Topical Medicaments Research Articles

Diode Laser Trabeculoplasty in Patients with Pseudoexfoliative Glaucoma

Aim:A prospective study was carried out to examine the efficacy of diode laser trabeculoplasty (DLT) in the treatment of pseudoexfoliative glaucoma (XFG).Material and Methods:Laser trabeculoplasty was performed by Zeiss VISULAS 532s diode pumped solid state laser on 69 eyes of 40 patients with XFG and primary open-angle glaucoma. Power of 600–1,200 mW was used, with a spot size of 100 microns and a pulse of 0.10 second. One hour before DLT brimonidine 0.1 % was administered and during seven days after the treatment Dexamethasone 1 % was administered. All patients underwent complete ophthalmic evaluation before and at intervals after treatment (seven days, one, three and six months and one year postoperatively). During the follow-up period, patients were treated with the same topical anti-glaucoma medicaments as before diode laser trabeculoplasty.Results:Before treatment in XFG patients mean intraocular pressure (IOP) was 23.7±2.6 mmHg and seven days after DLT it was 16.8 ± 2.1 mmHg that is 26.9 % decrease from the baseline, on day 30 it was 14.3 ± 2.2 mmHg which is 38.3 % decrease from the baseline, after 3 months 13.9 ± 2.4 mmHg (39.0 % decrease from the baseline), after six months 13.8 ± 2.7 mmHg or 39.9 % decrease from the baseline and after one year 15.1 ± 3.1 mmHg that makes 36.3 % decrease from the baseline. No side effects (either objective or subjective) were present in examined patients.Conclusions:There is statistically significant difference between IOP before and after diode laser trabeculoplasty, so it is concluded that diode laser trabeculoplasty is an effective mode of treatment for eyes with open-angle glaucoma especially in patients with XFG.

“Experimental Evaluation of Indian Aloe (Aloe Vera) Leaves Pulp as Topical Medicament on Wound Healing”

Wounds are major cause of physical disabilities. Wound healing consists of orderly progression of series of events that establish the integrity of the damaged tissues. Indian Aloe (Aloe Vera) leaves pulp is used for medicinal purposes, including treatment of constipation, colitis, asthma, irritable bowel syndrome, diabetes, peptic ulcer, inflammation, heart burn, stress etc. The present study was undertaken on experimental evaluation of Indian Aloe (Aloe Vera) leaves pulp on wound healing activity through topical route on excision wound model. The activity was compared with standard drug Povidone Iodine ointment (5% w/w). Indian Aloe (Aloe Vera) leaves pulp was found to have better and faster wound healing effect than standard drug Povidone Iodine ointment on excision wound model.

Healing Effect of Bee Venom Cream to Full-Thickness Skin Wound in Rabbits

Experiments were undertaken to assess the healing effect of bee venom (BV) cream to full-thickness skin wound in rabbits. BV cream was compared with silver sulfadiazine (SS) as a topical medicament against a control on experimentally created full-thickness wounds. Two wounds measuring 2 × 2 cm were created bilaterally (4 wounds/rabbit) on the dorsolateral aspect of the trunk of 7 New Zealand white. Wound treatments were evenly distributed 4 sites, using a Latin square design. The contact layer of wounds was treated with physiological saline (control), SS cream and BV cream during 28 days. Wound healing was assessed on the basis of scab hardness, wound exudates, wound area, unepithelialized granulation tissue and histopathological findings. Topical application of BV and SS creams to wound reduced inflammation, debrided necrotic tissue and promoted granulation and epithelialization. Wound healing was statistically significantly faster in BV and SS treatments compared to the control (P

Frequency and antimicrobial resistance of bacteria isolated from oral and topical medicaments from Hilla, Iraq

The presence of microorganisms in pharmaceuticals is undesirable because they may cause spoilage of the product and may present an infection hazard to the consumers or patients. A total of 102 samples of oral and topical non-sterile pharmaceutical products were collected at random from different drug houses and pharmacies in Iraq, to investigate the microbial contamination of these products. Bacterial isolates recovered from these medicaments were subjected to susceptibility testing against various antibiotics by disk diffusion method according to Clinical and Laboratory Standards (CLSI) guidelines. The results revealed that the occurrence of gram-positive bacteria was in oral and topical medicaments while gram-negative bacteria were only detected in topical medicaments. More than 58% of Bacillus isolates were resistant to lincomycin and Bacillus mycoides isolates were resistant to beta-lactam antibiotics and trimethoprim-sulfamethoxazole. Staphylococcus spp. showed a relatively high resistance to ampicillin, amoxicillin, penicillin, tetracycline, and trimethoprim-sulfamethoxazole. S. epidermidis had the highest number of multi-resistant isolates. Furthermore, 87.5% of isolated gram-negative rods showed high resistance to beta-lactam antibiotics and 75% of them were highly resistant to erythromycin. One isolate of Pseudomonas aeruginosa was the most resistant among all gram-negative rod isolates. The high rate of resistance to antimicrobial agents of bacterial isolates recovered from oral and topical medicaments in this study may indicate a widespread antibiotic resistance among bacteria isolated from different sources, including those of anthropological and environmental origin.

366 Contact Allergy to Medicaments in Consecutively Patch-tested Patients in Uruguay

BackgroundAllergic contact dermatitis (ACD) to topical medicaments is common. Medicaments are responsible for approximately 30% of all cases of ACD. The most common drugs associated with ACD include topically applied antibiotics, antiseptics, antihistamines, anesthetics, nonsteroidal antiinflammatory drugs, and corticosteroids.Certain body areas are particularly susceptible (ie, genital and perianal areas, ears, eyes, face and lower legs)Predisposing factors are: occlusion (skin folds, use of bandages), application in damaged skin (stasis dermatitis & leg ulcers, and other chronic dermatitis) and long-lasting use of multiple medicamentsThe aim of our study was to study the prevalence of ACD to topical medicaments in patients with suspected ACD attending the Unit of Allergy at the University Hospital in Montevideo.Methods1175 consecutive patients; 781 F (63%) 394 M (37%) with suspected ACD were patch tested with the standard series and the topical medicament series, as well as other allergens according to the clinical situation.ResultsThe most frequent allergens were: Neomycin (7.1%), Thiomersal (3.8%), Benzocaine (1.9%), Bacitracin (1.9%), Propolis (1.5%), Gentamycin (1.2%), Tixocortol (1.1%) and Budesonide 24 (0.8%).ConclusionsContact allergy to topical medicaments is common in patients studied by a suspected ACD in Uruguay. In these cases the topical medicaments that the patient is using should be included when patch testing.

Allergic Contact Dermatitis from Diethyl Sebacate in a Topical Antimycotic Medicament

Diethyl sebacate is used in topical medicaments in United States and Japan. We described a case of allergic contact dermatitis from diethyl sebacate in a topical antimycotic medicament. Allergic reaction to diethyl sebacate is likely more common because our group has found three of eight sensitized cases. We believe that an investigation regarding the sensitized frequency to diethyl sebacate would conduct to improve the safety of products in United States and Japan.

Contact Dermatitis to Topical Medicaments

Topical medicaments are a common cause of allergic contact dermatitis. This study will evaluate the prevalence of contact allergy to a wide array of topical medicaments at the Ottawa Patch Test Clinic. The objectives of this study are to report the results of positive patch testing to topical medicaments at the Ottawa Patch Test Clinic and identify common sensitizers in topical medicaments. Patients were tested with the standard North American Contact Dermatitis screening series of 70 allergens plus supplementary allergens when indicated. A retrospective chart review of patients positive to topical medicaments between January 1, 2000, and September 30, 2010, was undertaken. The average age of patients was 49.5 years. Thirty-four percent were atopic. Common sensitizers included topical antibiotics (58%), steroids (30%), anesthetics (6%), and antifungals (6%). Patch testing showed that 61% of patients tested positive to antibiotics, 21% to topical steroids, 17% tested positive to topical anesthetics, and 1% tested positive to topical antifungals. The most common reactions were to bacitracin (44%) and neomycin (29%). The most common steroid screener was tixocortol-17-pivalate (group A) (19%), and the most common local anesthetic was lidocaine (12%). Topical medicaments of all kinds are common causes of allergic contact dermatitis. Those that are more readily available, in over-the-counter preparations, are the most frequent culprits.

Laser therapy for dentine hypersensitivity

Medline, Embase, the Cochrane Central database as well as the Cochrane Oral Health Group's Trials Register and the National Research Register. In addition relevant journals were hand searched from 2000 to 2010 (Lasers in Medical Sciences, Lasers in Surgery and Medicine, Photomedicine and Laser Surgery, Photodiagnosis and Photodynamic Therapy, Journal of Oral Rehabilitation, Journal of Periodontology, Journal of Clinical Periodontology, Journal of Endodontics, Clinical Oral Investigations, Journal of Dental Research, Journal of Oral Laser Applications, Journal of Periodontal Research and Periodontology 2000) together with the reference lists of relevant trials. Randomised controlled trials (RCT) that included patients with two or more hypersensitive teeth confirmed by evaporative stimulus or tactile hypersensitivity assessment, comparing laser therapy versus other topical desensitising agents, such as fluoride varnish, dentine bonding agents etc, that were published in English. Studies were assessed for quality by two reviewers independently and data were extracted using a standardised form. Because of heterogeneity of the studies meta-analysis was not performed, so a qualitative synthesis is presented. Eight trials (234 participants) met the inclusion criteria. Half of the included studies compared GaALAS laser with topical desensitising agents, but the findings were conflicting. The remaining studies involved Nd:YAG laser, Er:YAG laser and CO2 laser, and all showed that the three types of lasers were superior to topical desensitising agents, but the superiority was slight. The review suggests that laser therapy has a slight clinical advantage over topical medicaments in the treatment of dentine hypersensitivity. However more large sample-sized, long-term, high-quality randomised controlled clinical trials are needed before definitive conclusions can be made.

Allergic contact dermatitis: effect of age

The relationship between allergic contact dermatitis (ACD) and age has not been well documented. We searched for articles and textbooks based on age–ACD relationship and evaluated relevant data. The frequency of skin reactions to allergens increased with age in some studies, whereas others showed no definite effect. This might be caused by variations in study design, genetic factors or by external influences such as from different regions and environmental exposure. In general, investigators agree that elderly patients were more likely to have multiple contact allergies than younger persons. This may be because of the frequent use of topical medicaments and having a longer time for potential allergen exposure. However, a review of marketed transdermal products for ACD shows a very low incidence, and no age-related effects were reported. One exception to this low incidence of ACD is the transdermal product, Catapres-TTS® (clonidine), which has a reported incidence rate of ~16%. The generally low incidence of ACD in marketed products and the conflicting findings in the prevalence of specific age-related ACD indicate the need for further investigation as to the proclivity for developing new sensitivities with age.

The relevance of chlorhexidine contact allergy

Chlorhexidine is used for disinfection of skin and mucosae in medicine and dentistry. Prolonged exposure may lead to contact sensitization and allergic contact dermatitis or stomatitis. The purpose of this study was to analyse the sources of chlorhexidine exposure and sensitization, and to obtain data on the prevalence of sensitization and chlorhexidine-related contact allergy. From 1999, patch testing was performed with chlorhexidine digluconate (0.5% aq.) on 7610 general dermatology patients with suspected contact allergy at the Turku University Hospital Dermatology Department. The medical records were reviewed concerning the patients' exposure to chlorhexidine. A positive patch reaction to chlorhexidine was seen in 36 patients (0.47%). Current dermatitis or stomatitis caused by chlorhexidine-containing topical medicaments was seen in 5 patients. Chlorhexidine sensitization contributed to the current dermatitis in 11 patients. A history of earlier exposure to chlorhexidine-containing products was recalled by only 16 sensitized patients, whereas no exposure was revealed in 4 cases. Chlorhexidine-containing corticosteroid creams, skin disinfectants and oral hygiene products are principal sources of chlorhexidine contact sensitization. Exposure to chlorhexidine in cosmetics may lead to delayed improvement of eczema in sensitized patients, emphasizing the importance of identifying the potential cosmetic sources.

Effectiveness of laser therapy and topical desensitising agents in treating dentine hypersensitivity: a systematic review

The aim of this systematic review was to compare the effectiveness of laser therapy with that of topical desensitising agents in treating dentine hypersensitivity. A secondary objective was to determine the safety of laser application according to the relevant studies. A systematic search was performed in the MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the National Research Register, the Cochrane Oral Health Group's Trials Register database to retrieve all articles that were about randomised controlled trials involving the application of laser desensitising procedures and topical desensitising agents in the treatment of dentine hypersensitivity. A total of eight trials that met all inclusion criteria involving 234 participants were reviewed. Based upon the 'quality' of evidence, one study was classified as A level, five as B level and two as C level. Owing to the heterogeneity of the studies, a meta-analysis was not performed. Half of the included studies compared GaALAS laser with topical desensitising agents, but the findings were conflicting. The remaining studies involved Nd:YAG laser, Er:YAG laser and CO2 laser, and all showed that the three types of lasers were superior to topical desensitising agents, but the superiority was slight. A systematic review of the literature indicates the likelihood that laser therapy has a slight clinical advantage over topical medicaments in the treatment of dentine hypersensitivity. More large sample-sized, long-term, high-quality randomised controlled clinical trials are needed before definitive conclusions were made.

Partial nail avulsion: habit or evidence based?

Onychocryptosis is a relatively common condition that can cause significant pain and discomfort. Partial nail avulsion (PNA) with phenolisation is a straightforward procedure performed by podiatrists on a daily basis. The procedure has shown a high rate of efficacy and low recurrence rate, and can be performed on high risk patients with close post-operative monitoring and those with concomitant infection. PNA with phenolisation of the nail matrix is a non-invasive procedure that does not require the use of an operating theatre and can be carried out in the podiatrist’s rooms. Pre-operative measures do need to be taken, a local sterile field should be set up and the toe and forefoot should be scrubbed. Once the procedure has been completed healing can be expected in 4-8 weeks. The PNA procedure has been taught to undergraduate podiatrists since the late 1970’s and has developed many small variations in how the procedure is carried out. Variations vary from pre-operative management (type of antisepsis used), phenolisation time (reported to be between 1 to 5 minutes), type of post phenol irrigation (saline, isopropyl alcohol or no irrigation) and post-operative dressing regimen. These variations however are usually operator dependant and based on personal experience. Post-operative management of PNA wounds have attracted a lot of interest, with the use of different dressings (provodone-iodine impregnated gauze and paraffin gauze) and topical medicaments (manuka honey, intrasite gel) aimed at increasing the healing rate and reducing the rate of infection, but quantitative analysis of the colonisation of the wound bed shows a bacterial count of zero after the use of phenol. The case of the phenolised wound is an interesting one, an acute wound that heals by secondary intention and freely discharges for 2-4 weeks postoperatively. After the application phenol and the destruction of all microbiological matter the post-operative focus should be in nurturing the recolonisation of the nail bed. Wounds that have a high as well as a low bacterial count have been shown to have an effect healing rates, but no studies have investigated the microbiological behaviour of a phenolised PNA wound.

Contact Dermatitis in Older Adults

Contact dermatitis is a significant health problem affecting the elderly. Impaired epidermal barrier function and delayed cutaneous recovery after insult enhances susceptibility to both irritants and allergens. Exposure to more numerous potential sensitizers and for greater durations influences the rate of allergic contact dermatitis in this population. Medical co-morbidities, including stasis dermatitis and venous ulcerations, further exacerbate this clinical picture. However, while these factors tend to increase the degree of sensitization in the elderly, waning immunity can actually decrease such a propensity. This interplay of both intrinsic and extrinsic factors makes a generalization on trends for contact dermatitis in older adults challenging. The literature has varying reports on the overall incidence of allergic contact dermatitis with advancing age. Nevertheless, it does clearly show that sensitivity to topical medicaments increases with age. Irritant contact dermatitis studies are more consistent, with less reactivity (to irritants) in older compared with younger skin. Diagnosis of both irritant and allergic contact dermatitis is based on a thorough history, complete skin examination, and comprehensive patch testing. The mainstay of therapy is avoidance of the offending chemical substances and the use of topical along with systemic therapies, depending on the severity of the condition.

Patch Testing in Atopic Dermatitis

Because atopic dermatitis (AD) patients differ from non-AD patients in immunologic responses (they lack β-defensins, are more likely to react to protein allergens, and are harder to experimentally sensitize to the nonprotein allergens), patch-test responses to commercially available patch test series may differ in AD patients. To compare responses to conventional patch tests in AD and non-AD patients and to assess the importance of specific allergens in AD. AD patients were strictly defined by history of childhood flexural dermatitis. Patients with active disease were routinely pretreated with systemic antistaphylococcal and antiyeast antibiotics before patch testing unless contraindicated. All final patch-test readings occurred at day 7. The overall number of positive patch-test results did not differ significantly in AD patients (n = 146) versus non-AD patients (n = 1,003). There was no significant increase in nickel sensitivity. There was a nonsignificant trend toward an increased number of positive patch-test reactions to tixocortol pivalate, Compositae mix, and propylene glycol in AD patients. In AD patients treated with antibiotics and systemic azoles before patch testing, the number of positive patch-test reactions is almost identical to that of non-AD patients. Patch-test reactions to components of topical medicaments may be more frequent in AD as compared to non-AD patients.

Ichthammol revisited

Scientific research has greatly expanded the therapeutic options for patients with cutaneous disease. This expansion, however, has not been without its drawbacks. While newer medications and procedures not only typically offer better disease control but they are also often associated with increased expense and problematic toxicities. Older medications often relegated to the dustbin of history may provide effective treatment of common dermatologic maladies and deserves reconsideration. Ichthammol, derived from shale oil, has been employed in the therapy of psoriasis, eczematous dermatitis, leg ulcers, seborrheic dermatitis, and furuncles for over a century and remains a useful topical medicament.

Contact Dermatitis with Topical Medicaments

Contact Dermatitis with Topical Medicaments

Pediatric contact dermatitis

Allergic contact dermatitis (ACD) in children, until recently, was considered rare. ACD was considered as a disorder of the adult population and children were thought to be spared due to a lack of exposure to potential allergens and an immature immune system. Prevalence of ACD to even the most common allergens in children, like poison ivy and parthenium, is relatively rare as compared to adults. However, there is now growing evidence of contact sensitization of the pediatric population, and it begins right from early childhood, including 1-week-old neonates. Vaccinations, piercing, topical medicaments and cosmetics in younger patients are potential exposures for sensitization. Nickel is the most common sensitizer in almost all studies pertaining to pediatric contact dermatitis. Other common allergens reported are cobalt, fragrance mix, rubber, lanolin, thiomersol, neomycin, gold, mercapto mix, balsum of Peru and colophony. Different factors like age, sex, atopy, social and cultural practices, habit of parents and caregivers and geographic changes affect the patterns of ACD and their variable clinical presentation. Patch testing should be considered not only in children with lesions of a morphology suggestive of ACD, but in any child with dermatitis that is difficult to control.

Gingival Veneers

Gingival veneers have been in clinical use for over 50 years and are a predictable, inexpensive, non-invasive, effective and aesthetically pleasing way of replacing lost tissue. They can also be used as delivery vehicles for topical medicaments. This article describes their indications, contra-indications and construction. Dentists in primary and secondary care should be aware of the use and fabrication techniques of gingival veneers.

Unusual Patterns in Contact Dermatitis: Medicaments

Allergic contact dermatitis to topical medicaments occurs often. Common medicaments associated with allergic contact dermatitis include topically applied antibiotics, antihistamines, nonsteroidal antiinflammatory drugs, anesthetics, and corticosteroids. In cases of suspected allergic contact dermatitis, medicaments that the patient is using should be included when patch testing. Body sites susceptible to allergic contact dermatitis to topical medicaments include scalp, face, anogenital area, and lower extremities.

Sources of sensitization, cross‐reactions, and occupational sensitization to topical anaesthetics among general dermatology patients

Contact sensitization to local anaesthetics is often from topical medicaments. Occupational sensitization to topical anaesthetics may occur in certain occupations. The aim of the study was to analyse the occurrence of contact sensitization to topical anaesthetics in general dermatology patients. Patch testing with topical anaesthetics was carried out in 620 patients. Possible sources of sensitization and the clinical histories of the patients are analysed. Positive patch test reactions to one or more topical anaesthetics were seen in 25/620 patients. Dibucaine reactions were most common (20/25), and lidocaine sensitization was seen in two patients. Six patients had reactions to ester-type and/or amide-type anaesthetics concurrently. Local preparations for perianal conditions were the most common sensitizers. One patient had developed occupational sensitization to procaine with multiple cross-reactions and with concurrent penicillin sensitization from procaine penicillin. Dibucaine-containing perianal medicaments are the major source of contact sensitization to topical anaesthetics. Although sensitization to multiple anaesthetics can be seen, cross-reactions are possible. Contact sensitization to lidocaine is not common, and possible cross-reactions should be determined when reactions to lidocaine are seen. Occupational procaine sensitization from veterinary medicaments is a risk among animal workers.