Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter To Editor
PMID: 17642926

Treatment of Schambergs disease with pentoxifylline

S Panda
 Woodlands Hospital, Kolkata, India

Correspondence Address:
S Panda
Ashok Swapna, 122/4, Dr. Jihan Ratan Dhar Road, Kolkata - 700028
How to cite this article:
Panda S. Treatment of Schambergs disease with pentoxifylline . Indian J Dermatol Venereol Leprol 2003;69:311-312
Copyright: (C)2003 Indian Journal of Dermatology, Venereology, and Leprology


I read with great interest article by Gandhi et al[1] and would like to offer some comments.

The authors have cited the report of Kano et al and have presumably designed their trial on its basis.[2] Kano et al administered pentoxifylline 300 mg daily for 8 weeks to 3 patients with Schamberg′s disease and reported significant clinical improvement after 2-3 weeks. Despite its anecdotal nature, this report attracted wide attention. But, subsequent studies have reported different results. Based on their findings on 2 patients, Basak and Ergin found both the suggested dosage and the duration of therapy (pentoxifylline 400 mg daily for 3 weeks, subsequently increased to 600 mg daily up to 8 weeks) to be inadequate and unable to induce clearing of lesions.[3]

Based on these reports, we performed a multicentric, randomized, investigator-blinded, parallel group, therapeutic trial to compare the effects of oral pentoxifylline 1200mg daily in 3 equally divided doses versus topical betamethasone dipropionate cream 0.05% applied as a thin film locally twice daily on 112 patients, since topical steroids are the traditional therapeutic modality in this disorder.[4] The total treatment period was 8 weeks and follow up was for another 24 weeks. We found that pentoxifylline had a beneficial effect and was more effective than topical betamethasone. However, its effect diminished in many patients at follow-up at six months and we concluded that a 2 month period of therapy was inadequate.

Hence we recommend an even longer period of therapy. This seems to be rational because the dosage regimen followed in our trial was similar to the conventional dosage of pentoxifylline in vascular disorders.[5] Though the cause of Schamberg′s disease is not known in almost 75% of cases,[6] capillary stasis has been proposed as a major factor behind the capillaritis. Gravity and increased venous pressure have been identified as important localizing factors in many cases.[7] In an earlier study, we too found a concomitance of Schamberg′s disease and stasis dermatitis in 13 cases and on retrospective analysis found a history of prior Schamberg′s disease in 8 out of 14 cases of stasis dermatitis.[8] So the dosage employed in our study would have been able to take advantage of the combined rheological and immunological actions of pentoxifylline.

In view of these facts, the findings of Gandhi et al, who used pentoxifylline in the dose of 400 mg daily and noticed a marked improvement (50%) in 50% of the study population (n = 20), is surprising. The gradation of clinical improvement denoting the percentage of clearance of lesions (< 25%, 25-50% and > 50%) is unclear, to say the least. What do these figures stand for? Is it the number of lesions or is it the area occupied by the lesions? If it signifies the number of lesions, as it apparently does, then it throws up a few more questions. It is well known that Schamberg′s disease is typified by punctate macules developing into confluent patches, papules and plaques and petechiae with indistinct margins, mainly on the lower extremities.[9] If the disease is not characterized by multiple distinct lesions, it is meaningless to talk about clearance of a certain number of individual lesions. If the percentage of clearance is taken to be that of the total area occupied by the lesions, we are beset with another problem: Schamberg′s disease is made up of lesions of irregular shapes and sizes; what then was the method adopted by the authors to calculate the area?

Another concern regarding the methodology is the assessment of clinical improvement, which was done by two different observers independently at 2-weekly intervals. It is a moot point whether any change is clinically discernible in Schamberg′s disease within 2 weeks and thus whether such frequent assessment is necessary. Besides, it is not clear if each patient was assessed twice by two different observers at each point of time and if that were not so, how the problem of inter-observer bias was addressed in the trial. It has also not been mentioned whether the observers had been properly blinded to minimize intra-observer bias.

The authors have mentioned the phenomenon of spontaneous clearance of lesions in Schamberg′s disease. As the incidence of such clearance is not documented, the only way to test the efficacy of any therapeutic modality would be a placebo-controlled study.

Pentoxifylline is recommended by the authors as the first-line therapy of Schamberg′s disease on the basis of their results. In a nutshell, the results were improvement of 50% (n = 10) patients to the extent of clearance of > 50% lesions in a small trial (n = 20). Even if we ignore the ill-defined measures of clinical improvement, such a conclusion based on the results of such a trial seems unfair.

Gandhi V, Singal A, Sachdeva B, Bhattacharya SN. Treatment of Schamberg's disease with pentoxifylline - therapeutic trial. Indian J Dermatol Venereol Leprol 2003;69:25-6.
[Google Scholar]
Kano Y, Hirayama K, Orihara M, Shiohara T. Successful treatment of Schamberg's disease with pentoxifylline. J Am Acad Dermatol 1997;36:827-30.
[Google Scholar]
Basak PY, Ergin S. Should pentoxifylline be regarded as an effective for Schamberg's disease? J Am Acad Dermatol 2001;44:548-9.
[Google Scholar]
Panda S, Malakar S, Lahiri K. Oral pentoxifylline versus topical betamethasone in Schamberg's disease-a comparative multicentric randomized investigator-blinded parallel group therapeutic trial. Arch Dermatol 2003 (in press).
[Google Scholar]
Colgan MP, Dormandy JA, Jones PW, Schraibman IG, Shanik DG, Young RA. Oxpentifylline treatment of venous ulcers of the legs. BMJ 1990;300:972-5.
[Google Scholar]
Wahba-Yahav AV. Schamberg's purpura: association with persistent hepatitis B surface antigenemia and treatment with pentoxifylline. Cutis 1994;54:205-6.
[Google Scholar]
Dowd PM, Champion RH. Purpura. In: Champion RH, Burton JL, Burns DA, Breathnach SM, editors. Rook/ Wilkinson/ Ebling Textbook of dermatology. 6th ed. Oxford: Blackwell Science; 1998. p. 2149-50.
[Google Scholar]
Lahiri K, Malakar S, Panda S. Are Schamberg's disease and stasis dermatitis spectral manifestations of the same disease? Ind J Dermatol 1999;44:220-1.
[Google Scholar]
Weedon D. Skin pathology. 2nd ed. London: Churchill Livingstone; 2002. p. 248.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections