Topical Usage Research Articles

Novel ophthalmic hyaluronic acid-hydrogel with curcumin nanoparticles for enhanced healing of ulcerative keratitis in rabbit model

Corneal ulcers, whether melting or indolent, are common in humans and companion animals. Treatment involves local administration of antibiotic eye drops and corneal healing drugs. Compared to traditional treatments for ulcerative keratitis, herbal medicines offer unique advantages, such as potent anti-inflammatory effects and inhibition of proinflammatory cytokines. Curcumin, extracted from the Curcuma Longa plant, possesses extensive pharmacological properties, such as anti-inflammatory, anti-cancer, and antioxidant properties, and is used in various medicines. In this study, we developed a novel ophthalmic drop hydrogel using a formulation of Curcumin NPs encapsulated with β-cyclodextrin and hyaluronic acid, to accelerate corneal healing and improve the quality of healed structures. The formation of Curcumin NPs into Hyaluronic acid-based hydrogels was characterized by zeta, FTIR, and scanning electron microscope (SEM) analyses. A total of 25 healthy male New Zealand Albino rabbits were experimentally induced with ulcerative keratitis and treated individually with topical medication. Rabbits were divided into five groups. Fluorescein dye staining, corneal clarity score, Schirmer tear test, proinflammatory cytokine measurement, and pathologic factors assessments were used to evaluate the optimised Curcumin NPs with β-cyclodextrin in Hyaluronic acid hydrogel. Our results demonstrated that the optimized Curcumin NPs with β-cyclodextrin in hyaluronic acid hydrogel significantly reduced the frequency of medication administration compared to conventional therapies, enhancing the quality of healed structures and effectively treating ulcerative keratitis. All findings in this study provide new insight into designing and fabricating novel ophthalmic medicine for ulcerative keratitis for topical usage.

Topical Probiotics Reduce Atopic Dermatitis Severity: A Systematic Review and Meta-Analysis of Double-Blind, Randomized, Placebo-Controlled Trials.

Atopic dermatitis (AD) is a chronic skin disease that commonly appears during childhood but can present at any age. There are interventions that are effective in treating AD in children, but it has been difficult to find effective treatments for adults. This systematic review and meta-analysis sought to determine the efficacy of topical probiotic treatment for AD in adult populations. A database search was conducted of peer-reviewed, double-blind clinical trials, and studies underwent a systematic exclusion and inclusion process, yielding four that met the criteria. Disease severity, as measured by a standardized scoring tool SCORAD (SCORing Atopic Dermatitis), was culled from each study and compared to placebo at two-week and four-week time points. All studies showed improvement in SCORAD in the treatment groups compared to baseline at all time points. Two showed significant decreases in SCORAD after two weeks of treatment, and three studies showed long-lasting improvement after four weeks of treatment. Interestingly, while each study showed a reduction in the severity of AD at the two- and four-week time points, a pooled meta-analysis did not show a statistically significant difference between treatment and control at four weeks of treatment. Clinically, there may be benefits to topical probiotic usage as evidenced by the individual studies; more studies need to be performed including adults to show statistical significance.

Regression course of ostium granulomas under topical intranasal steroids coverage after endoscopic dacryocystorhinostomy

This study aimed to elucidate the regression process of ostium granulomas under the usage of intranasal steroid after primary endoscopic dacryocystorhinostomy (DCR). The authors retrospectively reviewed 57 patients (a total of 72 ostia) who had ostium granulomas after primary endoscopic DCR between 2011 and 2015. Topical intranasal steroid spray was applied in all the patients since postoperative day 1. Adjunctive intralesional triamcinolone acetonide injections were administered for extensive and large-sized granulomas that caused impending ostium blockage. Sequential regression of the ostium granulomas and success rates of DCR were assessed using endoscopic photos. The granulomas completely disappeared in 69 (95.8%) ostia, and the average time interval from the surgery to the disappearance was 6.9 ± 2.8 months. Anatomical and functional surgical success rates were 90.3% and 84.7%, respectively. Intralesional steroid injections for ostium granulomas did not alter the outcomes compared to topical intranasal steroid usage significantly (p = 0.445). In conclusion, we observed that, by continuing the usage of intranasal steroids, ostium granulomas disappear gradually at postoperative 6 months. The intranasal surgical manipulation of granulomas, which results in more mucosal cicatricial change and impedes patient satisfaction, can be successfully avoided.

Semantic Web Usage in the Tourism Industry in Andalusia, Spain

Andalusia got the 4th place of tourists’ favorite destinations among 17 autonomous communities in Spain in September 2023 and almost returned to pre-pandemic normality regarding tourism. Although Spain is famous for its “sun and beach”, its tourist industry is facing new challenges in socio-economic, environmental and territorial issues; therefore, the role of artificial intelligence cannot be ignored in the evolution and transformation of the tourism business. AI algorithms reinforce decision-making capabilities through analysing real-time data. Effectiveness and efficiency of AI algorithms are dependent on well-structured, well-described and machine-readable meta data network which can be provided by Semantic Web standards. This article empirically study the current usage of Semantic Web formats, ontologies and touristic topics in 65 tourist-relevant web sites in Andalusia. Results show that just 57 % of examined sites used semantic markup with most of the semantic annotations (98.5%) made in three formats: Microdata, JSON-LD and RDFa. Furthermore, the Ontologies used in almost 90% of markups are ‘Schema.org’, ‘Data Vocabulary’ and ‘RDF’, but none of the special tourism ontologies appeared in examined tourism web sites. Therefore, Andalusia tourism websites should be enhanced with much more widespread Semantic Web in order to achieve a better performance in a future in which AI technologies will be widespread.

Patient-reported outcomes of topical finasteride/minoxidil treatment for male androgenetic alopecia: A retrospective study using telemedical data.

Oral finasteride and topical minoxidil are the current standard of care for male androgenetic alopecia and a combination of the two treatments can be considered for greater efficacy. Clinical trials of topical finasteride have also yielded promising results, but routine care data are lacking. To examine patient-reported outcomes of men with androgenetic alopecia who received topical finasteride admixed with minoxidil compared to the current standard of care (oral finasteride). Retrospective, cross-sectional study with data from a German direct-to-consumer teledermatology platform between December 2021 and January 2023. Patient-reported outcomes were collected through voluntary follow-up questionnaires provided after 6 weeks on topical finasteride/minoxidil or oral finasteride treatment. A total of 1545 patients who received topical finasteride/minoxidil treatment were included; 238 (15.4%) participated in the follow-up questionnaire. At week six, 62.2% (148/238) reported positive changes in their hair appearance, and 44.1% (105/238) reported an improvement of self-esteem. Treatment-related adverse events were reported in 11.8% (28/238). Full treatment adherence was observed in 74.4% (177/238). Comparing the topical treatment group to those receiving oral finasteride, lower treatment adherence was reported, along with higher rates of local adverse events; no difference was found in the incidence of sexual adverse events. Based on patient-reported outcomes, topical finasteride/minoxidil seems to be effective and well tolerated, but not superior to oral finasteride. Lower treatment adherence for topical usage must be considered when considering treatment options. Additional real-world data are needed to further evaluate the efficacy and safety of topical finasteride/minoxidil.

In Vivo Evaluation of Miconazole-Nitrate-Loaded Transethosomal Gel Using a Rat Model Infected with Candida albicans.

Miconazole nitrate (MCNR), an antifungal drug, is used to treat superficial infections. The objective of the current study was to assess the antifungal effectiveness of MCNR-loaded transethosomal gel (MNTG) against Candida albicans in an in vivo rat model. The outcomes were compared with those of the miconazole nitrate gel (MNG) and marketed Daktarin® cream (2%) based on histopathological and hematological studies. The results of the skin irritation test revealed the safety profile of the MNTG. The MNTG demonstrated the greatest antifungal activity in the histological analysis and the visible restoration of the skin, and the rats revealed an apparent evidence of recovery. Compared to the untreated group, the treated group's lymphocyte and white blood cells counts increased, but their eosinophil counts decreased. In conclusion, MNTG exhibited the greatest antifungal activity, which might be connected to the improved skin permeability of the transethosome's nanosized vesicles. Therefore, it could be considered a promising carrier for topical usage and the treatment of cutaneous candidiasis. More clinical research needs to be performed in order to demonstrate its effectiveness and safe usage in humans.

Implications of Emulating a Dermatologist: A Study of Topical medication usage for dermatoses prescribed by Non-Dermatologists in a rural area

Introduction: Over-the-counter (OTC) medications refer to drugs that a patient can purchase without prescription from a registered medical practitioner. Topical OTC medication usage for skin disorders is common in rural India, due to non-availability of Dermatologists. Inappropriate use of such drugs has resulted in various cutaneous adverse effects and antifungal resistance. Aims: To determine the pattern of usage of the different OTC topical medications for various Dermatological indications, their source of prescription and their cutaneous adverse effects. Materials and Methods: Patients presenting to Dermatology OPD with a history of usage of topical OTC drugs for skin disorders were recruited. Details such as type of OTC drug used, the source of its prescription, indications for which it was advised and patients knowledge regarding steroids were documented. Patients were examined for cutaneous adverse effects. Results: Out of 100 patients there were 46 males and 54 females. Dermatophytosis (29%) was the most common indication for which these drugs were used. The common side effects were itching (17.86%) and burning sensation (13.39%). Majority of the drugs were advised by pharmacists (36%) followed by friends and relatives (29%). Betamethasone was the commonest steroid and Betnovate was the commonest brand misused. Majority (97%) of the patients were unaware of topical steroids and their adverse effects. Conclusion: The growing threat of OTC drug abuse is evident from our study. Stringent drug control policies are required to regulate the sale of topical OTC drugs. Creating awareness among patients and General physicians about the adverse effects of OTC topical medications including steroids is truly the need of the hour.

ORAL CORTICOSTEROIDS AND THE LONG-TERM RISK OF CATARACT: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: A cataract can lead to visual deterioration, resulting in reduced vision capacity and partial or complete reversible vision loss. The most commonly associated risk factors for cataract include aging, diabetic retinopathy, glaucoma, and some medications such as glucocorticoids. Glucocorticoids are utilized in a variety of disorders, as long- and short-term, treatment such as topical ocular steroid usage, allergic rhinitis and inflammatory bowel disease as a result, the chance of cataract may increase and put a significant burden in countries. The aim: This study aims to show about oral corticosteroids and the long-term risk of cataract. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 79 articles, whereas the results of our search on SagePub brought up 208 articles, on Google Scholar brought up 26.000 articles. The results of the search conducted for the last year of 2014 yielded a total 25 articles for PubMed, 73 articles for SagePub, and 18.000 articles for Google Scholar. The result based on title screening, a total 2 articles for PubMed, 36 articles for SagePub, and 397 for Google Scholar. In the end, we get a total of 10 papers. We included five research that suitable the criteria. Conclusion: Using glucocorticoids either as inhaler and/or orally will increase the risk and prevalence of posterior subcapsular cataract and other ocular complications such as glaucoma.

571 - Case series of topical 1.5% ruxolitinib cream for pediatric vitiligo

Abstract Introduction/Background Pediatric Vitiligo affects 1.52% of 4-11-year-olds within the United States and 2.16% of 12-17-year-olds with non-segmental disease affecting 65% and 69% respectively (1). The FDA has not approved any medications for vitiligo for children younger than 12 years of age. Additionally, about one-third of pediatric vitiligo is segmental (1), and there is no FDA-approved topical agent for segmental vitiligo in any pediatric age group (2). Objectives To identify the efficacy of 1.5% ruxolitinib cream for pediatric vitiligo in clinical practice. Methods An IRB-exempted pediatric chart review was conducted addressing the usage of 1.5% ruxolitinib cream, currently FDA-approved for non-segmental vitiligo affecting 10% of body surface area or less for 12 years of age or older. All children and adolescents using topical 1.5% ruxolitinib cream including segmental, non-segmental, and mixed vitiligo including individuals up to age 17 years. Results Twelve children were identified with topical usage of 1.5% ruxolitinib cream for vitiligo ages 3-16 years (average age: 10.75 years). Demographics included 9 males, 3 females and race/ ethnicity included Black (n=1), Hispanic/ Latin X (n=4), Indian (n=1), and White (n=6). Vitiligo subtype included: Non-segmental vitiligo (n=7), Mixed type vitiligo (n=1), and segmental vitiligo (n=4). Regarding treatment subgroup of Non-segmental vitiligo and the non-segmental component of the Mixed type included 8 children, average age of 10.4 years (range 3-15 years), including 5 children under the age of 12 years (one 3-year-old, two 9 year-olds, and two 10 year-olds). Treatment was once daily in 1 child and twice daily in 7 children. One was lost to follow-up. Of the 6 children with documented response, average maximum repigmentation occurred at 6.14 months (range 3-12 months), with five achieving complete repigmentation, one partial repigmentation with only a three-month trial. The average length of disease before treatment began was 1.25 years (1 month to 6 years). The onset of response was 1.57 months on average (range 1-3 months). The initial location of response was the face (n=3), arms (n=2), and abdomen (n=1). No adverse events were reported. Four children had a complete blood count while on medication, with no laboratory abnormalities, including the 3-year-old. Two had a parent with vitiligo. Four patients previously failed tacrolimus topically, two patients failed topical class 2 corticosteroids, and one previously failed narrowband UVB, with no notable difference in response in these patients. Regarding treatment subgroup of Segmental vitiligo including five SV patients average age 11.2 years (range 5-16 years). One had facial segmental, one face and neck lesion (solitary stripe), one chest/back, and one on the lower abdomen. The five year-old did not repigment after 6 months of neck application, but never developed poliosis. The ten-year-old with segmental disease for 6 years had no response. The eleven-year-old SV of the chest/ back failed topical tacrolimus and responded with 40% repigmentation over 3 months, increasing to 90% after 5 months and 12 concurrent sessions of 308-nm laser. The 14-year-old developed slight poliosis, but started repigmenting within 3 weeks, with continuous usage and subtotal repigmentation at 14 months. The 16-year-old began to repigment after 1 month, with a concurrent weekly 308-nm laser, and subtotal repigmentation after 5 months. Repigmentation was One facial SV (12 treatments), one chest/back SV (12 treatments), and one NSV had concurrent 308-nm laser (24 treatments) with pulsed dexamethasone, without any notable adverse events. Two teenage males (ages 15 and 16 years) developed acne on sites of application on the face. Laboratory screening including complete blood count was normal during treatment for 2 patients evaluated. Conclusions NSV responds to 1.5% topical ruxolitinib consistently, with a solitary patient responding to once daily, and efficacy in children as young as three years of age with no notable lab abnormalities in screened patients. Topical 1.5% ruxolitinib cream appears very effective in repigmenting SV in children if used twice-daily and in combination with 308-nm laser sessions in the first 6 months. Topical ruxolitinib can cause acne in teenagers with facial segmental vitiligo. Early institution of topical 1.5% ruxolitinib cream appears to have a rapid onset of repigmentation (average 1.57 months) and rapid complete response (6.14 months). Clinical trials of 1.5% topical ruxolitinib in children are needed to identify outliers and long term outcomes. Early institution of therapy appears to speed up the response. Adjunctive 308-nm laser is promising but requires placebo-controlled trials.

CLINICO-EPIDEMIOLOGICAL STUDY OF TOPICAL STEROID DAMAGED FACE IN A TERTIARY CARE HOSPITAL

Objectives- The aim of the study was to determine the clinical features, extent, and dermographics of topical corticosteroid usage on the face in patients who were seen in the dermatology outpatient department. Materials and Methods: Between August 2022 and August 2023, a questionnaire-based analysis of patients attending the dermatology outpatient department of a tertiary care hospital was conducted. The study was comprised of 200 subjects who applied topical steroid on their face for more than 6 weeks and they were enquired regarding their history. Clinical assessment, and lesion photography was also done. Results: 200 patients with topical steroid damaged face were examined in the study. The most prevalent age range for topical steroid use was between 18 and 30 years which comprised 42% of total patients in the study. Out of 200 patients 149 were women [74.5%]. The average time between commencing the topical steroid regimen and the appearance of symptoms was six months. 74 [39.5%] used topical steroids to treat dermatophyte infections and the remaining subjects used them for miscellaneous reasons. In this study population, cream-based betamethasone valerate was the most frequently misused steroid. The most frequent adverse effect was hyperpigmentation (27%) followed by acneiform eruptions (25%) facial erythema (18%), hypertrichosis (12%), perioral dermatitis (4%) and skin atrophy (5%), hypopigmentation(9%). Conclusion: Topical steroid damaged face is a dermatological concern. The public must be made aware of the possible danger of topical steroid abuse to stop its indiscriminate use.

Topic Types and Usage Motives of Real-Time Chat Messages by Live Commerce Users Analyzed through Topic Modeling

Topic Types and Usage Motives of Real-Time Chat Messages by Live Commerce Users Analyzed through Topic Modeling

Post-keratoplasty glaucoma—Tackling tube exposure

Glaucoma drainage implants (GDI) are sometimes used in the treatment of refractory glaucoma associated with keratoplasty. An important complication of GDI is the exposure of the drainage tube. Two patients presented after penetrating keratoplasty and Ahmed glaucoma valve, with exposure of the GDI tube following prolonged topical steroid usage. This report addresses the risk factors and early signs of tube exposure that guide its prevention and management.

Topical Finasteride: A Comprehensive Review of Androgenetic Alopecia Management for Men and Women.

The most prevalent kind of alopecia, androgenetic alopecia, commonly known as male or female pattern hair loss, affects both men and women, with the frequency rising with advancing years. Even though practicing dermatologists and hair experts frequently encounter it, it might be one of the most challenging disorders to treat since choosing a course of action frequently requires a comprehensive analysis of several variables and moral judgment. Effectiveness, side effect profiles, practicability, promoting compliance, and treatment cost are the most important factors to take into account, especially given the chronic nature of androgenetic alopecia. A clinician's ability to select the optimum course of treatment for each patient may be constrained and clouded by their knowledge base, experience, and financial compensation. A search was done to find research on the effectiveness of topical finasteride therapy, including clinically pertinent case reports and papers. Only topical minoxidil and oral finasteride are now approved by the Food and Drug Administration and the European Medicines Agency for the treatment of androgenetic alopecia. Despite being effective for hair regeneration, systemic use of finasteride is accompanied by adverse effects that prevent long-term use. Investigating topical finasteride as another possible treatment plan may be fruitful. Early research on the use of topical finasteride is safe and encouraging, despite its limitations. More research on drug distribution, ideal topical strength and usage regularity, adverse effects, and application for other alopecias would aid in elucidating the range of topical finasteride use.

Local Application of Timolol 0.5% Solution in Treating Chronic Non-Healing Ulcers – A Prospective Study

Chronic non-healing ulcers are a variety of ulcers that occur mainly over the lower limb and are resistant to conventional therapy. There are modern treatments like various types of dressings and topical preparations available in the market. However, they are costly and may not be freely available to the general population. Topical usage of β2-AR antagonists like timolol may promote wound healing by enabling keratinocyte migration into the wound to initiate the re-epithelisation. The objective of this study is to assess the effectiveness of topical timolol 0.5% in accelerating the wound healing process by observing the signs of healing. It is a prospective observational study conducted in Government General Hospital, Rangaya Medical Medical College, Kakinada, after getting Institutional Ethical Committee approval from March 2021 to March 2023. One hundred patients with Chronic non-healing foot ulcers were taken for this study. Mean age was 47.64.60% of the study population was in the 20-55 years age group. Reduction in mean ulcer area was on day 15 and day 30 with topical application of timolol.

Value co-creation in a high-performance computing (HPC) service ecosystem: opportunities for European SMEs

PurposeThis paper aims to develop a conceptual framework as a valuable investigative tool for future empirical studies examining stakeholders’ interactions within a high-performance computing (HPC) service ecosystem and identifying the enablers for better value co-creation under various service provisioning contexts.Design/methodology/approachThis conceptual paper follows a theory adaptation research design that systematically examines the literature on a substantive topic encompassing HPC technology adoption and usage by European small and medium-sized enterprises (SMEs). Furthermore, it introduces theoretical perspectives from service innovation research as its methodological approach (method theory) to develop a theoretical framework for value co-creation within an HPC service ecosystem.FindingsThe conceptual framework presented in this paper identifies the critical resource elements of SMEs, which can potentially be integrated with other stakeholders’ resources and complement the limited internal resources of SMEs for enhanced value co-creation within an HPC service ecosystem.Research limitations/implicationsThe conceptualisation of an HPC service ecosystem and the potential of value co-creation through integrating stakeholders’ resources, presented in this paper, underscore further empirical research in this direction.Practical implicationsFindings from this paper can inform European policymakers for regional development to frame regional strategies and policies that enable SMEs to better uptake HPC services. Service providers can revisit their business models to reconfigure their organisational resources for enhanced value proposition and co-creation.Social implicationsThis study advances the agenda of transformative service research that aims uplifting changes and societal well-being through a more inclusive and sustainable value co-creation among a wider set of stakeholders within the service ecosystem.Originality/valueThe paper addresses an under-investigated research gap by examining SMEs’ adoption of HPC services and opportunities for higher value co-creation using a service ecosystem approach based on multi-actor interaction, collaboration and resource integration.

Blueberry Supplementation and Skin Health.

Environmental stressors such as air pollutants, ozone, and UV radiation are among the most noxious outdoor stressors affecting human skin and leading to premature skin aging. To prevent the extrinsic aging, the skin is equipped with an effective defensive system. However, cutaneous defense mechanisms can be overwhelmed through chronic exposure to environmental pollutants. Recent studies have suggested that the topical usage of natural compounds, such as blueberries, could be a good strategy to prevent skin damage from the environment. Indeed, blueberries contain bioactive compounds found to induce an active skin response against the environmental noxious effects. In this review, results from recent studies on this topic are discussed in order to build the argument for blueberries to possibly be an effective agent for skin health. In addition, we hope to highlight the need for further research to elucidate the mechanisms behind the use of both topical application and dietary supplementation with blueberries to bolster cutaneous systems and defensive mechanisms.

An Analysis of Literature on Topical Steroid Withdrawal in Dermatology

Topical steroids have been used to treat a variety of dermatological conditions and are one of the most commonly prescribed drugs in dermatology. These are Food and Drug Administration (FDA)-approved medications for treating diseases such as eczema, vitiligo, atopic dermatitis, discoid lupus erythematosus, and more. The mechanism of action of topical corticosteroids consists of anti-inflammatory, anti-mitotic, and immunosuppressive effects. Patients on topical corticosteroid treatments must be monitored carefully as there is a potential for adverse effects, especially in treatments lasting longer than several weeks. While when properly prescribed and monitored topical corticosteroid usage is considered safe, there have been growing concerns surrounding topical corticosteroid abuse, phobia, and withdrawal. Current research has focused on new therapeutic strategies and management protocols to improve long-term patient outcomes and mitigate the adverse effects of these drugs. In this narrative review, we describe the recent findings of clinical manifestations, patient perspectives in the literature, current knowledge, and misinformation and abuse pertaining to topical steroids.

Ketoconazole: A Promising Drug for Fungal Infections

Ketoconazole is a synthetic imidazole antifungal agent that can be used to treat surface fungal infections, genital, chronic mucocutaneous candidosis, and candidosis. Ketoconazole is a synthetic imidazole derivative that is effective after oral administration, unlike older imidazole antifungals like miconazole and clotrimazole. It works well for fungal infections on the skin, such as dermatophytosis and genital candidiasis. It has become useful for the treatment of persistent mucocutaneous candidiasis. In immunocompromised individuals, ketoconazole is also used to prevent fungal infections. It has lately been utilised as a therapy for advanced prostatic cancer because it inhibits the production of adrenal sex hormone. Although oral ketoconazole has been subjected to labelling modifications and market withdrawal because of substantial adverse effects, topical ketoconazole is widely regarded to be efficacious, safe, and best for treating superficial fungal infections. Onychomycosis, blepharitis, and hair loss are some of the new dermatologic indications for topical ketoconazole usage.

Community infectious disease treatment with antimicrobial agents – A longitudinal one year study of antimicrobials in two cities via wastewater-based epidemiology

Antimicrobial resistance (AMR) is one of the most significant global health threats. Inappropriate and over-usage of antimicrobial agents (AAs) is a major driver for AMR. Wastewater-based epidemiology (WBE) is a promising tool for monitoring AA usage in communities which is, for the first time, explored in this large scale, longitudinal study. Two contrasting urban catchment areas have been investigated: one city and one small town in the Southwest of the UK over a 13-month period in 2018–2019. Per capita daily intake of 17 AAs and metabolites has been estimated and obtained estimates were triangulated with catchment specific AA prescription data to understand AA usage patterns (both seasons driven prescription and AA prescription compliance). Results have demonstrated positive correlations for all quantifiable parent AAs and metabolites in wastewater, and spatial variability in AA usage was observed even in neighbouring urban areas. WBE and catchment specific prescription data showed similar seasonal trends but with low correlation in intake. The reasons might be variable prescribing patterns, prescription/intake outside the studied catchment, and/or lack of patient compliance. WBE proved useful in differentiating between consumption vs topical usage and/or direct disposal of unused AA. WBE is considered superior to prescription data as it provides information on AAs prescribed outside of the monitoring catchment, e.g. HIV antivirals and TB drugs. However, data triangulation, of both prescription data and wastewater data, provides the most comprehensive approach to understanding AA usage in communities.

A Prospective Prescription Audit of Topical Corticosteroid usage at Skin OPD in a Tertiary Care Centre

Introduction: Topical corticosteroids are used for various conditions in dermatology like vitiligo, eczema and psoriasis. They should be used rationally to minimize the side effects. The present study is done to document and improve the pattern of prescribing topical steroids among patients attending Skin OPD at tertiary care centre. Material & Methods: The study was a prospective audit of 100 prescriptions issued to the patients in skin OPD. The data was collected for age and sex of patients, dermatosis for which it is prescribed, number and molecule of drugs, with its dose, site, duration, strength, quantity and frequency of administration. Descriptive statistics was used for analysis. Results: Present study is an audit of 100 prescriptions. Sixty two patients were males and 49% were in 13-40 years of age group. Most common skin condition for which topical steroid prescribed was eczema in 34%. Average 3-6 drugs were prescribed in majority (82%) of prescriptions. The potent corticosteroids was the most frequently prescribed group in 46% prescriptions and most common molecule prescribed was betamethasone valerate in 27%. In 73% prescriptions twice daily application was advised. Maximum 50% prescriptions of TCS were for 7-15 days and site of application was mentioned in 70%. Generic and brand names were mentioned in all prescriptions with quantity of drug. Fingertip unit application was mentioned in 3% of prescriptions. Conclusion: The most common indication for prescribing topical steroids was eczema and the most common molecule prescribed was betamethasone valerate. Generic and brand names for drugs were used in all prescription, but advice about Finger tip method application was not a routine practice.