Biomedical subjects

R J Van Dooren-Greebe

Publications and source records attributed to R J Van Dooren-Greebe.

4 recordsLinked to original sources

PubMed1996

Prolonged treatment with oral retinoids in adults: no influence on the frequency and severity of spinal abnormalities.

It is generally accepted that the spine is the site of predilection for retinoid-induced skeletal abnormalities. However, the reported prevalence of skeletal problems varies widely. To investigate the frequency and severity of retinoid-induced spinal abnormalities, all records of patients who underwent spinal radiographs at the request of the department of dermatology between 1983 and 1993 were reviewed. This group of 135 patients comprised the total population of retinoid-treated patients and those patients who were investigated for possible future retinoid treatment. The mean treatment period in the total group was 30 months and the mean cumulative dose of retinoid was 31 g. In 50 patients the treatment period was > or = 24 months with 30 patients being treated for more than 48 months. Baseline radiographs were available from 26 patients and these were compared with the most recent X-rays during treatment. The mean treatment period in this 'prospective group' was 25 months and the mean cumulative dose of retinoid was 25 g. The prevalence of diffuse idiopathic skeletal hyperostosis (DISH), degenerative changes and osteoporosis in the total group was respectively 16%, 53% and 29%. There was no statistically significant relation between the duration of treatment or the cumulative dose and the prevalence or severity of DISH, degenerative changes and osteoporosis. Only the age of the patients was significantly related to the frequency and severity of skeletal abnormalities. In the 'prospective group', again, no important changes were observed between the radiographs at baseline and during treatment. In this study no relation whatsoever between spinal abnormalities and prolonged oral retinoid treatment could be established. The performance of annual routine spinal radiographs during retinoid treatment is not necessary in our opinion. Additional controlled and prospective studies on spinal and extraspinal skeletal abnormalities are required to develop definitive screening guidelines for patients submitted to long-term retinoid treatment.

Acitretin↗

PubMed1994

Methotrexate revisited: effects of long-term treatment in psoriasis.

In the past 22 years, 113 patients with severe psoriasis have been treated with low-dose methotrexate (MTX) in our department. The maximum weekly dosage was 15 mg (Weinstein schedule), the estimated mean cumulative dose was 4803 mg, and the estimated mean duration of therapy was 8 years and 11 months. In 81% of the patients, prolonged clearance or near clearance was achieved, indicating the potent and sustained potential of MTX in the treatment of both the pustular and erythematosquamous variants of psoriasis. Eighty-three patients (73%) had side-effects, most frequently abnormal liver function tests, nausea and gastric complaints. Apart from hair loss in seven patients, there were no mucocutaneous side-effects, probably because of the low-dose treatment schedule. In 71 patients MTX therapy was discontinued; in 33 patients because of side-effects. In 55 patients one or more liver biopsies were performed. Fibrosis was seen in seven of these patients (13%) and cirrhosis in two (4%). There was no relation between liver biopsy classification and cumulative dosage or duration of MTX therapy, nor was there any relation between liver histology and abnormal liver function tests. During this 22-year period, there were no deaths or life-threatening side-effects attributable to MTX treatment. We conclude that low-dose MTX (< or = 15 mg/week) is a relatively safe therapy for severe psoriasis, if patients are carefully selected beforehand, and regular monitoring for side-effects and drug interactions is performed during therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1994

Acitretin in the treatment of lamellar ichthyosis.

Etretinate and its metabolite acitretin have been shown to be highly effective in the treatment of various disorders of keratinization, including lamellar ichthyosis. The aim of the present study was to provide further information on acitretin dosage regimens in the management of lamellar ichthyosis. Seven patients with classical manifestations of lamellar ichthyosis participated in the study. Five patients improved markedly, and the remaining patients showed mild to moderate improvement. Two patients improved following gradual incremental increase in dosage (> or = 35 mg/day). Four patients, including a patient with the erythrodermic variant, required low-dose acitretin treatment (< or = 25 mg/day), as higher doses resulted in a marked deterioration in their skin condition. The dichotomy with respect to the response to acitretin suggests that lamellar ichthyosis is a spectrum of at least two conditions.

Acitretin↗

PubMed1993

Calciphylaxis.

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Calciphylaxis↗