P6168A reliable and relevant method for assessing dandruff product efficacybased on the adherent scalp flaking score (ASFS)

James Schwartz, PhD, Procter and Gamble, Cincinnati, OH, United States;Haruko Mizoguchi, PhD, Procter and Gamble, Cincinnati, OH, United States;Robert Bacon, Procter and Gamble, Cincinnati, OH, United States

Background: Dandruff and seborrheic dermatitis (D/SD) are common and trouble-some scalp conditions with the primary signs and symptoms being presence of skinflakes, pruritus, a tight feeling, and sometimes erythema. We sought to demonstratethe reliability and relevance of a clinical model for the assessment of therapeuticefficacy of a treatment using the Adherent Scalp Flaking Score (ASFS) method toquantitate the flaking severity.

Methods: Six randomized, double-blind, parallel design studies were conducted ineither North America or Asia with subjects suffering from dandruff using the ASFSgrading method before and after a 3-week test product treatment period.

Results: Treatment with a commercial potentiated 1% zinc pyrithione (ZPT)shampoo resulted in statistically significant (P \ .0001) improvements in totalASFS compared with the placebo cosmetic shampoo. Results were consistent acrossall studies, geographies, and product usage protocols (controlled on-site vs homeuse conditions), and were associated with statistically significant improvements inself-perception of scalp condition. A well designed clinical trial requires consider-ation of appropriate base size that takes into account the magnitude of therapeuticeffects coupled with the variability of the data.

Conclusion: The ASFS-based clinical model was shown to be a reliable and provenmethodology to assess the effectiveness of themost common antidandruff treatmenttechnology. The results are consistent with patient self-assessments, establishingthis methodology as relevant to patient perception of product benefits and for therigorous assessment of the performance of antidandruff treatments.

APRIL 20

ponsored by Procter and Gamble.

100% is s

P6236Abdominal metastasis of papillary thyroid cancer

Javier Pedraz, PhD, MD, Hospital Cl�ınico San Carlos, Dermatology Department,Madrid, Spain; Alberto Conde-Taboada, MD, Hospital Cl�ınico San Carlos,Dermatology Department, Madrid, Spain; Alejandro Fueyo-Casado, MD,Hospital Cl�ınico San Carlos, Dermatology Department, Madrid, Spain; EduardoL�opez-Bran, MD, Hospital Cl�ınico San Carlos, Dermatology Department, Madrid,Spain; Luc�ıa Campos-Mu~noz, MD, Hospital Cl�ınico San Carlos, DermatologyDepartment, Madrid, Spain

Papillary thyroid carcinoma is the most frequent type of thyroid malignancy, and theusual metastasis sites include the locoregional lymph nodes. Distant metastasis ofpapillary thyroid cancer is rare and usually involves the lungs, liver, bones, and brain.The skin metastasis of papillary thyroid carcinoma is a rare condition. The scalp isthe most frequent site involved in skin metastasis of papillary thyroid cancer. Othercutaneous areas that are involved with less frequency are the cheeks, shoulders,arms, abdomen, and thighs. In this report, we aim to present a case report of a 71-year-old woman with abdominal metastasis of papillary thyroid cancer. The patientpresented with a medical history of papillrary thyroid carcinoma diagnosed 21 yearsearlier. She had a medical history of total thyroidectomy and also had receivedradiotherapy at the very beginning and repeated doses of radiactive iodine therapyin the past 5 years. She also had a history of unilateral breast cancer removed 4 yearsago and treated with both chemotherapy pre- and postradiotherapy.When she cameto our clinic, she was under treatment with thyroid stimulatin hormoneesuppres-sive therapy with levothyroxine. She presented with a 2.5-cm 3 2.5-cm, flesh-colored tender nodule in her half right abodmen of 1 months’ duration. The lesionwas not painful at palpation. Excisional biopsy was carried out. Histopathologicexamination of the lesion revealed skin tissue with tumoral involvement of the fatcomposed of numerous follicles lined by relatively large cuboidal epithelial cellswith round nuclei, fine chromatin pattern, little granular cytoplasm, and eosino-philic colloidal material within some of follicles, and mitosis, which was consistentwith metastatic thyroidal carcinoma. The cells were intensively stained with TTF1but not with tyroglobulin stain. Our patient tried tyrosine kinase inhibitors with nosuccess because she had to stop the treatments because of side effects. The patientremains stable after 4 months of metastasis removal. The skin metastasis of papillarythyroid carcinoma is mostly associated with aggressive and disseminated disease andshows a poor outcome. Some authors suggested that the average patient survivaltime after discovering of skin metastasis is 19 months. Here, we have reported a caseof abdominal metastasis of papillary thyroid carcinoma in a patient with associatedbreast cancer.

cial support: None identified.

Commer

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P7153Acitretin-refractory oral, esophageal, and cutaneous lichen ruber planuscontrolled with alitretinoin

Antonios G. A. Kolios, MD, Departement of Dermatology, University HospitalZurich, Zurich, Switzerland; Alexander A. Navarini, MD, PhD, Department ofDermatology, Zurich, Switzerland

Background: Therapy refractory to classical treatment options of lichen planus (LP)could be a challenging approach for dermatologists. There are some case reportsabout successful treatments of cutaneous and oral LP but not in esophageal. Wepresent an unique case of a patient with cutaneous, oral and esophageal Lichenplanus which was refractory to classical treatment options (topical clobetasolpropionate and pimecrolimus, intramuscular triamcinolone acetonide) and couldnot tolerate systemic acitretin dosed up to 25 mg daily because of systemic sideeffects.

Methods: Alitretinoin was started at a dose of 30 mg daily.

Results: Both oral and skin changes and dysphagia completely resolved in 4 weekswithout any side effects and used the drug for 6months. No papules, enoral striae, ordysphagia recurred over the time of treatment.

Conclusion: Additional studies are needed to better understand the impact ofalitretinoin in LP. Our observation suggests as a new, well-tolerating treatmentoption for esophageal LP after failed response to previous standard treatments.

cial support: None identified.

Commer

P6045Acute generalized exanthematous pustules induced by overdose of oralacetaminophen for suicide attempt

Bassel Mahmoud, MD, PhD, Henry Ford Hospital, Detroit, MI, United States; TorShwayder, MD, Henry Ford Hospital, Detroit, MI, United States

Background: Acute generalized exanthematous pustulosis (AGEP) is a pustular skineruption that is usually drug related and to a lesser extent secondary to viralinfections. A broad range of drugs have been implicated such as b-lactam antibioticsand macrolides, followed by calcium channel blockers and antimalarials.

Case report: A 41-year-old white woman admitted with acute liver failure secondaryto oral acetaminophen overdose related to a suicide attempt. Patient developed arash on the face and trunk 2 days after the ingestion of the acetaminophen.Examination showed multiple discrete small pustules on erythematous base locatedon the face, chest, and upper aspect of the back. Laboratory investigations showedvery high levels of liver enzymes (ALTand AST). Clinical picture was consistent withAGEP.

Discussion: AGEP induced by oral acetaminophen has previously been reported.Although our case occurred after intake of large dose of acetaminophen, otherreport showed AGEP occurring after intake of only 1 tablet, which cleared afterdiscontinuation of the drug. Another report showed development of AGEPprovoked by patch testing for paracetamol. In our case, few days after acetamin-ophen was discontinued, liver enzymes started to trend down with clearing of theskin lesions.

cial support: None identified.

Commer

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