Clinical and experimental dermatology
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Clin. Exp. Dermatol. · Nov 2004
Clinical TrialTopical tacrolimus for treatment of childhood vitiligo in Asians.
Childhood vitiligo is a common disorder of pigmentation in India. Considering the lack of uniformly effective and safe treatment modalities for children with vitiligo, search for newer therapeutic agents continues. This study was designed to evaluate the role of topical tacrolimus in the treatment of childhood vitiligo. ⋯ Of these 19 children, repigmentation was marked to complete in 11 (57.9%), moderate in five (26.3%) and mild in three (15.7%) children. Side effects were minimal, such as the pruritus and burning noted in only three patients. Topical tacrolimus is an effective and well-tolerated treatment modality in Asian children with vitiligo.
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Clin. Exp. Dermatol. · Nov 2004
NK-1 antagonist CP99994 inhibits stress-induced mast cell degranulation in rats.
Mast cells are implicated in stress-induced inflammatory skin diseases such as psoriasis. Mechanisms of stress-induced mast cell degranulation however, are not entirely clear. Here we explore the role of activation of a Substance P (SP) receptor (NK-1) on mast cell degranulation upon exposure to stress in rats. ⋯ Both central and peripheral injection of CP99994 prevented stress-induced mast cell degranulation. Surprisingly, the combination of stress with SP decreased mast cell degranulation, suggesting that high levels of SP may counteract the stress responses. Results in this animal model suggest that NK-1 antagonists may be used therapeutically to treat stress-induced inflammatory skin diseases; however, drug doses should be chosen carefully.
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Clin. Exp. Dermatol. · Sep 2004
Clinical TrialOpen study of the efficacy and mechanism of action of topical imiquimod in basal cell carcinoma.
Imiquimod is an immune-response modifier that has been shown to be effective in the treatment of superficial and nodular basal cell carcinoma (BCC). The objective of this open-label study was to investigate the effectiveness of imiquimod 5% cream in superficial, nodular, and infiltrative BCC. Fifty-five Caucasian patients with primary BCC measuring 8 mm or more in diameter with a superficial, nodular, or infiltrative histological pattern were included in the study. ⋯ Multi-variate analysis demonstrated that baseline tumour size was the most powerful independent prognostic variable (P < 0.05). Treatment with imiquimod increased the apoptotic index (P < 0.05), reduced Bcl-2 expression (P < 0.05), and increased the number of CD3+, CD8+, CD20+, CD68+, granzyme B+, and S-100+ cells in the inflammatory infiltrate of the BCC (P < 0.05). In conclusion, imiquimod induced an antitumour immune response mediated by lymphocytes and macrophages, reduced Bcl-2 expression and increased the apoptotic index of BCC, and was clinically effective in 74% of BCCs after a 2-year follow-up period.
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Postgraduate higher specialist training of dermatology in the UK has become more structured over the past 8 years. Increased awareness of the need to police our profession has impelled the introduction of objective competency based assessment. Competency assessment will take three forms: mini clinical evaluation exercise, directly observed procedural skills and 360-degree assessment. These components of assessment will direct much needed rigour into the training system and may be the first step on the road to a formal exit examination in dermatology.
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Clin. Exp. Dermatol. · May 2004
The distribution of IgG subclasses in the lupus band suggests disease-specific alteration in subclass switching rather than polyclonal B-cell activation.
Deposition of immunoglobulins in the skin of patients with lupus erythematosus (LE), demonstrable as a linear band 'lupus band' at the basement membrane zone (BMZ) by direct immunofluorescence, was first described in 1963. Four decades after the discovery of the lupus band, a basic question regarding the origin of immunoglobulins of the lupus band is still unanswered. Is the lupus band just a manifestation of polyclonal B-cell activation commonly seen in systemic LE (SLE)? The distribution of IgG subclasses deposited in the skin of patients with SLE was identified using immunohistochemistry. The relative restriction of IgG of the lupus band to the IgG3 subclass demonstrated in this study provides evidence against polyclonal B-cell activation as the only cause of the lupus band and suggests disease-specific alteration in subclass switching.