Keratolytic Agents Research Articles

Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp

Seborrhoeic dermatitis is a chronic inflammatory skin disorder affecting primarily the skin of the scalp, face, chest, and intertriginous areas, causing scaling and redness of the skin. Current treatment options include antifungal, anti-inflammatory, and keratolytic agents, as well as phototherapy. To assess the effects of topical pharmacological interventions with established anti-inflammatory action for seborrhoeic dermatitis occurring in adolescents and adults. We searched the following databases up to September 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 9), MEDLINE (from 1946), Embase (from 1974), LILACS (from 1982), and the GREAT database. We searched five trials databases and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). We included RCTs in adults or adolescents (> 16 years) with diagnosed seborrhoeic dermatitis of the scalp or face, comparing topical anti-inflammatory treatments (steroids, calcineurin inhibitors, and lithium salts) with other treatments. Pairs of authors independently assessed eligibility for inclusion, extracted data, and evaluated the risk of bias. We performed meta-analyses if feasible. We included 36 RCTs (2706 participants), of which 31 examined topical steroids; seven, calcineurin inhibitors; and three, lithium salts. The comparative interventions included placebo, azoles, calcipotriol, a non-steroidal anti-inflammatory compound, and zinc, as well as different anti-inflammatory treatments compared against each other. Our outcomes of interest were total clearance of symptoms, erythema, scaling or pruritus scores, and adverse effects. The risk of bias in studies was most frequently classified as unclear, due to unclear reporting of methods.Steroid treatment resulted in total clearance more often than placebo in short-term trials (four weeks or less) (relative risk (RR) 3.76, 95% confidence interval (CI) 1.22 to 11.56, three RCTs, 313 participants) and in one long-term trial (lasting 12 weeks). Steroids were also more effective in reducing erythema, scaling, and pruritus. Adverse effects were similar in both groups.There may be no difference between steroids and calcineurin inhibitors in total clearance in the short-term (RR 1.08, 95% 0.88 to 1.32, two RCTs, 60 participants, low-quality evidence). Steroids and calcineurin inhibitors were found comparable in all other assessed efficacy outcomes as well (five RCTs, 237 participants). Adverse events were less common in the steroid group compared with the calcineurin group in the short-term (RR 0.22, 95% CI 0.05 to 0.89, two RCTs, 60 participants).There were comparable rates of total clearance in the steroid and azole groups (RR 1.11, 95% CI 0.94 to 1.32, eight RCTs, 464 participants, moderate-quality evidence) as well as of adverse effects in the short-term, but less erythema or scaling with steroids.We found mild (class I and II) and strong (class III and IV) steroids comparable in the assessed outcomes, including adverse events. The only exception was total clearance in long-term use, which occurred more often with a mild steroid (RR 0.79, 95% CI 0.63 to 0.98, one RCT, 117 participants, low-quality evidence).In one study, calcineurin inhibitor was more effective than placebo in reducing erythema and scaling, but there were similar rates in total clearance or adverse events for short-term treatment. In another study, calcineurin inhibitor was comparable with azole when erythema, scaling, or adverse effects were measured for longer-term treatment.Lithium was more effective than placebo with regard to total clearance (RR 8.59, 95% CI 2.08 to 35.52, one RCT, 129 participants) with a comparable safety profile. Compared with azole, lithium resulted in total clearance more often (RR 1.79, 95% CI 1.10 to 2.90 in short-term treatment, one RCT, 288 participants, low-quality evidence). Topical steroids are an effective treatment for seborrhoeic dermatitis of the face and scalp in adolescents and adults, with no differences between mild and strong steroids in the short-term. There is some evidence of the benefit of topical calcineurin inhibitor or lithium salt treatment. Treatment with azoles seems as effective as steroids concerning short-term total clearance, but in other outcomes, strong steroids were more effective. Calcineurin inhibitor and azole treatment appeared comparable. Lithium salts were more effective than azoles in producing total clearance.Steroids are similarly effective to calcineurin inhibitors but with less adverse effects.Most of the included studies were small and short, lasting four weeks or less. Future trials should be appropriately blinded; include more than 200 to 300 participants; and compare steroids to calcineurin inhibitors or lithium salts, and calcineurin inhibitors to azoles or lithium salts. The follow-up time should be at least one year, and quality of life should be addressed. There is also a need for the development of well-validated outcome measures.

Recommendations for adjunctive basic skin care in patients with psoriasis

Psoriasis is a multifactorial disease involving both genetic predisposition and external triggers, resulting in epidermal and immune dysfunctions. Regardless of the severity of the disease, patients require additional basic topical treatment with emollients. Basic skin care products are well known for their role in moisture retention and symptom control in psoriasis, yet patients underuse them. Dry skin and cutaneous inflammation are associated with an impaired epidermal barrier function. This breakdown of the skin barrier causes the release of pro-inflammatory mediators that exaggerate inflammation. to provide recommendations for the use of emollients (including ceramides, urea, keratolytic agents, zinc salts, niacinamide), thermal water and skin care products in psoriasis. A review of the current literature from 2000 to 2012 using Medline and Ovid was performed by a working group of five European Dermatologists with clinical and research experience in psoriasis. Either alone or used adjunctively, basic topical therapy can restore and protect skin barrier function, increase remission times between flare-ups and enhance the effects of pharmaceutical therapy. We provide physicians with a tool to assist them in implementing basic skin care in an integrated disease management approach.

Are topical keratolytic agents needed in the treatment of scalp psoriasis?

Topical corticosteroids are the primary treatment for scalp psoriasis. Keratolytic agents are promoted as adjunctive treatments. However, complex treatment regimens may result in poor adherence and outcomes. To evaluate the evidence for the need for use of topical keratolytic agents as opposed to topical corticosteroid monotherapy in the treatment of scalp psoriasis. A review of the literature was performed seeking clinical trials using topical keratolytics, topical corticosteroids or the combination for treatment of scalp psoriasis. Complete clearance of scalp psoriasis can be achieved in 10-78% of patients using topical corticosteroids alone, in 3% of patients using topical keratolytics alone, and in up to 84% using a combination of topical keratolytics and topical steroids. Clinical trials comparing the combination of keratolytics and topical corticosteroids versus topical corticosteroids alone found marginally more efficacy using combination regimens. We could not find any long term study evaluating the efficacy of combination therapy in scalp psoriasis and its effect on the patients' adherence. High potency topical corticosteroids are usually effective in treating scalp psoriasis in clinical trials. Poor efficacy in clinical practice may be owing to poor adherence to the treatment regimen. Using a keratolytic agent in conjunction with a topical corticosteroid may provide marginal additional benefit in clinical trials, but that benefit is likely outweighed by the downside of complicating treatment and reducing adherence in the clinical setting, unless a single product containing both medications were used.

Comparison of Microscopic Morphology of Fungi Using Lactophenol Cotton Blue (LPCB), Iodine Glycerol and Congo Red Formaldehyde Staining.

Comparison of Microscopic Morphology of Fungi Using Lactophenol Cotton Blue (LPCB), Iodine Glycerol and Congo Red Formaldehyde Staining.

Development and In-vitro Characterization of Fish Oil Oleogels Containing Benzoyl Peroxide and Salicylic Acid as Keratolytic Agents

Topical keratolytic agents such as benzoyl peroxide (BP) and salicylic acid (SA) are one of the common treatments for inflammatory skin diseases. However, the amount of drug delivery through the skin is limited due to the stratum corneum. The purposes of this study were to investigate the ability of fish oil to act as penetration enhancer for topical keratolytic agents and to determine the suitable gelator for formulating stable fish oil oleogels. 2 types of gelling agents, beeswax and sorbitan monostearate (Span 60), were used to formulate oleogels. To investigate the efficacy of fish oil oleogel permeation, commercial hydrogels of benzoyl peroxide (BP) and salicylic acid (SA) were used as control, and comparative analysis was performed using Franz diffusion cell. Stability of oleogels was determined by physical assessments at 20°C and 40°C storage. Benzoyl peroxide (BP) fish oil oleogels containing beeswax were considered as better formulations in terms of drug permeation and cumulative drug release. All the results were found to be statistically significant (p<0.05, ANOVA) and it was concluded that the beeswax-fish oil combination in oleogel can prove to be beneficial in terms of permeation across the skin and stability.

NOVEL EXCIPIENTS AS DIFFERENT POLYMERS: A REVIEW

Novel excipient is a new chemical entity, a new innovation that has not been used in any drug approved by regulatory authorities. Market trends suggest that pharma companies are not eager to use novel excipients because they don’t want to add additional risks to product being developed as regulatory authority might not approve drug product because of new excipient. Apart from this, pharma companies are also worried about reliable supply from GMP production facilities while using novel excipients. The US FDA also encourages innovation in excipients to develop new drugs or improve approved therapeutics and IPEC is helping to drive acceptance of these novel products into the market. The objective of the present research is to assess the use of different polymers as novel excipients in the development of suitable pharmaceutical dosage forms. These novel excipients used as surface active agents, keratolytic agents, bioreagents and The identified excipients were also studied for their physical and chemical properties along with their regulatory requirements.

이산화탄소 레이저를 이용한 모설의 치료

모설(hairy tongue)은 혀의 사상유두(filiform papillae)가 과도하게 신장되어 발생하는 질환이다. 임상적으로 혀의 배면후방 1/3 부위에 주로 발생하며, 혀의 측면과 첨부에 생기는 경우는 드물다. 섭취하는 음식물과 색소유발 박테리아 등에 따라 백색에서 갈색, 검은색까지 다양한 색의 착색을 보인다. 대부분 증상이 없지만, 환자들은 주로 심미적인 문제로 병원을 찾으며, 드물게 오심, 구취, 미각이상, 불쾌한 느낌 등을 유발할 수 있다. 정확한 병인은 알려져 있지 않지만, 구강위생 관리 소홀, 구강 내 세균총의 변화, 감염, 방사선치료, 항생제, 면역 억제제 등의 사용, 과도한 음주, 흡연, 타액분비 감소 등이 소인으로 작용할 수 있다. 임상 소견이 매우 전형적이므로 육안으로도 진단이 충분히 가능하며, 생검은 필요하지 않다. 모설의 치료는 기본적인 유발요인들을 찾아서 제거해 주며, tongue cleaner 등을 이용해 혀를 부드럽게 닦아주도록 교육하고, 일부 경우에 있어서는 keratolytic agent를 사용하기도 한다. 모설 치료에 외과적 술식을 사용하는 경우는 드물지만, 유발 요인 제거 등의 다양한 치료법을 적용하였음에도 불구하고 장기간 호전이 없는 모설 환자에서, 이산화탄소 레이저(Carbondioxide laser, <TEX>$CO_2$</TEX> laser)를 적용하여 효과적으로 치료한 증례를 보고하고자 한다. Hairy tongue is a disease caused by hypertrophy of filiform papillae on the tongue dorsum. Clinically, it occurs on the posterior 1/3 of the tongue dorsum and is rarely observed on the lateral and tip of the tongue. Several types of colored pigmentation from white to brown and black appear depending on the ingested food and the existing pigmentation inducing bacteria. Although clinically asymptomatic, patients will visit the clinic for esthetic problems and at rare intervals experience nausea, halitosis, dysgeusia and unpleasant sensation. The exact etiology is yet not known but causes such as inappropriate oral hygiene control, a shift in oral bacterium, infection, radiotherapy, use of antibacterial drugs or immunosuppressants, excessive smoking or alcohol drinking and decrease of salivary flow rate may be a factor of the disease. Clinical symptoms are quite typical and diagnosis may be made simply by observation, not necessarily biopsy. Treatment of hairy tongue is done by eliminating the etiology factors, brushing the tongue gently with a tongue cleaner and in some cases using keratolytic agent. Although it is rare to treat hairy tongue surgically, we will introduce a case successfully treated using carbondioxide laser(<TEX>$CO_2$</TEX> laser), after no sufficient improvement had been made by conservative treatment.

Urea: a comprehensive review of the clinical literature

Urea is an organic compound that has been used clinically for dermatological diseases for more than a century. Urea is a potent emollient and keratolytic agent, making urea an effective monotherapy for conditions associated with dry and scaly skin. A systematic review of the literature is needed to provide clinicians with evidence-based applications of urea in the treatment of dermatological diseases. A PubMed search was conducted using the term "urea" combined with "skin," "ichthyosis," "psoriasis," "xerosis," "emollient," "onychomycosis," "dermatitis," and "avulsion." A total of 81 publications met inclusion criteria and were evaluated. Treatment indication(s), test agents, number of subjects, treatment protocols, results, and side effects were recorded. Effective treatment with urea has been reported for the following conditions: ichthyosis, xerosis, atopic dermatitis/eczema, contact dermatitis, radiation induced dermatitis, psoriasis/seborrheic dermatitis, onychomycosis, tinea pedis, keratosis, pruritus, and dystrophic nails. Furthermore, urea has been used with other medications as a penetration enhancing agent. Mild irritation is the most common adverse event, proving urea to be a safe and tolerable topical drug without systemic toxicity. Urea is a safe, effective dermatologic therapy with wide-ranging clinical utility and minimal, non-systemic side effects. In order to optimize patient care, dermatologists should be well informed with regards to urea's indications and efficacy.

Psoriasis Clinical Implications and Treatment: A Review

Psoriasis is a common skin disorder affecting the population worldwide. It is a T-cell mediated autoimmune disorder leading to keratinocyte hyperproliferation. Psoriasis has genetic predisposition that is further aggravated by certain stimulating factors. In spite of significant advances in understanding the pathogenesis of psoriasis, the exact etiology of the disease remains unknown. The clinical manifestations of this disease include various forms that affect different parts of the body. Treatment options vary according to the mode of application or severity of the disease. Earlier treatments have included application of emollients or keratolytic agents to hydrate the skin or shed off the skin. But later treatments have been modified to treat the underlying T-cell proliferation. Hence, topical treatments like coal tar, vitamin D, retinoids, topical calcineurin inhibitors for treating mild psoriasis, systemic treatments including methotrexate, cyclosporine, acitretin, hydroxyurea, as well as light therapy for severe psoriasis have become more prominent. Current treatment modalities are associated with the risk of serious side effects from prolonged treatment. Combinations of these therapies have provided effective and rapid modalities to suppress the disease and reduce the side effects of treatment. In addition, newer carrier systems for conventional drugs are being developed to improve the effectiveness of treatment and reduce the side effects. Development of biologics and gene therapy have revolutionized the treatment of this skin disease. Although an array of therapies to suppress the psoriatic condition exists, none are curative.

Rickets associated with ichthyosis

Nutritional rickets in disorders of keratinisation is very rare. A 12-year-old girl with autosomal dominant ichthyosis vulgaris is reported who presented with tetany and a waddling gait. She had the classic clinical, biochemical and radiological features of rickets. She was treated with vitamin D and calcium supplements together with keratolytic and emollient agents, which was followed by biochemical and clinical remission. This appears to be the first report of rickets associated with autosomal dominant ichthyosis vulgaris.

Evaluation of topical potassium hydroxide solution for treatment of plane warts

Background:Plane wart is a common dermatological disease that is caused by human papilloma virus; although the rate of spontaneous recovery is high, it usually takes a long time to occur. Many modalities of treatments have been used but none of them proved to be uniformly effective. Potassium hydroxide (KOH) solution is a well-known keratolytic agent with many dermatological uses.Objective:To evaluate the efficacy and tolerability of topical KOH solution in the treatment of plane warts.Materials and Methods:A total of 250 patients with plane warts, consulting the department of Dermatology and Venereology of Basra Teaching Hospital between March 2008 and October 2009, were enrolled in this opened therapeutic trial study. Patients were divided into two age and sex cross-matched equal groups; patients in group (A) were treated with topical 5% KOH solution once at night, while patients in group (B) were treated with topical 10% KOH solution once nightly. Only 107 patients from group (A) and 95 patients from group (B) completed the study, while the remainders were defaulted for unknown reasons. The patients were evaluated at second and fourth week to assess the cure rates and side effects, those patients who showed complete cure were followed up for 3 months to detect any recurrence.Results:At the end of second week, 9.3% of group (A) patients showed complete disappearance of their warts, vs 66.3% of group (B) patients. At the end of fourth week, 80.3% of group (A) patients showed complete response in comparison with 82.1% of group (B) patients. The side effects for the treating solution in both concentrations include itching, burning sensation, erythema, and temporary dyspigmentations, that were reported in 77.6% of group (A) patients in comparison with 90.5% of group (B) patients. Recurrence rate was reported in 5.8% of group (A) patients vs 5.1% of group (B) patients during the three months period of follow-up.Conclusions:Topical KOH solution is proved to be an effective and safe treatment of plane warts in both concentrations (5% and 10%) with no important side effects.

Papular, Profuse, and Precocious Keratosis Pilaris

Keratosis pilaris (KP) is a frequent and benign condition in children characterized by the presence of rough, follicular papules and varying degrees of erythema. Different variants have been described, including simple KP and red KP. Between September 2007 and October 2010, 11 children with profuse and precocious KP seen at the department of pediatric dermatology were included. They defined an underemphasized clinical variant of childhood KP: the papular, profuse, and precocious KP characterized by early age of onset (<18 mos), extensive involvement of the limbs and cheeks, and papular nature of lesions. No clinical association has been found. The main complication was episodes of folliculitis. Diagnosis was delayed for all patients. Treatment is difficult, but association between emollient and keratolytic agents can provide some help.

Erfolgreiche Therapie eines Morbus Darier mit Alitretinoin

A 18-year-old man with severe Darier disease was treated with alitretinoin 30 mg daily. In addition he used topical keratolytic agents. The duration of treatment was 52weeks. First significant improvement was noted within one week after starting treatment. Itchiness and erythema, particularly on the head and in the chest area, decreased spontaneously after starting the treatment. From week 4 on a remarkable reduction in scaling, fissures and hyperkeratosis was observed. After 52weeks the patient was clear of disease, except for residual symptoms on his chest. Treatment was well tolerated without any side effects.

Treatment of rare keratinization disorders: what’s new?

Disorders of keratinization encompass a wide variety of monogenic skin diseases characterized by inheritable disturbances in the differentiation of epidermal keratinocytes leading to hyperkeratosis and/or epidermal fragility. Over the last decade, many new etiologies have been found for these diseases, but until recently this has not been paralleled by a similar good progress in therapy. The purpose of this article is to review the treatment of three groups of disorders of keratinization: congenital ichthyoses due to autosomal-recessive inheritance (e.g., lamellar ichthyosis and ichthyosiform erythroderma); keratinopathies due to dominant-negative keratin mutations (epidermolytic ichthyosis, epidermolysis bullosa simplex and pachyonychia congenita); and acantholytic diseases due to autosomal-dominant disorders of cell adhesion (Darier–White and Hailey–Hailey diseases). Recent advances in the use of keratolytic agents, retinoids, botulinum toxin and molecular biology techniques are discussed. In conclusion, there is reason for optimism among patients with keratinization disorders as there are now an increasing number of improved therapeutic strategies.

A NEW LIGHTENING APPROACH TO ACNE TREATMENT-COMBINING THERAPY MODALITIES FOR MAXIMIZING ACNE TREATMENT: PHOTOTHERAPY (LHE), DRUGS, SKIN REJUVENATION AND SKIN TIGHTENING

Combination therapies are increasingly being used for the treatment of acne. 2 years of clinical experience using a combination of drugs with LHE™ phototherapy on moderate to severe acne patients. Patients first underwent a series of 8-10 bi-weekly LHE treatments to reduce their dermal inflammatory process. These treatments were combined with keratolytic agents which are not contraindicated with phototherapy. The combined LHE/drug treatment regimen was followed by a series of LHE skin rejuvenation procedures to treat post acne symptoms of localized erythema, post inflammatory hyperpigmentation and scars. This double phototherapy protocol appears to offer excellent clinical and aesthetic results with no side effects or complications and may be repeated if relapse occurs.

Nanocarrier-based hydrogel of betamethasone dipropionate and salicylic acid for treatment of psoriasis

Introduction:Betamethasone dipropionate (BD) has anti-inflammatory, immunomodulatory, and antiproliferative activity. The aim of the current work was to test the hypothesis that the addition of corticosteroid such as BD and a keratolytic agent such as salicylic acid in nanocarrier based microemulsions formulation would result in enhancement and sustaining of corticosteroid delivery rate leading to better anti-psoriatic activity. Clinical use of BD is restricted to some extent due to its poor permeability across the skin. So to increase its permeation across the skin, microemulsion-based gel formulations were prepared and characterised.Materials and Methods:Microemulsions were prepared by aqueous phase titration method, using oleic acid:sefsol (1.5:1), Tween 20, isopropyl alcohol, and distilled water as the oil phase, surfactant, cosurfactant and aqueous phase, respectively. Selected formulations were subjected to physical stability studies and consequently in vitro skin permeation studies. Surface studies of optimized formulation were done by transmission electron microscopy. In vivo anti-inflammatory activity was done by carageenan-induced raw paw edema method.Results:The droplet size of microemulsions ranged from 60 to 190 nm. The optimized formulation exhibited viscosity 28.55 ± 2.03 mP, refractive index 1.409, pH 6.4, and conductivity 10-4 scm-1. The optimized microemulsion was converted into hydrogel using carbopol 934, and salicylic acid was incorporated into it. Drug deposition in skin was found to be 29.73 μg/mg. Assessment of skin permeation was done by histopathology studies which indicated changes in the structure of epidermal membrane of skin. In vivo anti-inflammatory activity indicated 72.11% and 43.96% inhibition of inflammation in case of developed microemulsion gel and marketed gel, respectively.Conclusions:The developed microemulsion gel containing BD and salicylic acid provided sustained and good anti-inflammatory activity for the treatment of psoriasis.

Evaluation of a urea/lactic acid-based topical keratolytic agent (ULABTKA) for prevention of capecitabine-induced hand and foot syndrome (HFS): NCCTG trial N05C5.

9017 Background: HFS is a dose-limiting toxicity of capecitabine, occurring in 43-71% of patients. No effective preventative treatment has been definitively demonstrated. Urea/lactic acid have hydrating and keratolytic properties. Pilot data suggest that they may prevent HFS. The purpose of this trial was to evaluate the prophylactic use of a ULABTKA for capecitabine-induced HFS. Methods: A randomized double-blind phase III trial evaluated 137 patients (pts) receiving their first ever cycle of capecitabine at a dose of either 2,000 or 2,500 mg/m2 per day for 14 days. Pts were randomized to a ULABTKA vs. a placebo cream, which was applied to the hands and feet BID for 21 days after the start of capecitabine. Pts completed a HFS Diary (HFSD) daily while applying the cream. HFS toxicity grade (CTCAE v 3.0) was also collected at baseline and at the end of each cycle. The primary endpoint was assessed by comparing the percentage of pts in each group who self-reported moderate severity (or worse) HFS during cycle 1 as measured by the HFSD. The planned 132 pts provided 80% power for detecting a moderate effect size of 18% difference with a two-sided Fisher's exact test at a 5% Type I significance level. Results: The percentage of pts with moderate or severe HFS was not different between the two arms, with 13.6% in the ULABTKA arm and 10.2% in the placebo arm (p % 0.768, using a Fisher's exact test). Maximum HFS severity frequency data and chi-square p-values from this cycle 1 are illustrated in the Table. Cycle 1 CTCAE skin toxicity was higher in the ULABTKA arm, but not significantly so (p % 0.82). No significant differences were observed in other toxicities between the two arms. Conclusions: These data do not support the efficacy of a ULABTKA cream for preventing symptoms of HFS in patients receiving capecitabine. HFS severity Location Hands Feet Combined (hands and feet) Urea Placebo Urea Placebo Urea Placebo None 35 (59%) 36 (74%) 38 (64%) 34 (69%) 32 (54%) 31 (63%) Mild 18 (31%) 11 (22%) 14 (24%) 10 (20%) 19 (32%) 13 (27%) Moderate 5 (9%) 1 (2%) 6 (10%) 3 (6%) 6 (10%) 3 (6%) Severe 1 (2%) 1 (2%) 1 (2%) 2 (4%) 2 (3%) 2 (4%) P value 0.324 0.727 0.747 No significant financial relationships to disclose.

Intralesional Pingyangmycin Treatment for Resistant Plantar Warts

Background: The diagnosis of viral warts is often straightforward, but their treatment is difficult and always takes a long time. Nowadays warts are usually treated with conventional methods including topical keratolytic agents, cryotherapy, electrosurgery and laser surgery. However, such treatments cause different complications, and the warts become recalcitrant. Objective: To investigate the effect of intralesional pingyangmycin injection for resistant plantar warts. Methods: From June 2006 to September 2008, we treated 66 patients with plantar warts by intralesional pingyangmycin injection after informed consent. Results: The lesions of 58 patients cleared (87.88%) after up to 4 treatments. The remaining 8 patients (12.12%) achieved partial clearance. No serious side effects were observed. Conclusion: Intralesional injection of pingyangmycin might be an effective, safe and generally well-tolerated treatment for plantar warts.

Preparation and Evaluation of Microemulsion Systems Containing Salicylic Acid

Microemulsions (MEs) are clear, thermodynamically stable systems. They were used to solubilize drugs and to improve topical drug availability. Salicylic acid (SA) is a keratolytic agent used in topical products with antimicrobial actions. The objective of this work was to prepare and evaluate SA ME systems. Different concentrations of SA were incorporated in an ME base composed of isopropyl myristate, water, and Tween 80: propylene glycol in the ratio of 15:1. Three ME systems were prepared: S2%, S5%, and S10% which contain 2%, 5%, and 10% of SA, respectively. Evaluation by examination under cross-polarizing microscope, measuring of percent transmittance, pH measurement, determination of the specific gravity, assessment of rheological properties, and accelerated stability study were carried out. The data showed that the addition of SA markedly affected the physical properties of the base. All systems were not affected by accelerated stability tests. Stability study for 6 months under ambient conditions was carried out for S10%. No remarkable changes were recorded except a decrease in the viscosity value after 1 month. The results suggested that ME could be a suitable vehicle for topical application of different concentrations of SA.

Keratolytics for psoriasis: Are they necessary?

It is a common belief that keratolytic agents are required to enhance the penetration of topical medications into thick psoriatic plaques. However, is this belief evidence-based?