Treatment for syphilis in antenatal care: compliance with the three dose standard treatment regimen

Background: In South Africa, three doses of benzathine penicillin 2.4 MU at weekly intervals are recommended for treating syphilis in pregnancy. Limited information is available on compliance with the recommended regimen, in terms of time to starting treatment, number of doses, and timing of treatment. Methods: The study was conducted to establish the degree of compliance with treatment for syphilis. Timing of treatment and the titres of the rapid plasma reagin (RPR) positive women were recorded. A retrospective record review was conducted of 18 128 antenatal records. These were records of women attending antenatal care clinics in a tertiary hospital catchment area in KwaZulu Natal between February 2001 and January 2002. Results: Treatment patterns showed that 15.9% received no treatment, 13.2% one dose, 5.8% received two doses, and 64.8% received three doses. In total, 188 women (1.03%) were found to be RPR positive. Of these 36% were found to be high titre positives (titre ⩾1:8). Conclusion: Completed treatment was significantly associated with age of gestation at first visit (p = 0.029), with women attending later in pregnancy less likely to receive all three doses of treatment

Unresponsive Zoon’s vulvitis and balanitis treated with topical pimecrolimus: our experience

Unresponsive Zoon’s vulvitis/balanitis treated with topical pimecrolimus: our experience Zoon’s vulvitis and balanitis are notorious for their recalcitrant nature to conservative topical and some surgical therapy, and frequently balanitis requires circumcision as a curative measure. Topical calcineurin inhibitors (tacrolimus and pimecrolimus) approved for atopic dermatitis, have a potential in other inflammatory skin diseases. We investigated the efficacy and safety of pimecrolimus 1% cream in Zoon’s vulvitis and balanitis unresponsive to conservative topical therapy with a follow-up period of 18 months. Eleven patients (four woman and seven uncircumcised men ) aged between 45 and 78 years with histologically proven Zoon’s vulvitis or balanitis, were treated for 16 weeks twice daily with pimecrolimus 1% cream in an observational study. Clinical examination and recording of patients symptoms was performed before, after four and eight weeks, and after three and four months of therapy, respectively. All cases had photographs taken before and after treatment. All patients experienced improvement in symptoms with remarkable relief of pruritus and burning after the first weeks of treatment. At the end of therapy, clinical resolution was observed in ten patients (four woman and six men). Partial resolution was reached in one man. All patients showed no relapse during the follow-up period. On the basis of our case observations, pimecrolimus seems to be effective in Zoon’s vulvitis and balanitis unresponsive to conservative topical therapy. We emphasize its possible use as an alternative therapy expecially in men who declines circumcision

Topical calcineurin inhibitors in the management of anogenital lichen sclerosus unresponsiveto ultra-potent corticosteroids: our experience

Lichen sclerosus (LS) is a chronic disease with evidence of a lymphocyte- mediated origin. Corticosteroids have been the mainstay of therapy for LS. The potential for side-effects and tachyphylaxis limit their utility in providing long-term disease control. Topical calcineurin inhibitors (TCIs) (tacrolimus and pimecrolimus) approved for atopic dermatitis, have a potential in other inflammatory skin diseases. We investigated the efficacy and safety of tacrolimus ointment 0.1% and pimecrolimus 1% cream in anogenital LS unresponsive to ultra-potent corticosteroids. Ten patients (four woman and six men) aged between 52 and 76 years with histologically proven active anogenital LS, were treated for 16 weeks twice daily with either topical tacrolimus (one woman and three men) or pimecrolimus (three woman and three men) in an observational study. Clinical examination and recording of patients symptoms were performed before, after four and eight weeks, and after three and four months of therapy, respectively. Of the ten subjects enrolled, one individual (a man treated with tacrolimus) discontinued the study due to severe pain at week 2. Eight patients experienced improvement in symptoms with remarkable relief of pain and pruritus after the first weeks of treatment. At the end of therapy, complete remission of symptoms was achieved in eight patients, and clearance of active LS was reached in two cases (one woman treated with tacrolimus and one man treated with pimecrolimus). Partial resolution was reached in six patients (one woman and one man treated with tacrolimus, two woman and two men treated with pimecrolimus). All patients showed no recurrence of disease activity during the follow-up period of 21 months. In our opinion TCIs seem to be effective in LS, expecially in anogenital LS unresponsive to ultrapotent corticosteroid

Malignant hypercalcemia in vulvar cancer

Humoral hypercalcemia of malignancy (HHM) is a common paraneoplastic syndrome, most often associated with squamous cell carcinoma of the lung, esophagus, kidneys and breast, but rarely with vulval cancer. In most patients, HHM is associated with over-production of a peptide analogue of parathormone (parathyroid hormone-related protein, PTHrP). The case of a 70-year-old patient with massive squamous cell epithelioma of the vulva complicated by HHM is reported. To our knowledge, this is the first documented case with high serum concentrations of PTHrP and immunohistochemical confirmation of PTHrP production by neoplastic cells