Super Formulário de Dermatologia 2014: Principais Doenças Dermatológicas e Tratamentos Disponíveis Na Manipulação

Super Formulário de
Dermatologia
2014
Principais Doenças Dermatológicas e
Tratamentos Disponíveis na Manipulação
Índice
Acne..................................................................................................................................4
Principais Tratamentos ........................................................................................6
Exemplos de Formulações Tópicas...................................................................8
Exemplos de Formulações de Uso Oral .........................................................10
Rosácea .........................................................................................................................11
Principais Tratamentos ......................................................................................13
Exemplos de Formulações ...............................................................................14
Discromias ......................................................................................................................15
Discromia ............................................................................................................16
Vitiligo ..................................................................................................................17
Estudos ................................................................................................................20
Melasma (Cloasma) .........................................................................................24
Psoríase ...........................................................................................................................28
Estudos ................................................................................................................32
Dermatite .......................................................................................................................37
De Contato ........................................................................................................39
Atópica ...............................................................................................................42
Seborreica ..........................................................................................................45
Estudos ................................................................................................................47
Afecções dos Pelos.......................................................................................................50
Alopecias............................................................................................................52
Alopecia Areata – Principais Tratamentos ....................................................53
Estudos ................................................................................................................54
Alopecia Androgenética – Principais Tratamentos .....................................58
Estudos ................................................................................................................59
Hirsutismo ............................................................................................................61
Estudos ................................................................................................................63
Hiperidrose .....................................................................................................................67
Micoses Superficiais ......................................................................................................71
Ceratofitoses e Dermatofitoses .......................................................................72
Pitiríase Versicolor – Principais Tratamentos ...................................................73
Dermatofitoses – Principais Tratamentos .......................................................75
Estudos ................................................................................................................76
Onicomicoses ................................................................................................................78
Estudos ................................................................................................................81
Caspa .............................................................................................................................84
Estudos ................................................................................................................87
Ceratose Actínica .........................................................................................................90
Estudos ................................................................................................................93
Líquen Plano ..................................................................................................................96
Estudos ................................................................................................................99
Exemplos de Formulações .............................................................................100
Referências Bibliográficas ..........................................................................................101
Abstracts.......................................................................................................................107
_______________________Acne
Acne
A acne vulgar é um distúrbio autolimitado da unidade pilossebácea que é vista
normalmente em adolescentes. A maioria dos casos se apresenta com uma
variedade pleomórfica de lesões, consistindo em comedóes, pápulas, pústulas
e nódulos. Embora o curso da acne possa ser autolimitado, as sequelas podem
ser para a vida toda, com formação de cicatrizes hipertrtóficas ou deprimidas
(Wolff et al., 2011).
Sua patogênese é multifatorial, mas foram identificados quatro passos básicos.

Estes elementos-chave são: hiperproliferação folicular epidérmica, excesso de
produção de sebo, inflamação e a presença e atividade de Propionibacterium
acnes (Wolff et al., 2011).
Legenda: Mecanismo de formação das lesões acneicas.
A principal região atingida é a face e, em menor grau, dorso, peito e ombros.

A doença é caracterizada por uma grande variedade de lesões clínicas, as
quais podem ser inflamatórias e não inflamatórias. As não inflamatórias são os
comedões, que podem ser abertos ou fechados. Já as inflamatórias variam de
pequenas pápulas com bordas avermelhadas a pústulas e nódulos com
flutuação. Pode ser classificada em: Acne não-inflamatória (Grau I), Acne
inflamatória (Graus II, III, IV e V) (Wolff et al., 2011).
Um entendimento dos quatro passos

principais da fisiopatogenia da acne conduz
aos princípios de tratamento. Os mecanismos
de ação da maioria dos tratamentos comuns
da acne podem ser divididos nas seguintes
categorias: correção do padrão alterado da
ceratinização do folículo; diminuição da
atividade da glândula sebácea; redução da
população bacteriana folicular e efeito anti-
inflamatório (Wolff et al., 2011).
Referências
Wolff, K; Goldsmith, LA; Katz, SI; Gilchrest, BA; Paller, AS; Leffell, DJ. Fitzpatrick – Tratado de Dermatologia. 7 ed. Vol 1. Rio de Janeiro: Revinter,
2011
Principais Tratamentos
Tratamentos Tópicos
Tratamento Tópico
Concentração
Composto Propriedades
Usual
Antimicrobiano e
comedolítico.
Também é inibidor
competitivo da
Creme a 20%
Ácido Azelaico tirosinase, podendo ser
Gel a 15%
utilizado em pacientes
com
hiperpigmentação
pós-inflamatória
Creme, loção,
sabonete e
Peróxido de Benzoíla Antimicrobiano
emplastro a 2,5 a
10,0%
Solução ou gel a
Eritromicina Antibiótico
2,0%
Clindamicina Solução a 2,0% Antibiótico
Creme ou gel a
Isotretinoína
0,025 ou 0,05% Comedolítico e anti-
Tretinoína Gel a 0,04 ou 0,1% inflamatório
Retinoides
Adapaleno Gel a 0,1%
Ceratolítico e
Ácido Salicílico 2,0 a 6,0%
esfoliante
Ceratolítico,
Loções, creme e
Enxofre antisséptico e
pomadas até 10,0%
antifúngico
Referências
Wolff, K; Goldsmith, LA; Katz, SI; Gilchrest, BA; Paller, AS; Leffell, DJ. Fitzpatrick – Tratado de Dermatologia. 7 ed. Vol 1. Rio de
Janeiro: Revinter, 2011.
Azulay & Azulay. Dermatologia.4ª ediçao. Editora Guanabara Koogan, 2006.
Tratamentos Sistêmicos
Tratamento Sistêmico
Concentração
Composto Propriedades
Usual
Tetraciclinas 500 a 1.000 mg/dia Antibiótico
250 a 500 mg três
Azitromicina Antibiótico
vezes por semana
Clindamicina 150 a 300 mg 6/6h Antibiótico
1 a 2 g diários em 2 a
Eritromicina Antibiótico
4 doses
50 a 100 mg diários
Dapsona Antibiótico
por 3 meses
Antiandrógeno. Reduz
Espironolactona 50 a 100 mg/dia a produção de sebo e
melhora a acne
Pacientes com acne
nodular grave. Inibição
Isotretinoína 0,5 a 1,0 mg/kg/dia
da atividade das
glândulas sebáceas
Acetato de ciproterona 2 mg Antiandrógeno
Etinilestradiol 35 microgramas Antiandrógeno
Referências
Martindale, The complete drug reference, 34ª edition.
Exemplos de Formulações Tópicas
1. Loção Oil-free Antisseborreica e Queratolítica
Ácido Salicílico ........................................2,0%

Enxofre Líquido........................................5,0%
Loção Oil-free ………………………qsp 100 ml
Aplicar diariamente, no período noturno, sobre
as áreas com acne ou conforme orientação
médica.
2. Sabonete de Limpeza para Peles Acneicas
Peróxido de Benzoíla ...............................4,0%

Sabonete Líquido LESS-free..............qsp 120ml
Lavar as áreas com acne uma vez ao dia no
período noturno ou conforme orientação
médica.
3. Gel Redutor da Acne
Adapaleno...............................................0,1%
Peróxido de Benzoíla ...............................2,5%
Gel de Lecigel™...................................qsp 50g
as áreas com acne ou conforme orientação
médica.
4. Creme com Antiandrógeno Tópico
Ácido Azeláico........................................10,0%
Eritromicina .............................................2,0%
Gel Creme Oil-free..............................qsp 50g
Aplicar duas vezes ao dia sobre as áreas com
acne ou conforme orientação médica.
5. Gel de Eritromicina
Eritromicina..............................................2,0%
Aplicar diariamente sobre as áreas com acne
ou conforme orientação médica.
6. Creme com Ácido Salicílico
Ácido Salicílico.........................................2,0%
Creme Olivem 5%...............................qsp 30g
7. Gel com Tretinoína
Tretinoína..............................................0,04%
8. Gel com Adapaleno
Adapaleno...............................................0,1%
9. Loção Oil-free Clindamicina
Clindamicina ...........................................2,0%
Loção Oil-free ………………………qsp 100 ml
Exemplos de Formulações de Uso
Oral
1. Cápsulas Redutoras da Acne Grave na Mulher
Acetato de
Ciproterona.............................2mg
Etinilestradiol ........................................35mcg
Cápsula............................................qsp 1 UN
Mande 21 cápsulas.
Administrar 1 cápsula ao dia durante 21 dias, a
partir do 1º dia de menstruação.
Após um intervalo de 7 dias, inicia-se um novo
ciclo de tratamento.
2. Cápsulas de Azitromicina
Azitromicina................................250 a 500mg
Cápsula............................................qsp 1 UN
Administrar 1 cápsula três vezes por semana ou
conforme orientação médica.
3. Cápsulas de Isotretinoína
Isotretinoína..........................................70mg*
Cápsula............................................qsp 1 UN
Administrar 1 cápsula ao dia ou conforme
orientação médica.
*Dose usual para um adulto de 70 Kg.
4. Cápsulas de Dapsona
Dapsona.......................................50 a 100mg
Cápsula............................................qsp 1 UN
Administrar 1 cápsula ao dia por três meses ou
____________________Rosáce
a
Rosácea
Apesar do conhecimento universal, a rosácea permanece como um tópico

controverso em dermatologia, principalmente em virtude de sua fisiopatologia
incerta e de sua grande variação clínica. É caracterizada pelo eritema na parte
central da face e que persiste por meses ou anos. As áreas convexas do nariz,
bochechas, queixo e testa são as mais afetadas. Têm-se invocado causas
gastrintestinais, psicogênicas, infecciosas, climáticas e alimentares, porém sem
fundamento científico (Wolff et al., 2011).
As características primárias da rosácea (que podem ser observadas, mas não

são necessárias ao diagnóstico) incluem vermelhidão/flushing, pápulas, pústulas
e telangiectasia. As características secundárias incluem queimação e sensação
de picadas na face, edema, placas eritematosas, aparência seca, rinofima,
vermelhidão periférica e manifestações oculares (Wolff et al., 2011).
Devido à sua evolução, a tendência atual é classificá-la em quatro estágios:

estágio I (eritema episódico); estágio II (eritema moderado e persistente com
telangiectasias finas); estágio III (eritema, telangiectasias, pápulas e pústulas) e
estágio IV (eritema intenso e persistente) (Wolff et al., 2011).
Antes de implementar um tratamento, os fatores desencadeantes específicos

para cada indivíduo devem ser identificados (Wolff et al., 2011).
Referências
Wolff, K; Goldsmith, LA; Katz, SI; Gilchrest, BA; Paller, AS; Leffell, DJ. Fitzpatrick – Tratado de Dermatologia. 7 ed. Vol 1. Rio de Janeiro: Revinter,
2011
Tratamento Tópico
Concentração
Composto
Usual
Ácido Azelaico Gel a 15%
Gel, creme e loção a
Metronidazol
0,75 a 1,0%
Sulfacetamida de Sódio 10,0%
Enxofre 5,0%
Clindamicina 2,0%
Eritromicina 2,0%
Peróxido de Benzoíla 2,5 a 10,0%
Concentração Propriedades
Composto
Usual
Pacientes com
rosácea apresentam
níveis elevados de
EROs quando
comparado a
pacientes saudáveis.
Os resultados desse
estudo
Azitromicina 500 mg demonstraram que
as propriedades
antioxidantes da
azitromicina (500 mg)
reduziu os níveis de
EROs e melhorou os
sinais e sintomas
dessa patologia
(Bakar et al., 2007).
Referências
Bakar O, Demirçay Z, Yuksel M, Haklar G, Sanisoglu Y. The effect of azithromycin on reactive oxygen species in rosacea. Clin
Exp Dermatol. 2007 Mar;32(2):197-200. Epub 2007 Jan 18.
Exemplos de Formulações
1. Creme Redutor da Rosácea
Sulfacetamida de Sódio..........................10,0%
Enxofre.....................................................5,0%
Gel Creme Oil-free..............................qsp 50g
Aplicar sobre as áreas com rosácea duas vezes
ao dia ou conforme orientação médica.
2. Cápsulas de Azitromicina – Redução dos Sinais e

Sintomas
Azitromicina..........................................500mg
Cápsula..............................................qsp 1UN
Mande 12 cápsulas. Consumir uma cápsula ao
dia por três dias consecutivos em cada
semana por um período de quatro semanas ou
3. Gel de Metronidazol
Metronidazol............................................1,0%
Aplicar sobre as áreas com rosácea uma vez
ao dia ou conforme orientação médica
Novo!
Oximetazolina 1%, creme qsp 30g. Aplciar 1 vez
ao dia.
4. Gel de Clindamicina
Clindamicina............................................2,0%
Aplicar sobre as áreas com rosácea uma vez
ao dia ou conforme orientação médica
_________________Discromias
Discromia
Discromia é um termo genérico que engloba toda e qualquer alteração da cor

da pele. Na maioria das vezes, o processo relaciona-se à quantidade de
melanina. Outros pigmentos endógenos (bilirrubina, derivados hemoglobínicos)
e exógenos (cloroquina, tetraciclina) produzem discromias. Podem ser
localizadas, generalizadas ou sistêmicas, congênitas, hereditárias ou adquiridas
pelos mais diversos mecanismos. Podem ser classificadas em hipocromias ou
acromias (diminuição ou ausência de melanina), hipercromias (excesso de
melanina), leucomelanodermias (mistura das duas anteriores e discromias por
outros pigmentos (Azulay e Azulay, 2006).
Coloração
da pele
Grânulos de Grânulos de
melanina melanina
Melanossom
a
Melanócito
Referências
Azulay e Azulay. Dermatologia. 4ed. Rio de Janeiro: Guanabara Koogan, 2006.
Vitiligo
É uma dermatose caracterizada por manchas acrômicas, em geral bilaterais e

simétricas, de etiologia desconhecida. Ocorre em qualquer idade, porém é
mais frequente na segunda ou na terceira década de vida. Sua frequência é
de 1% na população e não tem preferência por sexo ou etnia. Embora capaz
de causar prejuízo apenas estético, muitas vezes desencadeia distúrbios
psicossociais de grande importância (Azulay e Azulay, 2006).
As manchas decorrem da diminuição ou inexistência de melanócitos. Três

teorias procuram explicar a destruição dos melanócitos: neurogênica, segundo
a qual fatores neuroquímicos inibem a melanogênese e têm efeito tóxico sobre
os melanócitos; autoimune, segundo a qual haveria destruição dos melanócitos
por mecanismo imunológico e autodestruição dos melanócitos por substância
envolvidas na formação da melanina (quinona, fenóis e outras) (Azulay e
Azulay, 2006).
Há localizações preferenciais para crescimento das manchas, como face,

punhos, dorso dos dígitos, genitália, dobras naturais da pele, regiões periorificiais
e eminências ósseas (cotovelos). O vitiligo pode ser classificado de acordo com
a extensão da superfície corporal acometida. A doença deve ser considerada
estável ou em progressão, o que auxilia na definição da estratégia para o
tratamento. O objetivo do tratamento inclui a estabilização da doença e a
repigmentação (Azulay e Azulay, 2006).
Referências
Composto Concentração Usual

Propionato
Creme ou pomada a
de
0,05%
Clobetasol
Corticosteróid Acetonido de
Creme ou pomada a 0,1%
es Triancinolona
Dipropionato
de
Creme a 0,05%
Betametason
a
Tacrolimus Pomada de 0,03 a 1,0%
L-fenilalanina Gel a 10,0%
Di-hidroxiacetona (DHA) Creme a 6,0%
Referências
Rajatanavin N, Suwanachote S, Kulkollakarn S. Dihydroxyacetone: a safe camouflaging option in vitiligo. Int J Dermatol. 2008
Apr;47(4):402-6.
Kanwar AJ, Dogra S, Parsad D. Topical tacrolimus for treatment of childhood vitiligo in Asians. Clin Exp Dermatol. 2004
Nov;29(6):589-92. Xu AE, Zhang DM, Wei XD, Huang B, Lu LJ. Efficacy and safety of tarcrolimus cream 0.1% in the treatment of
vitiligo. Int J Dermatol. 2009 Jan;48(1):86-90. Majid I. Does topical tacrolimus ointment enhance the efficacy of narrowband ultraviolet
B therapy in vitiligo? A left-right comparison study. Photodermatol Photoimmunol Photomed. 2010 Oct;26(5):230-4.
Camacho F, Mazuecos J. Oral and topical L-phenylalanine, clobetasol propionate, and UVA/sunlight--a new study for the treatment of
vitiligo. J Drugs Dermatol. 2002 Sep;1(2):127-31.
Composto Concentração Usual Propriedades
Extrato antioxidante e
Polypodium leucotomos 250 mg três vezes ao dia
imunomodulador
Anti-inflamatório,
imunomodulador,
Minociclina 100 mg uma vez ao dia
antioxidante e
antimicrobiano
10 mg por dois dias
Dexametasona Corticoide
consecutivos
Antioxidante e
Ginkgo biloba 40 mg três vezes ao dia
imunomodulador
L-fenilalanina 100 mg/kg/dia
0,3 mg/kg com redução
Prednisona Corticoide
gradativa
Referências
Middelkamp-Hup MA, Bos JD, Rius-Diaz F, Gonzalez S, Westerhof W. Treatment of vitiligo vulgaris with narrow-band UVB and oral
Polypodium leucotomos extract: a randomized double-blind placebo-controlled study. J Eur Acad Dermatol Venereol. 2007
Aug;21(7):942-50.
Parsad D, Kanwar A. Oral minocycline in the treatment of vitiligo--a preliminary study. Dermatol Ther. 2010 May-Jun;23(3):305-7.
Radakovic-Fijan S, Fürnsinn-Friedl AM, Hönigsmann H, Tanew A. Oral dexamethasone pulse treatment for vitiligo. J Am Acad
Dermatol. 2001 May;44(5):814-7.
Parsad D, Pandhi R, Juneja A. Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo. Clin Exp Dermatol.
2003 May;28(3):285-7.
Estudos
Di-hidroxiacetona
Uma Opção Segura Para Disfarce do Vitiligo
A di-hidroxiacetona promove uma opção terapêutica segura e eficaz do vitiligo

recalcitrante. Os pacientes com a pele escura precisam de uma concentração
mais alta de DHA que os pacientes com a pele mais clara.
Rajatanavin N, Suwanachote S, Kulkollakarn S. Dihydroxyacetone: a safe camouflaging
option in vitiligo. Int J Dermatol. 2008 Apr;47(4):402-6.
Extrato de Polypodium leucotomos Via Oral + Fototerapia

com UVB de Banda Estreita
Aumento da Repigmentação nas Regiões da Cabeça e do Pescoço em
Pacientes com Vitiligo
Há uma clara tendência em aumentar a repigmentação nas regiões da

cabeça e do pescoço em portadores de vitiligo associando a fototerapia NB-
UVB à terapia oral de extrato de P. leucotomos. O efeito pode ser maior em
pacientes com pele mais clara
Middelkamp-Hup MA, Bos JD, Rius-Diaz F, Gonzalez S, Westerhof W. Treatment of vitiligo
vulgaris with narrow-band UVB and oral Polypodium leucotomos extract: a randomized
double-blind placebo-controlled study. J Eur Acad Dermatol Venereol. 2007
Aug;21(7):942-50.
Tratamento com Minociclina Oral no Vitiligo

Interrupção da Progressão da Doença
A minociclina oferece uma abordagem única e potencialmente poderosa para

o combate à atividade da doença. O estudo demonstrou a eficácia da
minociclina no tratamento do vitiligo. Estudos controlados devem ser realizados
para confirmar sua eficácia.
Parsad D, Kanwar A. Oral minocycline in the treatment of vitiligo--a preliminary study.
Dermatol Ther. 2010 May-Jun;23(3):305-7.
Tratamento com Tacrolimus Tópico a 0,03%

Promove Repigmentação Completa em 57,9% de Crianças com Vitiligo
A aplicação tópica de tacrolimus é uma modalidade terapêutica eficaz e bem

tolerada em crianças asiáticas com vitiligo.
Kanwar AJ, Dogra S, Parsad D. Topical tacrolimus for treatment of childhood vitiligo in
Asians. Clin Exp Dermatol. 2004 Nov;29(6):589-92.
Pomada de Tacrolimus a 0,1%
Eficaz e Bem Tolerada para Tratamento do Vitiligo da Face e da Nuca
A aplicação tópica de pomada de tacrolimus é uma alternativa terapêutica

eficaz e bem tolerada para o tratamento do vitiligo, especialmente envolvendo
as mãos e a nuca.
Xu AE, Zhang DM, Wei XD, Huang B, Lu LJ. Efficacy and safety of tarcrolimus cream 0.1%
in the treatment of vitiligo. Int J Dermatol. 2009 Jan;48(1):86-90.
Pomada de Tacrolimus
Aumento da Eficácia da Fototerapia UVB de Banda Estreita no Vitiligo
A adição do tratamento tópico com tacrolimus aumentou a extensão global

das repigmentações com a fototerapia NB-UVB no vitiligo e também reduziu a
necessidade de doses de NB-UVB acumulativas para alcançar os benefícios
terapêuticos nos pacientes afetados.
Majid I. Does topical tacrolimus ointment enhance the efficacy of narrowband
ultraviolet B therapy in vitiligo? A left-right comparison study. Photodermatol
Photoimmunol Photomed. 2010 Oct;26(5):230-4.
Terapia de Pulso Oral com Dexametasona

Impedimento da Progressão do Vitiligo
Os dados mostraram que a terapia de pulso oral com dexametasona é eficaz

no impedimento da evolução do vitiligo, mesmo não induzindo
satisfatoriamente a repigmentação na maioria dos pacientes de coorte. Leves
a moderados eventos adversos são comuns nesta modalidade de tratamento.
Entretanto, a supressão sustentada da produção de cortisol não ocorreu com o
regime de pulso.
Radakovic-Fijan S, Fürnsinn-Friedl AM, Hönigsmann H, Tanew A. Oral dexamethasone
pulse treatment for vitiligo. J Am Acad Dermatol. 2001 May;44(5):814-7.
Gingko biloba Oral

Eficácia no Tratamento do Vitiligo Limitado ou com Disseminação Lenta
O extrato de G. biloba é uma terapia simples, segura e eficaz na interrupção da

progressão da doença.
Parsad D, Pandhi R, Juneja A. Effectiveness of oral Ginkgo biloba in treating limited,
slowly spreading vitiligo. Clin Exp Dermatol. 2003 May;28(3):285-7.
L-fenilalanina Tópica + Propionato de Clobetasol e UVA no

Tratamento do Vitiligo
A L-fenilalina, combinada ao propionato de clobetasol a 0,025%, e à luz solar
durante os meses ensolarados ou a lâmpadas de UVA nos meses de inverno,
aparentemente promoveram melhorias no vitiligo evolutivo sem efeitos
adversos, sendo especialmente recomendados para a área da face ou para
crianças.
Camacho F, Mazuecos J. Oral and topical L-phenylalanine, clobetasol propionate, and
UVA/sunlight--a new study for the treatment of vitiligo. J Drugs Dermatol. 2002
Sep;1(2):127-31.
Exemplos de Tratamentos
1. Redução do Vitiligo
L-fenilalanina.........................................10,0%
Propionato de Clobetasol.....................0,025%
Gel....................................................qsp 30ml
as áreas com vitiligo ou conforme orientação
médica.
+
L-fenilalanina...................................100mg/kg
Cápsula..............................................qsp 1UN
Consumir uma cápsula ao dia ou conforme
orientação médica
+
Exposição à UVA
Conforme orientação médica.
2. Repigmentação nas Regiões da Cabeça e Pescoço
Polypodium
leucotomos.........................250mg
Cápsula..............................................qsp 1UN
Consumir três cápsulas ao dia ou conforme
+
Fototerapia com NB-UVB
Duas vezes por semana ou conforme
3. Pomada de Propionato de Clobetaol
Propionato de Clobetasol.......................0,05%
Pomada Oclusiva.................................qsp 30g
Aplicar diariamente sobre as áreas com vitiligo
4. Pomada de Tacrolimus
Tacrolimus................................................1,0%
Aplicar diariamente sobre as áreas com vitiligo
5. Cápsulas de Ginkgo biloba
Extrato de Gingko biloba.........................40mg

Cápsula..............................................qsp 1UN
Administrar 3 cápsulas ao dia ou conforme
6. Cápsulas de Minociclina
Minociclina..........................................100 mg
Cápsula..............................................qsp 1UN
Melasma (Cloasma)
O melasma é um quadro caracterizado por manchas castanhas, mais ou menos

intensas, de limites irregulares, localizado em áreas de exposição solar. Na
maioria das vezes, limita-se à face, porém pode surgir no colo e nos membros
superiores. Na face, pode ocorrer na região frontal, temporal, malar, supralabial,
dorso nasal e madibular (Azulay e Azulay, 2006).
É considerada uma fotodermatose, pois o sol é um fator desencadeante e

agravante. Pode surgir na gestação (cloasma gravídico) ou com o uso de
hormônios exógenos (anticoncepcionais e terapia de reposição hormonal).
Predomina no sexo feminino, ocorrendo com menos frequência no sexo
masculino (Azulay e Azulay, 2006).
O tratamento baseia-se na fotoproteção e no uso de agentes

despigmentantes. Os fotoprotetores devem ser químicos e físicos, e a restrição
à exposição solar é indispensável (Azulay e Azulay, 2006).
Referências
Tratamento Tópico
Creme ou solução até Despigmentante
Hidroquinona
5,0%
Estimulador da mitose
e da renovação
Ácido Retinoico 0,01 a 0,05%
celular. Promove o
clareamento da pele.
Hidrocortisona 1,0% Corticoide
Inibidor competitivo
Ácido Azelaico 20,0%
da tirosinase
Ácido Kójico 1,0 a 4,0% Inibidor da tirosinase
Kójico Dipalmitato 1,0 a 5,0% Inibidor da tirosinase
Alfa-glucosídeo da
Alpha-arbutin 3,0% hidroquinona. Inibidor
da tirosinase.
Antioxidante inibidor
Vitamina C 5,0% da síntese de
melanina.
Antioxidante inibidor
Ácido Ferúlico 0,1 a 0,5% da síntese de
melanina.
Referências
1. Creme Redutor de Hipercromias
Ácido Kójico.............................................3,0%
Ácido Retinoico.......................................0,05%
Aplicar nas áreas com melasma no período
noturno ou conforme orientação médica.
2. Creme Clareador Potencializado
Hidroquinona...........................................4,0%
Ácido Retinoico.......................................0,05%
Hidrocortisona..........................................1,0%
Aplicar nas áreas com melasma no período
noturno ou conforme orientação médica.
3. Silicone Clareador
Kójico Dipalmitato....................................5,0%
Alpha-arbutin...........................................3,0%
Seda de Silicone................................qsp 30ml
Aplicar nas áreas com melasma duas vezes ao
dia ou conforme orientação médica.
4. Loção Oil-free Clareadora
Alpha-arbutin...........................................3,0%
Vitamina C...............................................5,0%
Loção Oil-free...................................qsp 30 ml
5. Creme Clareador Potencializado
Ácido Azeláico........................................10,0%
Ácido Ferúlico..........................................3,0%
Aplicar nas áreas com melasma orientação
médica.
NOVO ÚNICO MECANISMO DE AÇÃO

INOVAÇÃO
Meliatone 2%, ac.tranexamico 3%, niacinamida

PC 4%, Cisteamina 5%, VCIP 2%, n-
acetylglucosamina 3%, gel especial qsp 30g.
Aplicar a noie na primeira semana por 15
minutos, na segudan semana por 3 horas,
remover,
E aplicar o creme antioxidante com
Glutationa 0,5%, dermaspheres C 2%, inaclear
2%, coenzima Q10 0,5%, vit.E 0,5%, ac.ferulico
0,5%, base second skin qsp 30g. Aplicar no
melasma, dormir com este creme.,
USO ORAL - discromias

Bioblanc 100mg, proantocianidina de uvas
50mg, vit.C 100mg, vit.E 400 ui, gisodin 80mg,
hiroxitirosol 50mg, polypodium leucotomos
80mg, colágeno qsp 1 capsula. Mande 60
capsulas. Tomar 1 cp 2 vezes ao dia.
Protocolo CISTEAMINA BY NEOFARMA

Cisteamina home care
cysteamine 5%, Niacinamida PC 4%, edta 0,2%,
n-acetylglucosamina 3%, VCIP 2%,
ac.tranexamico 2,5%, desonida 0,05%, gel qsp
15 g, essência qs,
MODO DE USO: Aplicar nos locais desejados
(melasma),
Na primeira semana deixar agir por 15 minutos,
Na segunda semana, pode deixar por 3 horas,
remover com água e sabonete neutro.
Creme antioxidante
Inaclear 1%, dermaspheres C 4%, VCIP 2%, alfa-
bisabolol 0,5%, ac.ferulico 0,5%, glutationa
0,5%, essência qs base second skin qsp 15g.
MODO DE USO: Aplicar nos locais de melasma,
Após a retirada do creme com cisteamina.
O paciente dorme com o produto, so remove
no dia seguinte pela manhã e aplica
fotoprotetor.
Cisteamina HCL........................... 6%
Ácido retinóico .................................5%
Ácido tranexâmico ...........................5%
N-acetylglucosamina .......................3%
VCIP .............................................2%
Niacinamida PC ................................ 4%
Gel especial qsp ............................ 30g
Modo de uso: Aplicar em toda a região a ser

tratada e deixar
agir por 4 HORAS.
Remover com água e sabonete neutro de

glicerina, aplicar pós
peeling hidratante.
Número de sessões: 4
Intervalos: 15 dias, OU A CRITÉRIO MÉDICO.
Serum fluido para microagulhamento

Cysteamine 2,5%, Ác.tranexâmico 1,5% ,
niacinamida PC 4%, Full White 0,5%, kawai kirei
0,3%, glutationa 0,5% ,
VCIP 2%, Ácido kójico 2%, betametasona
valerato 0,05%, essência laranjeira,
Serum fluido qsp 30 ml.
• Modo de uso: Aplicar ANTES, DURANTE E APÓS o
procedimento,
• espalhar bem, não remover.
6. Loção com Ácido Ferúlico e Vitamina C
Ácido Ferúlico..........................................2,0%
Vitamina C...............................................5,0%
Loção Oil-free...................................qsp 30 ml
___________________Psoríase
Psoríase
A psoríase é uma doença inflamatória, cutâneo-articular, crônica e recorrente
que se caracteriza por hiperplasia epidérmica, ciclo evolutivo acelerado dos
ceratinócitos associados a uma ativação imune inapropriada (Azulay e Azulay,
2006).
Tem distribuição universal, com prevalência variando de 1 a 3%, dependendo

da população em estudo, porém é rara em negros. Apresenta dois picos de
incidência: um antes dos 30 anos e outro aos 65 anos. Quando ocorre antes dos
30 anos, tem um pior prognóstico. Acomete os dois sexos igualmente (Azulay e
Azulay, 2006).
Tem base hereditária, provavelmente multifatorial, o que significa dizer que é de

herança poligênica e requer fatores ambientais para sua expressão (Azulay e
Azulay, 2006).
O ciclo evolutivo das células epidérmicas é mais rápido na psoríase do que na

pele normal, o que levaria, devido à imaturidade das células, à grande
produção de escamas (paraceratose). A lesão clássica é uma placa bem
demarcada, elevada e vermelha, com superfície escamosa. As lesões podem
variar de tamanho, de pápulas a placas que cobrem grandes áreas corporais.
Sob a escama, a pele possui um eritema homogêneo brilhante, e pontos de
sangramento ocorrem quando a escama é removida. Tende a ser simétrica, o
que ajuda a estabelecer o diagnóstico (Wolff et al., 2011).
Um amplo espectro de tratamentos tópicos e sistêmicos está disponível. A

maioria é de caráter imunomodulador. A escolha do tratamento deve levar em
consideração a gravidade da doença e, como é uma doença crônica, deve-
se conhecer o perfil de segurança para uso prolongado (Wolff et al., 2011).
Superfície com
descamação
Base
eritematosa
Legenda:
Histopatologia da
pele com psoríase.
Referências
Janeiro: Revinter, 2011
Tratamento Tópico
Gel, creme ou pomada com
Tacrolimus Anti-inflamatório
0,1% a 0,5%
Ácido Salicílico 6,0% Queratolítico
Inibe a enzima fosfodiesterase e
promove aumento na
Cafeína 10,0%
concentração de AMPc
intracelular.
Pomada a 20,0% Psoríase pediátrica
Indigo naturalis Tratamento da psoríase em
Pomada a 0,1%
placa
10,0 a 12,0% em cremes ou Normaliza o processo de
Ácido Lático
loções queratinização.
10,0 a 25,0% em creme ou Emoliente, hidratante e
Ureia
loção. queratolítico.
Ação antiproliferativa através
Piritionato de 0,25 a 2,0% em solução, de ‘interações do DNA’,
Zinco creme e shampoo. antileveduras, antissépticas e
de mecanismos queratolíticos.
Reduz a inflamação por suprimir
Triancinolona De 0,1 a 0,5% em creme, a migração de
Acetonido pomada ou loção polimorfonucleares e reverter a
permeabilidade capilar
Corticosteroide de alta
potência que inibe a
0,025% em creme ou
Fluocinolona proliferação celular. É
pomada, 0,01% em solução
Acetonido imunossupressor,
ou 0,01% em shampoo.
antiproliferativo e anti-
inflamatório.
Suprime a mitose e aumenta a
Propionato de 0,05% em pomada, creme, síntese de proteínas que
Clobetasol loção, solução ou espuma. reduzem a inflamação, além de
promover vasoconstrição.
Corticosteroide de baixa
Hidrocortisona 1,0 ou 2,5 em creme.
potência
Metotrexato Gel a 1,0%
Betametasona 50% em petrolato. Corticosteroide
Eritromicina 1g/dia Antibiótico
Tratamento da
Metotrexato 5 mg/semana psoríase ungueal
grave
150 mg/dia (3 semanas) e
Bupropiona 150-300 mg/dia (3
semanas)
Aumento do efeito dos
Sinvastatina 40mg/dia
esteróides tópicos
1200mg/dia em três doses
Pentoxilifina
por 2 meses
Referências
Polat M, Lenk N, Yalcin B, Gür G, Tamer E, Artuz F, Alli N. Efficacy of erythromycin for psoriasis vulgaris. Clin Exp Dermatol. 2007
May;32(3):295-7.
Lee JY. Severe 20-nail psoriasis successfully treated by low dose methotrexate. Dermatol Online J. 2009 Nov 15;15(11):8.
Modell JG, Boyce S, Taylor E, Katholi C. Treatment of atopic dermatitis and psoriasis vulgaris with bupropion-SR: a pilot study.
Psychosom Med. 2002 Sep-Oct;64(5):835-40.
Naseri M, Hadipour A, Sepaskhah M, Namazi MR. The remarkable beneficial effect of adding oral simvastatin to topical
betamethasone for treatment of psoriasis: a double-blind, randomized, placebo-controlled study. Niger J Med. 2010 Jan-
Mar;19(1):58-61.
Ana Claudia Milanez Rigoni, Sueli Coelho da Silva Carneiro. Estudo Aberto com Pentoxifilina em Pacientes com Psoríase. An bras
Dermatol, Rio de Janeiro, 76(1):39-49, jan./fev. 2001.
Estudos
Tacrolimus Tópico
Eficácia Comprovada no Tratamento da Psoríase Facial
A pomada de tacrolimus a 0,1% foi eficaz no tratamento da psoríase facial e

intertriginosa.
Lebwohl M, Freeman AK, Chapman MS, Feldman SR, Hartle JE, Henning A; Tacrolimus
Ointment Study Group. Tacrolimus ointment is effective for facial and intertriginous
psoriasis. J Am Acad Dermatol. 2004 Nov;51(5):723-30.
Ácido Salicílico + Tacrolimus Tópico

Resultados Positivos no Tratamento da Psoríase
A associação tópica de gel de ácido salicílico a 6% + pomada de tacrolimus a

0,1% se mostrou efetiva no tratamento da psoríase.
Carroll CL, Clarke J, Camacho F, Balkrishnan R, Feldman SR. Topical tacrolimus ointment
combined with 6% salicylic acid gel for plaque psoriasis treatment. Arch Dermatol. 2005
Jan;141(1):43-6.
Cafeína Tópica
Avaliação da Eficácia no Tratamento da Psoríase Vulgar
Baseando-se nos resultados do estudo, a cafeína tópica é uma terapia efetiva,

segura e de baixo custo para a psoríase, apresentando lento início de ação.
Vali A, Asilian A, Khalesi E, Khoddami L, Shahtalebi M, Mohammady M. Evaluation of the
efficacy of topical caffeine in the treatment of psoriasis vulgaris. J Dermatolog Treat.
2005;16(4):234-7.
Pomada de Indigo naturalis a 20,0%

Eficaz e Segura no Tratamento da Psoríase Pediátrica
A terapia com a pomada de Indigo naturalis exibe uma série de vantagens no

tratamento da psoríase pediátrica, pois apresenta eficácia e segurança, além
de promover remissão dos sintomas da doença por um longo período.
Adicionalmente, a terapia parece ser mais economicamente viável do que os
tratamentos convencionais.
Lin YK, Yen HR, Wong WR, Yang SH, Pang JH. Successful treatment of pediatric psoriasis
with Indigo naturalis composite ointment. Pediatr Dermatol. 2006 Sep-Oct;23(5):507-10.
Propionato de Clobetasol a 0,05%

Seguro e Eficaz para o Tratamento da Psoríase em Placas Leve a
Moderada
O propionato de clobetasol a 0,05% é seguro e eficaz para o tratamento da

psoríase em placas leve a moderada em pacientes com idade de 12 anos ou
mais.
Kimball AB, Gold MH, Zib B, Davis MW; Clobetasol Propionate Emulsion Formulation
Foam Phase III Clinical Study Group. Clobetasol propionate emulsion formulation foam
0.05%: review of phase II open-label and phase III randomized controlled trials in
steroid-responsive dermatoses in adults and adolescents. J Am Acad Dermatol. 2008
Sep;59(3):448-54, 454.e1. Epub 2008 Jun 9.
Gel de Metotrexato a 1,0%

Opção Eficaz e Bem Tolerada que Promove 97% de Melhora Global nas
Lesões da Psoríase Vulgar
Segundo os resultados apresentados pelo estudo, o gel hidrofílico de

metotrexato a 1% foi bem tolerado e apresentou eficácia significativamente
superior quando comparado com o placebo, podendo ser considerado como
opção para o tratamento da psoríase vulgar.
Eskicirak B, Zemheri E, Cerkezoglu A. The treatment of psoriasis vulgaris: 1% topical
methotrexate gel. Int J Dermatol. 2006 Aug;45(8):965-9.
Fluoncinolona Acetonido a 0,01%

Promove Melhora Significativamente Superior nos Sinais da Psoríase do
Couro Cabeludo
Os resultados desse estudo mostraram que uma base oleosa contendo

acetonido de fluocinolona é uma terapia efetiva no tratamento da psoríase do
couro cabeludo. Esse estudo também mostrou que o veículo sozinho causa uma
melhora nos sinais da psoríase, mas a adição de 0,01% do esteroide de baixa
potência, acetonido de fluocinolona, levou a uma melhora significativamente
superior.
Pauporte M, Maibach H, Lowe N, Pugliese M, Friedman DJ, Mendelsohn H, Cargill I,
Ramirez R. Fluocinolone acetonide topical oil for scalp psoriasis. J Dermatolog Treat.
2004 Dec;15(6):360-4.
Sinvastatina Oral + Betametasona Tópica

Efeito Benéfico Para o Tratamento da Psoríase
Esse estudo foi o primeiro duplo-cego, randomizado e placebo-controlado a

demonstrar que a sinvastatina oral aumenta os efeitos terapêuticos de
esteroides tópicos no tratamento da psoríase. O aumento de risco de acidentes
cardiovasculares em portadores da psoríase e os efeitos protetores da
sinvastatina favorecem mais ainda seu uso no tratamento dessa doença
cutânea.
Naseri M, Hadipour A, Sepaskhah M, Namazi MR. The remarkable beneficial effect of
adding oral simvastatin to topical betamethasone for treatment of psoriasis: a double-
blind, randomized, placebo-controlled study. Niger J Med. 2010 Jan-Mar;19(1):58-61.
Pentoxifilina em Pacientes com Psoríase

A análise deste trabalho mostrou resposta terapêutica entre boa e ótima em
60% dos pacientes, mas novos estudos controlados devem ser levados a termo.
Ana Claudia Milanez Rigoni, Sueli Coelho da Silva Carneiro. Estudo Aberto com
Pentoxifilina em Pacientes com Psoríase. An bras Dermatol, Rio de Janeiro, 76(1):39-49,
jan./fev. 2001.
Bupropiona Oral
Tratamento Para Pacientes que Não Respondem à Terapia
Farmacológica Usual
O bom perfil de tolerabilidade e a relativa segurança da bupropiona tornam o

uso desse fármaco viável para o tratamento de pacientes portadores de
psoríase ou dermatite que não respondem à terapia farmacológica usual.
Modell JG, Boyce S, Taylor E, Katholi C. Treatment of atopic dermatitis and psoriasis
vulgaris with bupropion-SR: a pilot study. Psychosom Med. 2002 Sep-Oct;64(5):835-40.
Baixa Dose de Metotrexato

Tratamento da Psoríase Ungueal Grave
O presente caso confirma que o metotrexato semanal em baixa dose pode ser
uma boa opção de tratamento para distrofia ungueal psoriática grave em
pacientes que não apresentam contraindicações para essa terapia.
Lee JY. Severe 20-nail psoriasis successfully treated by low dose methotrexate.
Dermatol Online J. 2009 Nov 15;15(11):8.
Eritromicina
Eficácia no Tratamento da Psoríase Vulgar
O estudo sugere que os macrolídeos podem ser utilizados como terapia

coadjuvante para psoríase vulgar.
Polat M, Lenk N, Yalcin B, Gür G, Tamer E, Artuz F, Alli N. Efficacy of erythromycin for
psoriasis vulgaris. Clin Exp Dermatol. 2007 May;32(3):295-7.
1. Associação Eficaz na Redução dos Sintomas da Psoríase

em Placa
Tacrolimus................................................0,1%
Pomada...............................................qsp 50g
Aplicar sobre áreas com psoríase uma vez ao
+
Ácido Salicílico.........................................6,0%
Gel......................................................qsp 50g
Aplicar sobre as áreas com psoríase uma vez
2. Pomada para Tratamento da Psoríase Pediátrica
Indigo naturalis......................................20,0%
Pomada...............................................qsp 50g
Aplicar sobre as áreas com psoríase duas vezes
3. Tratamento Oral + Tópico
Sinvastatina.............................................40mg
Cápsula..............................................qsp 1UN
Administrar uma cápsula ao dia ou conforme
+
Betametasona........................................50,0%
Petrolato............................................qsp 50ml
Aplicar sobre as áreas com psoríase uma vez
4. Pomada de Tacrolimus – Tratamento da Psoríase Facial

Tacrolimus................................................0,1%
Pomada...............................................qsp 50g
Aplicar sobre áreas com psoríase conforme
5. Pomada de Cafeína – Tratamento da Psoríase Vulgar
Cafeína..................................................10,0%
Pomada...............................................qsp 50g
6. Creme com Ácido Lático
Ácido Lático...........................................10,0%
7. Cápsulas de Metotrexato em Baixa Dose
Metotrexato...............................................5mg
Cápsula..............................................qsp 1UN
Administrar 1 cápsula por semana ou conforme
8. Cápsulas de Pentoxilifina
Pentoxilifina..........................................400mg
Cápsula..............................................qsp 1UN
__________________Dermatite
Dermatite
Corresponde a um grupo de dermatoses inflamatórias, pruriginosas, com

características clínicas e histopatológicas comuns e muito bem definidas. As
lesões elementares que definem as dermatites são eritema, edema, vesículas,
crostas e descamação.
De acordo com a predominância dessas lesões, o quadro pode ser classificado

em agudo, subagudo ou crônico. As dermatites resultam de causas internas ou
externas, com etiologia variada e mecanismos patogênicos diversos. São de
ocorrência muito frequente, sendo mais comum a dermatite de contato,
seguida da atópica e da seborreica. Acometem igualmente ambos os sexos e
todas as etnias.
A característica básica do processo é de natureza seroexsudativa, acometendo

epiderme e derme papular.
Referências
Dermatite de Contato
A dermatite de contato pode ser dividida em dois tipos que apresentam

etiologia e fisiopatogenia distintas: dermatite de contato por irritante primário
(DCIP) e dermatite de contato alérgica (DCA).
Dermatite de Contato por Irritante Primário
É provocada, em geral, por substâncias alcalinas ou ácidos fracos que, não

tendo capacidade de provocar queimadura e/ou necrose, produzem apenas
irritação cutânea. Essas substâncias, ao entrar em contato com a pele, causam
injúria aos ceratinócitos, surgindo, posteriormente, reação inflamatória na
derme papilar. Clinicamente, caracteriza-se por eritema, descamação e, por
vezes, vesículas e bolhas. O prurido, em geral, é discreto ou ausente, sendo
substituído por sensação de dor ou queimação.
Dermatite de Contato Alérgica
Na DCA existe envolvimento primário do sistema imunológico, sendo exemplo

clássico da hipersensibilidade tipo IV, que é a hipersensibilidade retardada ou
mediada por células. O tempo desse processo será de pouco dias para
alérgenos com alto poder sensibilizante, podendo levar anos para outros
antígenos. Em geral, a hipersensibilidade adquirida persiste por toda a vida,
embora, eventualmente, ocorra o desenvolvimento de tolerância com a
exposição continuada. Assim, na dermatite de contato alérgica, os agentes
etiológicos são substâncias químicas pouco complexas.
Referências
Tratamentos Tópicos e Sistêmicos

Compressas com Solução
Permanganato de Potássio
a 0,0025% por 24h
Ácido Bórico Solução a 1 - 2%
Creme, loção ou pomada
Hidrocortisona
com 0,1 a 2,5%
Tacrolimus Pomada a 0,03 ou 0,1%
Prednisona 0,5 mg/kg
Referências
1. Pomada com Hidrocortisona e Tacrolimus
Hidrocortisona..........................................1,0%
Tacrolimus................................................0,1%
Pomada...............................................qsp
50g
Aplicar sobre as áreas com dermatite uma vez
2. Tratamento Oral para a Dermatite de Contato
Prednisona.............................................35mg*
Cápsula..............................................qsp 1UN
*Dose usual para um adulto de 70 kg.
3. Compressas com Permanganato de Potássio
Permanganato de Potássio.................0,0025%
Solução...........................................qsp 100ml
Aplicar as compressas sobre as áreas com
dermatite de contato nas primeiras 24h após o
surgimento dos sintomas ou conforme
4. Compressas com Ácido Bórico
Ácido Bórico.............................................2,0%
Solução...........................................qsp 100ml
Aplicar as compressas sobre as áreas com
dermatite de contato conforme orientação
médica.
Dermatite Atópica
A Dermatite Atópica é a principal manifestação cutânea da atopia (a

tendência hereditária a desenvolver alergia a antígenos alimentares ou
inalantes) expressando-se por eczema, asma ou rinite alérgica.
Trata-se de uma doença genética de herança poligênica com evidentes

alterações imunológicas, fortemente influenciada por fatores ambientais e,
eventualmente, emocionais. Sua prevalência varia de acordo com a
localização geográfica, as condições climáticas, o nível socioeconômico e a
poluição.
Alterações sudorais, do manto lipídico da pele e baixo limiar ao prurido são

características bem conhecidas da dermatite atópica. O estresse induzido no
atópico provoca eritema e prurido nas áreas do eczema. Sua imunopatologia
é complexa e pouco conhecida, envolvendo distúrbios da imunidade humoral,
imunidade celular e disfunção de outras células imunes.
Referências
Tratamento Tópico
Tratamento Tópico
Ureia 5 a 10%
Coaltar Pastas e cremes a 2-4%
Tacrolimus Pomada de 0,03 ou 0,1%
Pomada a 0,5-2,0% por
Hidrocortisona
curtos períodos de tempo
Mometasona Pomada a 0,1%
Creme, loção ou pomada
Desonida
a 0,05%
Dipropionato de
Pomada a 0,05%
Betametasona
Valerato de Betametasona Pomada a 0,025-0,1%
Creme, gel, pomada ou
Propionato de Clobetasol
espuma a 0,05%
Creme, gel, loção ou
Fluocinolona Acetonido
pomada a 0,0025-0,025%
Cetirizina 10 mg/dia
Loratadina 10 mg/dia
Ciclosporina 5 mg/dia
15 mg uma ou duas vezes
Metotrexato
por semana
Azatioprina 1 a 3 mg/kg/dia
Referências
1. Creme Hidratante Redutor da Dermatite Atópica
Ureia......................................................10,0%
Hidrocortisona..........................................1,0%
Creme Olivem 5%................................qsp 50g
Aplicar sobre as áreas com dermatite atópica
uma vez ao dia ou conforme orientação
médica.
2. Fluocinolona Acetonido em Óleo de Amendoim
Fluocinolona Acetonido..........................0,01%
Óleo de Amendoim.........................qsp 100ml
Aplicar sobre as áreas com dermatite atópica
duas vezes ao dia ou conforme orientação
médica.
3. Cápsulas de Metotrexato
Metotrexato............................................15mg
Cápsula.............................................qsp 1UN
Administrar uma ou duas cápsulas por semana
4. Cápsulas de Azatioprina
Azatioprina..................................70 a 210mg*
Cápsula.............................................qsp 1UN
* Dose usual para um adulto de 70 kg.
Dermatite Seborreica
É uma dermatite crônica de caráter constitucional, associando elementos

fisiopatológicos de hiperproliferação epidérmica a eventual participação de
Malassezia spp. Ocorre em pelo menos 5% da população geral, tendo altíssima
incidência sobre os portadores do HIV.
Em sua etiofisiopatogenia, foram demonstradas amplamente alterações na

dinâmica epidérmica (aumento do índice de mitoses e do trânsito
transepidérmico), semelhantes à da psoríase, porém em menor intensidade.
As lesões são maculopaulosas, eritematosas ou amareladas e sem brilho,

delimitadas ou recobertas por escamas de aspecto gorduroso, que se
distribuem pelas áreas seborreicas (couro cabeludo, face, regiões pré-esternal,
interescapular, flexuras axilares e anogenitais). O prurido, quando presente, é
discreto, à exceção das lesões no couro cabeludo. O couro cabeludo está
quase sempre comprometido, muitas vezes isoladamente.
A doença tem tendência à cronicidade e recorrência, podendo,

eventualmente, evoluir para eritrodermia esfoliativa. É frequente seu
agravamento ou desencadeamento por estresse emocional ou físico e pelo frio.
A exposição ao sol, em geral, diminui sua intensidade.
Referências

LCD (Alcatrão) Shampoo a 5,0%
Piritionato de Zinco Shampoos com 1,0 a 2,0%
Sulfeto de Selênio 1,0 a 2,5%
Coaltar 2,0 a 3,0%
Shampoo ou creme com
Cetoconazol
1,0 a 2,0%
Propionato de Clobetasol Shampoo a 0,05%
Octopiroolamina 1,0
Climbazol 0,45%
Ciclopirox 1,0%
Ácido Salicílico 2,0 a 6,0%
Hidrocortisona 0,1 a 2,5%
Desonida Gel a 0,05%
Tacrolimus Pomada a 0,1%
Terbinafina 250 mg/dia
Cetoconazol 200 – 400 mg/dia
100 – 200 mg/dia por 1 a 3
Itraconazol
semanas
50 mg/dia por duas
Fluconazol
semanas
Referências
Estudos
Shampoo de Cetoconazol 2,0% Associado ao Shampoo de
Propionato de Clobetasol a 0,05%
Tratamento da Dermatite Seborreica do Couro Cabeludo de Moderada
a Grave
A terapia da combinação dos dois shampoos, com alternância entre eles e uso
duas vezes por semana, mostrou eficácia significativamente maior do que o uso
do shampoo de cetoconazol isolado e um efeito sustentado no tratamento da
dermatite seborreica do couro cabeludo moderada a grave.
Ortonne JP, Nikkels AF, Reich K, Ponce Olivera RM, Lee JH, Kerrouche N, Sidou F,
Faergemann J. Efficacious and safe management of moderate to severe scalp
seborrhoeic dermatitis using clobetasol propionate shampoo 0·05% combined with
ketoconazole shampoo 2%: a randomized, controlled study. Br J Dermatol. 2011
Jul;165(1):171-6. doi: 10.1111/j.1365-2133.2011.10269.x.
Piroctona Olamina + Climbazol

De acordo com resultados de um estudo o shampoo de piroctona olamina a
0,5% e climbazol a 0,45% reduziu efetivamente a quantidade de caspa do couro
cabeludo e apresentou atividade antimicótica.
Schmidt-Rose T, Braren S, Fölster H, Hillemann T, Oltrogge B, Philipp P, Weets G, Fey S.
Efficacy of a piroctone olamine/climbazol shampoo in comparison with a zinc
pyrithione shampoo in subjects with moderate to severe dandruff. Int J Cosmet Sci. 2011
Jun;33(3):276-82. doi: 10.1111/j.1468-2494.2010.00623.x. Epub 2011 Jan 27.
Piritionato de Zinco 1 a 2%
O shampoo de piritionato de zinco (1%-2%) promove a cura da caspa do couro
cabeludo, normalizando a queratinização epitelial, a produção de sebo ou
ambos.
Ranganathan S, Mukhopadhyay T. Dandruff: the most commercially exploited skin
disease. Indian J Dermatol. 2010 Apr-Jun;55(2):130-4.
Ácido Salicílio + Pirictona Olamina

A combinação de piroctona olamina (0,75%) e ácido salicílico (2%) mostrou-se
ligeiramente mais eficaz do que o piritionato de zinco (1%) na redução da
gravidade e da área afetada pela descamação do couro cabeludo.
Lodén M, Wessman C. The antidandruff efficacy of a shampoo containing piroctone
olamine and salicylic acid in comparison to that of a zinc pyrithione shampoo. Int J
Cosmet Sci. 2000 Aug;22(4):285-9.
Gel de Desonida a 0,05%

Um estudo mostrou que o gel de desonida a 0,05% foi eficaz, bem tolerado e
uma opção com benefícios estéticos para o tratamento da dermatite
seborreica da face e do couro cabeludo.
Kircik LH. Treatment of scalp and facial seborrheic dermatitis with desonide hydrogel
0.05%. J Clin Aesthet Dermatol. 2009 Feb;2(2):32-6.
Itraconazol Oral no Tratamento da Dermatite Seborreica
O tratamento inicial com itraconazol 200 mg/dia foi benéfico para os pacientes
com dermatite seborreica facial moderada a grave com redução do eritema,
descamação e prurido.
Shemer A, Kaplan B, Nathansohn N, Grunwald MH, Amichai B, Trau H. Treatment of
moderate to severe facial seborrheic dermatitis with itraconazole: an open non-
comparative study. Isr Med Assoc J. 2008 Jun;10(6):417-8.
Fluconazol Oral
Após o tratamento com fluconazol, 50 mg/dia por 2 semanas, houve cura
clínica em 31,5% dos pacientes com dermatite seborreica e melhora em 68,5%
destes.
Zisova LG. Fluconazole and its place in the treatment of seborrheic dermatitis--new
therapeutic possibilities. Folia Med (Plovdiv). 2006;48(1):39-45.
1. Tratamento da Dermatite Seborreica de Couro Cabeludo

de Moderada a Grave
Cetoconazol.............................................2,0%
Shampoo.........................................qsp 120ml
Uso duas vezes por semana, alternando com o
shampoo de clobetasol ou conforme
+
Propionato de Clobetasol........................0,05%
Shampoo.........................................qsp 120ml
Uso duas vezes por semana, alternando com o
shampoo de cetoconazol ou conforme
2. Shampoo Antifúngico
Piroctona Olamina....................................0,5%
Climbazol................................................0,45%
Shampoo.........................................qsp 120ml
Uso tópico diário ou conforme orientação
médica.
3. Shampoo Redutor da Descamação do Couro Cabeludo
Ácido Salicílico..........................................2,0%
Piroctona Olamina..................................0,75%
Shampoo.........................................qsp 120ml
Uso tópico duas vezes por semana ou
4. Gel Para Dermatite Seborreica Facial
Desonida................................................0,05%
Hidrocortisona...........................................1,0%
Gel.......................................................qsp 30g
Aplicar sobre a face uma vez ao dia, no
período noturno ou conforme orientação
médica.
_________Afecções dos Pelos
Afecções dos Pelos
Apesar de não possuírem funções vitais no ser humano, os pelos exercem um
papel psicológico de extrema importância, visto que são verificadas frequentes
queixas relacionadas a seus excessos ou reduções na clínica dermatológica
diária, sempre que escapam das normas social, cultural e/ou esteticamente
aceitas.
O diagnóstico das doenças pilares torna-se cada vez mais sofisticado, apesar
de mais racional. Além do exame clínico prévio, inclusive do ponto de vista
hormonal, biopsia tridimensional, microscopias polarizadas, dermatoscopia,
análises químicas especiais, dosagem de enxofre, microscopia de varredura,
técnicas de fluorescência e de imunofluorescência têm sido usadas em
pesquisas.
As afecções capilares podem ser classificadas em dois grupos: alopecias

(diminuição excessiva de pelos) e hirsutismo e hipertricose (excesso de pelos em
lugares não desejados).
Referências
Alopecias
Alopecia Areata
Caracteriza-se mais frequentemente por perda rápida e completa de pelos em
uma ou mais áreas do couro cabeludo e, às vezes, de outras regiões (barba,
supercílio, púbis, etc), originando placas alopécicas de pele lisa, sem sinais
inflamatórios, geralmente circulares, com 1 a 5 cm de diâmetro. Na borda
periférica, pelos aparentemente normais são facilmente destacáveis, e outros,
de cerca de 0,5 a 1,0 cm de comprimento, assemelham-se a pontos de
exclamação (extremidade distal mais espessa que a proximal).
Ocorre igualmente em homens e mulheres, sobretudo em jovens. Embora, na

maioria dos casos, haja repilação espontânea em alguns meses, outras vezes o
processo progride com surgimento de novas lesões, que, por confluência,
podem atingir todo o couro cabeludo (alopecia total).
Apesar de sua etiopatogenia não estar totalmente esclarecida, consideram-se

de importância os fatores genéticos, os autoimunes e o estresse emocional.
A conduta terapêutica deve ser individualizada, considerando-se a faixa etária

e a extensão da doença. As diferentes modalidades de tratamento são úteis
em controlar a doença, porém não são capazes de curá-la. O tratamento pode
ser tópico, intralesional ou sistêmico.
Alopecia Androgenética
A masculina segue uma apresentação clínica característica, de acordo com os
recessos frontais e frontoparenterais (entradas) classificada em 8 graus por
Hamilton e Norwood. Alguns casos podem evoluir, de modo a produzir uma
calvície. De modo geral, o início se dá entre os 20 e 30 anos e progride
lentamente.
A feminina é mais difusa e está classificada em 3 graus (Ludwig). Nota-se uma

rarefação com progressão para a região frontotemporal. Como na masculina,
os cabelos tornam-se gradativamente mais finos, com pelos terminais menos
numerosos. Pode ter início na puberdade em indivíduos geneticamente
predispostos, ou seja, com familiares de ambos os sexos com alopecia
androgenética, mesmo sem sinais de hiperandrogenismo, ou na menopausa,
fase em que são comuns alterações do metabolismo androgênico.
O tratamento da alopecia androgenética no homen, como na mulher pode ser

realizado de maneira tópica, sistêmica e/ou cirúrgica.
Referências
Alopecia Areata

88 a 98% (imediatamente
Solução de Fenol neutralizado com álcool)
de 14 em 14 dias
Minoxidil 5,0% duas vezes ao dia
Acetonido de Triancinolona 0,1%
Tacrolimus 0,1%
Sensibilização com 2,0%,
Após 2 semanas
aplicação de solução a
Difreciprona
0,001% com aumento
gradual (0,01, 0,1, 0,2, 0,5,
1,0 e 2,0%)
Propionato de Clobetasol Espuma a 0,05%
Ciclosporina 6 mg/kg/dia
500 mg/ 2-3 vezes ao dia
aumentados a 3 g/dia
Sulfassalazina
divididos em 3 doses por 4
meses
Acetonido de Triancinolona 4,0 a 48 mg/dia
Azatioprina 2 mg/kg/dia
Prednisona 300 mg uma vez ao mês
15, 20 ou 25 mg por
Metotrexato
semana
Referências
Estudos
Difenciprona Tópica
Tratamento Eficaz na Alopecia Areata
Este estudo mostrou que a difenciprona tópica no tratamento de alopecia

areata grave é eficaz, e com menores taxas de recidivas quanto mais cedo for
iniciado o tratamento. O crescimento capilar no couro cabeludo foi excelente
(76-100%) em 40,7% dos pacientes, boa (51-75%) em 14,8%, moderada (26-50%)
em 14,8% e leve (<25%) em 29,6%.
Maryam A, Hassan S, Farshad F, Parastoo B, Vahide L. The efficacy of topical
diphencyprone in the treatment of alopecia areata. Indian J Dermatol. 2009;54(1):88-9.
Azatioprina em Pacientes com Alopecia Areata

Eficácia de Tratamento com Redução da Perda Capilar após 6 Meses de
Utilização
O tratamento com azatioprina é uma monoterapia sistêmica que clinicamente

promove melhora relevante na alopecia areata moderada a grave. A
azatioprina é uma droga que apresenta baixo custo e boa tolerância. A
eficácia a longo prazo e a segurança desse tratamento deveriam ser avaliadas
em mais estudos controlados com maior número de pacientes.
Farshi S, Mansouri P, Safar F, Khiabanloo SR. Could azathioprine be considered as a
therapeutic alternative in the treatment of alopecia areata? A pilot study. Int J
Dermatol. 2010 Oct;49(10):1188-93. doi: 10.1111/j.1365-4632.2010.04576.x.
Sulfassalazina
Tratamento da Alopecia Persistente
Após o uso de sulfassalazina, a resposta considerada boa foi observada em 10

pacientes (25,6%), a moderada em 12 (30,7%) e a insatisfatória ou sem resposta
em 17 (43,5%) dos pacientes tratados. A sulfassalazina pode ser utilizada como
uma terapia alternativa no tratamento dos pacientes com alopecia areata
recalcitrante.
Rashidi T, Mahd AA. Treatment of persistent alopecia areata with sulfasalazine. Int J
Dermatol. 2008 Aug;47(8):850-2. doi: 10.1111/j.1365-4632.2008.03700.x.
Prednisona
Tratamento da Alopecia Areata Generalizada
O estudo permitiu concluir que a dose mensal de terapia de pulso com

prednisona 300 mg parece ser eficaz e segura. Pode ser recomendada como
tratamento de primeira linha para AA generalizada.
Ait Ourhroui M, Hassam B, Khoudri I. Treatment of alopecia areata with prednisone in a
once-monthly oral pulse. Ann Dermatol Venereol. 2010 Aug-Sep;137(8-9):514-8. doi:
10.1016/j.annder.2010.06.002. Epub 2010 Aug 17.
Metotrexato Isolado ou Associado à Prednisona
Tratamento da Alopecia Areata Universal
De acordo com os resultados deste estudo, conclui-se que o metotrexato

isolado ou em combinação com doses baixas de corticosteroides orais resultou
em crescimento do cabelo completo em metade dos pacientes que
apresentavam alopecia areata total ou universal.
Chartaux E, Joly P. Long-term follow-up of the efficacy of methotrexate alone or in
combination with low doses of oral corticosteroids in the treatment of alopecia areata
totalis or universalis. Ann Dermatol Venereol. 2010 Aug-Sep;137(8-9):507-13. doi:
10.1016/j.annder.2010.06.031. Epub 2010 Aug 21.
Espuma Leave-on de Propionato de Clobetasol a 0,05%
Pesquisadores italianos comprovaram a eficácia de uma preparação tópica

para o tratamento da alopecia areata - espuma de propionato de clobetasol
a 0,05%. O uso dessa espuma, 2 vezes ao dia, 5 dias na semana, durante 3
meses, resultou na melhora do crescimento capilar em 89% dos pacientes. A
formulação também apresentou boa aceitação cosmética e um melhor perfil
de adesão do paciente ao tratamento.
Tosti A, Iorizzo M, Botta GL, Milani M. Efficacy and safety of a new clobetasol propionate
0.05% foam in alopecia areata: a randomized, double-blind placebo-controlled trial. J
Eur Acad Dermatol Venereol. 2006 Nov;20(10):1243-7.
1. Espuma de Propionato de Clobetasol sem Enxague
Propionato de Clobetasol........................0,05%
Espuma............................................qsp 120ml
Aplicar no couro cabeludo massageando duas
vezes ao dia ou conforme orientação médica.
2. Cápsulas de Metotrexato + Prednisona
Metotrexato.............................................20mg
Cápsula.............................................qsp 1 UN
Administrar uma cápsula por semana ou
+
Prednisona.............................................10mg
Cápsula.............................................qsp 1 UN
3. Cápsulas de Ciclosporina
Ciclosporina.........................................420mg*
Cápsula.............................................qsp 1 UN
*Dose usual para um adulto de 70kg.
Azatioprina...........................................140mg*
Cápsula.............................................qsp 1 UN
*Dose usual para um adulto de 70kg.
5. Solução com Minoxidil
Minoxidil...................................................5,0%
Solução............................................qsp 100ml
Aplicar sobre as regiões afetadas 2 vezes ao
6. Loção com Acetonido de Triancinolona
Acetonido de
Triancinolona.......................0,1%
Loção...............................................qsp 100ml
Aplicar sobre as regiões afetadas conforme
7. Loção com Tacrolimus
Tacrolimus................................................0,1%
Loção...............................................qsp 100ml
Aplicar sobre as regiões afetadas conforme
Alopecia Androgenética

Tipo Composto Concentração Usual
2,0 a 5,0% duas vezes
Minoxidil
ao dia
Masculina
Alfa-estradiol 0,025%
Finasterida 1 mg/dia
Minoxidil 2,0%
Feminina Alfa-estradiol 0,025%
Finasterida 2,5 mg/dia
Shampoo com 1,0 a
Cafeína
Ambos 5,0%
Finasterida Gel a 1,0%
Referências
Estudos
Minoxidil + Alfa-estradiol
Reduz a Queda Capilar e Aumenta a Espessura dos Fios na Alopecia
Androgenética
O tratamento com minoxidil pode induzir a um aumento na densidade e na

espessura do fio de cabelo, ao passo que o tratamento com alfa-estradiol
promove resultados na desaceleração ou estabilização da perda capilar.
Blume-Peytavi U, Kunte C, Krisp A, Garcia Bartels N, Ellwanger U, Hoffmann R.
Comparison of the efficacy and safety of topical minoxidil and topical alfatradiol in the
treatment of androgenetic alopecia in women. J Dtsch Dermatol Ges. 2007
May;5(5):391-5.
Cafeína Tópica
Eficaz no Tratamento da Alopecia Androgenética
Um estudo mostrou que a cafeína é um tratamento promissor no estímulo do

crescimento dos fios capilares com impacto clínico importante para o
tratamento da alopecia androgenética, uma vez que reverte a miniaturização
dos folículos induzida pela testosterona.
Fischer TW, Hipler UC, Elsner P. Effect of caffeine and testosterone on the proliferation of
human hair follicles in vitro. Int J Dermatol. 2007 Jan;46(1):27-35.
Gel de Finasterida a 1,0%

Aumenta o Número e a Espessura dos Fios Capilares
Um estudo clínico contou com 45 pacientes do sexo masculino com alopecia

androgenética, os quais utilizaram um gel de finasterida a 1% ou finasterida oral
1 mg. Medições em série indicaram um aumento significativo na contagem de
cabelos terminais entre os dois grupos, sendo a terapia com finasterida eficaz
na alopecia androgenética.
Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of
finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol
Venereol Leprol. 2009 Jan-Feb;75(1):47-51.
1. Loção Capilar com Minoxidil e Alfa-estradiol
Minoxidil...................................................2,0%
Loção Capilar...................................qsp 100ml
Aplicar sobre o couro cabeludo 1 vez ao dia
Alfa-estradiol........................................0,025%
Loção Capilar...................................qsp 100ml
Aplicar sobre o couro cabeludo 2 vezes ao dia
2. Shampoo de Cafeína - Estimulante do Crescimento

Capilar
Cafeína.....................................................5,0%
Shampoo..........................................qsp 120ml
Aplicar sobre os cabelos molhados e
massagear até completa formação de
espuma, deixar agir por 2 minutos e enxaguar
completamente com água, ou conforme
3. Gel Capilar de Finasterida - Aumento do Número e

Espessura dos Fios
Finasterida................................................1,0%
Gel...................................................qsp 100ml
Aplicar sobre o couro cabeludo uma vez ao
Hirsutismo
É um aumento de pelos terminais na mulher em áreas que, fenotipicamente,

são usuais ao homem. Está diretamente relacionado a situações que exista um
aumento de andrógenos circulantes. Pode estar acompanhado de outros sinais
de hiperandrogenismo, como seborreia, alopecia androgenética, acne,
irregularidades menstruais e clitoromegalia.
As principais causas são a síndrome dos ovários policísticos, a síndrome de

Cushing, hiperplasia adrenal congênita, tumores ovarianos e adrenais e
estímulos hipofisários normalmente relacionados à hiperprolactinemia.
O tratamento do hirsutismo passa inicialmente pela definição da doença de

base, caso existente, podendo ser física ou medicamentosa.
Referências
Tratamentos Tópico e Sistêmico

Creme a 0,25%
Finasterida
2,5 mg/dia
Dexametasona 0,25 mg/dia por 6 meses
Orlistat 120 mg duas vezes ao dia
Sinvastatina 20 mg/dia por 6 meses
Mio Inositol 2 g/dia
Espironolactona 100 mg/dia
Flutamida 125 mg/dia
Acetato de Ciproterona + 2,0 mg + 0,035 mg em
Etinilestradiol ciclos de 21 dias
Acetato de Ciprotetona em 50 a 100 mg durante 10
associação dias
Referências
Estudos
Creme de Finasterida a 0,25%

Reduz o Crescimento e a Espessura dos Pelos Faciais
A finasterida aplicada topicamente a 0,25% diminuiu significativamente o

crescimento e a espessura dos pelos em mulheres com hirsutismo facial. Além
disso, não foi observado nenhum efeito adverso.
Lucas KJ. Finasteride cream in hirsutism. Endocr Pract. 2001 Jan-Feb;7(1):5-10.
Dexametasona a 0,25 mg
A dexametasona é um glicocorticoide sintético com potentes efeitos anti-
inflamatórios. Reduz os níveis de andrógenos em mulheres com SOPC (síndrome
dos ovários policísticos) e hirsutismo.
Vanky E, Salvesen KA, Carlsen SM. Six-month treatment with low-dose dexamethasone
further reduces androgen levels in PCOS women treated with diet and lifestyle advice,
and metformin. Hum Reprod. 2004 Mar;19(3):529-33. Epub 2004 Jan 29.
Orlistat a 25 mg
O orlistat é um inibidor específico das lipases gastrointestinais. Reduz a
concentração de andrógenos e melhora do quadro de hirsutismo.
Metwally M, Amer S, Li TC, Ledger WL. An RCT of metformin versus orlistat for the
management of obese anovulatory women. Hum Reprod. 2009 Apr;24(4):966-75. Epub
2008 Dec 18.
Sinvastatina a 20 mg
A sinvastatina é um inibidor da HMG-CoA redutase, responsável pela biossíntese
do colesterol. Provoca melhora da infertilidade e do hirsutismo em mulheres com
SOPC (Síndrome dos Ovários Policísticos).
Rashidi B, Abediasl J, Tehraninejad E, Rahmanpour H, Sills ES. Simvastatin Effects on
Androgens, Inflammatory Mediators, and Endogenous Pituitary Gonadotropins Among
Patients With PCOS Undergoing IVF: Results From a Prospective, Randomized, Placebo-
Controlled Clinical Trial. J Investig Med. 2011 Apr 27. [Epub ahead of print]
Mio Inositol 2 g/dia

O Mio Inositol é uma vitamina do complexo B que reduz a incidência do
hirsutismo e da acne em mulheres portadoras da SOPC.
Zacchè MM, Caputo L, Filippis S, Zacchè G, Dindelli M, Ferrari A. Efficacy of myo-inositol
in the treatment of cutaneous disorders in young women with polycystic ovary
syndrome. Gynecol Endocrinol. 2009 Aug;25(8):508-13
Espironolactona 100 mg
A espironolactona é um diurético que atua na troca de íons sódio-potássio e de
acordo com um estudo, é capaz de reduzir o grau de hirsutismo.
Brown J, Farquhar C, Lee O, Toomath R, Jepson RG. Spironolactone versus placebo or
in combination with steroids for hirsutism and/or acne. Cochrane Database Syst Rev.
2009 Apr 15;(2):CD000194.
Flutamida a 125 mg
A flutamida é um antiandrógeno capaz de reduzir o grau de hirsutismo.
Unluhizarci K, Ozel D, Tanriverdi F, Karaca Z, Kelestimur F. A comparison between
finasteride, flutamide, and finasteride plus flutamide combination in the treatment of
hirsutism. J Endocrinol Invest. 2009 Jan;32(1):37-40.
1. Creme de Finasterida
Finasterida..............................................0,25%
Creme Olivem 5%................................qsp 50g
Aplicar sobre as regiões afetadas 1 ou 2 vezes
2. Cápsulas de Ciproterona + Etinilestradiol
Acetato de
Ciproterona...........................2,0mg
Etinilestradiol......................................0,035mg
Cápsula..............................................qsp 1UN
Mande 21 cápsulas.
Administrar uma cápsula ao dia em ciclos de
21 dias ou conforme orientação médica.
3. Cápsulas de Orlistat
Orlistat..................................................120mg
Cápsula..............................................qsp 1UN
Administrar duas cápsulas ao dia ou conforme
4. Cápsulas de Dexametasona
Dexametasona......................................0,25mg
Cápsula..............................................qsp 1UN
Administrar duas cápsulas ao dia ou conforme
5. Cápsulas de Mio Inositol
Mio Inositol..........................................500 mg
Cápsula..............................................qsp 1UN
6. Cápsulas de Espironolactona
Espironolactona.....................................100mg
Cápsula..............................................qsp 1UN
7. Cápsulas de Finasterida
Finasterida..............................................2,5mg
Cápsula..............................................qsp 1UN
________________Hiperidrose
Hiperidrose
É a hiperprodução de suor, que pode ser generalizada, localizada, simétrica ou

assimétrica.
Existem duas etiopatogenias principais para a explicação das hiperidroses:

emocional ou cortical e termorreguladora ou hipotalâmica. A hiperidrose
assimétrica decorre de alterações neurológicas. Há ainda um tipo especial: a
hiperidrose gustativa, que é localizada (lábios, testa e nariz) e consequência da
ingestão de certos alimentos (picantes e condimentados) em determinadas
pessoas; não se conhece sua patogenia.
Um problema social de elevada importância é a hiperidrose axilar e

palmoplantar, que se agrava ou ocorre exatamente nos momentos de
ansiedade. O tratamento pode ser cirúrgico, médico-sistêmico ou local.
Recentemente, foi introduzida a toxina botulínica com extremo sucesso.
Referências
Solução a 20% ou
Cloreto de Alumínio
saturada
Formol 1,0 a 3,0%
Cloridrato de Alumínio 10 a 25%
Solução a 3,0%
Formaldeído
Gel a 0,75%
Referências
1. Emulsão Desodorante Antihiperidrose
Emulsão Desodorante.......................qsp 100ml

Aplicar sobre as regiões desejadas sempre que
necessário ou conforme orientação médica.
2. Espuma Antihiperidrose
Espuma Antihiperidrose....................qsp 100ml

Aplicar sobre as regiões desejadas sempre que
necessário ou conforme orientação médica.
________Micoses Superficiais
Micoses Superficiais
São doenças produzidas por fungos que se localizam preferencialmente na
epiderme e/ou em seus anexos, podendo, entretanto, eventualmente, invadir a
derme e, em raríssimos casos, até mesmo órgãos internos. O contágio inter-
humano é frequente.
Ceratofitoses
São micoses essencialmente superficiais, cujos fungos localizam-se na queratina
da epiderme e dos pelos, normalmente sem provocar fenômenos de
hipersensibilidade.
A pitiríase versicolor é uma doença de distribuição universal, que atinge todas

as raças e não possui predileção por sexo. Possui maior prevalência na idade
adulta, e em locais de clima quente e úmido. As lesões são inicialmente
arredondadas, pois surgem a partir da estrutura pilossebácea (devido à lipofilia
do agente), no entanto, podem confluir. Em geral, são hipocrômicas e
descamativas, mas podem ser hipercrômicas ou eritematosas.
Dermatofitoses
São doenças causadas por um grupo de fungos, os quais geralmente, em vida
parasitária, se alimentam da queratina da pele, dos pelos e das unhas. Têm
distribuição universal, mas com certas peculiaridades. A prevalência é maior nas
zonas tropical e subtropical, em regiões de clima quente e úmido. A mesma
espécie pode produzir quadros clínicos bem diferentes, e inclusive com
seletividade de grupos etários. Pode atingir o couro cabeludo (tinea capis), o
corpo (tinea corporis), os pés (tinea pedis), as unhas (tinea unguium). Os quadros
clínicos são bastante individualizados.
Referências
Pitiríase Versicolor

Loção a 2,5% por 10
Sulfeto de Selênio minutos, uma vez ao dia
por 7 dias
Cetoconazol Creme a 2,0%
Terbinafina Creme ou solução a 1,0%
Creme, gel, suspensão ou
Ciclopirox
solução a 0,7%
Fluconazol 50 mg/dia por 6 semanas
Referências
1. Loção com Sulfeto de Selênio
Sulfeto de Selênio.....................................2,5%
Loção...............................................qsp 100ml
Aplicar por 10 minutos uma vez ao dia por 7
dias ou conforme orientação médica.
2. Creme com Terbinafina
Terbinafina................................................1,0%
Creme Olivem 5%___________________qsp 50g
Aplicar nas regiões afetadas uma vez ao dia
3. Creme com Cetoconazol
Cetoconazol..............................................2,0%
Creme Olivem 5%___________________qsp 50g
Aplicar nas regiões afetadas uma vez ao dia
4. Cápsulas de Fluconazol
Fluconazol...............................................50mg
Cápsula____________________________qsp
1UN
Administrar 1 cápsula ao dia por 6 semanas ou
Dermatofitoses

Iodo + Àcido Salicílico + Ácido Solução alcoólica com 1%
Benzoico + 2% + 3%
Terbinafina 1,0%, 5,0% ou 10,0%
Miconazol 2,0%
Ciclopirox 0,77%
Ureia 20% na tinea pedis
Itraconazol 100 mg/dia
Fluconazol 150 mg/semana
Referências
Estudos
Terbinafina a 1,0%
Eficaz na Tinea pedis
De acordo com os resultados, as taxas de efetividade de tratamento na

semana 6 foram 66, 70 e 61% para terbinafina 1, 5 e 10%, respectivamente
quando comparadas com o placebo, sendo portanto, superior ao último.
Terbinafina nas concentrações de 1 e 5% não foi inferior à terbinafina 10%.
de Chauvin MF, Viguié-Vallanet C, Kienzler JL, Larnier C. Novel, single-dose, topical
treatment of tinea pedis using terbinafine: results of a dose-finding clinical trial.
Mycoses. 2008 Jan;51(1):1-6.
Ciclopirox a 0,77%
O gel de ciclopirox aplicado 1 ou 2 vezes ao dia reduziu os sinais e sintomas da
tinea pedis na semana 8 quando comparado ao veículo. A cura micológica e
as taxas de cura completa foram maiores nos regimes de ciclopirox. Também
foi observada redução mais precoce da contagem bacteriana. Não houve
diferenças entre os grupos em relação à taxa de eventos adversos.
Gupta AK, Skinner AR, Cooper EA. Evaluation of the efficacy of ciclopirox 0.77% gel in
the treatment of tinea pedis interdigitalis (dermatophytosis complex) in a randomized,
double-blind, placebo-controlled trial. Int J Dermatol. 2005 Jul;44(7):590-3.
1. Solução Formadora de Filme com Terbinafina
Terbinafina.................................1, 5 ou 10,0%
Solução Formadora de Filme................qsp 2ml
Utilizar em aplicação única ou conforme
2. Gel de Ciclopirox
Ciclopirox................................................0,77%
Gel.......................................................qsp 30g
Aplicar nas regiões afetadas 2 vezes ao dia ou
3. Pomada de Ureia
Ureia.......................................................20,0%
Pomada Oclusiva..................................qsp 50g
Aplicar nas regiões afetadas 1 vez ao dia ou
______________Onicomicoses
Onicomicoses
Correspondem a qualquer infecção do leito ungueal causada por fungos. Os
principais agentes etiológicos são os dermatófitos. Em quaisquer das
onicomicoses é muito mais prevalente o envolvimento das unhas dos pés,
provavelmente devido ao trauma local associado a um crescimento mais lento.
Por serem crônicas e recalcitrantes à terapia, representam uma fonte
endógena para o acomentimento de outras áreas.
São raras na infância e têm prevalência de cerca de 3% em adultos com 55

anos, tendendo a aumentar com a idade. Como fatores predisponentes, tem-
se tinea pedis, hiperidrose, uso de chuveiros públicos, sapatos, meias sintéticas,
unhas morfologicamente alteradas e com crescimento lento (o que explica a
maior prevalência nos idosos), diabetes, má circulação e deficiência
imunológica.
Referências

8,0% a cada 3 dias na 2
Ciclopirox Olamina primeiras semanas e então
semanalmente
Solução a 28% duas vezes
Tioconazol
ao dia
Miconazol 1,0%
Ureia 30 a 40%
Ureia + Ácido Salicílico 20% + 10%
200 mg duas vezes ao dia
Itraconazol
durante 7 dias
Fluconazol 300 mg/semana
Estudos
Terbinafina Oral Intermitente

Mais Efetiva que Itraconazol
O regime posológico intermitente de terbinafina apresentou eficácia e

segurança similar à terapia padrão ouro de terbinafina em regime contínuo e
taxas de cura efetiva superiores à terapia de pulso com itraconazol.
Gupta AK, Lynch LE, Kogan N, Cooper EA. The use of an intermittent terbinafine
regimen for the treatment of dermatophyte toenail onychomycosis. J Eur Acad
Dermatol Venereol. 2009 Mar;23(3):256-62
Succi et al., (2013) demonstraram que o tratamento intermitente mais a abrasão

da unha provou ser uma alternativa estatisticamente eficaz, segura e com
menor custos para o tratamento de onicomicose das unhas.
Succi IB, Bernardes-Engemann AR, Orofino-Costa R. Intermittent therapy with terbinafine
and nail abrasion for dermatophyte toe onychomycosis: a pilot study. Mycoses. 2013
Jan 8. doi: 10.1111/myc.12032. [Epub ahead of print]
Jaiswal et al., (2007) demonstraram que a pulsoterapia de terbinafina é uma

alternativa eficaz e segura no tratamento da onicomicose por dermatófitos.
Jaiswal A, Sharma RP, Garg AP. An open randomized comparative study to test the
efficacy and safety of oral terbinafine pulse as a monotherapy and in combination with
topical ciclopirox olamine 8% or topical amorolfine hydrochloride 5% in the treatment
of onychomycosis. Indian J Dermatol Venereol Leprol. 2007 Nov-Dec;73(6):393-6.
Arca et al., (2002) realizaram um estudo comparativo entre o fluconazol, o

itraconazol e a terbinafina. Os resultados demonstraram que todas as drogas
foram eficazes, porém o fluconazol foi o menos eficaz. Com relação ao
custo/eficácia, efeitos secundários e taxas de cura, a terbinafina foi a droga de
escolha deste estudo.
Arca E, Taştan HB, Akar A, Kurumlu Z, Gür AR. An open, randomized, comparative study
of oral fluconazole, itraconazole and terbinafine therapy in onychomycosis. J
Dermatolog Treat. 2002 Mar;13(1):3-9.
Salo e Pekurinen (2002) realizaram um estudo randomizado, duplo-cego e

duplo-simulado para comparar a eficácia da terbinafina com o fluconazol. O
estudo clínico demonstrou que a terbinafina foi mais eficaz do que o fluconazol,
atingindo taxas mais elevadas de cura micológica e clínica e sendo também
mais rentável.
Salo H, Pekurinen M. Cost effectiveness of oral terbinafine (Lamisil) compared with oral
fluconazole (Diflucan) in the treatment of patients with toenail onychomycosis.
Pharmacoeconomics. 2002;20(5):319-24.
Fluconazol + Ureia
Um estudo realizado no Departamento Médico de Micologia do Instituto Pasteur
do Irã demonstrou que o tratamento tópico da onicomicose com uma
combinação de fluconazol 1% e ureia 40% foi mais eficaz do que o fluconazol
1% isolado no tratamento da onicomicose causada por dermatófitos.
Bassiri-Jahromi S, Ehsani AH, Mirshams-Shahshahani M, Jamshidi B. A comparative
evaluation of combination therapy of fluconazole 1% and urea 40% compared with
fluconazole 1% alone in a nail lacquer for treatment of onychomycosis: therapeutic
trial. J Dermatolog Treat. 2012 Dec;23(6):453-6. doi: 10.3109/09546634.2011.588191. Epub
2011 Jul 24.
Esmalte de Ciclopirox a 8,0%

Um estudo realizado no Instituto de Pesquisa do Pé Diabético de Glendale,
Estados Unidos, demonstrou que o ciclopirox a 8,0% em esmalte é um
tratamento seguro e eficaz para o onicomicose subungueal distal em pacientes
com diabetes melitus tipo 2 sob tratamento com insulina ou terapia com
hipoglicemiante oral. Foi observada melhora em 84,4% dos pacientes.
Brenner MA, Harkless LB, Mendicino RW, Page JC. Ciclopirox 8% nail lacquer topical
solution for the treatment of onychomycosis in patients with diabetes: a multicenter,
open-label study. J Am Podiatr Med Assoc. 2007 May-Jun;97(3):195-202.
Referências
1. Cápsulas de Terbinafina Intermitente
Terbinafina............................................250mg
Cápsula..............................................qsp 1UN
Mande 30 cápsulas.
Dose diária durante 4 semanas seguida por um
intervalo de 4 semanas sem tratamento e,
posteriormente, um curso adicional de 4
semanas de terbinafina 250 mg/dia.
2. Esmalte de Fluconazol + Pomada de Ureia
Fluconazol................................................1,0%
Esmalte.............................................qsp 8,0ml
Aplicar na regiões afetadas 1 a 2 vezes ao dia
Ureia......................................................40,0%
Aplicar nas regiões afetadas 1 a 2 vezes na
semana antes da aplicação do esmalte de
fluconazol ou conforme orientação médica.
______________________Casp
a
Caspa
A caspa (pitiríase capitis; dermatite seborreica do couro cabeludo) é uma

doença prevalente em todo o mundo, apesar das várias opções de
tratamento. Não deve ser definida apenas pela sua apresentação clínica,
fisiopatologia e/ou seu espectro etiológico. A definição deve incluir também seu
impacto na sociedade, pois o couro cabeludo escamoso mostra-se anti-
higiênico podendo fazer o paciente sentir-se constrangido e envergonhado,
afetando sua autoestima e confiança (Manuel e Ranganathan, 2011).
A caspa pode ser considerada um distúrbio primário dentro de uma escala

fisiológica - caspa, dermatite seborreica e psoríase - cuja condição é agravada
pela flora comensal - Malassezia. Os fatores desencadeantes da caspa são
microbianos e não-microbianos, e para a formação da caspa pode ser
necessária apenas uma ou a combinação de muitas causas. Dentre as causas
conhecidas destacam-se a exposição solar, a oleosidade do couro cabeludo,
a função barreira da pele e contaminação por Malassezia furfur (Manuel e
Ranganathan, 2011).
Tratamento da caspa requer uma abordagem racional e deve ser adaptada a

cada paciente. A etiologia fúngica deve ser confirmada antes do uso de
qualquer linha de terapia antifúngica. A doença deve ser confirmada como
primária ou secundária, de modo a decidir a linha específica de tratamento
(Manuel e Ranganathan, 2011).
Antifúngicos
Tratamento
s da Caspa
Anti-
Queratolític
inflamatório
os
s
Referências
Manuel F, Ranganathan S. A new postulate on two stages of dandruff: a clinical perspective. Int J Trichology. 2011
Jan;3(1):3-6
Composto Concentração Usual Função
Cetoconazol 2,0% Antifúngico
Fluconazol 2,0% Antifúngico
Nitrato de Miconazol 2,0% Antifúngico
Antifúngico e
Piritionato de Zinco 1,0 a 2,0%
Antimicrobiano
Antisseborreico e
Sulfacetamida Sódica 5,0%
antibacteriano
Anti-inflamatório
Acetonido de Fluocinolona 0,01%
esteroidal
Ácido Salicílico 2,0% Queratolítico
Anti-inflamatório
Propionato de Clobetasol 0,05%
esteroidal
Piroctona Olamina 0,75% Antifúngico
Normalizador da
Enxofre 5,0%
secreção sebácea
Anti-Inflamatório
Desonida 0,05% esteroidal e
antipruriginoso
Referências
Estudos
Shampoo com Piroctona Olamina e Ácido Salicílico

Ambos os shampoos foram altamente eficazes na redução da caspa. No
entanto, a combinação de piroctona olamina e ácido salicílico pareceu ser
ligeiramente mais eficaz do que o piritionato de zinco na redução da gravidade
e da área afetada pela descamação do couro cabeludo.
Lodén M, Wessman C. The antidandruff efficacy of a shampoo containing piroctone
olamine and salicylic acid in comparison to that of a zinc pyrithione shampoo. Int J
Cosmet Sci. 2000 Aug;22(4):285-9. doi: 10.1046/j.1467-2494.2000.00024.x.
Shampoo com Propionato de Clobetasol

A aplicação do shampoo de propionato de clobetasol, durante curto período
de tempo, é um tratamento efetivo e seguro para a dermatite seborreica do
couro cabeludo, reduzindo a irritação e a caspa.
Reygagne P, Poncet M, Sidou F, Soto P. Clobetasol propionate shampoo 0.05% in the
treatment of seborrheic dermatitis of the scalp: results of a pilot study. Cutis. 2007
May;79(5):397-403.
Shampoo de Ciclopirox Olamina a 1,5%

Um estudo mostrou que o uso de um shampoo de ciclopirox olamina a 1,5% em
pacientes com caspa leve a moderada foi efetivo e seguro, reduzindo
progressivamente a caspa e aliviando o prurido.
Lee JH, Lee HS, Eun HC, Cho KH. Successful treatment of dandruff with 1.5% ciclopirox
olamine shampoo in Korea. J Dermatolog Treat. 2003 Dec;14(4):212-5.
Piritionato de Zinco
O piritionato de zinco promove a cura da caspa do couro cabeludo,
normalizando a queratinização epitelial, a produção de sebo ou ambos.
Ranganathan S, Mukhopadhyay T. Dandruff: the most commercially exploited skin
disease. Indian J Dermatol. 2010 Apr-Jun;55(2):130-4.
Nitrato de Miconazol a 2,0% em Shampoo

Um estudo mostrou que um shampoo contendo um antifúngico, nitrato de
miconazol a 2%, mostrou atividade anti-caspa semelhante ao shampoo de
sulfeto de selênio (um composto citostático) a 2,5%.
Sheth RA. A comparison of miconazole nitrate and selenium disulfide as anti-dandruff
agents. Int J Dermatol. 1983 Mar;22(2):123-5.
Nitrato de Miconazol a 2,0% em Condicionador
O uso de nitrato de miconazol não só em shampoo, mas também em
condicionador, promove maior eficácia no controle da caspa, pois o ativo
permanece mais tempo no couro cabeludo, contribuindo na redução da
proliferação da Malassezia.
Sei Y, Kobayashi M, Soude E. Study on the usefulness of rinse containing miconazole
nitrate for treatment of dandruff. Med Mycol J. 2011;52(3):229-37.
Cetoconazol + Ácido Salicílico + Piritionato de Zinco

A associação entre o cetoconazol e o piritionato de zinco para uso tópico é
uma opção segura e efetiva no tratamento da caspa, apresentando melhora
dos escores para todas as áreas do couro cabeludo e demonstrando melhora
significativa dos sinais e sintomas, como eritema e prurido.
Saple DG, Ravichandran G, Desai A. Evaluation of safety and efficacy of ketoconazole
2% and zinc pyrithione 1% shampoo in patients with moderate to severe dandruff--a
postmarketing study. J Indian Med Assoc. 2000 Dec;98(12):810-1.
1. Espuma de Cetoconazol, Piritionato de Zinco e Ácido

Salicílico
Cetoconazol..............................................1,0%
Piritionato de Zinco...................................0,5%
Espuma............................................qsp 100ml
Aplicar diariamente no couro cabeludo nos
primeiros 7 dias e 2 vezes por semanas nas 3
semanas subsequentes ou conforme
2. Shampoo com Piroctona Olamina e Ácido Salicílico
Piroctona Olamina..................................0,75%
Shampoo Creme..............................qsp 120ml
Utilizar 2 a 3 vezes por semana, deixando agir
por 5 minutos, ou conforme orientação
médica.
3. Condicionador Vegetal com Nitrato de Miconazol
Nitrato de Miconazol.................................2,0%
Condicionador Vegetal.....................qsp
120ml
Aplicação tópica conforme orientação
médica.
___________Ceratose
Actínica
Ceratose Actínica
É conhecida também com o nome de ceratose senil, devido ao seu

aparecimento na idade avançada. É uma manifestação de irradiação solar
cumulativa, progressiva, persistente e duradoura, daí sua localização
preferencial nas áreas expostas, em especial a calva. É, em geral, múltipla e
caracteriza-se por pequenas lesões (alguns milímetros ou centímetros de
diâmetro) discretamente salientes, de coloração acastanhada, com superfície
rugosa. Às vezes, o aspecto é de lesão atrófica e eritematosa com
descamação.
Referências
5-Fluoruracila 0,5%
Ácido Salicílico 10,0%
Ácido Tricloroacético 40%
Ácido Glicólico 70,0%
Piroxicam 1,0%
Diclofenaco em gel de ácido
3,0%
hialurônico
Adapaleno 0,1 a 0,3%
Ácido Retinoico 0,05%
Resorcinol 14%
Solução de Jessner Ácido Salicílico 14%
Ácido Lático 14%
Estudos
5-Fluoruracila + Ácido Salicílico

A aplicação tópica de baixas doses de 5-fluoruracila/ácido salicílico
demonstrou melhores taxas histológicas e clínicas de remissão da ceratose
actínica, sendo considerado um tratamento eficaz da lesão.
Stockfleth E, Kerl H, Zwingers T, Willers C. Low-dose 5-fluorouracil in combination with
salicylic acid as a new lesion-directed option to treat topically actinic keratoses -
histological and clinical study results. Br J Dermatol. 2011 Apr 25. doi: 10.1111/j.1365-
2133.2011.10387.x. [Epub ahead of print]
Ácido Glicólico a 70% ou Solução de Jessner + 5-

Fluouracila
A combinação da solução de Jessner ou ácido glicólico a 70% com solução de
5-fluoruracila a 5% (peeling superficial de pulso) foi seguro e muito efetivo no
tratamento da ceratose actínica múltipla e difusa.
Bagatin E, Teixeira SP, Hassun KM, Pereira T, Michalany NS, Talarico S. 5-Fluorouracil
superficial peel for multiple actinic keratoses. Int J Dermatol. 2009 Aug;48(8):902-7.
Peeling de Ácido Glicólico-TCA

Clinicamente, o peeling de ácido glicólico-TCA foi efetivo no tratamento de
peles fotodanificadas. Este peeling foi ligeiramente mais eficaz na remoção de
ceratoses actínicas que o peeling de solução de Jessner-TCA.
Tse Y, Ostad A, Lee HS, Levine VJ, Koenig K, Kamino H, Ashinoff R. A clinical and
histologic evaluation of two medium-depth peels. Glycolic acid versus Jessner's
trichloroacetic acid. Dermatol Surg. 1996 Sep;22(9):781-6.
Piroxicam a 1,0%
O uso do gel de piroxicam a 1% por 90 dias induziu completa regressão em 48%
das ceratoses actínicas avaliadas, correspondendo às lesões ceratóticas e
verrucosas.
Campione E, Diluvio L, Paternò EJ, Chimenti S. Topical treatment of actinic keratoses
with piroxicam 1% gel: a preliminary open-label study utilizing a new clinical score. Am
J Clin Dermatol. 2010;11(1):45-50. doi: 10.2165/11311170-000000000-00000.
Diclofenaco a 3,0% em Gel de Ácido Hialurônico a 2,5%

O tratamento da ceratose actínica com diclofenaco a 3% em um gel de ácido
hialurônico a 2,5% é efetivo e bem tolerado durante um período de 3 a 6 meses.
Pflugfelder A, Welter AK, Leiter U, Weide B, Held L, Eigentler T, Dirschka T, Stockfleth E,
Nashan D, Garbe C. Open label randomized study comparing 3 months vs. 6 months
treatment of actinic keratoses with 3% diclofenac in 2.5% hyaluronic acid gel: a trial of
the German Dermatologic Cooperative Oncology Group. J Eur Acad Dermatol
Venereol. 2011 Mar 18. doi: 10.1111/j.1468-3083.2011.04005.x. [Epub ahead of print]
Gel de Adapaleno
O gel de adapaleno a 0,1% ou 0,3% foi bem tolerado e melhorou as lesões de
ceratose actínica, as manchas solares, bem como outras características da pele
fotodanificada.
Kang S, Goldfarb MT, Weiss JS, Metz RD, Hamilton TA, Voorhees JJ, Griffiths CE.
Assessment of adapalene gel for the treatment of actinic keratoses and lentigines: a
randomized trial. J Am Acad Dermatol. 2003 Jul;49(1):83-90.
Peeling de TCA a 40%
Um peeling a 40% de TCA (um peeling de média profundidade) adicionado de

tratamento tópico com retinoide melhora manchas solares e lesões de ceratose
actínica.
Rendon MI, Berson DS, Cohen JL, Roberts WE, Starker I, Wang B. Evidence and
considerations in the application of chemical peels in skin disorders and aesthetic
resurfacing. J Clin Aesthet Dermatol. 2010 Jul;3(7):32-43.
Ácido Retinoico a 0,05%

O tratamento com ácido retinoico a 0,05% por, no mínimo, 6 meses reduziu a
atipia melanocítica e queratinocítica em peles fotoenvelhecidas, sendo
considerado quimioprotetor na carcinogênese epitelial.
Cho S, Lowe L, Hamilton TA, Fisher GJ, Voorhees JJ, Kang S. Long-term treatment of
photoaged human skin with topical retinoic acid improves epidermal cell atypia and
thickens the collagen band in papillary dermis. J Am Acad Dermatol. 2005
Nov;53(5):769-74.
1. Solução de DMSO com 5-Fluoruracila e Ácido Salicílico
5-Fluoruracila...........................................0,5%
Ácido Salicílico........................................10,0%
Solução com DMSO a 8%............................qsp
Aplica sobre as regiões afetadas 1 vez ao dia
por até 12 semanas ou conforme orientação
médica.
2. Gel de Piroxicam
Piroxicam...................................................1,0%
Gel.......................................................qsp 50g
3. Diclofenaco em Gel de Ácido Hialurônico
Diclofenaco...............................................3,0%
Gel de ácido hialurônico a 2,5%............qsp
50g
4. Gel de Adapaleno
Adapaleno........................................0,1 a 3,0%
Gel.......................................................qsp 50g
_______________Líquen Plano
Líquen Plano
Líquen plano é um distúrbio inflamatório comum que afeta a pele, membranas,

mucosas, unhas e cabelo. A aparência do líquen plano ou dermatose
liquenoide se parece com a das excrescências secas, finamente sulcadas e
cobertas de caspa da vegetação simbiótica conhecida como líquen.
O líquen plano é uma entidade com pápulas “liquenoides” prototípicas que

apresentam cor e morfologia distintas, desenvolvem-se em localizações típicas
e manifestam padrões característicos de evolução. Os sintomas e achados na
pele que caracterizam o líquen plano são representados por pápulas poligonais
purpúricas e pruriginosas.
Pelo menos 2/3 dos casos ocorrem entre os 30 e 60 anos de idade. Não há
predileção sexual. Mulheres geralmente são afetadas aos 50 e 60 anos,
enquanto homens desenvolvem a doença um pouco antes.
Referências

Fluocinolona Acetonida 0,1%
Proprionato de Clobetasol 0,05%
Acetonido de Triancinolona Solução com 40 mg/ml
Ácido Retinoico 0,05%
Ciclosporina 100 mg/ml 3 vezes ao dia
Tacrolimus 0,1%
30 a 60 mg/dia por 4 a 6
Prednisona
semanas
Prednisolona 30 mg/dia por 10 dias
Ciclosporina 3 a 10 mg/kg/dia
Dapsona 100 a 200 mg/dia
Tretinoína 10 – 30 mg/dia
Azatioprina 1 a 3 mg/kg/dia
Referências
Estudos
Tacrolimus Tópico
O tacrolimus tópico é eficaz no tratamento do líquen plano oral. A maioria dos
pacientes experienciou melhora dos sintomas em menos de 1 mês de
tratamento. No entanto, os efeitos são temporários, com ressurgimento dos
sintomas após interrupção do tratamento.
Byrd JA, Davis MD, Bruce AJ, Drage LA, Rogers RS 3rd. Response of oral lichen planus to
topical tacrolimus in 37 patients. Arch Dermatol. 2004 Dec;140(12):1508-12.
Triancinolona Acetonido em Enxaguatório Bucal

Tratamento do Líquen Plano Oral
A aplicação de um enxaguatório bucal contendo triancinolona acetonido é

um tratamento apropriado para o líquen plano oral, em vista de sua alta
eficácia e baixo risco de re-infecção fúngica.
González-García A, Diniz-Freitas M, Gándara-Vila P, Blanco-Carrión A, García-García A,
Gándara-Rey J. Triamcinolone acetonide mouth rinses for treatment of erosive oral
lichen planus: efficacy and risk of fungal over-infection. Oral Dis. 2006 Nov;12(6):559-65.
Tacrolimus vs. Triancinolona Acetonido
A aplicação tópica de uma pomada com 0,1% de tacrolimus induziu melhor

resposta terapêutica inicial do que a pomada de triancinolona acetonido a
0,1%.
Laeijendecker R, Tank B, Dekker SK, Neumann HA. A comparison of treatment of oral
lichen planus with topical tacrolimus and triamcinolone acetonide ointment. Acta Derm
Venereol. 2006;86(3):227-9.
1. Enxaguatório Bucal com Triancinolona Acetonido
Triancinolona Acetonido............................0,3%
Enxaguatório Bucal............................qsp 100ml
Bochecar diariamente durante 60 segundos ou
2. Cápsulas de Ciclosporina
Ciclosporina................................210 a 700mg*
Cápsula..............................................qsp 1 UN
*Dose usual para um adulto de 70 Kg.
3. Cápsulas de Prednisona
Prednisona.......................................30 a 60mg
Cápsula...............................................qsp 1UN
Administrar 1 cápsula ao dia por 4 a 6 semanas
Azatioprina..................................70 a 210 mg*

Cápsula...............................................qsp 1UN
* Dose usual para um adulto de 70 Kg.
Referências Bibliográficas
1. Bakar O, Demirçay Z, Yuksel M, Haklar G, Sanisoglu Y. The effect of
azithromycin on reactive oxygen species in rosacea. Clin Exp Dermatol. 2007
Mar;32(2):197-200. Epub 2007 Jan 18.
2. Rajatanavin N, Suwanachote S, Kulkollakarn S. Dihydroxyacetone: a safe

camouflaging option in vitiligo. Int J Dermatol. 2008 Apr;47(4):402-6.
3. Middelkamp-Hup MA, Bos JD, Rius-Diaz F, Gonzalez S, Westerhof W.

Treatment of vitiligo vulgaris with narrow-band UVB and oral Polypodium
leucotomos extract: a randomized double-blind placebo-controlled study. J Eur
Acad Dermatol Venereol. 2007 Aug;21(7):942-50.
4. Parsad D, Kanwar A. Oral minocycline in the treatment of vitiligo--a

preliminary study. Dermatol Ther. 2010 May-Jun;23(3):305-7.
5. Kanwar AJ, Dogra S, Parsad D. Topical tacrolimus for treatment of

childhood vitiligo in Asians. Clin Exp Dermatol. 2004 Nov;29(6):589-92.
6. Xu AE, Zhang DM, Wei XD, Huang B, Lu LJ. Efficacy and safety of
tarcrolimus cream 0.1% in the treatment of vitiligo. Int J Dermatol. 2009
Jan;48(1):86-90.
7. Majid I. Does topical tacrolimus ointment enhance the efficacy of

narrowband ultraviolet B therapy in vitiligo? A left-right comparison study.
Photodermatol Photoimmunol Photomed. 2010 Oct;26(5):230-4.
8. Radakovic-Fijan S, Fürnsinn-Friedl AM, Hönigsmann H, Tanew A. Oral

dexamethasone pulse treatment for vitiligo. J Am Acad Dermatol. 2001
May;44(5):814-7.
9. Parsad D, Pandhi R, Juneja A. Effectiveness of oral Ginkgo biloba in

treating limited, slowly spreading vitiligo. Clin Exp Dermatol. 2003 May;28(3):285-
7.
10. Camacho F, Mazuecos J. Oral and topical L-phenylalanine, clobetasol

propionate, and UVA/sunlight--a new study for the treatment of vitiligo. J Drugs
Dermatol. 2002 Sep;1(2):127-31.
11. Lebwohl M, Freeman AK, Chapman MS, Feldman SR, Hartle JE, Henning A;
Tacrolimus Ointment Study Group. Tacrolimus ointment is effective for facial and
intertriginous psoriasis. J Am Acad Dermatol. 2004 Nov;51(5):723-30.
12. Ortonne JP, van de Kerkhof PC, Prinz JC, Bieber T, Lahfa M, Rubins A, Wozel
G, Lorette G; European Tacrolimus Psoriasis Study Group. 0.3% Tacrolimus gel and
0.5% Tacrolimus cream show efficacy in mild to moderate plaque psoriasis:
Results of a randomized, open-label, observer-blinded study. Acta Derm
Venereol. 2006;86(1):29-33.
13. Carroll CL, Clarke J, Camacho F, Balkrishnan R, Feldman SR. Topical
tacrolimus ointment combined with 6% salicylic acid gel for plaque psoriasis
treatment. Arch Dermatol. 2005 Jan;141(1):43-6.
14. Vali A, Asilian A, Khalesi E, Khoddami L, Shahtalebi M, Mohammady M.

Evaluation of the efficacy of topical caffeine in the treatment of psoriasis vulgaris.
J Dermatolog Treat. 2005;16(4):234-7.
15. Lin YK, Yen HR, Wong WR, Yang SH, Pang JH. Successful treatment of
pediatric psoriasis with Indigo naturalis composite ointment. Pediatr Dermatol.
2006 Sep-Oct;23(5):507-10.
16. Kimball AB, Gold MH, Zib B, Davis MW; Clobetasol Propionate Emulsion
Formulation Foam Phase III Clinical Study Group. Clobetasol propionate emulsion
formulation foam 0.05%: review of phase II open-label and phase III randomized
controlled trials in steroid-responsive dermatoses in adults and adolescents. J Am
Acad Dermatol. 2008 Sep;59(3):448-54, 454.e1. Epub 2008 Jun 9.
17. Naseri M, Hadipour A, Sepaskhah M, Namazi MR. The remarkable

beneficial effect of adding oral simvastatin to topical betamethasone for
treatment of psoriasis: a double-blind, randomized, placebo-controlled study.
Niger J Med. 2010 Jan-Mar;19(1):58-61.
18. Ana Claudia Milanez Rigoni, Sueli Coelho da Silva Carneiro. Estudo Aberto
com Pentoxifilina em Pacientes com Psoríase. An bras Dermatol, Rio de Janeiro,
76(1):39-49, jan./fev. 2001.
19. Modell JG, Boyce S, Taylor E, Katholi C. Treatment of atopic dermatitis and
psoriasis vulgaris with bupropion-SR: a pilot study. Psychosom Med. 2002 Sep-
Oct;64(5):835-40.
20. Lee JY. Severe 20-nail psoriasis successfully treated by low dose
methotrexate. Dermatol Online J. 2009 Nov 15;15(11):8.
21. Polat M, Lenk N, Yalcin B, Gür G, Tamer E, Artuz F, Alli N. Efficacy of

erythromycin for psoriasis vulgaris. Clin Exp Dermatol. 2007 May;32(3):295-7.
22. Ortonne JP, Nikkels AF, Reich K, Ponce Olivera RM, Lee JH, Kerrouche N,
Sidou F, Faergemann J. Efficacious and safe management of moderate to
severe scalp seborrhoeic dermatitis using clobetasol propionate shampoo 0•05%
combined with ketoconazole shampoo 2%: a randomized, controlled study. Br J
Dermatol. 2011 Jul;165(1):171-6. doi: 10.1111/j.1365-2133.2011.10269.x.
23. Schmidt-Rose T, Braren S, Fölster H, Hillemann T, Oltrogge B, Philipp P, Weets

G, Fey S. Efficacy of a piroctone olamine/climbazol shampoo in comparison with
a zinc pyrithione shampoo in subjects with moderate to severe dandruff. Int J
Cosmet Sci. 2011 Jun;33(3):276-82. doi: 10.1111/j.1468-2494.2010.00623.x. Epub
2011 Jan 27.
24. Ranganathan S, Mukhopadhyay T. Dandruff: the most commercially
exploited skin disease. Indian J Dermatol. 2010 Apr-Jun;55(2):130-4.
25. Lodén M, Wessman C. The antidandruff efficacy of a shampoo containing

piroctone olamine and salicylic acid in comparison to that of a zinc pyrithione
shampoo. Int J Cosmet Sci. 2000 Aug;22(4):285-9.
26. Kircik LH. Treatment of scalp and facial seborrheic dermatitis with
desonide hydrogel 0.05%. J Clin Aesthet Dermatol. 2009 Feb;2(2):32-6.
27. Shemer A, Kaplan B, Nathansohn N, Grunwald MH, Amichai B, Trau H.

Treatment of moderate to severe facial seborrheic dermatitis with itraconazole:
an open non-comparative study. Isr Med Assoc J. 2008 Jun;10(6):417-8.
28. Zisova LG. Fluconazole and its place in the treatment of seborrheic
dermatitis--new therapeutic possibilities. Folia Med (Plovdiv). 2006;48(1):39-45.
29. Maryam A, Hassan S, Farshad F, Parastoo B, Vahide L. The efficacy of

topical diphencyprone in the treatment of alopecia areata. Indian J Dermatol.
2009;54(1):88-9.
30. Farshi S, Mansouri P, Safar F, Khiabanloo SR. Could azathioprine be

considered as a therapeutic alternative in the treatment of alopecia areata? A
pilot study. Int J Dermatol. 2010 Oct;49(10):1188-93. doi: 10.1111/j.1365-
4632.2010.04576.x.
31. Rashidi T, Mahd AA. Treatment of persistent alopecia areata with

sulfasalazine. Int J Dermatol. 2008 Aug;47(8):850-2. doi: 10.1111/j.1365-
4632.2008.03700.x.
32. Ait Ourhroui M, Hassam B, Khoudri I. Treatment of alopecia areata with

prednisone in a once-monthly oral pulse. Ann Dermatol Venereol. 2010 Aug-
Sep;137(8-9):514-8. doi: 10.1016/j.annder.2010.06.002. Epub 2010 Aug 17.
33. Chartaux E, Joly P. Long-term follow-up of the efficacy of methotrexate

alone or in combination with low doses of oral corticosteroids in the treatment of
alopecia areata totalis or universalis. Ann Dermatol Venereol. 2010 Aug-
Sep;137(8-9):507-13. doi: 10.1016/j.annder.2010.06.031. Epub
34. Tosti A, Iorizzo M, Botta GL, Milani M. Efficacy and safety of a new
clobetasol propionate 0.05% foam in alopecia areata: a randomized, double-
blind placebo-controlled trial. J Eur Acad Dermatol Venereol. 2006
Nov;20(10):1243-7.
35. Blume-Peytavi U, Kunte C, Krisp A, Garcia Bartels N, Ellwanger U, Hoffmann

R. Comparison of the efficacy and safety of topical minoxidil and topical
alfatradiol in the treatment of androgenetic alopecia in women. J Dtsch
Dermatol Ges. 2007 May;5(5):391-5.
36. Fischer TW, Hipler UC, Elsner P. Effect of caffeine and testosterone on the
proliferation of human hair follicles in vitro. Int J Dermatol. 2007 Jan;46(1):27-35.
37. Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic
effects of finasteride gel and tablet in treatment of the androgenetic alopecia.
Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):47-51.
38. Lucas KJ. Finasteride cream in hirsutism. Endocr Pract. 2001 Jan-Feb;7(1):5-
10.
39. Vanky E, Salvesen KA, Carlsen SM. Six-month treatment with low-dose
dexamethasone further reduces androgen levels in PCOS women treated with
diet and lifestyle advice, and metformin. Hum Reprod. 2004 Mar;19(3):529-33.
Epub 2004 Jan 29.
40. Metwally M, Amer S, Li TC, Ledger WL. An RCT of metformin versus orlistat
for the management of obese anovulatory women. Hum Reprod. 2009
Apr;24(4):966-75. Epub 2008 Dec 18.
41. Zacchè MM, Caputo L, Filippis S, Zacchè G, Dindelli M, Ferrari A. Efficacy

of myo-inositol in the treatment of cutaneous disorders in young women with
polycystic ovary syndrome. Gynecol Endocrinol. 2009 Aug;25(8):508-13
42. de Chauvin MF, Viguié-Vallanet C, Kienzler JL, Larnier C. Novel, single-

dose, topical treatment of tinea pedis using terbinafine: results of a dose-finding
clinical trial. Mycoses. 2008 Jan;51(1):1-6.
43. Gupta AK, Skinner AR, Cooper EA. Evaluation of the efficacy of ciclopirox
0.77% gel in the treatment of tinea pedis interdigitalis (dermatophytosis complex)
in a randomized, double-blind, placebo-controlled trial. Int J Dermatol. 2005
Jul;44(7):590-3.
44. Gupta AK, Lynch LE, Kogan N, Cooper EA. The use of an intermittent
terbinafine regimen for the treatment of dermatophyte toenail onychomycosis.
J Eur Acad Dermatol Venereol. 2009 Mar;23(3):256-62
45. Succi IB, Bernardes-Engemann AR, Orofino-Costa R. Intermittent therapy

with terbinafine and nail abrasion for dermatophyte toe onychomycosis: a pilot
study. Mycoses. 2013 Jan 8. doi: 10.1111/myc.12032. [Epub ahead of print]
46. Jaiswal A, Sharma RP, Garg AP. An open randomized comparative study
to test the efficacy and safety of oral terbinafine pulse as a monotherapy and in
combination with topical ciclopirox olamine 8% or topical amorolfine
hydrochloride 5% in the treatment of onychomycosis. Indian J Dermatol Venereol
Leprol. 2007 Nov-Dec;73(6):393-6.
47. Arca E, Taştan HB, Akar A, Kurumlu Z, Gür AR. An open, randomized,
comparative study of oral fluconazole, itraconazole and terbinafine therapy in
onychomycosis. J Dermatolog Treat. 2002 Mar;13(1):3-9.
48. Salo H, Pekurinen M. Cost effectiveness of oral terbinafine (Lamisil)
compared with oral fluconazole (Diflucan) in the treatment of patients with
toenail onychomycosis. Pharmacoeconomics. 2002;20(5):319-24.
49. Bassiri-Jahromi S, Ehsani AH, Mirshams-Shahshahani M, Jamshidi B. A

comparative evaluation of combination therapy of fluconazole 1% and urea 40%
compared with fluconazole 1% alone in a nail lacquer for treatment of
onychomycosis: therapeutic trial. J Dermatolog Treat. 2012 Dec;23(6):453-6. doi:
10.3109/09546634.2011.588191. Epub 2011 Jul 24.
50. Brenner MA, Harkless LB, Mendicino RW, Page JC. Ciclopirox 8% nail
lacquer topical solution for the treatment of onychomycosis in patients with
diabetes: a multicenter, open-label study. J Am Podiatr Med Assoc. 2007 May-
Jun;97(3):195-202.
51. Manuel F, Ranganathan S. A new postulate on two stages of dandruff: a

clinical perspective. Int J Trichology. 2011 Jan;3(1):3-6
52. Lodén M, Wessman C. The antidandruff efficacy of a shampoo containing

piroctone olamine and salicylic acid in comparison to that of a zinc pyrithione
shampoo. Int J Cosmet Sci. 2000 Aug;22(4):285-9. doi: 10.1046/j.1467-
2494.2000.00024.x.
53. Reygagne P, Poncet M, Sidou F, Soto P. Clobetasol propionate shampoo

0.05% in the treatment of seborrheic dermatitis of the scalp: results of a pilot study.
Cutis. 2007 May;79(5):397-403.
54. Lee JH, Lee HS, Eun HC, Cho KH. Successful treatment of dandruff with 1.5%
ciclopirox olamine shampoo in Korea. J Dermatolog Treat. 2003 Dec;14(4):212-5.
55. Ranganathan S, Mukhopadhyay T. Dandruff: the most commercially

exploited skin disease. Indian J Dermatol. 2010 Apr-Jun;55(2):130-4.
56. Sheth RA. A comparison of miconazole nitrate and selenium disulfide as

anti-dandruff agents. Int J Dermatol. 1983 Mar;22(2):123-5.
57. Sei Y, Kobayashi M, Soude E. Study on the usefulness of rinse containing

miconazole nitrate for treatment of dandruff. Med Mycol J. 2011;52(3):229-37.
58. Saple DG, Ravichandran G, Desai A. Evaluation of safety and efficacy of

ketoconazole 2% and zinc pyrithione 1% shampoo in patients with moderate to
severe dandruff--a postmarketing study. J Indian Med Assoc. 2000
Dec;98(12):810-1
59. Stockfleth E, Kerl H, Zwingers T, Willers C. Low-dose 5-fluorouracil in

combination with salicylic acid as a new lesion-directed option to treat topically
actinic keratoses - histological and clinical study results. Br J Dermatol. 2011 Apr
25. doi: 10.1111/j.1365-2133.2011.10387.x. [Epub ahead of print]
60. Bagatin E, Teixeira SP, Hassun KM, Pereira T, Michalany NS, Talarico S. 5-
Fluorouracil superficial peel for multiple actinic keratoses. Int J Dermatol. 2009
Aug;48(8):902-7.
61. Tse Y, Ostad A, Lee HS, Levine VJ, Koenig K, Kamino H, Ashinoff R. A clinical
and histologic evaluation of two medium-depth peels. Glycolic acid versus
Jessner's trichloroacetic acid. Dermatol Surg. 1996 Sep;22(9):781-6.
62. Campione E, Diluvio L, Paternò EJ, Chimenti S. Topical treatment of actinic

keratoses with piroxicam 1% gel: a preliminary open-label study utilizing a new
clinical score. Am J Clin Dermatol. 2010;11(1):45-50. doi: 10.2165/11311170-
000000000-00000.
63. Garbe C. Open label randomized study comparing 3 months vs. 6 months
treatment of actinic keratoses with 3% diclofenac in 2.5% hyaluronic acid gel: a
trial of the German Dermatologic Cooperative Oncology Group. J Eur Acad
Dermatol Venereol. 2011 Mar 18. doi: 10.1111/j.1468-3083.2011.04005.x. [Epub
ahead of print]
64. Kang S, Goldfarb MT, Weiss JS, Metz RD, Hamilton TA, Voorhees JJ, Griffiths
CE. Assessment of adapalene gel for the treatment of actinic keratoses and
lentigines: a randomized trial. J Am Acad Dermatol. 2003 Jul;49(1):83-90.
65. Rendon MI, Berson DS, Cohen JL, Roberts WE, Starker I, Wang B. Evidence
and considerations in the application of chemical peels in skin disorders and
aesthetic resurfacing. J Clin Aesthet Dermatol. 2010 Jul;3(7):32-43.
66. Cho S, Lowe L, Hamilton TA, Fisher GJ, Voorhees JJ, Kang S. Long-term
treatment of photoaged human skin with topical retinoic acid improves
epidermal cell atypia and thickens the collagen band in papillary dermis. J Am
Acad Dermatol. 2005 Nov;53(5):769-74.
67. Byrd JA, Davis MD, Bruce AJ, Drage LA, Rogers RS 3rd. Response of oral
lichen planus to topical tacrolimus in 37 patients. Arch Dermatol. 2004
Dec;140(12):1508-12.
68. González-García A, Diniz-Freitas M, Gándara-Vila P, Blanco-Carrión A,

García-García A, Gándara-Rey J. Triamcinolone acetonide mouth rinses for
treatment of erosive oral lichen planus: efficacy and risk of fungal over-infection.
Oral Dis. 2006 Nov;12(6):559-65.
69. Laeijendecker R, Tank B, Dekker SK, Neumann HA. A comparison of

treatment of oral lichen planus with topical tacrolimus and triamcinolone
acetonide ointment. Acta Derm Venereol. 2006;86(3):227-9.
Abstracts
Clin Exp Dermatol. 2007 Mar;32(2):197-200. Epub 2007 Jan 18.

The effect of azithromycin on reactive oxygen species in rosacea.
Bakar O, Demirçay Z, Yuksel M, Haklar G, Sanisoglu Y.
Department of Dermatology, Acibadem Kozyatagi Hospital, Istanbul, Turkey.
obakar@asg.com
Abstract
BACKGROUND:
Recent evidence suggests that inflammation in rosacea is associated with
generation of reactive oxygen species (ROS) that are released by inflammatory
cells. The efficacy of current therapeutic agents for rosacea such as tetracyclines
and metronidazole has also been attributed to their antioxidant properties.
Recently, a macrolide antibiotic, azithromycin, has been found to be an
effective alternative in the treatment of rosacea.
AIM:
We planned a study to evaluate the antioxidant effects of azithromycin on ROS
in rosacea. We compared basal ROS concentrations measured in the facial skin
of patients with rosacea with the post-treatment levels and with those of healthy
controls.
METHODS:
Facial skin biopsies of 17 papulopustular patients with rosacea and 25 healthy
controls were taken. Rosacea patients were assigned to receive oral
azithromycin 500 mg on three consecutive days each week for 4 weeks. The total
number of inflammatory lesions (the sum of papules and pustules) on the face of
each patient with rosacea was counted at each visit. The luminol- and lucigenin-
enhanced chemiluminescence (CL) levels of patients with rosacea were
measured before and after 4 weeks of treatment and compared with those of
healthy controls.
RESULTS:
Rosacea patients had higher ROS levels than healthy controls (P < 0.001). A
statistically significant decrease of both luminol- and lucigenin-enhanced CL
levels were observed in patients with rosacea after treatment with azithromycin
(t = 4.602, P < 0.001; vs. t = 4.634, P < 0.001, respectively).
CONCLUSION:
Rosacea patients have higher ROS levels than healthy controls. The results of our
study support the antioxidant properties of azithromycin in rosacea.
PMID: 17244346 [PubMed - indexed for MEDLINE]
Int J Dermatol. 2008 Apr;47(4):402-6. doi: 10.1111/j.1365-4632.2008.03356.x.

Dihydroxyacetone: a safe camouflaging option in vitiligo.
Rajatanavin N, Suwanachote S, Kulkollakarn S.
Division of Dermatology, Department of Medicine, Faculty of Medicine,
Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400,
Thailand. ranrj@mahidol.ac.th
Abstract
BACKGROUND:
Most treatment protocols for vitiligo usually do not result in complete
repigmentation. Therefore, cosmetically acceptable camouflage, low cost and
easy to handle alternatives are warranted.
OBJECTIVE:
To evaluate the efficacy of low-cost self-tanner available in the Thai market in
normal subjects with skin types III, IV, and V, and the efficacy for camouflage of
6% dihydroxyacetone (DHA) cream in the treatment of vitiligo on exposed areas
of Asian skin.
METHODS:
The study was divided into two parts. Part 1 is a prospective study of 15 healthy
volunteers using three different DHA creams which were available in the Thai
market with concentrations of 3.5%, 4.2%, and 5%. Part 2 was a retrospective
study of 20 patients suffering from vitiligo affecting the face and/or hands and
feet who were treated with 6% DHA. The data were collected through direct
examination, telephone interview, face-to-face interview, and photographs.
RESULTS:
In healthy volunteers, we found that color matching was achieved by using a
higher concentration of DHA in darker-skin subjects. Most of the vitiligo patients
(88.9%) reported moderate to marked satisfaction with the cosmetic results of 6%
DHA cream.
CONCLUSION:
Dihydroxyacetone offers a safe and effective therapeutic option for recalcitrant
vitiligo. Dark-skin subjects need a higher concentration of DHA cream than
lighter-skin subjects.
J Eur Acad Dermatol Venereol. 2007 Aug;21(7):942-50.

Treatment of vitiligo vulgaris with narrow-band UVB and oral Polypodium
leucotomos extract: a randomized double-blind placebo-controlled study.
Middelkamp-Hup MA, Bos JD, Rius-Diaz F, Gonzalez S, Westerhof W.
Netherlands Institute for Pigment Disorders, Department of Dermatology,
Academic Medical Center, 1100 DD Amsterdam, The Netherlands.
m.a.middelkamphup@amc.uva.nl
Abstract
BACKGROUND:
The first choice treatment for vitiligo vulgaris is narrow-band UVB (NB-UVB), but no
satisfactory treatment exists.
OBJECTIVES:
To investigate if Polypodium leucotomos, an antioxidative and
immunomodulatory plant extract, improves NB-UVB-induced repigmentation.
METHODS:
Fifty patients with vitiligo vulgaris randomly received 250 mg oral P. leucotomos
or placebo three times daily, combined with NB-UVB twice weekly for 25-26
weeks.
RESULTS:
Repigmentation was higher in the P. leucotomos group vs. placebo in the head
and neck area (44% vs. 27%, P = 0.06). Small repigmentation increases (P = n.s.)
were observed for the trunk (6% increased repigmentation), extremities (4%), and
hands and feet (5%) in the P. leucotomos group vs. placebo. Patients attending
more than 80% of required NB-UVB sessions showed increased repigmentation in
the head and neck area in the P. leucotomos group vs. placebo (50% vs. 19%, P
< 0.002); no significant differences were seen in the other body areas. Patients
with skin types 2 and 3 showed more repigmentation in the head and neck area
in the P. leucotomos group vs. placebo (47% vs. 21%, P = 0.01), and no significant
differences were seen in the other body areas. No conclusions could be drawn
on skin types 4 and 5 due to low patient numbers.
CONCLUSION:
There is a clear trend towards an increase in repigmentation of vitiligo vulgaris
affecting the head and neck area when NB-UVB phototherapy is combined with
oral P. leucotomos. This effect may be more pronounced in light skin types.
Dermatol Ther. 2010 May-Jun;23(3):305-7. doi: 10.1111/j.1529-8019.2010.01328.x.

Oral minocycline in the treatment of vitiligo--a preliminary study.
Parsad D, Kanwar A.
Department of Dermatology, Postgraduate Institute of Medical Education and
Research, Chandigarh, India. parsad@mac.com
Abstract
For effective treatment of vitiligo, it is as important to arrest the progression of the
disease, as it is to induce repigmentation. Epidermal oxidative stress has been
documented in vitiligo patients, and there is much support for a free-radical-
mediated damage as an initial pathogenic event in melanocyte degeneration
in vitiligo. Minocycline possesses a wide repertoire of anti-inflammatory,
immunomodulatory, and free-radical scavenging actions in addition to their
well-characterized antimicrobial effects. Recently, it has been shown that
minocycline can rescue melanocytes from oxidative stress in vitro. Minocycline
100 mg was tried in this study to elucidate its role in arresting disease activity.
Thirty-two patients with gradually progressive (slow spreading) vitiligo were
enrolled in this study. The patients were advised to take minocycline 100 mg once
daily. In 29 patients, the progression of the disease was arrested, and only three
patients showed development of new lesions and/or enlargement of existing
lesions. Ten patients showed arrest of further depigmentation after 4 weeks of
treatment. Thus, minocycline offers a unique and potentially powerful approach
to the management of arresting the activity of the disease. The present study
showed the effectiveness of minocycline in the treatment of vitiligo. Further
controlled studies should be undertaken to confirm its efficacy.
Clin Exp Dermatol. 2004 Nov;29(6):589-92.

Topical tacrolimus for treatment of childhood vitiligo in Asians.
Kanwar AJ, Dogra S, Parsad D.
Department of Dermatology, Venereology and Leprology, Postgraduate Institute
of Medical Education and Research, Chandigarh, India. ajkanwar@sify.com
Abstract
Childhood vitiligo is a common disorder of pigmentation in India. Considering the
lack of uniformly effective and safe treatment modalities for children with vitiligo,
search for newer therapeutic agents continues. This study was designed to
evaluate the role of topical tacrolimus in the treatment of childhood vitiligo.
Twenty-five children with vitiligo were treated with topical 0.03% tacrolimus
ointment applied twice daily for 12 weeks. Response was noted as marked to
complete (> 75% repigmentation), moderate (50-75% repigmentation) and mild
(< 50% repigmentation). Twenty-two children (9 boys and 13 girls) of mean age
7.2 +/- 1.4 years completed the study. Twelve (54.5%) children had vitiligo vulgaris,
nine (40.9%) had focal vitiligo and one (4.5%) had segmental vitiligo. The mean
duration of disease was 8 +/- 3 months. Nineteen (86.4%) children showed some
repigmentation at the end of 3 months and other three had no response. Of
these 19 children, repigmentation was marked to complete in 11 (57.9%),
moderate in five (26.3%) and mild in three (15.7%) children. Side effects were
minimal, such as the pruritus and burning noted in only three patients. Topical
tacrolimus is an effective and well-tolerated treatment modality in Asian children
with vitiligo.
Int J Dermatol. 2009 Jan;48(1):86-90. doi: 10.1111/j.1365-4632.2009.03852.x.

Efficacy and safety of tarcrolimus cream 0.1% in the treatment of vitiligo.
Xu AE, Zhang DM, Wei XD, Huang B, Lu LJ.
Department of Dermatology, the Third Hospital of Hangzhou, Hangzhou, China.
xuaiehz@msn.com
Abstract
BACKGROUND:
Vitiligo is an acquired, pigmentary skin disorder which is disfiguring and difficult to
treat. Phototherapy and application of topical corticosteroids are most
commonly prescribed. However, these therapies are often not effective and use
of corticosteroids on the face may lead to cutaneous atrophy, telangiectasia,
and ocular complications.
OBJECTIVE:
We sought to assess the efficacy of topical tacrolimus ointment in the treatment
of vitiligo.
METHODS:
A prospective pilot study was performed of 30 patients with vitiligo. Patients were
treated with tacrolimus ointment for at least 4 months. Clinical responses were
documented during clinic visits, and by pretacrolimus and post-tacrolimus
photography.
RESULTS:
Twenty-five (83.3%) patients showed some repigmentation at the end of 4
months. Patients with vitiligo for more than 5 years also responded well to
tacrolimus ointment. Repigmentation in active vitiligo was superior to that in
stable vitiligo. 80% of patients with segmental vitiligo of the head and neck
showed some response to tacrolimus, but there was no statistical significance
between segmental and vulgaris vitiligo. The mean percentage of
repigmentation on the head and neck was greater than that on the trunk and
extremities. Four patients initially experienced burning on application.
CONCLUSIONS:
Topical tacrolimus ointment is an effective and well-tolerated alternative therapy
for vitiligo especially involving the head and neck.
Photodermatol Photoimmunol Photomed. 2010 Oct;26(5):230-4. doi:

10.1111/j.1600-0781.2010.00540.x.
Does topical tacrolimus ointment enhance the efficacy of narrowband
ultraviolet B therapy in vitiligo? A left-right comparison study.
Majid I.
Department of Dermatology and STD, Government Medical College, Srinagar,
Jammu & Kashmir, India. imran54@yahoo.com
Abstract
BACKGROUND:
Narrowband ultraviolet B (NB-UVB) therapy has emerged as one of the most
favored treatment options in patients with generalized vitiligo. The aim of
combining topical agents is to improve the efficacy of NB-UVB in causing
repigmentation in vitiligo.
AIMS AND OBJECTIVES:
The present study aims to study the effect of combining topical tacrolimus to NB-
UVB therapy in causing repigmentation in vitiligo lesions.
METHODS:
This prospective single-blind study was performed on 80 patients of generalized
vitiligo above 12 years of age who had symmetrically distributed vitiligo lesions
on the face, trunk or limbs. The patients applied topical tacrolimus 0.1% ointment
twice daily on selected symmetrically distributed lesions on the left side of the
body. No topical agent was applied on the corresponding lesions on the right
side. The patients also received whole-body NB-UVB exposure three times every
week on non-consecutive days according to a set protocol. Lesions selected for
the comparison analysis were photographed serially and assessed by a single-
blinded observer for the extent or repigmentation achieved. The extent of
repigmentation achieved was calculated on the basis of VASI scoring. The time
taken for the initial repigmentation to start, the overall repigmentation achieved
as well as any adverse effects were noted down and compared between the
selected lesions on the two sides. Results: Seventy-four patients with 234
symmetrical vitiligo lesions were available for comparison analysis at the end of
study period. The mean repigmentation achieved on the left-sided study lesions
was approximately 71% (VASI score of approximately 4.0) as compared with
60.5% on the symmetrically distributed right-sided lesions (VASI score of 3.4).
Moreover, the repigmentation started earlier on the study lesions on left side than
on the right-sided ones. No significant adverse events were reported with the
combination treatment.
CONCLUSIONS:
Addition of topical tacrolimus increases the extent of overall repigmentation
achieved with NB-UVB therapy in vitiligo and also reduces the cumulative NB-
UVB dose needed to achieve a therapeutic benefit in affected patients.
© 2010 John Wiley & Sons A/S.
J Am Acad Dermatol. 2001 May;44(5):814-7.

Oral dexamethasone pulse treatment for vitiligo.
Radakovic-Fijan S, Fürnsinn-Friedl AM, Hönigsmann H, Tanew A.
Divisions of Special and Environmental Dermatology and General Dermatology,
Department of Dermatology, University of Vienna Medical School, Austria.
s.radakovic@akh-wien.ac.at
Abstract
BACKGROUND:
Oral corticosteroid pulse therapy has provided inconsistent results in the
treatment of Indian patients with vitiligo.
OBJECTIVE:
We wanted to evaluate the efficacy, safety, and tolerability of oral
dexamethasone pulse therapy in a cohort of Austrian patients with vitiligo.
METHODS:
Twenty-nine patients with vitiligo were included in the study. Of these, 25 had
progressive and 4 had stable disease. The patients were given weekly pulses of
10 mg dexamethasone each on 2 consecutive days followed by 5 days off
treatment for a maximum period of 24 weeks. Clinical response and side effects
were evaluated in monthly intervals. Plasma cortisol and corticotropin levels were
monitored before and up to 6 days after the dexamethasone pulse in the first
and fourth week of treatment in 14 patients.
RESULTS:
After a mean treatment period of 18.2 +/- 5.2 weeks, the disease activity was
arrested in 22 of 25 patients (88%) who had active vitiligo before the study.
Marked repigmentation occurred in 2 patients (6.9%) and moderate or slight
repigmentation in 3 patients (10.3%) each. No response was noted in 21 patients
(72.4%). Side effects were recorded in 20 patients (69%) and included weight
gain, insomnia, acne, agitation, menstrual disturbance, and hypertrichosis.
Plasma cortisol and corticotropin values were markedly decreased 24 hours after
the second dexamethasone dose, yet returned to baseline values within the off
treatment period before the next dexamethasone pulse.
CONCLUSION:
Our data show that oral dexamethasone pulse treatment is effective in arresting
progression of vitiligo yet fails to induce satisfactory repigmentation in the great
majority of our patient cohort. Mild to moderate side effects are common with
this treatment modality; however, sustained suppression of endogenous cortisol
production does not occur with the pulse regimen.
Clin Exp Dermatol. 2003 May;28(3):285-7.

Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo.
Parsad D, Pandhi R, Juneja A.
Department of Dermatology, Postgraduate Institute of Medical Education and
Research, Chandigarh, India. dprs@satyam.net.in
Abstract
For effective treatment of vitiligo, it is as important to arrest the progression of the
disease as it is to induce repigmentation. Recently, oxidative stress has been
shown to play an important role in the pathogenesis of vitiligo. Ginkgo biloba
extract has been shown to have antioxidant and immunomodulatory properties.
In a double-blind placebo-controlled trial, we evaluated the efficacy of G.
biloba extract in controlling the activity of the disease process in patients with
limited and slow-spreading vitiligo and in inducing repigmentation of vitiliginous
areas. Fifty-two patients were assigned to two treatment groups (A and B) in a
double-blind fashion, but only 47 patients could be evaluated, because one
patient in group A and four patients in group B withdrew for reasons unrelated to
the study. Patients in group A were given G. biloba extract 40 mg three times
daily whereas patients in group B received placebo in similar doses. A statistically
significant cessation of active progression of depigmentation was noted in
patients treated with G. biloba (P = 0.006). Marked to complete repigmentation
was seen in 10 patients in group A, whereas only two patients in group B showed
similar repigmentation. The G. biloba extract was well tolerated. G. biloba extract
seems to be a simple, safe and fairly effective therapy for arresting the
progression of the disease.
J Drugs Dermatol. 2002 Sep;1(2):127-31.

Oral and topical L-phenylalanine, clobetasol propionate, and UVA/sunlight--a
new study for the treatment of vitiligo.
Camacho F, Mazuecos J.
Departamento de Dermatología Médico-Quirúrgica y Venereología Hospital
Universitario Virgen Macarena Avda. Doctor Fedriani s/n 41009, Sevilla, Spain.
camachodp@medynet.com
Abstract
BACKGROUND:
Vitiligo is a hypopigmented skin condition that usually requires a combination of
treatment options.
AIM:
To demonstrate the effectiveness of topical and oral L-phenylalanine in
combination with light plus 0.025% clobetasol propionate at night.
PATIENTS AND METHODS:
We have performed an open trial on a group of 70 patients with evolutive vitiligo.
Participants were treated with oral (100 mg/Kg/day) and topical (gel at 10%) L-
phenylalanine, exposed to sunlight (spring-summer) or UVA lamps (autumn-
winter), and given 0.025% clobetasol propionate at night. All patients were
revisited every 6 months while in the study, with a maximum of 4 revisits.
Biochemical studies were performed at the beginning of the treatment and at
each revisit.
RESULTS:
Overall, 90.9% of participants showed improvement, with 68.5% of patients
achieving an improvement of 75% or more. This 75% improvement rate was
reached 87.9% of the time on the face, 60.4% on the trunk, and 54.6% on the
limbs. However, there was a moderate response to the treatment in patients with
focal and segmental vitiligo. There was a slight additional improvement in
patients receiving UVA lamp light. No biochemical abnormalities were found in
any patients.
CONCLUSION:
L-phenylalanine in combination with 0.025% clobetasol propionate and sunlight
during sunny months or UVA lamps in winter, appears to improve evolutive vitiligo
without side effects, and therefore is especially recommended on the face or for
children.
J Am Acad Dermatol. 2004 Nov;51(5):723-30.

Tacrolimus ointment is effective for facial and intertriginous psoriasis.
Lebwohl M, Freeman AK, Chapman MS, Feldman SR, Hartle JE, Henning A;
Tacrolimus Ointment Study Group.
Mt. Sinai School of Medicine, New York, New York, USA.
Abstract
BACKGROUND:
Intertriginous and facial involvement are manifestations of psoriasis that require
a different approach than is used for typical plaque psoriasis on other skin areas.
Topical corticosteroids are the primary treatment for psoriasis; however, the side
effects of corticosteroids are magnified on intertriginous and facial skin. Topical
tacrolimus offers the potential for anti-inflammatory effect without the atrophy or
other local side effects associated with the use of topical corticosteroids.
OBJECTIVE:
To determine the efficacy and tolerability of 0.1% tacrolimus ointment for the
treatment of facial or intertriginous psoriasis.
METHODS:
One hundred sixty-seven patients 16 years or older were evaluated in an 8-week,
randomized, double-blind, vehicle-controlled, multi-center study. Upon entry into
the study, patients were randomized 2:1 to apply the tacrolimus ointment 0.1% or
vehicle twice daily to all psoriatic lesions of the face or intertriginous areas for 8
weeks. The physician's global assessment was used to assess improvement from
baseline. The inverse psoriasis severity for patients was measured using a 6-point
scale from clear to very severe.
RESULTS:
As early as day 8, more patients ( P = .004) had cleared or achieved excellent
improvement in the 0.1% tacrolimus ointment group compared to the vehicle
group (24.8% vs 5.8%). At the end of the 8-week treatment period 65.2% of the
tacrolimus ointment group and 31.5% of the vehicle were clear or almost clear (
P < .0001) based on a Static Severity Score. Adverse events were similar in the
0.1% tacrolimus ointment and vehicle groups. Conclusion Tacrolimus ointment is
an effective treatment for psoriasis of the face or intertriginous areas.
Comment in
Pimecrolimus and tacrolimus for the treatment of intertriginous and facial
psoriasis: are they effective? [Arch Dermatol. 2005]

Acta Derm Venereol. 2006;86(1):29-33.
0.3% Tacrolimus gel and 0.5% Tacrolimus cream show efficacy in mild to
moderate plaque psoriasis: Results of a randomized, open-label, observer-
blinded study.
Ortonne JP, van de Kerkhof PC, Prinz JC, Bieber T, Lahfa M, Rubins A, Wozel G,
Lorette G; European Tacrolimus Psoriasis Study Group.
Service de Dermatologie, Hôpital Archet 2, Nice, France. jean-
paul.ortonne@unice.fr
Abstract
The efficacy and safety of 0.3% tacrolimus gel and 0.5% tacrolimus cream
compared with calcipotriol ointment were evaluated in adults (n = 124) with mild
to moderate plaque psoriasis. Treatment was twice daily for a maximum of 12
weeks. Clinical efficacy was assessed by the percentage change in the local
psoriasis severity index of a target lesion between baseline and week 12. By week
12, the median percentage changes in local psoriasis severity index of the target
lesions in the tacrolimus gel, tacrolimus cream and calcipotriol groups were
55.6%, 50.0% and 58.6%, respectively (no statistically significant differences).
Clinical improvement was observed after one week and increased throughout
the study. Tacrolimus-treated patients experienced more application site skin
burning (tacrolimus gel and cream both 31.0% versus 7.5% for calcipotriol; p =
0.011). Skin burning was mostly mild in intensity and decreased substantially after
1 week of treatment. There were no differences in the nature and incidence of
infections and no clinically relevant changes in laboratory values.
Arch Dermatol. 2005 Jan;141(1):43-6.

Topical tacrolimus ointment combined with 6% salicylic acid gel for plaque
psoriasis treatment.
Carroll CL, Clarke J, Camacho F, Balkrishnan R, Feldman SR.
Department of Dermatology, Wake Forest University School of Medicine, Winston-
Salem, NC 27157, USA.
Abstract
BACKGROUND:
While oral tacrolimus is effective for the treatment of psoriasis, tacrolimus
ointment has shown only spotty efficacy in the treatment of plaque psoriasis. The
efficacy of tacrolimus ointment for the treatment of facial and intertriginous
psoriasis suggests that if tacrolimus penetration can be increased, the ointment
could be used for effective treatment of plaque psoriasis.
OBJECTIVE:
To assess whether tacrolimus ointment is an effective psoriasis treatment when
used in a combination regimen with the penetration-enhancer salicylic acid.
METHODS:
A total of 30 adult subjects with generally symmetrical plaque-type psoriasis were
randomized to treatment with 6% salicylic acid gel plus vehicle or 6% salicylic
acid gel plus 0.1% tacrolimus ointment in a 12-week left-right comparison study.
The primary outcome was the difference between tacrolimus- and vehicle-
treated target lesions in the change in the sum of erythema, scale, and thickness
scores from baseline to end of treatment.
RESULTS:
A total of 24 subjects completed the trial. Combination treatment with tacrolimus
ointment or vehicle plus salicylic acid gel was well tolerated. There was greater
improvement of the sum score in the tacrolimus plus salicylic acid-treated target
plaques than in the vehicle plus salicylic acid-treated plaques at weeks 1, 2, and
8 (P<.05). The efficacy of this regimen was confirmed by investigator and subject
global assessments of plaque severity.
CONCLUSIONS:
The combination of 0.1% tacrolimus ointment and 6% salicylic acid gel is an
effective treatment for psoriasis. Although the results reported herein are from a
small exploratory study, the magnitude of the effect was sufficiently large as to
be detectable with statistical significance (P<.05).
J Dermatolog Treat. 2005;16(4):234-7.

Evaluation of the efficacy of topical caffeine in the treatment of psoriasis vulgaris.
Vali A, Asilian A, Khalesi E, Khoddami L, Shahtalebi M, Mohammady M.
Department of Dermatology, Isfahan University of Medical Sciences (IUMS), Iran.
vali@med.mui.ac.ir
Abstract
BACKGROUND:
Psoriasis is a common disease which often requires long-term maintenance
therapy. In psoriatic epidermis, the level of cyclic adenosine monophosphate
(cAMP) decreases. It has been reported that beta-blockers exacerbate existing
psoriatic plaque and decrease the concentration of intracellular cAMP. Caffeine
is a methylxanthine that inhibits phosphodiesterase enzyme and results in a higher
concentration of intracellular cAMP.
OBJECTIVE:
Evaluation of the efficacy of topical caffeine 10% in the treatment of psoriasis.
The patients were treated by topical application of 10% caffeine or placebo
three times per day on the right or left side of the body (randomly selected by
flipping a coin). Thirty-nine patients with stable plaque psoriasis were included in
a randomized, double-blind, placebo-controlled, right/left comparison. The
patients visited every other week for a period of 8 weeks. Their Psoriatic Area and
Severity Index (PASI) scores were assessed at each visit.
RESULTS:
The reductions in PASI scores measured at the four visits for the caffeine-treated
group were 2.64+/-2.89, 4.47+/-3.62, 5.73+/-4.16, 6.58+/-4.40 and for the placebo-
treated group the values were 1.45+/-2.32, 3.04+/-2.68, 4.02+/-3.36, 4.43+/-3.45,
respectively. Comparing the corresponding results of the two groups, p values at
the second, fourth, sixth and eighth week were 0.081, 0.083, 0.079 and 0.047,
respectively. Based on presented p values, the treatment with caffeine is more
effective than with placebo after 8 weeks (p<0.05), and the only side effect of
caffeine is mild itching.
CONCLUSION:
Based on the results of the trial, topical caffeine is an effective, safe and
inexpensive treatment for psoriasis, with a delay in action.
Pediatr Dermatol. 2006 Sep-Oct;23(5):507-10.

Successful treatment of pediatric psoriasis with Indigo naturalis composite
ointment.
Lin YK, Yen HR, Wong WR, Yang SH, Pang JH.
Department of Traditional Chinese Medicine, Center for Traditional Chinese
Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Abstract
The treatment of psoriasis in children is still an intractable problem and demands
a long-term therapy with prolonged efficacy that is free from serious adverse
events. Many modes of therapy are currently in use but the disease is often
resistant to treatment owing to the unacceptable toxicity that leads to poor
compliance. Therefore, to develop an alternative treatment is indispensable.
Traditional Chinese medicine has been documented for over 1000 years to
provide various effective treatments for inflammatory skin diseases. Herein, we
report an 8-year-old boy with recalcitrant pediatric psoriasis who, after multiple
treatment failures with conventional antipsoriatic medications, showed
remarkable clinical improvement with 8 weeks of topical treatment with Indigo
naturalis composite ointment. Remission has lasted for over 2 years until now. Our
patient's response suggests that topical Indigo naturalis composite ointment may
provide a safe and effective alternative treatment for pediatric psoriasis.
J Am Acad Dermatol. 2008 Sep;59(3):448-54, 454.e1. doi:

10.1016/j.jaad.2008.04.020. Epub 2008 Jun 9.
Clobetasol propionate emulsion formulation foam 0.05%: review of phase II
open-label and phase III randomized controlled trials in steroid-responsive
dermatoses in adults and adolescents.
Kimball AB, Gold MH, Zib B, Davis MW; Clobetasol Propionate Emulsion
Formulation Foam Phase III Clinical Study Group.
Collaborators (41)
Clinical Unit for Research Trials in Skin, Massachusetts General and Brigham and
Women's Hospitals, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND:
Clobetasol propionate 0.05% emulsion foam was recently developed for use on
multiple body sites.
OBJECTIVE:
We sought to evaluate safety and efficacy of clobetasol emulsion foam 0.05% to
treat steroid-responsive dermatoses in multiple age groups.
METHODS:
A phase II open-label study evaluated the effect of clobetasol foam on the
hypothalamic-pituitary-adrenal axis in 52 participants aged 6 years or older with
mild-to-severe atopic dermatitis (AD). Cosyntropin stimulation test was used to
determine the effect of clobetasol foam on hypothalamic-pituitary-adrenal axis,
with a normal response considered to be a postinjection serum cortisol level
greater than 18 mug/dL. Another phase II open-label pharmacokinetic safety
study was conducted in 32 participants aged 12 years or older with mild-to-
moderate plaque-type psoriasis. Pharmacokinetic parameters evaluated
included maximal plasma concentration of clobetasol propionate, time to
achieve maximum concentration, and area under the curve. Two phase III,
randomized controlled studies assessed treatment success in participants aged
12 years or older with moderate-to-severe AD (N = 377) or mild-to-moderate
plaque-type psoriasis (N = 497). In all studies, participants received study drug for
2 weeks. In the AD study, treatment success was determined using a composite
end point requiring an Investigator's Static Global Assessment (ISGA) score of 0
or 1, erythema score of 0 or 1, induration/papulation score of 0 or 1, and
improvement in the ISGA score of at least two grades from baseline. Likewise, the
study in plaque-type psoriasis used a composite end point requiring an ISGA
score of 0 or 1, erythema score of 0 or 1, scaling score of 0 or 1, plaque thickness
score of 0, and improvement in the ISGA score of at least two grades from
baseline.
RESULTS:
Significantly more participants achieved treatment success on clobetasol foam
than vehicle foam (P < .0001 and P = .0005 for each study). Reversible
hypothalamic-pituitary-adrenal axis suppression was observed in 27% of
participants aged 18 years or older and 47% in participants aged between 6 and
younger than 12 years, but 0% in participants aged between 12 and younger
than 18 years.
LIMITATIONS:
The studies evaluated short-term use only.
CONCLUSION:
Clobetasol emulsion formulation foam is safe and effective for treatment of
moderate-to-severe AD and mild-to-moderate plaque-type psoriasis in patients
aged 12 years or older.
Niger J Med. 2010 Jan-Mar;19(1):58-61.

The remarkable beneficial effect of adding oral simvastatin to topical
betamethasone for treatment of psoriasis: a double-blind, randomized, placebo-
controlled study.
Naseri M, Hadipour A, Sepaskhah M, Namazi MR.
Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran.
Abstract
BACKGROUND:
Psoriasis is a common chronic inflammatory disease with unpredictable
prognosis. Given the immunomodulatory effects of statins, the present study was
conducted to determine whether the addition of orally administered simvastatin
to the topical betamethasone, a standard antipsoriatic treatment, can produce
a more powerful therapeutic response against this clinical conundrum.
METHOD:
In a double-blind study, 30 patients with plaque type psoriasis were randomly
divided into two equal treatment groups. Group 1 received oral simvastatin (40
mg/d) plus topical steroid (50% betamethasone in petrolatum) for 8 weeks and
group 2 received oral placebo plus the same topical steroid for the same time
period. Psoriasis Area and Severity Index (PASI) score was checked before and
at the end of the treatment period.
RESULTS:
PASI score decreased significantly in both groups, but the decline of PASI score
was more significant in patients who received simvastatin (Mann-Whitney test; P-
value = 0.001). No side effect or any laboratory abnormality was detected in
patients.
CONCLUSION:
Our work, which is the first double-blind, randomized, placebo-controlled study
on this subject, shows that oral simvastatin enhances the therapeutic effect of
topical steroids against psoriasis. The increased risk of cardiovascular accidents
in psoriatic patients and the protective effect of statins against cardiovascular
disease further encourages their use in the treatment of this clinical conundrum.
Psychosom Med. 2002 Sep-Oct;64(5):835-40.

Treatment of atopic dermatitis and psoriasis vulgaris with bupropion-SR: a pilot
study.
Modell JG, Boyce S, Taylor E, Katholi C.
Department of Psychiatry, the University of Alabama at Birmingham School of
Medicine, Birmingham, AL 35294-0018, USA. jgmodell@earthlink.com
Abstract
OBJECTIVE:
To determine whether the antidepressant bupropion may be useful in treating
atopic dermatitis and psoriasis in nondepressed patients.
METHOD:
Ten nondepressed subjects with atopic dermatitis and 10 with psoriasis
completed a single-track, open-label treatment protocol with bupropion-SR in
doses of 150 mg/day and 300 mg/day, administered sequentially for 3 weeks
each, followed by a 3-week wash-out. Treatment response was assessed at the
end of each 3-week period.
RESULTS:
Six of the 10 subjects with atopic dermatitis showed a reduction in affected body
surface area by the end of 6 weeks of bupropion treatment, with affected area
increasing toward the prestudy baseline in all responders following bupropion
discontinuation-a highly significant treatment effect (p =.0003). Of the 10 subjects
having psoriasis, improvement over baseline after 6 weeks of treatment was seen
in eight subjects, with coverage increasing toward the prestudy baseline in the
responders following bupropion discontinuation (p =.001). Average reduction in
affected area in the responders at week 6 of treatment was approximately 50%
in both groups.
CONCLUSIONS:
The generally good tolerability and relative safety of bupropion-SR makes a trial
of this agent worthwhile in patients with atopic dermatitis or psoriasis who have
failed treatment with more conventional medications. Normalization by
bupropion of potentially causative neuroendocrine, immunologic, or
catecholaminergic abnormalities in both of these dermatologic disorders is a
possible mechanism of action for the observed salutary effects of this drug on our
subjects' skin disease.
Comment in
Bupropion in psoriasis and atopic dermatitis: decreased tumor necrosis factor-
alpha? [Psychosom Med. 2003]
Dermatol Online J. 2009 Nov 15;15(11):8.

Severe 20-nail psoriasis successfully treated by low dose methotrexate.
Lee JY.
Department of Dermatology, National Cheng Kung University, College of
Medicine and University Hospital, Tainan, Taiwan. yylee@mail.ncku.edu.tw
Abstract
Severe involvement of the nail matrix can lead to extensive dystrophic changes
of the nail plate. Topical or intralesional corticosteroids, photochemotherapy,
oral retinoids, and methotrexate (MTX) are among the therapies used. Treatment
of severe psoriatic nail disease is often unsatisfactory. We report a case of severe
psoriatic nail dystrophy involving all 20 nails successfully treated by low dose MTX.
A previously healthy 11-year-old girl presented with painful deformity involving all
20 nails that developed over a one-month period. Examination revealed
geographic and fissured tongue, as well as severe nail dystrophy of all 20 nails
characterized by erythematous swelling of the nail folds, yellowish discoloration
of nail plates with pitting, severe crumbling and destruction, transverse
depressions, prominent oil spots, and swelling of proximal nail. Topical clobetasol
propionate and calcipotriol were tried first but the nail dystrophy continued to
progress. Low dose of MTX (5 mg per week) was initiated. The response was fairly
satisfactory with emergence of normal plate proximally as early as 4 weeks;
complete resolution of the severe nail dystrophy was achieved after 9 and 13
months of MTX therapy for fingers and toes, respectively. The present case
illustrates that weekly low dose oral MTX may be a good treatment option for
severe psoriatic nail dystrophy in patients without other contraindications for MTX
therapy.
Clin Exp Dermatol. 2007 May;32(3):295-7.

Efficacy of erythromycin for psoriasis vulgaris.
Polat M, Lenk N, Yalcin B, Gür G, Tamer E, Artuz F, Alli N.
First Dermatology Department, Ankara Numune Education and Research
Hospital, Ankara, Turkey. drmuhterempolat@mynet.com
Abstract
Psoriasis is characterised by the presence of neutrophil overactivation and
overproduction of interleukin (IL)-6 and IL-8 from keratinocytes. It is now clear that
macrolide antibiotics have anti-inflammatory effects, such as inhibition of IL-6, IL-
8 and tumour necrosis factor-alpha, perhaps by suppressing the transcription
factor nuclear factor-kappaB or activator protein-1, and reduction of neutrophil
activity. It is thus possible that macrolides might be a candidate for adjunctive
treatment of psoriasis. In this study, we investigated the effectiveness of
treatment with the macrolide antibiotic, erythromycin, for skin lesions and pruritus
of patients with psoriasis. In total, 60 patients with psoriasis, especially pruritic
psoriasis, were included. This was an open-label study and the analysis was on an
intention-to-treat basis. Oral macrolide antibiotics and topical corticosteroids
were given to the study group of 36 patients. The control group (24 patients) were
treated only with topical corticosteroids. After a 4-week treatment period, scores
on the Psoriasis Area and Severity Index (PASI) at baseline and at the end of the
treatment, and the effectiveness in reducing itching were compared within and
between both groups. Although there was no statistically significant difference
between the baseline mean PASI of the two groups (P=0.81), there was a
statistically significant difference between the mean PASI of the two groups at
the end of the treatment (P=0.023, 95% confidence interval: - 3.45 to - 0.27). The
comparison of the mean difference in PASI yielded a statistically significant
difference (P=0.03, 95% confidence interval 0.73-3.55). Our study suggests that
macrolides could be used as one of the adjunctive therapies for psoriasis vulgaris.
Br J Dermatol. 2011 Jul;165(1):171-6. doi: 10.1111/j.1365-2133.2011.10269.x.

Efficacious and safe management of moderate to severe scalp seborrhoeic
dermatitis using clobetasol propionate shampoo 0•05% combined with
ketoconazole shampoo 2%: a randomized, controlled study.
Ortonne JP, Nikkels AF, Reich K, Ponce Olivera RM, Lee JH, Kerrouche N, Sidou F,
Faergemann J.
Hôpital de l'Archet 2, 06202 Nice Cedex 3, France. ortonne@unice.fr
Abstract
BACKGROUND:
Topical antifungals and corticosteroids are the mainstay of treatment for
seborrhoeic dermatitis. The short-contact clobetasol propionate 0•05% shampoo
(CP) is an efficacious and safe once-daily treatment for scalp psoriasis.
OBJECTIVES:
To evaluate the efficacy and safety of CP alone and combined with
ketoconazole shampoo 2% (KC) in the treatment of moderate to severe scalp
seborrhoeic dermatitis.
METHODS:
This randomized and investigator-blinded study consisted of three phases, each
lasting 4 weeks. During the treatment phase, subjects were randomized to
receive KC twice weekly (K2), CP twice weekly (C2), CP twice weekly alternating
with KC twice weekly (C2 + K2) or CP four times weekly alternating with KC twice
weekly (C4+K2). All subjects received KC once weekly during the maintenance
phase and were untreated during the follow-up phase.
RESULTS:
At the end of the treatment phase, all three CP-containing regimens were
significantly more efficacious than K2 in decreasing the overall disease severity
(P < 0•05). Both combination regimens were also significantly more efficacious
than K2 in decreasing each individual sign of the disease (P < 0•05). While the C2
and C4 + K2 groups experienced slight worsening during the maintenance
phase, the efficacy of C2 + K2 was sustained and remained the highest among
all groups. All regimens were well tolerated without inducing any skin atrophy.
Similarly low incidences of telangiectasia, burning and adverse events were
observed among the four groups.
CONCLUSIONS:
The combination therapy of twice-weekly CP alternating with twice-weekly KC
provided significantly greater efficacy than KC alone and a sustained effect in
the treatment of moderate to severe scalp seborrhoeic dermatitis.
© 2011 The Authors. BJD © 2011 British Association of Dermatologists 2011.
Int J Cosmet Sci. 2011 Jun;33(3):276-82. doi: 10.1111/j.1468-2494.2010.00623.x.

Epub 2011 Jan 27.
Efficacy of a piroctone olamine/climbazol shampoo in comparison with a zinc
pyrithione shampoo in subjects with moderate to severe dandruff.
Schmidt-Rose T, Braren S, Fölster H, Hillemann T, Oltrogge B, Philipp P, Weets G,
Fey S.
Research & Development, Beiersdorf AG, Unnastrasse 48, 20245 Hamburg,
Germany.
Abstract
Dandruff is a chronic scalp disorder characterized by scaling and itching. A
successful anti-dandruff shampoo not only has to provide superior anti-dandruff
relief to ensure patient compliance. It also needs to offer excellent cosmetic and
hair conditioning benefits at the same time. In this study, the efficacy of a
shampoo containing 0.5% piroctone olamine and 0.45% climbazole (shampoo 1)
was compared with a widely available commercial shampoo containing 1% zinc
pyrithione (shampoo 2). In vitro studies investigating the anti-mycotic efficacy of
a combination of 0.5% piroctone olamine and 0.45% climbazole as well as 1%
zinc pyrithione were performed. To study substantivity, pig skin punches were
used as a model system and a test of wet combability was performed to
characterize combing ease. In vivo home-in-use studies were carried out to
determine the efficacy of both shampoos to improve scalp condition and
reduce itching in subjects suffering from moderate to severe dandruff. Results
demonstrated a comparable anti-fungal effectiveness for 0.5% piroctone
olamine plus 0.45% climbazole and 1% zinc pyrithione, respectively. Shampoo 1
showed a significantly higher anti-mycotics substantivity compared to shampoo
2. After treatment with shampoo 1, the wet combing force was significantly
reduced compared with shampoo 2, suggesting a better combability following
the use of shampoo 1. In an in vivo split head design study, shampoo 1 was shown
to be equally effective in reducing the amount of dandruff on the scalp
compared with shampoo 2. The approval rate of volunteers regarding the
question 'The use of this shampoo decreases the itching of my scalp?' after a 4-
week treatment with shampoo 1 equaled 90%. Overall, the shampoo formulation
with 0.5% piroctone olamine and 0.45% climbazole effectively reduces the
amount of dandruff and, at the same time, provides hair conditioning
advantages.
© 2011 The Authors. ICS © 2011 Society of Cosmetic Scientists and the Société
Française de Cosmétologie.
Indian J Dermatol. 2010 Apr-Jun;55(2):130-4. doi: 10.4103/0019-5154.62734.

Dandruff: the most commercially exploited skin disease.
Ranganathan S, Mukhopadhyay T.
CavinKare Research Centre, No.12 Poonamallee Road, Ekkattuthangal,
Chennai - 600 097, India.
Abstract
The article discuss in detail about the prevalence, pathophysiology, clinical
manifestations of dandruff including the etio-pathology. The article also discusses
in detail about various treatment methods available for dandruff. The status of
dandruff being amphibious - a disease/disorder, and relatively less medical
intervention is sought after for the treatment, dandruff is the most commercially
exploited skin and scalp disorder/disease by personal care industries.
PMID: 20606879 [PubMed] PMCID: PMC2887514
Int J Cosmet Sci. 2000 Aug;22(4):285-9. doi: 10.1046/j.1467-2494.2000.00024.x.

The antidandruff efficacy of a shampoo containing piroctone olamine and
salicylic acid in comparison to that of a zinc pyrithione shampoo.
Lodén M, Wessman C.
ACO Hud AB, Research & Development, Box 622, S-194 26 Upplands Vàsby,
Sweden.
Abstract
Dandruff (pityriasis capitis) is a chronic scalp condition characterized by scaling
and sometimes itching and redness. Shampoos containing antifungal agents are
used to control the scaling condition. In the present study, two shampoos with
different actives are compared in a double-blind, randomised and bilateral
study on 19 subjects. One shampoo contained piroctone olamine (0.75%)
combined with salicylic acid (2%) and the other contained zinc pyrithione (1%)
as active ingredient. The subjects were treated twice weekly with the shampoos
for almost 4 weeks. Before each treatment the degree of dandruff was
evaluated. Both shampoos were highly effective in reducing the dandruff. The
combination of piroctone olamine and salicylic acid appeared to be slightly
more effective than zinc pyrithione in reducing the severity and area affected
by the scaling.
PMID: 18503415 [PubMed]
J Clin Aesthet Dermatol. 2009 Feb;2(2):32-6.

Treatment of scalp and facial seborrheic dermatitis with desonide hydrogel
0.05%.
Kircik LH.
DermResearch PLLC, Louisville, Kentucky; Indiana University, School of Medicine,
Louisville, Kentucky.
Abstract
Background: Desonide is a low-potency corticosteroid recently formulated in a
novel aqueous gel (hydrogel) formulation. Currently US Food and Drug
Administration approved for use in the treatment of mild-to-moderate atopic
dermatitis, this hydrogel formulation may offer aesthetic advantages over
traditional vehicles. Objective: To conduct a pilot study evaluating efficacy,
tolerability, and patient preference of desonide hydrogel 0.05% for the treatment
of scalp and facial seborrheic dermatitis. Methods:Subjects treated affected
areas on the face or scalp twice daily for four weeks. Evaluations of pruritus,
target area scaling, induration and erythema; static global assessments; and
photography were conducted. Results: Ten subjects aged 13 to 73 years with
mild scalp or facial seborrheic dermatitis completed the study. Statistically
significant reductions in pruritus, target area scaling, erythema, and induration,
and significant improvements in static global assessments were demonstrated
over Baseline (all P<0.05). Conclusion:Desonide hydrogel 0.05% may provide an
effective, well-tolerated, and cosmetically elegant treatment option for scalp
and facial seborrheic dermatitis.
Isr Med Assoc J. 2008 Jun;10(6):417-8.

Treatment of moderate to severe facial seborrheic dermatitis with itraconazole:
an open non-comparative study.
Shemer A, Kaplan B, Nathansohn N, Grunwald MH, Amichai B, Trau H.
Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel.
Abstract
BACKGROUND:
Seborrheic dermatitis is a common chronic disease. Malassezia yeasts have been
implicated in the pathogenesis of this disease. Antifungal agents are known to
be effective in the treatment of Malassezia yeast infections.
OBJECTIVES:
To evaluate the efficacy of itraconazole in the treatment of mild to severe facial
seborrheic dermatitis.
METHODS:
Sixty patients with moderate to severe seborrheic dermatitis were evaluated in
an open non-comparative study. Patients were treated with oral itraconazole,
initially 200 mg/day for a week, followed by a maintenance therapy of a single
dose of 200 mg every 2 weeks. Four clinical parameters (erythema, scaling,
burning, itching) were assessed using a 0-3 score. Mycological evaluation
determined the presence of Malassezia spores in the scales using a direct smear.
RESULTS:
At the end of the initial treatment significant improvement was reported in three
clinical parameters: erythema, scaling, itching. Maintenance therapy led to only
slight further improvement. Burning sensation was only mildly improved during the
treatment. The quantity of Malassezia spores present in the direct smear
decreased throughout the treatment period. No blood test abnormalities were
found during the treatment.
CONCLUSIONS:
In this study initial treatment with itraconazole was beneficial in patients with
moderate to severe seborrheic dermatitis.
Folia Med (Plovdiv). 2006;48(1):39-45.

Fluconazole and its place in the treatment of seborrheic dermatitis--new
therapeutic possibilities.
Zisova LG.
Department of Dermatology and Sexually Transmitted Diseases, Medical
University, Plovdiv, Bulgaria.
Abstract
Seborrheic dermatitis is a subacute or chronic disease of the skin, affecting the
seborrhea afflicted areas and presenting with erythema and desquamation. The
inflammatory reaction towards the fungi Malassezia spp. is considered to have a
basic etiologic connection with this disease. Taking into consideration the
pathogenesis, treatment of the dermatitis should be directed towards
eradication of Malassezia spp., reduction of the skin lipids, and suppression of the
inflammatory response. A wide variety of agents presented in different forms--
ointments, shampoos and drugs--can offer quick, safe and effective treatment
alternatives. The purpose of the present study was to monitor the therapeutic
effects of the anti-fungal drug fluconazole in patients with seborrheic dermatitis.
We compared two study groups of patients: Group I--27 patients with seborrheic
dermatitis stage I, II and III, treated with fluconazole, 50 mg/day for two weeks.
As topical therapy we applied clobetasol propionate 0.05% ointment. After the
completion of the therapeutic course, 85% of the patients in this group were
clinically cured and their symptoms faded away. Fifteen percent of the subjects
in this group--mainly stage III seborrheic dermatitis patients, showed partial but
significant clinical improvement. The specific fungal test for Malassezia spp. on
Dixon agar was negative in 93% of the cases in this group. Group II--eleven
patients with similar clinical indexes were treated with fluconazole 50 mg/day
only, for the same time period. The therapeutic results in this group were also
satisfactory--31.5% of the patients were cured and 68.5% showed clinical
improvement. In 74% of the patients the specific test for Malassezia spp. was
negative after treatment. Fluconazole treatment in patients with seborrheic
dermatitis proves to be successful, effective and safe.
Int J Dermatol. 2010 Oct;49(10):1188-93. doi: 10.1111/j.1365-4632.2010.04576.x.

Could azathioprine be considered as a therapeutic alternative in the treatment
of alopecia areata? A pilot study.
Farshi S, Mansouri P, Safar F, Khiabanloo SR.
Department of Dermatology, Tehran University of Medical Sciences, Imam
Hospital, Tehran, Iran. sfarshi@razi.tums.ac.ir
Abstract
Alopecia areata is an autoimmune disease resulting in partial or total nonscarring
hair loss and the treatment of severe alopecia areata is difficult. The aim of this
study was to evaluate the efficacy and safety of azathioprine as a systemic
monotherapy for moderate to severe alopecia areata. A total of 20 patients [14
men (70%) and six women (30%)] with minimum 6 months history of alopecia
areata were included. The extent of scalp hair regrowth during and after the
completion of the 6 months treatment was evaluated by the Severity of Alopecia
Tool (the SALT score). The daily drug intake was calculated as 2 mg/kg of body
weight. Mean duration of current episode of scalp hair loss was 26.4 (26.4 ± 17)
months. Mean regrowth percentage was 52.3% (52.3 ± 38.4). Mean hair loss
percentage before treatment was 72.7% (72.7 ± 28.3) compared with 33.5% (33.5
± 30.7) after 6 months of azathioprine treatment. This showed a highly significant
statistical difference (Paired t-test, CI 95% =21.5-54.1). Mean hair loss score (S(0)
-S(5) ) before treatment was 3.9 (3.9 ± 1.6) and after 6 months of azathioprine treatment
was 1.8 (1.8 ± 1.3). Assessment showed significant difference from baseline score (sign
test, P < 0.0001). No significant statistical difference was observed with respect to
gender before and after azathioprine treatment. Treatment with azathioprine as
a systemic monotherapy clinically produces relevant improvement in moderate-
to-severe alopecia areata. Generally azathioprine is a low-cost and well-
tolerated drug and with controlled studies on larger number of patients, long-
term efficacy and safety of this treatment should be investigated.
© 2010 The International Society of Dermatology.
Int J Dermatol. 2008 Aug;47(8):850-2. doi: 10.1111/j.1365-4632.2008.03700.x.

Treatment of persistent alopecia areata with sulfasalazine.
Rashidi T, Mahd AA.
Department of Dermatology, Urmia University of Medical Sciences, and Shams
Clinicopathology Laboratory, Urmia, Iran.
Abstract
BACKGROUND:
Alopecia areata is an autoimmune disease with no definitive treatment, and
some cases persist despite standard therapies. Sulfasalazine has been reported
to show success in the treatment of persistent cases of alopecia areata.
Objective To assess the efficacy of sulfasalazine in cases of recalcitrant alopecia
areata that do not respond to topical and intralesional corticosteroids, 5%
minoxidil, or psoralen plus ultraviolet-A (PUVA) therapy.
METHODS:
Thirty-nine patients with persistent alopecia areata received 3 g of oral
sulfasalazine for 6 months, and terminal hair regrowth was quantified as no
response, moderate response, or good response.
RESULTS:
A good response occurred in 10 of the 39 patients (25.6%), a moderate response
in 12 (30.7%), and a poor or no response in 17 (43.5%).
CONCLUSION:
Sulfasalazine can be used as an alternative drug in patients with persistent
alopecia areata.
Ann Dermatol Venereol. 2010 Aug-Sep;137(8-9):514-8. doi:

10.1016/j.annder.2010.06.002. Epub 2010 Aug 17.
[Treatment of alopecia areata with prednisone in a once-monthly oral pulse].
[Article in French]
Ait Ourhroui M, Hassam B, Khoudri I.
Service de dermatologie, CHU Ibn Sina, Rabat, Maroc.
Abstract
BACKGROUND:
Various modalities have been used in the treatment of alopecia areata (AA),
including pulsed oral corticosteroids. The aim of this study was to evaluate the
efficacy and safety of pulsed oral prednisone in the management of AA.
METHODS:
This was a prospective study in patients with progressive AA affecting more than
40% of the scalp. All patients received 5mg/kg (300 mg) oral prednisone once a
month for 3 to 6 months and were examined for adverse effects. Hair growth was
classified as complete, cosmetically acceptable, incomplete or no growth.
RESULTS:
Thirty-four patients (18 men) with a mean age of 12+/-3 years were included. AA
was ongoing for a mean 2 (1-17) years. Thirteen (38%) patients presented
multifocal AA, six universalis (20%), six multifocal with ophiasic pattern (18%), six
totalis (18%), and three ophiasic (6%). Six patients (18%) had no regrowth. At 3
months, incomplete or cosmetically acceptable response was noted in 28
patients (82%). At 6 months, 14 patients (41%) presented complete response,
eight patients (23%) had a persistent incomplete response, and six patients (18%)
had a persistent cosmetically acceptable response. Adverse effects were noted
in five patients (15%). Variables predictive for no-growth response were nail
involvement (P=0.001), associated dysimmunity (P=0.017), and universalis form
(P=0.050).
CONCLUSION:
A once-monthly oral pulse of 300 mg prednisone appears effective and safe. It
can be recommended as first-line treatment for widespread AA.
Copyright 2010 Elsevier Masson SAS. All rights reserved.
Ann Dermatol Venereol. 2010 Aug-Sep;137(8-9):514-8. doi:

10.1016/j.annder.2010.06.002. Epub 2010 Aug 17.
[Treatment of alopecia areata with prednisone in a once-monthly oral pulse].
[Article in French]
Ait Ourhroui M, Hassam B, Khoudri I.
Service de dermatologie, CHU Ibn Sina, Rabat, Maroc.
Abstract
BACKGROUND:
Various modalities have been used in the treatment of alopecia areata (AA),
including pulsed oral corticosteroids. The aim of this study was to evaluate the
efficacy and safety of pulsed oral prednisone in the management of AA.
METHODS:
This was a prospective study in patients with progressive AA affecting more than
40% of the scalp. All patients received 5mg/kg (300 mg) oral prednisone once a
month for 3 to 6 months and were examined for adverse effects. Hair growth was
classified as complete, cosmetically acceptable, incomplete or no growth.
RESULTS:
Thirty-four patients (18 men) with a mean age of 12+/-3 years were included. AA
was ongoing for a mean 2 (1-17) years. Thirteen (38%) patients presented
multifocal AA, six universalis (20%), six multifocal with ophiasic pattern (18%), six
totalis (18%), and three ophiasic (6%). Six patients (18%) had no regrowth. At 3
months, incomplete or cosmetically acceptable response was noted in 28
patients (82%). At 6 months, 14 patients (41%) presented complete response,
eight patients (23%) had a persistent incomplete response, and six patients (18%)
had a persistent cosmetically acceptable response. Adverse effects were noted
in five patients (15%). Variables predictive for no-growth response were nail
involvement (P=0.001), associated dysimmunity (P=0.017), and universalis form
(P=0.050).
CONCLUSION:
A once-monthly oral pulse of 300 mg prednisone appears effective and safe. It
can be recommended as first-line treatment for widespread AA.
Copyright 2010 Elsevier Masson SAS. All rights reserved.

J Eur Acad Dermatol Venereol. 2006 Nov;20(10):1243-7.
Efficacy and safety of a new clobetasol propionate 0.05% foam in alopecia
areata: a randomized, double-blind placebo-controlled trial.
Tosti A, Iorizzo M, Botta GL, Milani M.
Dermatology Clinic University of Bologna, Bologna, and R & D Mipharm, Milan,
Italy.
Abstract
BACKGROUND:
Clinical efficacy of topical corticosteroids in alopecia areata (AA) is still
controversial. Positive clinical results have been obtained using ointments with
occlusive dressing but this approach has a low patient compliance. Recently, a
new topical formulation (thermophobic foam: Versafoam) of clobetasol
propionate 0.05% has been introduced on the market (Olux, Mipharm, Milan,
Italy) (CF). This formulation is easy to apply. After application to the skin the foam
quickly evaporates without residues and it has a good patient compliance. In
vitro studies have also shown that this formulation enhances the delivery of the
active compound through the skin.
AIM:
To evaluate the efficacy, safety and tolerability of CF in the treatment of
moderate to severe AA.
SUBJECTS AND METHODS:
Thirty-four patients with moderate to severe AA (eight men, mean age 40+/-13
years) were enrolled in a randomized, double-blind, right-to-left, placebo-
controlled, 24-week trial. Alopecia grading score (AGS) was calculated at
baseline and after 12 and 24 weeks of treatment using a 0-5 score (0=no
alopecia; 5=alopecia totalis). Clobetasol foam and the corresponding placebo
foam (PF) were applied twice a day for 5 days/week for 12 weeks (phase 1) using
an intrapatient design (right vs. left). From weeks 13 to 24 each enrolled patient
continued only with the treatment (both on the right and left site) that was
judged to have a greater efficacy than that on the contralateral side (phase 2).
The primary outcome of the trial, evaluated on an intention-to-treat basis, was
the hair regrowth rate, which was evaluated using a semiquantitative score
(RGS) (from 0: no regrowth, to 4: regrowth of 75%).
RESULTS:
At baseline the AGS was 4.1 (range: 2-5). Nine (26%) patients prematurely
concluded the trial. At the end of phase 1, a greater hair regrowth was observed
in 89% of the head sites treated with CF vs. 11% in the sites treated with PF. The
RGS was 1.2+/-1.6 in the CF-treated sites and 0.4+/-0.8 in the PF-treated sites
(P=0.001). A RGS of 2 (hair regrowth of more than 25%) was observed in 42% CF-
treated sites and in 13% of PF-treated sites (P=0.027). In seven subjects (20%) a
RGS of 3 to 4 (hair regrowth of 50%) was observed in CF-treated sites. In three
subjects (9%) a RGS of 4 (hair regrowth of 75%) was observed in CF-treated sites.
In one patient only, in a PF-treated region, a RGS of 3 was observed. The AS was
reduced to 3.8 by CF treatment at the end of phase 1 and to 3.3 at the end of
phase 2 (P=0.01). From weeks 12 to 24 the treatment with CF induced a further
increase in the RGS (from 1.2 to 1.5+/-1.4). Forty-seven per cent of CF-treated
patients had a RGS of 2 at the end of the trial. A total of eight patients (25%) at
the end of the treatment with CF showed a RGS of 3. Folliculitis occurred in two
patients. No significant modifications in cortisol and ACTH blood levels were
observed during the trial.
CONCLUSION:
This new formulation of clobetasol propionate foam is an effective, safe and well-
tolerated topical treatment for AA. This formulation has a good cosmetic
acceptance and patient compliance profile.
J Dtsch Dermatol Ges. 2007 May;5(5):391-5.

Comparison of the efficacy and safety of topical minoxidil and topical alfatradiol
in the treatment of androgenetic alopecia in women.
[Article in English, German]
Blume-Peytavi U, Kunte C, Krisp A, Garcia Bartels N, Ellwanger U, Hoffmann R.
Department of Dermatology and Allergy, Charité- Medical University, Berlin,
Germany. ulrike.blume-peytavi@charite.de
Abstract
BACKGROUND:
Two drugs which are approved for the treatment of androgenetic alopecia in
women in Germany were compared with regard to their influence on hair
growth.
Patients were randomized to group I (n = 52) who used 2% minoxidil solution twice
daily for a period of 12 months or to group II (n = 51) who used 0.025% alfatradiol
solution once daily for 6 months and were then switched to 2% minoxidil solution
for months 7-12. Changes in hair growth parameters were determined using the
TrichoScan.
RESULTS:
Topical treatment with 2% minoxidil solution for 6 months resulted in a significant
increase of cumulative hair thickness (p < 0.0001) and absolute hair density (p <
or = 0.0025), whereas these parameters of hair growth remained nearly
unchanged after 6 months of treatment with alfatradiol solution. Evaluation of
the same parameters from month 7 to month 12 demonstrated that 12 months
minoxidil treatment resulted in an increasing stabilization (group I). After the
alfatradiol-->minoxidil switch in group II a significant increase in cumulative hair
thickness (p < 0.0001) and absolute hair density (p < 0.0001) was achieved. Both
study medications were well tolerated.
CONCLUSIONS:
Treatment with minoxidil can induce an increase in hair density and hair
thickness,whereas treatment with alfatradiol results in deceleration or
stabilization of hair loss.
Int J Dermatol. 2007 Jan;46(1):27-35.

Effect of caffeine and testosterone on the proliferation of human hair follicles in
vitro.
Fischer TW, Hipler UC, Elsner P.
Department of Dermatology and Allergology, Friedrich-Schiller-University, Jena,
Germany. tobias.fischer@derma.uni-jena.de
Abstract
BACKGROUND:
Androgenetic alopecia (AGA) is a common problem in men of all ages,
affecting approximately 50% at 50 years of age. The underlying cause is an
androgen-dependent miniaturization of genetically predetermined hair follicles.
Here, the hair organ culture model was used to investigate the effects of
testosterone and caffeine; the latter being a promising candidate for hair growth
stimulation.
METHODS:
Hair follicles from 14 biopsies, taken from the vertex areas from male AGA
patients, were cultivated for 120-192 h in vitro with normal William's E medium
(control) or William's E medium containing different concentrations of
testosterone and/or caffeine. Hair shaft elongation was measured daily and at
the end of cultivation, cryosections of follicles were stained with Ki-67 to evaluate
the degree and localization of keratinocyte proliferation.
RESULTS:
Significant growth suppression was found in hair follicles treated with 5 microg/ml
testosterone. This was counteracted by caffeine in concentrations of 0.001% and
0.005%. Moreover, caffeine alone led to a significant stimulation of hair follicle
growth. These results were confirmed immunohistochemically by Ki-67 staining.
CONCLUSIONS:
Androgen-dependent growth inhibition of ex vivo hair follicles from patients
suffering from AGA was present in the human hair organ culture model, a
constellation which may serve for future studies to screen new substances
against androgen-dependent hair loss. Caffeine was identified as a stimulator of
human hair growth in vitro; a fact which may have important clinical impact in
the management of AGA.
Indian J Dermatol Venereol Leprol. 2009 Jan-Feb;75(1):47-51.

Comparing the therapeutic effects of finasteride gel and tablet in treatment of
the androgenetic alopecia.
Hajheydari Z, Akbari J, Saeedi M, Shokoohi L.
Department of Dermatology, Boo Ali Sina (Avicenna) Hospital, Mazandaran
University of Medical Sciences, Sari, Iran. zhajheydari@yahoo.com
Abstract
BACKGROUND:
Finasteride, a type II-selective 5alpha-reductase inhibitor, as a causative agent
of decreasing dihydroxy testosterone (DHT) level, is effective in the treatment of
male androgenic alopecia.
AIM:
We compared the local and oral finasteride in the treatment of androgenic
alopecia.
METHOD:
This is a double blind, randomized clinical trial study of 45 male patients, who
were referred with alopecia to the private clinics and departments in Boo-Ali Sina
Hospital, in Sari. Patients with male androgenic alopecia were selected
according to the history and physical examinations. The patients were randomly
divided into two: topical finasteride (A) and oral finasteride (B) groups. Topical
finasteride group (A) received a topical gel of 1% finasteride and placebo
tablets, while the oral finasteride group (B) received finasteride tablets (1 mg)
and gel base (without drug) as placebo for 6 months. The patients were followed
by clinical observation and recording of side effects prior to the treatment and
at the end of first week, and then by a monthly follow-up. The size of bald area,
total hair count, and terminal hair were studied. Data were analyzed by
descriptive and Chi-square statistical test.
RESULTS:
The mean duration of hair loss was 18.8+/-23.10 months. Each month the terminal
hair, size of bald area and hair count between the two groups were compared.
There were no significant differences between the two groups as a viewpoint of
hair thickness, hair counts and the size of bald area. Serial measurements
indicated a significant increase in hair counts and terminal hair counts between
the two groups.
CONCLUSIONS:
The results of this study showed that the therapeutic effects of both finasteride
gel and finasteride tablet were relatively similar to each other.
Endocr Pract. 2001 Jan-Feb;7(1):5-10.

Finasteride cream in hirsutism.
Lucas KJ.
Down East Medical Associates, Morehead City, North Carolina 28557, USA.
Abstract
OBJECTIVE:
To determine, in a preliminary study, whether women with hirsutism attributable
to various causes would benefit from treatment with finasteride cream.
METHODS:
Finasteride cream (0.25%) and placebo cream were administered to eight
women with various degrees of facial hirsutism. The two creams were used on
opposite sides of the face in an area of excessive hair growth. The side chosen
for the finasteride cream versus placebo was randomized and blinded. In a 1
cm2 area on each side of the face, hair counts were done every 2 months
throughout the 6-month study period. Hair thickness was also measured.
RESULTS:
Hair follicles respond to testosterone by the conversion of this androgen to
dihydrotestosterone through the action of 5a-reductase. Finasteride partially
blocks this enzyme. Because of the easy solubility of this medication through the
skin, a cream applied to the area of hair growth would be expected to decrease
hirsutism locally. After a 6-month period, mean hair counts decreased
significantly from 27.5 to 15.5 (P<0.05) in the finasteride-treated sites but showed
no significant change from baseline in the placebo-applied sites. Moreover, the
mean thickness of the measured hairs (in hundredths of millimeters) was
significantly different between the placebo and finasteride-treated sites (4.33
versus 3.11, respectively; P<0.001).
CONCLUSION:
In this study of women with facial hirsutism, topically applied finasteride
significantly decreased hair growth and thickness, and no adverse effects were
noted.
Comment in
The following popper user interface control may not be accessible. Tab to the
next button to revert the control to an accessible version.Destroy user interface
controlTopical finasteride therapy in hirsutism. [Endocr Pract. 2001]
Hum Reprod. 2004 Mar;19(3):529-33. Epub 2004 Jan 29.

Six-month treatment with low-dose dexamethasone further reduces androgen
levels in PCOS women treated with diet and lifestyle advice, and metformin.
Vanky E, Salvesen KA, Carlsen SM.
Department of Obstetrics and Gynecology, St Olavs Hospital, University Hospital
of Trondheim, Norway. eszter.vanky@medisin.ntnu.no
Abstract
BACKGROUND:
The purpose of this study was to investigate the effect of low-dose
dexamethasone on androgen levels in women with polycystic ovary syndrome
(PCOS) treated with diet and lifestyle counselling, and metformin.
METHODS:
A prospective, randomized, double blind, placebo-controlled study was carried
out. Thirty-eight women with PCOS were randomized to either dexamethasone
0.25 mg daily or placebo for 26 weeks. All received diet and lifestyle counselling
at inclusion and metformin 850 mg three times daily during the whole study. Main
outcome measures were: androgen levels, body mass index (BMI), insulin c-
peptide, fasting glucose and serum lipids. Two-tailed t-tests and Pearson's
statistics were used.
RESULTS:
Compared with the placebo, dexamethasone reduced testosterone by 27%,
androstenedione by 21%, dehydroepiandrosterone sulphate by 46% and free
testosterone index by 50% in women with PCOS treated with diet and lifestyle
advice, and metformin. BMI, fasting glucose, insulin c-peptide and serum lipid
levels were unaffected.
CONCLUSIONS:
Six-month, low-dose dexamethasone treatment further reduces androgen levels
in metformin-treated PCOS women.
Hum Reprod. 2009 Apr;24(4):966-75. doi: 10.1093/humrep/den454. Epub 2008

Dec 18.
An RCT of metformin versus orlistat for the management of obese anovulatory
women.
Metwally M, Amer S, Li TC, Ledger WL.
Sheffield University and Teaching Hospitals, The Jessop Wing, Tree Root Walk,
Sheffield S10 4ED, UK. m.metwally@sheffield.ac.uk
Abstract
BACKGROUND:
Treatment of obesity-related anovulation poses a significant clinical challenge.
Occasionally, the use of antiobesity medications such as orlistat or insulin
sensitizing agents such as metformin is sometimes indicated in these patients. This
study aimed to compare the effects of metformin and orlistat for improving
ovulation in obese anovulatory women.
METHODS:
This was an open-label RCT. A total of 40 women were randomized to receive
either metformin (n = 20) or orlistat (n = 20). BMI as well as the androgen profile
and the ovulatory status were assessed at baseline and at four weekly intervals
for 3 months. Different anthropometric and endocrine parameters were also
assessed as possible predictors of ovulation.
RESULTS:
There was no significant difference between the two study arms regarding the
ovulation rate for metformin and orlistat [40% (n = 8/20) and 25% (n = 5/20),
respectively, P = 0.31]. Both arms showed a significant drop in the BMI,
testosterone and androstendione concentrations (P < 0.05), but there was no
difference between the two arms. Patients who ovulated had significantly lower
concentrations of baseline LH, androstendione, dehydroepiandrosterone and
free androgen index (P < 0.05). Among these factors, a low baseline LH was
found to be the only independent predictor of ovulation (area under curve,
0.85).
CONCLUSIONS:
Both metformin and orlistat show a similar effect on weight loss, ovulation rates
and androgen concentrations. However, the effects on ovulation rates need to
be confirmed in larger studies. The presence of a low baseline serum LH was
found to be the most important predictor of ovulation. The study was registered
at clinicaltrials.gov. NCT00292799.
Gynecol Endocrinol. 2009 Aug;25(8):508-13. doi: 10.1080/09513590903015544.

Efficacy of myo-inositol in the treatment of cutaneous disorders in young women
with polycystic ovary syndrome.
Zacchè MM, Caputo L, Filippis S, Zacchè G, Dindelli M, Ferrari A.
Gynecological-Obstetric Department, IRCCS San Raffaele Hospital, Vita-Salute
University, Milan, Italy. m.zacche@gmail.com
Abstract
BACKGROUND:
Polycystic ovary syndrome (PCOS) is the most common endocrine cause of
hirsutism, acne and pattern alopecia, often characterised by ovulation disorders
(usually manifested as oligo- or amenorrhea). In addition, 30-40% of women with
PCOS have impaired glucose tolerance, and a defect in the insulin signalling
pathway seems to be implicated in the pathogenesis of insulin resistance. For this
reason, insulin-lowering medications represent novel approach in women with
PCOS. The aim of this study was to evaluate the effects of myo-inositol (MYO), an
isoform of inositol, belonging to the vitamin B complex, in the treatment of
cutaneous disorders like hirsutism and acne.
METHODS:
Fifty patients with PCOS were enrolled in the study. BMI, LH, FSH, insulin, HOMA
index, androstenedione, testosterone, free testosterone, hirsutism and acne were
evaluated at the baseline and after receiving MYO therapy for 6 months.
RESULTS:
After 3 months of MYO administration, plasma LH, testosterone, free testosterone,
insulin and HOMA index resulted significantly reduced; no significant changes
were observed in plasma FSH and androstenedione levels. Both hirsutism and
acne decreased after 6 months of therapy.
DISCUSSION:
MYO administration is a simple and safe treatment that ameliorates the
metabolic profile of patients with PCOS, reducing hirsutism and acne.
Mycoses. 2008 Jan;51(1):1-6.

Novel, single-dose, topical treatment of tinea pedis using terbinafine: results of a
dose-finding clinical trial.
de Chauvin MF, Viguié-Vallanet C, Kienzler JL, Larnier C.
Laboratoire de Parasitologie Mycologie, Hôpital Saint-Louis, Paris, France.
martinefeuilhade@yahoo.fr
Abstract
Tinea pedis is the most common dermatophytosis requiring topical antifungals for
at least 1-4 weeks. To determine the effectiveness of a novel topical single dose
formulation of terbinafine (film forming solution-FFS) in the treatment of tinea
pedis, 344 outpatients from 43 dermatological centres in France and Bulgaria
suffering from tinea pedis with possible extension to soles confirmed by
mycological examination (direct and culture) were evaluated for efficacy of
terbinafine 1%, 5%, 10% FFS in a randomised double blind vehicle controlled
parallel group dose finding study. Evaluations were carried out at baseline, 1 and
6 weeks after a single application of FFS. Effective treatment rate based on
negative mycology (direct and culture) and minimal signs and symptoms (two
or less with only mild recorded) was measured at week 6. Effective treatment
rates at week 6 with terbinafine 1%, 5% and 10% FFS were 66%, 70%, 61%
compared with 18% with placebo. All three active preparations were shown to
be significantly superior to placebo (P < 0.001). Terbinafine 1% and 5% FFS were
shown to be non-inferior to terbinafine 10% FFS. Terbinafine 1% FFS is an effective,
safe dose for the treatment of tinea pedis. This novel product represents a
significant advance with the enhanced compliance and convenience that it
offers.
Int J Dermatol. 2005 Jul;44(7):590-3.

Evaluation of the efficacy of ciclopirox 0.77% gel in the treatment of tinea pedis
interdigitalis (dermatophytosis complex) in a randomized, double-blind,
placebo-controlled trial.
Gupta AK, Skinner AR, Cooper EA.
Division of Dermatology, Department of Medicine, Sunnybrook and Women's
College Health Sciences Center, Toronto, Canada. agupta@execulink.com
Abstract
BACKGROUND:
Ciclopirox is an antifungal agent and is effective against both Gram-positive and
Gram-negative bacteria. These properties may give ciclopirox an advantage
over other antifungal agents in the treatment of interdigital tinea pedis with
secondary bacterial infection (dermatophytosis complex).
OBJECTIVE:
To evaluate the efficacy of ciclopirox 0.77% gel in the treatment of tinea pedis
interdigitalis with secondary bacterial infection in a prospective, randomized,
double-blind, placebo-controlled clinical study.
SUBJECTS AND METHODS:
One hundred subjects were enrolled in this 8-week study (twice-daily ciclopirox,
40 subjects; once-daily ciclopirox, 40 subjects; twice-daily vehicle, 20 subjects).
Mycologic sampling, bacterial swabs, and evaluations for symptoms and signs of
tinea pedis were performed on a target webspace at baseline and at weeks 2,
4, and 8. Global evaluations were made by both investigator and subject at
each visit.
RESULTS:
Ciclopirox gel applied once or twice daily significantly reduced the signs and
symptoms at week 8, compared with vehicle (P<0.0036). The mycologic cure and
complete cure rates were much higher for the ciclopirox regimens than for the
vehicle regimen. Early reduction of bacterial counts was noted with the
ciclopirox regimens. There was no significant difference in the adverse event rate
between the ciclopirox groups and the placebo group.
CONCLUSION:
Ciclopirox 0.77% gel, applied once or twice daily, is effective and safe in the
treatment of tinea pedis interdigitalis with concomitant bacterial infection
(dermatophytosis complex).
J Eur Acad Dermatol Venereol. 2009 Mar;23(3):256-62. doi: 10.1111/j.1468-

3083.2008.03036.x.
The use of an intermittent terbinafine regimen for the treatment of dermatophyte
toenail onychomycosis.
Gupta AK, Lynch LE, Kogan N, Cooper EA.
Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences
Center and the University of Toronto, Toronto, Ontario, Canada.
agupta@execulink.com
Abstract
OBJECTIVE:
To compare the efficacy and safety of intermittent terbinafine with standard
courses of terbinafine and itraconazole for dermatophyte toenail
onychomycosis.
DESIGN:
Data from a Canadian study of continuous terbinafine (CTERB) and intermittent
itraconazole (III) was compared to an intermittent terbinafine regimen (TOT)
using similar protocol to the randomized study.
INTERVENTIONS:
Terbinafine 250 mg/day for 4 weeks followed by 4 weeks of no terbinafine and
then an additional 4 weeks of terbinafine 250 mg/day (TOT); terbinafine 250
mg/day for 12 weeks (CTERB); itraconazole pulse of 200 mg twice daily for 7 days
on, 21 days off, three pulses given (III).
RESULTS:
At 72 weeks, mycological cure rates (negative KOH and culture) were 36 of 43
(83.7%), 25 of 32 (78.1%), and 17 of 30 (56.7%), for the TOT, CTERB, and III groups,
respectively (P = 0.01 for TOT vs. III). Effective cure rates (simultaneous
mycological cure and < or =10% nail plate involvement) were 34 of 43 (79.1%),
21 of 32 (65.6%), and 11 of 30 (36.7%), respectively (P < 0.001 for TOT vs. III; P = 0.02
for CTERB vs. III). No significant differences in effective and mycological cure rates
were noted between the two terbinafine groups. Adverse events reported were
similar to those reported in the respective package inserts. Most adverse events
were mild to moderate, transient, and did not require interruption of the drug
regimens. No serious adverse events were reported.
CONCLUSIONS:
A TOT intermittent terbinafine regimen provided similar efficacy and safety to the
gold standard continuous terbinafine regimen and better effective cure rates
than pulse itraconazole therapy.
Mycoses. 2013 Jan 8. doi: 10.1111/myc.12032. [Epub ahead of print]

Intermittent therapy with terbinafine and nail abrasion for dermatophyte toe
onychomycosis: a pilot study.
Succi IB, Bernardes-Engemann AR, Orofino-Costa R.
Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro,
Rio de Janeiro, Brazil.
Abstract
Onychomycosis constitutes up to 50% of all nail disorders. Toenails are generally
affected, mostly due to dermatophytes. Terbinafine is the most potent antifungal
agent in vitro against dermatophytes. There are few randomised controlled trials
using a non-continuous dose of terbinafine. The aim of this open-label pilot study
was to reduce the total drug amount, the collateral effects and, specially, the
costs; albeit maintaining the same efficacy of the standard regimens. Compare
the outcomes of two different intermittent regimens with the same total amount
of the medication (42 tablets in 6 months). Forty-one patients were divided into the
following groups: terbinafine 250 mg day(-1) , for 7 days, monthly or terbinafine 500
mg day(-1) , once daily, for 7 days, every 2 months, both plus nail abrasion during
6 months. The efficacy was evaluated at months 6, 12 and 18 using the disease
free nail criteria. Total cure = group I: eight patients (44.4%) and group II: eight
patients (44.4%). Partial cure = group I: five patients (27.8%) and group II: four
patients (22.2%). Treatment failure = group I: five patients (27.8%) and group II:
three patients (16.7%). Recurrence = group I: zero patients (0.0%) and group II:
three patients (16.7%). Two intermittent dosing regimens of terbinafine plus nail abrasion
proved to be an alternative statistically effective, safe and with reduced drug costs
for dermatophytes toenail onychomycosis.
© 2012 Blackwell Verlag GmbH.
PMID: 23294342 [PubMed - as supplied by publisher]
Indian J Dermatol Venereol Leprol. 2007 Nov-Dec;73(6):393-6.

An open randomized comparative study to test the efficacy and safety of oral
terbinafine pulse as a monotherapy and in combination with topical ciclopirox
olamine 8% or topical amorolfine hydrochloride 5% in the treatment of
onychomycosis.
Jaiswal A, Sharma RP, Garg AP.
Department of Dermatology and Venereology, L. L. R. M. Medical College,
Meerut, Uttar Pradesh, India.
Abstract
BACKGROUND:
Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts
and molds.
AIMS:
To study the efficacy and safety of oral terbinafine pulse as a monotherapy and
in combination with topical ciclopirox olamine 8% or topical amorolfine
hydrochloride 5% in onychomycosis.
METHODS:
A clinical comparative study was undertaken on 96 Patients of onychomycosis
during the period between August 2005 to July 2006. Forty-eight patients were
randomly assigned in group A to receive oral terbinafine 250 mg, one tablet
twice daily for seven days every month (pulse therapy); 24 patients in group B to
receive oral terbinafine pulse therapy plus topical ciclopirox olamine 8% to be
applied once daily at night on all affected nails; and 24 patients in group C to
receive oral terbinafine pulse therapy plus topical amorolfine hydrochloride 5%
to be applied once weekly at night on all the affected nails. The treatment was
continued for four months. The patients were evaluated at four weekly intervals
till sixteen weeks and then at 24 and 36 weeks.
RESULTS:
We observed clinical cure in 71.73, 82.60 and 73.91% patients in groups A, B and
C, respectively; Mycological cure rates against dematophytes were 88.9, 88.9
and 85.7 in groups A, B and C, respectively. The yeast mycological cure rates
were 66.7, 100 and 50 in groups A, B and C, respectively. In the case of
nondermatophytes, the overall response was poor: one out of two cases (50%)
responded in group A, while one case each in group B and group C did not
respond at all.
CONCLUSION:
Terbinafine pulse therapy is effective and safe alternative in treatment of
onychomycosis due to dermatophytes; and combination therapy with topical
ciclopirox or amorolfine do not show any significant difference in efficacy in
comparison to monotherapy with oral terbinafine.
J Dermatolog Treat. 2002 Mar;13(1):3-9.

An open, randomized, comparative study of oral fluconazole, itraconazole and
terbinafine therapy in onychomycosis.
Arca E, Taştan HB, Akar A, Kurumlu Z, Gür AR.
Department of Dermatology, Gülhane Military Medical Academy, School of
Medicine Etlik, Ankara, Turkey. earca@gata.edu.tr
Abstract
BACKGROUND/AIM:
In this open, randomized and comparative study, the safety and efficacy of
systemic fluconazole, itraconazole and terbinafine was investigated in 50
patients with distal subungual toenail onychomycosis diagnosed clinically and
mycologically. The patients with positive mycology and also the patients with
positive microscopy and negative culture were investigated.
METHODS:
The treatment duration was 3 months, and the follow-up period was 6 months.
Patients were randomly assigned: 16 patients received 150 mg fluconazole once
weekly, 18 patients received 200 mg itraconazole twice daily with meals during
the first week of each month, and 16 patients received 250 mg/day terbinafine
during the treatment period.
RESULTS:
In a clinical evaluation, at the endpoint of the follow-up period, the clinical cure
rates were 81.3% (13/16) in the terbinafine group, 77.8% (14/18) in the
itraconazole group, and 37.5% (6/16) in the fluconazole group. The mycological
cure rates were 75% (12/16), 61.1% (11/18) and 31.2% (5/16), respectively. The
overall assessment rates were 62.5% (10/16), 61.1% (11/18) and 31.2% (5/16),
respectively. Statistically significant intra-group reductions from baseline
symptom severity values were seen at the endpoint of treatment and at the
endpoint of the follow-up period for all three treatment groups in onycholysis,
subungual hyperkeratosis, affected-area percentage score and total score
parameters (p < 0.001). At the endpoint of the follow-up period, statistically
significant differences between the treatment groups were seen in clinical,
mycological and overall assessment (p < 0.05). However, while no statistically
significant difference between the terbinafine and itraconazole groups was
seen, there was a clinical and statistical difference between the other groups
and the fluconazole group. Treatment was not stopped for side effects such as
mild gastrointestinal and central nervous system symptoms. These effects were
noted in four patients in the fluconazole group (25%), five patients in the
itraconazole group (27.8%), and three patients in the terbinafine group (18.75%).
The clinical laboratory data on all three drug groups did not show any statistically
or clinically significant intra-group changes from baseline values at the endpoint
(p > 0.05).
CONCLUSION:
This comparative study of systemic fluconazole, itraconazole and terbinafine
showed that all three drugs were effective and safe in the treatment of
onychomycosis. However, fluconazole, at these doses and treatment durations,
was the least effective. With regard to cost-effectiveness, side effects and the
cure rates, terbinafine could be the drug of choice in the short-term treatment
of toenail onychomycosis.
Pharmacoeconomics. 2002;20(5):319-24.
Cost effectiveness of oral terbinafine (Lamisil) compared with oral fluconazole
(Diflucan) in the treatment of patients with toenail onychomycosis.
Salo H, Pekurinen M.
Source
Health Services Research Ltd, Helsinki, Finland.
Abstract
OBJECTIVE:
To determine the cost effectiveness of terbinafine (Lamisil) tablets compared
with fluconazole (Diflucan) capsules in the treatment of patients with toenail
onychomycosis.
METHODS:
Data from a randomised, double-blind, double-dummy, multicentre study were
used as the basis for this study. Terbinafine 250 mg/day for 12 weeks (n = 48) was
compared with fluconazole 150mg once weekly for 12 weeks (n = 45) or 24 weeks
(n = 44) in patients with culture-confirmed toenail onychomycosis caused by
dermatophyte infection. At the end of the study (week 60), complete clinical
cure of the target toenail was achieved in 67% of patients in the terbinafine
group, compared with 21 and 32%, respectively, in the 12- and 24-week
fluconazole groups. We subsequently used these data to calculate the cost
effectiveness of the three treatment regimens, defining cost effectiveness as the
cost per complete clinical cure of the target toenail at week 60.
RESULTS:
The cost effectiveness of terbinafine for each complete clinical cure was superior
to that of either of the fluconazole regimens. Costs per cure were Finnish markka
(Fmk) 2824 ($US618) for terbinafine, compared with Fmk3748 ($US820) and
Fmk4922 ($US1077), respectively, for the two fluconazole regimens.
CONCLUSIONS:
The clinical study showed that terbinafine was significantly more effective than
fluconazole in the treatment of onychomycosis, achieving statistically higher
rates of mycological and clinical cure. We have now shown that terbinafine is
also more cost effective. These findings have important implications for both
medical and social policy.
J Dermatolog Treat. 2012 Dec;23(6):453-6. doi: 10.3109/09546634.2011.588191.

Epub 2011 Jul 24.
A comparative evaluation of combination therapy of fluconazole 1% and urea
40% compared with fluconazole 1% alone in a nail lacquer for treatment of
onychomycosis: therapeutic trial.
Bassiri-Jahromi S, Ehsani AH, Mirshams-Shahshahani M, Jamshidi B.
Medical Mycology Department, Pasteur Institute of Iran. basiri@pasteur.ac.ir
Abstract
This is a randomized, double-blind study enrolling 70 patients with onychomycosis
of the finger and toenails. Clinical and mycological efficacies as well as
measures of safety were assessed monthly for a maximum of 6 months of
treatment. The treatment regimens were: fluconazole 1% and fluconazole 1%
with urea 40%. These results indicated topical treatment of onychomycosis with
a combination of fluconazole 1% and urea 40% was more effective (82.8%) than
fluconazole 1% (62.8%) nail lacquer alone in treatment of dermatophytic
onychomycosis. Fluconazole was well tolerated and side effects were negligible.
At the end of therapy and the end of the 6-month follow-up, fluconazole 1% and
urea 40% demonstrated statistically significant superiority in clinical and
mycological responses compared with fluconazole 1% alone.
PMID: 21781012 [PubMed - in process]
J Am Podiatr Med Assoc. 2007 May-Jun;97(3):195-202.

Ciclopirox 8% nail lacquer topical solution for the treatment of onychomycosis in
patients with diabetes: a multicenter, open-label study.
Brenner MA, Harkless LB, Mendicino RW, Page JC.
Institute for Diabetic Foot Research, Glendale, NY 11385, USA.
Abstract
BACKGROUND:
An open-label, noncomparative study was conducted to assess the safety and
efficacy of ciclopirox 8% nail lacquer topical solution in patients with type 2
diabetes mellitus.
METHODS:
Forty-nine diabetic patients with distal subungual onychomycosis were treated
once daily for 48 weeks with ciclopirox 8% nail lacquer, a topical nail solution
approved for the treatment of patients with mild-to-moderate onychomycosis.
RESULTS:
Treatment resulted in clinical improvement in 63.4% of patients. Most patients
(85.7%) had a mycologic outcome of improvement or cure, with 54.3% attaining
mycologic cure. Consideration of mycologic and clinical outcomes generated
a treatment outcome of improvement, success, or cure in 84.4% of patients.
Moreover, patients experienced improvement in the diseased area of the nail
(63.4%), nail surface (56.1%), nail color (48.8%), and nail thickness (65.9%).
Ciclopirox 8% nail lacquer was safe, with treatment-related adverse events
limited to infection in one patient, which resolved in 15 days; the patient
completed the study. No treatment-related serious adverse events were
observed.
CONCLUSION:
Ciclopirox 8% nail lacquer is a safe and effective treatment for distal subungual
onychomycosis in patients with type 2 diabetes mellitus receiving insulin or oral
hypoglycemic therapy.
Int J Trichology. 2011 Jan;3(1):3-6. doi: 10.4103/0974-7753.82117.

A new postulate on two stages of dandruff: a clinical perspective.
Manuel F, Ranganathan S.
Deparment of Dermatology, Skin Clinic, 22, Paper Mills Road, Perambur, Chennai,
Tamil Nadu, India.
Abstract
Dandruff (pityriasis capitis, seborrheic dermatitis confined to the scalp) is a
disease that has been around for centuries despite several treatment options.
Almost every day new players are entering the market with various antidandruff
products, perhaps due to an increase in the incidence of dandruff all over the
world. Interestingly, clinicians, especially dermatologists, gave little attention to
this problem. At the end, the dandruff sufferer is puzzled by the array of
antidandruff products with varied claims entering the market day by day. Why
have we not achieved complete treatment success against dandruff? Is
dandruff a disease or disorder? It seems that our understanding about dandruff
perfectly fits into the famous saying of Albert Einstein, "as the area of light
increases, so does the circumferences of darkness." Have dermatologists left
dandruff unattended, only to be exploited by the personal care industry?

Int J Cosmet Sci. 2000 Aug;22(4):285-9. doi: 10.1046/j.1467-2494.2000.00024.x.
The antidandruff efficacy of a shampoo containing piroctone olamine and
salicylic acid in comparison to that of a zinc pyrithione shampoo.
Lodén M, Wessman C.
ACO Hud AB, Research & Development, Box 622, S-194 26 Upplands Vàsby,
Sweden.
Abstract
Dandruff (pityriasis capitis) is a chronic scalp condition characterized by scaling
and sometimes itching and redness. Shampoos containing antifungal agents are
used to control the scaling condition. In the present study, two shampoos with
different actives are compared in a double-blind, randomised and bilateral
study on 19 subjects. One shampoo contained piroctone olamine (0.75%)
combined with salicylic acid (2%) and the other contained zinc pyrithione (1%)
as active ingredient. The subjects were treated twice weekly with the shampoos
for almost 4 weeks. Before each treatment the degree of dandruff was
evaluated. Both shampoos were highly effective in reducing the dandruff. The
combination of piroctone olamine and salicylic acid appeared to be slightly
more effective than zinc pyrithione in reducing the severity and area affected
by the scaling.
PMID: 18503415 [PubMed]
Cutis. 2007 May;79(5):397-403.

Clobetasol propionate shampoo 0.05% in the treatment of seborrheic dermatitis
of the scalp: results of a pilot study.
Reygagne P, Poncet M, Sidou F, Soto P.
Galderma R&D, Sophia Antipolis, France.
Abstract
Seborrheic dermatitis (SD), a common dermatosis associating hyperseborrhea,
erythema, itching, and dandruff, has frequent scalp involvement. Malassezia
furfur infection seems to play an important role in the condition's etiopathology.
Treatment of SD usually consists of corticosteroids or antifungals, such as
ketoconazole. The aim of this multicenter, randomized, investigator-blinded,
parallel-group pilot study was to evaluate the efficacy and safety of clobetasol
propionate shampoo 0.05% after different short-contact application times
compared with its vehicle and ketoconazole foaming gel 2% in the treatment of
SD of the scalp. For 4 weeks, 55 subjects received one of the following treatments
twice weekly: clobetasol propionate shampoo for 2.5, 5, or 10 minutes;
clobetasol propionate vehicle for 10 minutes; or ketoconazole foaming gel for 5
minutes before rinsing off. Efficacy criteria included total severity score (TSS) and
individual scores of signs such as itching and global improvement. Safety
included reporting of burning, overall tolerance, and adverse events. Results
showed that an application of clobetasol propionate for 5 and 10 minutes
provided a similar mean percentage decrease of TSS, and the mean
percentage decrease of TSS for all active groups was significantly superior to that
of the vehicle (P < .01). Overall and local safety were good for all treatment
groups. The present pilot study demonstrated that a short-contact application of
clobetasol propionate shampoo is effective and safe in the treatment of SD of
the scalp.
J Dermatolog Treat. 2003 Dec;14(4):212-5.

Successful treatment of dandruff with 1.5% ciclopirox olamine shampoo in Korea.
Lee JH, Lee HS, Eun HC, Cho KH.
Department of Dermatology, Seoul National University College of Medicine,
Seoul, Korea.
Abstract
BACKGROUND:
Dandruff is a chronic scalp condition characterized by scaling. The common
causative agent is now accepted to be the lipophilic yeast Malassezia furfur.
Ketoconazole, a highly effective antifungal agent against M. furfur has been
used for the treatment of dandruff.
AIM:
To determine whether a 1.5% ciclopirox olamine shampoo is as effective as a 2%
ketoconazole shampoo for the treatment of mild to moderate dandruff.
METHODS:
A total of 64 patients, with mild to moderate dandruff, participated in the study.
The study consisted of three consecutive phases: a 2-week washout period, a 4-
week treatment period and a 2-week post-treatment period. Patients were
randomized equally to either the 1.5% ciclopirox olamine shampoo or 2%
ketoconazole shampoo. An overall dandruff score was calculated using an area
of dandruff involvement score and a severity score. Patients evaluated the
presence of pruritus and also reported a global evaluation of efficacy.
RESULTS:
In all, 57 patients successfully completed all three phases. The overall dandruff
score declined progressively throughout the treatment period for both
shampoos. A slight increase in pruritus was observed in the ciclopirox olamine
treatment group during the post-treatment phase. Regarding global self-
assessment of efficacy, both treatment groups were pleased with their scalp
condition following treatment.
CONCLUSION:
Ciclopirox olamine shampoo appears to offer an effective, safe and easy to use
treatment for mild to moderate dandruff.
Indian J Dermatol. 2010 Apr-Jun;55(2):130-4. doi: 10.4103/0019-5154.62734.

Dandruff: the most commercially exploited skin disease.
Ranganathan S, Mukhopadhyay T.
CavinKare Research Centre, No.12 Poonamallee Road, Ekkattuthangal,
Chennai - 600 097, India.
Abstract
The article discuss in detail about the prevalence, pathophysiology, clinical
manifestations of dandruff including the etio-pathology. The article also discusses
in detail about various treatment methods available for dandruff. The status of
dandruff being amphibious - a disease/disorder, and relatively less medical
intervention is sought after for the treatment, dandruff is the most commercially
exploited skin and scalp disorder/disease by personal care industries.
Int J Dermatol. 1983 Mar;22(2):123-5.

A comparison of miconazole nitrate and selenium disulfide as anti-dandruff
agents.
Sheth RA.
Abstract
The anti-dandruff efficacy of two shampoos containing 2% miconazole nitrate
and 2.5% selenium disulfide was compared in 15 subjects and eight subjects,
respectively. The antifungal drug, miconazole nitrate, was found to possess anti-
dandruff activity similar to selenium sulfide, a cytostatic compound. For
evaluation, techniques of clinical grading and the corneocyte count were used
and the latter was found inaccurate. Instead, clinical assessment by grading the
severity, supplemented by cytodiagnosis by smear examination was found more
helpful. The latter helps to evaluate both the altered pathophysiologic and
microbial factors operating in a given case of dandruff, which is a symptom
complex brought about by multiple etiologic factors.
Med Mycol J. 2011;52(3):229-37.

[Study on the usefulness of rinse containing miconazole nitrate for treatment of
dandruff--a double-blind, comparative study].
[Article in Japanese]
Sei Y, Kobayashi M, Soude E.
Department of Dermatology, Teikyo University School of Medicine University
Hospital, Mizonokuchi.
Abstract
A double-blind, comparative study was performed on the usefulness of rinse
containing miconazole nitrate(COFRM)compared to rinse without the reagent
for the treatment of dandruff, when together with shampoo containing
miconazole nitrate (COF). This study showed that both COFR and COFRM had
about 80% utility. On the other hand, though it was not significant, enhanced
improvement of itching by COFRM compared to COFR was detected 2 weeks
after start of the examination. These results suggest that by mixing the miconazole
nitrate with not only the shampoo but also rinse, the reagent more certainly
remained on the scalp so that proliferation of the Malassezia was disturbed.
Therefore, the effectiveness could clearly be more practically felt at the early
stage. Collectively, these results indicate that COFRM was a useful rinse that
allowed the effect to actually be felt in the short-term when used together with
COF and contributed to the compliance improvement.
Copyright © 2011 The Japanese Society for Medical Mycology

J Indian Med Assoc. 2000 Dec;98(12):810-1.
Evaluation of safety and efficacy of ketoconazole 2% and zinc pyrithione 1%
shampoo in patients with moderate to severe dandruff--a postmarketing study.
Saple DG, Ravichandran G, Desai A.
STDs, Leprosy and AIDS Medicine, Grant Medical College, GT Hospital, Mumbai.
Abstract
A postmarketing study was conducted on 236 patients from 23 centres suffering
from moderate to severe dandruff with a combination of ketoconazole and zinc
pyrithione (1%) for a duration of 4 weeks with 2 weeks further follow-up. Scoring
of dandruff was done on a 0-10 scale for each of the 6 regions of scalp at each
week up to 6 weeks. The results indicate that there was a consistent improvement
in dandruff scores over the treatment period and a reduction of > 90% was seen
for all areas of scalp individually as well as collectively as compared to baseline.
The treatment also showed significant improvement in other signs and symptoms
such as erythema and itching, with a highly favourable adverse event profile.
The overall assessment for global improvement by investigators showed good-
excellent results with high acceptability amongst the patient population for the
treatment. A combination shampoo of ketoconazole (2%) and zinc pyrithione
(1%) offers a safe and effective option in the treatment of dandruff.
Br J Dermatol. 2011 Nov;165(5):1101-8. doi: 10.1111/j.1365-2133.2011.10387.x.

Low-dose 5-fluorouracil in combination with salicylic acid as a new lesion-
directed option to treat topically actinic keratoses: histological and clinical study
results.
Stockfleth E, Kerl H, Zwingers T, Willers C.
Department of Dermatology, Venereology and Allergy, Berlin University Medical
Centre, Charité Skin Cancer Centre, Berlin, Germany.
eggert.stockfleth@charite.de
Abstract
BACKGROUND:
Actinic keratoses (AKs) arise after chronic sun exposure. Because long-term
ultraviolet (UV) damage may induce proliferation of atypical keratinocytes,
treatment of AKs is recommended.
OBJECTIVES:
To compare 5-fluorouracil 0•5%/salicylic acid 10•0% [low-dose 5-FU/SA
(Actikerall®)] with diclofenac 3% in hyaluronic acid (diclofenac HA) and vehicle
for the treatment of AKs.
METHODS:
This was a randomized, placebo-controlled, double-blind, parallel-group,
multicentre trial. Patients received topical low-dose 5-FU/SA once daily, its
vehicle or diclofenac HA twice daily for a maximum of 12 weeks. The final
evaluation was at week 20. The primary objectives were to demonstrate the
histological clearance rate of one predefined lesion. The secondary objectives
were the improvement of treated lesions, tolerability and safety.
RESULTS:
There were 470 patients with 4-10 AK lesions each (grade I or II) on the
face/forehead or bald scalp included in the study. Low-dose 5-FU/SA was
superior to diclofenac HA (P < 0•01) and vehicle (P < 0•0001) for histological
clearance of one representative lesion 8 weeks post-treatment. In 72•0%, 59•1%
and 44•8% of patients in the low-dose 5-FU/SA, diclofenac HA and vehicle
groups, respectively, the week-20 biopsy revealed no AKs. Significantly more
lesions were cleared with low-dose 5-FU/SA (74•5%) compared with diclofenac
HA (54•6%; P < 0•001) or vehicle (35•5%; P< 0•001). Low-dose 5-FU/SA was
superior in terms of complete clinical clearance: 55•4%, vs. diclofenac HA
(32•0%, P < 0•001) and vehicle (15•1%P < 0•001). Application-site disorders
(mainly burning and inflammation) were more frequent with low-dose 5-FU/SA
but mainly of mild to moderate intensity.
CONCLUSIONS:
Topical low-dose 5-FU/SA demonstrated higher histological and clinical
clearance rates vs. diclofenac HA or vehicle. Low-dose 5-FU/SA is an effective
lesion-directed treatment for AKs.
© 2011 The Authors. BJD © 2011 British Association of Dermatologists.
Int J Dermatol. 2009 Aug;48(8):902-7. doi: 10.1111/j.1365-4632.2009.04106.x.

5-Fluorouracil superficial peel for multiple actinic keratoses.
Bagatin E, Teixeira SP, Hassun KM, Pereira T, Michalany NS, Talarico S.
Department of Dermatology, Cosmetic Dermatology Unit, and Department of
Pathology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
edileia_bagatin@yahoo.com.br
Abstract
BACKGROUND:
Chronically photodamaged skin usually presents with multiple, widespread,
actinic keratoses (AKs), and treatment of the entire affected area is
recommended.
METHODS:
We report our experience with a combination of Jessner's solution or 70% glycolic
acid (GA) with 5% 5-fluorouracil (5-FU) solution for superficial pulse peeling used
in the treatment of widespread AKs in 31 patients. Pulse peelings were performed
at biweekly intervals. The endpoint for treatment was complete or maximum
clearance of the lesions at clinical evaluation. Pre- and post-skin biopsy and
histopathologic examination were performed in three patients for the purpose of
demonstrating the pulse peel effects.
RESULTS:
All patients achieved a satisfactory result, including the complete regression, or
at least 80% clearing, of AK lesions and an overall improvement of
photodamaged skin.
CONCLUSION:
We consider this superficial 5-FU pulse peel to be a safe, well-tolerated, very
effective, and highly inexpensive therapeutic option for the treatment of
multiple, diffuse AKs. Its benefit/cost ratio will be of interest to public health
services, mainly in developing countries.

Dermatol Surg. 1996 Sep;22(9):781-6.
A clinical and histologic evaluation of two medium-depth peels. Glycolic acid
versus Jessner's trichloroacetic acid.
Tse Y, Ostad A, Lee HS, Levine VJ, Koenig K, Kamino H, Ashinoff R.
Section of Dermatologic and Laser Surgery, New York University Medical Center,
New York, USA.
Abstract
BACKGROUND:
Chemical peels using alpha hydroxy acids have become one of the most
frequently requested dermatologic procedures. The use of glycolic acid in
superficial chemical peels is now well established. However, the role of glycolic
acid in medium-depth chemical peels has yet to be elucidated.
OBJECTIVE:
We performed a clinical and histologic comparison of 70% glycolic acid versus
Jessner's solution as part of a medium-depth chemical peel using 35%
trichloroacetic acid (TCA).
METHODS:
Thirteen patients with actinic keratoses, solar lentigines and fine wrinkling were
evaluated prospectively. Each patient was treated with 70% glycolic acid plus
35% TCA (GA-TCA) to the right face and Jessner's solution plus 35% TCA (JS-TCA)
to the left face. Clinical and histologic changes were evaluated at 7, 30, and 60
days postoperatively.
RESULTS:
Clinically, the GA-TCA peel was effective in treating photodamaged skin. The
GA-TCA peel was slightly more efficacious in removing actinic keratoses (clinical
response score = 1.5) than the JS-TCA peel (clinical response score = 1.0).
Histologically, the GA-TCA peel caused the formation of a slightly thicker Grenz
zone (mean = 0.053 mm) 60 days postpeel than the JS-TCA peel (mean = 0.048
mm) (not statistically significant). The GA-TCA peel caused more
neoelastogenesis than the JS-TCA peel, while the JS-TCA peel resulted in more
papillary dermal fibrosis and neovascularization than the GA-TCA peel.
CONCLUSION:
The GA-TCA peel is a new medium-depth chemical peel that is effective in
treating photodamaged skin.
Am J Clin Dermatol. 2010;11(1):45-50. doi: 10.2165/11311170-000000000-00000.

Topical treatment of actinic keratoses with piroxicam 1% gel: a preliminary open-
label study utilizing a new clinical score.
Campione E, Diluvio L, Paternò EJ, Chimenti S.
Department of Dermatology, University of Rome Tor Vergata, Rome, Italy.
campioneelena@hotmail.com
Abstract
BACKGROUND:
The cyclo-oxygenase enzymes 1 and 2 (COX-1 and COX-2) are both involved in
skin tumorigenesis, causing inhibition of apoptosis, angiogenesis, invasiveness,
recruitment of growth factors, immunosuppression, and production of
carcinogens. Piroxicam is a nonselective nonsteroidal anti-inflammatory drug
that blocks the activity of COX-1 and COX-2.
OBJECTIVE:
To evaluate the efficacy and tolerability of piroxicam 1% gel in the treatment of
actinic keratoses.
METHODS:
Piroxicam 1% gel was applied twice daily for 12 weeks to 31 actinic keratoses.
The lesions were evaluated clinically and by means of dermoscopy at an initial
baseline visit, at intermediate visits, and after 90 days. Changes were evaluated
using a new scoring system (AKESA), based on the clinical presence of erythema,
scale, and atrophy on a target lesion. In our experience, the use of piroxicam 1%
gel for 90 days induced complete regression in 48% of evaluated actinic
keratoses, corresponding to keratotic and verrucous clinical variants. In these
lesions, the AKESA score was markedly reduced after treatment. Adverse effects
were pruritus, mild erythema, dry skin, and, rarely, rash. Our preliminary trial shows
that piroxicam exerts anti-tumorigenic effects and may play a useful role in the
chemoprevention of skin cancers.
J Am Acad Dermatol. 2003 Jul;49(1):83-90.

Assessment of adapalene gel for the treatment of actinic keratoses and
lentigines: a randomized trial.
Kang S, Goldfarb MT, Weiss JS, Metz RD, Hamilton TA, Voorhees JJ, Griffiths CE.
University of Michigan School of Medicine, Department of Dermatology, Ann
Arbor, USA. swkang@med.umich.edu
Abstract
BACKGROUND:
Adapalene is a synthetic retinoid with an established clinical efficacy against
acne and good local tolerability. Its effectiveness in the treatment of
photodamaged skin has not been studied.
OBJECTIVE:
We sought to determine the safety and efficacy of adapalene gel in the
treatment of actinic keratoses and solar lentigines.
METHODS:
In a prospective, 2-center, randomized, controlled, investigator-masked,
parallel-group study, 90 patients with actinic keratoses and solar lentigines were
treated daily with either adapalene gel (0.1% or 0.3%) or its vehicle gel for 4
weeks, followed by twice-daily applications, if tolerated, for up to 9 months.
RESULTS:
Of the 90 Caucasian patients (69 male, 21 female; mean age 63.1 years) who
were enrolled into the study, 83 patients completed 9 months of treatment. With
adapalene gel 0.1% and 0.3%, the mean number of actinic keratoses was
reduced by 0.5 +/- 0.9 (mean +/- SE) and 2.5 +/- 0.9, respectively. Whereas, with
the vehicle gel, there was an increase of 1.5 +/- 1.3 (P <.05). After 1 month of
treatment, the patients who received adapalene had significant lightening of
solar lentigines as compared with the patients who were treated with vehicle gel
(P <.05). After 9 months, 57% and 59% of the patients had lighter lesions in the
adapalene 0.1% and 0.3% groups, respectively, in comparison with only 36% in
the vehicle group (P <.05). Histologic evaluations revealed improved cellular
atypia and reduced epidermal melanin in adapalene-, as compared with
vehicle-treated group. The differences, however, were not statistically significant.
A retrospective evaluation of paired clinical photographs (before and after 9-
month treatment) by 2 dermatologists who were treatment-blinded revealed
significant improvement in wrinkles and other clinical features of photoaged skin
with adapalene as compared with its vehicle.
CONCLUSION:
Adapalene gel 0.1% and 0.3% were well tolerated and improved actinic
keratoses, solar lentigines, and other features of photodamaged skin.
J Clin Aesthet Dermatol. 2010 Jul;3(7):32-43.

Evidence and considerations in the application of chemical peels in skin
disorders and aesthetic resurfacing.
Rendon MI, Berson DS, Cohen JL, Roberts WE, Starker I, Wang B.
Abstract
Chemical peeling is a popular, relatively inexpensive, and generally safe method
for treatment of some skin disorders and to refresh and rejuvenate skin. This article
focuses on chemical peels and their use in routine clinical practice. Chemical
peels are classified by the depth of action into superficial, medium, and deep
peels. The depth of the peel is correlated with clinical changes, with the greatest
change achieved by deep peels. However, the depth is also associated with
longer healing times and the potential for complications. A wide variety of peels
are available, utilizing various topical agents and concentrations, including a
recent salicylic acid derivative, beta-lipohydroxy acid, which has properties that
may expand the clinical use of peels. Superficial peels, penetrating only the
epidermis, can be used to enhance treatment for a variety of conditions,
including acne, melasma, dyschromias, photodamage, and actinic keratoses.
Medium-depth peels, penetrating to the papillary dermis, may be used for
dyschromia, multiple solar keratoses, superficial scars, and pigmentary disorders.
Deep peels, affecting reticular dermis, may be used for severe photoaging,
deep wrinkles, or scars. Peels can be combined with other in-office facial
resurfacing techniques to optimize outcomes and enhance patient satisfaction
and allow clinicians to tailor the treatment to individual patient needs. Successful
outcomes are based on a careful patient selection as well as appropriate use of
specific peeling agents. Used properly, the chemical peel has the potential to fill
an important therapeutic need in the dermatologist's and plastic surgeon's
armamentarium.
J Am Acad Dermatol. 2005 Nov;53(5):769-74.

Long-term treatment of photoaged human skin with topical retinoic acid
improves epidermal cell atypia and thickens the collagen band in papillary
dermis.
Cho S, Lowe L, Hamilton TA, Fisher GJ, Voorhees JJ, Kang S.
Department of Dermatology, University of Michigan Medical School, USA.
Abstract
BACKGROUND:
Risk of photocarcinogenesis and the relevance of collagen in wrinkle
effacement are two issues related to prolonged use of retinoic acid (RA) that
have not been fully addressed.
OBJECTIVE:
Our purpose was to investigate the degree of epidermal cellular atypia and the
thickness of papillary dermal collagen in photoaging after long-term use of RA.
METHODS:
Thirty-four subjects with photoaged skin were treated daily with 0.05% RA for at
least 6 months. Epidermal cellular atypia was graded by means of a
semiquantitative scale. Thickness of collagen band was measured by using
image-analysis software.
RESULTS:
Compared with pretreatment findings, melanocytic and keratinocytic atypia
was significantly reduced and the collagen band thickness doubled.
LIMITATIONS:
This was an open-label study.
CONCLUSION:
Improvement in epidermal cellular atypia is consistent with the ability of RA to
act as a chemopreventive agent in epithelial carcinogenesis. Prolonged use also
significantly increased collagen matrix deposition in dermal repair zones, which
most likely contributes to wrinkle effacement by RA.
Arch Dermatol. 2004 Dec;140(12):1508-12.

Response of oral lichen planus to topical tacrolimus in 37 patients.
Byrd JA, Davis MD, Bruce AJ, Drage LA, Rogers RS 3rd.
Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA.
Erratum in
Arch Dermatol. 2005 Mar;141(3):370.
Abstract
BACKGROUND:
Topical tacrolimus has been reported to be effective for the treatment of oral
lichen planus. This article describes our experience with topical tacrolimus in
patients treated for symptomatic oral lichen planus.
OBSERVATIONS:
A survey was mailed to 40 patients with symptomatic oral lichen planus treated
with topical tacrolimus. Surveys were completed by 37 patients (93%) a mean of
1.3 years after initiation of treatment. Thirty-three (89%) of the 37 patients reported
symptomatic improvement, and 31 (84%) reported partial to complete lesion
clearance while using topical tacrolimus. On average, patients noted
improvement in 1 month. Twelve patients (32%) reported adverse effects
consistent with those reported previously (ie, burning, irritation, and tingling).
Among the 28 patients still using the medication, 15 patients (54%) apply it at
least once daily. Of the 9 patients who discontinued using the medication, 5
experienced recurrence.
CONCLUSIONS:
Topical tacrolimus is effective for the treatment of oral lichen planus. Most
patients experienced symptomatic improvement in less than 1 month. However,
the effect is temporary; when topical tacrolimus is discontinued, oral lichen
planus may flare again.
Oral Dis. 2006 Nov;12(6):559-65.

Triamcinolone acetonide mouth rinses for treatment of erosive oral lichen planus:
efficacy and risk of fungal over-infection.
González-García A, Diniz-Freitas M, Gándara-Vila P, Blanco-Carrión A, García-
García A, Gándara-Rey J.
Department of Oral Surgery and Oral Medicine, School of Dentistry, University of
Santiago de Compostela, Santiago de Compostela, Spain.
gonzalezygarcia@gmail.com
Abstract
OBJECTIVES:
To assess the efficacy of triamcinolone acetonide mouthrinse for treatment of
erosive oral lichen planus (OLP), and to evaluate the risk of fungal over-infection.
Clinical records of all cases of erosive and erosive-ulcerative OLP treated in our
Oral Medicine Service over the period 1993-2003 were reviewed. All patients had
been treated with mouthrinses containing triamcinolone acetonide at 0.3% (T1)
or 0.5% (T2). Clinical outcome for each patient was classified at 1, 3 and 6 months
after start of treatment as total remission (TR), partial remission (PR) or no remission
(NR). Fungal over-infection was also recorded.
RESULTS:
A total of 35 cases were included in the study. Clinical outcomes considering
both treatment groups together (T1 + T2) were as follows: at month 1, 28.6% TR,
62.9% PR, 8.6% NR; at month 3, 57.1% TR, 37.1% PR, 5.7% NR; and at month 6, 80.0%
TR, 17.1% PR, 2.9% NR. In four patients (11.4%) fungal over-infection was noted
during the study period.
CONCLUSION:
Triamcinolone acetonide mouthrinse is an appropriate treatment for erosive OLP,
in view of the high efficacy and low risk of fungal over-infection.
Acta Derm Venereol. 2006;86(3):227-9.

A comparison of treatment of oral lichen planus with topical tacrolimus and
triamcinolone acetonide ointment.
Laeijendecker R, Tank B, Dekker SK, Neumann HA.
Department of Dermatology, Albert Schweitzer Hospital, Dordrecht, The
Netherlands. R.Laeijendecker@asz.nl
Abstract
Treatment of symptomatic oral lichen planus remains a challenging problem. This
study compared the efficacy of topical tacrolimus ointment with triamcinolone
acetonide ointment in patients with oral lichen planus. Twenty patients (group I)
were treated with topical tacrolimus 0.1% ointment 4 times daily, and 20 (group
II) were treated with triamcinolone acetonide 0.1% ointment 4 times daily. The
clinical effect was graded after 6 weeks. In group I, 6 patients healed, 12 showed
improvement and 2 showed no improvement. In group II, 2 patients healed, 7
improved and 11 showed no improvement. The most commonly reported side-
effect in both groups was temporary burning or stinging at the site of application.
Unfortunately, oral lesions recurred within 3-9 weeks of cessation of treatment in
13 of the 18 patients who had initially shown an improvement or were healed in
group I and in 7 of the 9 patients in group II. Topical tacrolimus 0.1% ointment
induced a better initial therapeutic response than triamcinolone acetonide 0.1%
ointment. However, relapses occurred frequently within 3-9 weeks of the
cessation of treatment.

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Sua patogênese é multifatorial, mas foram identificados quatro passos básicos.

Legenda: Mecanismo de formação das lesões acneicas.

A principal região atingida é a face e, em menor grau, dorso, peito e ombros.

Um entendimento dos quatro passos

Ácido Salicílico ........................................2,0%

2. Sabonete de Limpeza para Peles Acneicas

Peróxido de Benzoíla ...............................4,0%

3. Gel Redutor da Acne

4. Creme com Antiandrógeno Tópico

7. Gel com Tretinoína

8. Gel com Adapaleno

9. Loção Oil-free Clindamicina

1. Cápsulas Redutoras da Acne Grave na Mulher

Apesar do conhecimento universal, a rosácea permanece como um tópico

As características primárias da rosácea (que podem ser observadas, mas não

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Antes de implementar um tratamento, os fatores desencadeantes específicos

1. Creme Redutor da Rosácea

2. Cápsulas de Azitromicina – Redução dos Sinais e

Discromia é um termo genérico que engloba toda e qualquer alteração da cor

É uma dermatose caracterizada por manchas acrômicas, em geral bilaterais e

As manchas decorrem da diminuição ou inexistência de melanócitos. Três

Há localizações preferenciais para crescimento das manchas, como face,

Composto Concentração Usual

A di-hidroxiacetona promove uma opção terapêutica segura e eficaz do vitiligo

Extrato de Polypodium leucotomos Via Oral + Fototerapia

Há uma clara tendência em aumentar a repigmentação nas regiões da

Tratamento com Minociclina Oral no Vitiligo

A minociclina oferece uma abordagem única e potencialmente poderosa para

Tratamento com Tacrolimus Tópico a 0,03%

A aplicação tópica de tacrolimus é uma modalidade terapêutica eficaz e bem

A aplicação tópica de pomada de tacrolimus é uma alternativa terapêutica

A adição do tratamento tópico com tacrolimus aumentou a extensão global

Terapia de Pulso Oral com Dexametasona

Os dados mostraram que a terapia de pulso oral com dexametasona é eficaz

Gingko biloba Oral

O extrato de G. biloba é uma terapia simples, segura e eficaz na interrupção da

L-fenilalanina Tópica + Propionato de Clobetasol e UVA no

2. Repigmentação nas Regiões da Cabeça e Pescoço

5. Cápsulas de Ginkgo biloba

Extrato de Gingko biloba.........................40mg

O melasma é um quadro caracterizado por manchas castanhas, mais ou menos

É considerada uma fotodermatose, pois o sol é um fator desencadeante e

O tratamento baseia-se na fotoproteção e no uso de agentes

1. Creme Redutor de Hipercromias

2. Creme Clareador Potencializado

5. Creme Clareador Potencializado

NOVO ÚNICO MECANISMO DE AÇÃO

Meliatone 2%, ac.tranexamico 3%, niacinamida

USO ORAL - discromias

Protocolo CISTEAMINA BY NEOFARMA

Ácido retinóico .................................5%

Ácido tranexâmico ...........................5%

Gel especial qsp ............................ 30g

Modo de uso: Aplicar em toda a região a ser

agir por 4 HORAS.

Remover com água e sabonete neutro de

Intervalos: 15 dias, OU A CRITÉRIO MÉDICO.

Serum fluido para microagulhamento

6. Loção com Ácido Ferúlico e Vitamina C

Tem distribuição universal, com prevalência variando de 1 a 3%, dependendo

Tem base hereditária, provavelmente multifatorial, o que significa dizer que é de