Bath Oil Research Articles

Randomized Trial Examining Efficacy of Mentha piperita in Reducing Chronic Headache Discomfort in Youth

BackgroundYouth with chronic headache experience disruption to routine activities and require significant health care utilization. While interventions targeting a relaxation response have shown clinically significant benefit in headache outcomes, peppermint oil has not been evaluated for efficacy in a pediatric headache population. AimsTo explore the extent to which a brief aromatherapy intervention improves subjective and objective indicators of discomfort beyond passive relaxation in youth with chronic headaches. DesignSingle-center, randomized, experimental study. MethodsPatients were randomly assigned to a brief foot bath or foot bath plus peppermint oil group. Measurements were collected at baseline, mid-intervention, and post-intervention. Data included heart rate and subjective pain, anxiety, and satisfaction scores. ResultsForty-six adolescents (89% female, mean age 15.2 years) diagnosed with a primary headache disorder were enrolled. Both groups reported a significant decrease in pain, though the intervention group plateaued (p < .01) and the control group progressively decreased intensity at each time-point (p < .01). Whereas both groups reported a decrease in anxiety over time (p < .01), the control group reported less of a decrease in anxiety than the intervention group (p = .03). The control group had a significant decrease in mean heart rate (p < .01). There were no adverse events. The intervention was well tolerated, liked, and recommended by 95.5% of study participants. ConclusionsA brief intervention intended to activate the relaxation response produced a subjective reduction in pain and anxiety. However, the addition of peppermint oil to a foot bath did not significantly improve pain or anxiety beyond the control condition.

Treatments for atopic dermatitis.

Atopic dermatitis usually develops in childhood, but can occur in adults. Management involves drug and non-drug treatments to clear the skin. Not all patients with atopic dermatitis have allergies. Most patients have trigger factors that can be avoided. All patients should use soap substitutes and bath oils. Moisturisers are important for improving the condition of the skin. Topical corticosteroids are the main drug treatment. The choice of corticosteroid depends largely on the site of the atopic dermatitis. Topical calcineurin inhibitors can be considered for sensitive sites such as the face where potent topical corticosteroids are potentially harmful. Adjunctive treatments given during flares of dermatitis include bleach baths and wet dressings. Antihistamines may help to relieve itch. Phototherapy may be considered by a specialist for adults if there is inadequate response to treatment. Severe cases of atopic dermatitis may require systemic treatment. Immunosuppressants, such as ciclosporin, have been used and now dupilumab and upadacitinib are available for severe chronic atopic dermatitis.

Effect of pine-tar bath on disease severity in moderate-to-severe childhood eczema: an investigator-blinded, crossover, randomized clinical trial

Background Atopic dermatitis (AD) is a chronic inflammatory disease associated with pruritus and sleep loss. Pine-tar has long been used for various chronic skin conditions in which its polycyclic aromatic hydrocarbon (PAH) component is anti-inflammatory and its resin acids antiseptic. The null hypothesis of this trial is that there is no difference in clinical efficacy between a pine-tar product and its vehicle for AD. Methods A 3-month, investigator-blinded, crossover, randomized control trial (RCT) was conducted in which each patient was assigned to bathing with pine-tar bath oil for one month and vehicle bath oil for another, with a washout period of 1-month in-between. Acceptability and efficacy of the bath products were measured. Disease severity scores (scoring atopic dermatitis (SCORAD) and patient-oriented eczema measure (POEM), quality of life questionnaires, noninvasive skin biophysiological measurements, blood IgE levels, and Staphylococcus aureus (SA) colonization status were assessed before and following bathing. Results Significant improvements were found in total SCORAD (p = .030), POEM (p = .004), SA colonization status (p = .002), and log-transformed IgE level (p = .009) among patients who bathed with pine-tar in the overall RCT study using intention-to-treat analysis. For per protocol analysis, significant improvements were found in total SCORAD (p = .024), objective SCORAD (p = .011), extent (p = .014), intensity (p = .032), pruritus (p = .047), POEM (p = .044), SA colonization status (p = .035), and log-transformed IgE level (p = .028). Acceptability to both bath-oils was good, and no product-related serious adverse events were recorded. Conclusions Bathing with pine-tar is an efficacious and recommendable adjuvant practice for AD patients. Disease improvement is associated with reduction of SA and IgE.

Examination of Skin Moisturizing Effect of Bed Bath with Bath Oil in the Elderly

Examination of Skin Moisturizing Effect of Bed Bath with Bath Oil in the Elderly

A Systematic Review of the Effectiveness of Aromatherapy Massage on Sleep in Children and Infants

Background: Sleep disturbances among child patients are a commonly reported problem. We aimed to review the effectiveness of aromatherapy on sleep disorders of children and infants. Materials and Methods: This review was conducted with a systematic search of electronic resources in English such as Medline (via PubMed), Scopus, Web of Science, Cochrane Library, and EMBASE, with no time limit from inception up to February 2019; using the following keywords alone or in combination: (Aromatherapy OR Smell OR Olfactory OR Essential oil) AND (Sleep Disorders OR Sleep OR Sleep Paralysis OR Sleep Arousal Disorders) AND (Children OR Infant OR Baby OR Neonate OR Pediatric). Results: Four studies were included in the review. In the first study, a comparison of the nights with and without aromatherapy showed no significant difference regarding length of time the children were asleep, sleep onset time and number of interruptions during the night. In the second study, aromatherapy with Rosa damascena essential oil significantly improved sleep quality parameters in children except with daytime sleeping (p=0.059). In the third study, a significant decrease was observed in the sleep quality score in children with acute lymphoblastic leukemia in aromatherapy with oil of orange than in the controls (p<0.05). In the fourth study, the infants in the Lavender bath oil group spend more time in deep sleep and less time crying prior to sleep onset than in the control group (p<0.05). Conclusion: Aromatherapy with Lavender and Rosa damascena essential oil and orange oil can improve group sleep quality, deep sleep and time crying prior to sleep onset. However, it was not effectiveregarding sleep disorder in children with autism.

Renewable sources: applications in personal care formulations.

A global tendency for products considered environmentally sustainable, and ecologically obtained led the industry related to personal care formulations to fund the research and the development of personal care/cosmetics containing ingredients from natural resources. Furthermore, consumers are aware of environmental and sustainability issueans, thus not harming the environment represents a key consideration when developing a new cosmetic ingredient. In this study we review some examples of active ingredients or raw materials used in cosmetics/personal care/biomedical products that are coming from either through biotechnological systems, or as byproducts of several industries. A skin formulation containing biosynthetic actives, prepared by us and the study regarding its dermocosmetic properties are also described. The need for the standardization processes, the safety assessment tools, the improvement of the exploitation methods of these renewable sources in order the production to be ecologically and economically better are also discussed.

Emollient formulations containing antiseptics reduce effectively the level of Staphylococcus aureus on skin.

BackgroundIncreased skin colonization by Staphylococcus aureus is associated with atopic eczema (AE) severity. Reduction of S. aureus levels on the skin results in an improvement in the clinical condition.MethodsThe antimicrobial activity of topical products including a bath oil, cream, and wash combining antiseptics and emollients (A+E) was compared to products containing emollients only. The preference of patients with AE for A+E cream or emollient only cream to relieve symptoms of itching, erythema, and inflammation when applied three times daily for 10 days is evaluated. Repeat insult patch testing of the products is also conducted.ResultsA significant reduction in microbial counts was found following use of A+E bath oil (4.09±0.32 vs 6.20±0.24 log10 cfu/mL S. aureus, P<0.001), A+E cream (5.50±0.63 vs 5.94±0.72 log10 cfu/foot S. aureus, P=0.002), and A+E wash (2.71±0.48 vs 3.57±0.31 log10 cfu/mL Escherichia coli, P<0.001) compared to the emollient only products. The A+E cream was preferred to the emollient only cream (P=0.004) by patients with AE. All three tested formulations were found to be non-irritating and non-sensitizing to the skin.ConclusionThe bath oil, cream, and wash containing antiseptics and emollients decrease the level of bacteria on the skin, including S. aureus, compared to emollient only products. Patients with AE preferred the A+E cream compared to the emollient only cream to relieve symptoms of itching, erythema, and inflammation. The choice of formulation allows clinicians and patients to choose a suitable product for the short-term treatment of eczema flare-ups caused by bacterial infections.

Epicutaneous Exposure to Peanut Oil Induces Systemic and Pulmonary Allergic Reaction in Mice

Background: The prevalence of peanut allergy (PA) is constantly on the rise. Atopic dermatitis (AD) is a major risk factor for developing food allergy. Some bath oils and skin creams used for treating AD contain peanut oil, and it has been suggested that exposure to peanut allergens through a disrupted skin barrier is a potential cause of PA. Our aim was to investigate whether application of peanut oil to irritated skin causes a systemic or respiratory allergic response to peanuts in an animal model. Methods: BALB/c mice underwent epicutaneous sensitization with either peanut oil (PM, n = 9) or phosphate buffered solution (controls, n = 9) daily for 5 consecutive days. Ten days after the last exposure the mice were challenged with intranasal peanut protein for 5 consecutive days. Bronchial alveolar lavage fluid was collected for cellular studies and measurement of cytokine levels. Sera were collected for immunoglobulin E (IgE) measurement. Results: Epicutaneous peanut oil sensitization increased leukocyte and eosinophil counts and interleukin-13 levels (p = 0.003, p = 0.0006 and p = 0.03, respectively), in addition to increasing total serum IgE (p = 0.03). Conclusions: The results suggest that topical application of peanut oil may play a role in the etiology of PA.

SBA-15 MOLECULAR SIEVE: SYNTHESIS, CHARACTERIZATION, AND APPLICATION IN OIL/WATER SEPARATION

This work evaluates the use of molecular sieve SBA-15 as adsorbent in oil removal process. The synthesis and characterization tests used X-ray Diffraction (XRD), Energy-dispersive X-ray spectroscopy (EDX), physical N2 adsorption, Scanning Electron Microscopy (SEM), adsorption capacity in organic solvents (gasoline, kerosene, and diesel oil), and Foster Swelling. Following, this work performed the evaluation of SBA-15 as adsorbent in the process of removing oil from a synthetic effluent, through the finite bath system (Batch adsorption). Finite bath system tests used a factorial 22 experimental design with three experiments at the central point. At that stage, two variables were evaluated: initial oil concentration (100, 300, and 500 mg /L) and mechanical agitation (100, 200, and 300 rpm). Through the experiments, it was possible to observe the following response variables: percentage of total removal (% Rem) and removal capacity in equilibrium (qeq). For comparison level, the experiments also evaluated response variables for the tests without mechanical agitation. Characterization techniques (DRX, EDX, SEM, Physical N2 Adsorption) presented results compatible with the characteristics presented by mesoporous materials. Foster Swell tests confirmed the affinity of SBA-15 molecular sieve with the organic solvents used: gasoline, kerosene, and diesel oil. The testing system determined both finite bath oil removal percentage (% Rem) 97.04%, and removal capacity at equilibrium (qeq) of 48.58 mg /g, indicating that the use of SBA-15 molecular sieve is a viable option in the oil removal process.

Pilot Studies on Two Complementary Bath Products for Atopic Dermatitis Children: Pine-Tar and Tea.

Background: Few standardized bath product clinical trials were performed for atopic dermatitis patients. Pine-tar and green tea extracts are plant-derived products that have been described as having anti-allergic effects which may reduce AD disease severity. Methods: The efficacy of two complementary bath products was studied and compared. Efficacy and acceptability of the bath products were measured by patient general acceptability of treatment (GAT: very good, good, fair or poor), disease severity (SCORAD: SCoring Atopic Dermatitis), quality of life (CDLQI: Children Dermatology Life Quality Index), and pertinent clinical parameters were measured before and after four weeks of treatment. Sample size calculations for further clinical trials were performed. In one group, nine AD patients were subjected to bathing with a pine-tar bath oil for 10–15 min daily for four weeks. In another group, 20 AD subjects bathed with a teabag containing green tea extracts for four weeks. Results: Significant improvements in clinical- and patient-orientated parameters were found in the pine-tar bathing group, but not the tea-bag bathing group. Both groups reported very good/good GAT on the studied products. Teabag bathing was considered not efficacious for further clinical trials. Conclusions: The pilot studies provided preliminary data on the efficacy of pine tar bath oil. We do not document a significant efficacy for bathing with tea extracts. Bathing with pine-tar is potentially a complementary topical treatment with good patient acceptance and adherence, but further evidence-based research for its recommendations is needed.

DESENVOLVIMENTO E AVALIAÇÃO DA EFICÁCIA DE COSMETICOS SENSORIAIS COM AÇÃO ANTIESTRESSE

Neurocosmetics are cosmetics that act in the body in a similar way to endogenous neuromediators, exerting beneficial effects on the health and beauty of skin, hair and cutaneous attachments. Essential oils of jasmine and lavender, used in neurocosmetics, act on the receptors of the skin acting in the emotional state, alleviating the symptoms of anxiety, stress, depression, nervous tension and insomnia. Two formulations have been developed: Body Bath Oil and Moisturizing Cream containing essential oils of jasmine and lavender. A sample of 20 people (men and women), who duly approved the inclusion criteria of the research: Accept participate in the 30 Colloquium Vitae, vol. 10, n. Especial 5, Jul–Dez, 2018, p.29-34. ISSN: 1984-6436. DOI: 10.5747/cv.2018.v10.nesp5.000329 research signing the Free and Informed Consent Form. Judges will use neurocosmetics for 14 days. The anti-stress efficacy of each product was evaluated through structured questionnaires. It was also evaluated the sensorial of the cosmetic products after its use. The attributes that were evaluated in this experiment will be: appearance of the product, ease of spreading, degree of hydration and fragrance, after its use. The skin of the judges was analyzed using the Skin Analyzer Pen SK-02. The data collected were evaluated through analysis of variance ANOVA, where the results were considered significant when the probability was less than 5% by the Tukey test. The twenty volunteers who participated in this research, who used body oil and moisturizer both containing the essential oils of lavender and jasmine, reported that these products were effective in reducing the level of stress. The sensations observed after the application of the body oil and moisturizer on the skin were refreshment, decreased nervous tension, tranquility, comfort and softness. Through the statistical analysis it was verified that there were no significant differences of acceptance among the formulations in the attributes: ease of spread, sensation in the skin and intention to buy. So all volunteers reported that they would buy the products if they were marketed

The usage of the most frequently preferred herbal products in Turkey by mothers for themselves and their children

Today, mothers visit the pharmacies with several complaints for themselves and their children. Although these complaints may seem simple at first glance, they are of importance due to their frequency among people. In this area herbal medications as well as chemical agents are used in the treatment. The problem mentioned most frequently by mothers is hypogalactia according to surveys taken for this study. Therefore, there are several of herbal medicines or medicinal teas are used for their galactagogue effect in pharmacies. The problems encountered in children include lack of appetite, colds, colic, insomnia and weakness of the immune system. Therefore, herbal remedies and medicinal teas are recommended in pharmacies as dietary supplement, immune system strengtheners, anti-colds and gas. The preparations for external use are herbally included in the composition of anti-rash creams or lotions, foam shampoos, hair and body shampoos, baby oil and lotions, and bath oils.

Sublimation of DAN Matrix for the Detection and Visualization of Gangliosides in Rat Brain Tissue for MALDI Imaging Mass Spectrometry.

Sample preparation is key for optimal detection and visualization of analytes in Matrix-assisted Laser Desorption/Ionization (MALDI) Imaging Mass Spectrometry (IMS) experiments. Determining the appropriate protocol to follow throughout the sample preparation process can be difficult as each step must be optimized to comply with the unique characteristics of the analytes of interest. This process involves not only finding a compatible matrix that can desorb and ionize the molecules of interest efficiently, but also selecting the appropriate matrix deposition technique. For example, a wet matrix deposition technique, which entails dissolving a matrix in solvent, is superior for desorption of most proteins and peptides, whereas dry matrix deposition techniques are particularly effective for ionization of lipids. Sublimation has been reported as a highly efficient method of dry matrix deposition for the detection of lipids in tissue by MALDI IMS due to the homogeneity of matrix crystal deposition and minimal analyte delocalization as compared to many wet deposition methods 1,2. Broadly, it involves placing a sample and powdered matrix in a vacuum-sealed chamber with the samples pressed against a cold surface. The apparatus is then lowered into a heated bath (sand or oil), resulting in sublimation of the powdered matrix onto the cooled tissue sample surface. Here we describe a sublimation protocol using 1,5-diaminonaphthalene (DAN) matrix for the detection and visualization of gangliosides in the rat brain using MALDI IMS.

Impact of Frying on Fatty Acid Profile and Rheological Behaviour of Some Vegetable Oils

Rheological properties and fatty acid profile of sunflower oil (SO), cottonseed oil (CO) and palm olein (PO) during deep frying for 4, 8, 12 and 16 h were investigated. In the different systems, linoleic acid decreased while palmitic, stearic and oleic acids increased in the bath oil upon frying. The shear stress versus shear rate data was fitted to Newtonian, Bingham and Herschel-Bulkley rheological models. The flow behavior of fresh and used SO, CO and PO was measured at 25°C. All samples at zero time of frying (fresh oil) showed Newtonian behavior with correlation coefficients greater than 0.99 at 25°C and slight non-Newtonian behavior after 4, 8, 12 and 16 h of frying. Palm olein showed higher increase in viscosity in comparison to CO and SO. Rheological parameters of vegetables oils showed great changes, wherein the highest change in viscosity was recorded after 16 h of frying. Palm olein had higher flow behavior parameters than SO and CO. The increase in frying time caused an increase in K, ηB, τ0HB, τ0B, and η values, while the n values decreased with increasing the frying time. The viscosities of the vegetable oils were plotted against either C18:1 or C18:2 and there were highly positive correlations between them (R2 = 0.99). The temperature dependence of viscosity was studied by using the Arrhenius relationship and the activation energy indicates the sensitivity of the viscosity to the temperature change. The rheological parameters and viscosity measurements can provide a good overall estimate of frying oil quality.

The effectiveness of using a bath oil to reduce signs of dry skin: A randomized controlled pragmatic study

BackgroundDry skin (xerosis cutis) is increasingly recognized as a relevant health problem in daily life and in health and nursing care. The use of bath additives such as oils is common to reduce dry skin, but empirical evidence supporting this practice is limited. ObjectivesThe aim of this study was to investigate the effectiveness of using a bath oil additive in improving skin barrier function and ameliorating dry skin in comparison to non-oil containing skin cleansers for bathing or showering. DesignSingle centre randomized observer blind pragmatic parallel group trial. SettingsOutpatient/community care. ParticipantsVolunteers showing clinically mild to moderate dry skin recruited from the city of Berlin. MethodsHealthy children and adults were randomly assigned to use either a commercially available bath oil or to continue using their regular non-oil containing skin cleansers every other day over a study period of 28days. Skin barrier parameters and the severity of dry skin were assessed at baseline and at two follow-up visits at the study centre. Transepidermal water loss was the primary outcome. ResultsAll sixty participants randomized completed the trial. Median age was 32.5 (IQR 8.3 to 69) years. At the end of study the mean transepidermal water loss in the intervention group was statistically significant lower compared to the control group (mean difference −1.9 (95% CI −3.1 to −0.8) g/m2/h). Stratum corneum hydration was statistically significantly higher in the intervention group at the end of the study. Skin surface pH and roughness were comparable in both groups and remained unchanged, while both groups showed a trend to improvement in dry skin symptoms ConclusionsThis pragmatic trial provides empirical evidence that the regular use of the investigated bath oil is effective in improving the skin barrier function in children and adults with mild dry skin when used in routine skin care and supports its use as a basic element for the management of a broad spectrum of dry skin conditions. Trial registrationClinicalTrials.gov Identifier NCT02557698.

Experimental and Numerical Analysis of Stress and Stick-Slip Effect of the Test Stand

Experimental and numerical analysis describes the design of noise removal effect of the friction pair of trapezoidal screw in a special device call Stick-Slip effect. Solution of the problems builds on previous measurements and testing sliding pairs, which was testing in last analysis. The pair worked in the special bath oil, its characteristics is that it does not support the mechanical lubrication. Measurements and calculations showed that it is necessary to enlarge the diameter for 32 kN load trapezoidal screw. This will reduce the contact pressure, which leads to polish the contact surfaces. You then slip together better and are not as easily stick slip effect.

General measures and quality of life issues in psoriasis.

Psoriasis generally does not affect survival but has significant detrimental effect on quality of life (QOL), which may be comparable to that of ischemic heart disease, diabetes, depression, and cancer. The foremost important thing in the management of psoriasis is counseling of the patient. The clinician needs to be empathetic and spend adequate time with the patient and educating the patient about psoriasis. Clinicians should make it clear to the patient that the primary goal of treatment is control of the disease rather than cure. Eating a balanced and low glycemic diet could be an important adjuvant factor in the prevention and treatment of moderate nonpustular psoriasis. Obese people are more likely to have severe psoriasis and psoriatic arthritis than people with an average body mass index. Dietary supplementation with oily fish, rich in n-3 fatty acids, in psoriasis had shown mixed results in trials. Promising results have been documented for parenteral application of n-3 fatty acid, but not with oral supplementation. Increased smoking or alcohol abuse increases the risk of developing psoriasis and may influence disease severity, and hence must be avoided. Soaking in warm water with bath oil can be done in extensive psoriasis for hydration and emollient effect, and bland soaps or soap substitutes should be used; antiseptics should be avoided as they may irritate the skin. Relatively small, localized patches of psoriasis may improve with occlusion, i.e., waterproof adhesive dressings. The use of emollients is an internationally accepted standard adjunctive to the treatment of psoriasis. Dermatology Life Quality Index is a psychometrically sound and responsive measure of psoriasis-specific outcomes and most comprehensively captures the impact of clinical signs and symptoms on patient's well-being.

Self-reported Lupus flare: Association with everyday home and personal product exposure

BackgroundThe number of chemicals in household products has driven concern about potential adverse health through their use. Most research concentrates on product chemicals with reproductive and carcinogenic consequences, however some evidence exists that immune effects can lead to exacerbation of autoimmune illnesses such as lupus (SLE). ObjectivesThis paper examines household and personal product exposure patterns in a pilot case/control study of female Australians. We also examined associations between common product exposure and SLE symptom exacerbation over a year period. MethodsWe enrolled 41 control and 80 SLE participants aged 18–80 years. Qualitative techniques of structured interview and thematic analysis retrospectively explored patterns of product use, and flare history data of SLE participants. Negative binomial regression models explored associations between self-reported flare (SRF) days and exposure to 34 common home product groups. ResultsMean product counts did not differ between participant groups (mean 33.1: SD 11.8), or flare groups (flare mean 32.6:SD 12, no-flare 31.8:SD 6.6). Products used for personal hygiene and general house cleaning were most frequently used.Significant association with increased SRF day relative risk (IRR) was seen for bath oil use (IRR 1.008, CI 1.00–1.02). Paradoxical “protective” effects, (reduced SRF days) were found for cleansing beauty (IRR 0.999, CI 0.998–0.999), make-up (IRR 0.998, CI 0.997–0.999); adhesives (IRR 0.994, CI 0.991–0.997) and paint (IRR 0.99, CI 0.986–0.995). ConclusionsEveryday product exposures can impact on symptom exacerbation in SLE. Some offering protection and others increased health risk. Identifying environmental associations offer the possibility of life-style interventions to reduce illness impact.

Rheological characteristics of vegetable oils as affected by deep frying of French fries

Fatty acid composition and rheological characteristics of sunflower oil (SO), cottonseed oil (CO) and palm olein (PO) during deep frying for 4–16 h were investigated. In the different oils, linoleic acid decreased while palmitic, stearic and oleic acids increased in the bath oil during frying. Total phenolic content (TPC) in different oils increased during frying and strongly correlated with frying time. As frying progressed, it was observed that the rate of increase in TPC was relatively slower in PO than in the SO and CO. The shear stress versus shear rate results was fitted to Newtonian, Bingham and Herschel–Bulkley rheological models. The flow behaviour of fresh and fried SO, CO and PO was recorded at 25 °C. Fresh oils showed Newtonian behaviour with correlation coefficients greater than 0.99 at 25 °C and slight non-Newtonian behaviour after frying. Palm olein showed higher increase in viscosity in comparison to CO and SO. Rheological parameters of vegetables oils showed great changes, wherein the highest change in viscosity was recorded after 16 h of frying. Palm olein had higher flow behavior parameters than SO and CO. The increase in frying time caused an increase in K, ηB, τ0HB, τ0B, and η values, while the n values decreased with increasing the frying time. The viscosities of oils were plotted against the levels of C18:1 and C18:2 wherein highly positive correlations were found between them (R2 = 0.99). The temperature dependence of viscosity was studied by using the Arrhenius relationship and the activation energy indicates the sensitivity of viscosity to changes in temperature. It could be concluded that the rheological parameters can provide an overall estimate of oil quality during frying.

Cetuximab Related Eyelash Elongations for Patients with Metastatic Rectum Carcinoma: Metabolic Complete Response

Dear Editor: Colorectal cancer (CRC) is the second most common cause of cancer related death for developed countries. Over the past decades, significant improvements have been achieved on the pathogenesis of CRC and new therapeutic options are available today. However, it is not exactly known as some of the patients respond to treatments well while others have poor responses1. A 58-year-old man was diagnosed with stage IV rectum adenocarcinoma with multiple liver metastases. The whole body position emission tomography (PET) revealed that multiple liver metastases (SUV max between: 7.9 to 9.2). A KRAS test in the patient's primary tumor revealed no mutations in the KRAS gene. He received palliative chemotherapy with FOLFIRI plus cetuximab and showed a good tumor response after 6 months and discontinued further treatments. After the 6 cycles of treatment, the PET-computed tomography scan was taken and it revealed no pathological uptakes. However, after the 3 cycles of treatment, acneiform eruptions were observed and the patient noted changes in his eyelash (Fig. 1). Toxicities were induced by skin care, bath oils, emollient creams, sun protections and trimming eyelashes, and thus, cetuximab treatment was continued without dose reductions or interruptions. After the cetuximab was discontinued, the patient's eyelash and skin returned to pretreatment state. The patient exhibited progressive diseases after a relatively long period of tumor controls. His performance status was good and he was clearly a candidate for continuation of tumor-directed therapy. Treatment was continued with FOLFIRI plus cetuximab for another 6 months and good tumor responses were achieved again. Nonetheless, acneiform eruptions and eyelash elongation were observed after reintroductions of cetuximab (Fig. 2). The authors are indebted to the patient for his permission for publication. Fig. 1 Eyelash elongation after cetuximab treatment (published with permission of patient). Fig. 2 Patient's second photograph after reintroduction of cetuximab (published with permission of patient). Epidermal growth factor receptor (EGFR) is one of the new targets in the treatment of many tumor types. Cetuximab is a chimeric monoclonal antibody which binds the EGFR with high affinities and competitively inhibits ligand binding and inhibits activation of downstream signaling pathways. It has been reported that approximately 30% to 50% of metastatic CRC has K-ras mutations. K-ras wild type (WT) status is associated with survival benefits in cetuximab-treated metastatic colorectal cancers2. However, not all WT patients respond to cetuximab and some patients with mutant K-ras experience long-term disease controls, and thus, it is necessary for clinicians to predict clinical outcomes more accurately1. EGFR inhibitors (EGFRIs) are generally well-tolerated and do not have the severe systemic side effects. Nevertheless, EGFRIs frequently cause skin toxicity and may lead to discontinuation of treatment. Although papulopustular rash is the most observed toxicity, the xerosis, pruritis, paronychia, hyperpigmentation and hair changes can be noticed. Eyelash elongation is an uncommon drug-associated adverse effect of EGFRIs and it is most frequently associated with cetuximab3-5. The exact mechanisms of EGFRIs related skin toxicities are not fully understood but several mechanisms have been proposed. EGFR is highly expressed in the skin and hair follicles, and EGFR is important for normal skin development. For that reason, inhibiting the EGFR leads the toxicities, and it is frequently observed in patients. It was suggested in different studies that rash was associated with a better outcome and rash might be a surrogated clinical marker. However, management of EGFRIs related skin toxicities is important for maintaining both dose intensities for EGFRIs and quality of life. Although previous trials suggested that skin care, topical antibiotics and immunomodulatory agents, prophylactic uses of tetracycline and minocycline decrease the severity of rash, therefore, dose reductions, interruptions and cessations are required3,4. The long eyelashes are not a drug-limiting adverse effect, but trimming the lashes usually ameliorates local symptoms, and elongations of eyelashes might be associated with a better outcome and a surrogated clinical marker.