Elephantiasis nostras verrucosa (ENV) is an uncommon condition caused by repeated inflammation and lymphatic obstruction. It occurs mainly in the lower extremities and is characterized by skin changes, including hyperkeratotic mossy papules and plaques, non-pitting edema, and cobblestone-like appearances. ENV can be diagnosed based on its typical clinical manifestations (pseudoepitheliomatous hyperplasia with enlarged lymphatic spaces, fibrous tissue proliferation, and chronic inflammation) and by skin biopsy. Although ENV is difficult to treat, reduction of lymphedema and use of keratolytic agents may be helpful. To our knowledge, only three cases of ENV have been reported. However, the case of ENV treated with oral acitretin has not been reported in domestic literatures. Therefore, we report the case of a 45-year-old woman who developed ENV. She had a past history of cellulitis and was successfully treated with oral acitretin.
Acitretin ; Biopsy ; Cellulitis ; Edema ; Elephantiasis ; Female ; Humans ; Hyperplasia ; Inflammation ; Keratolytic Agents ; Lower Extremity ; Lymphedema ; Middle Aged ; Skin

Animals ; Keratolytic Agents ; pharmacology ; Neural Crest ; embryology ; metabolism ; Signal Transduction ; drug effects ; Tretinoin ; pharmacology ; Zebrafish ; Zebrafish Proteins ; genetics ; metabolism

OBJECTIVETo observe the clinical curative effect of Chinese herbal medicine combined with acitretin capsule in treating psoriasis of blood-heat syndrome (P-BH).

METHODSEighty patients of P-BH were randomly assigned to two groups, 39 in Group A and 41 in Group B. Both was treated with Chinese herbal medicines for clearing heat, cooling blood and removing toxic substance, and acitretin capsule was given to Group A additionally, with 8 weeks as one therapeutic course. The clinical curative effect was compared between groups, and the change of psoriasis activity severe index (PASI) scores before and after treatment was observed.

RESULTSThe total effective rate in Group A was 84.2% and that in Group B 68.2%, also showing significance between groups (P<0.01). PASI score lowered significantly after treatment in both groups, showing statistical significance (P<0.01), but no significant difference between groups. Little adverse reaction was found in Group B, while in Group A, the adverse reaction was of even milder degree, which could be alleviated by adjusting the herbal medicine and symptomatic treatment administration.

CONCLUSIONSThe effect of Chinese herbal medicine combined with acitretin capsule was superior to Chinese herbal medicine alone in treating P-BH, but the adverse reaction of acitretin capsule could be alleviated by adjusting the herbs used. However, the result is waiting to be verified further by larger samples.

Acitretin ; administration & dosage ; Adult ; Aged ; Capsules ; Combined Modality Therapy ; Diagnosis, Differential ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Hematologic Diseases ; complications ; diagnosis ; drug therapy ; Hot Temperature ; Humans ; Keratolytic Agents ; administration & dosage ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Psoriasis ; diagnosis ; drug therapy ; Syndrome ; Treatment Outcome ; Young Adult

We report a case of a 9-year old male who presented with 2 months history of well-defined keratotic follicular papules on an erythematous base located on the scalp, face, trunk and extensor aspects of the extremities. Of the 5 clinical types of pityriasis rubra pilaris (PRP), our patient was classified as type III or the classical juvenile pityriasis rubra pilaris. Treatment modalities focused on the giving of topical corticosteroids, emolients and keratolytics which showed marked improvement on the cutaneous lesions.

Human ; Male ; Child ; Adrenal Cortex Hormones ; Extremities ; Face ; Keratolytic Agents ; Pityriasis Rubra Pilaris ; Scalp ; Torso

Minoxidil induces hair growth in male pattern baldness and prolongs the anagen phase. All-trans retinoic acid (ATRA) has been reported to act synergistically with minoxidil in vivo: they can enhance more dense hair regrowth than either compound alone. We evaluated the effect of minoxidil combined with ATRA on hair growth in vitro. The effect of co-treatment of minoxidil and ATRA on hair growth was studied in hair follicle organ culture. In cultured human dermal papilla cells (DPCs) and normal human epidermal keratinocytes, the expressions of Erk, Akt, Bcl-2, Bax, P53 and P21 were evaluated by immunoblot analysis. Minoxidil plus ATRA additively promoted hair growth in vitro, compared with minoxidil alone. In addition, minoxidil plus ATRA elevated phosphorylated Erk, phosphorylated Akt and the ratio of Bcl-2/Bax, but decreased the expressions of P53 and P21 more effectively than by minoxidil alone. Our results suggest that minoxidil plus ATRA would additively enhance hair growth by mediating dual functions: 1) the prolongation of cell survival by activating the Erk and Akt signaling pathways, and 2) the prevention of apoptosis of DPCs and epithelial cells by increasing the ratio of Bcl-2/Bax and downregulating the expressions of P53 and P21.
Tretinoin/*administration & dosage ; Minoxidil/*administration & dosage ; Keratolytic Agents/administration & dosage ; Humans ; Hair/cytology/*drug effects/*growth & development ; Drug Combinations ; Dose-Response Relationship, Drug ; Cells, Cultured ; Cell Proliferation/drug effects

OBJECTIVETo investigate the mechanism of tazarotene against active psoriasis vulgaris.

METHODSA randomized, controlled trial was conducted in 43 patients with active psoriasis vulgaris, who were divided into tazarotene and control groups. Promyelocytic leukemia (PML) mRNA in active psoriatic lesions before and 14 days after tazarotene treatment was detected by in situ hybridization.

RESULTSPML mRNA expression was detected not only in the basal layer (86.96%), but also in the suprabasal layers of the epidermis in the manner of focal expression (78.26%). After tazarotene treatment, virtually no PML mRNA expression could be detected in the psoriatic lesions (8.69% in the basal layer and 4.35% in the suprabasal layers). PML mRNA expression in the control group underwent no obvious changes during the observation.

CONCLUSIONSTazarotene may inhibit abnormal proliferation of keratinocytes through down-regulating PML gene expression in active psoriatic epidermis.

Adolescent ; Adult ; Double-Blind Method ; Down-Regulation ; drug effects ; genetics ; Epidermis ; drug effects ; metabolism ; pathology ; Female ; Gene Expression ; drug effects ; Humans ; In Situ Hybridization ; Keratolytic Agents ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Neoplasm Proteins ; genetics ; Nicotinic Acids ; administration & dosage ; therapeutic use ; Nuclear Proteins ; genetics ; Promyelocytic Leukemia Protein ; Psoriasis ; drug therapy ; genetics ; RNA, Messenger ; biosynthesis ; genetics ; Transcription Factors ; genetics ; Tumor Suppressor Proteins ; genetics

A 17-year-old woman had an extensive nevus comedonicus affecting the left sides of the breast, trunk, axilla, and upper extremity. Her condition was complicated by episodes of re-current cyst formation, secondary infection, and atrophic scars. We performed various therapeutic approaches include topical keratolytic agents, manual extraction of comedones, excision of smaller lesions, and systemic antibiotics but the response was unsatisfactory. We tried systemic isotretinoin and minocycline and the pustulation of the lesions was reduced. Herein we report a rare case of linearly arranged extensive nevus comedonicus.
Adolescent ; Anti-Bacterial Agents ; Axilla ; Breast ; Cicatrix ; Coinfection ; Female ; Humans ; Isotretinoin ; Keratolytic Agents ; Minocycline ; Nevus* ; Upper Extremity

BACKGROUND: Several keratolytic agents have been used in many dirmatologic conditions such as callus, keratosis palmaris of plantaris, however the evaluation method of the effects of keratolytiic agents has not been good enough in clinical use. OBJECT: We have conducted an investigation to measure the effect of several keratolytic agents using an in vitro model. METHOD: We measured the fegraded protein of keratin by the bui iet method after adding enzymes such as trypsin, pepsin and papain, and irritants, salicylic acid and sodii m lauryl sulfate to the collected callus. RESULT: The order of the keratolytic effect of the enzymes was trypsir >pepsin>papain. It was difficult to detect the keratolytic effect of salicylic acid becaues of color hiidrance and there was an increasing tendency of keratolyti effect of sodium lauryl sulfate, however it was prominent mainly at a high concentration. CONCLUSION: These results suggested that the potency of similar types of keratolytic enzymes such as pepsin, trypsin and papain can be possible. However it was not such a sitable model to check the potency of the keratolytic effect of salicylic acid and the eoncentration tevel may be an important factor for certain kinds of chemicals such as sodium lauryl sulfate.
Bony Callus ; Irritants* ; Keratolytic Agents ; Keratosis ; Papain ; Pepsin A ; Salicylic Acid ; Sodium Dodecyl Sulfate ; Trypsin

Hyperkeratosis of the nipple and areola is a rare skin disordr characterized clinically by thickening and discoloration of the skin of the areola and/or nipple and pathoiog cally by papillomaosis or acanthosis-nigricans like changes. We report a case of hyperkeratosis of the nipple and areola occuring in a woman with no underlying endocrinopathy and no other additional hyperkeratotic conditions. Ttie iresent case seems to be the nevoid form by the Levy-Franckel classification. Treatment with topical medications including steroids and keratolytic agents produced no improvement. Therefore we recommeneded surgical excision because the paient was greatly disturbed by the appearance of the lesions. Surgical excision and full thickness skin graft were performed sucessfully.
Classification ; Female ; Humans ; Keratolytic Agents ; Nipples* ; Skin* ; Steroids ; Transplants*

We report two cases of hyperkeratosis of the nipple and areola which occurred in 22-year-old woman and 13-year-old girl. The former was suffered from mild pruritic, verrucous thickening and brownish discoloration of both nipples and areolae for 5 years. The latter had asymptomatic, verrucous thickening and dark brownish hyper- pigmentation of the right nipple and areola for 3 years. Both showed mild to marked hyperkeratosis and papillomatosis with increased pigmentation in the basal cell layer histopathologically. In both cases, the lesions were not responsive to the topical medications including steroids and keratolytic agents. Therefore we recommended surgical excision because the patients are greatly disturbed by the appearance of the lesions.
Adolescent ; Female ; Humans ; Keratolytic Agents ; Nipples* ; Papilloma ; Pigmentation ; Steroids ; Young Adult