The Journal of dermatology
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Randomized Controlled Trial Clinical Trial
A specific thrombin inhibitor, argatroban, alleviates herpes zoster-associated pain.
We report the result of a randomized, controlled, open trial of anti-thrombin therapy for herpes zoster-associated pain. Fifty-five herpes zoster patients within 8 days after the onset of skin lesion were enrolled in the trial. Patients were treated with an optimal dose of oral acyclovir (4000 mg/day for 7 days) with or without intravenous administration of a specific anti-thrombin agent, argatroban (10 mg/day, three times a week). ⋯ The results suggested that relatively low doses of argatroban are effective in reducing herpes zoster-associated pain. Up-regulation of prothrombin expression by the vascular endothelial and sweat gland epithelial cells in the active skin lesion and transient elevation of plasma thrombin-antithrombin III complex levels in a proportion of patients suggest a lesional generation of thrombin in herpes zoster. This may be relevant to the beneficial effects of the anti-thrombin treatment on the resolution of herpes zoster-associated pain.
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Comparative Study
Long-term follow-up study of onychomycosis: cure rate and dropout rate with oral antifungal treatments.
The "complete cure" of onychomycosis requires long-term treatment with a systemic antifungal agent. Therefore, to properly assess the effects of an antifungal agent on onychomycosis requires a long follow-up. We have conducted a retrospective analysis of the patients treated with griseofulvin (GRF) from 1962 to 1992 and a clinical study to compare the long-term effect of GRF with that of a new oral antifungal agent, itraconazole (ITCZ), for patients who received treatment from 1992 to 1995. ⋯ Furthermore, from a multiple regression analysis, the GRF/ITCZ administration required to cure onychomycosis was estimated to be 3.92 + 0.161 [Age (years)] + 0.635 [Number of infected toenails] months. The results of this study suggest that the biggest problem associated with the treatment of onychomycosis with an oral antifungal agent is compliance in long-term therapy. Notably, the final cure rate of ITCZ therapy went over 90%, suggesting that the low dose continuous therapy, the standard treatment protocol in Japan, was a key contributing factor for the higher cure rate for ITCZ.
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Comment Letter Case Reports
About the paper "Elephantiasis neuromatosa and Becker's melanosis" (J Dermatol, 26: 396-398, 1999).
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A rare association of twenty-nail dystrophy with segmental vitiligo is described in two patients. Vitiligo preceded the nail dystrophy. ⋯ Longitudinal nail biopsy revealed a histological picture suggestive of eczematous changes and lichen planus respectively. Intramatrix injections of triamcinolone acetonide into the proximal and lateral nail folds were administered with considerable improvement.
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We report two cases of basal cell carcinoma (BCC) arising on the genitalia. The first case was a 49-year-old male who became aware of a dull erythematous plaque with a keratotic surface on his scrotal skin, and the second case was a 44-year-old female suffering from a keratotic plaque on her right vulvar region. Neither lesion was ulcerative. ⋯ Histopathological study revealed that both lesions were BCC. Many questions regarding the pathogenesis of BCC still remain to be clarified. Because most of the reported cases have been ulcerative lesions and the genital region is an uncommon site for BCCs, caution should be taken in cases in whom a clinically non-ulcerative tumor suspected to be angiokeratoma or seborrheic keratosis arises in this region.