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The treatment of melasma remains a clinical challenge despite a considerable number of topical agents being tested in monotherapy or in association. The aim of this study is to eva/uate the efficacy and the safety of the depigmentation cream D4® in the treatment of epidermal melasma, which is mainly an association of glycolic and kojic acids, arbutin and depigmentation factor 174J/276-D. Seventeen female and two male Caucasians patients applied in a twice daily regimen for 12 weeks the depigmentation cream D4® on lesions of epidermal melasma. The response to the treatment was assessed by clinical evaluation, analog linear scale, calculation of the affected area, colorimetry and standard photography at 0, 4, 8 and 12 weeks. The treatment resulted in a progressive, but significative reduction on the intensity of melasma (p=O.OO1) and on the extension of the lesions (p=O.01), with a similar evaluation of the improvement made by both the observers and the subjects at weeks 4, 8 and 12. As a result of the progressive whitening of the lesions, co/orimetric measurement revealed a progressive in crease of the L (Lightness) parameter in the treated areas with values of 58.8, 60.4, 61.2 and 62.0 at O, 4, 8 and 12 weeks, respectively. Side-effects, mainly local irritation, affected 43.8% of the patients in the first month of the treatment period, but decreased to 25% by the end of the study. Only one patient discontinued the treatment due to a local adverse effect. The depigmentation cream D4® is an efficacious agent for the treatment of epidermal melasma

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BACKGROUND: The etiologic diagnosis of hand dermatitis (HD) is often difficult. Knowledge of the relationship between atopy and nickel sensitivity as risk factors for HD is limited. OBJECTIVE: To compare irritant contact dermatitis, allergic contact dermatitis, and dyshidrotic eczema relative to personal atopy, patch-testing results, occupation, and clinical patterns. METHODS: From patients referred for patch testing, 714 consecutive individuals with HD were retrospectively studied. RESULTS: Half of the patients had eczema confined to the palms. The dorsal pattern was more prevalent in atopic patients, compared to nonatopic patients. Irritant contact dermatitis was the most frequent diagnosis (55.3%), followed by allergic contact dermatitis (24.4%) and dyshidrotic eczema (20.3%). Among housewives, health workers, and mechanics, irritants were of much greater importance than allergens whereas among hairdressers and bricklayers, the opposite was found. The prevalence of personal atopy did not differ significantly between different types of HD. Nickel sensitivity was much less frequent in irritant contact dermatitis than in allergic contact dermatitis or dyshidrotic eczema. The distribution of clinical patterns was similar. CONCLUSION: This study suggests that different etiologic diagnoses of HD cannot be distinguished by clinical pattern, prevalence of personal atopy, or nickel-sensitivity.

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Objectivo: Neste trabalho pretendeu-se avaliar a eficácia e a agradabilidade cosmética de um champô de lactato de amónio a 6 por ciento, cetoconazol a 1 por ciento e piroctonalonamina a 0,5 por ciento* no tratamento da pitiríase do couro cabeludo.Método: Utilizou-se o champô durante quatro semanas, em 30 doentes, 16 do sexo masculino e 14 do feminino, duas ou três vezes por semana, com uma só aplicação de 1 a 2 ml, em massagem ligeira, durante dois minutos. A acção do champô foi estudada na redução da extensão e da intensidade da descamação, do eritema e do prurido. Resultados: Na avaliação final feita por cinco médicos, catorze (48,2 por ciento) doentes foram classificados com muito bom, treze (44,7 por ciento) com bom e dois (6,9 por ciento) com regular, enquanto que na avaliação dos doentes, nove (31,0 por ciento) deram a classificação de muito bom, dezasseis (55,2 por ciento) a de bom e quatro (13,8 por ciento) a de regular. Em nenhum caso se verificou a classificação de mau. A diminuição da área da pitiríase observou-se sobretudo nos casos em que, na consulta inicial, era superior a 50 cm2. Como efeitos secundários, dois doentes referiram acentuação da oleosidade, um, queda de cabelo e, outro, dermite irritativa.Conclusões: o champô revelou-se eficaz e bem tolerado no controle da pitiríase do couro cabeludo, nas condições prescritas, durante um mês. (AU) - Pt

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