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Take Charge of Your Life! Just do it!" You've seen it on billboards, in magazines, on television. "Just do it!" Sure, it's an advertising slogan, but it's still good advice. [...]

Tretinoin, or retinoic acid, is a compound related to vitamin A which has improved skin that has been aged by sun exposure. Of 30 patients who participated in a four-month study, 21 continued tretinoin treatment for 10 months, and 16 continued for 22 months. Patients who did not continue treatment cited inconvenience or objection to further biopsies, but not lack of effectiveness, as the reason. Evaluation of patients receiving the more prolonged treatment showed that improvement of skin appearance and structure continued in spite of reductions in the dosage or frequency of treatment. Most improvements occurred during the first 6 to 10 months of therapy. Besides continued improvement of skin wrinkling and texture, 71 percent of liver spots disappeared. Other notable changes associated with treatment were increased skin pinkness, which was not adverse, and skin dryness with a red, flaking dermatitis, which diminished with continued treatment. There was no difference in adverse effects at different doses of tretinoin. Anatomic changes and the persistence of improvement for two months after therapy was discontinued indicate that tretinoin alters basic skin structure rather than causing a transient, superficially beneficial, swelling of the skin. The study suggests that tretinoin is likely to benefit sun-aged skin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Alopecia areata is the loss of hair in sharply defined patches, usually involving the scalp or beard, and accounts for two percent of dermatologic outpatient visits. The disease may also occur in severe forms such as the total loss of scalp hair, alopecia totalis, or the total loss of body hair, alopecia universalis. Alopecia areata has been treated with various forms of therapy including corticosteroids, ultraviolet light, minoxidil, and topical cyclosporine. Cyclosporine prevents the activation of a type of immune cell, the T helper cells, which may be involved in the pathogenesis of alopecia areata. The effectiveness of cyclosporine given orally, or by mouth, was evaluated for 12 weeks in six patients with alopecia areata. Three patients had alopecia universalis, one had alopecia totalis, and two had patchy alopecia areata of the scalp. Hair regrowth occurred within the second and fourth weeks of treatment initially on the scalp and later on the face, chest, pubic area, extremities, and axilla or armpit region. Hair regrowth on the scalp, that was considered cosmetically acceptable, occurred in three patients. There was significant hair loss in all patients within three months of stopping drug treatment. Hair regrowth was associated with changes in the hair follicles and in the immune cells, such as the T helper cells; these changes are described. The results indicate that cyclosporine is effective for the short-term treatment of alopecia areata; successful treatment is associated with changes in the immune cells within the hair follicle. (Consumer Summary produced by Reliance Medical Information, Inc.)

Systemic use of the immunosuppressive agent cyclosporin has been shown to be effective in the treatment of psoriasis, a common skin disorder characterized by circumscribed red patches covered by thick dry scales. Oral administration of cyclosporine has been associated with side effects that are related to the size of the dose given. Topical application of cyclosporine has not proved effective. To determine whether cyclosporine produces its effect on psoriasis by working systemically or locally on the lesion, six patients were studied. Each patient had one psoriasis lesion injected with cyclosporine, one with a pharmacologically neutral solution or vehicle, and one with saline solution. These injections were done three times a week for four weeks. All six psoriatic lesions injected with cyclosporine showed either complete or significant clearing when compared with the other lesions injected with vehicle or saline. When treatment was administered once a week, the effect was only minimal. It appears that cyclosporine does not have to be taken systemically to be effective. Failure of cyclosporine to work topically may be the result of inadequate penetration into the skin. (Consumer Summary produced by Reliance Medical Information, Inc.)

The breezes of spring aren't so gentle for people allergic to weed pollen, grass pollen, and mold spores. You've got your mother's eyes, your father's smile, and--a chronic stuffy nose? [...]

An estimated three fourths of all visits to family physicians are related in some way to stress. It was the morning after. The morning after her visit to the emergency [...]

But It Was an Accident! The Emergency Room Mercy Hospital Your Town, USA Every Day, 1991 3:30 p.m. Rick Jones, a 40-~ear-old sheet metal worker, arrives at the registration desk, [...]

Rob had a birthday last was a good time. as a party, complete with family, friends, gifts, and a cake with 41 candles. Rob felt great. He had a routine [...]

Jim Allen, a 58-year-old married Caucasian male, woke up at 3:00 a.m. with tightness in the middle of his chest, radiating to his back, neck, and arms. He was mildly [...]

Myths--fanciful stories, unsubstantiated accounts, unscientific beliefs--all provide the basis for commonly held misunderstandings about sexual activity in senior years. As more and more people enjoy longer life with good health, [...]

1. "Take charge of your body and learn ways to keep it healthy." "Please do not abuse your health by expecting antibiotics and other medicines to be prescribed for you [...]

It never ends. It just keeps going on--the investigation and trial, appeals, probation hearings, the grieving and the pain of losing a child to murder are prolonged and intensified." Years [...]

Forty-two? Forty-three? Forty-four? Don't ask me when it begins. I'm not at all sure. But I do know that middle age is an imminent reality for me and my friends. [...]

What began as a nagging backache turned out to be a weakening of the wall of the aorta (aneurysm) extending from the upper chest into the lower abdomen. The decision [...]

Doctors act like doctors because they are trained (by doctors) to act like doctors. Managers act like managers, not like doctors, because they are trained differently. The training process-education, socialization, [...]

How to Prepare for the ABMM Examination Don't waste your time studying for the certification exam of the American Board of Medical Management. IF! If your knowledge of health economics [...]

Low back pain hurts a lot of people and costs a lot of money. Eight out of 10 people experience low back pain at some time in their lives. it [...]

Susan was not her usual cheerful self. I could tell that something was not right in her world. When I asked her how things were going, tears came to her [...]

Background:Adapalene is a synthetic retinoid with an established clinical efficacy against acne and good local tolerability. Its effectiveness in the treatment of photodamaged skin has not been studied. Objective:We sought to determine the safety and efficacy of adapalene gel in the treatment of actinic keratoses and solar lentigines. Methods:In a prospective, 2-center, randomized, controlled, investigator-masked, parallel-group study, 90 patients with actinic keratoses and solar lentigines were treated daily with either adapalene gel (0.1% or 0.3%) or its vehicle gel for 4 weeks, followed by twice-daily applications, if tolerated, for up to 9 months. Results:Of the 90 Caucasian patients (69 male, 21 female; mean age 63.1 years) who were enrolled into the study, 83 patients completed 9 months of treatment. With adapalene gel 0.1% and 0.3%, the mean number of actinic keratoses was reduced by 0.5 ± 0.9 (mean ± SE) and 2.5 ± 0.9, respectively. Whereas, with the vehicle gel, there was an increase of 1.5 ± 1.3 (P< .05). After 1 month of treatment, the patients who received adapalene had significant lightening of solar lentigines as compared with the patients who were treated with vehicle gel (P< .05). After 9 months, 57% and 59% of the patients had lighter lesions in the adapalene 0.1% and 0.3% groups, respectively, in comparison with only 36% in the vehicle group (P< .05). Histologic evaluations revealed improved cellular atypia and reduced epidermal melanin in adapalene-, as compared with vehicle-treated group. The differences, however, were not statistically significant. A retrospective evaluation of paired clinical photographs (before and after 9-month treatment) by 2 dermatologists who were treatment-blinded revealed significant improvement in wrinkles and other clinical features of photoaged skin with adapalene as compared with its vehicle. Conclusion:Adapalene gel 0.1% and 0.3% were well tolerated and improved actinic keratoses, solar lentigines, and other features of photodamaged skin. (J Am Acad Dermatol 2003;49:83-90.)

Appropriate management of the family medicine cabinet is mostly just good, common sense. Mom, I feel miserable. I have a headache, my nose is all stopped up, my throat feels [...]

In a double-blind trial, 21 patients with severe plaque psoriasis were randomly assigned to receive oral cyclosporine, 14 mg/kg/d, or its vehicle. After four weeks of therapy the 11 cyclosporine recipients had the following response to treatment: two had total clearing and six improved markedly, two moderately, and one minimally; whereas ten vehicle-treated patients showed no change or minimal improvement. Vehicle-treated patients, after a switch to cyclosporine for four weeks, demonstrated impressive improvement similar to that seen in patients who initially received only cyclosporine. Moderate or marked improvement or total clearing was noted in 17 (81%) of 21 and 20 (95%) of 21 after one and four weeks of therapy, respectively. Mitotic figures and leukotriene B4 levels in lesions decreased 86% and 64%, respectively, after seven days of cyclosporine therapy. Mononuclear (including activated T cells) and polymorphonuclear leukocyte infiltrates were markedly reduced in lesions of all patients after seven days of cyclosporine therapy. These results suggest that (1) psoriasis may have an immunologic basis mediated by activated T cells and/or other immune cells; (2) if a long-term regimen with a favorable efficacy—side effect ratio can be determined, cyclosporine would be a significant advance in the treatment of psoriasis.(JAMA 1986;256:3110-3116)

A conventional stock assessment model is applied to determine the impact of entrainment and impingement at the Monroe Power Plant on the yellow perch stock of the Western basin of Lake Erie. Parameters of the model are estimated using power plant data, biological data available in the literature, and commercial catch data. The model is applied to estimate the age structure and biomass of the perch stock and to estimate the impact of the power plant on abundance of the impingeable stock and abundance and biomass of the exploited stock. The level of impact was examined under a range of mortality conditions. Under the most extreme conditions examined of full pumping, high fishing mortality, and low natural mortality, the fishable biomass is reduced by 1.7%. This impact is not large, but there are several other power plants and many additional water intakes around the Western basin of Lake Erie.

The production of 14CO2in the breath from an intravenous dose of [14C-N-methyl] -erythromycin (the erythromycin breath test [ERMBT]) and the measurement of the ratio of 6-β-cortisol to free cortisol (6-β-F/FF) in the urine have each been proposed as means of measuring hepatic P450IIIA catalytic activity in patients. We found that there was a significant correlation between the results of each test (r = 0.59, p < 0.001) in 47 patients who were without liver disease and who were not taking medications believed to influence P450IIIA catalytic activity. In the 24 of these patients who were subsequently treated with the P450IIIA substrate cyclosporine, the ERMBT result was highly correlated with the mean trough cyclosporine blood level observed; however, there was no correlation between urinary 6-β-F/FF and the cyclosporine blood levels. In a separate study of a patient during the anhepatic phase of liver transplantation surgery, the ERMBT result decreased by greater than 85%, whereas urinary 6-β-F/FF decreased by just 50%. We conclude that the ERMBT and urinary 6-β-F/FF do not always provide similar information about P450IIIA catalytic activity in patients, possibly because of extrahepatic production of 6-β-F. Of the two tests, the ERMBT appears to provide the most relevant information for cyclosporine administration.Clinical Pharmacology and Therapeutics (1992) 52, 265–273; doi:10.1038/clpt.1992.140

BACKGROUND AND DESIGN: The efficacy of topical tretinoin (all-trans-retinoic acid) in treating photoaging is well established. Questions that remain are (1) whether irritation causes all or part of the improvement; (2) the concentration of tretinoin that maximizes clinical response with minimal side effects; and (3) the effects of long-term treatment on components of the cutaneous immune system. To address these issues, 99 photoaged patients completed a 48-week study using 0.1% tretinoin cream (n=32), 0.025% tretinoin (n=35), or vehicle (n=32) once daily in a double-blind manner. Before and after treatment, we assessed histologic features, keratinocyte expression of HLA-DR and intercellular adhesion molecule-1, numbers of epidermal Langerhans' cells and epidermal and dermal T lymphocytes, and vascularity as measured by dermal endothelial cell area. RESULTS: Both 0.1% and 0.025% tretinoin produced statistically significant overall improvement in photoaging of the face compared with vehicle; there were no clinically or statistically significant differences in efficacy between the two concentrations of tretinoin. After 48 weeks, 0.1% and 0.025% tretinoin produced similar statistically significant epidermal thickening (by 30% and 28%, respectively) compared with vehicle (11% decrease) and increased vascularity (by 100% and 89%, respectively) compared with vehicle (9% decrease). By various analyses, irritant side effects (erythema and scaling) were statistically significantly greater with 0.1% tretinoin than with 0.025% tretinoin. No significant changes occurred in any immunologic markers when tretinoin and vehicle treatments were compared. CONCLUSIONS: Tretinoin 0.1% and 0.025% produce similar clinical and histologic changes in patients with photoaging, despite significantly greater incidence of irritation with the higher concentration. The separation between clinical improvement and irritation suggests that mechanisms other than irritation dominate tretinoininduced repair of photoaging in humans.(Arch Dermatol. 1995;131:1037-1044)

BACKGROUND: Cyclosporine therapy is highly effective in the treatment of psoriasis. To minimize side effects, the lowest effective dosage for maintenance therapy should be sought. METHODS: We selected 61 patients who had achieved clearing or near-clearing of psoriasis during an induction phase of cyclosporine therapy. We then randomly assigned them in a double-blind fashion to receive one of two dosages of cyclosporine (1.5 or 3 mg/kg per day) or placebo for maintenance treatment. For each patient, the time to relapse was the time from the start of maintenance therapy until the patient showed a two-point worsening of psoriasis on a seven-point scale, up to a maximum of 4 months, when the study ended. RESULTS: Sixty patients completed the maintenance study. The mean time to relapse was significantly longer in the 3-mg/kg group (12± 1 weeks) than in the 1.5-mg/kg group (9±1 weeks; P=.04) and the placebo group (7± 1

• BACKGROUND AND DESIGN.— To avoid systemic side effects, topical and intralesional administration of cyclosporine has been used; however, only intralesional administration has been successful. To understand more about the dosing requirements and resultant tissue levels of intralesional cyclosporine, we injected psoriasis plaques in a double-blind fashion with three different concentrations of cyclosporine (17 mg/mL in seven patients, 10 mg/mL in 13 patients, and 2.5 mg/mL in 11 patients) or matching vehicle three times weekly for 4 weeks. RESULTS.— Statistically significant improvement was observed in plaques treated with 17 mg/mL (P =.003) compared with vehicle-treated plaques; the improvements in plaques treated with 10 mg/mL (P=.078) and 2.5 mg/mL (P=.054) achieved marginal statistical significance compared with vehicle treatment. Four weeks after discontinuation of ther

• In an 8-week double-blind trial of sulfasalazine for the treatment of moderate-to-severe psoriasis, 23 and 27 patients received the active and placebo tablets, respectively. At the end of the double-blind phase, there were 17 assessable patients receiving sulfasalazine; 7 (41%) had marked improvement, 7 (41%) had moderate improvement, and 3 (18%) demonstrated minimal change. Only 1 patient receiving placebo demonstrated moderate improvement, whereas the rest had minimal improvement or worsening of psoriasis. When the randomization code was broken, patients receiving sulfasalazine were allowed to continue therapy for an additional 4 weeks in an open manner, while those using placebo left the study. Six of 23 patients discontinued sulfasalazine therapy during the double-blind phase because of side effects, 4 due to the development of a cutaneous eruption and 2 due to nausea. Fourteen of 17 patients, who were assessable at the end of the 8-week double-blind phase, completed the additional 4 weeks of sulfasalazine therapy. Of these 14 patients, marked improvement occurred in 8 (57%), moderate improvement in 2 (14%), and minimal improvement in 4 (29%), compared with pretherapy. The low incidence of severe side effects makes sulfasalazine a consideration for oral therapy in patients whose disease severity does not justify use of methotrexate, etretinate, or psoralen plus UV-A, but whose disease severity is too widespread for safe and practical use of topical corticosteroids.(Arch Dermatol. 1990;126:487-493)

BACKGROUND AND DESIGN: Stretch marks are disfiguring lesions usually caused by excessive stretching of skin. We investigated the response of early, clinically active stretch marks to topical 0.1% tretinoin (retinoic acid) cream. In a double-blind, randomized, vehicle-controlled study, 22 patients applied either 0.1% tretinoin (n=10) or vehicle (n=12) daily for 6 months to the affected areas. Patients were evaluated by physical examination monthly and by analysis of biopsy specimens of stretch marks obtained before and at the end of therapy in comparison with untreated normal skin. RESULTS: After 2 months, patients treated with tretinoin had significant improvement in severity scores of stretch marks compared with patients who received vehicle (P&lt;.05). After 6 months, eight (80%) of the 10 tretinointreated patients had definite or marked improvement compared with one (8%) of the 12 vehicle-treated patients (P=.002). Targeted stretch marks in patients treated with tretinoin had a decrease in mean length and width of 14% and 8%, respectively, compared with an increase of 10% (P&lt;.001) and 24% (P=.008), respectively, in patients who received vehicle. There were no significant differences in various measures of quality and quantity of dermal collagen and elastic fibers in stretch marks when tretinoin and vehicle treatments were compared. CONCLUSIONS: Topical application of tretinoin significantly improves the clinical appearance of early, active stretch marks. The processes that are responsible for the clinical improvement remain unknown.(Arch Dermatol. 1996;132:519-526)

BACKGROUND AND DESIGN: The ability of superficial dermabrasion to improve clinical features of photoaged skin is well known, but the specific biological mechanisms involved are poorly understood. The so-called repair zone, as visualized by routine histologic examination, has been attributed to new collagen formation within the papillary dermis and may be responsible for clinical improvement following dermabrasion. We investigated molecular and histologic events occurring in dermabraded skin and correlated them with clinical improvement. Ten photoaged patients (mean age, 59 years) underwent facial dermabrasion to the level of the papillary dermis. Clinical severity of photoaging was graded in a blinded manner at baseline and 12 weeks after dermabrasion. Biopsy specimens obtained at baseline and 3 and 12 weeks after dermabrasion were analyzed histologically and by in situ hybridization for fibroblast procollagen I mRNA, immunohistologically and by Western blotting with a monoclonal antibody specific for the aminoterminal cleavage site of procollagen I. RESULTS: Masson's trichrome staining demonstrated an increase in collagen from baseline (as an upper dermal band in the dermabrasion ''repair zone'') at 3 and 12 weeks' postdermabrasion. Immunohistologic examination demonstrated papillary dermal fibroblast staining for procollagen I at baseline that increased by threefold at 3 weeks' postdermabrasion and by 1.5-fold at 12 weeks' postdermabrasion. Western blotting demonstrated an average-fold increase in pN collagen I of 4.2± 1.5 at 3 weeks and of 2.7±0.7 at 12 weeks. By in situ hybridization, baseline levels of procollagen I mRNA in papillary dermal fibroblasts increased sixfold at weeks 3 and 12 postdermabrasion. Increase in procollagen I mRNA correlated with clinical improvement, ie, reduction in wrinkling. CONCLUSION: Superficial dermabrasion clinically improves photoaged skin, and this improvement correlates strongly with increased collagen I gene expression.(Arch Dermatol. 1994;130:1136-1142)

BACKGROUND AND DESIGN: Melasma is an acquired, masklike, facial hyperpigmentation. The pathogenesis and treatment of melasma in black (African-American) patients is poorly understood. We investigated the efficacy of topical 0.1% all-trans-retinoic acid (tretinoin) in the treatment of melasma in black patients. Twenty-eight of 30 black patients with melasma completed a 10-month, randomized, vehicle-controlled clinical trial in which they applied either 0.1% tretinoin or vehicle cream daily to the entire face. They were evaluated clinically (using our Melasma Area and Severity Index), colorimetrically, and histologically. RESULTS: After 40 weeks, there was a 32% improvement in the Melasma Area and Severity Index score in the tretinoin treatment group compared with a 10% improvement in the vehicle group. Colorimetric measurements showed lightening of melasma after 40 weeks of tretinoin treatment vs vehicle. Lightening of melasma, as determined clinically, correlated well with colorimetric measurements. Histologic examination of involved skin revealed a significant decrease in epidermal pigmentation in the tretinoin group compared with the vehicle group. Side effects were limited to a mild ''retinoid dermatitis'' occurring in 67% of tretinoin-treated patients. Among the patients in this study in comparison with comparably recruited white patients, melasma was reported to have begun at a later age and was more likely to be in a malar distribution.Conclusions: This controlled study demonstrates that topical 0.1% tretinoin lightens melasma in black patients, with only mild side effects.(Arch Dermatol. 1994;130:727-733)

† BACKGROUND AND DESIGN.— The assessment of the severity of cutaneous photodamage and its response to treatment is an impractical consideration for most practitioners without extensive experience or recourse to high-quality, standardized, baseline photographs. To address this problem, a ninepoint photonumeric standard scale was developed using photographs of subjects representing grades of photodamage from none to severe. This scale was formally tested in a side-by-side comparison with a conventional and widely used written descriptive scale. A panel of seven graders used both scales to score two sets of 25 photographs of photodamaged individuals, and the intergrader agreement and repeatability for the scales were calculated. RESULTS.— The photonumeric scale demonstrated significantly greater agreement between graders than did the descriptive scale (chance-corrected agreements of 0.31 and 0.11, respectively, P&lt;.0001) with no significant difference in repeatability between the two methods. CONCLUSIONS.— This study demonstrates that the photonumeric standard scale is superior to existing methodology in the accurate assessment of cutaneous photodamage and would be a useful adjunct to studies of the efficacy of skin repair agents for this indication.(Arch Dermatol. 1992;128:347-351)

• A histologic study was designed to evaluate the pilosebaceous unit of the scalp in nonpustular patch- and plaque-stage psoriasis. Punch biopsy specimens from involved and uninvolved areas of 28 patients were sectioned in a horizontal plane for qualitative and quantitative study. All samples were evaluated in a blind mode, and data were analyzed for statistical significance. There was no evidence for alopecia of any type. Sebaceous gland atrophy was a frequent concomitant in the psoriatic lesion, with probable down-sizing of the hair follicle and thinner hair shafts. Paradoxical sebaceous gland atrophy and down-sized hair follicles in psoriasis may be due to possible inhibiting effects of yet unidentified factors produced by the epidermal lesion.(Arch Dermatol. 1989;125:639-642)

† Findings from an eight-week fish oil-supplemented diet given to 13 psoriatic patients demonstrated that eicosapentaenoic acid (20:5,n3 [EPA]) and docosahexaenoic acid (22:6,n3 [DCHA]) are rapidly incorporated into the sera, neutrophils, and epidermis of participating patients, and that the incorporation of EPA and DCHA into epidermal lipids increased with weeks of supplementation with minimal alteration of arachidonic acid (AA) in the epidermal lipids. Global clinical evaluation showed that eight patients demonstrated mild to moderate improvement in their psoriatic lesions. Improved clinical response correlated with high EPA/DCHA ratios attained in epidermal tissue specimens. These findings underscore the need for further investigations into the role of dietary n3 fatty acids, particularly the possibility of pentaenoic acid as a potential protective agent and/or therapeutic adjunct for the clinical management of psoriasis.(Arch Dermatol 1986;122:1277-1282)

• The HLA type of patients with various kinds of immune reactions to bovine collagen implants were evaluated to determine a possible genetic basis for such responses. All patients suffering adverse clinical reactions to bovine collagen implants were lacking the HLA-DR4 antigen. All patients who received multiple bovine collagen injections without having adverse clinical reactions were lacking HLA-B5 and HLA-DR5 and had a significantly increased incidence of HLA-DR4. Combinations of histocompatibility antigens may influence immune response to bovine collagen implants.(Arch Dermatol 1986;122:650-654)

In a 16-week randomized, double-blind, vehicle-controlled study of topical tretinoin in the treatment of photoaging, all patients applied topical tretinoin to one forearm and vehicle cream to the other. Half of the patients received tretinoin to the face, and half received vehicle cream. All 30 patients who completed the study showed statistically significant improvement in photoaging on the tretinoin-treated forearms, but not on the vehicle-treated forearms. Fourteen of the 15 patients who received tretinoin to the face had improvement in photoaging, whereas none of the vehicle-treated patients' faces improved, a statistically significant difference in response between the two groups. Statistically significant histologic changes were seen in forearm skin treated with tretinoin, but not with vehicle cream. Side effects were limited to irritation of tretinoin-exposed skin.(JAMA 1988;259:527-532)

The daily dose of cyclosporine required to attain a desired blood level can vary greatly among patients. Because elimination of cyclosporine depends on its metabolism in the liver by an enzyme (cytochrome P-450IIIA) that also demethylates erythromycin, we reasoned that the ability of patients to demethylate a test dose of erythromycin might be useful in estimating their appropriate daily doses of cyclosporine. Accordingly, the [14C-N-methyl] erythromycin breath test was administered to 32 patients before they received 3.0, 5.0, or 7.5 mg/kg/day cyclosporine to treat psoriasis. We found that a simple mathematical equation incorporating just the 14CO2production, the age of the patient, and the daily dose of cyclosporine accounted for almost 80% (R2= 0.78) of the interpatient variability in cyclosporine blood levels we observed. Our data indicate that P-450IIIA activity largely accounts for the relationship between dose of cyclosporine and blood levels for an individual patient. We conclude that the erythromycin breath test may be a convenient guide for cyclosporine dosing.

Long-term sun exposure (UV-A and -B light) results in characteristic clinical changes of the skin (eg, wrinkles, lentigines, elastosis, roughness, and sallowness) collectively known as photodamage.1 We observed that a number of our patients have asymmetrical facial photodamage, with the left side of the face appearing more severely photodamaged than the right side. We postulated that this perceived left-sided predominance of severe photodamage may have arisen from exposure to UV light while driving a left-hand-drive automobile. We performed a study designed to test this hypothesis. METHODS. A total of 120 patients (age range, 43 to 81 years; mean, 62 years; 105 female and 15 male subjects) were recruited through the mail using a questionnaire that obtained the following information: age, sex, occupation, percentage of time spent as an automobile driver, number of years as a driver, number of hours driven per week, and the percentage of time driving with