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Biomedical subjects

A M Layton

Publications and source records attributed to A M Layton.

At least 37 records · Page 2Linked to original sources
PubMed1994

A comparison of intralesional triamcinolone and cryosurgery in the treatment of acne keloids.

Keloid scarring presents a difficult therapeutic problem. It is a recognized sequel to acne vulgaris, and may be extensive and disfiguring. The data from this double-blind study, in which intralesional triamcinolone or cryosurgery were used as treatment for keloids, demonstrate that by treating early, and in particular vascular, keloids with the latter, 85% will show a moderate to good response in terms of flattening. Treatment with intralesional triamcinolone was also beneficial, but the response to cryosurgery was significantly better in early, vascular lesions.

Acne Keloid↗
PubMed1994

Long-term safety of isotretinoin as a treatment for acne vulgaris.

We assessed possible long-term side-effects of isotretinoin therapy in 720 patients who had received one or more courses of treatment, and had a mean follow-up period of 4.9 years (range 2-12 years). Most patients (442) had received a total cumulative dose of 120-200 mg/kg body weight. One hundred and sixty-two patients received a cumulative dose of < 120 mg/kg body weight, and 116 received a cumulative dose > 200 mg/kg. Fifty-two patients (7.2%) reported persistent symptoms during the follow-up period. No correlation was found between age, sex, cumulative dose, or number of courses of isotretinoin and occurrence of reported possible side-effects. The reported symptoms were predominantly musculoskeletal (2%) or mucocutaneous (4.8%), and were mild in all cases. Xeroderma, dry eye syndrome, arthralgia, and possible exacerbation of eczema, were considered to be infrequent but probable long-term side-effects. The findings of this study indicate that isotretinoin in the treatment of acne is a safe drug, with no serious long-term side-effects.

Acne Vulgaris↗
PubMed1994

Investigation of the expression of the extracellular matrix glycoproteins tenascin and fibronectin during acne vulgaris.

Tenascin and fibronectin are extracellular matrix glycoproteins which can interact with cells and alter their capacity to adhere, migrate and proliferate. In contrast with fibronectin, tenascin has a restricted distribution in normal skin, but is induced during epidermal proliferation, and in wound healing. Because acne involves hyperproliferation of ductal keratinocytes, and rupture of the duct may occur during inflammation, the distribution of tenascin and fibronectin was investigated in acne lesions, and also in acne keloids. Biopsies obtained from patients attending the acne clinics were cryostat-sectioned and stained with tenascin antiserum. The extent of tenascin staining in the dermis around the pilosebaceous unit was measured. Tenascin was continually expressed around normal control pilosebaceous ducts; it was maximal around the acroinfundibulum, extending 20.83 +/- 9.32 microns (n = 14) into the dermis, compared with staining around the infrainfundibulum (11.88 +/- 3.70 microns, n = 14). This was not significantly different from staining around normal pilosebaceous ducts obtained from acne patients. In non-inflamed lesions tenascin staining increased significantly around the infrainfundibulum to 76.88 +/- 29.97 microns (n = 12), compared with this region in the normal follicles. The staining around the acroinfundibulum did not change significantly. Around inflamed lesions the whole of the dermis was positive for tenascin. No changes were detected in the staining pattern for fibronectin, which stained the whole dermis in all the sections tested. The keloid samples stained strongly for both extracellular matrix glycoproteins. Thus, increased tenascin expression appears to be associated with the development of acne lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Acne Vulgaris↗
PubMed1994

A clinical evaluation of acne scarring and its incidence.

Despite scarring being a recognized sequel of acne, the actual extent and incidence of residual scarring remains unknown. One hundred and eighty-five acne patients were included in this study (101 females, 84 males). Patients were selected from acne clinics and their acne scarring was examined. The scarring was quantified according to a lesion count and allocated a score. The type and extent of scarring was correlated to the age and sex of the patient, the site of the acne, the previous acne grade according to the Leeds Technique, acne type (noted in clinic at the original referral time) and duration of acne, before adequate therapeutic measures had been instituted. Results indicate that facial scarring affects both sexes equally and occurs to some degree in 95% of cases. Total scarring on the trunk was significantly greater in males, as was hypertrophic and keloid scarring in these sites (P < 0.05). There were significant correlations between the initial acne grade and the overall severity of scarring in all sites and in both sexes (P < 0.01). Superficial inflamed papular acne lesions as well as nodular lesions were capable of producing scars. A time delay up to 3 years between acne onset and adequate treatment related to the ultimate degree of scarring in both sexes and in all three sites. This emphasizes the need for earlier adequate therapy in an attempt to minimize the subsequent scarring caused by acne.

Acne Vulgaris↗
PubMed1993

A multicentre 12-week open study of a lipid-soluble folate antagonist, piritrexim in severe psoriasis.

An open, 12-week, multicentre study was conducted to assess the efficacy of piritrexim isethionate in the treatment of severe psoriasis. Piritrexim isethionate is a lipid-soluble dihydrofolate reductase inhibitor which cannot form polyglutamates, and may be as effective as methotrexate in the treatment of psoriasis. If, as is suspected, but as yet unproven, methotrexate polyglutamates are responsible for the hepatotoxicity of methotrexate, piritrexim should be less hepatotoxic, and may offer an alternative to methotrexate therapy. Fifty-five patients were enrolled, of whom 41 completed the study. Patients were allocated to receive either 150, 225, 300, or 450 mg of piritrexim weekly, in divided doses over 72 h (low-dose groups, 150 and 225 mg), or over 36 h (300 and 450 mg groups). Twenty-four of the 41 patients who completed the study had a greater than 50% improvement in the severity of their psoriasis, as demonstrated by a reduction in the Psoriasis Severity Score, a measure analogous to the PASI scoring system. Adverse events were common, but mild, and were controlled by dose reduction. Piritrexim appears to be an effective therapy for severe psoriasis at doses of 300 and 450 mg weekly, in three divided doses over 36 h.

Drug Administration Schedule↗
PubMed1993

Isotretinoin for acne vulgaris--10 years later: a safe and successful treatment.

The purpose of this study was to assess the long-term benefit of isotretinoin in otherwise therapy-resistant acne. We also assessed risk factors which might influence the long-term outcome. We studied 88 patients (mean age 20.8 years), most of whom had suffered from acne for many years (mean 7.4 years). They received isotretinoin in an initial dose of 0.5 or 1.0 mg/kg/day. The dose was subsequently adjusted according to response and side-effects. Most patients only required 4 months' therapy to produce at least 85% clinical improvement. The patients were seen up to 10 years post-therapy (mean 9 years). Sixty-one patients were still virtually clear of disease. Of the others, 16% required further treatment with conventional antibiotics and 23% required a second course of isotretinoin. Of those who relapsed, 96% did so within 3 years of stopping therapy. The patients' age, sex, and duration of acne did not influence outcome. However, in patients with predominantly truncal acne, especially when severe, there was an increased incidence of relapse. Sebum excretion is known to correlate with acne severity, but the long-term degree of sebum suppression was found not to be related to relapse. The dose schedule, in particular cumulative dose, was an important factor in determining relapse rate. Those patients who received 0.5 mg/kg daily, or a cumulative dose of < 120 mg/kg, had a significantly higher relapse rate than patients receiving a larger dose. We did not elicit any long-term systemic or biochemical side-effects. We conclude that isotretinoin is a safe and effective therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Acne Vulgaris↗
PubMed1993

Isotretinoin for the treatment of acne vulgaris: which factors may predict the need for more than one course?

We investigated 299 patients treated 5-10 years ago with isotretinoin, and followed them for 5 years post-treatment. Of the 299 patients 22.7% required repeat courses of treatment; 17% had two courses, 5% had three courses and 1% had 4-5 courses. Response to further treatment was predictably successful, was not associated with any additional adverse reactions, and produced no persistent side-effects. Factors contributing to the need for further courses of treatment included lower dose regimens (0.1 and 0.5 mg/kg), the presence of severe acne, being a female over the age of 25 at the onset of therapy, and having a prolonged history of acne.

Acne Vulgaris↗
PubMed1993

A case of Achenbach's syndrome.

Achenbach's syndrome is a rarely reported clinical entity consisting of spontaneous or mechanically induced haematomas on the volar aspects of fingers which are associated with burning pain and swelling of the digits. We describe such a case in a 46-year-old nursing sister.

Female↗
PubMed1993

Acne induced by inhaled corticosteroids.

Four cases of acne apparently induced by inhalation of potent corticosteroids prescribed for the treatment of asthma are described. In one case there appeared to be a dose-dependent relationship. While acne induced by topical or systemic administration of corticosteroids is well recognized, acne following inhaled corticosteroids has not previously been reported.

Acne Vulgaris↗
PubMed1993

Phototoxic eruptions due to doxycycline--a dose-related phenomenon.

The tetracycline group of antibiotics still remains the most successful oral treatment for acne. They are relatively free from side-effects apart from the occasional gastrointestinal upset or vaginal candidosis. Rarer side-effects include drug rashes, pigmentation with minocycline and a light-sensitive eruption with doxycycline. The incidence of light-sensitive rashes with doxycycline at a dose of 100 mg daily, is in the order of 3%. Acne does not always respond to conventional regimens of antibiotics and higher dosages may be required. We report a highly significant incidence of light-sensitive eruptions in patients receiving doxycycline at a daily dose of 150 mg or above.

Acne Vulgaris↗
PubMed1992

Guidelines for optimal use of isotretinoin in acne.

Isotretinoin is most effective for patients with acne who fail to respond to other forms of treatment; virtually all patients respond to isotretinoin, 0.5 to 1.0 mg/kg/day. As many as 61% of patients are cured after one course, but 39% require further isotretinoin (16%) or oral antibiotics (23%). The relapse rate can be reduced by the administration of the higher dose of 1 mg/kg/day (thus achieving a significant cumulative dose of > 120 mg/kg), especially to young patients and men with truncal acne and more severe disease. About 85% require a 4-month course, but 15% require longer treatment, with some up to 10 months. There are several reasons for a slow response to treatment, including the presence of macrocomedones, ovarian dysfunction, and as-yet unknown factors. Macrocomedones can be treated with light cautery, ovarian dysfunction with hormonal therapies, and in those persons who have no obvious explanation for slow response, persistence with isotretinoin alone is required. Repeat courses of isotretinoin can also be given. Six years ago most patients treated with isotretinoin had severe acne (60%), but today most patients (60%) have therapy-resistant moderate acne. Isotretinoin is a consideration in such patients to reduce the physical and psychological effects of acne, particularly because there is no simple method to treat acne scars.

Acne Vulgaris↗