Background: Delayed pressure urticaria (DPU) is characterized by the appearance of typical painful skin lesions (weals) after pressure stimulus. Oral corticosteroids are effective treatments but long-term therapy is p...Background: Delayed pressure urticaria (DPU) is characterized by the appearance of typical painful skin lesions (weals) after pressure stimulus. Oral corticosteroids are effective treatments but long-term therapy is problematic. A new topical formulation of clobetasol propionate 0.05%in thermophobic foam (CF) (Olux) has recently become available. The foam is easy to apply, with low skin residues. Objectives: To evaluate in a double-blind placebo-controlled trial the efficacy, tolerability and safety of CF in the topical treatment of DPU. Methods: Twenty-six subjects with a positive history of DPU (13 men, mean age 44 years) were enrolled in a 4-week trial. CF or the corresponding placebo were applied twice daily. Drug application was performed in the most affected areas and in a target area where a standardized pressure challenge test was performed at baseline and at week 4. Efficacy was evaluated by scoring skin lesions regarding erythema, oedema and itching (0, no sign; 4, severe signs) and by calculating the area of the pressure challenge-induced lesion. Safety was evaluated by measuring plasma levels of adrenocorticotropic hormone (ACTH) and cortisol. Results: CF significantly (P = 0.0001) reduced lesion area by 84%in comparison with baseline values and by 97%in comparison with the placebo group values. Lesion area in the CF group was reduced from 144 cm2 to 21 cm2 at the end of the study. No significant differences in lesion area and clinical lesion scores were observed in the placebo group (lesion area 201 cm2 at baseline; 216 cm2 after 4 weeks). A significant clinical improvement was observed in all treated skin areas in the CF group. Mean ±SD erythema score was reduced by CF from 1.8 ±0.6 at baseline to 0.6 ±0.5 at the end of the treatment (P = 0.001). Similar modifications were observed also for oedema (from 1.6 ±0.6 to 0.2 ±0.5) and itching score. Nonsignificant modifications of plasma levels of ACTH, cortisol and glucose were observed in both study groups, in comparison with baseline values. No adverse events were recorded during the trial in either treatment group. Conclusions: CF is effective, safe, convenient and well tolerated in the short-term treatment of DPU.展开更多
Association of malignant melanoma (MM) with various clinical forms of skin depigmentation is well-known. We report a case highlighting the importance of careful examination of patients with skin hypomelanoses, includi...Association of malignant melanoma (MM) with various clinical forms of skin depigmentation is well-known. We report a case highlighting the importance of careful examination of patients with skin hypomelanoses, including vitiligo and halo nevi, in order to exclude the presence of MM. A 66-year old woman presented with a 6-month history of vitiligo-like depigmentation of the face and halo nevi. Physical examination unexpectedly revealed also the presence of a regressing MM associated with a clinically evident lymphoadenopathy. Predominant dermoscopic features of the lesion were an irregular vascular pattern and regression structures, associated with peripheral areas of irregular pigmentation without pigment network. The literature concerning the association between leukoderma and MM is also reviewed.展开更多
文摘Background: Delayed pressure urticaria (DPU) is characterized by the appearance of typical painful skin lesions (weals) after pressure stimulus. Oral corticosteroids are effective treatments but long-term therapy is problematic. A new topical formulation of clobetasol propionate 0.05%in thermophobic foam (CF) (Olux) has recently become available. The foam is easy to apply, with low skin residues. Objectives: To evaluate in a double-blind placebo-controlled trial the efficacy, tolerability and safety of CF in the topical treatment of DPU. Methods: Twenty-six subjects with a positive history of DPU (13 men, mean age 44 years) were enrolled in a 4-week trial. CF or the corresponding placebo were applied twice daily. Drug application was performed in the most affected areas and in a target area where a standardized pressure challenge test was performed at baseline and at week 4. Efficacy was evaluated by scoring skin lesions regarding erythema, oedema and itching (0, no sign; 4, severe signs) and by calculating the area of the pressure challenge-induced lesion. Safety was evaluated by measuring plasma levels of adrenocorticotropic hormone (ACTH) and cortisol. Results: CF significantly (P = 0.0001) reduced lesion area by 84%in comparison with baseline values and by 97%in comparison with the placebo group values. Lesion area in the CF group was reduced from 144 cm2 to 21 cm2 at the end of the study. No significant differences in lesion area and clinical lesion scores were observed in the placebo group (lesion area 201 cm2 at baseline; 216 cm2 after 4 weeks). A significant clinical improvement was observed in all treated skin areas in the CF group. Mean ±SD erythema score was reduced by CF from 1.8 ±0.6 at baseline to 0.6 ±0.5 at the end of the treatment (P = 0.001). Similar modifications were observed also for oedema (from 1.6 ±0.6 to 0.2 ±0.5) and itching score. Nonsignificant modifications of plasma levels of ACTH, cortisol and glucose were observed in both study groups, in comparison with baseline values. No adverse events were recorded during the trial in either treatment group. Conclusions: CF is effective, safe, convenient and well tolerated in the short-term treatment of DPU.
文摘Association of malignant melanoma (MM) with various clinical forms of skin depigmentation is well-known. We report a case highlighting the importance of careful examination of patients with skin hypomelanoses, including vitiligo and halo nevi, in order to exclude the presence of MM. A 66-year old woman presented with a 6-month history of vitiligo-like depigmentation of the face and halo nevi. Physical examination unexpectedly revealed also the presence of a regressing MM associated with a clinically evident lymphoadenopathy. Predominant dermoscopic features of the lesion were an irregular vascular pattern and regression structures, associated with peripheral areas of irregular pigmentation without pigment network. The literature concerning the association between leukoderma and MM is also reviewed.
