ISSN:0954-6634    

DOI:10.3109/09546639109086757

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

OBJECTIVE To determine the relative cost effectiveness of long term rotational antibiotics and isotretinoin for moderate/severe acne over a 5-year period.DESIGN Retrospective study of pairs of patients matched for age, sex, acne severity and duration of acne.SETTING Teaching hospital dermatology out-patient department.SUBJECTS A group of 100 patients under long-term assessment for relapse rate following isotretinoin treatment were matched against a group of 100 similar patients who were given long-term antibiotics.MAIN OUTCOME MEASURE Prescribing costs and costs of out-patient visits. Costings were derived for dispensing from hospital (isotretinoin and antibiotics) or the community (antibiotics).RESULTS The mean duration of courses of isotretinoin was 19 weeks compared with 64.4 months for courses of rotational antibiotics and topical medication. Isotretinoin produced more than 60% improvement in 88% of patients, while only one patient in the antibiotic group improved by more than 50% of the initial acne severity and 34% suffered deterioration of acne over the 5-year treatment period. The median cost of isotretinoin and any additional acne treatment was£650 (±£65.16 (95% ci)) and the mean cost of rotational antibiotics was£1863 (±£56.80) if dispensed from the hospital pharmacy or£2108 (±£61.10) if dispensed in the community. These differences were highly significant (p<.001).CONCLUSION A single course of isotretinoin was much more effective than any equivalent course of antibiotics although more expensive. For the treatment of moderate/ severe acne, isotretinoin proved to be significantly more cost effective than long term rotational antibiotics over the 5-year period of observation. There is, therefore, not only a great personal saving in terms of distress and discomfort, but also an important global saving in financial terms from using isotretinoin rather than long-term rotational antibiotics. In addition, there were significant differences between hospital- and community-based dispensing of antibiotics and topical preparations for acne.

ISSN:0954-6634    

DOI:10.3109/09546639109086758

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Gonadotrophin releasing hormone analogues (GnRH-A) suppress ovarian activity resulting in lowering of plasma oestrogens and androgens of ovarian origin, thus reducing androgen drive to target organs in the skin. They may be of value in the treatment of hirsuties. Sixteen female patients with mild idiopathic hirsuties and normal menstrual cycles were studied. Patients received depot implants of GnRH-A (goserelin) at 4-weekly intervals for 6 months initiated in early follicular phase as well as a single oestradiol implant at the time of the first goserelin implant. Hair measurements, by a global scoring system and microscopy (hair diameter, growth rate and presence of medulla), sebum excretion rates, and measurements of circulating testosterone, sex hormone binding globulin, and free androgen index were made at 8-weekly intervals throughout the trial. The treatment was well tolerated. Seven patients had amenorrhoea and the remaining nine had reduced menstrual bleeding. Only one patient complained of mild flushing. Patients did not notice significant improvement over the active study period. There was a 10–15% fall in sebum excretion rate compared with baseline during the treatment period (week 8 to 24) with a rebound 8 weeks after the last treatment, but these changes did not reach statistical significance. There was no consistent change in hair diameter or hair growth rate or in the numbers of hairs in which the medulla was intact, partially present or absent. There was a significant fall in Ferriman and Gallwey hirsuties score during the treatment period (p<0.05). The study demonstrated that although the GnRH-A caused suppression of testosterone and free testosterone index, this effect was not sufficient to influence hair growth rate or hair diameter in a group of patients with mild idiopathic hirsuties.

ISSN:0954-6634    

DOI:10.3109/09546639109086759

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

The vitamin-D analogue calcipotriol has immunological properties which suggest that it may be effective in alopecia areata. To investigate this we assessed the response to treatment with this compound in a group of 20 patients with alopecia totalis or universalis. The study was of placebo-controlled double-blind design. Each subject applied ointment containing 50μg/g calcipotriol to one side of the scalp and matching vehicle to the other. There was no evidence of a response to calcipotriol in this group of subjects with very severe alopecia.

ISSN:0954-6634    

DOI:10.3109/09546639109086760

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Fifty patients with cutaneous mosaic warts resistant to standard therapy took part in a double-blind, placebo-controlled study to assess the efficacy of inosine pranobex used as an adjunct to standard topical treatments. No statistically significant difference was found in cure rates between the active (37.5%) and placebo treatments (34.6%) at 6 months, nor was there any relationship between clinical response and either antibody production or in vitro assay of lymphocyte proliferative activity against human papilloma virus (HPV) type 2 in either group.

ISSN:0954-6634    

DOI:10.3109/09546639109086761

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

In a double-blind randomized comparative study, 75 patients with dermatomycoses (one cutaneous candidosis and 74 dermatophyte infections) were treated with amorolfine cream 0.125% (group A, 25 patients), 0.25% (group B, 25 patients) or 0.5% (group C, 25 patients). Treatment, consisting of a once daily application, was continued for 1 week after clinical cure, the maximum duration of treatment was limited to 6 weeks. Assessment of the results was based on both clinical and mycological parameters. At the end of the treatment clinical cure rates ranged from 76% to 84%, and mykological cure ranged from 64% to 76%. There were two patients in each group (8%) who did not respond to the treatment, and eight patients had to withdraw due to side-effects. At the assessment 2 months post-therapy 20 patients (80%) in group A, 17 (68%) in group B and 18 (72%) in group C were cured. There were six relapses: 3 (12%) in group B and 3 (12%) in group C. There was no significant difference between the three groups in terms of clinical and mycological response, duration of treatment or tolerance.

ISSN:0954-6634    

DOI:10.3109/09546639109086762

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

The efficacy of a medicated tape containing 8μg/cm2fluocinolone acetonide (FA) was compared with 0.025% FA cream applied under occlusive dressing in two groups of psoriatic patients. At the end of the treatment no difference was detected between the two groups. The FA medicated tape offers many advantages: better compliance, control of dose of steroid delivered, and a major saving in the cost of treatment.

ISSN:0954-6634    

DOI:10.3109/09546639109086763

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

We report a case of Cushing's syndrome following obsessional abuse of a potent topical steroid lotion applied exclusively to the scalp, and which resolved after the lotion was withdrawn. This case exemplifies the danger of prolonged undersupervised use of potent topical steroids and caution is necessary with all long-term prescriptions.

ISSN:0954-6634    

DOI:10.3109/09546639109086764

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Alopecia mucinosa associated with T-cell lymphoma has no satisfactory treatment. We report a patient with a T-cell lymphoma associated with a B-cell lymphoma (malignant monoclonal gammapathy) which was treated with recombinant interferon-alpha. Alopecia mucinosa, which had been present for 3 years and had not responded to topical corticosteroids, photochemotherapy and a dmonth course of systemic chemotherapy, disappeared within 3 months after initiation of interferon. The drug was also effective in both lymphomas, and that may be one explanation for hair regrowth. A direct effect of interferon on fibroblasts is also possible.

ISSN:0954-6634    

DOI:10.3109/09546639109086765

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

In recent years, much attention has been focused on cyclosporin as a new alternative drug for the treatment of recalcitrant disabling psoriasis vulgaris. This drug has the important advantage of being non-myelotoxic as compared to other immunosuppressants. In conjunction with the earlier reported data concerning the clinical use of cyclosporin to treat severe psoriasis, three treatment schedules are outlined: short-term, intermittent and long-term. Uncontrolled treatment of psoriasis with cyclosporin could increase the risk of irreversible renal damage. The use of cyclosporin, therefore, requires a multidisciplinary ap proach in which regular consultations and monitoring by a dermatologist and, if warranted, by a nephrologist are imperative.

ISSN:0954-6634    

DOI:10.3109/09546639109086766

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor