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The influence of irradiation with UV-A and PUVA (8-methoxypsoralen and UV-A) on delayed hypersensitivity reactions to microbial antigens was studied in healthy human individuals. Skin reactions to Candidaalbicans antigen and PPD were enhanced by UV-A als well as by PUVA compared with nonirradiated tests. A statistically significant difference was reached with UV-A for both antigens. For PUVA, erythemogenic doses to Candida tests produced a significant increase of response. [ABSTRACT FROM AUTHOR]

Ketoconazole 200-400 mg was given once daily for a maximum period of 12 months to 31 patients with chronic (mean duration, 12 years) dermatophyte infections of the hands and/or feet. Griseofulvin had previously been withdrawn due to intolerance or lack of effect. All skin and nail infections improved clinically. Fifty percent of the patients with skin infections and 26% of those with nail infections became clinically clear and culture-negative. Six months later, relapses had occurred in 8 of 12 patients (67%) with cleared skin lesions, and in 2 of 5 (40%) with cleared nail infections. Ketoconazole was discontinued in one patient due to headache and in another due to asymptomatic transient elevation of hepatic laboratory tests. Ketoconazole is an alternative when a replacement for griseofulvin is required, provided the degree of disability justifies the risk of drug toxicity. [ABSTRACT FROM AUTHOR]

A double-blind study of twenty-eight patients with severe oral lichen planus treated with etretinate (75 mg daily) or a placebo for 2 months, showed that the oral retinoid had a marked beneficial effect. Nine non-responders who had received only placebo then entered an open cross-over study and they responded well to etretinate. Etretinate thus provided effective symptomatic relief for severe oral lichen planus, but side-effects were common, and six patients stopped treatment because of them. [ABSTRACT FROM AUTHOR]

Dequalinium chloride is a topical antiseptic, whose use may be attended by skin necrosis. Since microcirculatory changes are an early and distinct manifestation of tissue injury, the tissue damaging effect of dequalinium chloride on the microcirculation was examined. The immediate vascular reactions were studied by vital microscopy of the hamster cheek pouch and the late effects were visualized by microangiography of the rabbit ear. An aqueous solution of dequalinium chloride in concentrations well below those used in clinical practice induced severe microcirculatory disturbances. [ABSTRACT FROM AUTHOR]

A total of 113 patients with recurrent genital herpes were enrolled in a multicentre cross-over study. Two consecutive recurrences were treated with either oral acyclovir 200 mg or matching placebo five times daily for five days. Acyclovir significantly reduced the time to crusting and healing and the duration of new lesions and symptoms. Acyclovir was not found to have any clinically significant effect on the haemato-logical or biochemical parameters measured, or to have caused adverse events and was well tolerated. Early self-initiated treatment may abort a recurrent attack of genital herpes without progression to the ulcerative or crusting stage. [ABSTRACT FROM PUBLISHER]

The article focuses on two new cases of autoerythrocyte sensitization syndrome, with special emphasis on psychiatric aspects. This syndrome is characterized by painful ecchymotic lesions of the skin that develop in a very stereotypic manner. It is noted that this syndrome is prevalent in North America and Australia and been confined to women between 15 and 65. The patients exhibited hysteroid, sensitive and psychoinfantile personality traits, inadequate social adaptation and mental insufficiency. Explanatory models are presented to account for the observed association between the specific somatic symptom picture and the fairly consistent psychiatric features.

The recommended isotretinon dose for severe (nodulocystic) acne has for almost 40 years been 0,5-1,0 mg/kg/day reaching a cumulative dose of 120-150 mg/kg.  Moderately severe acne has been treated with long-term systemic antibiotics, which carries a risk for microbial resistance in skin och intestinal flora. The Swedish Medical Products Agency approved in 2014 that patients with acne recurring after oral antibiotics given for at most two 3-month periods can be considered for isotretinoin treatment, but the dose regimen was not changed. These patients have moderate inflammatory acne (papulopustular) and studies over the recent years have shown that treatment with low-dose isotretinoin, 0,2-0,4 mg/kg/day, until acne recovery and independent of cumulative dose is effective. There are less frequent and less severe mucocutaneous side-effects, reduced risk of acne flares and it is considerably less expensive than traditional dosing. The duration of treatment is however prolonged, and the pregnancy prevention program must be followed.

Rosacea is a chronic inflammatory disease with facial erythema and papulopustules. It is common in middle-aged/elderly persons and often affects self-perception and social well-being. It is generally classified into four subtypes. Improved understanding of pathophysiology has resulted in novel treatment approaches, but routine management in health care usually follows old trails. Most patients are managed in primary care. Greater attention to the reduced skin barrier, avoidance of exacerbating factors, better topicals and encouragement to topical maintenance treatment should reduce the use of oral tetracyclines. Low-dose isotretinoin is reserved for treatment-resistant patients, but relapses are frequent unlike its use in acne. In order to reduce antibiotic use, we propose that patients should be referred to a dermatologist for optimization of therapy including consideration of isotretinoin following tetracycline treatment of a maximum of 4-6 months.

In 2003 the European Agency for the Evaluation of Medicinal Products amended the summary product characteristics for oral isotretinoin to standardise information provided from the different countries of the European Community. The Committee for Proprietary Medicinal Products recommended that among others, exclusively severe forms of acne (such as nodular or conglobate acne or acne at risk of permanent scarring) resistant to "adequate courses" of standard therapy with systemic antibacterials and local therapy should benefit from oral isotretinoin. However, no indication was provided on what were considered adequate courses or the possibility given to use oral isotretinoin as first line treatment. The aims of the present report were: 1) to provide a specialist view on when it is appropriate to introduce oral isotretinoin as a second line therapy for acne, taking into consideration optimum dosage and duration of systemic antibiotics prior to the start of the oral isotretinoin, and 2) to support the use of oral isotretinoin as first line therapy in specific cases for acne in clinical practice. The recommendations are based on an exhaustive literature review as well as on the personal experience of the members of an European panel of acne specialists. The EEP agreed with the decision made by the CPMP that oral isotretinoin should be administered as 2nd line therapy in those cases of severe acne, which were resistant to or which did not respond successfully to an initial combination regimen with systemic antibiotics and topical treatments (topical retinoids +/- benzoyl peroxide). However, the members emphasized that a number of prognostic factors, as well as psychosocial morbidity should be taken into account when choosing the regimen and that these factors may influence the use of oral isotretinoin as first line therapy.

Non-rational prescribing of oral antibiotics in acne is common, and there is currently an unmet need for up-to-date guidelines that specifically address these issues. Presented here is a set of recommendations on the use of oral antibiotics in acne, developed by a group of European acne specialists, designed to be considered by dermatologists and general practitioners in their daily practice throughout Europe. Recommendations cover optimal choice of antibiotic, drug doses, duration of treatment, combination treatment, and maintenance therapy.