Emollient Cream Research Articles

Management of side-effects

The current treatment of chronic hepatitis C is the triple combination of pegylated interferon, ribavirin and a new direct-acting antiviral [either telaprevir (TVR) or boceprevir (BOC)]. This new association produces better viral response rates, but may induce or enhance adverse events, which can lead to discontinuation of treatment. TVR regimens are associated with an increased risk of dermatological side-effects such as rash, albeit generally mild. In these cases, optimal skincare treatments, including emollient creams and topical corticosteroids, allow the continuation of antiviral treatment. In a minority of cases, the rash may be severe and life-threatening, leading to immediate discontinuation of all treatments. The goal for the physician is to differentiate severe cutaneous adverse reactions (SCARs), including DRESS (drug reactions with eosinophilia and systemic symptoms). Anaemia is also more frequent with triple combinations using TVR or BOC. The management of anaemia requires the use of erythropoietin alpha (EPO) and the need to decrease ribavirin doses. Thus, monitoring haemoglobin has to be more frequent in difficult-to-treat patients such as cirrhosis cases; nevertheless, despite the use of EPO and ribavirin-dose adaptation, blood transfusion is sometimes still required. Thus, triple combination therapy with a DAA is effective, but it increases the rate of adverse events, and adds to the well-known adverse effects of pegylated interferon and ribavirin. This suggests the need for a different clinical and biological management of patients treated with the triple combination.

Association of glycerol and paraffin in the treatment of ichthyosis in children: an international, multicentric, randomized, controlled, double‐blind study

Efficacy and tolerance should be considered in topical treatments of chronicle affections with impaired skin barrier function such as ichthyosis. To demonstrate the efficacy of Dexeryl in reducing severity of ichthyosis. A prospective, multicentre, randomized, placebo controlled study was performed with patients under 18 years suffering from a non-bullous form of ichthyosis. A double-blind period using Dexeryl (an emollient cream containing glycerol 15% and paraffin 10%) or placebo (its vehicle) during 4 weeks followed by an open label period with all patients treated by Dexeryl for 8 weeks. Improvement of ichthyosis was assessed by cutaneous xerosis evolution (SRRC score): the percentage of patients with 50% reduction of the SRRC score at D28 was the primary criterion. The assessment of pruritus [visual analogue scale (VAS)], global evaluation and safety were secondary. The percentage of patients with at least 50% reduction of SRRC score at D28 was significantly higher in Dexeryl group (60.3%) vs. vehicle group (43.5%; P = 0.008). Reduction of pruritus on VAS was significantly higher at D28 with Dexeryl (-2.16) compared to that in placebo (-1.49), P < 0.05. The improvement continues through the open label period: at D84 we observed -2.5 of SRRC score in the Dexeryl group vs.-1.8 for the group previously treated by vehicle. Investigators found Dexeryl efficacy as satisfying for about 80% of treated patients vs. 50% with vehicle. Concerning safety, most of the adverse events were not related to treatment. Dexeryl showed a significant improvement of xerosis and related symptoms in children with ichthyosis and was well tolerated.

Efficacy of topical 10% urea-based lotion in patients with ichthyosis vulgaris: a two-center, randomized, controlled, single-blind, right-vs.-left study in comparison with standard glycerol-based emollient cream

Background:Ichthyoses are genetic disorders of keratinization which are uncomfortable due to their conspicuous scaling, itching and cosmetic problems. Ichthyoses can lead to social discrimination and psychological problems. Ichthyosis vulgaris (IV) is the most common form of these geno-dermatoses. IV is a chronic disorder that often requires continuous therapy. Emollient and keratolytic products are the mainstay treatments of IV. It is important that efficient, safe and well tolerated therapies should be available. Direct comparative data regarding efficacy of different emollient products in IV patients are very few.Objective:The aim of the study was to investigate the keratolytic and moisturizing properties as well as the tolerance of a new urea topical formulation (Ureadin Rx10) when applied to hyperkeratotic and dry skin in patients with (IV) in comparison with a standard emollient cream.Methods:The study was conducted as a two-center, randomized, controlled, single-blind, intra-patient (right-vs.-left) trial design. A total of 30 patients with IV between 8 and 65 (mean age: 25 years) treated with a 10% urea-based lotion, Ureadin Rx 10*Ureadin RX 10 is a registered trade name of ISDIN, Spain. (URx), for 4 weeks or a glycerol-based emollient cream, Dexeryl†Dexeryl is a registered trade name of Pierre Fabre Dermatologie. (DC), in a right-vs.-left study design. Primary outcome was a 5-point SRRC Index score (evaluating scaling roughness, redness and cracks) evaluated at baseline and after 2 and 4 weeks of treatment. As secondary endpoints patients evaluated also the global efficacy (GE) and global tolerability (GT) scores with the help of a 10 cm visual analogue scale (0 = no efficacy at all/very bad tolerability; 10: excellent efficacy/excellent tolerability).Results:At baseline the mean (SD) SRRC score was 9.5 (1.9) in the URx treated sites and 9.5 (1.9) in the DC treated sites. A total of 27 patients (90%) concluded the study period. Three patients were withdrawn prematurely because of itching and burning sensation after DC application (1 patient) or URx application (2 patients). At week 4, in comparison with baseline values, both treatments were shown to be clinically effective: SRRC significantly (p = 0.0001) decreased to 3.3 (1.8) after URx (a 65% relative reduction) and to 5.7 (2.5) after DC (a 40% relative reduction). SRRC was significantly lower in URx treated regions in comparison with DC both after 2 and 4 weeks of treatment (p = 0.0005). Mean GE score in areas treated with URx was significantly (p = 0.0001) higher than in the areas treated with the DC (8.9 vs.7.3). Both treatments were in general well tolerated. GT score was 8.1 (range 10 to 3) with URx and 8.4 (range 10 to 3) with DC application (p = ns). The two main limitations of this trial are the study design (single blind), and the small sample size which is not adequate for an evaluation of safety.Conclusion:Ureadin Rx 10 lotion has shown a greater efficacy on ichthyosis vulgaris in term of reduction of scaling, roughness, redness and cracking in comparison with a glycerol-based emollient cream. Tolerability of the two topical treatments was comparable. Further studies with larger sample sizes are needed for the evaluation of safety and tolerability of urea 10% lotion in this clinical setting.

THE INFLUENCE OF TOPICAL GLUCOCORTICOSTEROIDS ONCYTOKINE GENE EXPRESSION IN THE SKIN AND PERIPHERALBLOOD OF ATOPIC DERMATITIS PATIENTS

Background. To investigate the influence of mometasone furoate 0,1% cream on cytokine gene expression in the skin and peripheral blood of atopic dermatitis (AD) patients comparing with control. Material and methods. 40 AD patients were included in the study and divided into 2 groups. group 1 patients were given continuous course of mometasone furoate 0,1% cream treatment for 14 days. group 2 patients were given indifferent emollient elobase cream for 14 days. Clinical efficacy of the treatment was assessed on the following features: SCORAD index, Investigators global Assessment (IgA) score and subjective assessment of itch and dryness of the skin according to skin area to be studied. Skin samples and peripheral blood of atopic dermatitis were used as material for immunological study. Interleukin (IL)1B, IL2, IL2r, IL4, IL5, IL6, IL7, IL8, IL10, IL 12A, IL12B, IL15 (total), IL15 , IL17A, IL18, IL23, IL28, IL29, Interferon (IFN)-ƒ, Tumor necrosis factor (TNF), Transforming growth factor beta 1 (TGFB1), forkhead box P3 (FOXP3) gene expression were defined in the skin and peripheral blood of AD patients by realtime reverse transcription polymerase chain reaction (RT-pCR). Results. positive clinical effect was found with all AD patients on the mometasone furoate 0,1% cream therapy background for 14 days and also dryness, rushes and skin itch decreased. Stаtistical significant decrease of proinflammatory cytokines IL2, IL2r, IL5, IL8, IL12В, IL23, IFN-ƒ gene expression was marked. They are the markers of chronic inflammation and Th1 immune response. Studying peripheral blood after mometasone furoate 0,1% cream treatment increase of TGFB1, FOXP3 gene expression level was found. no significant changes of cytokine gene expression in AD patients, who got elobase cream were found. Conclusion. Antiinflammatory activity of mometasone furoate 0,1% cream was shown by its influence on proinflammatory cytokines IL2, IL2r, IL5, IL8, IL12В, IL23, IFN-ƒ gene expression in the skin and mechanisms of immune response in moderate and severe AD patients.

Therapeutic effects of Tephrosia vogelii ointment in the treatment of bovine dermatophilosis

The therapeutic effect of a cream ointment prepared from the leaves of Tephrosia vogelii Hook F., was tested for the treatment of bovine dermatophilosis in four local cows of the Sokoto Gudali breed and two 50% Holstein Friesian crosses in Jos, Plateau State Nigeria. All the selected animals used in this study were naturally infected by the Dermatophilus congolensis organism. The selected animals all showed established, oozing, and hard crusty lesions on their skins, typical of dermatophilus lesions. All the animals had various degrees of infections ranging from mild to severe, with the lesions located on different parts of the skin. Six of the animals were selected for the experimental treatment with the prepared ointment made from the leaves of T. vogelii, while the rest of the infected animals in the herd were kept untreated as the control. A cream ointment was prepared from the leaves of T. vogelii for topical application on the skin lesions of the affected animals. The ointment was applied liberally on the lesions every other day. The crusts on the skins of the affected animals were observed to start falling off from the third day in the local animals, and on the sixth day in the crosses, following the first application of the ointment. Complete healing and new hair growth was observed within the period of 4 to 8 weeks. The affected areas of the skins became completely healed and normal without any problem in all the affected animals. No healing or improvement was observed in the control group that was left untreated. Key words: Tephrosia vogelii, bovine dermatophilosis, cream ointment.

The effect of aqueous cream BP on the skin barrier in volunteers with a previous history of atopic dermatitis

The emollient aqueous cream BP is frequently used for the treatment of atopic dermatitis (AD), yet it is associated with a high rate of adverse cutaneous reactions. It contains the harsh anionic surfactant sodium lauryl sulphate, a known negative environmental factor associated with the exacerbation of AD. To investigate the effect of aqueous cream BP on stratum corneum (SC) integrity and skin barrier function in volunteers with a predisposition to a defective skin barrier. Thirteen volunteers with a previous history of AD (no symptoms for 6 months) applied aqueous cream BP twice daily to the volar side of one forearm for 4 weeks. The other forearm was left untreated as a control. Permeability barrier function and SC integrity were determined before and after treatment by measuring transepidermal water loss (TEWL) in conjunction with tape-stripping. For comparison, 13 volunteers with current AD were recruited for assessment, without treatment, of SC integrity and skin barrier function at unaffected sites. Topical application of aqueous cream BP resulted in significant elevation of baseline TEWL and a concomitant decrease in SC integrity. Measurements made after no treatment in volunteers with current AD, at unaffected sites, suggest that application of aqueous cream BP negatively affects the skin barrier towards the damaged state associated with onset of flares of the disease. Aqueous cream BP used as a leave-on emollient caused severe damage to the skin barrier in volunteers with a previous history of AD. Aqueous cream BP should not be used as a leave-on emollient in patients with AD.

The effect of avocado butter to stability of avocado emollient cream

The characteristic of emollient cream that contained of avocado butter as anti-aging is influenced by amount of avocado butter used. The research has a purpose to exploit and develop usage of avocado butter in the field of cosmetic. The research has done by making A/M cream used 1-11% avocado butter with melting and mixing method at temperature of 70-75 °C. Stability of product creams were be evaluated, and tested with accelerated test using elevated temperature. The result showed that concentration of avocado butter between 1-11% can be made become W/O emollient cream. The cream stability was progressively influenced by amount of avocadobutter, the increasing of avocado butter would make progressively good stability, the stability go down at 7% concentration. The best stability creams has shown by cream that contain 5% avocado butter, Key words: avocado butter, A/M cream type, emollient cream, stability of cream

Bioequivalence of two formulations of tretinoin emollient cream (0.05%)

Bioequivalence of two formulations of tretinoin emollient cream (0.05%)

A Dead Sea Water-Enriched Body Cream Improves Skin Severity Scores in Children with Atopic Dermatitis

Dead Sea (DS) mud and water are known for their unique composition of minerals, and for their therapeutic properties on inflammatory skin diseases. The objective of the study was to evaluate the efficacy of an emollient cream enriched with DS water in children with atopic dermatitis (AD). Eighty six AD children were randomized in a double-blind controlled study to receive twice-daily topical treatment with a body cream enriched with DS minerals (TP) compared to two types of control: 1) DM, DS minerals with lower DS water concentrations than TP, and 2) an emollient (E) with no DS minerals. Efficacy was assessed by a change in clinical skin severity scores: SCORing Atopic Dermatitis (SCORAD), investigator’s global assessment (IGA) and patient global assessment (PGA) as well as by objective physiological parameters: transepidermal water loss (TEWL), stratum corneum hydration (SCH), affected body surface area (BSA) and Objective Severity Assessment of Atopic Dermatitis (OSAAD). The total length of the trial was 12 weeks divided to 6 visits at weeks 0, 2, 4, 6, 8, 12. The study showed that both TP and DM creams improved OSAAD scores. Only TP improved TEWL and SCH. TP was the most effective regarding TEWL, SCH and OSAAD compared to DM and E. Treatment with E decreased more significantly IGA score compared to TP. Although within each treatment group significant improvements in SCH, BSA, SCORAD, IGA and PGA were observed, the reduction in BSA, SCORAD and PGA was not significantly different among the groups. Our results clearly show the benefits of TP as a leave on-skin emulsion enrich with DS water in terms of skin barrier function. Thus, TP can serve as an effective adjuvant treatment for AD skin as well as for its maintenance.

Allergic contact dermatitis to propyl gallate and pentylene glycol in an emollient cream

A 62-year-old man, with a 20-year history of seborrhoeic dermatitis, presented with a worsening of his dermatitis. He had previously been demonstrated to be allergic to various topical corticosteroids, so he had been using an emollient cream (Sebclair), containing piroctone olamine and various anti-inflammatory substances, for 6 months, with good effect. Patch testing to the cream and its ingredients revealed positive reactions to both propyl gallate and pentylene glycol. A positive reaction to propylene glycol was also detected, whereas patch testing to butylene glycol was negative. Complete remission followed avoidance of the offending substances.

A Phase I Dose Escalation Study of Steroid Sulfatase Inhibitor BN83495/STX64 in Postmenopausal Women with ER Positive Breast Cancer.

Abstract Background: BN83495/STX64 is an irreversible steroid sulfatase (STS) inhibitor blocking the hydrolysis of sulfated estrone E1S and dehydroepiandrosterone DHEAS to their unsulfated active forms and thereby preventing conversion to Estradiol (E2) and Androstenediol (adiol), respectively. A phase I dose escalation study was conducted in post-menopausal women (PW) with ER+ metastatic breast cancer (MBC). The aim of the study was to determine the optimal biological dose (OBD) defined as the dose at which STS inhibition in peripheral blood mononuclear cells (PBMCs) ≥ 95% after 7 (D7) and 28 (D28) days of repeated oral daily administration and which also showed a maximal reduction in plasma E2 and adiol levels at D28 with no drug-related Grade 3 (Gr 3) or higher toxicity. Pharmacokinetics (PK), safety, tolerability and anti-tumour activity of BN83495 were also assessed.Methods: Patients (pts) had received at least one line of hormone therapy (HT) and at most 2 lines of chemotherapy (CT) in the adjuvant and/or advanced disease setting. Three to six pts were recruited into each of 5 sequential dose cohorts (1, 5, 20, 40 and 80 mg). The steady-state PK of BN83495 were assessed in all pts. Serum concentrations of E2 and Adiol were determined pre-dose, on D7 and D28 by HPLC-MS/MS analysis. Objective antitumor response was assessed according to RECIST criteria (version 1.0).Results: 29 pts were evaluable for safety. All had received one prior HT for MBC (Aromatase Inhibitors (AI): 86.2% Tamoxifen: 13.8%) and 12 (41.4%) received 2 lines of HT for MBC. BN83495 was well tolerated at doses up to 40 mg. Gr 3 fatigue with positive rechallenge was observed after 3 months of treatment in one pt at 80 mg. The main toxicity was dry skin Gr≤2 (N=12) that was observed in some pts in all cohorts from 20 mg up and was treated with emollient creams. Other toxicities included Gr 1/2 fatigue (N=6), hot flushes (N=3) and nausea (N=2).27 pts were evaluable for efficacy and hormone and STS evaluation. 14 pts received ≥ 3 months treatment. There were 3 SD ≥ 6 months, one each at 13 months (#020, 40 mg), 8 months (#015, 20 mg) and 7 months (#027, 80 mg, hormone resistant pt). Biopsy-proven erythematous skin infiltration in one patient (#027) was no longer visible after 1 month of treatment. Nearly complete STS enzyme inhibition was observed at all doses. The OBD was determined to be 40 mg. At this dose, mean Adiol reduction was -54.0% (-74.0—34.0) and E2 was –27.4% (-47.6- -7.2).An additional cohort (6 pts) was enrolled at 40 mg and FDG PET-scan was performed. Decrease &amp;gt;25% in hypermetabolic volume was noted in 2/5 lesions in 2 patients for whom data are available.Conclusion: BN83495 was well tolerated. Disease stabilizations ≥ 6 months were observed in this heavily pre-treated population including in one hormone resistant pt. The OBD was determined to be 40 mg. Complete FDG-PET scan data will be presented. Based on data obtained so far, BN83495 has shown activity. The study is ongoing. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4097.

Use of Mustela Stelatopia moisturising products in children with atopic dermatitis

THE AIM OF THE STUDY WAS To estimate the efficiency and tolerance of daily application of Mustela Stelatopia emollient cream and bath oil as products for care of child's skin in 64 children suffering from atopic dermatitis. Results. The study showed that Mustela Stelatopia had a considerable treatment-and-prophylactic effects resulted to lower dryness and reduced itching. Skin humidity and SCORAD index during the study had expressed positive dynamics in children of the basic group unlike the comparison group

Topical Triamcinolone for Persistent Phimosis

Between 2% and 5% of uncircumcised boys have persistent or pathological phimosis. Traditional treatment is usually circumcision. Recently medical treatment with topical corticosteroids has become more popular. We evaluated the efficacy of the topical steroid triamcinolone compared to foreskin retraction with an emollient cream and verified the long-term success rate of these treatments. We performed a double-blind, randomized, placebo controlled study to compare 2-month twice daily treatment with emollient cream (placebo group 1) vs 0.1% triamcinolone (experimental group 2). Boys between ages 3 and 12 years with persistent or pathological phimosis were included in analysis. Study EXCLUSION criteria were previous treatment with topical corticosteroid, untreated balanitis and any known medical condition with immune system impairment. Patients were seen 2, 4 and 12 months after treatment initiation. Success was defined as complete, easy foreskin retraction at 4 and 12 months. Statistical analysis was done using Fisher's exact test. We enrolled 63 patients, of whom 43 completed the study. Despite multiple attempts 20 patients had incomplete followup and were excluded from study. Placebo group 1 included 25 patients and triamcinolone group 2 included 21. In group 1 the success rate was significantly lower than in group 2 (9 patients or 39% vs 16 or 76%, p = 0.0086). At 2 months 5 and 16 nonresponders in groups 2 and 1, respectively, were treated in nonblinded fashion with topical triamcinolone. In this subgroup 1 of 3 group 2 patients and 6 of 13 in group 1 achieved complete, easy retraction. Two and 1 patients were lost to followup in groups 1 and 2, respectively. Circumcision was required in only 5 patients (11.6%), including 4 (17.4%) initially in group 1. No complications were noted in either group. Triamcinolone is a highly effective and safe short-term treatment for persistent physiological or pathological phimosis. However, at long-term followup recurrence is frequent and not rare with triamcinolone and it may require re-treatment or circumcision.

Is American Hegemony Bad or Just Better than Alternatives?

War, Peace and Hegemony in a Globalized World: The Changing Balance of Power in the 21st Century. Edited by Chandra Chari. London: Routledge, 2008. 256 pp., hardcover (ISBN-13: 9780415435772). This collection of essays covers familiar ground but still offers value as a largely Asian perspective on hegemony and globalization. Fourteen of the 18 contributors are from Asia, nine from India alone. In an introduction by Chandra Chari, the volume rejects the notion, popular among Western realists, that American hegemony is necessary to avoid anarchy and expects “the processes of globalization, which have economically empowered a large number of countries across the globe,” to provide new “bargaining chips” to strengthen multilateralism. Opening chapters address global perspectives. Eric Hobsbawn, the eminent British scholar, leads off with a blistering attack against the “political crazies” (p. 23) in the United States who after 9/11 abandoned the “emollient cream” (p. 22) of American Cold War policies and sought global hegemony through military might. If these crazies prevail, he predicts “another century of conflict” (p. 20). Akira Iriye and Joseph Nye, two equally eminent Harvard scholars, celebrate the “momentum toward transnationalism” (p. 33) ignited by globalization and expect that growing diversity especially on the economic and information chess boards of world affairs will check American military pretensions. William Wallace at the University of Saint Andrews worries that the world may be approaching “a nuclear tipping point beyond which a ‘cascade of proliferation’ could occur as states assume that the international nuclear order can no longer provide them with sufficient protection” (p. 56). Prem Shankar Jha, an Indian journalist, argues that “capitalism has …

Management of dry skin conditions in older people

This article examines the physiological changes that occur in the skin with advancing age that make it more prone to skin problems. Examples of common skin disorders that may affect older people are provided. Intrinsic factors such as a genetic tendency to eczema, and extrinsic factors such as the effects of sun damage and general poor health can both affect the skin of older people. The management of dry skin conditions in this age group is investigated and the value of emollient therapy, involving the use of bath emollients, soap substitutes and leave-on emollient lotions, creams or ointments, is discussed.

The Effect of Daily Treatment with an Olive Oil/Lanolin Emollient on Skin Integrity in Preterm Infants: A Randomized Controlled Trial

To date, appropriate skin therapy for premature infants has not been clearly defined. Emollient creams are often used without solid evidence for a benefit to the neonate. The aim of the current study was to investigate the cutaneous effects of two different topical ointment therapies. Between October 2004 and November 2006 we prospectively enrolled 173 infants between 25 and 36 weeks of gestation admitted to a neonatal intensive care unit. Infants were randomly assigned to daily topical treatment with water-in-oil emollient cream (Bepanthen), olive oil cream (70% lanolin, 30% olive oil), or to a control group. Each neonate was continuously treated for a maximum of 4 weeks. Skin condition (skin score reflecting degree of dermatitis) in these groups was compared at weeks 1, 2, 3, and 4. Neonates treated with olive oil cream showed statistically less dermatitis than did neonates treated with emollient cream, and both had a better outcome than those in the control group (p < 0.001 in weeks 2-4). Treatment effects persisted throughout the study period and applied to infants of all gestational ages. This study demonstrates that topical skin therapy lowers the risk of dermatitis. Olive oil cream was superior to water-in-oil emollient cream.

Viewpoint 2

Chronic exposure to the ultraviolet (UV) component of solar radiation leads to photoageing which is characterised clinically by fine and coarse wrinkles, dyspigmentation, telangiectasia, laxity, roughness and a sallow appearance (1). Histologically, photoageing is represented by changes in the dermal extracellular matrix including disorganisation and loss of collagen and fibrillin fibrils in the papillary dermis and deposition of dystrophic elastotic material in the reticular dermis (2). The impact of photoageing extends beyond a risk of developing precancerous and cancerous skin lesions and impairs an individual’s psychosocial well-being with anxiety and social isolation as reported consequences (3). Many over-the-counter cosmetic products claim to reduce the clinical signs of photoaged skin; however there is scant evidence from randomized controlled trials (RCTs) to support such claims (4). The use of topical retinoids, including tretinoin, isotretinoin and tazarotene, has been shown in several large RCTs, over the past 20 years, to significantly reduce both the clinical and histological signs of photoageing. Tretinoin emollient cream (0.05% and 0.02%) and tazarotene cream (0.1%) have US Food and Drug Administration approval for the treatment of photoageing. Kligman et al. published the first study of the use of topical tretinoin in the treatment of photoageing (5). Since that time, many placebo-controlled clinical trials have confirmed the ability of topical tretinoin, isotretinoin and tazarotene to repair photoaged skin (6–32). Two large RCTs compared two different retinoids: the first compared tretinoin 0.05% emollient cream and tazarotene 0.01%, 0.025%, 0.05% and 0.1% creams, with vehicle. All retinoid treatment groups demonstrated significant improvements in fine wrinkling as compared with vehicle. Both 0.05% tretinoin emollient cream and 0.1% tazarotene cream led to significant improvement in mottled hyperpigmentation (25). The second trial compared tretinoin 0.05% emollient cream to tazarotene 0.1% cream. The incidence of treatment success, as defined by ≥50% improvement at the study endpoint, was 78% and 67% in the tazarotene group and tretinoin groups respectively. For adverse effects the only significant difference was a higher incidence of skin irritation in the tazarotene group during the first week of treatment (33). The clinical effects of long-term topical retinoid use have been presented in the results of a 24-month RCT of tretinoin 0.05% emollient cream (30). Significant improvements in fine and coarse wrinkling, sallowness, mottled hyperpigmentation and lentigines were noted in the tretinoin treatment group. Use of topical retinoid may be associated with ‘retinoid dermatitis’ which is characterised by local irritation, erythema and desquamation. Side-effects may become less problematic with duration of therapy, or alternatively may be reduced by a more gradual institution of treatment and/or reduced frequency of application. The efficacy of once or three times weekly application of tretinoin emollient cream was evaluated in a long-term extension study of 126 individuals who had already completed 48 weeks of once daily treatment. The benefits obtained from initial daily application were maintained by three times weekly, and to a lesser degree, once weekly application. Of note discontinuing treatment led to some loss of clinical improvement for all variables (21). In many of the more recent studies to investigate the effects of topical retinoids, subjects have also been required to apply sunscreen on a daily basis. Isotretinoin 0.05% combined with sunscreens in a cream formulation used on a once daily basis over a 6 month period produced a significant reduction (P < 0.01) in skin wrinkles as compared with vehicle (29). Furthermore, and intriguingly, regular application of sunscreen alone has been shown to reduce histological signs of solar elastosis (34). The use of photoprotection to prevent signs of photoageing is gaining increasing public interest, with many cosmetic products now containing sunscreen. The regular use of sunscreen should be encouraged in conjunction with ‘sunsmart’ behaviour. Ultraviolet radiation reduces collagen synthesis in the skin accompanied by production of matrix metalloproteinases (MMP). MMP degrade dermal collagen and fibrillin, thereby leading to wrinkling. Studies have shown that application of tretinoin prior to UV exposure can inhibit production of MMP, and thus prevent degradation of collagen (35). Use of topical retinoids induces synthesis of type I collagen in the dermis (16,36). These observations demonstrate the role of retinoids in both preventing and reversing the signs of UV-induced skin ageing. In conclusion, despite the vast array of ‘antiageing’ products now available topical retinoids and sunscreens remain the most tried and tested treatments with long established safety records and proven efficacy in the treatment and prevention of UV-induced skin ageing.

Acceptability of massage with skin barrier-enhancing emollients in young neonates in Bangladesh.

Oil massage of newborns has been practised for generations in the Indian sub-continent; however, oils may vary from potentially beneficial, e.g. sunflower seed oil, to potentially toxic, e.g. mustard oil. The study was carried out to gain insights into oil-massage practices and acceptability of skin barrier-enhancing emollients in young, preterm Bangladeshi neonates. Preterm infants of <33 weeks gestational age were randomized to high-linoleate sunflower seed oil, Aquaphor Original Emollient Ointment, or the comparison group (usual care). A survey was administered at admission to assess routine skin-care practices prior to admission and at discharge to assess acceptability of emollient therapy during hospitalization. Oil massage was given to 83 (21%) of 405 babies before hospital admission, 86% (71/83) of whom were delivered at home. Application of oil, most commonly mustard oil (88%, 73/83), was started within one hour of birth in 51 cases (61%) and was applied all over the body (89%, 74/83) one to six (mean 2.2) times before admission. Of infants who received emollient therapy in the hospital, 42% (n=32) of mothers reported that the emollient applied in the hospital was better than that available at home, and only 29% would use the same oil (i.e. mustard oil) in the future as used previously at home. No problems resulted from use of emollient in the hospital. Topical therapy with sunflower seed oil or Aquaphor was perceived by many families to be superior to mustard oil. If caregivers and health professionals can be motivated to use inexpensive, available emollients, such as sunflower seed oil that are beneficial, emollient therapy could have substantial public-health benefit.

Long-term safety and histopathologic changes following treatment of photodamaged facial skin with tretinoin emollient cream 0.05% in darkly pigmented subjects

Long-term safety and histopathologic changes following treatment of photodamaged facial skin with tretinoin emollient cream 0.05% in darkly pigmented subjects

Evaluation of Adrenal Suppression of a Lipid Enhanced, Topical Emollient Cream Formulation of Hydrocortisone Butyrate 0.1% in Treating Children with Atopic Dermatitis

Corticosteroids are currently the first line of treatment for patients with atopic dermatitis. In the pediatric population however, the potential impact of adrenal suppression is always an important safety concern. Twenty boys and girls, 5-12 years of age, with normal adrenal function and a history of atopic dermatitis were maximally treated three times daily with a lipid-rich, moisturizing formulation of hydrocortisone butyrate 0.1% for up to 4 weeks. At the conclusion of the 4-week treatment period, cosyntropin injection stimulation testing showed no evidence of adrenal suppression. In addition, the therapy was noted to be highly efficacious, with a clinical success rate of 80% (Physician Global Score of (0) clear or (1) almost clear). No local side effects associated with prolonged use of topical corticosteroids were reported. In summary, this study supports the contention that this lipid-rich, moisturizing formulation of hydrocortisone butyrate 0.1% was a well-tolerated and beneficial treatment for atopic dermatitis, demonstrating no adrenal suppression in the pediatric population aged 5-12 years. The relevance of these findings for children below 5 years of age, because of difference in body mass/surface area ratios, remains to be determined.