Topical Modalities Research Articles

Balanitis of Zoon treated with 30% salicylic acid lotion – A case series

Balanitis of Zoon or balanitis circumscripta plasmacellularis is a non-venereal balanitis affecting middle-aged uncircumcised men. It follows a benign protracted course with a minimal tendency for spontaneous resolution. Chronicity of disease and genital distribution is sufficient to evoke anxiety among subjects and is the primary reason for dermatological consultation. Many topical modalities (antibiotics, antifungals, and immunomodulators) have been resorted to as therapeutic measures with variable and unsatisfactory results and recurrences. Circumcision is a definitive and curative treatment. However, 30% salicylic acid (SA) lotion can prove to be a promising therapeutic alternative, especially for subjects reluctant for circumcision. We are presenting a case series of 10 patients with balanitis of the Zoon treated with 30% SA lotion.

Topical steroids or emollients: does order matter?

Topical corticosteroids, topical steroid-sparing agents, and emollients are all used to treat atopic dermatitis. However, there are no formal guidelines dictating the order and timing in which these topical modalities should be applied. Additionally, the order of application may change drug absorption, efficacy, and distribution. This is especially important for patients with atopic dermatitis. These patients have a dysfunctional skin barrier, which can lead to greater systemic absorption of drugs. Moreover, children already have an increased rate of systemic absorption due to a higher ratio of body surface area to body weight. Thus, the order of application of topical regimens is of the utmost importance in pediatric dermatology. This manuscript presents an updated review of the literature with a focus on guiding clinicians toward the best practices from the available resources.

Comparing the Efficacy of Topical 4% Benzoyl Peroxide Versus Topical 0.1% Adapalene for Treatment of Acne Vulgaris in Skin of Color Population: A South Asian Perspective.

Introduction Acne vulgaris is one of the most common skin problems encountered in the dermatology department. It is a chronic, inflammatory disease of the pilosebaceous unit, clinically presenting with comedones, papules, pustules, nodules, and cysts. With its particularly high prevalence in the younger population, it has significant adverse sequelae on patient's quality of life. At present, due to an enhanced understanding of the pathogenesis of acne, various therapeutic modalities are available. The current management strategies generally follow a systematic treatment escalation based on disease severity and treatment response. However meticulous choice of appropriate anti-acne medicine for the acne type is the key to the management plan. Starting with mild to moderate types of acne as per the Leeds photometric grading scale, the most useful topical agents include topical retinoids, benzoyl peroxide, and topical antibiotics while systemic therapies such as oral antibiotics or isotretinoin are generally reserved for moderate to severe acne treatment. The skin of color (SOC) population is a relatively neglected group concerning the optimum and safe management strategies in different dermatological conditions and acne is no different, where there remains a need for comparing the available topical modalities for appropriate drug selection in the treatment of mild to moderate acne in SOC population. Objective The objective of this study was tocompare the efficacy of topical 4% benzoyl peroxide versus topical 0.1% adapalenein the treatment of acne vulgaris in the SOC population. Methods The participants were divided into two groups, groups A and B. A total of 64 patients of both genders, with acne vulgaris (duration > three months) were included in the study. In group A, 32 patients were administered topical 0.1% adapalene whereas, in group B, 32 patients were given topical 4% benzoyl peroxide. Both medicines were applied at night daily. Patients were called for follow-up after 12 weeks. In both groups, the final efficacy evaluation was done using the Global Acne Grading System (GAGS) scoreafter 12 weeks of treatment period. Results In group A, the age ranged from 15 to 40 years with a mean age of 25.781±3.93 years while the duration of complaint was 5.843±1.27 months. GAGS score was 25.281±2.65 and mean BMI was 23.092±3.51 kg/m2. In group B, the mean age was 25.187± 4.06 years, the duration of complaint was 7.375±2.25 months, the GAGS score was 23.906± 2.60 while the mean BMI was 21.485±3.88 kg/m2. Efficacy in group A was noted in 25 (78.1%) patients as compared to 24 (75%) patients in group B (p =0.768). Conclusion The present study showed that the safety and efficacy of 0.1% adapalenethe traditional drug 4% benzoyl peroxide in the SOC population was comparable.

Comparative Analysis of US Guidelines for the Management of Cutaneous Squamous Cell and Basal Cell Carcinoma.

This study presents a comparative analysis of recently published guidelines to manage cutaneous squamous cell carcinoma (cSCC) and cutaneous basal cell carcinoma (cBCC) within the United States (US). A PubMed database search was performed for the time period between June 1, 2016, and December 1, 2022. A comprehensive comparison was performed in the following clinical interest areas: staging and risk stratification, management of primary tumor and regional nodes with curative intent, and palliative treatment. Guidelines from 3 organizations were analyzed: the American Academy of Dermatology (AAD), the National Comprehensive Cancer Network (NCCN), and the American Society for Radiation Oncology (ASTRO). The guidelines used different methodologies to grade evidence, making comparison difficult. There was agreement that surgery is the preferred treatment for curative cBCC and cSCC. For patients ineligible for surgery, there was a consensus to recommend definitive radiation. AAD and NCCN recommended consideration of other topical modalities in selected low-risk cBCC. Postoperative radiation therapy (PORT) was uniformly recommended in patients with positive margins that could not be cleared with surgery and in patients with nerve invasion. The definition and extent of nerve invasion varied. All guidelines recommended surgery as the primary treatment in patients with lymph node metastases in a curative setting. The criteria used for PORT varied; NCCN and ASTRO used lymph node size, number of nodes, and extracapsular extension for recommending PORT. Both NCCN and ASTRO recommend consideration of systemic treatment along with PORT in patients with extracapsular extension. Conclusion: US guidelines provide contemporary and complementary information on the management of cBCC and cSCC. There are opportunities for research, particularly in the areas of staging, indications for adjuvant treatment in curative settings, extent of nerve invasion and prognosis, and the role of systemic treatments in curative and palliative settings.

Advancements in Managing Wound Biofilm: A Systematic Review and Meta-analysis of Randomized Controlled Trials on Topical Modalities.

Despite numerous available agents claiming anti-biofilm properties on wounds, the substantiating evidence remains inconclusive. This study aimed to assess the immediate impact of topical wound treatments on wound biofilm and healing outcomes in acute and chronic ulcers. We comprehensively searched PubMed, ClinicalTrials.gov, and Google Scholar. In addition, eligible gray literature was incorporated. English-language randomized controlled trials (RCTs), observational, cohort, and case-control studies targeting biofilm prevention, inhibition, or elimination across diverse wound types were included. Primary outcomes included biofilm presence and elimination, supplemented by secondary outcomes encompassing reduced wound size, complete closure, and diminished infection indicators. Bacterial load reduction and biofilm presence were also assessed. Twenty-eight articles met the inclusion criteria. Various modalities were identified, including biofilm-visualization techniques, such as wound blotting and handheld autofluorescence imaging. Pooled analysis for the primary outcomes was infeasible due to limited eligible studies and data-reporting challenges. As for the secondary outcomes, the pooled analysis for complete surgical wound closure (2 RCTs, yielding n=284) and presence of surgical site infections/inflammation (2 RCTs, yielding n=284) showed no significant difference, with a log odds ratio (LOD) of 0.58 (95% confidence interval [CI]: -.33, 1.50) and LOD -0.95 (95% CI: -3.54, 1.64; τ2 = 2.32, Q = 2.71, P = .10), respectively. Our findings suggest insufficient evidence to support anti-biofilm claims of topical modalities. Clinicians' skill appears to play a pivotal role in biofilm elimination and wound healing enhancement, with potential optimization through visual-guided techniques, such as wound blotting and autofluorescence imaging. More rigorous clinical trials are warranted to ascertain the efficacy of these techniques.Level of Evidence: Therapeutic, 1A.

The use of topical Rapamycin in successfully treating non-Langerhans cell histiocytosis in a pediatric patient

Non-Langerhans cell histiocytosis (non-LCH) refers to a collection of medical conditions distinguished by the excessive growth of histiocytes in bodily tissues. It is important to note that these conditions do not meet the established diagnostic criteria for Langerhans cell histiocytosis (LCH). Juvenile xanthogranuloma (JXG) and benign cephalic histiocytosis (BCH) represent the prevailing forms of cutaneous non-LCH. We present a case of JXG which responded to topical treatment with a 0.1% topical ointment of Rapamycin. Rapamycin, an immunosuppressive and antineoplastic agent, can thus be a viable alternative non-invasive topical modality for managing JXG. However, it is imperative to conduct prolonged observations to evaluate the efficacy and potential adverse reactions.

A Prospective Study to Compare the Efficacy of Cryotherapy Versus Intralesional Steroid in Alopecia Areata.

Background:Alopecia areata (AA) is an autoimmune disease that results in the loss of hair on the scalp and elsewhere on the body. The present study was conducted to compare the intralesional steroid and cryotherapy in the treatment of AA.Materials and Methods:The present clinical study was conducted in the Department of Dermatology, Venereology, and Leprology, Muzaffarnagar Medical College. The simple random sampling technique was used for randomly dividing the subjects into two groups: group I (local cryotherapy) and group II (intralesional corticosteroid).Results:A positive response was significantly more among the intralesional steroid group (86.0%) when compared with the cryotherapy group (62.0%). There was a significant difference in relapse between intralesional steroid group (22.0%) and cryotherapy group (16.0%). An excellent response was significantly more among the intralesional steroid group (44.0%) when compared with the cryotherapy group (18.0%). Poor response was significantly more among the cryotherapy group (18.0%), compared with the intralesional steroid group (0.0%). The mean pre-treatment, post-treatment, and the change from pre- to post-treatment Severity of Alopecia Tool [SALT] were compared between cryotherapy and intralesional steroid groups using the unpaired t-test. The mean pre-treatment, post-treatment, and the change from pre- to post-treatment SALT were significantly more among the intralesional steroid group when compared with the cryotherapy group.Conclusion:The authors found that superficial cryotherapy could be a meaningful adjuvant treatment option for AA patients. There was a significantly less relapse rate with cryotherapy. Among the currently available topical modalities for the treatment of AA, the best response was to the intralesional steroids followed by cryotherapy.

Nail unit squamous cell carcinoma: updates on diagnosis, surgical approach, and the use of mohs micrographic surgery.

Nail unit squamous cell carcinoma (NSCC) is a malignant neoplasm that can arise from any part of the nail unit including the nail bed, nail matrix, nail groove, and nail fold. Nail unit SCC is the most common malignant nail neoplasm, and yet its diagnosis often is delayed, partly due to the clinical presentation of NSCC mimicking benign conditions such as onychomycosis, warts, and paronychia. Nail unit SCC has a low rate of metastasis; however, a delayed diagnosis often can result in local destruction and bone invasion. It is imperative for dermatologists who are early in their training to recognize this entity and refer for treatment. Many approaches have been used to treat NSCC, including wide local excision, digital amputation, cryotherapy, topical modalities, and recently Mohs micrographic surgery (MMS).

Abstract 4437: Anti-tumor immunotherapeutic strategy for uveal melanoma by combining photodynamic therapy with ROCK inhibitor

Abstract Uveal melanoma (UM) is the most frequent intraocular malignant tumor among adults. Although UM is a rare disease, the prognosis of patients with UM is poor since nearly 50% of patients develop metastatic disease, and the overall survival outcome is dismal. Here, we suggest a novel and optimal treatment regime for UM not only offering lower burden to patients with high applicability but also preventing lethal metastatic disease by empowering the immune system through the combination of local Photodynamic therapy (PDT) and ROCK inhibitor. PDT is a topical treatment modality with the minimally invasive therapeutic method and now broadly used in a treatment option for the eyes. PDT with chlorin e6 based formulated FIC elicits immunogenic cell death (ICD) of cancer cells, and hallmarks of ICD stimulate antigen-presenting cells (APCs). Furthermore, ripasudil, one of the ROCK inhibitors, is clinically approved for the treatment of glaucoma and ocular hypertension in the form of an eye drop solution. Ripasudil is repurposed as an anticancer compound based on the immuno-stimulatory effect of ROCK inhibition. A combination of FIC-PDT with ripasudil mediated stimulation of APCs leads primed cytotoxic T cell infiltration into the tumor microenvironment (TME) and eventually augment anti-tumor immunity. Moreover, the combinational strategy sensitizes PD-1/PD-L1 immune checkpoint blockade (ICB) therapy to improve survival rates over time and inhibit tumor growth of the distant tumor by generating a systemic anti-tumor immune response. Collectively, our therapeutic strategy may lead to a new treatment option for UM by suppressing the primary tumor effectively and preventing the metastatic disease. Citation Format: Seohyun Kim, In-San Kim. Anti-tumor immunotherapeutic strategy for uveal melanoma by combining photodynamic therapy with ROCK inhibitor [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4437.

A study on clinical profile of patients with melasma at a Tertiary carse hospital

Melasma is an acquired pigmentation of the face, predominantly affecting women with multiple factors like high oestrogen states (pregnancy, OCP therapy), genetic factors, sunlight, cosmetics, drugs & autoimmune thyroid disease implicated in its etiology. The various topical modalities of treatment include broad spectrum sunscreens, hydroquinone in various concentration, tretinoin, salicylic acid, glycolic acid, azelaic acid. Alternative treatments to topicals include chemical peels, laser treatment and dermabrasion. The outcome of treatment also varies because of it refractory nature. Cosmetics also assume an important role in the management of this condition as a temporary means of camouflage. In the present study78 patients (65%) had malar distribution, 40 patients had centrofacial distribution and 2 patients with mandibular type reported.

Single Oral Dose of Ivermectin as a New Therapeutic Trial for Contacts of Patients with Scabies

Background: Scabies is one of the common epidemic and endemic diseases worldwide. Many topical therapeutic modalities for scabies are available. Topical ivermectin has been used effectively in treatment of scabies but there is no oral effective therapy that prevents contacts to get scabies. Objective: To evaluate the effectiveness of oral ivermectin in prevention of scabies contacts to get scabies. Patients and Methods: The study is a single-blinded therapeutic study that was conducted in the Center of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from April 2018 through October 2019.Two hundred sixty healthy scabies contacts were included in this study, their ages ranged from 5-60 years with a mean ± SD of 19.3± 1.9 years. All these contacts were screened for active scabies and they were all free. The contacts of scabies were treated by ivermectin tablet 200 microgram per kg as a single dose after 2 hours from dinner. They were seen regularly after 4 weeks to be re-examined and to record any scabies and drug side effects. Results: The response after four weeks of single dose therapy of healthy contacts showed that 245 (94%) from 260 were free of scabies and only 15(6%) contacts showed infection with scabies and this was statistically significant Chi-square (c2= 148, P-value less than 0.00000001. No any side effects were noticed in any treated contacts. Conclusion: Oral single ivermectin dose is an effective therapy to prevent scabies contacts to get infection. It an easy method of prevention which is very useful in condition of scabies outbreaks and epidemics to stop the rapid spread of the disease.

The efficacy of combining fractional CO2 laser and tacrolimus ointment in the treatment of vitiligo

Background Treatment of vitiligo is very challenging. Topical tacrolimus is one of the topical modalities reported to be successful. No single treatment, however, gives on its own satisfactory results, and combination treatments offer better outcomes. Fractional CO2 laser (FCO2) has been recently studied as an adjuvant treatment with other modalities in vitiligo. Objective To evaluate the value of adding FCO2 laser before tacrolimus ointment in vitiligo. Patients and methods This is a randomized controlled prospective clinical trial including 27 patients with stable vitiligo with a total of 152 lesions. Lesions on one side of the body received one session of FCO2 every month for 3 months in addition to tacrolimus ointment twice daily for 3 months, whereas lesions on the other side of the body received tacrolimus ointment only. Results Lesions treated with the combination modality showed improvement in 17 (22.36%) lesions, with a mean reduction in Vitiligo Area Scoring Index (VASI) of 10.05%, whereas lesions treated with tacrolimus only showed improvement in 13 (17.1%) lesions, with a mean reduction in VASI of 5.535%, yet these differences were not statistically significant (P=0.46 and 0.24, respectively). Acral lesions showed significantly more reduction in VASI when treated with combination therapy than with tacrolimus only (P=0.034). Lesions with shorter duration showed significant more reduction in VASI scores when treated with the combination (P=0.024). Conclusion Treatment of stable vitiligo with FCO2 before tacrolimus yields mild improvement, statistically not significantly better than tacrolimus only except in acral areas. Lesions of shorter duration show significantly better response to the combination treatment than to tacrolimus only.

A pharmaco-epidemiological study of psoriasis

Background: Psoriasis is a chronic relapsing disease necessitates long-term therapy. The disease severity, comorbidities, and access to health care determine the choice of therapy for psoriasis. The main aim of the treatment of psoriasis is to induce prolonged remission and suppress the disease as there is no cure. It is only palliative and symptomatic treatment, and the choice of treatment modality is according to the type of presentation. The various modalities of treatment available include topical therapies, systemic therapies, phototherapy, and biologics. The difference includes among clinical varieties in their presenting features, severity, natural course, and response to the treatment are responsible for variation in choice of therapy.Methods: In this descriptive study, data collected from patients diagnosed with psoriasis who were admitted in a K.S. Hegde Charitable hospital from January 2017 to January 2019 were analysed for demographic features, disease pattern and drug use pattern in patients.Results: Psoriasis vulgaris/plaque type of psoriasis was commonly observed type of psoriasis in our patients with fourth and fifth decade patients getting more affected. Diabetes was the most commonly associated comorbid disorder. The patients were treated both with systemic and topical modalities of treatment, antihistaminic and methotrexate were most commonly most commonly used systemic drug and moisturizers and glucocorticoids were used topical drugs.Conclusions: Psoriasis needs a multimodality treatment with careful monitoring for the comorbid disorder. Treatment choice is individualised depending on the severity and body parts affected.

Role of different topical modalities in improvement of facial hyperpigmentation and skin rejuvenation

<p class="abstract"><strong>Background:</strong> Facial hypermelanosis is a psychologically stressful condition for modern men and women who are cosmetically more conscious than their ancestors. There are various lightening agent used for several months before effect becomes apparent and are much more effective when pigment is epidermal. these topical agents include hydroquinone, liquorice derivatives niacinamide, glycolic acid, arbutin and deoxyarbutin, ascorbic acid, 4-n-butyl resorcinol, retinoids topical steroids mequinol, kojic acid, azelaic acid, 5% tranexmic acid, glutathione cream etc.</p><p class="abstract"><strong>Methods:</strong> A randomized, controlled study was done. 220 patients were given either treatment will be given depending upon the physician choice after taking well informed consent from the patient. Patients' assessment regarding the degree of improvement of complexion since the beginning of therapy was evaluated.<strong></strong></p><p class="abstract"><strong>Results:</strong> The percentage satisfactory response for different modalities was as follow kojic acid 2% cream- 55.55%, 20% azelaic acid cream- 53.12%, 4-n-butyl resorcinol 0.3% cream- 57.89%, 5% tranexmic acid lotion- 48.83% and glutathione cream- 55.76%.</p><p><strong>Conclusions:</strong> Out 220 patients post inflammatory hyperpigmentation was the most common facial condition. Total 61 patients of PIH were there in the present study including 26 males and 35 females followed by melasma. All The modalities were effective in the treatment of different types- pigmentary conditions. </p>

Treatment outcome of acne vulgaris with topical application of clindamycin gel and benzoyl peroxide gel as supplementary files

<p class="abstract"><strong>Background:</strong> Acne vulgaris is one of the commonest inflammatory skin disorders. It also has a psychosocial impact on patients, specially known in adolescents and hence needs effective treatment. The objectives of the study was to find out and ascertain different clinical presentations of acne vulgaris in both sexes of various age groups and to find out the outcome of treatment with various topical modalities in various clinical types.</p><p class="abstract"><strong>Methods:</strong> A total of 150 patients with acne vulgaris were studied with age group >10 years. Detailed history, thorough physical examination and relevant investigations were done. Patients were divided into 2 groups of 75 each and each group received different treatment and were followed up at 4th, 8th and 12th week.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of 12 weeks there was significant improvement in grade-II patients treated with cindamycin 1% gel.</p><p><strong>Conclusions:</strong> The results of the study show that different grades of acne vulgaris respond with different regimens. </p>

A randomised open label comparative study evaluating the effectiveness, adherence and safety between 2% mupirocin ointment and 2% fusidic acid cream in children with impetigo

<p class="abstract"><strong>Background:</strong> Impetigo is a superficial bacterial skin infection that affects mainly children, which is highly contagious. Topical anti-bacterials are most commonly used in both primary and secondary impetigo. Clinical trials have shown high efficacy of these topicals along with systemic antibiotics in both complicated and uncomplicated impetigo. However use of these topical modalities alone in uncomplicated primary impetigo is limited. The aim of the study was to compare the efficacy, safety and adherence to treatment of mupirocin with fusidic acid in primary impetigo.</p><p class="abstract"><strong>Methods:</strong> A total of 60 patients with a clinical diagnosis of primary impetigo, between 2-14 years of age, having <10 lesions, skin infection rating score >4 and pus score equal to or more than one who attended Dermatology OPD, in Chengalpattu Medical College Hospital from February 2018 to March 2019. Study design was a comparative analytical study.<strong></strong></p><p class="abstract"><strong>Results:</strong> Baseline disease characteristics such as number of lesions, the severity of disease (SIRS), and pus scores were statistically similar between the two groups. The clinical improvement observed with mupirocin (25/30) and fusidic acid (24/30) treatment in primary impetigo was not statistically significant (p>0.05). Both drugs were tolerated well.</p><p><strong>Conclusions:</strong> Both mupirocin and fusidic acid showed similar clinical success in patients with primary impetigo. Though fusidic acid has additional anti-inflammatory property and its treatment is cost effective, but irritant effects observed in some patients, which reduces the compliance, lead to consider mupirocin as first line treatment in primary impetigo. </p>

Controlled Clinical Trials: Comparison The efficacy of some Single Topical Scabies Treatment Modalities versus Combined Topical Modalities

Controlled Clinical Trials: Comparison The efficacy of some Single Topical Scabies Treatment Modalities versus Combined Topical Modalities

Development of a core outcome set for clinical trials in basal cell carcinoma: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey

BackgroundBasal cell carcinoma is the most common skin cancer worldwide. Treatment options include both surgical and topical modalities. Although risk of metastasis is low, basal cell carcinoma can be invasive and infiltrate important underlying structures such as bone or cartilage. While many clinical trials examining therapies for basal cell carcinoma exist, the lack of consensus in outcome reporting across all trials poses a concern. Proper evaluation and comparison of treatment modalities is challenging. In order to address the inconsistencies present, this project aims to determine a core set of outcomes which should be evaluated in all clinical trials of basal cell carcinoma.Methods/designOutcomes will be extracted over four phases: (1) a systematic literature review, (2) patient interviews, (3) other published sources, and (4) stakeholder involvement. Potential outcomes will then be examined by the Steering Committee, who may add or remove outcomes. The Delphi process will then be performed to condense the list of outcomes generated. Two rounds of Delphi surveys will be performed with two groups of participants – physicians and patients. A consensus meeting with relevant stakeholders will be conducted after the Delphi exercise to further select outcomes, taking into account participant scores. By the end of the meeting, members will vote and decide on a final recommended set of core outcomes. For the duration of the study, we will be in collaboration with both the Core Outcome Measures in Effectiveness Trials (COMET) initiative and the Cochrane Skin Group – Core Outcome Set Initiative (CSG-COUSIN).DiscussionThis study aims to develop a core outcome set to guide assessment in clinical trials on basal cell carcinoma. The end-goal is to improve the consistency of outcome reporting and allow proper evaluation of treatment effectiveness.

Localized neuropathic pain: an expert consensus on local treatments.

BackgroundPain localization is one of the hallmarks for the choice of first-line treatment in neuropathic pain. This literature review has been conducted to provide an overview of the current knowledge regarding the etiology and pathophysiology of localized neuropathic pain (LNP), its assessment and the existing topical pharmacological treatments.Materials and methodsLiterature review was performed using Medline from 2010 to December 2016, and all studies involving LNP and treatments were examined. A multidisciplinary expert panel of five pain specialists in this article reports a consensus on topical approaches that may be recommended to alleviate LNP and on their advantages in clinical practice.ResultsSuccessive international recommendations have included topical 5% lidocaine and 8% capsaicin for LNP treatment. The expert panel considers that these compounds can be a first-line treatment for LNP, especially in elderly patients and patients with comorbidities and polypharmacy. Regulatory LNP indications should cover the whole range of LNP and not be restricted to specific etiologies or sites. Precautions for the use of plasters must be followed cautiously.ConclusionAlthough there is a real need for more randomized controlled trials for both drugs, publications clearly demonstrate excellent risk/benefit ratios, safety, tolerance and continued efficacy throughout long-term treatment. A major advantage of both plasters is that they have proven efficacy and may reduce the risk of adverse events such as cognitive impairment, confusion, somnolence, dizziness and constipation that are often associated with systemic neuropathic pain treatment and reduce the quality of life. Topical modalities also may be used in combination with other drugs and analgesics with limited drug–drug interactions.

Patents and Recent Innovations in Topical Membrane Therapy of Refractory Rhinosinusitis.

Chronic Rhinosinusitis (CRS), one of the commonest chronic inflammatory disorders, is encountered daily in all healthcare settings. In its refractory form, CRS seems to prevail over most up-to-date surgical interventions and systemic medical remedies, owing to our poor understanding of its perplexing pathophysiology. Although several systemic influences impinge on the progression of inflammation, the true interplay between offensive and defensive factors takes place on-site, i.e. across the sinonasal epithelial coating. Therefore, current treatment strategies shift the weight of CRS management toward topical modalities, which combine the benefits of surgical approach with the healing effect of conventional medications. An explosive emergence of relevant patents is still in progress, emphasizing the need for classification and comparison. Novel delivery methods of medications into the sinus cavities include modifications of traditional rinses, state-of-the-art nebulizing devices, and the revolutionary concept of sustained drug application utilizing carrier gels or nasal implants. As far as the introduction of new medications is concerned, recent patents propose alterations to the physical and chemical properties of irrigating solutions, as well as the local use of antiseptics, hydragogues, and anti-biofilm agents. This review focuses on the local pathophysiologic events of CRS and the most exciting innovations regarding its topical management.