Faculty Bibliography

In a double-blind crossover study, oral papaverine hydrochloride in doses of 150-300 mg t.i.d. was compared to placebo as an adjunctive treatment of atopic dermatitis. Twenty patients completed both 2-week phases of the crossover during which time the physician's weekly evaluation included an estimate of percentage skin involvement with disease, global evaluation and the grading of the erythema, scale and lichenification of a representative plaque. The patients' evaluation included their assessment of the degree of pruritus, and an estimate of the percentage of the day pruritus was present as well as a global evaluation of disease. Papaverine demonstrated no statistically significant advantage over placebo for any of the parameters measured and was noted to cause transient asymptomatic liver function test abnormalities in 3 of the study patients

Etretinate is an aromatic retinoid and derivative of vitamin A soon to be approved for general use in the U.S. as therapy for severe psoriasis. We report on liver morphology and function in 18 subjects who received the drug for at least 5 years as part of a clinical trial. The majority (14) suffered no or mild and reversible structural liver changes; mild transient elevations in serum triglyceride and liver enzymes were noted occasionally. Of the remaining four patients, mild periportal fibrosis was documented in two, another had changes similar to chronic active hepatitis, and a fourth had cirrhosis that was unrelated to alcohol use. Liver function data, cumulative drug dose, and treatment duration were generally not reflective of these changes. The results of this study suggest a need for periodic liver biopsy to monitor patients on long-term etretinate therapy