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2 2 Journal Watch πæ. ª «μ Õ»«ππ å π.õ. πæ. «πå πå 1 A prospective randomized clinical trial comparing topical aloe vera with 0.1% triamcinolone acetonide in chronic plaque psoriasis º ß π«õß Õ. Õπ àπ Ëπ πõ Ë Prague πà π πà Ÿ (Õ ππ È ªìπ ÿª Ë π πõ π«æ å ) Choonhakarn C, et al. Abstract P347. Presented at the International Congress of Dermatology MedPage Today (5/26, Bankhead) reported that, according to a study presented at a dermatology conference, "patients with plaque psoriasis had a greater reduction in disease activity when treated with topical aloe vera compared with a topical steroid." For the study, researchers from Thailand's Khon Kaen University "evaluated aloe vera and an active comparator." They recruited "80 patients who had a baseline" Psoriasis Area and Severity Index (PASI) "score of about 11." Next, they randomized "the patients... to 70 percent aloe vera cream or 0.1 percent triamcinolone acetonide. The primary outcome was the change in PASI score from baseline to eight weeks." By study end, "the PASI score decreased by an average of 7.7 points in the aloe vera group and 6.6 in the patients treated with the topical steroid." Overall, "six patients (16.2 percent) in the aloe vera group had PASI 75 responses compared with four (10.5 percent) in the steroid group." 2 LCD Plus NB-UVB Reduces Time to Improvement of Psoriasis vs. NB-UVB Alone μàõ π ËÕß π π ËÕß "Role" Õß Topical treatment π Á ß π LCD, CCT ß «Ê ß πõ Ÿà ËÕ Ê «à â π Ë àμõ πõßμàõ biologics Á ßμÕ πõß μàõ Goeckerman Regimen π Jerry Bagel, M.D. Medical Director, Psoriasis Treatment Center of Central New Jersey, East Windsor, NJ J Drugs Dermatol Apr 2009; 8(4): Background: Use of coal tar with narrowband (NB) ultraviolet B (UVB) light (the Goeckerman regimen) is an effective treatment for plaque psoriasis that has become impractical in outpatient care mainly due to the inconvenience and aesthetic concerns of coal tar.

3 3 Objective: This study evaluated the safety, efficacy, and convenience of adding a novel LCD (coal tar) solution to standard NB-UVB phototherapy in adults with chronic plaque psoriasis. Methods: Patients applied LCD solution to half-body twice daily at home and received outpatient full-body NB-UVB light therapy 3 times a week for up to 12 weeks. A blinded investigator graded psoriasis severity of body halves and bilateral target lesions and monitored adverse reactions. Patients rated their psoriasis symptoms and LCD solution aesthetics. Results: NB-UVB + LCD therapy reduced the median time to clearance or minimal disease in at least 50% of the population by 3 weeks (4 weeks with NB-UVB + LCD versus 7 weeks with NB-UVB alone). A statistically superior clinical response was observed by the end of week 4 with NB-UVB + LCD versus NB-UVB alone (P < 0.05) for: PGA, target lesions, ESI scores, and patient-reported symptoms. Conclusion: Incorporating an at-home regimen with a novel LCD solution into outpatient NB-UVB light therapy is safe, convenient, effective, and can improve psoriasis more quickly than NB-UVB light therapy alone. 3 Lupus erythematosus tumidus: response to antimalarial treatment in 36 patients with emphasis on smoking Ÿ ÿà Ë À Õ à ß ß æ Ë «Ë ßμàÕ ªìπ Connective tissue diseases àπ Rheumatoid Arthritus Lupus Erythematosus πõ π Èπ Á ß Àâμ «LE ÕßμÕ πõßμàõ â«antimalarials ß â«π Authors Kreuter A. Gaifullina R. Tigges C. Kirschke J. Altmeyer P. Gambichler T. Arch Dermatol Mar 2009; 145(3):244-8, OBJECTIVE: To determine the efficacy of antimalarial drug use in patients with lupus erythematosus tumidus. DESIGN: Retrospective single-center study. SETTING: Dermatologic clinic at a university hospital. PATIENTS: Thirty-six patients with multifocal lupus erythematosus tumidus. Intervention Treatment with either chloroquine phosphate or hydroxychloroquine sulfate. MAIN OUTCOME MEASURES: Cutaneous Lupus Erythematosus Disease Area and Severity Index score. RESULTS: Treatment with antimalarial drugs resulted in a significant reduction in the Cutaneous Lupus Erythematosus Disease Area and Severity Index score, from 4 (range, 2-8) at baseline to 1 (range, 0-6) after 3 months of therapy (P <.001). Twenty-two patients (61%) exhibited complete or almost complete clearance of skin lesions, consistent with a clinical score of 0 or 1. No difference in efficacy was noted between the chloroquine-treated group and the hydroxychloroquine-treated group (P =.40). Adverse effects (nausea, dizziness, and headache) occurred only in patients treated with chloroquine. Twenty-eight patients (78%) were smokers, and smokers had a significantly higher mean (SD) clinical score than nonsmokers (5.1 [1.8] vs 3.3 [1.6]; P =.03). Moreover, smokers had a significantly lower reduction in clinical score with antimalarial treatment compared with nonsmokers (r = 0.30; P =.03; 95% confidence interval, to 0.57). Eighty-eight percent of nonsmokers (7 of 8 patients) but only 57% of smokers (16 of 28 patients) had a clinical score of 1 or 0 after 3 months of treatment with antimalarial drugs. CONCLUSIONS: These retrospective study findings demonstrate that antimalarial treatment is highly effective in multifocal lupus erythematosus tumidus. Lower incidence of adverse effects and equal efficacy might favor the use of hydroxychloroquine. Patients who smoke should be encouraged to join smoking cessation programs because they will respond better to antimalarial treatment. Lotion in Mild-to-Moderate Acne Vulgaris Õ ß Õ Àπ Ëß À π â Ë àõ â" " π Mohamed L. Elsaie M.D. MBA,a,b Mahmoud F. Abdelhamid MD Ph.D. b Lotfy T. Elsaaiee M.D. Ph.D. FACTM,c and Hanaa M. Emam M.D. Ph.D. b J Drugs Dermatol Apr 2009; 8(4): Background: Botanical extracts and preparations have been used in different pathological conditions with success. An important group of phytochemical phenolic compounds are the catechins found in green tea. Acne is a widely occurring inflammatory condition that is estimated to affect 40 to 50 million Americans. Finding an effective, safe, cost-effective and well-tolerated treatment is the challenge. Objective: To determine the efficacy of 2% green tea lotion in mild-to-moderate acne vulgaris. Methods: Twenty patients fulfilling enrolment criteria were included. Green tea was given and applied twice daily for a period of 6 weeks. The patients were seen every 2 weeks to evaluate the lesions and any side effects. To determine efficacy on acne severity, the authors used both total lesion count (TLC) and their devised severity, index (SI). Total lesions count (TLC) was

4 4 calculated as papules + pustules while SI was scaled with numbers (1, 2 or 3) correlating to TLC in order of increasing intensity. TLC < 10 was given an SI of 1, TLC was given an SI of 2 and TLC > 20 was given an SI of 3. Results: The mean total lesion count (TLC) decreased from 24 before the treatment to 10 after 6 weeks after treatment, a reduction of 58.33%. The difference was statistically significant (P < , 95% confidence interval [CI] of the difference = ). The mean severity index (SI) decreased from 2.05 before treatment to 1.25 after 6 weeks treatment, a decrease of 39.02%. The difference was statistically significant (P < , confidence interval [CI] of the difference = ). Conclusion: Topical 2% green tea lotion is an effective, cost-effective treatment for mild-tomoderate acne vulgaris. 5 Diet and acne: a review of the evidence Paper π È ªìπ systematic review Õπ πõ æ ÿªπ Elsa H. Spencer, Ph.D., Hope R. Ferdowsian, M.D., MPH, and Neal D. Barnard, M.D. Int J Dermatol Apr 2009; 48: Conclusions Evidence suggests that components of Western diets, particularly dairy products, may be associated with acne. The hormonal effects of dietary components, such as glycemic index levels or fat or fiber intake, may mediate the effect of diet on acne risk. Until 2005, cross-sectional, case-control, cohort, and clinical intervention studies designed to address the relationship between diet and acne typically failed to incorporate adequate controls, objective measures, and appropriate statistical analyses. Well-designed prospective studies published since 2005 have elucidated the mechanisms whereby particular foods and dietary constituents may influence acne risk and severity. In order to test the efficacy of dietary interventions, prospective, randomized trials, including controls for environmental stressors, acne medications, age, pubertal stage, and age at menarche, are essential. 6 Incidence of nonmelanoma skin cancer in a cohort of patients with vitiligo πõ Ÿà Õ«à ºŸâªÉ«à ß «Õ ªìπ Áߺ «Àπ ß æ Ë Èπ «à π Ë«ª À Õ à À Ê studies ˺à π Õ «à à æ Ë Èπ π study π È æ «à squamous cell carcinomas æ Ë Èπ Á πâõ μà à π ß μ ËÕ ª ª Ë«ª Camile L. Hexsel, M.D.,a Melody J. Eide, M.D., MPH,a,b Christine C. Johnson, MPH, Ph.D.,b Richard Krajenta, BS, Gordon Jacobsen, MS,b Iltefat Hamzavi, M.D., a and Henry W. Lim, M.D. J Am Acad Dermatol June 2009; 60: Background: Nonmelanoma skin cancer (NMSC) incidence in patients with vitiligo has not been studied. Objective: We sought to quantify the incidence of NMSC in patients with vitiligo. Methods: A cohort of 477 patients with vitiligo and no history of NMSC seen in an outpatient academic center between January 2001 and December 2006 was established. All charts for patients with vitiligo were reviewed for incident NMSC, and histopathology verified. Age-adjusted (2000 US Standard Mil ion) incidence rates were calculated and compared to US rates. Results: Six patients with NMSC were identified; all were Caucasian (61 years). Age-adjusted incidence rates were: basal cell carcinoma, male 1382/100,000; basal cell carcinoma, female 0; squamous cell carcinoma, male 465/100,000; squamous cell carcinoma, female 156/100,000. Except for basal cell carcinoma in females, all rates were higher than US rates but not statistically significant. Limitations: Comparison incidence rates from the general patient population during the same time period were unavailable. Conclusion: Health care providers should be aware of the possible risk of NMSC in Caucasian patients with vitiligo.

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