Background. Elevated levels of antibody to streptococcal exoenzymes have been found in patients with psoriasis or psoriatic arthritis. Research on the role of streptococcal antigen in psoriasis has been hampered by a potential molecular mimicry between streptococcal epitopes and human epidermal keratin. Objective and Methods. Evidence of microbial product was sought in skin biopsies of psoriasis patients thought clinically to have either streptococcal carrier state or gastrointestinal candidal colonization. A polyclonal antibody to streptococcal-derived exoenzymes unlikely to share antigenic structures with normal human skin, and an anticandidal antibody, were used with linked streptavidin biotin amplification stain. Results. The predicted microbial product appeared heavily in lesional epidermis, but unexpectedly also as a thin deposit along the skin basement membrane zone (SBMZ) of apparently unaffected skin. Staining was negative for nonpsoriatic subjects. Conclusions. The findings support a direct effect of microbial antigen in psoriasis. They also suggest an important role for SBMZ as a very large adhesive surface in the first step of a process of percutaneous epidermal elimination of foreign antigens and microbial toxins. The many autoimmune phenomena seen so often at the SBMZ are probably a physiologic part of this important immune function. Efforts to enhance the adhesive properties of SBMZ should be exploitable for both diagnostic and therapeutic benefit.

It has been suggested previously that psoriasis is best explained as a distinctive inflammatory response to a variety of microbial stimuli, all acting primarily through activation of the alternative complement pathway. For the past several years we have conducted a "Problem Psoriasis Clinic" based on that premise. Patients are questioned, examined, and subjected to microbiologic laboratory investigations in an attempt to identify possibly relevant microorganisms, and then are treated with antibiotics. This article lists the most commonly found microorganisms in psoriasis patients and describes the usual treatment for each. Results obtained with this approach compare favorably with those achieved with more usual anti-psoriasis treatments. We recommend that a microbiologic investigation and a trial of antimicrobial treatment should precede any plan to treat psoriasis patients with anything more than the simplest topical agents.

Twenty-eight patients with severe cutaneous infections received cefoperazone, 2 grams intramuscularly twice a day for seven days. A wide range of gram-positive and gram-negative pathogens were isolated from admission cultures. All patients showed rapid clinical improvement. Two patients did not complete the full course of therapy because of intervening medical problems unrelated to the antibiotic. No significant side effects were noted. Relapses or reinfections occurred in two patients. In conclusions, cefoperazone is a safe and effective antibiotic for use in skin infections requiring parenteral therapy.

The addition of 5 days of rifampin therapy to a 10- or 14-day course of penicillin or erythromycin therapy has been shown to reduce greatly the rate of chronic streptococcal carriage. The empiric use of rifampin in combination with penicillin or erythromycin in nine of nine patients with streptococcal-associated psoriasis appeared to coincide with a marked improvement in their skin.

At the Problem Psoriasis Clinic at the University of Tennessee, Memphis, we use an antimicrobial approach for the treatment of psoriasis. This method is described for patient history, physical examination, and laboratory tests as well as treatment.

The recent discovery that human epidermal cells themselves make and secrete the components necessary for activation of the alternative complement pathway appears to provide an explanation for how human skin is ordinarily able to avoid colonization by molds and other organisms. It also helps clarify the mechanisms underlying clinical and laboratory findings seen in chronic mucocutaneous candidiasis, dandruff, and psoriasis. Psoriasis seems best explainable as a visible, late stage of the inflammatory sequelae of activation of the alternative complement pathway in the epidermis.

It has been suggested previously that psoriasis is best explained as a distinctive inflammatory response to a variety of microbial stimuli, all acting primarily through activation of the alternative complement pathway. For the past several years we have conducted a "Problem Psoriasis Clinic" based on that premise. Patients are questioned, examined, and subjected to microbiologic laboratory investigations in an attempt to identify possibly relevant microorganisms, and then are treated with antibiotics. This article lists the most commonly found microorganisms in psoriasis patients and describes the usual treatment for each. Results obtained with this approach compare favorably with those achieved with more usual anti-psoriasis treatments. We recommend that a microbiologic investigation and a trial of antimicrobial treatment should precede any plan to treat psoriasis patients with anything more than the simplest topical agents.

The aim of the study was to investigate the teratogenicity of oral nystatin treatment during pregnancy in the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996. In total, 38,151 pregnant women who delivered newborn infants without any defects (control group) and 22,843 pregnant women who had foetuses or newborns with congenital abnormalities (CA)(case group) were included in the study. 106 (0.5%) case and 143 (0.4%) control pregnant women were treated with oral nystatin (crude OR with 95% CI = 1.2, 1.0-1.6). A teratogenic potential of nystatin was seen in 1 CA-group (hypospadias) in 2 different approaches of the study (case-control and total control--CA groups comparison) during the critical period of this congenital abnormality. The conclusion of the study is that treatment with oral nystatin during pregnancy presents little teratogenic risk to the foetus, but the possible association between hypospadias and nystatin needs further study.

OBJECTIVE: The dose-effect relationship of nifuratel (CAS 4936-47-4)+ nystatin (CAS 1400-61-9, CAS 34786-70-4)(Macmiror Complex) in topical treatment of vulvo-vaginitis was studied. METHOD: Sixty patients with Trichomoniasis and/or Candidiasis were randomized to: 1) nifuratel 125 mg/nystatin 50000 IU, 2) nifuratel 250 mg/nystatin 100000 IU, 3) nifuratel 500 mg/nystatin 200000 IU. Undistinguishable ovules were intravaginally applied qd for 10 days. The dose-effect relationship was assessed by ANCOVA. RESULT: After 5 days the microbiological cure rate occurred in 10% of patients in the least dose, in 40% in the middle dose and in 85% in the highest dose group (P = 0.000). After 10 days of treatment, the microbiological cure rate increased to 45%, 84%, and 95%, respectively (P = 0.007). Clinical signs and symptoms gradually disappeared in a dose- and time-dependent manner. No relapse has been observed after 10 day-follow up on 46 patients. CONCLUSION: The results confirmed a linear relationship between nifuratel + nystatin dose and effect. The least effective dose was nifuratel 250 mg + nystatin 100,000 IU once daily for 5 days and the best dose in terms of risk/benefit ratio was nifuratel 500 mg + nystatin 200,000 IU once daily for 5 days.

PURPOSE: To evaluate the antifungal effect of a nystatin mouth rinse to control oral candidiasis of elderly patients in palliative care. MATERIALS AND METHODS: 52 cancer patients (mean age: 83 years) hospitalized in a long term care facility for chronically ill geriatric patients. Mouth rinsing with 15 ml nystatin solution (4,000 Ul/ml) was carried out for one minute, six times daily, over two weeks. Yeasts were collected and seeded on CHROMagar. Growth was read qualitatively and quantitatively after two days' incubation at 37 degrees C. RESULTS: Clinical signs of oral candidiasis were observed in 31% of cases. High yeast scores were observed in 58% of the residents. There was an association between signs of oral candidiasis and high yeast scores (p < 0.001). Treatment for two weeks caused no clinical changes nor reduced yeast scores. CONCLUSIONS: No clinical or antifungal effect from the nystatin suspension suggests that the concentration of nystatin in the mouth rinse was too low. A more effective procedure should be employed for antifungal treatment of terminally ill patients. Appropriate antimicrobial solutions with lubricating activity should be developed and applied to prevent oral diseases.

BACKGROUND: Propylthiouracil (PTU) has been used in the treatment of hyperthyroidism for many years and inhibits the enzyme 5'-deiodinase, which converts thyroxine to triiodothyronine. Several studies have reported PTU as an effective treatment for plaque psoriasis. PTU exhibits immunomodulatory effects; however, its exact mechanism of action in psoriasis is unknown. Few patients were studied in these reports and treatment with PTU was continued for no longer than 8 weeks. METHODS: In this study we report on four patients with resistant plaque psoriasis who had treatment with oral PTU for 4-32 weeks (mean 18.4). RESULTS: Three of the four patients exhibited moderate clinical improvement with reductions in psoriasis severity observed within 4-6 weeks of commencing PTU therapy. The side effects noted were subclinical hypothyroidism in two patients and worsening of muscle aches in one patient. Monitoring included regular thyroid function, full blood count, and liver and renal function tests. CONCLUSION: This study illustrates that oral PTU can be a useful addition to the therapy of resistant cases of plaque psoriasis and shows that this treatment can be continued for longer than 8 weeks with few side effects occurring secondary to PTU.

The clinical feature of 20 cases with oral candidiasis in Sjögren's syndrome (SS) were reported, and the treatment effect by topical nystatin smearing, 2% sodium bicarbonate solution rinsing, and transfer factor injecting for about 2 months were analysed. The results showed that the diagnostic criterion of oral candidiasis in SS included two aspects: the SS changes confirmed by labial gland biopsy and candidal hyphae and spores found in a smear. The results indicated that the comprehensive treatments were proved to be effective for oral candidiasis in SS.

BACKGROUND: Pustular psoriasis of the nail apparatus is a common disease that greatly influences the quality of life because of its chronic course and poor response to treatment. OBJECTIVES: To review the clinical and histopathological features, the response to treatment and the long-term follow-up of 46 patients with pustular psoriasis of the nail unit. METHODS: Treatments utilized included oral retinoids (n = 12), oral nimesulide (n = 13), topical calcipotriol (n = 15) and topical steroids (n = 18). Retinoids were utilized as first choice in seven patients with involvement of several digits and in five patients with severe relapses, whereas topical calcipotriol, oral nimesulide or topical steroids were utilized in patients with involvement of a single nail. Topical calcipotriol was also prescribed as maintenance therapy in patients who responded to oral treatment. Twenty-five patients were followed for more than 5 years. RESULTS: Improvement or regression of the lesions was obtained in 23 of 46 patients. Retinoids were effective in six of 12 patients, nimesulide in four of 13, topical calcipotriol in nine of 15 and topical steroids in four of 18. The long-term follow-up showed a complete remission of the disease in only two patients, both affected by pustular psoriasis involving multiple nails. All other patients experienced periodic relapses which were in most cases controlled by regular use of topical calcipotriol. CONCLUSIONS: Severe cases of pustular psoriasis of the nail are best treated with systemic retinoids. Topical calcipotriol is effective in about 50% of patients with localized disorder and is also useful as maintenance therapy after retinoid treatment.

BACKGROUND: Antifungal therapy has been claimed to be effective in polysymptomatic patients with diffuse symptoms from multiple body systems and even well defined diseases, traditionally not related to fungi. Hypersensitivity to fungus proteins and mycotoxins has been proposed as the cause. METHODS: We conducted a 4-week randomized, double-blind, placebo-controlled study in 116 individuals selected by a 7-item questionnaire to determine whether the antifungal agent nystatin given orally was superior to placebo. At the onset of the study, the patients were free to select either their regular diet or a sugar- and yeast-free diet, which resulted in four different subgroups: nystatin + diet (ND); placebo + diet (PD); nystatin (N); and placebo (P). RESULTS: Nystatin was significantly better than placebo in reduction of the overall symptom score (P < 0.003). In six of the 45 individually recorded symptoms, the improvement was significant (P < 0.01). All three active treatment groups reduced their overall symptom scores significantly (P < 0.0001), while the placebo regimen had no effect (P = 0.83). The benefit of diet was significant within both the nystatin (ND > N) and the placebo groups (PD > P). CONCLUSIONS: Nystatin is superior to placebo in reducing localized and systemic symptoms in individuals with presumed fungus hypersensitivity as selected by a 7-item questionnaire. This superiority is probably enhanced even further by a sugar- and yeast-free diet.