Improvement In Clinical Appearance Research Articles

Assessment of Clinical Outcomes in Patients with Oral Lichen Planus and Oral Lichenoid Lesions (OLP & OLL) Following Treatment with Topical Corticosteroids

Objective: To assess the clinical outcomes in patients with oral lichen planus and oral lichenoid lesions (OLP & OLL) following treatment with topical corticosteroids. Methodology: A total of 175 patients diagnosed with OLP and OLL were recruited from the outpatient department. This cross-sectional study was conducted at Institute of Dentistry (IOD) & CMH, Lahore from July 2023 to December 2023. Inclusion criteria included patients aged 18 years and above with clinically and histopathologically confirmed OLP or OLL lesions. All enrolled patients received topical corticosteroid therapy according to a standardized protocol. Patients were instructed on proper application techniques and advised to adhere to the prescribed treatment regimen. Clinical evaluation of the oral mucosal lesions was performed at baseline and at regular follow-up. Outcome measures included changes in lesion size, severity of symptoms (pain, burning sensation), and overall improvement in clinical appearance. Results: The mean age of the patients was 52.4 years (SD: 10.3). In terms of gender distribution, among the included patients 25 patients (28.57%) were male and 25 patients (71.42%) were female. Among the symptoms observed, Pain was reported by 95 patients (54.28%), Burning Sensation by 110 patients (62.85%), Discomfort by 75 patients (42.85%), and Other symptoms by 20 patients (11.42%). In the clinical outcomes observed with topical corticosteroids, reduction in lesion size was noted in 140 patients, accounting for 80.0%, complete resolution of lesions occurred in 60 patients, representing 34.3%, and reduction in symptoms was reported by 155 patients, constituting 88.6%. Oral candidiasis was noted in 7 patients (4.0%), Mucosal atrophy occurred in 13 patients (7.42%), whereas the majority. Conclusion: In conclusion, our study underscores the efficacy of topical corticosteroid therapy in managing oral lichen planus (OLP) and oral lichenoid lesions (OLL). With 80.0% of patients experiencing a reduction in lesion size, 34.3% achieving complete resolution of lesions, and 88.6% reporting a reduction in symptoms, our findings highlight the significant therapeutic benefits of topical corticosteroids.

Topical oil formulation of plant extracts and vitamins as effective treatment for stretch marks and xerosis—An observational longitudinal study

BackgroundStretch marks are linear scars that result from elastic fiber destruction. They usually occur as the consequence of rapid change in the body mass (weight gain and loss, pregnancy, weightlifting), long‐term steroid use, or endocrinopathies. Treatment is challenging and mainly based on topical and procedural therapies, although the standard of care is still under debate.PurposeTo evaluate the efficacy and tolerance of a topical oil formulation of plant extracts and vitamins on the aesthetic improvement of stretch marks and xerosis.Materials and methodsFifty male and female patients, aged between 14 and 45 years, with stretch marks referring at the University Hospital Federico II, Naples, were enrolled between March and November 2019. Topical application of plant extracts and vitamin‐rich oil was performed twice daily on affected skin for 4 months. Patients were monitored at baseline (T0), and at two‐month (T1) and 4‐month (T2) follow‐ups, through clinical and dermoscopic assessment, confocal microscopy, cutaneous ultrasound, MoistureMeterEpiD, and X‐Rite spectrocolorimeter. Primary endpoints were as follows: 70% clinical improvement of stretch marks and 3‐point decrease in clinical score from baseline to T2. Secondary endpoints were as follows: change in the T0 parallel pattern of collagen fibers at confocal microscopy, cutaneous thickness increase at ultrasounds, cutaneous hydration increase at MoistureMeterEpiD, erythema reduction at X‐Rite spectrocolorimeter, and safety and adverse events (AEs).ResultsAt 4‐month follow‐up, stretch marks improved objectively and subjectively in all patients (p < 0.001). In detail, there was a 29% and 71% improvement in clinical appearance of stretch marks at T1 and T2, respectively, as documented dermoscopically and by the 3‐point reduction in the assessor's mean clinical score at each follow‐up visits [from 8.1±0.7 at baseline to 5.7±1.0 at T1 and 2.3 ±0.5 at T2 (p < 0.001)]. Erythema decreased by 15% and 30% and in parallel hydration increased by 25% and 71%, at T1 and T2, respectively (p < 0.001). At T2 confocal microscopy of stretch marks, dermal collagenous fibers assumed casual disposition with reticular pattern and refractivity, as signs of collagen remodeling and neocollagenesis, and also the T2 cutaneous ultrasound revealed increased epidermal thickness and decreased dermal hypoechogenicity as for a higher skin hydration.ConclusionOur study showed that a topical oil formulation rich in plant extracts and vitamins appears to be effective and safe in treating stretch marks and xerosis.

Topical rapamycin reduces markers of senescence and aging in human skin: an exploratory, prospective, randomized trial

Aging is a major risk factor for the majority of human diseases, and the development of interventions to reduce the intrinsic rate of aging is expected to reduce the risk for age-related diseases including cardiovascular disease, cancer, and dementia. In the skin, aging manifests itself in photodamage and dermal atrophy, with underlying tissue reduction and impaired barrier function. To determine whether rapamycin, an FDA-approved drug targeting the mechanistic target of rapamycin (mTOR) complex, can reduce senescence and markers of aging in human skin, an exploratory, placebo-controlled, interventional trial was conducted in a clinical dermatology setting. Participants were greater than 40 years of age with evidence of age-related photoaging and dermal volume loss and no major morbidities. Thirty-six participants were enrolled in the study, and nineteen discontinued or were lost to follow-up. A significant (P = 0.008) reduction in p16INK4A protein levels and an increase in collagen VII protein levels (P = 0.0077) were observed among participants at the end of the study. Clinical improvement in skin appearance was noted in multiple participants, and immunohistochemical analysis revealed improvement in histological appearance of skin tissue. Topical rapamycin reduced the expression of the p16INK4A protein consistent with a reduction in cellular senescence. This change was accompanied by relative improvement in clinical appearance of the skin and histological markers of aging and by an increase in collagen VII, which is critical to the integrity of the basement membrane. These results indicate that rapamycin treatment is a potential anti-aging therapy with efficacy in humans.Trial registration ClinicalTrials.gov Identifier: NCT03103893.

Are there safe and effective treatments for patients with stretch marks?

Evidence-Based Answer The topical agents Verum® and Trofolastin® may reduce the incidence of stretch marks, while treatment with tretinoin or laser therapy may result in overall clinical improvement in appearance of stretch marks (SOR: B, small RCTs and a cohort trial).

The use of diverting colostomies in paediatric peri-anal burns: Experience in 45 patients

Peri-anal burns are common in children. Continual exposure to enteric organisms may lead to a contaminated burn wound, invasive sepsis, graft loss, scar contracture, anal and urinary malfunction, and delayed discharge from hospital. Use of a temporary diverting colostomy has been advocated to reduce complications. To review the incidence, indications, methods, bacteriology, therapeutic effects and outcomes of colostomy for perianal burns. A prospective study of children with peri-anal burns and stomas over a 17-year period. Prophylactic or therapeutic faecal diversion was achieved by temporary, divided sigmoid end-colostomy with Hartmann's closure of the distal end. Between 1995 and 2012, 45 children with peri-anal burns received a colostomy. The mean total body surface area burned was 35% (range 3 - 80%). There were 28 flame burns, 16 fluid burns and 1 contact burn. Prophylactic colostomies were performed in 29 children, on average on day 6 after admission, and therapeutic colostomies to counteract deep wound infection and septicaemia in 16 patients, on average on day 24. In all but 2 cases there was a marked improvement in clinical appearance, graft take and healing. The bacterial profile changed from gut-derived organisms to Pseudomonas aeruginosa or no pathogens. Complications occurred in 5 patients (11.1%). Three stomas required manual reduction. Two children died of established septic shock, compounded by stomal dehiscence in 1 case. Reversal of the colostomy was performed on average at 4 months. Diverting colostomy has therapeutic advantages in a select group of paediatric burns patients in whom continual faecal soiling poses a threat to both graft and life.

Promising Efficacy with the 308 Nm Excimer Laser Phototherapy in Early Stage Mycosis Fungoides

Abstract 4990 Background:Mycosis fungoides is the most common type of cutaneous T-cell lymphoma. Early stage disease is effectively managed with skin directed therapies such as UV light and topical steroids. Excimer laser (EL) delivers monochromatic, UVB light at a wavelength of 308 nm via hand held device that covers an area of 2 × 2 cm. It generates a short-pulse radiation that is concentrated on an affected area of skin, thereby allowing a delivery of higher dose on precisely targeted tissue. In contrast to other phototherapy techniques such as narrow band UV light, the EL is ideally suited for patients with small number of patch lesions. Although EL was successfully utilized in the management of psoriasis and vitiligo, there is not extensive experience with this modality in patients with CTCL. Objectives:To assess safety and efficacy of EL therapy in patients with early stage MF who failed ≥1 skin directed therapy. Design and Methods:This is a retrospective analysis of seven consecutive patients with stage 1 MF treated with EL phototherapy between January 2011 and August 2011 in a single institution. Seven patients with histologically confirmed common type MF, and one patient with folliculotropic MF received 308 nm EL therapy after failure of at least one prior skin directed therapy. The median age was 48 years (range 24–77 yrs). Four (57%) were male, 3 (43%) were female, six (86%) were Caucasian, and 1(14%) were African American. Biopsies and photos were obtained at diagnosis and after the completion of 24 treatments. Results:Treatment was initiated at a dose of 200 millijoules (mJ) and was increased by 10–15% each subsequent treatment. The max dose of treatment ranged from 240 mJ to 850 mJ. The total number of administered treatments was 24 delivered over period of 3 months. The median number of treated lesions was 2 (range 1–5). The surface area of treated lesions was <10%. Six patients achieved clinical improvement in appearance of lesions and intensity of pruritis; 2 (29%) achieved clinical remission as confirmed with photos and post-treatment biopsies. One (14%) patient developed first degree burn and 1 (14%) patient developed pruritis. These resolved by the second treatment with EL. There were no treatment-related serious adverse events observed. Conclusion:Our results suggest that EL is effective and well tolerated skin-directed treatment modality for selected patients with early stage MF. However, longer follow-up will be required to assess durability of responses. Advantages of this approach include shorter treatment duration and lower risk of carcinogenesis in the non-affected areas of skin. Prospective study with a larger cohort of patients is necessary to further assess efficacy and safety of this approach. Disclosures:No relevant conflicts of interest to declare.

Treatment of Hypertrophic Scars and Keloids Using Intense Pulsed Light (IPL)

Keloids and hypertrophic scars are extremely disturbing to patients, both physically and psychologically. This study prospectively assessed the safety and efficacy of intense pulsed light (IPL) on scars originating from burns, trauma, surgery, and acne. Hypertrophic scars in 109 patients, originating from surgical incisions (n = 55), traumatic cuts (traffic accidents) (n = 24), acne scars (n = 6), keloids (n = 5), and burns (n = 19), were treated using an IPL Quantum device. Treatment was administered at 2-4-week intervals, and patients received an average of 8 treatments (range = 6-24). Using digital photographs, Changes in scar appearance were assessed by two physicians who were blinded to the study patients and treatments. The photographs were graded on a scale of 0 to 4 (none, minimal, moderate, good, excellent) for improvement in overall clinical appearance and reduction in height, erythema, and hardness. An overall clinical improvement in the appearance of scars and reductions in height, erythema, and hardness were seen in the majority of the patients (92.5%). Improvement was excellent in 31.2% of the patients, good in 25.7%, moderate in 34%, and minimal in 9.1%. Over half the patients had good or excellent improvement. In the preventive IPL treatment group, 65% had good to excellent improvement in clinical appearance. Patient satisfaction was very high. This study suggests that IPL is effective not only in improving the appearance of hypertrophic scars and keloids regardless of their origin, but also in reducing the height, redness, and hardness of scars.

1% Hydrocortisone ointment is an effective treatment of pruritus ani: a pilot randomized controlled crossover trial

Pruritus ani (PA) is a common condition which is difficult to treat in the absence of obvious predisposing factors. There is paucity of evidence-based guidelines on the treatment of this condition. We examined whether 1% hydrocortisone ointment is an effective treatment for PA. A pilot randomized, double-blind, placebo-controlled, crossover trial was carried out. Eleven patients consented to take part in the trial and ten completed the study. After a 2-week run-in period, patients with primary PA were randomly allocated to receive 1% hydrocortisone ointment or placebo for 2 weeks followed by the opposite treatment for a further 2-week period. There was a washout period of 2 weeks between treatments. The primary outcome measure was reduction in itch using a visual analogue score (VAS). The secondary outcome measures were improvement in quality of life measured using a validated questionnaire (Dermatology Life Quality Index, DLQI) and improvement in clinical appearance of the perianal skin using the Eczema Area and Severity Index (EASI) score. Treatment with 1% hydrocortisone ointment resulted in a 68% reduction in VAS compared with placebo (P=0.019), a 75% reduction in DLQI score (P=0.067), and 81% reduction in EASI score (P=0.01). A short course of mild steroid ointment is an effective treatment for PA.

Near Infrared Spectroscopy as a Potential Method to Detect Bovine Respiratory Disease

Bovine respiratory disease (BRD) continues to bethe leading cause of illness and death loss from weaning through finishing. There is no objective method to evaluate a live animal's severity of sickness or their response to treatment. A pilot study was conducted at a commercial feedyard to evaluate the ability of near-infrared spectroscopy to differentiate between cattle identified as healthy and those identified as having undifferentiated bovine respiratory disease. At processing, 215 randomly selected 900 lb (409 kg) heifers were evaluated to determine tissue oxygen saturation (StO2) levels. Mean ranks of the StO2 values were found to be 176.86+/- 5.50. One-hundred head of cattle pulled for clinical signs of bovine respiratory disease were evaluated in the hospital. Animals were classified as first pull, second pull and third pull based upon clinical observations. First pull animals were those with no previous history of being treated for respiratory disease and having signs of BRD with rectal temperature at or above 104 ° F ( 40° C). Second pulls and third pulls were those animals failing to respond to either a first treatment or a second treatment for BRD as evidenced by no improvement in clinical appearance or rectal temperature remaining above 104.0 F. Mean StO2 ranks were 110.42 +/- 11.29, 120.08 +/- 14.48 and 132.83 +/- 19.00 for first, second and third pulls, respectively. A significant difference was found between the rank of the StO2 values in cattle at processing and those classified as first, second or third pulls (P&lt;0.05). No difference was found between the three pull classifications. The authors feel that the results shown in this study provide the basis for further research in the evaluation of BRD with near-infrared spectroscopy.

Near infrared spectroscopy as a potential method to detect bovine respiratory disease (2004)

Bovine respiratory disease continues to be the leading cause of illness and death loss from weaning through finishing. There is no objective method to evaluate a live animal's severity of sickness or their response to treatment. A pilot study was conducted at a commercial feedyard to evaluate the ability of near infrared spectroscopy to differentiate between cattle identified as healthy and those identified as having undifferentiated Bovine Respiratory Disease (BRD). At processing, 215 randomly selected 900 lb heifers were evaluated to determine tissue oxygen saturation (StO2) levels. Mean ranks of the StO2 values were 176.86 ± 5.50. One hundred cattle pulled for clinical signs of bovine respiratory disease were evaluated in the hospital. Animals were classified as: 1st pull, 2nd pull, and 3rd pull on the basis of clinical observations. First-pull animals were those having no previous history of being treated for respiratory disease and having signs of BRD, with rectal temperature at or above 104°F. Second pulls and 3rd pulls were those animals failing to respond to either a first treatment or a second treatment for BRD as evidenced by no improvement in clinical appearance or by rectal temperature remaining above 104°F. Mean StO2 ranks were 110.42 ± 11.29, 120.08 ± 14.48, and 132.83 ± 19.00 for 1st, 2nd, and 3rd pulls, respectively. A significant difference was found between the rank of the StO2 values in cattle at processing and those classified as 1st, 2nd, or 3rd pulls (P<0.05). No difference was found between the three pull classifications. Results provide the basis for further research in the evaluation of BRD with near infrared spectroscopy.

Retinal capillary hemangioma treated with verteporfin photodynamic therapy

PURPOSE: To describe a case of exudative retinal capillary hemangioma treated with photodynamic therapy that resulted in an improvement in clinical appearance and visual acuity. DESIGN: Interventional case report. METHODS: A 55-year-old Asian man presented with a large exudative peripheral retinal capillary hemangioma of the left eye causing serous retinal detachment, cystoid macular edema, and a best-corrected visual acuity of 20/200. The hemangioma was treated with three successive sessions of verteporfin photodynamic therapy (PDT). RESULTS: With 10 months of follow-up after the initial treatment, involution of the hemangioma, reduction of subretinal fluid, and improvement of best-corrected visual acuity to 20/80 was seen. CONCLUSION: Photodynamic therapy may be an effective treatment option in select cases of exudative retinal capillary hemangioma.

The use of percutaneous transluminal angioplasty in hepatic artery stenosis after transplantation.

Graft ischemia following liver transplantation is associated with a high incidence of morbidity and mortality. The present report concerns a group of seven patients in whom an anastomotic stenosis of the hepatic artery was identified. Three patients had unexplained allograft dysfunction at a median time of 28 days (range 13-64 days), and 3 had a biliary leak at a median time of 42 days after liver transplantation (range 35-270 days). In one patient the stenosis was diagnosed by routine Doppler ultrasound one week after transplant. Management was by percutaneous transluminal angioplasty at a median time of 35 days (range 13-270 days) after transplantation. After angioplasty there was a marked improvement in clinical appearance, liver function, and liver histology in 5 of the 7 patients. Those patients who had a biliary leak subsequently developed strictures that eventually required biliary tract reconstruction (hepaticojejunostomy) in two and retransplantation in one. Percutaneous transluminal angioplasty is an effective way of improving arterial blood flow in cases of anastomotic stenosis, reducing the likelihood of complete occlusion by thrombosis. If recognized early and treated promptly ischemic changes in the graft can resolve and the development of biliary strictures may be avoided.

Early Lower Limb Surgery in Duchenne Muscular Dystrophy

The objective of early lower limb surgery in Duchenne muscular dystrophy (DMD) is to preserve the patient's walking capacity and functional independence for as long as possible by using limited surgical therapy. The indications for such therapy derive from careful follow-up of patients, with special attention to muscular and/ or aponeurotic contractures as well as developing functional limitations. Since 1985, 22 patients with DMD treated by early operation were followed up; at the end of the follow-up period, 19 of the 22 patients were still able to walk and 11 were aged >10 years. The improvement in clinical appearance of these patients with limited operation and the absence of braces in the postoperative period underlines the usefulness of this technique.

Etretinate treatment for psoriasis inhibits epidermal ornithine decarboxylase

Previous studies of the polyamines and their biosynthetic enzyme ornithine decarboxylase (ODC) in psoriatic skin have revealed several abnormalities, including significantly elevated ODC activity. Retinoids have also been shown to modulate polyamine biosynthesis and inhibit ODC activity after different stimuli in various cell and tissue systems. The effect of etretinate has been studied on ODC activity in involved and uninvolved psoriasis skin. Increased ODC activity was found in pretreatment samples from both involved and uninvolved psoriatic skin compared with normal volunteers. Etretinate treatment significantly reduced ODC activity in both involved and uninvolved skin in psoriatics to a similar level of activity before any improvement in clinical appearance was noted. Inhibition of epidermal ODC activity in psoriasis may represent one mechanism of retinoid action on the abnormal skin psoriasis.