemic therapies currently being used.

Concepts: Cancer, Ultraviolet, Electromagnetic spectrum, Sunlight, Eczema, Psoriasis, Psoralen, Coal tar


Abstract Although erythrasma is a superficial skin infection, there is no consensus on the treatment model of erythrasma. Objective: To compare the efficacy of erythromycin, single-dose clarithromycin and topical fusidic acid in the treatment of erythrasma in a double-blind, placebo-controlled, randomized trial. Methods: Hundred and fifty-one patients over 18 years of age were included in this study. Patients were randomized and divided into five groups. They received clarithromycin, erythromycin, fusidic acid cream, placebo cream or placebo tablets. Patients were evaluated by Wood’s light reflection scores and the initial score values and the values on the days of 2, 7 and 14 were compared statistically. Results: According to the mean of Wood’s light reflection scores, the efficacy of fusidic acid cream therapy was significantly higher than other therapies. When the efficacy of clarithromycin and erythromycin therapy was compared, clarithromycin therapy was significantly more effective than erythromycin therapy at 48 h. However, there was no statistical difference on the days of 7 and 14. Conclusion: Topical fusidic acid proved to be the most effective treatment; however, clarithromycin therapy may be an alternative regimen in the treatment of erythrasma because of its efficiency and better patient’s compliance.

Concepts: Statistics, Medical terms, Light, Refraction, Randomized controlled trial, Effectiveness, Efficacy, Fusidic acid


Abstract Background: Several treatment modalities had been used for the treatment of vitiligo but the optimal treatment has not yet been identified. Aim: To evaluate the efficacy and safety of intradermal injection of 5-flurouracil (5-FU) combined with narrow-band ultraviolet B (NB-UVB) as a treatment option for vitiligo. Patients and methods: The study included 60 vitiligo patients with overall symmetrical lesions affecting less than 30% of body surface area. For each patient, one side of the body was treated with NB-UVB alone (control side) while the other side was treated with NB-UVB therapy in addition to intradermal injection of 5-FU (50 mg/ml), 0.01-0.02 ml per injection with 1 cm apart in skin of vitiligo, every 2 weeks for 4 months. Results: The overall repigmentation was significantly higher in the 5-FU side compared with control side in all body parts (p < 0.001) except for the acral lesions where the difference was not significant (p = 0.561). No systemic side effects of 5-FU were detected, and the majority of the patients reported pain during injections. Conclusions: Intradermal 5-FU injection in combination with NB-UVB could be considered as a simple, safe, tolerable and cheap technique for treatment of vitiligo. It shortens the duration of NB-UVB therapy and improves the outcome, repigmentation. Longer follow-up is needed.

Concepts: Pharmacology, English-language films, Human skin color, Vitiligo, Psoralen


Abstract This is a randomized, double-blind study enrolling 70 patients with onychomycosis of the finger and toenails. Clinical and mycological efficacies as well as measures of safety were assessed monthly for a maximum of 6 months of treatment. The treatment regimens were: fluconazole 1% and fluconazole 1% with urea 40%. These results indicated topical treatment of onychomycosis with a combination of fluconazole 1% and urea 40% was more effective (82.8%) than fluconazole 1% (62.8%) nail lacquer alone in treatment of dermatophytic onychomycosis. Fluconazole was well tolerated and side effects were negligible. At the end of therapy and the end of the 6-month follow-up, fluconazole 1% and urea 40% demonstrated statistically significant superiority in clinical and mycological responses compared with fluconazole 1% alone.

Concepts: Medicine, Effectiveness, Finger, Onychomycosis, Nail, Nail disease, Terbinafine, Itraconazole


Abstract Background The oral tetracyclines, especially minocycline hydrochloride, are often used as an effective treatment for perioral dermatitis, however they are sometimes difficult to use because of the side effects, especially in children. Objective The effectiveness of β-lactam antibiotics was evaluated in three cases of perioral dermatitis. Methods Three Japanese patients with perioral dermatitis were treated with cefcapene pivoxil hydrochloride hydrate per os 100 to 300 mg per day. They were one girl (age 10) and two adult women (age 32, 37). One of the adult patients had a past history of Meniere’s disease and the other had had a side effect, vertigo, from minocycline hydrochloride treatment. The presence of fusobacteria before and after the treatment was examined using the tape-stripping toluidine blue method. Results These patients showed the improvement in 1 to 2 weeks and were much improved or cured after 2 to 5 weeks. No side effects were found during the treatment. Fusobacteria were positive before treatment but became negative after the treatment in all of them. Conclusion β-lactam antibiotics might be a useful treatment for perioral dermatitis, especially in cases who cannot take tetracyclines.

Concepts: Effect, Effectiveness, Ménière's disease, Adverse effect, Acne vulgaris, Rosacea, Tetracycline antibiotics, Minocycline


Abstract Objectives: β-blocker propranolol was discovered to be highly effective for the treatment of IHs (infantile hemangiomas) since 2008. However, no serious side effects of its use have been reported so far in Asia, especially in China. To determine the safety of this therapy, we analyzed the side effects in 97 infants who used propranolol (2 mg· kg-1· d-1) against hemangioma from 2010 to 2011. Materials and methods: We performed routine blood and urine tests, hepatic and renal function tests, myocardial enzyme, electrolytes and blood sugar levels at baseline. Electrocardiogram (ECG) monitoring was performed 48 h after administration of the first dose (2 mg· kg-1· d-1). Every patient (n = 97) was required to report to our hospital once a month. Results: The following adverse effects were observed: bronchial hyperactivity (n = 5), cyanosis and cold extremities (n = 1), agranulocytosis (n = 1), and low body temperature (n = 1). These side effects were reported for the first time in Asia. Conclusions: Although propranolol is effective against IHs, its potential side effects should be considered and appropriate monitoring performed. Further studies need to be conducted to determine the optimal dose and duration of propranolol treatment for large and complex hemangiomas.

Concepts: Therapeutic effect, Enzyme, Glucose, Renal function, Blood sugar, Electrolyte, Sugar, Hemangioma


Abstract Background: Cutaneous squamous cell carcinomas (CSCC) are very common. Localized CSCC are cured by surgery and/or radiotherapy and have a better prognosis than locally inoperable advanced CSCC. Cetuximab has recently been proposed to treat locally advanced CSCC when surgery or radiotherapy cannot be offered. Objective: We report results of a pilot study conducted in inoperable CSCC patients treated with Cetuximab alone or combined with chemotherapy or radiotherapy. Methods: This study was conducted in 20 CSCC patients. RECIST criteria were used to evaluate clinical and radiological responses. Results: Five patients received Cetuximab associated with radiotherapy (CR), nine with Carboplatin (CC) and six as monotherapy (CM) over 1-month cycle treatments. Response to treatment was evaluated every 2 cycles. After 2 months of treatment, we observed 9 partial responses, 6 stabilizations, and 4 progressions. Disease control rate was of 78 % (100% for CR, 87.5% for CC and 50% for CM) with a 47%-response rate (80% for CR, 37.5% for CC and 33% for CM). Conclusion: We confirm the potential interest of Cetuximab to treat unresectable advanced CSCC alone or combined with CC and CM These results justify discussing a further randomized study combining radiotherapy and Cetuximab.

Concepts: Cancer, Lung cancer, Chemotherapy, Radiation therapy, Carcinoma, Squamous cell carcinoma, Squamous epithelium, Head and neck cancer


Abstract Background: Pruritus ani (PA) is defined as intense chronic itching affecting perianal skin. Objective: We aimed to determine the efficacy of topical tacrolimus treatment in atopic dermatitis (AD) patients who have PA. Methods: The study included 32 patients with AD who were suffering PA. Patients were randomized into two groups. In total, 16 patients used 0.03% tacrolimus ointment and 16 patients used Vaseline® as placebo. All groups applied topical treatments to their perianal area twice daily for 4 weeks. The treatments were then reversed for 4 weeks after a 2 weeks wash out period. Results: In total, 32 patients with AD who had refractory anal itching were enrolled in the present study. None of the patients had obtained successful results with previous treatments. There was a statistically significant decrease in the recorded EASI, DLQI and itching scores for the tacrolimus group compared to the placebo groupat weeks 4 and 6 of treatment (p < 0.05). Conclusion: Topical tacrolimus treatment was well tolerated and effective in controlling persistent PA in AD patients.

Concepts: Allergy, Symptoms, Tacrolimus, Hemorrhoid, Itch, Anal fissure, Atopic dermatitis, Pruritus ani