Cutis
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Superiority of a combined contraceptive containing drospirenone to a triphasic preparation containing norgestimate in acne treatment.
This double-blind study compared the efficacy and tolerability of a combined oral contraceptive containing 30 microg ethinyl estradiol and 3 mg drospirenone (EE/DRSP; Yasmin) with a triphasic preparation containing 35 microg EE and 0.180, 0.215, 0.250 mg norgestimate (EE/NGM; Pramino, also known as Ortho Tri-Cyclen) in the treatment of acne vulgaris. The combined presence of antiandrogenic and antimineralocorticoid activities of drospirenone is unique to this novel progestin in that these characteristics most closely resemble those of progesterone. The study was designed to show that EE/DRSP was noninferior or superior to EE/NGM as to the relative decrease from baseline to cycle 6 in percentage of inflammatory and total lesion counts and the investigators' assessment of acne improvement. ⋯ Furthermore, both preparations increased the level of sex hormone-binding globulin (SHBG) and decreased the levels of androgens, changes typically associated with acne improvement. Both preparations were well tolerated. In conclusion, owing to the unique pharmacologic activities of drospirenone, the combined oral contraceptive EE/DRSP provides an effective treatment option in female patients with mild to moderate acne.
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Case Reports
Sustained remission of treatment-resistant cutaneous T-cell lymphoma with oral bexarotene.
Cutaneous T-cell lymphomas (CTCL) encompass a spectrum of clinical and histologic variants, characterized by malignant CD4+ T lymphocytes in the skin and visceral organs. This is a case report of a 74-year-old man with CTCL, including ulcerative lesions, resistant to multiple systemic therapies. Treatment with oral bexarotene resulted in rapid and sustained remission of both cutaneous and systemic symptoms.
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For more than 3 decades, piezogenic pedal papules have been described in the literature. While many individuals with these papules are asymptomatic, patients with trauma or connective tissue diseases can experience pain. ⋯ Three injections of a solution of equal parts betamethasone (Celestone) and bupivacaine (Marcaine) were curative in a male patient with Ehlers-Danlos syndrome type III with PPPP. In addition, combination steroid/anesthetic injection provides another method of treatment in the management of PPPP.
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Acquired reactive perforating collagenosis (ARPC) is a rare perforating disease of the skin. It is characterized by hyperkeratotic papules with transepidermal elimination of degenerated material including collagen and elastic fibers. The disease presents clinically as umbilicated papules with a central adherent keratotic plug. ⋯ It presents most frequently in patients with diabetes mellitus, in patients with leukemia receiving chemotherapy, and in those on sustained immunosuppressive therapy. We describe a patient with type 2 diabetes mellitus and end-stage renal disease requiring hemodialysis in whom extensive cutaneous mucormycosis with secondary spread to the brain, lumbar spine, and breast developed in the setting of ARPC. To our knowledge, this is the first case report of a patient with ARPC who developed extensive cutaneous mucormycosis.
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As we face the task of helping to rebuild Iraq, it is worthwhile to review our experience with past humanitarian aid missions and past conflicts. These efforts serve as models for the types of problems we may encounter today. It also is critical to review available data concerning the unique aspects of cutaneous diseases in that part of the world.