It may be extreme to suggest that hidradenitis suppurativa (HS) is to blame for the Russian revolution, but one dermatologist believes it influenced Karl Marx’s work. After investigating Marx’s correspondence, Professor Sam Shuster, honorary consultant at the Norfolk and Norwich University Hospital, concluded that Marx suffered from HS, not boils, as has been stated. Professor Shuster says that a number of Marx’s health complaints, such as joint pain, lesions on the body, face and scalp, and a painful eye condition, could be due to HS. He also notes that psychological distress is severe in HS patients and says this explains Marx’s self-loathing and alienation.
Shuster S. Br J Dermatol 2007;158 (1): 1–3
Effectiveness of bath emollients
Specialised bath products to relieve the symptoms of eczema are of ‘questionable’ value, according to a review. The authors highlight that there are no published randomised controlled trials on bath emollients in the treatment of atopic eczema and no consensus of clinical opinion that they are effective. It would be helpful to know, they say, how these products compare with the use of an emollient as a soap substitute during bathing, followed by application of a topical emollient. They conclude that treatment involving topical emollients without the use of bath emollients is ‘entirely reasonable’.
Drug Thera Bull 2007; 45: 73-5
Topical pimecrolimus in eczema
Topical pimecrolimus is a less effective eczema treatment than moderate or potent corticosteroids and 0.1% tacrolimus, a Cochrane review suggests. The authors conclude the drug’s therapeutic role is uncertain, owing to a lack of key comparisons with mild corticosteroids. Their analysis included 31 trials involving 8,019 patients. Short- and long-term studies showed topical pimecrolimus to be more effective than vehicle, but comparisons with topical corticosteroids and 0.1% tacrolimus showed it to be less effective than these treatments, and to result in more withdrawals from treatment.
Ashcroft D, Chen LC, Garside R et al. Cochrane Database Syst Rev 2007; Issue 4: CD005500
Treating pruritus ani
A short course of mild corticosteroid ointment can effectively treat pruritus ani, researchers at King’s College Hospital have found. Ten patients completed the crossover pilot study, in which they were randomly assigned to receive 1% hydrocortisone or placebo for two weeks followed by the opposite treatment for two weeks, with a two-week washout period in between. Corticosteroid treatment resulted in a significant reduction in itch compared with placebo, and improvements in quality of life scores and the clinical appearance of the perianal skin.
Al-Ghnaniem R, Short K, Pullen A et al. Int J Colorectal Dis 2007; 22: 1,463-7
Wound complications after skin biopsy
A high rate of wound complications associated with significant host and procedural risk factors has been identified in a UK study of 100 diagnostic skin biopsies in dermatology inpatients. Wound complications occurred in 29 biopsies; 27 were due to wound infection. Complications were more frequent for biopsies below the waist, those carried out in the ward rather than the operating theatre, for smokers and those taking corticosteroids.
Wahie S, Lawrence CM. Arch Dermatol 2007; 143: 1,267-71
Moxifloxacin prescribing update
Following a review of recent safety data, changes have been made to the prescribing information for moxifloxacin, warning of the risk of potentially fatal liver failure and toxic epidermal necrolysis. The MHRA has reminded healthcare professionals to be vigilant about the early signs and symptoms of these disorders and to ask patients to seek medical advice as appropriate.
Drug Safety Update 2007; 1(4): 10
Imiquimod for nodular BCC
Topical imiquimod shows ‘modest’ activity against small nodular basal cell carcinoma (BCC), according to the results of a phase III trial investigating efficacy and tolerability. Researchers in Germany randomised 102 patients with nodular BCC to receive topical imiquimod three times a week for eight or 12 weeks. Of the 90 patients who completed the study, 78 per cent had complete clinical clearance, while 64 per cent showed complete histopathological clearance. Efficacy was better in nodular BCC of <1cm in diameter. The researchers say that because 17 per cent of patients with clinical clearance had pathological evidence of disease, excisional biopsy of the treated site is still indicated.
Eigentler TK, Kamin A, Weide BM et al. J Am Acad Dermatol 2007; 57: 616-21
Methotrexate or ciclosporin for psoriasis
Ciclosporin is more effective than methotrexate for treating chronic plaque psoriasis over the short term, but both therapies can provide satisfactory control and improve quality of life. Researchers in Sweden randomised 84 patients with moderate-to-severe plaque psoriasis to methotrexate or ciclosporin for 12 weeks. Outcome measures included the Psoriasis Area and Severity Index (PASI) and a visual analogue scale (VAS) for patient self-assessment. Ciclosporin showed more change in PASI by 12 weeks (72 v 58 per cent), indicating greater effectiveness. VAS scores also improved more in the ciclosporin group, but physical functioning improved more in the methotrexate group.
Flytström I, Stenberg B, Svensson A, Bergbrant IM. Br J Dermatol 2007;158 (1): 116–121
Topical phenytoin in wound healing
A positive effect on wound healing in a variety of wounds is likely with the use of topical phenytoin. Researchers in Northern Ireland systematically identified, summarised and critically appraised the clinical evidence on the effects of wound healing in a variety of wounds. Fourteen randomised controlled trials were included. There was moderate evidence supporting the use of topical phenytoin for the treatment of leg ulcers, leprosy wounds, chronic wounds and diabetic foot ulcers. There was limited evidence for the use of topical phenytoin in the treatment of burns and war wounds.
Shaw J, Hughes CM, Lagent KM, Bell PM. Br J Dermatol 2007; 157(5): 997-1,004