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ePaper created 2014-09-15, 12:31:02 | version 1.32.01
with DCP in alopecia areata. 139 patients with severe alopecia areata (the majority with the subtotal, total, or universalis type) were treated in Nijmegen with topical immunotherapy (DCP).[2] Patients were initially treated unilaterally; the other side of the scalp served as a control. In 50% of the patients the response was either excellent (total regrowth) or satisfactory (subtotal regrowth with only a few remaining bald patches). The most frequent side effects were eczematous reactions with blistering, spreading of the induced contact eczema, and sleep disturbances. Coal tar treatment has been a mainstay of atopic dermatitis treatment for more than 150 years. The carcinogenic effects of coal tar have been shown in animal experiments. Van der Valk and his collea- gues developed two research projects on the safety of tar: 1. Biomarker development: 1-hydroxypyrene proved to be a marker for systemic availability of tar products. It was shown that this marker is highly sensitive and reproducible. In particular, during pregnancy, healthcare workers should not apply tar products to patients. 2. Epidemiology of cancer after the coal tar treatment: it was shown in the largest patient sample in the world, that there was no increased frequency of cancer in patients treated with coal tar.[3] Coal tar continues to be an important topical treatment.[4] Infantile hemangiomas may represent major challenges in affected children. Recently, the treatment with propranolol has opened new opportunities. The Nijmegen group - the interdisciplinary working group HECOVAN (Hemangioma and Congenital Vessel malformations Nijmegen) - has studied the clinical characteristics of hemangiomas, the effect of hemangiomas on quality of life and the efficacy and safety of propranolol. From the studies it is evident that infantile hemangiomas have a major psychosocial impact.[5] The clinical characteristics differ between individual patients. It is important to realize that infantile hemangiomas may seriously impact health.[6] An impressive improvement by propranolol treatment could be shown convincingly in a large group of infants with hemangiomas.[7,8] References 1. Bröcker EB, Echternacht-Happle K, Hamm H, et al. Abnormal expression of class I and class II major histocompatibility antigens in alopecia areata: modulation by topical immunotherapy. J Invest Dermatol. 1987; 88: 564-8. 2. Steen PH van der, van Baar HM, Perret CM, et al. Treatment of alopecia areata with diphenylcyclopropenone. J Am Acad Dermatol. 1991; 24: 253-7. 3. Roelofzen JH, Aben KK, Oldenhof UT, et al. No increased risk of cancer after coal tar treatment in patients with psoriasis or eczema. J Invest Dermatol. 2010; 130: 953-61. doi: 10. 1038/jid.2009.389. Epub 2009 Dec 17. 4. Roelofzen JH, Aben KK, Khawar AJ, et al. Treatment policy for psoriasis and eczema: a survey among dermatologists in the Netherlands and Belgian Flanders. Eur J Dermatol. 2007; 17(5): 416-21. Epub 2007 Aug 2. 5. Zweegers J, van der Vleuten CJ. The psychosocial impact of an infantile haemangioma on children and their parents. Arch Dis Child. 2012; 97(10): 922-6. doi : 10. 1136/archdischild-2012-302470. Epub 2012 Aug 4. 6. Hermans DJ, Boezeman JB, Van de Kerkhof PC, et al. Differences between ulcerated and non-ulcerated hemangiomas, a retrospective study of 465 cases. Eur J Dermatol. 2009; 19(2): 152-6. doi: 10. 1684/ejd.2008.0576. Epub 2008 Dec 23. 101 BWEADVSMGFINCORR:Opmaak 1 21-07-2014 17:40 Pagina 101