In brief

Photodynamic therapy guideline update
Long-term studies provide reassurance on the safety of repeated use of topical photodynamic therapy (PDT), according to updated guidelines. The authors highlight that randomised controlled trials have demonstrated a high efficacy for topical PDT in the treatment of actinic keratoses, Bowen's disease and superficial basal cell carcinoma (BCC), and efficacy in thin nodular BCC. Trials have also shown superior cosmetic outcome after PDT compared with standard therapies. However, they add that current evidence does not support use of topical PDT in squamous cell carcinoma. Latest evidence relating to PDT in the treatment of other dermatoses, including acne and psoriasis, is also discussed.
Morton CA, McKenna KE, Rhodes LE et al. Br J Dermatol 2008; 159: 1245-66

Review questions probiotics for eczema
Probiotics are not an effective treatment for eczema and may carry a risk of adverse events, a Cochrane review has found. Twelve randomised controlled trials, involving 781 children, were included. The reviewers found no significant difference in participant- or parent-rated symptom scores or overall eczema severity in favour of probiotic treatment. There was also no significant difference in investigator-rated eczema severity between probiotic and placebo treatments. Furthermore, 46 patients had reportedly experienced side-effects, including infections and bowel ischaemia, after taking probiotics.
Boyle RJ, Bath-Hextall FJ, Leonardi-Bee J et al. Cochrane Database Syst Rev 2008; 4: CD006135

Indigo ointment could combat psoriasis
A topical ointment based on indigo may benefit patients with plaque psoriasis, researchers in Taiwan have found. Forty-two outpatients with chronic plaque psoriasis applied either indigo naturalis ointment or vehicle ointment topically to each of two bilaterally symmetrical psoriatic plaque lesions for 12 weeks. Significant reductions in scaling, erythema and induration, as well as plaque area, were achieved with the indigo ointment compared with control. Approximately 31 of 42 patients experienced clearance or near clearance of their psoriasis in the lesion treated with indigo ointment.
Lin YK, Chang CJ, Chang YC et al. Arch Dermatol 2008; 144: 1457-64

Rash associated with antiepileptics
The rate of cross-sensitivity between certain antiepileptic drugs (AEDs) leading to the development of a rash is high, according to US researchers. They found this was especially true for carbamazepine and phenytoin. The researchers determined incidence of AED-related rash in 1,875 epilepsy outpatients. A total of 14.3 per cent of patients had a rash attributed to at least one AED; 2.8 per cent had a rash attributed to two or more AEDs. Of the 59 patients with a rash to carbamazepine who were also prescribed phenytoin, 57.6 per cent also had a rash with phenytoin. Of the 81 patients with a rash attributed to phenytoin who were also prescribed carbamazepine, 42 per cent also had a rash attributed to carbamazepine.
Hirsch LJ, Arif H, Nahm EA et al. Neurology 2008; 71: 1527-34

Burn cream may delay healing
A cream commonly used to treat burns may actually delay healing, Cochrane reviewers have concluded. They assessed 26 randomised controlled trials, most of which were methodologically poor. A number of studies showed delays in time to wound healing and increased number of dressing applications in patients treated with silver sulfadiazine dressings. Biosynthetic dressings were associated with a decrease in time to healing and reduction in pain during dressing changes. The reviewers say there is a lack of high quality trials on dressings for superficial and partial thickness burn injury, and thus the available evidence is of limited use in helping clinicians choose a suitable treatment.
Wasiak J, Cleland H, Campbell F. Cochrane Database Syst Rev 2008; 4: CD002106

Vulval dermatoses and autoimmune disorder
An association between autoimmune disorder and autoantibodies with erosive lichen planus (LP) of the vulva has been demonstrated in a UK study. In addition, the research has confirmed the autoimmune associations of vulval lichen sclerosus (LS). The study involved 190 women with typical features of adult-onset LS of the vulva, 126 women with adult-onset erosive LP of the vulva and 922 female controls. Autoimmune disorders were more frequent in patients with erosive LP than controls (29 versus 9 per cent), and in those with LS compared with controls (28 versus 9 per cent). Circulating autoantibodies were more frequent in those with erosive LP compared with controls (41 versus 20 per cent).
Cooper SM, Ali I, Baldo M, Wojnarowska F. Arch Dermatol 2008; 144: 1432-5

Moisturisers and dry skin
Regular use of moisturisers can make skin drier, according to a doctoral thesis undertaken at Uppsala University in Sweden. Healthy volunteers underwent seven weeks of treatment with test moisturisers; changes in transepidermal water loss, skin capacitance and susceptibility to an irritant were noted, indicating altered barrier function. One moisturiser resulted in altered mRNA expression of several genes involved in the assembly, differentiation and desquamation of the stratum corneum, and in lipid metabolism. The author concludes that careful selection of ingredients and avoidance of those with a negative impact on the skin could lead to moisturisers generating a desired clinical effect.

Fish in diet protects against eczema
Eating a fishy diet before the age of nine months can reduce the risk of developing eczema by a quarter, research from Sweden suggests. The study included data on diet and evidence of allergic eczema among 4,921 infants at age six and 12 months. Breastfeeding, or the age at which milk and eggs were introduced into the diet, did not affect eczema risk. However, the introduction of fish into the diet before the age of nine months reduced the risk by 25 per cent. Keeping a pet bird was also associated with a significant reduction in risk, but having a furry pet was not.
Alm B, Aberg N, Erdes L et al. Arch Dis Child 2008; doi:10.1136/adc.2008.140418

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