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Volume 1, Number 3, January 1996
Contents: (Full text available in print editition.)
Topical Vitamin E Formulations: Not Always BenignThe apparent lack of efficacy of oral vitamin E (alpha-tocopheryl acetate) for most dermatologic disease (1) has not stopped the widespread use of vitamin E in moisturizing and anti-aging creams, lotions, oils, and ointments, based on the mistaken notion that vitamin E can somehow "improve" the skin by removing wrinkles and improving tone.
As dermatologists, we believed that even if topical vitamin E served a limited function, its use was nonetheless relatively benign. Unfortunately, this is not always the case. Although the systemic administration of vitamin E almost never produces any untoward reaction, various topical preparations can cause allergic dermatitis.
Vitamin E and Contact Dermatitis: An Epidemic in Switzerland!
In Spring 1992, an epidemic outbreak of papular and, more frequently, follicular rashes caused by a new line of cosmetics occurred throughout Switzerland. More than 900 cases were reported (263 by dermatologists plus 642 reported directly to the manufacturer), representing at least three cases of contact dermatitis per 1,000 units sold. Patch and use testing isolated vitamin E linoleate (a mixture of tocopheryl esters, mainly tocopheryl linoleate) as the causative agent. Onset of symptoms was 1-160 days (median 14 days) after first use of the cosmetics. The lesions were long lasting, widely distributed, associated with a pronounced pruritus, and frequently aggravated by sweating, solar irradiation, or heat. The rash subsided within 1-4 weeks following topical or oral corticosteroid treatment but sometimes relapsed after sun exposure. Lesions were frequently misdiagnosed as drug eruptions, viral exanthems, urticaria, polymorphous light eruption, or ectoparasitosis.(2)
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2. Greaves MW, Weinstein GD. "Treatment of psoriasis." N Eng J Med 1995; 332:581-588.
3. Paul MA, Jorizzo JL, Fleischer AB Jr, et al. "Low-dose methotrexate treatment in elderly patients with bullous pemphigoid." J Am Acad Dermatol 1994; 31:620-625.
4. Wilson K, Abeles M. "A 2-year open ended trial of methotrexate in systemic lupus erythematosus." J Rheumatol 1994; 21:1674-1676.
5. LeBlanc BAGW, Dagenais P, Urowitz MB, et al. "Methotrexate in systemic lupus erythematosus." J Rheumatol 1994; 21:836-838.
5a. Bottomley WW, Goodfield MJD. "Methotrexate for the treatment of discoid lupus erythematosus." Br J Dermatol 1995; 133:655-656.
6. Olsen EA. "The pharmacology of methotrexate." J Am Acad Dermatol 1991; 25:306-318.
7. Webster GF, Razsi LK, Sanchez M, et al. "Methotrexate therapy in sarcoidosis." Annals Intern Med 1989; 111: 538 - 539.
8. Weiner MJ. "Methotrexate in cortico-resistant urticaria." Annals Intern Med 1989; 110:848.
9. Hwang GC, Lin AY, Chen W, et al. "Development and optimization of methotrexate topical formulation." Drug Devel and Ind Pharmacy 1995; 21:1941-1945.
10. Duhra P. "Treatment of gastrointestinal symptoms associated with methotrexate therapy for psoriasis." J Am Acad of Dermatol 1993; 28:466-469.
11. Whiting-O'Keefe QE, Fye KH, Sack KD. "Methotrexate and histologic abnormalities: a meta-analysis." Am J Med 1991; 90:711-716.
11a. Boffa MJ, Chalmers RJG, Haboubi NY, et al. "Sequential liver biopsies during long-term methotrexate treatment for psoriasis: a reappraisal." Br J Dermatol 1995; 133:774-778.
12. Kremer JM, Alarcon GS, Lightfoot RW Jr, et al. "Methotrexate for rheumatoid arthritis: suggested guidelines for monitoring liver toxicity." Arthritis Rheum 1994; 37:316- 328.
13. Petrazzuoli M, Rothe MJ, Grin-Jorgensen C, et al. "Monitoring patients taking methotrexate for hepatotoxicity." J Am Acad Dermatol 1994; 31:969-977.
Minoxidil was first made available OTC in the UK in September 1995. Prior to that, New Zealand, Guatemala, Denmark, and the Netherlands granted similar status for the treatment of hair re-growth for androgenetic alopecia. Canada is still awaiting OTC approval.
The USA FDA Advisory Committee has recently approved the use of minoxidil 5% for the treatment of male pattern hair loss. Regulatory authorities in New Zealand and Denmark have approved the use of minoxidil 5%.
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