Topical Research Articles

Flare-Up Phenomenon Triggered by Patch Testing of Topical Ointments Containing Nitrofurazone and Polyethylene Glycol

Flare-Up Phenomenon Triggered by Patch Testing of Topical Ointments Containing Nitrofurazone and Polyethylene Glycol

The impact of systemic and topical antimicrobial therapy combined with non-surgical periodontal therapy: A meta-analysis.

Combining antibiotics with non-surgical periodontal therapy has a beneficial impact in case of infection while its role for dental-related outcomes is still unclear. The current study's main objective was to evaluate the impact of adding adjuvant systemic and topical antimicrobial therapy to non-surgical periodontal therapy. A systematic literature search was accomplished and 1,093 study participants with periodontal diseases were recruited to the current study; 541 of them were treated with adjuvant systemic or topical antimicrobial agents and 552 with non-surgical interventions. The inclusion criteria of the current study took into account only randomized clinical trials. Adding systemic antibiotics to non-surgical intervention resulted in a significant enhancement regarding probing pocket depth reduction (PPD). Metronidazole/amoxicillin showed a significant impact on PPD and the clinical attachment level (CAL), while doxycycline showed no significant impact regarding CAL. Using topical antimicrobial agents showed a significant beneficial role in reducing PPD regarding doxycycline, while non-significant effects were seen with metronidazole. Adding adjuvant systemic and topical antimicrobial agents to non-surgical periodontal therapy showed a beneficial impact regarding PPD and CAL (metronidazole/amoxicillin and doxycycline). In addition, using doxycycline as a topical agent showed a beneficial impact on the reduction of PPD.

TC-325 superiority in Malignant Gastrointestinal Bleeding - An Individual Patient Data Meta-analysis of Randomized Trials.

The efficacy of topical hemostatic agents, recommended for peptic ulcer bleeding, remains poorly characterized in malignant gastrointestinal bleeding (GIB). We performed an individual patient data (IPD) meta-analysis assessing the efficacy of topical hemostatic agents in malignant GIB. The literature was searched using OVID MEDLINE, EMBASE, and ISI Web of Sciencedatabases (database inception to November 2023). Only randomized controlled trials (RCTs) comparing topical hemostatic agents to conventional endoscopic modalities in malignant GIB were included. Original RCT patient-level data were obtained. PRISMA guidelines were followed. Quality of the evidence was evaluated using the revised Cochrane risk of bias tool, and certainty of evidence with the GRADE approach. The primary outcome was immediate hemostasis; secondary outcomes were 30-day rebleeding and the composite measure of further bleeding (persistent bleeding or 30-day rebleeding). Other outcomes were all-cause mortality, adverse events, and need for additional non-endoscopic treatment. Odds ratios (ORs) from endpoint comparisons were pooled using logistic regression models. Overall, 985 citations were identified; 3 RCTs (n=160 patients) were included with all assessing TC-325 (Hemospray™). TC-325 achieved immediate hemostasis more often than conventional endoscopic modalities (OR=46.6 (5.89; 369.1)) (low level certainty). Thirty-day rebleeding (OR=0.28 (0.11; 0.70)) and further bleeding (OR=0.11 (0.05; 0.26)) were both significantly lower with TC-325 (very low level certainty). All-cause mortality and need for additional non-endoscopic treatment did not differ between groups. No adverse events were reported. Subgroup analysis confirmed TC-325 superiority in patients with upper GIB. TC-325 appears superior to conventional endoscopic therapy in managing patients with malignant GIB. TC-325 results in improvements in immediate hemostasis, 30-day rebleeding and further bleeding, based on very low-to-low certainties of evidence.

Clinical and dermoscopic patterns of idiopathic guttate hypomelanosis

Depigmented skin lesions are of great concern in society, especially in the Indian subcontinent. These comprise many infective and inflammatory conditions that cause apprehension and anxiety among patients due to the social stigma attached to these conditions. Idiopathic guttate hypomelanosis (IGH) appears similar to many depigmented lesions and differentiation of IGH from these conditions is difficult clinically as well as histopathologically. IGH is one of the common causes of acquired leukoderma. It is also called disseminated lenticular leukoderma. The etiology is yet not clearly delineated, probably multifactorial. Various etiological factors have been proposed including ultraviolet (UV) exposure, post-phototherapy (psoralen and UVA monotherapy, narrowband-UVB), aging, genetic factors, trauma, and autoimmunity. Clinically, it is characterized by multiple, discrete porcelain-white round to oval macules of 2–5 mm average size. It most commonly occurs in the elderly. The most common sites observed are chronically sun-exposed areas such as the arm, pretibial regions, and forearm extensors. It is not easy to differentiate IGH from other hypo and depigmented conditions such as vitiligo, pityriasis versicolor, extragenital lichen sclerosus et atrophicus, guttate morphea, and post-inflammatory hypopigmentation. It poses a diagnostic challenge to dermatologists. One has to differentiate depigmented lesions from vitiligo as it carries tremendous social implications as social stigma, especially in India. Research on dermoscopic evaluation is uncommon in the literature, despite the abundance of clinic-epidemiological and histological studies of IGH. Four dermoscopic patterns, namely, petaloid, amoeboid, feathery, and nebuloid have been described. These patterns are specific to IGH and help clinicians to differentiate many depigmented skin lesions from IGH in clinical practice. Patients often seek cosmetic treatment. There has been no standard therapy for this condition. Newer treatment modalities range from topical agents to procedure-based therapies and have enhanced the therapeutic armamentarium.

REVIEW OF NANOEMULGEL FOR TREATMENT OF FUNGAL INFECTIONS

The skin is the largest of the body’s organs and it has a big role to play in maintaining homeostasis and defending against microbial invaders. Fungal infections are responsible for a large proportion of the global burden of skin diseases; affecting millions, especially in developing countries. The application of antifungal drugs as topical agents is one of the best techniques to treat major fungal infections that affect the skin, which involves several advantages such as localized delivery, and lower systemic toxicity among others. These findings also suggest that nano-emulgel could be used as an alternative system for delivering drugs through topical administration. However, issues such as the inability to load bulky drug molecules and safety concerns about surfactants and gelling agents limit their potential use as drug carriers by this pathway. It is necessary to carefully study these issues further so that we can exploit fully what this nano-emulgel may offer in terms of dermatological medications.

Current Treatments for Generalized Pustular Psoriasis: A Narrative Summary of a Systematic Literature Search.

Generalized pustular psoriasis (GPP) is a rare, chronic and potentially life-threatening autoinflammatory skin disease characterized by widespread eruption of sterile pustules, with or without systemic inflammation. GPP can significantly reduce patients' quality of life (QoL). Several therapeutic approaches have been described in the literature, but there is no consensus on optimal treatment. In this review, we summarize published literature on efficacy, safety and QoL outcomes associated with current treatment of GPP with both approved and non-approved products. Embase and MEDLINE databases were searched (1980-September 2023). A search protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on the PROSPERO database (CRD42021215437). Details on publication, population, intervention, efficacy, safety and QoL were captured and checked by independent reviewers. In total, 118 publications were included, with only 19% of publications reporting on the results of clinical trials. Treatment modalities reported for GPP included non-biologic systemic therapies such as retinoids, cyclosporine and methotrexate, topical agents, biologics and small molecules, among others. Results were highly heterogeneous and methodological quality was very low, with only the interleukin-36R inhibitor spesolimab reporting results from placebo-controlled randomized trials; based on this, spesolimab is now approved for GPP treatment in regions including the USA, Japan, China, the EU and several other countries. Some other biologics are approved exclusively in Japan and Taiwan for the treatment of GPP based on open-label studies with small patient numbers in lieu of double-blind studies. Non-standardization of clinical outcomes across studies remains a major hurdle in reaching a consensus on optimal treatment. However, recently trials have been conducted using well-defined, disease-specific endpoints to evaluate GPP-targeted treatments, which will hopefully advance patient care. In conclusion, this review highlights the need for prospective randomized studies with GPP-specific endpoints to determine the optimal treatment strategy.

50550 2-Week Application of Topical Colloidal Oatmeal Gel Cream Supports the Growth of Skin Commensal Staphylococcus Epidermidis in Subjects with Mild-to-Moderate Atopic Dermatitis

50550 2-Week Application of Topical Colloidal Oatmeal Gel Cream Supports the Growth of Skin Commensal Staphylococcus Epidermidis in Subjects with Mild-to-Moderate Atopic Dermatitis

Comparative efficacy of pharmacological and non-pharmacological interventions for mitigating pain and anxiety associated with venipuncture: a randomised controlled trial

BackgroundVenipuncture is one of the most commonly performed medical procedures in paediatric care, but it can also be one of the most painful and distressing experiences for patients. Finding effective...

Mupirocin Ointment Effect on Polyposis Recurrence After Sinus Surgery.

Staphylococcus aureus is an identified pathogen involved in the recurrence of symptoms in patients with chronic rhinosinusitis with nasal polyps. We investigated the effectiveness of a topical ointment of mupirocin applied in the nasal vestibule in lessening symptom recurrence and improving the efficiency of functional endoscopic sinus surgery. Patients with chronic rhinosinusitis, nasal polyps, and a positive nostril culture for Staphylococcus aureus were included in a clinical trial. The right nostril was determined as the intervention group (applying mupirocin ointment) and the left as the control group (applying vitamin A ointment). Lund-Mackay radiological scores and Lund-Kennedy endoscopic scores were examined at the time of diagnosis and six months later. Among 60 patients with chronic rhinosinusitis with nasal polyps, 91.6% were positive for nostril Staphylococcus aureus. Comparing the average of the diagnostic radiological and endoscopic scores with the follow-up values in both groups indicated a significant improvement after surgery (P-value=0.001, 0.001). However, there was no significant difference in the radiological and endoscopic score improvements between the study and control groups (P-value > 0.56, 0.74). Nasal mupirocin administration following endoscopic sinus surgery cannot significantly prevent symptom recurrence in chronic rhinosinusitis with nasal polyps.

Understanding Global Access to Topical Onychomycosis Therapy: A Systematic Review and Meta-Analysis.

Equal access to medicines is crucial to ensuring public health, but access is difficult to measure, especially for infections where changes in infective species make treatment choices highly dynamic. This study investigated if the combination of infection prevalence with medicine efficacy and regulatory availability could access medicines access of topical onychomycosis medicines. Two databases, PubMed and Web of Science, were used to identify relevant information published between 1990 and 2019. For the meta-analysis, human onychomycosis investigations using PCR analysis were included. Reviewers independently selected eligible articles, extracted data and assessed the study quality. A random-effects meta-analysis model with a Freeman-Tukey transformation was employed to the PCR data. For the meta-analysis, the global infection trends and regional differences in the infective organisms were determined. Of the 26 studies analysed, the PCR analysis in 18 studies confirmed onychomycosis in about half of the visually suspected cases (55%, CI 43%-67%). Across all 26 studies dermatophytes were the most prevalent infective organism (57%, CI 37%-76%), but a sub-group analysis showed yeasts predominated in females (31%, CI 0%-84%) (p < 0.0001), in fingernail infections (42%, CI 21%-65%) (p < 0.0001) and in arid countries (p < 0.0001). Combining these results with medicine efficacy data showed that residents from 83 of the 92 countries assessed (90%) could not access the most efficacious topical product, and 22% could not access any broad-spectrum agents. Countries in Africa had the poorest access to topical onychomycosis medicines. This study identified that access to effective topical products for onychomycosis is a global problem. This issue appeared to be due to under-representation of candida infections in pivotal clinical studies of topical onychomycosis products. A head-to-head multicentre study for topical efinaconazole or a novel broad spectrum topical agent is needed to help resolve these access problems. PROSPERO-CRD42023464744.

SUCRALFATE MAY BE AN EFFECTIVE TOPICAL AGENT IN PREVENTING ORAL MUCOSITIS

SUCRALFATE MAY BE AN EFFECTIVE TOPICAL AGENT IN PREVENTING ORAL MUCOSITIS

Acropustulosis of Infancy in Yemeni Infants and Children Mohammed Abdul Qader Almalmi Consultant of Dermatology and Aesthetic Medicine in Doctor Almalmi Clinic Sanaa Yemen and Specialist Dermatology and Aesthetic Medicine in be you Plus Clinic Dubai UAE

Background: Infantile acropustulosis is a recurrent, self-limited, pruritic, vesicopustular eruption of the palms and the soles occurring in young children during the first 2-3 years of life. Newly described in 1979, it is probably much more common than the scarcity of reports would imply. Objective: The objective of the study was to identify the pattern of pruritic vesicopustular skin eruptions in Yemeni infants. Patients and Methods: Twenty five male and females Yemeni infants patients 1 to 3 years old presented with pruritic erythematous macules or papules that progress into vesicles and then pustules in the palms, the soles, and the lateral surfaces. Lesions may occur on the dorsal aspects of the hands and the feet as well as the trunk, the scalp, and the face. The intensity and the duration of attacks diminish with each recurrence. No other organ systems are involved. They treated with topical Betamethasone cream or ointment and systemic antihistamine. The skin biopsy followed by histopathological examination was not specific. Results: The clinical data and the investigations showed that the 25 Yemeni infants had acropustulosis. Conclusion: Acropustulosis of infancy in Yemeni infants is very common skin disorder. The bad hygiene may play an important role in the etiology or allergic substances. It is not recurrence.

Wound care used topical ointment made from a combination of cherry leaf extract (Muntingia calabura L) and manuka honey on the healing process of superficial second-degree burns: a case report

Background: Burns are one of the most common accidental injuries in the community. Improper treatment of burns can lead to disability and even death. Applying topical therapy aims to reduce excessive collagen repositioning and accelerate healing. We tried treating burn wounds with an ointment that uses a combination of cherry leaf extract and manuka honey to test the effectiveness of wound healing.Case presentation: We report two cases of superficial burns that underwent wound treatment using an ointment containing cherry leaf extract and manuka honey.Conclusion: Wound treatment with an ointment containing cherry leaf extract and manuka honey can speed up the healing process in patients with superficial second-degree burns.

Novel Honeycomb Nanoclay Frameworks With Hemostatic and Antibacterial Properties.

Our laboratory recently developed a new class of high surface area, honeycomb Nanoclay Microsphere Framework absorbents (NMFs) that prompt rapid hemostasis. In the present work, we propose a novel approach to develop antibacterial Topical Hemostatic Agents (THAs) by anchoring silver nanoparticles (AgNPs) onto NMFs. This combination was obtained by a chemical co-reduction approach, followed by freeze-processing, and was shown to ensure stability and on-site delivery of AgNPs, without altering the hemostatic properties of NMFs. Silver-loaded NMFs showed no change in their unique architecture and led to a 55% increase in clot strength, compared to standard control plasma or commercially available THA, and a significant decrease in mean fibrin fiber diameter. Silver nanoparticles were successfully released when solubilized and prevented the growth of both Pseudomonas aeruginosa and Staphylococcus aureus at concentrations of 22 and 30 ppm of silver released, respectively. Overall, cell mortality was between 9.1 ± 5.1% and 6.3 ± 3.2%, depending on AgNP concentration, confirming a low cytotoxicity. Silver-loaded nanoclay microsphere frameworks appear to constitute promising candidates as topical hemostatic agents for secondary management of hemostasis when infection control is needed.

Nephroprotective and anti-inflammatory effects of resveratrol topical ointment in albino rats following full-thickness cutaneous burn wound

Nephroprotective and anti-inflammatory effects of resveratrol topical ointment in albino rats following full-thickness cutaneous burn wound

Comparative Evaluation of Endo Ice® Refrigerant Spray, Endo Frost® Refrigerant Spray and Topical Anesthetic Agent Precaine B® on the Pain Perception in Children Prior to Administration of Local Anaesthesia – An Invivo Study

To compare and evaluate the efficacy of Endo Ice® refrigerant spray, Endo Frost® refrigerant spray and topical anaesthetic agent Precaine B® on the pain perception during local anaesthesia administration in pediatric dental patients.  Material and methods: A total of 87 participants in the age group of 6-12 years were divided into 3 groups randomly with 29 in each group. The cotton applicator sprayed with Endo Ice was held in contact with the buccal mucosa for 10 seconds. Immediately after the removal of the cotton applicator, inferior alveolar nerve block was administered. Similarly, Endo Frost was used on the participants. 0.1 mg of Precaine B was applied over the injection site contacting the buccal mucosa using sterile cotton applicator. FLACC evaluation was done by one trained personnel during the local anaesthesia administration. Following the local anesthesia, the participants were asked to rate their pain experience using VAS.  Results: The mean score of the Endo ice, Endo frost, and Precaine B were 4.3793, 4.4828 and 5.5517 respectively using the FLACC scale. The mean score of the Endo ice, Endo frost, and Precaine B were 4.2069, 4.2069 and 4.931 respectively using the VAS scale. Greater reduction in pain perception were observed in Endo Ice group followed by Endo Frost group and Precaine group. It was not statistically significant (p&lt;0.005).  Conclusion: Endo ice, Endo frost and Precaine B were effective in reducing the pain perception in children, thereby reducing their fear and anxiety. Endo Ice group showed greater reduction in pain perception and higher efficacy than other groups, even though the results were not statististically significant.

Evaluation of topical hemostatic agents (THA) used in perioperative period in thyroidectomy patients: assessment of ultrasonographic characteristics, resolution durations, and potential long-term complications

Evaluation of topical hemostatic agents (THA) used in perioperative period in thyroidectomy patients: assessment of ultrasonographic characteristics, resolution durations, and potential long-term complications

Extending the IMQ Model: Deep Characterization of the Human TLR7 Response for Early Drug Development.

Imiquimod (IMQ; brand name Aldara®) is a registered topical agent that has been proven to induce local inflammation via the Toll-like receptor (TLR)7 pathway. The purpose of this study was to characterize TLR7-mediated inflammation following 7days (168h) of topical IMQ exposure in healthy volunteers, and to compare the effects of short exposure (48h-72h) with prolonged exposure (120h-168h). IMQ (100mg) was applied under occlusion to 5 different tape-stripped treatment sites on the back of 10 healthy participants for a maximum of 7 consecutive days. Erythema and skin perfusion were measured daily up to 168h. Biopsies for immunohistochemical staining and RNA sequencing were collected at 0h, 48h, 72h, 120h and 168h post IMQ application. IMQ triggered an inflammatory response starting at 48h after application, including erythema and perfusion of the skin. At the transcriptomic level, IMQ induced TLR7 signalling, IRF involvement and activation of TNF signalling via NF-κB. Furthermore, an enhanced inflammatory response at the cellular level was observed after prolonged IMQ exposure, with cellular infiltration of dendritic cells, macrophages and T cells which was also corroborated by transcriptomic profiles. No difference was found in the erythema and perfusion response after 168h of IMQ exposure compared to 72h. Prolonged IMQ exposure revealed enhanced cellular responses and additional pathways with modulated activity compared to short exposure and can therefore be of interest as a model for investigational compounds targeting innate and adaptive immune responses.

If patients had a choice - Treatment satisfaction and patients' preference in therapy of actinic keratoses.

Actinic keratoses (AK) are increasing in incidence and represent the most common (pre-)cancerous lesion in the fair-skinned population, with a high unmet medical need. In order to increase treatment adherence, it is very important to assess patients' therapy-related evaluations of different treatment options. 100 patients with AK who were treated with at least two different treatment options were included. They rated their therapies using the Treatment Satisfaction Questionnaire for Medication (TSQM, maximum 100 points per category) and a Likert scale (LS, 1 = very satisfied; 6 = not satisfied). Patients were also asked about their needs in terms of treatment goal, cost, type, duration, and location of treatment. 81% of the study participants were male and on average 74 years old. 95% had field cancerization. Eight frequently used therapy procedures were evaluated by the patients (surgery, cryotherapy, various topical agents, photodynamic therapy). The TSQM satisfaction scores ranged from 78.47 ±16.07 (surgical procedures) to 53.03 ±22.13 (diclofenac-HA). Statistically significant differences between the procedures were only found in the area of efficacy. Side effects were classified as low. Low recurrence rate and safe removal were the most important treatment goals (LS: 1.18 ±0.44 and 1.27 ±0.53, respectively). Understanding patient preferences is essential for adherence and is therefore of great importance for the success of AK therapy. Personalized approaches should be considered in the choice of therapy.

Cannabis-Containing Cream for CKD-Associated Pruritus: A Double-Blind, Placebo Controlled Trial

Rationale & ObjectiveThis study aims to compare the efficacy of a cannabis cream and a placebo in the treatment of chronic kidney disease (CKD)-associated pruritus. Study DesignA double-blind randomized controlled study. Setting & ParticipantsSixty hemodialysis patients with the Worst Itching Intensity Numerical Rating Scale (WI-NRS) ≥ 3. ExposurePatients received cannabis cream or placebo. OutcomesThe primary endpoint was the WI-NRS score at week 4. The secondary endpoints included the WI-NRS at week 2, Skindex-10 score at week 2 and 4, and the mean difference score between baseline and week 4 for WI-NRS and the Skindex-10 score Analytical ApproachWe utilized unpaired t-tests or Mann–Whitney U tests, along with Chi-square or Fisher’s exact tests as appropriate. Adjusted mean differences were determined using ANCOVA, adjusting for baseline scores. ResultsAmong 60 participants, mean age was 61.6 ± 14.4 years and mean baseline WI-NRS was 6.7 ± 1.7. The placebo and cannabis cream groups were similar at baseline, although more individuals in the placebo group had diabetes. At 4 weeks, the WI-NRS dropped to 2.6 in the cannabis group and 3.6 in the placebo group (mean difference after adjustment for baseline scores:-1.1, 95% CI: -2.1 to -0.2, p = 0.02). Skindex-10 scores at week 4 were also lower in the cannabis group, but after adjustment for baseline scores, statistical significance was not maintained. No side effects were observed in either group. LimitationsA single study with a small sample size restricts its generalizability. Variances in participants' diabetes statuses might have impacted itch outcomes. The absence of cannabinoid level assessment in blood prevents conclusive determination of potential systemic impacts. A four-week follow-up period inadequately captures long-term effect. ConclusionsIn CKD-associated pruritus, the topical cream containing cannabis significantly reduced the severity of itching symptoms compared to the placebo.