Rosacea fulminans.
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Dose-Response Relationship, Drug↗
Biomedical subjects
J S Strauss
Publications and source records attributed to J S Strauss.
A randomized trial of the efficacy of a new micronized formulation versus a standard formulation of isotretinoin in patients with severe recalcitrant nodular acne.
BACKGROUND: Isotretinoin is very frequently the drug of choice for the management of severe recalcitrant nodular acne. Recently, a new micronized and more bioavailable formulation of isotretinoin has been developed that permits once-daily administration in lower doses than usually used with standard isotretinoin (Accutane), regardless of whether it is taken with or without food. OBJECTIVE: Our purpose was to determine whether micronized isotretinoin and standard isotretinoin are clinically equivalent. METHODS: In this multicenter, double-blind, double-dummy study, 600 patients with severe recalcitrant nodular acne were treated with either 0.4 mg/kg of micronized isotretinoin once daily without food (n = 300) or 1.0 mg/kg per day of standard isotretinoin in two divided doses with food (n = 300). Lesion counts were monitored over 20 weeks. RESULTS: Both treatment groups in this well-controlled clinical trial experienced an equivalent reduction in the number of total nodules (facial plus truncal). In addition, an equivalent proportion of patients achieved 90% clearance of the total number of nodules. Both formulations had similar results for other efficacy variables. CONCLUSION: Once-daily use of the micronized and more bioavailable formulation of isotretinoin under fasted conditions is clinically equivalent to the standard twice-daily formulation under fed conditions in the treatment of severe recalcitrant nodular acne.
Acne Vulgaris↗
Safety of a new micronized formulation of isotretinoin in patients with severe recalcitrant nodular acne: A randomized trial comparing micronized isotretinoin with standard isotretinoin.
BACKGROUND: Isotretinoin is a very effective drug for treating severe recalcitrant nodular acne. A new micronized formulation of isotretinoin has been shown to be clinically equivalent to standard isotretinoin with improved bioavailability and minimal food effect. The safety profile of the micronized formulation has not been described previously. OBJECTIVE: The objective of this article is to report the incidence and intensity of adverse events found in a comparative, double-blind efficacy study that showed clinical equivalence of the new micronized formulation of isotretinoin and the standard isotretinoin formulation (Accutane). METHODS: Six hundred patients with severe recalcitrant nodular acne were treated with micronized isotretinoin (n = 300) under fasted conditions or standard isotretinoin (n = 300) under fed conditions. One cohort received single daily doses of 0.4 mg/kg of micronized isotretinoin without food and the other cohort received 1.0 mg/kg per day of standard isotretinoin in two divided doses with food. Adverse events were monitored during 20 weeks of drug therapy. RESULTS: The proportion of adverse events in most body systems was generally lower in patients receiving micronized isotretinoin than in those receiving standard isotretinoin. CONCLUSION: Micronized isotretinoin appears to have a safety profile similar to that of standard isotretinoin and to carry a lower risk of mucocutaneous events and hypertriglyceridemia.
Acne Vulgaris↗
A comparative trial of two retinoids commonly used in the treatment of acne vulgaris.
BACKGROUND: Topical retinoids are highly effective treatments for acne vulgaris. The various formulations and concentrations available allow physicians to tailor therapies to individual patient's needs and minimize the cutaneous irritation that is often observed with the use of these drugs. OBJECTIVE: To compare the efficacy and safety of tretinoin gel microsphere 0.1% with adapalene gel 0.1% in the treatment of acne vulgaris. METHODS: A 12-week double-blind study was conducted, and patients were evaluated at baseline and at weeks 2, 3, 4, 6, 8, 10, and 12. RESULTS: Although the two drugs displayed similar efficacy in the resolution of acne lesions at 12 weeks, a significantly greater reduction in the number of comedones was seen at week 4 among patients treated with tretinoin gel microsphere (p = 0.047). Patients receiving tretinoin gel microsphere had an increased incidence of dryness (weeks 8 and 10) and peeling (weeks 3, 6, 8, and 10) compared with those patients treated with adapalene gel, but the two groups were comparable with respect to erythema, burning/stinging, and itching. CONCLUSION: Both drugs have similar efficacy in the resolution of acne lesions but tretinoin gel microsphere may result in a faster onset of action in the reduction of comedones compared to adapalene.
Acne Vulgaris↗
Some thoughts on rosacea.
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Helicobacter Infections↗
Concomitant administration of vitamin E does not change the side effects of isotretinoin as used in acne vulgaris: a randomized trial.
BACKGROUND: Isotretinoin treatment is frequently associated with reversible, dose-related side effects. Recent studies claimed that combining vitamin E with high-dose isotretinoin ameliorated isotretinoin-induced side effects. OBJECTIVE: The purpose of this double-blind, randomized study was to determine the effects of a fixed dose of vitamin E on the side effects of isotretinoin for treatment-resistant acne vulgaris. METHODS: One hundred forty subjects were randomly assigned to one of two treatment programs with isotretinoin (1 mg/kg) together with either vitamin E (800 IU/day) or a vitamin E placebo for 20 weeks. The incidence, severity, and duration of the side effects (eg, dry eyes, dry lips) were assessed. RESULTS: A fixed 800 IU/day dose of vitamin E did not improve the incidence, severity, or duration of side effects associated with isotretinoin (1 mg/kg per day). CONCLUSION: Vitamin E did not significantly ameliorate retinoid side effects when combined with 1 mg/kg of isotretinoin in the treatment of acne.
Acne Vulgaris↗
How do you provide treatment if different people need different things at different times?
This chapter emphasizes the need to focus on the individual's process of reintegration. It identifies three key questions that need to be asked of the patient and answered.
Chronic Disease↗
Virtual microscopy: high resolution digital photomicrography as a tool for light microscopy simulation.
Recent advances in microcomputers and high resolution digital video cameras provide pathologists the opportunity to combine precision optics with digital imaging technology and develop new educational and research tools. We review recent advances in virtual microscopy and describe techniques for viewing digital images using a microcomputer-based workstation to simulate light microscopic examination, including scanning at low power to select features of interest and zooming to increase magnification. Hardware and software components necessary to acquire digital images of histological and cytological slides, and closely simulate their examination under a light microscope are discussed. The workstation is composed of a MicroLumina digital scanning camera (Leaf Systems, Southborough, MA), light microscope (Olympus Optical Co., Lake Success, NY), Pentium (Intel Corp., Santa Clara, CA) 166 MHz microcomputer configured with 64 megabytes of random access memory (RAM), a MGA Millenium Powerdesk graphics card (Matrox Graphics, Inc., Montreal, Canada) and Photoshop software (Adobe Systems Inc., San Jose, CA) running in a Windows 95 (Microsoft Corp., Redmond, WA) environment. Images with spatial resolutions of up to 2700 x 3400 pixels in 36-bit color, can be displayed simultaneously as distinct images in a montage, or merged into a single composite image file to highlight significant features of a histological or cytological slide. These image files are saved in Joint Photographers Experts Group (JPEG) format using compression ratios of up to 80:1 without detectable visual degradation. The advantages and technical limitations of various workstation components are addressed and applications of this technology for pathology education, proficiency testing, telepathology, and database development are discussed.
Forecasting↗
"Virtual microscopy" and the internet as telepathology consultation tools: diagnostic accuracy in evaluating melanocytic skin lesions.
The Internet offers a widely available, inexpensive tool for telepathology consultations. It allows the transfer of image and text files through electronic mail (e-mail) or file transfer protocols (FTP), using a variety of microcomputer platforms. We studied the use of the Internet and "virtual microscopy" tools for the diagnosis of 35 skin biopsies, including a variety of benign and malignant melanocytic lesions. Digitized images from these lesions were obtained at 40x and 100x optical magnification, using a high resolution digital camera (Microlumina, Leaf Systems, Southborough, MA), a light microscope with a phototube adapter and a microcomputer with a Pentium 166 MHz microprocessor. Two to four images of each case were arranged on a "canvas" to represent the majority or an entire biopsy level, using Photoshop software (Adobe Systems Inc., San Jose, CA). The images were compressed using Joint Photographers Expert Group (JPEG) format. The images were then viewed on a computer video monitor in a manner that closely resembles light microscopy, including scrolling by using the "hand tool" of Photoshop and changing magnification digitally up to 4 times without visible image degradation. The image files, ranging in size from 700 kilobytes to 2.1 megabytes (average 1.6 megabytes) were attached to e-mail messages that contained clinical information, using standard Multipurpose Internet Mail Extension (MIME) protocols and sent through the Internet, for interpretation by a dermatopathologist. The consultant could open the images from the e-mail message, using Microsoft Outlook Express (Microsoft Corp., Redmond, WA) and Photoshop software, scroll them, change magnification and render a diagnosis in a manner that closely simulates light microscopy. One hundred percent concordance was obtained between the telepathology and traditional hematoxylin and eosin slide diagnoses. The Internet and relatively inexpensive "virtual microscopy" tools offer a novel technology for dermatopathology consultations. Potential applications of this technology to pathology and technical problems posed by the use of an open, widely distributed network to share sensitive medical information are discussed.
Biopsy↗
Virtual microscopy and public-key cryptography for Internet telepathology.
The Internet is a potentially inexpensive, widely available medium for telepathology, but there are concerns about its reliability and security. Using a digital camera, 41 photomicrographs of transbronchial biopsies, at x 100 optical magnification, were captured and digitized at 2700 x 3400 pixel, 24 bit/pixel resolution. The image files were saved in JPEG format at medium compression, attached to text files with patient information, encrypted for security in the S/MIME format using a digital signature and digital envelope, and transmitted by email. Received email files were decrypted automatically and the images viewed with standard software. Telepathology diagnoses were compared with original interpretations. The images averaged 810 kByte in size. The encryption and decryption did not cause significant delays in overall transmission time and, together with transmission, did not produce noticeable image degradation. The received image files could be viewed in a manner that simulated light microscopy. There was agreement between telepathology and original diagnoses in 92% of the cases. All the discrepancies were due to inadequate area selection because the pathological features of interest were present in histological levels other than those photographed. The use of high-resolution digital photomicrography, the Internet and public-key cryptography offers an effective and relatively inexpensive method of telepathology consultation. The method is best suited for the diagnosis of small biopsy specimens that require the transmission of only a few digital images that represent the majority of the biopsy materials.
Bronchi↗
Sebaceous gland, acne and related disorders--an epilogue.
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Acne Vulgaris↗
International Foundation for Dermatology: the first 8 years.
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Dermatology↗
In memoriam Herman Beerman (1901-1995).
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Dermatology↗
Beyond the biopsychosocial model: integrating disorder, health, and recovery.
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Activities of Daily Living↗
Planning for the future: a prescription for dermatology's survival.
The specialty of dermatology has reached its current position of esteem through a combination of superior practice standards and organizational skills displayed by persons such as Clarence S. Livingood. In the next few years, as unpredictable changes occur in the health care system, our specialty, with fewer than 2% of U.S. practicing physicians, and without a significant hospital base, will face unique challenges. We must meet these by continuing to interact with organized medicine. The major focus of this article will be on who are the important players in this area and what can we expect to accomplish through collaborative and cooperative interchanges.
Certification↗
Intensive studies of patients and the experiences of investigators and clinicians.
Mental processes, normal or abnormal, are complex and multifaceted, needing to be viewed from diverse perspectives. But our field has split increasingly into two discrete groups. One group includes those investigators and clinicians who are often seen as most scientific and have restricted themselves more and more exclusively to directly observable, generally superficial phenomena and patients as classified according to those phenomena. Such variables can be reliably rated, a crucial aspect of any scientific endeavor. But in this group there has been a tendency to be like the person who lost the keys in the middle of the block but looked for them at the corner because "the light is better here." Those of us in this group have tended to act as though, if we can't measure a phenomenon with relative ease, it doesn't exist--potentially the antithesis of an adequate science. Others, and they have become rarer, have focused on understanding the psychological processes of individuals with mental disorder in great depth, while paying less attention to questions of scientific approaches to proof.
Female↗
The person with schizophrenia as a person. II: Approaches to the subjective and complex.
In the mental health field, the attention given to the subjective side of a person's experience is grossly inadequate. The best way to reflect the subjectivity of a person may be by means of the subjectivity of another. To take account of both subjective experience and objective measures in the course of mental disorders, a new concept is needed. This may be the person's story.
Adaptation, Psychological↗