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ORIGINAL CONTRIBUTIONS
Year : 1990  |  Volume : 56  |  Issue : 3  |  Page : 223-225

Efficacy of cotrimoxazole and PUVA for the management of chronic folliculitus of legs




Correspondence Address:
Kalpana Shenoy


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  Abstract 

Twenty five patients with chronic follicufitis of legs (CFL) were treated with cotimoxazole and 8-methoxypsoralen followed by exposure to sunlight for 15 minutes. In another 20 patients taken as control 8-MOP was substituted with a placebo. After 45 days 19 (90.5%) patients in the study group as compared-to 11 (55%) in the control group were free of lesions (p). At the end of 3 months 10 (62.5%) out of 16 patients in the study group as compared to 3 (30%) out of 10 patients in the control group showed improvement which was statistically not significant (p ). Coagulase positive Staphylococcus aureus was isolated from the pus in all the 45 cases. In vitro experiments were carried out by mixing the Staphylococcus with a solution of 50 micro -gm/ml of 8 MOP, 1200 micro -gm/ml cotrimoxazole and 50 micro-gm/ml8-MOP mixture, 1200 micro -gm/ml of cotrimoxazole and saline. A part of each of the samples was exposed to sunlight for 15 minutes between 3 pm and 3.15 pm and then streaked on blood agar medium Remaining part was streaked without sun exposure. Inhibition of growth was observed with photoactivated 8 - MOP, cotrimoxazole and 8-MOP mixture and cotrimoxazole, both with and without exposure to sunlight. Sunlight alone did not inhibit the growth.


Keywords: Chronic folliculitis of legs, cotrimoxazole, PUVA


How to cite this article:
Shenoy K, Srinivas C R, Sharma S, Shivananda P G, Shetty J N. Efficacy of cotrimoxazole and PUVA for the management of chronic folliculitus of legs. Indian J Dermatol Venereol Leprol 1990;56:223-5

How to cite this URL:
Shenoy K, Srinivas C R, Sharma S, Shivananda P G, Shetty J N. Efficacy of cotrimoxazole and PUVA for the management of chronic folliculitus of legs. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 Jun 2];56:223-5. Available from: http://www.ijdvl.com/text.asp?1990/56/3/223/3531


Chronic folliculitis'of the legs (CFL) recurs almost invariably following withdrawal of treatment with antibiotics. We have reported 2 cases of lupoid sycosis[1] and 4 cases of CFL[2] which were controlled following treatment with PUVA and co­trimoxazole . This double-blind in vivo and in vitro study was undertaken to assess the effectiveness of this regime.


  Materials and Methods Top


Forty five clinically diagnosed cases of CFL were studied. Severity of the disease was graded by the number of pustules, 1-5 pustules (Grade I), 6-10 (Grade II) and more than 10 pustules (Grade Ill). All patients were treated with one tablet of co-trimoxazole (sulfamethoxazole 800 mg and trimethoprim 160 mg) twice daily. Twenty five of these patients selected randomly, in addition received 20 mg of 8-MOP at 8 AM followed by exposure to sunlight from 10 AM to 10.15 AM. In the control group, 8 MOP was substituted with a colour, size and weight matched placebo made of lactose and starch.

One ml of each of the solutions containing 50 micro-gm/ml of 8-MOP, 1200 micro gm/ml of cotrimoxazole, a combination of 50 micro-gm/ml of 8-MOP and 1200 micro gm/ml of cotrimoxazole, and 0.9 gm% saline were taken in 4 respective test tubes. Suspension of Staphylococcus aureus Scientific Name Search  cultured from the pus of each patient was prepared by mixing 0.01 ml suspension with 1 ml of 0.9 gm% of saline which was further diluted to 10-3. One ml of Staphylococcus aureus suspension was added to each test tube and 1 ml of the mixture from each test tube was poured into 4  Petri dish More Detailses and exposed to sunlight from 3 PM to 3.15 PM. The remaining 1 ml was poured into 4 more petri dishes but these were not exposed. The petri dishes were incubated at 30° C for 18 hours following which the colonies were counted. The experiment was repeated each time the bacteria were isolated from the pus.

UVA from sunlight between 10 AM to 10.15 AM and 3 PM to 3.15 PM was measured by a UVA photometer as described by the authors.[3]


  Results Top


All the 45 patients were free of lesions after 15 days. After 45 days, 19 (90.5%) patients in the study group were clinically free of the lesions [Table - 1], and the difference with the control group was statistically significant (p < 0.02). At the end of 3 months, 10 (62.5%) patients in the study group as against 3 (30.3%) in the control group were clinically free. The improvement was statistically not significant (p > 0.05).

Exposure to sunlight in the presence of both the drugs or individual drug, prevented the growth of bacilli [Table - 2]. Sun exposure alone did not prevent the growth. 8-MOP though effective following exposure did not inhibit the growth by itself [Table - 2].

The average UVA at 10 AM was 9 mw/cm2 and at 3 PM it was 7.5 mw/cm2. Thus the patients who were exposed for 15minutes received about 9 joules/cm2 of UVA and the bacterial colonies received 7.6 joules/cm2.


  Comments Top


The treatment of CFL is frustrating both to the physician and the patients. We have reported favourable response of the present regimen in 2 cases of lupoid sycosis[1] and 4 cases of CFL[2]. The present study was undertaken to ascertain the effectiveness of this treatment by a double­blind method. Whereas 8-MOP and UV light effectively inhibited the growth of bacteria in culture, cotrimoxazole with or without exposure was just as effective. Thus our study confirmed that photoactivated 8-MOP is effective in inhibiting the bacterial growth as previously reported[4] but failed to prove that the combination is additionally effective. In vitro experiments confirmed that sunlight alone did not inhibit the growth of bacteria [Table - 2]. Thus it is unlikely that the relatively better clinical effect noticed in the study group as against the control group was because of sunlight alone. Recurrences in the study group were less severe than in the controls.

It is possible that phototherapy increases the effective local concentration of the antibiotics and -also exerts a direct action on the bacteria. Recurrences in the study group are possibly due to variations in the susceptibility of the bacteria to the chemotherapeutic agent or inadequate local blood supply due to severe perifollicullar scarring but not due to presence of any other bacteria as no bacteria apart from coagulase positive Staphylococcus aureus was isolated from any of the 45 cases studied.

 
  References Top

1.Srinivas CR and Shenoy K: Lupoid sycosis -treatment with PUVA and cotrimoxazole, Internal J Dermatol, 1987; 26:8 - 9.  Back to cited text no. 1    
2.Srinivas CR and Shenoy K: Control of chronic folliculitis of legs with PUVASOL and cotrimoxazole, Ind J Dermatol Venereol Leprol, 1987; 53:43 - 44.  Back to cited text no. 2    
3.Srinivas CR, Devadiga R, Rajeev VK et al: Exposure time to sunlight for PUVASOL, Ind J Dermatol Venereol Leprol (In press.)  Back to cited text no. 3    
4.Fowlks WL, Grifith DG and Oginsky EL: Photosensitisation of bacteria by furocoumarins and related compounds, Nature, 1958; 181:571 - 572.  Back to cited text no. 4    


    Tables

[Table - 1], [Table - 2]

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