Tacrolimus in Dermatology

Background: Tacrolimus (FK 506), a metabolite of the fungus Streptomyces tsukubaensis, is an anti-T-cell drug. It acts by inhibiting the production of IL-2, IL-3, IL-4, TNFα, and GM-CSF. More potent and with slightly less secondary effects than cyclosporine, it has been the object of considerable interest, especially in conditions that could benefit from the latter. Objective: In psoriasis, a placebo-controlled double-blind study has shown oral tacrolimus at 0.1 mg/kg/day to be effective in controlling recalcitrant lesions. In human, small studies have reported tacrolimus ointment to be effective in controlling acute contact dermatitis. Short-term trials of topical tacrolimus in the treatment of atopic dermatitis have recently shown excellent results in both adults and children. In animal studies of hair growth disorders, topical tacrolimus induces anagen and protects from chemotherapy-induced alopecia. Animal studies with the ointment for the prevention of skin graft rejection, lupus dermatoses, and skin papilloma formation have also shown to be promising. Conclusions: There are case reports of pyoderma gangrenosum, Sezary's syndrome, and Behçet's disease successfully treated with oral tacrolimus but, because of their small number, they remain anecdotal at this point.

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Lack of Disulfiram-Like Reaction with Metronidazole and Ethanol

Annals of Pharmacotherapy ◽

10.1345/aph.1a066 ◽

2002 ◽

Vol 36 (6) ◽

pp. 971-974 ◽

Cited By ~ 31

Author(s):

Jukka-Pekka Visapää ◽

Jyrki S Tillonen ◽

Pertti S Kaihovaara ◽

Mikko P Salaspuro

Keyword(s):

Blood Pressure ◽

Animal Studies ◽

Case Reports ◽

Human Case ◽

The Other ◽

Double Blind Study ◽

Healthy Male ◽

Double Blind ◽

Blood Samples ◽

Human Volunteers

BACKGROUND: Metronidazole, an effective antianaerobic agent, has been reported to have aversive properties when ingested with ethanol. This is thought to be due to the blocking of hepatic aldehyde dehydrogenase (ALDH) enzyme followed by the accumulation of acetaldehyde in the blood. However, based on animal studies and on only 10 human case reports, the existence of metronidazole-related disulfiram-like reaction has recently been questioned. OBJECTIVE: To investigate the possible disulfiram-like properties of metronidazole and ethanol in human volunteers. METHODS: Of 12 healthy male volunteers in this double-blind study, one-half received metronidazole for 5 days and the other half received placebo. All volunteers received ethanol 0.4 g/kg at the beginning of the study. Repeated blood samples were taken every 20 minutes for 4 hours, and blood acetaldehyde and ethanol concentrations were determined. Blood pressure, heart rate, and skin temperature were also measured every 20 minutes for objective signs of a possible disulfiram-like reaction. Volunteers also completed a questionnaire focusing on the subjective signs of disulfiram-like reaction. RESULTS: Metronidazole did not raise blood acetaldehyde or have any objective or subjective adverse effects when used together with ethanol. CONCLUSIONS: This study shows that metronidazole does not have an effect on blood acetaldehyde concentrations when ingested with ethanol and does not have any objective or subjective disulfiram-like properties. However, it is possible that disulfiram-like reaction can occur in some subgroups and by other mechanisms than the inhibition of hepatic ALDH.

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The Use of Dexamethasone in Premature Infants at Risk for Bronchopulmonary Dysplasia or Who Already Have Developed Chronic Lung Disease: A Cautionary Note

PEDIATRICS ◽

10.1542/peds.88.2.413 ◽

1991 ◽

Vol 88 (2) ◽

pp. 413-414

Author(s):

LEE FRANK

Keyword(s):

Risk Factors ◽

Bronchopulmonary Dysplasia ◽

Animal Studies ◽

Very Low Birth Weight ◽

Double Blind Study ◽

Dexamethasone Treatment ◽

Double Blind ◽

High Incidence ◽

Potential Risk Factors ◽

Clinical Problems

To the Editor.— The distressingly high incidence of bronchopulmonary dysplasia (BPD) in today's very low birth weight premature infant population and the prolonged morbidity and tumultuous clinical problems associated with BPD in these tiny infants have led to a trial usage of dexamethasone treatment to try to assuage these problems in this patient population. The report of Kazzi et al1 is noteworthy because the authors not only indicate in clear fashion the failure of relatively prolonged dexamethasone treatment to ameliorate the hospital course of infants with BPD (in a randomized prospective double-blind study), but they also clearly identify potential risk factors associated with dexamethasone treatment that are of concern to them as clinical investigators, risk factors based both on clinical and experimental animal studies.

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A Comparison of the Efficacy of Ketorolac and Indomethacin for Postoperative Analgesia following Laparoscopic Surgery in Day Patients

Anaesthesia and Intensive Care ◽

10.1177/0310057x9602400216 ◽

1996 ◽

Vol 24 (2) ◽

pp. 237-240 ◽

Cited By ~ 8

Author(s):

G. C. Murrell ◽

T. Leake ◽

P. J. Hughes

Keyword(s):

Case Reports ◽

Double Blind Study ◽

Random Allocation ◽

Day Case ◽

Double Blind ◽

Group I ◽

Rectal Suppository ◽

Analgesic Supplement ◽

Visual Analog Pain Score ◽

Postoperative Renal Failure

The analgesia provided in the postoperative period by three regimens commonly used in our private anaesthetic practice were compared in a double-blind study of one hundred and thirty-seven women presenting for day-case laparoscopic procedures. After random allocation into three groups, all patients were similarly anaesthetized and then received both a rectal suppository and an IM injection. Group P received two placebos, Group I had an indomethacin suppository 100 mg, and Group K an IM injection of ketorolac 30 mg. The trial showed a statistically significant reduction in pain at 180 minutes postoperatively in the group receiving ketorolac (visual analog pain score of 13.8 v 21.7). The parenterally administered ketorolac may be a useful analgesic supplement in these patients. However the trial was aborted following the appearance in the literature of case reports of postoperative renal failure. Further investigation of the efficacy and side-effect profile of reduced doses may be warranted.

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ULTRASONOGRAPHY AS A DIAGNOSTIC MODALITY OF TIBIAL STRESS FRACTURES

Journal of Musculoskeletal Research ◽

10.1142/s0218957708001997 ◽

2008 ◽

Vol 11 (02) ◽

pp. 55-61 ◽

Cited By ~ 7

Author(s):

Uri Farkash ◽

Javier Naftal ◽

Estela Deranze ◽

Alexander Blankstein

Keyword(s):

Bone Scan ◽

Imaging Modality ◽

Case Reports ◽

Stress Fractures ◽

Surface Irregularity ◽

Double Blind Study ◽

Basic Training ◽

Double Blind ◽

Diagnostic Modality ◽

Medicine Service

Tibial stress fractures (SFs) are a common orthopedic problem during military basic training. Bone scan is considered the gold standard for diagnosing this condition. Several case reports have described sonographic features of stress fractures. This is a prospective, double-blind study to compare diagnostic ultrasound (US) examination with isotope bone scan in diagnosing SF. Thirty-one soldiers who were referred to the nuclear medicine service for a bone scan to rule out tibial SF participated in this study. The SF lesions of the lower extremities were classified according to the classification criteria introduced by Zwas et al.20 US examination was performed on the same day. Areas of cortical thickening and other pathologies like bone surface irregularity and bone discontinuity were recorded. Each examination was graded as either normal or suggestive of representing a SF. Thirty of 62 tibiae were diagnosed as having SF according to bone scan, whereas US examination suggested SF in 35 tibiae. US examination was positive in 20 of 30 tibiae with SF (67% sensitivity, 53% specificity). Although US correctly diagnosed SF in 20 tibiae, bone scan remains the chosen imaging modality to detect SF in soldiers. US was not found to be a reliable modality to diagnose SF.

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Efficacy of Topical Calcineurin Inhibitors in Lichen Planus

Journal of Cutaneous Medicine and Surgery ◽

10.1177/120347541201600403 ◽

2012 ◽

Vol 16 (4) ◽

pp. 221-229 ◽

Cited By ~ 15

Author(s):

Michael Samycia ◽

Andrew N. Lin

Keyword(s):

Lichen Planus ◽

Strong Evidence ◽

Oral Lichen Planus ◽

Case Reports ◽

Calcineurin Inhibitors ◽

Double Blind ◽

Tacrolimus Ointment ◽

Topical Tacrolimus ◽

Topical Calcineurin Inhibitors ◽

Oral Lichen

Background: Topical calcineurin inhibitors have been studied in many skin disorders, including lichen planus. Objective: To evaluate published reports of the use of topical calcineurin inhibitors in lichen planus. Methods: We searched PubMed, Ovid/Cochrane, and Embase using the keywords “tacrolimus,” “pimecrolimus,” “topical calcineurin inhibitors,” and “lichen planus.” Results: We examined 5 double-blind studies, 1 investigator-blinded study, 10 open prospective studies, 6 retrospective studies, and 28 case reports evaluating tacrolimus or pimecrolimus for oral, vulvovaginal, and cutaneous lichen planus. Conclusions: Strong evidence (double-blind and open studies) supports the use of topical tacrolimus ointment in oral lichen planus, with efficacy at least equal to topical clobetasol propionate 0.05% ointment. Treatment of oral lichen planus with topical tacrolimus ointment can result in demonstrable blood tacrolimus levels, but without clinically significant adverse events. Strong evidence (double-blind and open studies) supports the use of topical pimecrolimus 1% cream in oral lichen planus, with efficacy equal to that of topical triamcinolone acetonide 0.1% paste. For vulvovaginal lichen planus, pimecrolimus was superior to placebo in one double-blind study, and tacrolimus was effective in open studies. Only case reports support the efficacy of topical calcineurin inhibitors in cutaneous lichen planus.

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Oxcabazepine (®Trileptal) in Anti-Epileptic Polytherapy

Behavioural Neurology ◽

10.1155/1990/340801 ◽

1990 ◽

Vol 3 (1) ◽

pp. 35-39 ◽

Cited By ~ 4

Author(s):

Peder Klosterskov Jensen

Keyword(s):

Seizure Frequency ◽

Active Metabolite ◽

Epileptic Activity ◽

Double Blind Study ◽

Duration Of Treatment ◽

Double Blind ◽

Significant Difference ◽

Daily Dose ◽

Adults And Children ◽

Clonic Seizures

The anti-epileptic activity of oxcarbazepine (OXC) was compared with that of carbamazepine (CBZ) and the primary active metabolite of OXC, a monohydroxy derivative (MHD). Altogether 255 patients receiving either OXC or MHD (192 and 63 patients respectively) were included in the analysis of efficacy. Out of these 255 patients a total of 40 were children. The duration of treatment varied between 8 and 24weeks. The daily dose of OXC or MHD varied between 600 and 5400 mg (in children 600–2400 mg). Out of five studies two were double-blind controlled studies (including a total of 105 patients) whereas the remaining three were open studies. The results of these studies indicate that, in adults with epilepsy, there is no statistically significant difference in overall seizure frequency between CBZ and OXC. In one double-blind study the number of generalized tonic-clonic seizures was significantly less frequent during treatment with OXC than with CBZ. No statistically significant difference with regard to side-effects was observed between OXC and CBZ. The results in children with epilepsy show a statistically significant difference in seizure frequency in favour of OXC, in comparison with CBZ. Overall, the polytherapy studies in adults and children support the effectiveness and safety of oxcarbazepine.

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Quetiapine and Hypothyroidism: A Literature Review

European Psychiatry ◽

10.1016/s0924-9338(09)71242-8 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1 ◽

Cited By ~ 1

Author(s):

V. Kontaxakis ◽

D. Karaiskos ◽

B. Havaki-Kontaxaki ◽

D. Skourides ◽

P. Ferentinos ◽

...

Keyword(s):

Observational Study ◽

Thyroid Function ◽

Case Reports ◽

Double Blind Study ◽

Double Blind ◽

Medline Search ◽

Replacement Treatment ◽

Product Monograph ◽

Open Question ◽

Reversible Condition

Objective:Recently, there is an interest on the possible association between quetiapine and hypothyroidism. the aim of this study is to critically review all the reported cases in the international literature.Methods:A Medline search for all studies dealing with quetiapine induced hypothyroidism was carried out from January 1997 to June 2008.Results:Published literature on quetiapine's impact on thyroid function consists of 1 double-blind study, 1 observational study, 2 open studies, 3 case reports and data from the product monograph. A study on elderly psychotic patients revealed only small decreases in T4 levels, while another one in adolescents show trends for decrease in T4 and a marked increase in TSH. an observational study of thyroid function in patients treated with quetiapine and other antipsychotics, found a decrease in T4 with no changes in TSH and T3 and another one only slight increases in TSH. in the case reports all patients excibited clinical hypothyroidism. in one case there was a positive history for hypothyroidism, while in another one the patient had experienced lithium induced hypothyroidism in the past. According to quetiapine manufacturer 0.4% of the patients experienced TSH increases with half of them requiring thyroid replacement treatment. in studies, where quetiapine was adjunct to lithium or divalproate, 12% of patients had elevated TSH levels.Conclusion:We suggest a careful thyroid monitoring for patients initiating quetiapine, since hypothyroidism may emerge and masquerade psychopathologic manifestations. However, there is an open question whether thyroid dysfunction is a permanent or reversible condition.

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A Controlled Study of the Use of Thioridazine in the Treatment of Hyperactive and Aggressive Children in a Children's Psychiatric Hospital

Canadian Psychiatric Association Journal ◽

10.1177/070674376400900308 ◽

1964 ◽

Vol 9 (3) ◽

pp. 239-247 ◽

Cited By ~ 8

Author(s):

Harvey R. Alderton ◽

B. A. Hoddinott

Keyword(s):

Status Epilepticus ◽

Side Effects ◽

Psychiatric Hospital ◽

Controlled Study ◽

Double Blind Study ◽

Double Blind ◽

Anticonvulsant Medication ◽

Adults And Children ◽

Hyperactive Behaviour ◽

Aggressive Children

Studies on the use of thioridazine in adults and children were reviewed and the paucity of the controlled objective investigated, observed. Thioridazine in doses of 25 mg. t.i.d. was administered to nine children with persistent marked aggressivity and hyper-activity. A double-blind study revealed a considerable reduction in aggressive, destructive and hyperactive behaviour. Status epilepticus occurred in an epileptic boy, necessitating an increase in anticonvulsant medication. No other side effects were observed. It is concluded that thioridazine is a safe and useful drug in the treatment of hyperactive, aggressive, destructive patterns of behaviour in children.

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Nocturnal Profile of Growth Hormone Secretion during Sleep Induced by Zolpidem: A Double-Blind Study in Young Adults and Children

Hormone Research ◽

10.1159/000181872 ◽

1991 ◽

Vol 35 (1) ◽

pp. 30-34 ◽

Cited By ~ 8

Author(s):

M. Colle ◽

P. Rosenzweig ◽

G. Bianchetti ◽

E. Fuseau ◽

A. Ruffié ◽

...

Keyword(s):

Growth Hormone ◽

Young Adults ◽

Hormone Secretion ◽

Growth Hormone Secretion ◽

Blind Study ◽

Double Blind Study ◽

Double Blind ◽

Adults And Children

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A 12 weeks, randomized and double-blind evaluation of the efficacy of oral supplements of probiotics (Lactogut and Lactogut Kidz) on atopic dermatitis in adults and children

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20203071 ◽

2020 ◽

Vol 6 (5) ◽

pp. 604

Author(s):

B. S. Chandrashekar ◽

Rashmi Agarwal ◽

Preethi B. Nayak ◽

S. Vijayraghavan ◽

Atul A. Deshmukh

Keyword(s):

Atopic Dermatitis ◽

Patient Satisfaction ◽

Conventional Therapy ◽

Primary Objective ◽

Double Blind Study ◽

Life Questionnaire ◽

Double Blind ◽

Serum Ige ◽

Adults And Children ◽

Secondary Objective

Background: The primary objective of the study was to evaluate the efficacy and safety of oral probiotics in the treatment of atopic dermatitis (AD) using the scoring atopic dermatitis (SCORAD) index, serum IgE levels and absolute eosinophil count (AEC). The secondary objective of the study was to determine the association of oral probiotic therapy and improvement in AD using global photographs, dermoscopic images (fotofinder) and individual patient satisfaction.Methods: This was a randomized, double-blind study conducted on 70 patients (20 adults and 50 children) with moderate to severe AD. The participants were randomized into control arm and treatment arm. The treatment arm received conventional and probiotic therapy and only conventional therapy was provided to the control arm. The research was carried out in five visits. For each visit, SCORAD was calculated and response compared using clinical and videodermoscopic images. Patient satisfaction was documented using a quality of life questionnaire during each visit.Results: Across the treatment arm, the mean serum IgE levels were greatly decreased in contrast to the control arm over the 12 weeks period. SCORAD score was significantly lowered in the treatment arm (55.20%) compared with 18.95% in the control arm. Dermoscopic assessment, global photographic assessment and patient satisfaction in the treatment arm showed statistically significant improvement in AD compared to the control arm.Conclusions: The decrease in SCORAD scores demonstrated strong associations with the use of probiotics in patients with AD as an adjunct to conventional therapy. Thus, in both adults and children suffering from moderate to severe AD, probiotic supplement can be administered effectively as an adjunct therapy.

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