Treatment of chronic and recalcitrant fissures of eczema by topical timolol

The role of endoscopy in patients with anorectal disorders

Topical timolol enhances surgical wound healing in the lower portion of the leg in older patients with comorbidities: A retrospective review

Background: Fissure in ano affects morbidity and quality of life of patients. Lateral internal sphincterotomy is the standard treatment for this condition. Chemical sphincterotomy using 2 percent Diltiazem gel is reported to be effective. This study was conducted to compare the efficacy of 2% diltiazem gel in the treatment of chronic fissure in ano with lateral internal sphincterotomy. Methods: 60 patients with fissure in ano were randomly divided into two groups of 30 each. Group A received 2% diltiazem gel applied topically and group B was treated with lateral internal sphincterotomy. The treatment outcomes were compared based on time to pain relief and time to complete healing of fissure. Results: Patients in both groups were comparable in terms of age, sex, dietary habits, and duration of symptoms. All patients complained of pain;however, majority had no relation of pain with defecation. 90% patients of group A and 96.7% patients of group B had constipation. Only 20% patients of group A and 36.7% of group B had bleeding per rectum. Sentinel tag was present in 46.7% patients in group A and 66.7% patients in group B. Pain was relieved earlier with LIS as compared to medical treatment with diltiazem. At 4th week 80% patients undergoing LIS but only 26.6% patients in diltiazem group had complete pain relief. However, all patients in both groups were relieved of pain by 12th week of treatment. With surgical treatment 19 (63.3%) patients had completely healed fissures at 4 weeks, as compared to none in group A. Although all fissures healed in both the groups at 12 weeks, healing of fissures occurred late in diltiazem group. Conclusion: All patients in both groups had pain relief and complete healing of fissures by 12th week, though response was delayed in patients receiving conservative treatment.

Chronic anal fissure is a significant cause of morbidity. Internal sphincterotomy has long been the operative treatment of choice. Concerns remain, however, on its effects on continence. Botulinum toxin has been used as an agent for chemical sphincterotomy, causing temporary alleviation of sphincter spasm and allowing the fissure to heal. The aim of the present study was to compare the results of sphincterotomy to botulinum toxin. The study was designed as a randomized controlled trial. All adult patients over the age of 18 with chronic idiopathic fissure in ano who had failed conservative treatment were included in the trial. Patients were randomized to receive either Botox or sphincterotomy. Pain, healing of fissure and continence scores were the outcomes assessed. A total of 38 patients were studied. Seventeen patients were randomized to receive Botox and 21, sphincterotomy. Patients in the Botox group were found to have significantly higher 2-week pain scores and reoperation rates, and poor healing. Continence scores were not significantly different in the two groups. Sphincterotomy gives better results than Botox in the treatment of fissure. Botox, however, is safe with no complications and no detriment to continence and could be used in certain situations.

Anal fissure is one of the most common anal disease characterized by intense anal pain, and deterioration of patients quality of life. Treatment is mainly based on the topical administration of calcium antagonist or nitric oxide ointments, and in cases refractory to medical treatment patients can undergo surgery. This study aims to assess the efficacy and safety of Levorag emulgel in the treatment of acute and chronic fissures using of a validated scoring system. A prospective observational study was carried out on patients with anal fissures between February and May 2022. The efficacy of the treatment was evaluated using the REALISE score, a new validated scoring system that rates VAS for pain, NSAID use, pain duration, bleeding, and quality of life (QoL), recorded after 10, 20 and 30 days from the beginning of treatment. Forty patients (median age 46 years, IQR 29-57, 70% women) with acute (22, 55%) or chronic (18, 45%) anal fissures entered the study. The median anal pain score according to the VAS scale decreased significantly from 7 (IQR 4.7-8) at baseline to 1 (IQR 0-3.2, p = 0.05) after 20 days. At the 30-day proctological examination, 22 patients (61%) were pain free (median VAS of 0, IQR 0-1.2, p < 0.05). Pain duration after defecation measured according to the REALISE score, showed a significant decrease after 10 days, from a median value of 2 (IQR 1-4) to 1 (IQR 1-1.2) (p < 0.005). The median value of the REALISE score decreased significantly, from 15 (IQR 11-19.25) at first proctological evaluation to 4 (IQR 4-6, p = 0.139) after 30 days of treatment. At day 30, complete fissure healing was achieved in 30 patients (80%). The healing rate was 82% and 78% in patients with acute and chronic anal fissures, respectively. The use of Levorag® Emulgel may represent a safe and effective non-invasive first line treatment in patients affected by acute or chronic anal fissure.

Fissure in ano is a troubling and painful condition that affects a great majority of the population world over. The nature and anatomy of fissure in ano is quite clear, and much is known about the various predisposing and contributing factors that lead to initiation and progression of the disease. The preferred method of treating them, one that results in optimal clinical results and the least pain and inconvenience to the patient, however, has been open to debate. This paper outlines a brief account of the present scenario of different techniques available for the treatment of chronic anal fissure. Medical manipulation of the internal sphincter should be a first-line treatment in anal fissure. When this fails or fissures recur, lateral subcutaneous internal sphincterotomy should be the preferred options for the treatment of chronic fissure in ano. Nevertheless, all the option should be presented to the patient with complete information about the method, cure rates, complications, and recurrence of the disease.

The international classification of diseases, 10th revision (ICD-10) includes several unvalidated diagnostic codes for hand eczema (HE). Knowledge is sparse on HE patient characteristics. To validate selected HE ICD-10 codes in the Danish National Patient Registry (DNPR) and describe disease characteristics, lifestyle factors and medication use in adult HE patients. Nineteen HE ICD-10 codes were selected and validated based on patient charts. Five cohorts were constructed based on the diagnostic code, DL30.8H (HE unspecified), in the DNPR: (i) patients with DL30.8H code (n = 8386), (ii) patients with DL30.8H code, but without atopic dermatitis (AD) (n = 7406), (iii) sex- and age-matched general population (n = 8386) without HE. Two additional cohorts nested in the DNPR included participants from the Danish Skin Cohort, (iv) patients with DL30.8H code but without AD (n = 1340) and (v) general population cohort (n = 9876). ICD-10 codes revealed positive predictive values ≥90% except irritant contact dermatitis (unspecified) (79.7%) and hyperkeratotic hand and foot eczema (84.1%). HE patients were most often women, middle-aged or older, of Danish ethnicity, had an atopic medical history and were smokers. Topical corticosteroid prescriptions were almost doubled in HE cohorts compared to general populations. We validated several HE ICD-10 codes and identified important HE patient characteristics.

Fissure in ano is a very common disorder of the anorectal region. Internal sphincter hypertonia with decreased relaxation coupled with mucosal ischemia of posterior anal canal are the major pathologies in chronic anal fissure (CAF). Though lateral internal sphincterotomy (LIS) remains the gold standard of treatment for the disease, it is accompanied by the potential complication of incontinence to both flatus and faecal matter. The aim of our study was to explore the role of topical diltiazem as an effective and a safe alternative to sphincterotomy for chronic anal fissure. Ninety patients with CAF were randomly assigned to group A and group B, with 45 patients each. Group A patients received 2% diltiazem topical application, twice daily, and group B patients underwent LIS. All the patients were reviewed at first, fourth and sixth week after initiation of treatment. Visual analogue scores for pain and healing of fissure by visual inspection were recorded and compared. In group A, 71% had complete healing of fissure at 6weeks, with fair amount of pain relief (mean VAS-3.38), and in group B, 96% showed healing of fissure, with excellent pain relief (mean VAS-1.87). Headache and flushing were noted in two patients in group A while no patients in group B developed incontinence. We conclude that LIS is more effective than topical diltiazem in the treatment of CAF. Topical diltiazem may be employed as an initial conservative treatment option before considering the surgical alternative.

Infantile hemangiomas usually regress spontaneously and do not need treatment as active nonintervention is considered the gold standard. However, facial lesions cause significant distress to parents and are associated with a risk of scarring, disfigurement, and airway obstruction, apart from syndromic associations. The management of infantile hemangiomas has changed considerably in the last few years with the advent of topical timolol preparations. We describe the first case of an infant with an ulcerated, superficial, perioral, and segment three hemangioma, who responded dramatically to topical timolol 0.5% ophthalmic solution within 2 months. We suggest that timolol ophthalmic solution may be an option for such lesions under close monitoring.

Tobacco smoking has been proposed to promote hand eczema. To examine the association between tobacco smoking and hand eczema and to investigate a possible dose-response relation. A national environmental health survey was performed in 2007. A questionnaire was mailed to 43,905 individuals and responses were obtained from 25,851 (59%). Questions on 1-year prevalence of hand eczema and on previous and current smoking were included. Respondents were asked to report number of cigarettes per day and to provide information on history of atopy and frequency of hand exposure to water. In total, answers regarding smoking and hand eczema were obtained from 25,428 individuals. Of regular daily smokers, 10·0% reported hand eczema vs. 9·1% of nonsmokers (P = 0·0951). A history of atopy showed the strongest influence on the occurrence of hand eczema: prevalence proportion ratio (PPR) 3·46. The PPR for hand eczema among individuals smoking > 15 cigarettes per day was 1·25 and 1·40 in uni- and multivariate analysis, respectively. Age, history of atopy, sex and water exposure were found to be confounders but not effect modifiers. A dose-response relation between level of smoking and 1-year prevalence of hand eczema was revealed with a PPR of 1·05 (P < 0·001) for the continuous variable of smoking habits, indicating a significantly increased prevalence of hand eczema among individuals with higher consumption of tobacco. An association between heavy smoking and hand eczema was confirmed. It is important to consider the level of exposure, as a dose-response relation was revealed, and to be aware of confounding factors.

Background: Fissure in Ano is a most troubling and painful condition that affects a great majority of population world over. It is one of the common reason of bleeding per anus. Though the nature and anatomy of fissure in Ano is quite clear still the method of treating them with optimal clinical results and least pain and inconvenience to the patient is still open to debate. Hence this study is intended to know conservative treatment method and to offer the patient the same, who are not willing for operative procedure. In the present era of evidence based medicine, in order to reduce the need for anesthesia and surgery this study is intended. Methods: The present study was conducted in 100 patients at Department of Surgery who have been clinically diagnosed as chronic fissure in Ano and also who are admitted in surgery ward for surgical treatment. Group – A: 50 patients who are subjected to chemical sphincterotomy with 2% Diltiazem gel used topically. Group – B: 50 patients who underwent Lateral sphincterotomy.Results: In present study 42/50 patients treated with conservative treatment got relief from pain and cured of fissure compared to that with surgical treatment. Hence 84% of patients were not exposed to surgical risk and were cured effectively with conservative treatment.Conclusions: Conclusion drawn from our study is that conservative treatment with Diltiazem very effective in the treatment of chronic fissure in Ano. This method can, not only be offered to the patient who are not willing for operative procedure but also it significantly reduces the need for anesthesia and surgery in many patients.

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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

Background Some patients with chronic hand dermatitis may complain of painful and itchy fissures; in some cases, the fissures are reluctant to conventional therapies of hand dermatitis. Objectives To evaluate the efficacy and safety of topical timolol eye drop 0.05% solution for the treatment of fissures in patients with hand dermatitis. Patients and Methods In this therapeutic trial, twenty-two cases with chronic hand dermatitis whose hand fissures are unresponsive to conventional therapies are treated with a single daily application of topical timolol eye drop 0.05% solution on the fissures for three weeks; those with complete disappearance of the fissures and symptoms are regarded as complete response, those with a decrease in size and number of fissures with partial or no improvement of symptoms are regarded as a partial response, and those with no change in size and number of fissures with no improvement in symptoms are regarded as no response, search of any side effect done. Results The age of the patients ranged from 16-39 years, and the majority were females. Eleven patients (50%) showed complete response, eight patients (36.4%) had a partial response, and three patients (13.6%) had no response. Patients with a single fissure had a statistically significant better response than those with multiple fissures. No, local or systemic side effects were recorded. Conclusion Topical timolol solution is an effective and safe choice for treating fissures in patients with hand dermatitis.

Hand eczema is a common condition that affects the hands and can have significant negative impacts on quality of life and socio-economic consequences. Unfortunately, treatment options are currently limited, with only alitretinoin approved for systemic treatment of severe chronic hand eczema. To identify new therapies, understanding the pathogenesis is crucial. Additionally, limited data is available on the prevalence and severity of chronic hand eczema in the general population. It was found that the lifetime prevalence of hand eczema in Dutch general population was 15.0%, with a one-year prevalence of 7.3%, and a majority of patients (56.9%) experiencing mild hand eczema. However, a significant portion of participants had severe to very severe hand eczema (1.9%). The majority of patients with hand eczema had chronic hand eczema, resulting in a one-year prevalence of 4.7%, and the severity of the condition was significantly higher in those with chronic complaints. A transcriptome (gene expression) and proteome (protein expression) analysis on vesicular hand eczema was conducted, in which it was found that the transcriptome of vesicular hand eczema overlaps largely with the transcriptome of eczema in patients with atopic dermatitis. Therefore, treatments for atopic dermatitis may also be effective in treating vesicular hand eczema. Finally, dupilumab, a biological treatment, showed promising results in hand eczema patients with atopic dermatitis in daily practice studies and in patients with severe hand eczema in a 16-week randomized, placebo-controlled clinical trial.