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The treatment of severe forms of oral lichen planus is still relatively unsatisfactory. In this controlled study, 0.1% tretinoin in an adhesive base was used in 23 patients. Fifteen other control patients were similarly treated with the vehicle alone. In the tretinoin-treated group, 71% of the atrophic-erosive lesions improved while 29% improved from the vehicle (P less than .05). Reticular-plaque lesions improved in 74% from tretinoin and in 15% from the vehicle (P less than .001). Irritation from tretinoin occurs and thorough usage information is mandatory.
A twice daily application of 2% erythromycin base in hydroalcoholic solution accompanied by once daily use of 0.05% tretinoin (retinoic acid) solution was substantially more effective than tretinoin or erythromycin alone for treatment of inflammatory acne of moderate severity. Therapeutic enhancement by this combination can be attributed to the different modes of action, erythromycin acting chiefly by suppressing Propionibacterium acnes, while tretinoin is comedolytic. In addition, by altering the horny layer barrier, tretinoin doubtless increases the penetration of erythromycin.
Twelve patients (20 +/- 2 years) with acne vulgaris were treated orally with 20-30 mg/day tretinoin (vitamin A acid) over 90-300 days. Various laboratory tests were performed to rule out unwanted pharmacological side effects. Tretinoin therapy was well tolerated except for minor complaints of dryness around the mucous membranes of mouth and nose. The acne remained unchanged. All laboratory tests were unremarkable except for a significant rise of ejaculate volume. Other sperm parameters, trichological, ophthalmological as well as blood and urine analyses showed no measurable effects of tretinoin therapy.
A controlled, randomized clinical study comparing different commercially available benzoly peroxide gels and tretinoin cream was undertaken by four investigators using similar protocols and case report forms. Results were based on lesion-count reduction over an 8-week period. No significant difference in reduction of total acne lesions was detected between the benzoyl peroxide gels and tretinoin cream. However, benzoyl peroxide was significantly better (P less than .02) in reduction of papules and as good as tretinoin in reduction of comedones. Results of this study suggest that excessive drying and peeling are not essential in the reduction of acne lesions.
Structural differences between untreated and tretinoin treated acne, uniquely evident with the scanning electron microscope, provide insight into the disease and its response to the drug. Early tretinoin therapy is characterized by the appearance of loosely adherent, parakeratotic cells which account for comedo expulsion and a disrupted skin surface. Persistence of the follicular and comedonal alterations account for the prophylactic value of long-term therapy. Meanwhile, the structure of the stratum corneum returns toward normal, with the clinical accommodation to the topical tretinoin.
The sequential application of tretinoin and a corticosteroid ointment was considerably more effective in the treatment of plaque-type psoriasis than either drug alone in a pilot study. The best results were obtained with 0.3% tretinoin followed by a potent corticosteroid ointment. Combined therapy was particularly efficacious in steroid-resistant psoriasis, including that on the palms, elbows, and knees. Irritancy from the high-strength tretinoin was a potentially troublesome side-effect. Care must be taken to avoid drug contact on areas that are easily irritated.
In four medical centers, 40 patients with keratinizing dermatoses were treated with topical tretinoin (vitamin A acid) 0.1% cream and salicylic acid 2% cream in a short-term, double-blind study. Tretinoin was the more effective treatment for several of the keratinizing dermatoses with the exception of palmar-plantar hyperkeratosis, for which it was not effective in the concentration and method of application used. The most striking clinical responses occurred in patients with lamellar ichthyosis and ichthyosis vulgaris. Local adverse reactions-chiefly pruritus, erythema, burning, excoriation, and irritation-were not severe and could be controlled by modification of the treatment regimen.
The entire corneal epithelium of each of 16 rabbits was removed bilaterally. Tretinoin (vitamin A acid) ointment was applied topically twice daily to the eyes of one half of the experimental animals, and the ointment base alone was applied to the eyes of the other half (the controls). On days 1, 2, and 3 after the removal of the epithelium, the healing of the denuded corneas of the animals receiving tretinoin was significantly (P = .01, .01, and .05, respectively) more advanced than the healing of the corneas of the control animals.
A clinical trial using tretinoin lotion 0.05%, benzoyl peroxide 5% and 10% as topical application was performed on 250 ambulatory patients suffering from various degrees of acne vulgaris. The results indicate that tretinoin applied in the morning and benzoyl peroxide applied at night is the most efficacious regimen to be used, with minimal side effects.
Topical tretinoin is a valuable therapeutic agent whose chief drawback has been local primary irritation. What were thought to be special difficulties with photosensitivity reactions and pigmentary changes in dark skin, really turn out to be other manifestations of the irritancy. Advances in the development of newer dosage forms and treatment regimens, together with expanded knowledge of the many factors which contribute to the problem, mean that there should be very few patients who cannot be treated with tretinoin. Only the rare patient with true hypersensitivity to the drug need be denied. Appropriate therapy still requires a modicum of personal attention to the individual patient's needs-but that is what the practice of medicine is all about.
Molluscum contagiosum spread by sexual contact may be mistaken for other venereal diseases. The occurrence of a penile lesion resembling herpes progenitalis, and successful therapy of genital mollusca with topical tretinoin (vitamin A acid) is described.
In patients with facial acne good results were obtained by topical treatment with a 0-05 per cent solution of retinoic-acid (tretinoin) solution and with a 0-025 per cent solution. The improvement was judged by clinical assessment and by counts of comedones, papules and pustules before and after the 12-week trial. Side-effects such as irritation and erythema were less with the 0-025 per cent solution. The use of swabs impregnated with a constant volume of solution and sealed in a sachet proved to be a convenient method of application. In the placebo group, swabs impregnated with the solvent only showed virtually no effect on facial acne.
The clinical and histologic features of lifelong reactive perforating collagenosis in a twenty-five year old woman are presented. Experimentally induced lesions showed the expected evolution and regression, although total time for the experimental lesion to develop and regress was shorter than the time necessary for those occurring spontaneously. Therapeutic trials with a wide variety of topical and systemic medications were without benefit, with the exception of tretinoin cream (0.1 percent), which was regularly effective in reducing the total number of lesions present.
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