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Abstract
In a prospective double-blind left-right comparative study, a cream containing 13-cis-retinoic acid 0.1% (13-cis-RA) and its cream base were applied to a test patch of skin of seven patients with Darier's disease for periods ranging from 3 to 10 weeks. A half-side reduction in papules was observed in four patients. The treatment had no effect on scaling and increased erythema in two patients. Clinical improvement of papules was statistically significant, whereas scaling and erythema did not change significantly. Side-effects of the study medication were only minimal and easily controlled by reduction of the application frequency. Biopsies for immunohistochemical examination were taken from representative skin lesions, one before and one from each side after treatment. Keratins 4 and 13 were induced by the treatment with topical 13-cis-RA in three and two patients, respectively. In conclusion, topical 13-cis-RA 0.1% cream is a well-tolerated therapy for Darier's disease. Induction of keratins 4 and 13 seems to offer an immunohistochemical tool for the investigation of the mode of action of 13-cis-RA.