Coal tar preparations have been widely used in Dermatology for more than 100 years _ despite their propensity to stain, stink, and sting. Tars may also photosensitize the skin, aggravate acne, or cause folliculitis. The polycyclic aromatic hydrocarbons (PAH) found in coal tar are associated with an increased risk of cancer in some occupational groups. A recent study looked at a group using a coal tar shampoo and found similar urinary levels of a coal tar metabolite to those found in coke-oven workers. The authors question both whether coal tar shampoos should be prescription only and if there should be a limit for PAH concentrations in such products.
In the study, Van Schooten and colleagues measured the urinary excretion of a PAH metabolite, 1-hydroxypyrene (1-OH-P), to determine whether PAH was readily absorbed after shampooing with a coal tar shampoo containing high concentrations of PAH (Resdan Forte, Whitehall). All 11 subjects had significantly increased urinary concentrations of 1-OH-P one and two days after using two applications of the shampoo for one evening. These elevated 1-OH-P concentrations were similar to those reported for an occupational group reporting an increased incidence of respiratory cancer: coke-oven workers exposed to PAH for a seven-day working period. Should coal tar shampoos be so widely available, the authors ask, and should there be a limit for PAH concentrations in such products?
(Lancet, 1994; 344[November 26]: 1505-6)
Cyclosporin (Sandimmune, Sandoz)-Lower Doses, Increased Safety
& More Reasonable Expectation
Short-term cyclosporin effective in Psoriasis
Up to 5 mg/kg/day oral cyclosporin used for over one year for
the treatment of chronic severe plaque psoriasis is highly effective,
although potential serious side effects of this therapy can limit
such use. Data from two recent studies show that short-term or
intermittent treatment is equally effective and has fewer side
effects. Garcovich and colleagues used an average dose of 3.7
mg/kg/day in 121 patients with chronic plaque psoriasis and 21
patients with other psoriatic conditions, for an average treatment
cycle of 7.5 weeks (range 4-12 weeks). They reported response
rates and duration of remission similar to those observed after
consecutive or long-term treatment cycles while side effects were
mild (Acta Dermato-Venereologica, 1994; 74 [suppl. 186]: 92).
A second study reported similar results. Peluso and colleagues
treated 26 severe plaque psoriasis patients with either 3 mg/kg/day
or 5 mg/kg/day cyclosporin for an average of ten weeks (range
4-12 weeks), then gave maintenance therapy for 2-4 months (Acta
Dermato-Venereologica, 1994; 74 [suppl. 186]: 90). Although the
results of this study were not as impressive as those from Garcovich's
study, patients were nonetheless acceptably maintained on low-dose
intermittent therapy, with relatively mild side effects. In both
studies, no patient stopped cyclosporin treatment due to adverse
events while remission was extended by the use of topical therapies
such as steroids, tars, or emollients.
Effective in Atopic Eczema
Oral cyclosporin is also highly effective for the treatment of
atopic eczema although, as with psoriasis, toxicity is a problem
with long-term use. A recent study by Munro and colleagues found
that remission could be maintained with low-dose or intermittent
cyclosporin (British Journal of Dermatology, 1994; 130: 376).
In this placebo-controlled, cross-over study, 24 patients were
treated with placebo or 5 mg/kg/day for eight weeks. Once they
had completed cross-over treatment, they were randomized to receive
stepwise reductions at two-week intervals in either daily cyclosporin
dose, to 1 mg/kg/day, or cyclosporin frequency, to 5 mg/kg/day
every five days. These reduced treatment regimes slowed the return
of eczema symptoms, with intermittent higher-dose therapy tending
to be better than continuous low-dose treatment.
Fluconazole (Diflucan, Pfizer)--A Wider Role in AIDS &
Other Diseases
Treating Cryptococcal Meningitis and Candidiasis in AIDS and
Other Immunocompromised Patients
Cryptococcal meningitis and candidiasis continue to be significant
problems in AIDS and other immunocompromised patients. One of
the best therapeutic regimes for the treatment of these infections
is fluconazole, a product that has several advantages over amphotericin
B. At doses of up to 400 mg/day, fluconazole is as effective as
amphotericin B in the treatment of relapsed cryptococcal meningitis,
but with fewer side effects.
Prevention of Primary Cryptococcal Meningitis in the AIDS Population
Recent data presented at the 34th ICAAC in Orlando also suggest
that fluconazole may be effective in the prevention of primary
cryptococcal meningitis in the AIDS population.
More Effective than Ketoco>
Transfer interrupted!
Back to contents