Treatment Of Dermatological Diseases Research Articles

Skin care in older people

The United Kingdom, along with the rest of the western world, is experiencing the phenomenon of increasing life span as standards of living and health care continue to improve (Department of Health 1999). The result is a dramatic increase in our ageing population, which necessitates change within society to successfully accommodate this. This is also true for nursing. Within the specialty of dermatology there is an increased need to examine the needs of the elderly population. This includes not only the diagnosis and treatment of dermatological diseases in elderly people, but also the provision of skin care education and practices alongside an increasing awareness of dermatological diseases that can occur in this age group.

Off-label prescribing in the treatment of dermatologic disease

Background: It is common practice for physicians to treat dermatologic conditions with medications that are not indicated for the specific condition being treated. These “off-label” prescriptions are often for medications that have both well accepted therapeutic value in the medical community and proven efficacy on the basis of results of clinical trials. Objective: Our purpose was to quantify the use of off-label prescriptions for dermatologic disease by a representative sample of physicians in the United States. Methods: Data from the 1990-1997 National Ambulatory Medical Care Survey, performed by the National Center for Health Statistics, were used to assess medications prescribed at office visits for dermatologic disease. We identified the most common diagnoses listed at office visits in which the primary and only diagnosis listed was dermatologic. For the leading 10 dermatologic conditions for which medications are indicated, we categorized each primary drug mention by indication. Results: We found that the range of off-label prescribing varied from 17% to 73%, with a weighted mean (± SD) of 32% ± 18%. The conditions most frequently managed with off-label prescriptions were acne rosacea (73%) and actinic keratosis (52%), whereas those with the fewest off-label prescriptions were atopic dermatitis (17%) and psoriasis (16%). The use of off-label prescriptions by dermatologists in the diseases studied ranged from 7% to 73% with a weighted mean (± SD) of 24% (± 24%), whereas the range for nondermatologists was 18% to 96% with a weighted mean (± SD) of 34% (± 18%). Conclusion: Off-label prescribing is common in the management of dermatologic conditions. From these data, we conclude that it is currently within the standard of care to use off-label prescriptions in the treatment of dermatologic disease. (J Am Acad Dermatol 2002;47:217-23.)

Off-label prescribing in the treatment of dermatologic disease

Off-label prescribing in the treatment of dermatologic disease

Topical cyclosporin in the treatment of dermatologic diseases.

Cyclosporine A (CsA) has been in clinical use for some decades, primarily for the prevention and treatment of organ transplant rejection and graft-versus-host disease. In more recent years, Cyclosporine has been recognized as beneficial in the treatment of dermatologic diseases, such as: psoriasis, lichen planus, Behcet disease, atopic dermatitis, pyoderma gangrenosum and epidermolysis bullosa acquisita. Above all, Cyclosporine is an important therapeutic modality for several dermatologic diseases that are refractory to other agents.

Important drug interactions in dermatology.

Drug interactions can occur at any step from absorption to elimination of a drug, and can induce adverse as well as beneficial effects. Since systemic drugs are increasingly available and important in the treatment of dermatological diseases, a variety of possible interactions between concomitantly administered drugs have to be considered by dermatologists. The xenobiotic-metabolising enzyme system cytochrome P450 (CYP) is involved in the metabolism of many drugs, regulating their plasma concentrations and activities. Furthermore, the adverse effects of many drugs depend on the basal activity and inducibility of particular CYP isoenzymes in an individual patient. Since drug therapy in dermatological practice is of increasing complexity, and an increasing number of potent systemic drugs have become commonly used therapeutic agents, this review focuses on the following topics with the aim of optimising dermatological drug therapy. In the first section, all the different types of drug interactions that can occur through pharmacokinetic and pharmacodynamic mechanisms are introduced briefly, and then discussed systematically with special reference to drugs important for dermatologists. Then, the network of drug interactions that may occur from absorption to elimination is presented. The most important drug interactions mediated by CYP isoenzymes are listed. Finally, the importance of pharmacogenetics for the development of new drugs and its potential impact on the optimisation of individual therapy regimens is discussed.

Guidelines of care for dermatologic conditions in patients infected with HIV

Guidelines of care for dermatologic conditions in patients infected with HIV

WS124 The impact of genomics on drug discovery: Prospects for improved treatment of dermatological diseases

WS124 The impact of genomics on drug discovery: Prospects for improved treatment of dermatological diseases

Apoptosis Induction by Ultraviolet Light A and Photochemotherapy in Cutaneous T-Cell Lymphoma: Relevance to Mechanism of Therapeutic Action

The anti-tumor action of many chemotherapeutic agents has recently been attributed to the induction of apoptosis in the malignant cell population. In this study, we investigated the ability of extracorporeal photopheresis (ExP) and in vitro PUVA (8-methoxy-psoralen + ultraviolet A) therapy to induce apoptosis in peripheral blood mononuclear cells from Sezary syndrome patients and normal controls. Flow cytometric analysis of ExP- or PUVA-treated peripheral blood lymphocytes demonstrated two distinct cell populations within 24 h of treatment. One population was similar to untreated controls with the other exhibiting characteristics of apoptotic cell death, i.e., a loss of cell volume and an accompanying increase in cell density. This latter population was comprised of cells with DNA strand breaks as determined by the Tdt-mediated deoxyuridine triphosphate-biotin nick end labeling assay. Apoptosis was also confirmed morphologically by fluorescent and electron microscopy as well as by demonstration of characteristic DNA strand breaks (laddering) using gel electrophoresis. Apoptosis was not observed with 8-methoxypsoralen (< or = 300 ng per ml) alone; however, ultraviolet A alone at doses > or = 2 J per cm2 induced apoptosis in lymphocytes. Peripheral blood T-cell subpopulations of Sezary syndrome patients, including the malignant clone, were equally susceptible to apoptosis subsequent to either photopheresis or PUVA treatment. In contrast, monocytes (CD14+/CD45+) appear to be resistant to apoptosis induction by ExP or PUVA treatment. Moreover, ExP-treated and untreated monocytes phagocytized apoptotic, but not untreated, peripheral blood mononuclear cells. ExP and PUVA have been shown to be efficacious and well-tolerated therapies in the treatment of dermatologic diseases and transplant rejection. These data suggest that induction of apoptosis may be an important event for therapeutic efficacy.

Benefits and risks of intralesional corticosteroid injection in the treatment of dermatological diseases.

Intralesional corticosteroid (CS) injections have been used to treat a variety of dermatological and non-dermatological diseases with variable results. The purpose of the injection is to attain a high concentration of the drug at the diseased site, with minimal systemic absorption. Several CS preparations are available for intralesional injection, although triamcinolone derivatives have gained the widest usage in dermatology. The dose and the interval between injections depend on the type, size and severity of the lesion as well as the response to the previous injections. The most critical issue in the efficacy and also in the development of complications of the injections, is the method of injection. Several local and systemic side-effects have been reported following intralesional injections, but most of them are rare or acceptable. Thus intralesional CS injection is an integral part of the clinical practice of dermatology. Since their introduction in 1951, intralesional CS injections have become an integral part of clinical practice in dermatology. They are used alone or in combination with other therapeutic modalities in the treatment of many skin diseases. The purpose of the injection is to attain a high local concentration of the CS at the diseased site, without significant systemic absorption, thus avoiding the numerous side-effects associated with systemic administration. Intralesional CS injection may be a valuable therapeutic modality in situations where topical CS are not suitable for use, either because of low potency and inefficient epidermal barrier penetration or in clinical conditions associated with epidermal atrophy.

Section Review: Retinoids: Biological Function and Use in the Treatment of Dermatological Diseases: Pulmonary-Allergy, Dermatological, Gastrointestinal &amp; Arthritis

Retinoids have increasingly gained acceptance for single agent or adjuvant therapy to treat dermatological diseases such as acne, photoageing, cutaneous neoplasia, psoriasis, disorders of keratinisation and various skin cancers. As potent biological modulators which regulate numerous cellular processes, retinoids have been administered as both chemotherapeutic and chemopreventive agents and offer a viable alternative to classical cancer chemotherapy. Although retinoid treatment has shown considerable promise, certain side-effects have limited chronic administration. As a result of recent discoveries regarding the biological function of retinoids and retinoid receptors, several new treatment strategies have been developed, including the application of receptor selective synthetic retinoids, combination therapies with other hormones or chemotherapeutic agents, and novel formulations. This has resulted in a new generation of retinoids and retinoid treatments which are in clinical development and which exhibi...

Local Suppression of Contact Hypersensitivity in Mice by a New Bifunctional Psoralen, 4,4',5'-trimethylazapsoralen, and UVA Radiation

Although psoralens plus UVA radiation (320-400 nm) have been widely used for the treatment of dermatologic diseases, the toxic effects of these agents have led investigators to develop new photochemotherapeutic compounds. One such compound is 4,4',5'-trimethylazapsoralen (TMAP), a new bifunctional molecule. The purpose of this study was to examine the immunologic side effects of repeated treatment of C3H mice with TMAP plus UVA radiation. During this treatment, the number of ATPase+, la+, and Thy-1+ dendritic epidermal cells greatly decreased in the treated site, despite the lack of phototoxicity. The reduction in the number of detectable cutaneous immune cells was accompanied by a decrease in the induction of contact hypersensitivity to dinitrofluorobenzene applied to the treated skin, an impairment in the antigen-presenting activity of draining lymph node cells, and the presence of suppressor lymphoid cells in the spleen of unresponsive mice. Treatment with UVA radiation alone also reduced the number of ATPase+, Ia+, and Thy-1+ cells in the skin, but did not cause any detectable alterations in immune function. This implies that morphologic alterations in these cells do not necessarily indicate loss of function. Thus, although TMAP in combination with UVA radiation is not overtly phototoxic, it is highly immunosuppressive in mice.

Clinical Summary of Copper Vapor Laser Treatment of Dermatologic Disease: A Private Practice Viewpoint

Clinical Summary of Copper Vapor Laser Treatment of Dermatologic Disease: A Private Practice Viewpoint

Rheumatological symptoms due to retinoids

Isotretinoin and etretinate are synthetic derivatives of vitamin A widely used in the treatment of dermatological diseases, mainly those affecting keratinization. They have numerous side-effects, among which the rheumatic symptoms are not the most common or the most severe. The main skeletal adverse reaction of retinoids is hyperostosis. It mainly occurs with protracted treatments and high dosages, and its incidence may exceed 80% after a few years of administration. Hyperostosis is axial, located in the cervical and thoracic spine, and may be responsible for limitation of movement; in the appendicular bone, enthesopathies occur at the foot, pelvis, hip, and less commonly the shoulder and elbow. They are usually mild and asymptomatic. The radiological appearance is very similar to diffuse idiopathic skeletal hyperostosis. Isotretinoin tends to be responsible for axial involvement, etretinate for peripheral locations. The other skeletal side-effects are uncommon and include periosteal proliferation, calcification of the interosseous membrane of the forearm and diffuse radiological bone hyperlucency. In children, premature epiphyseal closure is very rare. About 20% of patients complain of musculoskeletal pain and arthralgias. A few cases of true arthritis have been reported. Retinoids may be responsible for muscular damage and an abnormality of muscular tone resembling the stiff-man syndrome. Some cases of necrotizing vasculitis and three cases of Wegener's granulomatosis have been observed in patients treated with retinoids. Except for these latter arguable cases, rheumatoid syndromes due to retinoids are rather benign, and should not be an obstacle to the future development of their therapeutic utilization.

Side lights on treatment of dermatologic diseases of children.

Side lights on treatment of dermatologic diseases of children.