A combination therapy of calcipotriol cream and PUVA reduces the UVA dose and improves the response of psoriasis vulgaris

BACKGROUND

The addition of calcipotriol ointment to PUVA therapy for psoriasis vulgaris results in a lower total UVA dose and a faster onset of response. The addition of calcipotriol cream to PUVA, however, has not been studied.

OBJECTIVE

To investigate whether combining calcipotriol cream with PUVA therapy has a UVA sparing effect.

METHODS

We performed a randomized, multicentre, vehicle-controlled, double-blind, 12-week comparative study including 120 patients with psoriasis covering 20-50% body surface area. The study consisted of a washout phase followed by a 10-week treatment phase. PUVA therapy three times weekly was added within 1 week after randomization. Efficacy was assessed by the Psoriasis Area and Severity Index (PASI).

RESULTS

At baseline the mean PASI scores were 17.5 and 19.2 in the calcipotriol and vehicle (placebo) groups, respectively. At the end of treatment, the mean PASI scores were 2.65 and 7.03 (p<0.01), respectively. A reduction in PASI score >90% was observed in 69% of the patients in the calcipotriol-treated group and in 36.4% of the patients in the vehicle group (p<0.01).

CONCLUSION

Calcipotriol cream plus PUVA clearly reduces the cumulative dose of UVA and improves the response of psoriasis vulgaris to PUVA.

Evaluation of clinical efficacy and safety of adapalene 0.1% gel versus tretinoin 0.025% gel in the treatment of acne vulgaris, with particular reference to the onset of action and impact on quality of life

A randomized, multicentre, investigator-masked study was conducted in 105 patients with mild to moderate acne vulgaris to compare the efficacy and safety of adapalene 0.1% gel with tretinoin 0.025% gel after three months of treatment, with particular emphasis on reduction in inflammatory lesion counts after one week of treatment and impact on quality of life. In terms of efficacy, adapalene gel was found to be superior to tretinoin gel after one week of treatment, with respect to reduction in inflammatory lesion counts (32% vs. 17%, respectively; P = 0.001), total lesion counts (28% vs. 22%, respectively; P = 0.042) and global severity grade (28% vs. 16%, respectively; P = 0.001). No significant difference between the two treatments was found after 12 weeks of treatment for any of these variables. Evaluation of facial skin tolerance parameters showed significant differences between the two treatments in favour of adapalene for dryness, erythema, immediate and persistent burning and pruritus for at least one time point. One patient in the adapalene group and three patients in the tretinoin group experienced medical events which lead to discontinuation of treatment (skin irritation; NS). Quality of life scores improved more rapidly in the adapalene group than in the tretinoin group, with significant differences (P < 0.05) appearing at week 1 for questions related to problems with partners, close friends or relatives and to skin symptoms. There was also a significantly greater improvement in social and leisure activity in the adapalene group at week 12. Adapalene 0.1% gel reduced inflammatory and total lesion counts more rapidly than tretinoin 0.025% gel, and was also better tolerated. These differences appear to result in an earlier and greater quality of life improvement for the patients receiving adapalene.

Green hair

Green hair is an unusual dermatologic condition usually due to the deposition of copper from exogenous sources. We report the cases of two patients who presented to our clinic with green discoloration of their hair. This pigmentation of hair has generally been reported in patients with blond hair as a consequence of increased concentrations of copper in domestic or swimming pool water. Although an increased copper content of the affected hair seems to be a prerequisite, other predisposing factors have to be present for this situation to occur. These include previous hair damage (mechanical, sun exposure, bleaching, dyeing, waving), frequent contact with chlorinated water, or use of alkaline shampoos. Several options for treatment have been described for this problem, including application of hot vegetable oil, hydrogen peroxide, edetic acid- or D-penicillamine-containing shampoos, or hydroxyethyl diphosphonic acid.

[Thalidomide in the treatment of aphthosis and Behçet's disease. 4 years' experience]

The authors summarize their experience in the treatment of recurrent, necrotic and giant mucocutaneous aphthosis (9 cases) and Behçet's disease (9 cases) with Thalidomide during four years. In recurrent mucocutaneous aphthosis the results were very good, with fast disappearance of pain, healing of the ahthae and disappearance or delay of recurrence. The result in Behçet's disease is similar, possibly less, in mucocutaneous lesions. Uveitis also reacts favorably but we can not say that the results were superior to those obtained by other drugs (corticoids, cytostatics immunosuppressives), although its side effects are less. On the other hand it does not appear to have any effect on other symptoms such as arthritis (in which colchicine is active), thromboflebitis or fever. There is not sufficient experience to judge its action on neurological symptoms. The recommended dose is 100 mgr./day for 10 days, a higher dose does not appear to give better results. Patients who have received treatment several times appear to have the same results, but slower. Neurotoxicity has not been observed and the only side effect which has been noted is digestive intolerance in two cases, after which the medication was stopped. The authors consider that Thalidomide, with due precaution, which must be scrupulously determined, is the most active medicament in particularly severe cases with profusion of necrotic aphthae, mutilating and recurring mucocutaneous aphthosis, also being useful in controlling some symptoms of Behçet's disease.