Twenty patients with chronic solar damage of the skin were entered in a double-blind, within-patient trial to compare the effect of 0.05% tretinoin cream with a placebo applied once daily for 12 weeks. Sixteen completed the study. Clinical assessment of the individual signs of solar damage were recorded on separate visual analogue scales. After 12 weeks, there were significant improvements in fine wrinkling around the eyes, crease lines around the mouth and cheeks, wrinkling on the dorsum of the hands and yellow discoloration. Overall, 14 of the tretinoin-treated sides were judged to have improved compared to only two of the placebo-treated sides (P = 0.011). Measurement of skin thickness by pulsed A-scan ultrasound revealed that the sides treated with tretinoin were significantly thicker than the placebo-treated sides (P = 0.019). Skin biopsies taken before and after treatment showed an increase in mean epidermal thickness with tretinoin treatment (P = 0.019). The clinical signs of improvement persisted at the follow-up assessment performed 4 weeks after cessation of therapy.
Summary Although treatment of psoriasis with psoralen and ultraviolet A (PUVA) is associated with a long‐term risk of development of cutaneous squamous cell carcinoma (SCC), the role of PUVA alone is not established, as many patients in reported series had also received treatment with other carcinogens, such as superficial X‐rays or arsenic. We have recalled and examined 54 of the 63 patients still alive who have had PUVA treatment in our department, and who have been exposed to a cumulative UVA dose greater than 2000 J/cm2. None of the patients had been treated with superficial X‐rays or arsenicals. Ten patients (19%) had developed SCC, and 25 (46%) had histologically atypical squamous keratoses arising at body sites similar to the carcinomas. The patients with SCC were significantly older at the start of PUVA treatment than those with keratoses alone. None of the 13% of patients without PUVA lentigines had keratoses or SCCs. These results show that high‐dose PUVA treatment in the U.K., even when given alone, can frequently result in the development of SCC. Further malignancies are to be expected with continued follow‐up of the patients with squamous keratoses. Absence of PUVA lentigines may be a useful indicator of a lower risk of PUVA malignancy.
We report the case of an infant who presented with isolated cutaneous manifestations of Langerhans cell histiocytosis before the evolution of systemic features. In the transition period, at 9 months of age, nail unit changes became prominent, and persisted throughout the duration of systemic treatment. A change in clinical features coincided with a course of systemic gamma-interferon, which was given because immune paresis was suspected. Nail unit changes are rare in Langerhans cell histiocytosis, and this case illustrates the range of findings, including paronychia, nail fold destruction, onycholysis with subungual expansion, and nail plate loss. The significance of these changes as a prognostic indicator is controversial.
We report an 83-year-old woman with carcinoma erysipeloides due to an occult carcinoma. Immunohistochemical study of skin biopsies showed reactivity to S-100 protein and human milk fat globule antigen indicating that the tumour originated in the breast.
This randomised double-blind, placebo-controlled, cross-over study compared the effects of single oral doses of terfenadine 120 mg, cetirizine 10 mg, and loratadine 10 mg on experimentally induced weal and flare reactions. The areas of weal and flare induced by intracutaneous injections of histamine were measured using planimetry, weal thickness by A-scan pulsed ultrasound and erythema index by a device which measures the relative reflectance of red and green light. All three antihistamines suppressed the weal and flare area and weal thickness 3, 6, 12 and 24 h after dosing. At the usual currently recommended doses terfenadine and cetririzine were most effective after 6 h and were more potent than loratadine for the first 6 h of the study.
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