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Objetivo Determinar si el tratamiento con corticoides topicos potentes durante 3 dias es tan eficaz como la aplicacion de preparados de baja potencia durante siete dias en la dermatitis atopica infantil leve o moderada. Diseno Estudio aleatorizados, doble ciego, grupos paralelos durante 18 semanas, con visitas de seguimiento cada 6 semanas. Emplazamiento Se ha realizado en 13 centros de atencion primaria y un hospital docente en el area de Nottingham (Reino Unido). Poblacion de estudio Se han estudiado 207 ninos (de 1 a 15 anos) con dermatitis atopica leve o moderado: 174 en los centros de salud y 33 en la consulta ambulatoria hospitalaria. Fueron criterios de exclusion: eccema atopico grave, sensibilidad conocida al preparado en estudio y eccema limitado a la cara o el area del panal. Intervencion Los participantes del estudio fueron aleatorizados y asignados a uno de los dos brazos de tratamiento. Un grupo (n = 104) recibia hidrocortisona 1% dos veces al dia durante 7 dias y el otro (n = 103), valerato de betametasona al 0,1% dos veces al dia durante 3 dias, seguido por una base hidratante durante 4 dias Medicion del resultado Variables primarias: numero de dias libres de rascado y numero de recaidas. Variables secundarias: el control es evaluado comparando la mediana de duracion de la primera recaida y la mediana de duracion de la primera remision en los dos grupos de tratamiento. Tambien evaluan el numero de noches tranquilas, la gravedad de la enfermedad (seis signos de escala de gravedad de dermatitis atopica), la calidad de vida (indice de calidad de vida en ninos y cuestionario de impacto familiar), proporcion de fracasos del tratamiento, medidas del espesor de la piel y coste economico. Resultados principales No se han encontrado diferencias en los dos grupos estudiados. La mediana del numero de dias libres de rascado era de 118,0 en el grupo de baja potencia y 117,5 en el grupo potente (diferencia, 0,5; 95%; intervalo de confianza [IC] –2,0 a 4,0; p = 0,53). La mediana del numero de recaidas en ambos grupos fue de 1,0. El numero de recaidas por paciente oscila entre 0 y 9; 73 (44%) de los participantes no tuvieron ninguna recaida: 36 en el grupo suave y 37 en el grupo potente. Tampoco hay diferencias en la evaluacion de las variables secundarias Conclusiones La aplicacion de corticoides topicos potentes en pauta corta es tan eficaz como el uso prolongado de corticoides topicos de baja potencia en el control de la dermatitis atopica infantil leve o moderada.

Aims This study aimed to determine whether a 3-day burst of a potent steroid is more effective than a weak preparation used for 7 days in treating disease exacerbations and in maintaining remissions in children with atopic eczema. Methods A randomized, double-blind, parallel group study of 18 weeks' duration. 174 patients with mild or moderate atopic eczema were recruitment from 13 general practices in the Nottingham area. Two primary outcomes were evaluated: (i) the total number of scratch-free days and (ii) the number of disease relapses. Secondary outcomes included the median duration of the 1st disease relapse; the number of nights when sleep was not disturbed; disease severity (SASSAD), two quality-of-life measures (CLQI and DFI) and the number of treatment ‘failures’ in each arm. Skin thickness was measured using B-mode ultrasound. Results We found no differences between the two groups for any of the outcome measures used. The median number of scratch free days was 118.0 for the hydrocortisone group and 117.5 for the betamethasone valerate group (95% CI median difference −2–4, P = 0.53). The median number of relapses for both groups was 1. Both groups showed clinically significant improvements in disease severity and quality-of-life compared to baseline. No significant changes in skin thickness were observed. Conclusions For children with mild or moderate atopic eczema in the community, both 1% hydrocortisone used for 7 days, or betamethasone valerate 0.1% used for 3 days, are effective in controlling disease symptoms.

Background This NHS/HTA-funded study aimed to rank five commonly used antimicrobial therapies for acne in order of their clinical effectiveness and cost-effectiveness. We also wanted to identify which agents are less likely to promote resistance and those which are effective in patients who harbour high numbers of resistant Propionibacterium acnes strains. Methods From surgeries and colleges in the Nottingham and Leeds areas, 649 patients with mild to moderate facial acne were recruited. The two primary outcome measures were patient self-assessment of improvement in overall acne severity and reduction in inflamed lesion count, measured at 18 weeks. Secondary outcome measures included two acne severity scores, assessors' global estimation of improvement, quality of life and utility scores, enumeration of antibiotic resistant propionibacteria, and the incidence of adverse events. Results and Conclusions The most effective treatments (percentage with at least moderate improvement according to patients, mean change in lesion count) were the topical Benzamycin® b.d. (66%, − 27) and its components given separately (topical erythromycin o.d. + 5% benzoyl peroxide o.d.) (63%, − 26), followed by 5% benzoyl peroxide b.d. (60%, − 23). The least effective were oral oxytetracycline (55%, − 18) and minocycline (54%, − 22). The most cost-effective treatment was benzoyl peroxide and least cost-effective was minocycline. In terms of quality of life, benzoyl peroxide moved down the rankings and minocycline moved up. The two topical erythromycin-containing regimens produced the largest reductions and the oral treatments the smallest in the prevalence and population density of cutaneous propionibacteria. Prior bacterial colonisation did not affect outcome in the topical groups. Efficacy of both oral preparations was influenced by tetracycline resistant P. acnes strains. Disclaimer The views and opinions expressed are those of the authors and do not necessarily reflect those of the Department of Health.

EDITOR,—In their systematic review Anton J M de Craen and colleagues conclude, on the basis of a range of outcome measures, that the combination of paracetamol and codeine is a more effective analgesic than paracetamol alone.1 They find the increase in efficacy to be small but significant and suggest that future studies should report the proportion of patients in whom good or …

SUMMARY A rapid stability-indicating high-performance liquid chromatographic assay for noxythiolin has been developed and its application to the determination of the shelf-life of solid and solution forms is illustrated. Kinetic models which describe the degradation profile have been evaluated and concentrated solutions are modelled by a A = B + C system whereas more dilute solutions approximate to the A = B or limiting first-order case.

Salicylate esters undergo reversible transesterification in alcoholic solutions in which the ester radical differs from that of the alcohol. The reactions are base-catalyzed and the predominant pathway involves a concerted solvent attack upon the salicylate anion. Competitive hydrolysis of both ester components also follows this mechanism at moderate pH values but rates increase under strongly alkaline conditions as direct hydroxide attack becomes significant. In contrast, transesterification is independent of base concentration once full ionization is accomplished. Equations are presented to model the time-profile of reactant and product concentration. The process may affect the integrity of pharmaceutical formulations and a gel formulation is shown to degrade rapidly.

Circular high-performance thin-layer chromatography (HPTLC) has been used to differentiate a series of twelve tricyclic neuroleptics, using both normal phase and reverse phase procedures. The use of normal phase systems also allows the resolution of geometric isomers of chlorprothixene, clopenthixol and flupenthixol. Thirteen sulphonamides and Trirnethoprim may also be distinguished using HPTLC.

High-performance liquid chromatographic assays for the controlled-release penicillin complexes benzathine-cloxacillin, benzathine-penicillin V, procaine-penicillin G, benethamine -penicillin G and benzathine-penicillin G are described. Reversed-phase ion-paired chromatography using related aqueous acetonitrile mobile phases enables both components of the complex to be determined simultaneously. The utility of the methods is demonstrated by application to various formulations including fortified injections, which contain two complexes, and a suspension which also contains four preservatives.

The use of laser velocimetry for the non-invasive assessment of the effects of topically applied solvents and a model vasodilator, hexyl nicotinate, is reported. The importance of excluding solvent effects on the recorded response is emphasised and the value of the technique for predicting the effects of formulation changes is illustrated.

Potassium chloride release from a number of compressed hydrophilic polymer tablets is investigated with a view to designing a simple zero-order release system. The approach used is based on incorporation of low levels of effervescent mixtures within the table matrix. Supporting work on related polymeric systems is also discussed.