Short-contact Therapy Research Articles

Effectiveness and tolerability of short contact therapy with topical clindamycin and tretinoin combination compared to long contact therapy in the treatment of acne vulgaris in pediatric patients

Effectiveness and tolerability of short contact therapy with topical clindamycin and tretinoin combination compared to long contact therapy in the treatment of acne vulgaris in pediatric patients

Sequential Treatment With Topical Trifarotene and Injectable NASHA Gel in Acne Scars: A Case Series.

Topical retinoids are a mainstay in acne management and have been shown to improve skin texture. Injectable non-animal stabilized hyaluronic acid (NASHATM) gel as skin booster is largely used in aesthetic treatments to improve skin quality including the appearance of atrophic acne scars. To evaluate a new sequential treatment with topical trifarotene and injectable skin booster NASHA gel in acne scars. 10 patients between 19 and 25 years (3 males and 7 females) with previous moderate to severe acne vulgaris on the face with the outcome of atrophic and post-inflammatory slightly hyperpigmented scars were prescribed home short contact therapy (SCT) with topical trifarotene 50 μg/g at the evening for 3 months. A proper skincare routine for sensitive skin was also recommended. The 3-month retinoid therapy was followed by an injectable medical procedure with NASHA gel 20 mg/ml as skin booster. A minimum of 3 sessions to 10 sessions were carried out according to the severity of acne scars and the skin response observed. Adherence to the treatment was complete and the results evaluated by digital photography showed very effective results with high clinical improvement or almost complete resolution of atrophic acne scars. The results observed in this case series show that the sequential treatment with topical trifarotene and injectable NASHA gel as skin booster can be effective in the progressive reduction of acne scarring, potentially related to a synergic effect of skin remodeling and collagen stimulation. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7630.

Effect of Application, Duration and Dosing Frequency on the Efficacy and Adverse Effect of Adapalene in Acne Vulgaris: an Open-Label Randomized Controlled Study

Introduction: Topical retinoids are the mainstay of treatment for mild and moderate acne but longer duration of application causes adverse effects. The study aimed to evaluate the effect of application, duration, and dosing frequency on the efficacy and adverse effect of Adapalene in Acne Vulgaris.Materials and Methods: The study design was an open-label randomized controlled split-face trial. Patients with acne grades 1 and 2 were randomized into three groups using the split-face technique on the right and left sides. On the right side, patients applied adapalene daily in all the groups and alternately on the left face. The three groups of the study were overnight, 1 hour, and ½ hour application of adapalene. Follow up period was 4,8 and 12 weeks. Lesion count and side effects were evaluated at each follow-up.Results: Out of 292 who completed the study, the decrease in total lesion count was highest in the overnight group. Regarding specific lesion count, the decrease in non-inflammatory lesions was highest in the overnight group. However, short contact therapy with 1-hour application showed comparable efficacy with the overnight group in regards to inflammatory lesion count. There was a significant reduction of lesions in all groups from baseline to 12 weeks, with ½ hour group having minimal side effects followed by 1 hour and overnight.Conclusion: Short contact therapy for acne shows promising results in regard to efficacy and better tolerance.

Minimum Contact Time of 1.25%, 2.5%, 5%, and 10% Benzoyl Peroxide for a Bactericidal Effect Against Cutibacterium acnes.

PurposeBenzoyl peroxide (BPO) is an effective acne treatment and has been used as a cleanser and short contact therapy. However, data on the minimum contact time of BPO needed to kill Cutibacterium acnes are lacking. Thus, the aim of this study was to determine the minimum contact time of commonly used BPO concentrations for bactericidal effects on C. acnes.Materials and MethodsAn in vitro experimental study of clinically isolated C. acnes was performed to determine the minimal inhibitory concentration (MIC) of BPO using the broth microdilution method. Subsequently, the minimum contact times of various concentrations of BPO were evaluated, and their bactericidal effects were assessed by the plate count method.ResultsThe median MIC of BPO was 9375 µg/mL, which did not significantly differ between antibiotic-resistant and nonresistant C. acnes. The minimum contact time of BPO with C. acnes was significantly different among the BPO concentrations. For bactericidal activity against all isolates, 1.25%, 2.5%, 5%, and 10% BPO required 60 min, 15 min, 30 sec, and 30 sec, respectively.ConclusionBPO demonstrated bactericidal activity against both antibiotic-resistant and antibiotic-susceptible C. acnes. The in vitro contact time needed to kill C. acnes was almost immediate with 5% or more BPO, but ≤ 2.5% BPO required longer contact times for bactericidal effects.

Efficacy and tolerability of short contact therapy with tretinoin, clindamycin, and glycolic acid gel in acne: A randomized, controlled, assessor-blinded two-center trial: The MASCOTTE study.

Retinoids and antibiotics topical treatments are commonly used as first line therapy in mild to moderate acne. However, irritant contact dermatitis is a common side effect of topical retinoids. A strategy to increase local tolerability is the "short contact therapy" (SCT) approach, consisting in the application of the product with the complete removal after 30 to 60 minutes using a non-aggressive cleanser. A gel containing tretinoin 0.02%, clindamycin 0.8%, and glycolic acid 4% in polyvinyl alcohol (MP-gel) has shown to be effective as monotherapy in mild to moderate acne with a tolerability profile similar to other topical retinoids. So far, no trials have been performed with this gel comparing the tolerability profile of SCT with standard application therapy (SAT). We conducted a 2-center randomized parallel groups, controlled, assessor-blinded study, comparing MP-gel applied as SCT in comparison with MP-gel used as SAT (The "MASCOTTE" trial). Forty-six subjects (nine men and 37 women, mean age 23 ± 4 years, range 18-31 years) with mild-to-moderate acne were enrolled, after their written informed consent in a randomized, parallel groups controlled, assessor-blinded 8-week trial. Twenty-three were assigned to MP-gel once daily (evening application) using the SCT approach (ie, complete removal of product after 1 hour using a gentle cleanser), and 23 were randomized to the SAT approach with the same gel. The primary endpoint was the evolution of the tolerability score (TS) assessed evaluating four items: erythema, dryness, stinging, and burning, using a 4-point score scale (from 0: no symptom to 3: severe symptom). Secondary endpoints were the evolution of global acne grading system (GAGS) score (range: from 0 to >39) and the investigator global assessment (IGA of acne severity) score (range from 0 to 4). TS was evaluated at 2, 4, and 8 weeks. GAGS and IGA scores were evaluated at baseline and at week eight. At week eight, an efficacy global score (EGS) (from 1: no efficacy to 4: very good efficacy) and a tolerability global score (TGS) (from 1: very low tolerability to 3: very good tolerability) evaluation were also done. All the evaluations were performed by an investigator unaware of treatment groups allocation (SCT or SAT). Thirty-eight subjects (83%) completed the 8-week treatment period. Eight subjects (two in the SCT group and six in the SAT group) dropped out prematurely due to low skin tolerability. In the SCT the TS at week two was 1.3 ± 1.7, in the SAT group TS was significantly higher (3.1 ± 1.7) (P = .028). TS was significantly lower in SCT group vs SAT also at weeks four and eight (P = .01; ANOVA test). The GAGS score at baseline was 19 ± 7 in the SCT group and 23 ± 4 in the SAT group (NS). At week 8 the GAGS score in SCT was significantly reduced to 8.5 ± 2.8 (-55%) (P = .001 vs baseline) and was also significantly lower in comparison with SAT group (8.5 vs 15; P = .0054). The IGA scores at baseline were 1.9 ± 0.6 in SCT and 2.4 ± 0.7 in SAT group. At week eight, in comparison with baseline values IGA score was reduced significantly by 48% in SCT and by 30% in SAT. EGS and TGS were significantly higher (better clinical efficacy and better tolerability) in SCT in comparison with SAT (3.6 ± 0.5 and 2.9 ± 0.3 vs 2.7 ± 0.6 and 1.5 ± 0.7; respectively). This tretinoin, clindamycin, glycolic acid gel, applied as SCT, has shown a better skin tolerability and at least a comparable clinical efficacy in comparison with the standard application modality in the treatment of mild-to-moderate acne. The SCT therefore could be an effective treatment strategy which could improve subjects' compliance and adherence.

Combined therapy in vulvar lichen sclerosus: does topical tretinoin improve the efficacy of mometasone furoate?

AbstrractPurpose: To assess efficacy and safety profile of combining a potent corticosteroid with a retinoid in the treatment of vulvar lichen sclerosus (VLS).Methods: We retrospectively compared 21 VLS patients treated with tretinoin (T) in short-contact therapy and mometasone furoate (MMF) (group A) and 20 treated with cold cream (CC) and MMF (group B) for 5 consecutive days/week for 12 weeks. The efficacy parameters were the response rate, the percentage of patients achieving an improvement from baseline of ≥75% in subjective and objective scores and the mean reduction in subjective and objective scores.Results: Thirteen patients (75.2%) were considered as responders in group A and 15 (78.9%) in group B; 50% and 61.1% of patients in group A and 100% and 63.1% in group B achieved an improvement of at least 75% in subjective and objective scores, respectively. The scheme combining MMF and CC was better tolerated than the combination of MMF and T.Conclusions: The combination with a topical retinoid did not enhance the effectiveness of a potent corticosteroid in the treatment of VLS. Either the scarce efficacy of the short-contact therapy regimen or a less favorable safety profile of such combination may account for these findings.

Short contact therapy of acne with tretinoin

The most frequent side effect of topical retinoids is irritant contact dermatitis. It occurs in approximately 85% of patients; the percentage can reach up to 95% in patients treated with tretinoin. Severity of this dermatitis is moderate to severe in approximately 20% of patients. However, 15% of patients stop the treatment with tretinoin because of skin irritation. The authors used tretinoin as short contact therapy (SCT) in mild to moderate acne, in order to try to reduce the incidence and severity of irritant contact dermatitis. They present the final results of a sponsor-free, pilot, open, multicenter study. Seventy-four patients were treated with 0.05% tretinoin cream. It was applied once daily for 30 min. Treatment duration ranged from 8 to 32 weeks (mean duration: 12 weeks). Acne severity and treatment efficacy were evaluated by means of the Global Acne Grading System. A significant clinical improvement (≥50% from baseline) was observed in 41 patients (55.4%). Thirteen patients (17.6%) developed a mild skin irritation. Four patients (5.4%) stopped the treatment because of severe skin irritation. Efficacy of tretinoin used as SCT seems to be superimposable to that of tretinoin used according to standard modality. Tolerability of SCT with tretinoin is very good. This tolerability allows a high adherence of patients to the treatment and it markedly improves compliance.

Short-contact therapy with 0.1% tazarotene cream in patients with acne vulgaris: a multicenter, randomized, controlled clinical trial.

Objective To estimate the efficacy,local side effect of short-contact therapy with 0.1% tazarotene cream in patients with acne vulgaris and its impact on the relapse of acne vulgaris.Methods A multi-center,randomized,controlled study was carried out in 187 patients with acne vulgaris.Patients were randomly divided into three groups to receive 8(n=62)or 12(n=64)weeks of short-contact therapy or 8 weeks(n=61)of conventional therapy with 0.1%tazarotene cream.The global acne grading system (GAGS)was used to estimate the severity of acne at the baseline,end of treatment,2,4 and 8 weeks after treatment.Local side effects and relapse of acne vulgaris were also observed in patients.Results The incidence of local side effects was 11.48%,12.90%and 38-33%in 8-week,12-week and conventional group,respectively,with statistical difference among the three groups (X2=13.31,P 0.05).A low relapse rate of acne vulgaris was observed in the 12-week group,and there was a significant difference among the three groups on week 2,4 and 8 after the treatment(X2=3.29,3.78 and 5.85,respectively,P<0.05 or<0.01).Conclusioils Compared with conventional therapy,short-contact therapy with 0.1%tazarotene cream exhibits fewer local side effects but similar efficacy in acne vulgaris,and to extend the treatment course may lead to a decrease in relapse and increase in efficacy. Key words: Acne vulgaris; Administration; cutaneous; Tazarotene

Short contact therapy with topical 5-FU and cryosurgery for actinic keratoses

Short contact therapy with topical 5-FU and cryosurgery for actinic keratoses

Short Contact Therapy with Tazarotene in Psoriasis Vulgaris

Background: We present the results of a multicentre, not controlled, clinical study on the tolerability and efficacy of tazarotene gel, used as short contact therapy (SCT), in psoriasis vulgaris. Objective: To evaluate whether irritant contact dermatitis caused by tazarotene was less frequent and/or less severe with SCT than with traditional therapy, and whether SCT with tazarotene was as effective as traditional therapy. Methods: Forty-three patients with plaque psoriasis were treated by SCT with 0.1% tazarotene gel (once daily application for 20 min, followed by washing with water). Treatment duration was 45 days. Results: Irritant contact dermatitis caused by tazarotene used as SCT was much less frequent and severe than traditional treatment with the same drug. SCT with tazarotene was effective in the treatment of plaque psoriasis. Conclusion: Tazarotene, used as SCT, was better tolerated than the same drug used as traditional treatment. Furthermore, SCT appeared to be as effective as traditional therapy with the same drug.

Clobetasol propionate shampoo 0.05% and calcipotriol solution 0.005%: A randomized comparison of efficacy and safety in subjects with scalp psoriasis

Background: Scalp involvement in psoriatic patients represents a common issue. Treatment of the hairy skin requires adequate pharmaceutical formulations; hence, a new specific shampoo formulation of clobetasol propionate 0.05% was developed by Galderma R&D, Inc. Methods: For this multicenter, randomized, investigator‐masked, parallel group study, 151 subjects with moderate to severe scalp psoriasis were randomized to 4 weeks of treatment with clobetasol propionate shampoo or calcipotriol solution. Results: Clobetasol propionate demonstrated significantly superior efficacy to calcipotriol solution (total severity score: mean difference 0.51, 95% CI 0.05–0.97, p = 0.028; global severity score: mean difference 0.43, 95% CI 0.08–0.78, p = 0.016). Adverse events were more common in the calcipotriol group than in the clobetasol propionate shampoo group. Telangiectasia and skin atrophy did not differ significantly between treatments; however, a burning sensation was significantly more common in the calcipotriol solution group. Conclusions: Short contact therapy of scalp psoriasis with this new shampoo formulation of clobetasol propionate was significantly more effective and better tolerated than calcipotriol solution for the treatment of scalp psoriasis.

Dithranol short-contact treatment of scalp psoriasis

Background: Scalp psoriasis is often rather therapy-resistant and very patient-impairing. There are not many alternative treatments when descaling ointments and corticosteroids fail. Dithranol short-contact therapy is a very effective treatment for psoriatic lesions on the body, but little is known about its usefulness for the treatment of scalp psoriasis. OBJECTIVE: We studied the efficacy and side-effects of dithranol short-contact treatment of scalp psoriasis. METHODS: Included in the study were 13 patients with moderate to severe therapy-resistant psoriasis of the scalp. We used the Psoriasis Area and Severity Index (PASI) to assess the clinical efficacy. All reported side-effects were registered. The treatment was evaluated by the patients by means of a multiple choice questionnaire. RESULTS: Of the 13 patients, 12 completed the treatment. Six showed good results (clearance >80%), two showed moderate results (clearance 40-80%) and four showed bad results (clearance <40%). The mean clearance after treatment was 58% and after 3 months of follow-up it was still 55.8%. Nine different side-effects were reported, but none resulted in interruption of treatment for more than 2 days. It can be concluded that dithranol short-contact therapy is worth trying as an alternative in the treatment of scalp psoriasis in a selected group of patients in whom descaling ointments and topical corticosteroids are not effective.

EFFICACY OF SHORT‐CONTACT THERAPY WITH DITHRANOL IN CHILDHOOD PSORIASIS

Dithranol is a potent reducing substance and is thought to achieve its effect on psoriasis by reduction of cell turnover. It was shown to be efficacious in adults, but its efficacy has not been documented in children. The efficacy of short-contact therapy, a dithranol cream preparation, was retrospectively evaluated in 58 children with psoriasis. Dithranol cream (0.1-2%) was applied daily for 30 minutes to affected skin areas. Patients were evaluated at 1-4-week intervals. The median duration of therapy before the onset of remission was 2 months. Remission was achieved in 81% of the children. The median duration of remission was 4 months. Mild adverse skin reactions occurred in 20% of patients, but only one patient had to discontinue therapy. Short-contact therapy with dithranol cream preparation is an effective and well-tolerated treatment for childhood psoriasis. A thorough explanation of the disease and mode of therapy to patients and their parents is essential for good compliance and subsequent success.

Development of anthralin short-contact therapy in psoriasis: survey of published clinical trials.

In a survey of clinical trials concerning the efficacy of short-contact therapy with anthralin in psoriasis vulgaris, focusing principally on methodologic issues, twenty-four papers published between January 1982 and December 1989, in English, French, and Italian, were selected. Nine of 24 papers reported on more than one trial, giving a total of 37 clinical trials to be evaluated. A great heterogeneity was evident in many aspects of the design and conduct of these trials, making pooling of results impossible. Most trials suffered from flaws in general methodologic aspects such as randomization and blinding. Limitations in general applicability of results were discussed with reference to the popular use of self-control design and selection of composite indexes (e.g., PASI) as an outcome variable. Published trials are not a reliable guide to clinical decisions concerning short-contact therapy, and some methodologic observations we made could be of general interest in designing clinical trials of psoriasis.

Water-miscible dithranol cream in the treatment of psoriasis

Dithranol was prepared in water-miscible O/W cream formulations at 1, 2 and 4% concentrations. These creams were stable after up to 15 months storage at room temperature. When used for short-contact (10 to 20 minutes) therapy in 29 psoriasis patients, the results with 4% cream were similar to the published results with 1% dithranol in Lassar's paste or in petrolatum. Irritation was minimal. Electron microscopic studies before and after treatment revealed no ultrastructural alterations, in particular no damage to the mitochondria.

Combined tar-anthralin versus anthralin treatment lowers irritancy with unchanged antipsoriatic efficacy: Modifications of short-contact therapy and Ingram therapy

In 44 patients with chronic plaque psoriasis anthralin therapy was used as high-strength short-contact therapy in a bilateral comparison of anthralin versus 5% crude coal tar-anthralin combination. These two trials were undertaken with and without ultraviolet (UV) irradiation immediately after anthralin therapy. The combined tar-anthralin therapy was significantly less of an irritant during the first 3 weeks of treatment than anthralin alone, and it did not decrease the antipsoriatic efficacy. The use of UV irradiation, either with anthralin or tar-anthralin combination, did not produce an additional therapeutic effect. These findings lead us to prefer combined tar-anthralin therapy because of its lower irritancy in comparison with anthralin alone and they show the ineffectiveness of additional UV irradiation under the conditions of this study.

Comparison of dithranol and butantrone in short contact therapy of psoriasis

Thirty psoriatic out-patients were treated as a right-left comparison with dithranol (0.1, 0.5, 1, 2%) and butantrone (0.66, 1.3, 2.7, 3.9%) short contact therapy, both in white petrolatum. Fifteen of the treated patients cleared well and no obvious differences between the treated sides were clinically observed. Six patients showed some improvement, but in four of them the dithranol treated side cleared sooner and the therapy was continued with dithranol short contact therapy on both sides. In two patients the thick lesions cleared slowly and the therapy was continued with dithranol in Lassar´s paste. The treatment was discontinued in nine patients: in five patients because short contact therapy was ineffective and in one patient because of strong skin irritation on both treated sides. In three patients the treatment was discontinued for non-medical reasons. Butantrone has an antipsoriatic activity almost equal to that of dithranol. When short contact treatment is used, erythema and staining with butantrone are weaker than with dithranol. Because the short contact tolerability of butantrone was good, it might be possible to start with higher concentrations.

Irritation and staining by dithranol (anthralin) and butantrone (10-butyryl dithranol): further short contact and tape stripping experiments

Ten psoriatics were tested with three concentrations of butantrone (0.66, 2.0 and 3.9%) on the healthy skin of the back and the irritant and staining reactions were compared with those produced by 0.1 and 0.5% dithranol, both in white petrolatum. Of the three test areas one was stripped before exposure to simulate the penetration of a psoriasis lesion, one after exposure to simulate posttreatment washing and one was unstripped. The contact times were 20 and 60 min. The degrees of erythema and staining, and the increase in skin blood flow were measured 1, 2, 3 and 7 days after application. Both dithranol concentrations produced a markedly stronger increase of blood flow and erythema than any of the butantrone concentrations and a clear dose response when the concentration was raised from 0.1 to 0.5%. Such a dose response was not clearly seen with butantrone. Staining with both dithranol and butantrone was minimal. Apparently, higher concentrations of butantrone than dithranol can be used in short contact therapy if cumulation of the drug can be excluded by a short contact time and careful removal of the surplus drug.

Psoriasis treatment with betamethasone dipropionate using short-term application and short-term occlusion

High rates of penetration and of transepidermal water loss in psoriatic lesions allow reduction in the periods of application and occlusion, respectively, in corticoid treatment. In 11 patients application for 3-5 min combined with occlusion for 20 min was as effective as classical long-term corticoid treatment. On the other hand it was demonstrated by means of the vasoconstriction test that both reduction in time of application and occlusion to these periods led to a reduction in the amount of steroid absorbed by healthy skin. Thus "Short contact therapy" would probably minimize the steroid absorption by the uninvolved skin surrounding the psoriatic lesions, thereby reducing the risk of side-effects in treatment with potent corticoids.

Short-contact therapy

It is now six years since my colleagues and I predicted from pharmacokinetic studies that, in topical treatment, removing drugs from the skin after a short contact period should reduce side effects.¹At that time, we successfully applied this idea to the treatment of psoriasis with anthralin.¹ Meanwhile, more pharmacokinetic evidence has been gained that confirms early observations with steroids²and our first investigations^3,4: "Penetration into eczematous skin is much more rapid and higher than in normal skin." Thus, if we interrupt the application early enough, we hardly interfere with the therapeutic action, but we might prevent a drug-related reaction—ie, side effects—in perilesional skin.^5-9 The idea has been utilized, sometimes with modifications, by many individual dermatologic practitioners, with almost unanimous confirmation of the concept and its practicability.^10-23A restriction should be underlined immediately, that is, that the short-contact therapy needs an intelligent, motivated,