Vitiligo is an idiopathic leukoderma often with a progressive course causing destruction of melanocytes. The best methods for achieving cosmetically acceptable re-pigmentation of affected skin appear to be both local and systemic PUVA. They may, however, cause serious side effects, which is an argument for conducting research into new, equally effective photo-chemotherapeutic agents. One of these agents is khellin. We conducted a pilot study in 33 patients to evaluate the effectiveness of local KUVA and systemic PUVA therapy for vitiligo and to compare them in terms of the degree of re-pigmentation, duration of treatment, number of procedures, total UVA dose and side effects. Local KUVA required longer duration of treatment and higher UVA doses. KUVA-induced re-pigmentation depended on the age of the patients (r = -0.61, P = 0.001), and better results were achieved with younger individuals [% re-pigmentation = 81.76 - (1.48 x age in years)]. No side effects were observed in cases of local KUVA treatment. Erythema, itching and gastro-intestinal disturbances occurred with some patients treated with PUVA. The results demonstrate that local KUVA may effectively induce re-pigmentation of vitiligo-affected skin areas to a degree comparable to that achieved when using systemic PUVA, provided that treatment duration is long enough.

Both UVA/UVB monotherapy and UVA/UVB + topical CS lead to significant clinical improvement in patients with AD, but the addition of CS reduces the total UVB dose and duration of treatment without influencing the duration of remissions and frequency of side effects.

References1 Hajjeh RA, Conn LA, Stephens DS et al. Cryptococcosis in the United States: population-based multistate active surveillance and risk factors in HIV-infected persons. J Infect Dis 1999; 179 : 449 -454. 2 Gaddoni D, Resta F, Baldassari L et al. Criptococcosi cutanea in corso di AIDS. G Ital Dermatol Venereol 1993; 128 : 129 -132. 3 Vandersmissen G, Meuleman L, Tits G et al. Cutaneous cryptococcosis in corticosteroid-treated patients without AIDS. Acta Clin Belg 1996; 51 (2): 111 -117. 4 Nampoory MR, Khan ZU, Johny KV et al. Invasive fungal infections in renal transplant recipients. J Infect 1996; 33 (2): 95 -101. 5 Krcmery V Jr, Kunova A, Mardiak J. Nosocomial Cryptococcus laurentii fungemia in a bone marrow transplant patient after prophylaxis with ketoconazole successfully treated with oral fluconazole. Infection 1997; 25 (2): 130. 6 Bangert RL, Cho BR, Widders PR et al. A survey of aerobic bacteria and fungi in the feces of healthy psittacine birds. Avian Dis 1988; 32 : 46 -52. 7 Slavikova E, Vadkertiova R. Yeasts and yeast-like organisms isolated from fish-pond waters. Acta Microbiol Pol 1995; 44 (2): 181-189. 8 Bellosta M, Gaviglio MR, Mosconi M et al. Primary cutaneous cryptococcosis in an HIV-negative patient. Eur J Dermatol 1999; 9 (3): 224 -226. 9 Dimino-Emme L, Gurevitch AW. Cutaneous manifestations of disseminated cryptococcosis. J Am Acad Dermatol 1995; 32 (5, Part 2): 844 -850. 10 Kordossis T, Avlami A, Velegraki A et al. First report of Cryptococcus laurentii meningitis and a fatal case of Cryptococcus albidus cryptococcaemia in AIDS patients. Med Mycol 1998; 36 (5): 335 -339. 11 Johnson LB, Bradley SF, Kauffman CA. Fungaemia due to Cryptococcus laurentii and a review of non-neoformans cryptococcaemia. References 1 Carlson JA, Murphy M. Androgen receptors and lichen sclerosus (letter). J Am Acad Dermatol 2000; 43: 559. 2 Clifton M, Smoller B. Androgen receptors and lichen sclerosus (reply). J Am Acad Dermatol 2000; 43: 559. 3 Kohlberger PD, Joura EA, Bancher D, Gitsch G, Breitenecker G, Kieback DG. Evidence of androgen receptor expression in lichen sclerosus: an immunohistochemical study. J Soc Gynecol Invest 1998; 5: 331-333. 4 Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet 1999; 353: 1777-1783. 5 Carlson JA, Ambros R, Malfetano J et al. Vulvar lichen sclerosus and squamous cell carcinoma: a cohort, case control, and investigational study with historical perspective; implications for chronic inflammation and sclerosis in the development of neoplasia. J Am Board Fam Pract 1999; 12: 473 -476. 6 Tidy JA, Soutter WP, Luesley DM, MacLean AB, Buckley CH, Ridley CM. Management of lichen sclerosus and intraepithelial neoplasia of the vulva in the UK.

A 21-year-old woman of Romany origin, in the third trimester of her fourth pregnancy, was admitted to the hospital because of a generalized erythematous and pustular eruption and desquamation involving her face, neck, trunk, and extremities. The skin changes were accompanied by fever (100.4 degrees F [38 degrees C]) and malaise. The patient was convinced that the dermatitis was induced by the consumption of "spoilt" pork sausage (bad smell, changed taste) approximately 24 hours earlier. Clinical examination revealed a woman with phototype III skin, black eyes, and black hair, in good general health. Widespread, symmetrical, moderately intense erythema and isolated or coalescing targetoid lesions studded with discrete, pinhead-sized, nonfollicular pustules in the center or at the periphery were distributed over her face, trunk, groins, and upper and lower extremities (Figures 1). On the neck and abdomen, lamellar desquamation was observed (Figure 2). Palms, soles, scalp, mucous membranes, hair, and nails were not affected. Nikolsky's sign was negative. The patient complained of very slight skin burning and itching. The pregnancy was proceeding without any complications and her obstetric status was normal. The woman had neither any accompanying diseases, nor previous personal or family history of psoriasis, nor any known allergies. She had taken no systemic medication (not even vitamins). She had three pregnancies; two ended with the delivery of healthy babies and one of them was aborted at her will. Laboratory studies revealed leukocytosis (13.2 x 109/L), neutrophilia (8 x 109/L), anemia (hemoglobin, 108 g/L), and an elevated erythrocyte sedimentation rate (68-110 mm/h). The results from the following investigations were normal: urinalysis, renal and hepatic function, serum albumin, Ca, Na, K, aspartate aminotransferase titer, cryoprotein, hepatitis B surface antigen, and serum markers for syphilis. Bacterial and fungal cultures of pustular content were sterile. A skin biopsy specimen of lesional skin revealed subcorneal pustules containing leukocytes and necrotic keratinocytes and a mixed perivascular inflammatory infiltrate with isolated eosinophils in the dermis (Figure 3). The patient was treated with systemic methylprednisolone in gradually reduced doses, fluocinonide cream 0.05%, and emollients. As a result, her fever disappeared and her erythema faded. Frequent obstetric examination and cardiotocography were normal and showed no evidence of placental insufficiency. At 40 weeks' gestation, the patient spontaneously gave birth without any complications to a healthy boy. She was discharged with complete resolution of the skin lesions, preceded by massive desquamation of the epidermis. The 1-year follow-up of the patient revealed no relapses or new pustular eruptions.