Sunday, 28 August 2011

Erythema dyschromicum perstans treatment options

Erythema dyschromicum perstans (EDP) has similarities to lichen planus pigmentosus although the precise relationship of the two conditions has yet to be established.

How to treat it?

There is no established therapy for this condition. Having said so, there are 5 options to be considered.

1)     No therapy. The condition is persistent, but may resolve over time. In a series of 4 patients followed up for 2 years in Finland, 3 showed spontaneous resolution.

2)     Vitamin A. Lichen planus pigmentosus has responded (50 – 100% clearance in some patients)  to vitamin A prescribed in pulses of 100,000 units daily for 15 days (pulses were repeated  up to 10 times) in a study. This recommendation is considered by those who reckon that EDP is the same entity as lichen planus pigmentosus.

3)     Dapsone 100 mg/day for 8 to 12 weeks might be effective (anecdotal report).

4)     Oral steroids might work (anecdotal report).

5)     Clofazimine* 100 mg/day for 12 weeks. It seems that clofazimine reduces the inflammatory response in EDP. 4 out of 6 patients showed marked improvement.

*Barabda L, Torres-Alvarez B, Cortes-Franco R et al. Involvement of cell adhesion and activation molecules in the pathogenesis of erythema dyschromicum perstans (ashy dermatosis): the effect of clofazimine therapy. Arch Dermatol 1997; 133: 325–9.

Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology