Topical Regimen Research Articles

Resident Perspectives 56-5

Resident Perspectives 56-5

The efficacy of the boric acid-based maintenance therapy in preventing recurrent vulvovaginal candidiasis

Current gold-standard treatment of recurrent vulvovaginal candidiasis (RVVC) is mainly based on maintenance with fluconazole. Moderate to high recurrence rates at long-term use and secondary fluconazole resistance emerge as reasons to seek for new topical maintenance regimens. In this study, it is aimed to assess the efficacy and safety of boric acid-based treatment approach to treat clinical RVVC. In this retrospective study, patients who were diagnosed with RVVC received a treatment package for six months that consist of induction with boric acid vaginal suppositories 600 mg daily for 14 nights followed by maintenance for five nights starting with every fifth day of the menstrual cycles; a vaginal estriol-lactobacilli combination; and several rigorous life-style changes. The success was defined as the absence of symptomatic recurrence during the follow-up. Success rate at the first year was found to be 94.8% in a total of 173 patients. Mild, reversible side effects were observed in five patients (2.9%). Boric acid, along with a vaginal estriol-lactobacilli combination and lifestyle changes can be a safe and effective alternative in lieu of potent systemic antifungal drugs as a first-line treatment for the patients referred with RVVC.

Evaluation of the wound healing activity of ethanolic extract of Bergenia ciliata (Haw.) Sternb. rhizome with excision wound model in Wistar rats

Ethnopharmacological relevanceBergenia ciliata (Haw.) Sternb. is a plant growing in the Himalayan region of India where locals use its rhizomes for a variety of disease conditions including wounds and fractures. Although some of its pharmacological benefits have been documented, scientific validation of its wound healing property has not been done so far. Aim of the studyTo ensure use of this natural remedy as an alternative therapy to the faster wound healing, this study evaluated the wound healing activity of the ethanolic extract of Bergenia ciliata rhizome using excision wound model in Wistar rats. Material and methodsFour groups (n = 10) of rats were subjected to different topical wound regimens for 14 days. Simple paraffin-lanolin ointment was applied to the control group rats. One group was applied povidone-iodine 10% (w/w) ointment. The other two groups were treated with ointment of ethanolic extract of Bergenia ciliata at 5 or 10% (w/w) rhizome, respectively. Blood and wound tissue samples were collected on 7th and 14th day of treatment and were correspondingly subjected to histopathology, and the assays of L-hydroxyproline, D-glucosamine, antioxidants and pro-inflammatory cytokines. ResultsWound histology revealed increased collagenation, re-epithelialization and neovascularization while decreased bacterial colonies in the treatment groups. These histological changes and wound contraction were better in the 10% Bergenia ciliata group. Tissue L-hydroxyproline levels, blood enzymatic and non-enzymatic antioxidants were increased in the treatment groups. On 7th day of treatment glucosamine levels increased in the treatment groups, while as a reverse trend was observed on day 14. Plasma levels of TNF-α and IL-6 decreased in the treatment groups. ConclusionsThe results indicate that treatment with Bergenia ciliata extract ointment provides satisfactory wound healing which is comparable to that of the standard wound healing ointment, povidone-iodine and is surpassing simple lanolin-paraffin ointment. The improved wound healing, especially in the 10% Bergenia ciliata groups, can be attributed to satisfactory profile of the above studied parameters in these treatment groups which is also construed by the phytochemical analysis of its extract revealing the presence of antioxidant and anti-inflammatory compounds gallic acid, catechin, quercetin and rutin as the major active components.

27891 Safety and efficacy of an Avena sativa (oat) skin care regimen for therapy-related xerosis and pruritus in adult oncology patients undergoing systemic cancer treatments

Dermatologic adverse events, including xerosis and pruritus, are frequent in patients receiving systemic anticancer agents. There are few studies evaluating tolerance and efficacy of topical regimens to alleviate these untoward events. A 5-week (±1 week) clinical study was performed to determine the safety and efficacy of an Avena sativa (oat) skin care regimen (body wash, cream, and 0.5% pramoxine balm) in improving skin dryness and itch of adult patients undergoing systemic oncology treatments. Patients enrolled (n = 52) exhibited CTCAE Grade 1 or 2 (mild to moderate) xerosis (μ = 1.5), and/or pruritus (μ = 0.9) as a side effect of their cancer treatment. Baseline patient skin characteristics including skin hydration and barrier properties were evaluated revealing a dry skin state with an impaired moisture barrier. After 5 weeks, significant improvements (P ˂ .05) in xerosis (μ = 0.5) and pruritus (μ = 0.4) were observed by the dermatologist according to CTCAE Version 5.0 and noted by patients in the PRO-CTCAE. The regimen was well tolerated with no serious product-related adverse events. Significant improvements (P ˂ .05) in skin moisture were also measured following regimen usage. Patients perceived significant improvements, as demonstrated by the QOL scores (Skindex-16), in all subgroups: symptoms, emotional, and functional scales. Improvements in skin moisture, itch and comfort were also perceived by patients at 2 weeks. The Avena sativa (oat) daily skin care regimen not only demonstrated significant dry skin and itch reduction, but also improved patient QOL, suggesting that this regimen is effective for management of mild to moderate dermatologic side effects faced by adults undergoing systemic oncology treatments.

Sarcoidosis presenting as bilateral lacrimal gland swelling: a pediatric case report

BackgroundTo describe a case of pediatric sarcoidosis which initially presented as papillary conjunctivitis before manifesting as bilateral lacrimal gland swelling without other known systemic involvement.Case presentationA 10-year-old female presented to the pediatric ophthalmology clinic with complaints of bilateral eyelid swelling, tearing and itching for approximately 1 month. Her history and exam were most consistent with allergic conjunctivitis, for which she was started on a standard topical regimen. Despite initial improvement, she re-presented with significantly worsened eyelid swelling and minimal allergic symptoms. Enlargement of the lacrimal glands were palpable at this time. Lacrimal gland biopsy was obtained which demonstrated noncaseating granulomas. Systemic workup did not reveal evidence of disease involvement elsewhere.ConclusionsSarcoidosis in the pediatric population may present in a myriad of ways and is well-known to mimic other disease entities. We present a case of pediatric sarcoidosis which presented initially as papillary conjunctivitis before manifesting as bilateral lacrimal gland swelling without systemic involvement.

Corneal Allograft Rejection Associated With Herpes Zoster Recombinant Adjuvanted Vaccine.

The purpose of this article is to report 3 cases of corneal allograft rejection that occurred in temporal proximity to administration of the zoster subunit vaccine (RZV). Three cases of corneal transplant rejection that developed after RZV administration were identified. Clinical history, including existence of other risk factors, timing of rejection, corticosteroid therapy at the time of onset of rejection, and course were reviewed. The onset of symptoms occurred 5 weeks after the first RZV dose in 1 patient and 1 and 6 weeks after the second dose in the other 2 patients. Coexisting risk factors included history of endothelial keratoplasty in the fellow eye in 1 patient and previous failure of a penetrating keratoplasty because of rejection in a second patient. The third patient had a history of 1 episode of rejection in a previous graft that resolved and then experienced graft failure over several years. In 2 patients, rejection developed despite relatively high levels of topical steroid therapy: prednisolone acetate 1%, 4 × per day in 1 patient and difluprednate 0.05%, 3 × per day in a second patient. RZV, which elicits a more robust immune reaction than the zoster live-attenuated vaccine, ZVL, may increase the risk of allograft rejection in immunocompetent patients with preexisting corneal endothelial or penetrating transplants. Based on the available data, it may be reasonable to increase the topical corticosteroid regimen before the first dose, until approximately 3 months after the second dose of ZVL.

Comparison of preserved bimatoprost 0.01% with preservative-free tafluprost: A randomised, investigator-masked, 3-month crossover, multicentre trial, SPORT II.

This study compares the efficacy and tolerability of a preservative-free prostaglandin analogue (tafluprost 15 mg/ml) to a prostaglandin analogue that uses 0.02% of benzalkonium chloride (bimatoprost 0.1 mg/ml). Different prostaglandin analogues have been commercially approved, with differences in tolerability. Prospective, randomised, investigator-masked, 3-month crossover, multicentre trial. Sixty-four patients with ocular hypertension or open-angle glaucoma were randomised to two groups, after a 4-week washout period from their current topical drop regimen. Participants were randomised to tafluprost (Group 1; n = 33) or bimatoprost (Group 2; n = 31). At month 3, each group switched to the opposite treatment. IOP was evaluated at multiple timepoints. The primary outcome was difference in mean IOP between the two groups at the final visit. Secondary outcomes included change from baseline IOP at month 3 and month 6, difference in mean IOP at month 3 and difference in IOP at all timepoints. Safety outcomes included best-corrected visual acuity (BCVA), adverse events, ocular tolerability, optic nerve assessment and slit lamp biomicroscopy. Both medications significantly lowered IOP at month 6 compared to baseline: 5.4 mmHg (27%) for tafluprost and 6.8 mmHg (33%) for bimatoprost (p < 0.0001). No significant differences in any of the safety measures (including conjunctival hypearemia) were detected. Bimatoprost produced a statistically significant greater IOP reduction compared to tafluprost with minimal to no difference in side effects. This should be borne in mind when weighing up the pros and cons of preserved versus preservative-free prostaglandin analogue therapy. NCT02471105.

Perioperative Skin Conditioning for Patients With Skin of Color

The interest in cosmetic procedures for patients with skin of color is on an upward trend. Globally, dyschromia and hyperpigmentation remain the most common disorders for which patients seek treatment. The goals of a perioperative skin conditioning program include allowing a broad range of patients to be treated regardless of skin phototypes, maximizing results, and reducing risk of complications such as post-inflammatory hyperpigmentation and managing post-inflammatory hyperpigmentation if it occurs. The purpose of this article is to highlight common pigmentation concerns among patients with skin of color, the topical agents used to combat these concerns, and a practical approach to creating an effective yet straightforward topical skin care regimen that can be used across a wide range of patient skin phototypes. Before and after photos of patients with a variety of pigmentation concerns are presented along with a description of the treatment regimen used to improve their conditions and to get their skin to a safer state prior to performing any office-based procedures. By understanding the main concerns of patients with skin of color, one can use a simple and effective skincare regimen to allow these patients to be more safely treated. An effective skincare regimen both prepares the skin prior to procedures and postoperatively to help minimize dyschromias in the postoperative phase.

Topical antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving mechanical ventilation.

Topical antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving mechanical ventilation.

Effect of Intracameral Injection of Preservative Free, Fixed Concentration of Combined Mydriatic plus Anaesthetic Formulation on Corneal Endothelial Cell Count in Phacoemulsification

Purpose: To evaluate the efficacy and safety of intracameral injection of a standardized combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1% on corneal endothelial cell count at phacoemulsification. Methods: In this prospective randomized controlled study, 30 eyes of 30 patients undergoing phacoemulsification were assigned to 2 groups. 15 eyes (Intracameral Group A) received 0.2ml of a combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1% just after the first incision. While 15 eyes (Group B) received a topical regimen of one drop of each of cyclopentolate hydrochloride 1% and tropicamide 1%, every 15min for 1hour preoperatively. The main outcome measures were safety on corneal endothelium, by comparing the preoperative and 3 weeks postoperative corneal endothelium cell count in the two groups. Efficacy was also evaluated by measuring pupil size before capsulorhexis and before intraocular lens implantation, in both groups. Results: There was no significant statistical difference in the percentage of endothelial cell loss between the Groups A (27.4%) and the reference Group B (25.7%), with P value (0.595). Regarding Pupillary dilatation, adequate dilatation (&gt;7.4mm) was achieved in both groups. Dilatation was maintained to the end of operation in the Fydrane group, while in the reference group, reduction in pupillary dilatation occurred in 20% (3 cases) reaching pupil diameter 5.5mm before IOL implantation. Conclusions: This study showed that intracameral injection of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1% is safe on corneal endothelium and effective in maintaining pupillary dilatation throughout the surgery

Topical therapy for atopic dermatitis: A review

Background: Pediatric atopic dermatitis(AD) is very common, but its management is frustrating for the dermatologist, child and parents alike as this chronic inflammatory skin disease is marked with numerous difficult to control flares. Although country specific guidelines for AD exist, there is paucity of data with respect to dedicated topical care regimens for AD management in pediatric population. Purpose: This is a broad based review exploring various topical practices and management options to manage pediatric AD during flares and in remissions. Scope: The PubMed database was searched (to 1 June 2020) for English-language articles containing the keywords atopic dermatitis, atopic eczema, topical calcineurin inhibitor(TCI), topical corticosteroid(TCS), topical phosphodiesterase inhibitors, crisaborole, topical therapy. Articles focusing on topical managment for children with AD were chosen for further review. A limitation is that this is not a systematic review of the literature. We have relied heavily on The Indian Dermatology Expert Board Members 2019 Management Guidelines on AD and the 2014 American Academy of Dermatology (AAD) guidelines, soon to be updated. In our review, we focus on Skin directed therapies to repair and maintain healthy skin barrier, suppress inflammatory response, control flares, control itch and manage infectious triggers. Topicals can be used as first line therapy in mild AD, adjuvant for moderate-severe AD or as maintenance to keep the disease in remission. Topical therapy in AD is not limited to TCS, TCI, Crisaborole or newer molecules but also involves moisturization, emollient care and bathing practices; which have been discussed. Conclusion: Multiple topical therapies and practices have been successfully used to treat children with AD. An understanding of the available treatment options will help dermatologists striving to achieve best practice in the management of pediatric AD.

15918 Effects of a topical growth factor regimen after preelected cosmetic facial injection procedures

Americans spent $16.5 billion on surgical and minimally invasive cosmetic procedures in 2018, a 4% increase from the previous year1. This reflects how seeking treatments that address esthetics remains an important priority for patients. Skincare can also help address facial esthetics by targeting skin quality. However, there are limited studies assessing the effects of skincare following cosmetic facial injection procedures (CFIP). To assess the efficacy and tolerability of a novel regimen (NR; growth factors, antioxidant dual serums, and hyaluronic acid-based serum), following pre-elected facial neuromodulator and hyaluronic acid dermal filler treatments, a 16-week, multicenter study was conducted. 18 female subjects aged 34-65 with Fitzpatrick skin types II-V completed. All subjects pre-elected to receive CFIPs at baseline, and continued their regular skincare through week 4 (phase 1). During phase 2, week 4-week 16, subjects applied NR twice daily. Investigator grading, questionnaires and photography were conducted at all visits (baseline and weeks 4, 8, 12, 16). Preelected CFIPs and regular skincare provided significant improvements in overall photodamage, tactile roughness, skin tone evenness and fine/coarse lines during phase 1 (all P ≤ .05; paired t test). During phase 2, use of NR provided additional continued significant improvements vs week 4 for overall photodamage, tactile roughness, radiance and skin tone evenness at weeks 8, 12 and 16 (all P ≤ .002; paired t test). There was high subject satisfaction and patients tolerated the topical regimen well. Our study demonstrates that high-grade medical skincare after cosmetic facial injections improves skin quality and can be a useful adjunct to enhance cosmetic procedures.

16455 Treatment patterns among patients with atopic dermatitis using advanced therapies in the united states: Analysis of a retrospective claims database

Background: Many patients with AD are not adequately controlled with topical regimens alone. This analysis examined the management of patients using advanced therapy.

15474 A new topical daily cosmetic regimen for mild acne: A multicenter prospective trial

15474 A new topical daily cosmetic regimen for mild acne: A multicenter prospective trial

15525 Efficacy and safety of short-contact topical calcipotriene foam in combination with 5% or 1% fluorouracil cream after cryotherapy for actinic keratosis

Background: Treatments for actinic keratoses (AKs) include cryotherapy (LN2) and topical fluorouracil (5-FU), imiquimod, ingenol mebutate, and vitamin D. Due to irritation from usage, short-contact topical regimens have been reported.

Comparative study of topical regimen for adenoviral kearoconjunctivitis by 0.1% fluorometholone with and without polyvinyl alcohol iodine.

The aim of this study was to compare the efficacy of the topical regimens of iodine/steroids vs. antibiotics/steroids in acute to subacute adenoviral keratoconjunctivitis. A prospective open-label study. Nineteen patients diagnosed with unilateral or bilateral adenoviral conjunctivitis at less than 1week from onset were enrolled in this study. Patients were divided randomly into two groups; group 1 was treated with 1.5% levofloxacin with 0.1% fluorometholone administered four times a day and group 2 was treated with a sixfold dilution of polyvinyl alcohol iodine (PAI) solution with 0.1% fluorometholone four times a day. Conjunctival samples from all affected eyes were obtained for real-time PCR. The total scores of acute signs (i.e., eyelid edema, conjunctival injecton, conjunctival discharge, follicules, pseudomembranes, subconjunctival hemorrhage) and symptoms, HAdV DNA copy number, and the presence of multiple subepithelial corneal infiltrates (MSI) were evaluated every 5 visits up to Day 30 after diagnosis. Comparing the total scores of acute signs and symptoms and viral load, we observed no significant differences between the two groups. At day 15 after diagnosis the proportion of patients with MSI in group 2 (35.7%) was significantly lower than in group 1 (0%). The impact of topical iodine/steroid therapy on acute signs and symptoms associated with adenoviral conjunctivitis is limited and not substantially different in the responses to antibiotics/steroids. However, this regimen results in a significant decrease in the incidence of MSI during the subacute phase of infection.

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

BackgroundPrevious studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedic surgery. However, no study has investigated TXA in complex tibial plateau fracture surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of i.v. (intravenous) TXA and topical TXA.Material and methodsThis was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the i.v. group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared among the three groups. The pain, knee function, and quality of life (QoL) assessments were based on their corresponding scoring systems.ResultsBaseline data were comparable for all groups. The i.v. group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 49.4 mL and 219.3 ± 33.4 mL, respectively, all P values < 0.001). Patients in the i.v. group had lesser real Hb decrease than those in the control group (0.9 vs 1.5, P<0.001) and topical group (0.9 vs 1.2, P = 0.026). The blood coagulation level as measured using fibrinolysis (D-dimer) was lower in the i.v. group than in the control and topical groups on POD1 and POD3; however, this difference was not significant; the fibrin-degradation products also showed a similar trend. Patients in the topical group experienced less pain than those in the control group on POD2, POD4, and PO6W. The VAS pain score was 3.6 vs. 4.4 (POD2, P<0.05), 2.8 vs 3.3 (POD4, P<0.05), and 2.1 vs. 2.6 (PO6W, P<0.001) in the topical group vs control group, respectively. No significant differences were identified in vascular events, wound complications, adverse reactions, knee function, and QoL among the three groups.ConclusionTo our knowledge, this is the first study that showed both i.v. TXA and topical TXA are safe and effective for complex tibial plateau fractures. The i.v. regimen effectively reduced blood loss during the perioperative period, whereas patients under the topical regimen had less vascular events, wound complications, and a lower incidence of adverse reactions compared to those in the i.v. group.Trial registrationThe trial was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-1800017754, retrospectively registered from 2018 to 01-01).

Emerging Technologies to Target Drug Delivery to the Skin - the Role of Crystals and Carrier-Based Systems in the Case Study of Dapsone.

Dapsone (DAP) is a long-established molecule that remains a promising therapeutic agent for various diseases mainly because it combines antimicrobial and anti-inflammatory activities. Its oral application, however, is limited by the dose-dependent hematological side effects that may rise from systemic exposure. As an alternative to overcome this limitation, the administration of DAP to the skin has witnessed prominent interest in the past 20years, particularly when applied to the treatment of dermatological disorders. In this review, all technological strategies proposed to the topical delivery of DAP are presented. Most of the reported studies have been devoted to the clinical use and safety of a gel formulation containing both solubilized and microcrystalline drug, however, the technological characteristics of such preparation are still missing. In parallel, the incorporation of DAP into vesicular and particulate carriers (e.g. nano- and microemulsions, niosomes, invasomes, bilosomes, cubosomes, solid lipid nanoparticles, nanostructured lipid carriers, polymeric nanocapsules and polymer-lipid-polymer hybrid nanoparticles) appears to be an alternative to provide greater drug release control, enhanced drug solubilization and follicular targeting. Indeed, the main application of DAP topical formulations reported in the literature was the treatment of acne vulgaris, a disease located in the hair follicle. Other diseases affecting different regions of the skin (e.g. cutaneous lupus erythematosus and cutaneous leishmaniasis), however, may also benefit from a topical therapeutic regimen containing DAP. Therefore, the investigation of appendageal route in comparison to passive transmembrane diffusion as a function of targeted disease, as well as pharmacokinetic studies, are perspectives highlighted herein. Such studies may drive future efforts towards the rational development of safe and effective technologies to deliver DAP to the skin. Graphical abstract.

JAK-STAT Inhibitors in Atopic Dermatitis from Pathogenesis to Clinical Trials Results.

A common disease worldwide is known as atopic dermatitis (AD), named also as atopic eczema, which is a chronic recurrent complex inflammatory skin disorder. It affects 2–10% of the adult population and up to 20% of the pediatric population. The clinical AD picture appears in typically localized eczema and dry skin, and is dominated by a persistent pruritus followed by sleep disturbances. AD strongly impacts on the quality of life of AD patients and their families as well as on social and economic aspects. The pathogenesis of the disease is complex and consists of multiple interactions between immunological disturbances, skin barrier defect, and microbial dysbiosis with environmental influences. The treatment of AD reflects the pathogenetic disorders, starting from basic emollient therapy, and goes to topical anti-inflammatory regimens followed by phototherapy, systemic immunosuppressive drugs, and new biologic immunomodulators. This paper will thus summarize the novel collection of biological treatment JAK-STAT inhibitors dedicated to AD.

Clinical Benefits of Circadian-based Antioxidant Protection and Repair.

Skin activities follow endogenous circadian rhythms resulting in differences between daytime and nighttime properties. To address the variations in skin needs, a novel circadian-based dual serum system (LVS) was developed. A 12-week, double-blind, randomized, regimen-controlled, multi-center study was conducted to assess the efficacy and tolerability of LVS on subjects presenting with moderate-severe photodamage. 61 Female subjects (36&ndash;65 years; Fitzpatrick skin types I&ndash;VI) completed the study. The active group received LVS (daytime serum and nighttime serum) and basic skin care regimen (moisturizer and SPF 35 sunscreen), while the control group received the basic skin care regimen only. In addition to clinical grading, subject self-assessment questionnaires, and standardized photography, punch biopsies were taken in a subset of subjects for immunohistochemistry. Additionally, swab samples were taken for skin surface oxidation analysis. Significant improvements over control were observed in the active group in Radiance (weeks 4, 8, and 12), Overall Photodamage, Tactile Toughness, and Global Fine Lines/Wrinkles (week 12). Biopsy results, skin swab analysis and standardized photographs support the clinical grading findings. At all follow-up visits, LVS was consistently highly rated over control by subjects, with a significant proportion of subjects agreeing at week 12 that LVS &ldquo;improved the radiance of my skin,&rdquo; and &ldquo;improved the overall health and look of my skin&rdquo;. Results from this study suggest that LVS may provide essential protective and reparative effects to skin exposed to the damaging effects of environmental factors, and also demonstrates the value of including skin circadian rhythm-based concepts in a topical skincare regimen. J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5355.