Topical Urea Research Articles

A Randomized, Double-Blind, Placebo-Controlled Trial Evaluating the Effect of Topical Urea for Secondary Prophylaxis of Hand Foot Skin Reaction in Renal Cell Cancer Patients on Sunitinib Therapy

IntroductionHand foot skin reaction (HFSR) is a common dose-limiting adverse effect of multi kinase inhibitors (MKI) whose mechanism is not fully understood, and the prophylaxis is inadequate. ObjectiveIn this pilot study, a double-blind, randomized placebo-controlled trial was conducted to evaluate the effect of topical urea in secondary prevention of sunitinib-induced HFSR in renal cell cancer patients. MethodsOut of 55 screened patients, 14 were randomized to receive topical urea or placebo for four weeks. The association of HFSR with drug levels of sunitinib and its metabolite (n-desethyl sunitinib), genetic polymorphism of VEGFR2 gene, quality of life (QOL) and biochemical markers was also assessed. ResultsThe results showed that urea-based cream was not superior to placebo (P = .075). There was no change in the QOL in both the groups. Single nucleotide polymorphism was checked for two nucleotides rs1870377 and rs2305948 located in VEGFR2 gene on chromosome 4. SNP (variant T > A) at rs1870377 was associated with appearance of new HFSR as compared to the wild type, although the association was not statistically significant (OR 0.714). There was no statistically significant difference between mean plasma levels of sunitinib and N-desethyl sunitinib in urea arm as compared to placebo arm as compared to placebo. The best fit population pharmacokinetic model for sunitinib was one compartment model with first order absorption and linear elimination. The median (IQR) of population parameters calculated from the population pharmacokinetics model for Ka, V and Cl was 0.22 (0.21-0.24) h-1, 4.4 (4.09-4.47) L, 0.049 (0.042-0.12) L/hr, respectively. ConclusionThe study suggested that the urea-based cream was not superior to placebo in decreasing the appearance of new HFSR in renal cancer patients receiving 4:2 regimen of sunitinib.

Melanonychia and subungual papule in a middle-aged man

Melanonychia and subungual papule in a middle-aged man

Familial Lamellar Ichthyosis in 6 Years Old and 2 Years Old Children: A Rare Case Report

Background: Lamellar ichthyosis (LI) is a rare non-syndromic congenital ichthyosis and is autosomal recessive. LI patients are generally born with abnormalities of keratinization, then develop into lamellar scales and persist into adulthood. This study aimed to describe cases of lamellar ichthyosis and provide appropriate management to prevent worsening patient prognosis.
 Case presentation: A 6-year-old girl and her younger brother, 2-year-old have been complaining of scaly skin all over their bodies since birth. Both patients were born with a history of being covered by a collodion membrane. On physical examination, thick and wide lamellar scales were seen with an erythematous base and palmoplantar hyperkeratosis. Ectropion of the eyelids, eclabium in the mouth area, and microtia in the ears were seen. The results of the dermoscopy examination showed brownish quadrilateral structures with white scales forming a lamellar pattern. Laboratory examination showed vitamin D insufficiency. Both patients were referred to the Pediatric Polyclinic regarding insufficiency and developmental complaints. Patients received therapy in the form of moisturizers, artificial eye drops, topical urea as a keratolytic, and oral vitamin D 2,000 IU per day. There was a clinical improvement after 3 months of treatment.
 Conclusion: Lamellar ichthyosis is an autosomal recessive congenital ichthyosis with clinical manifestations limited to the skin. In a minority of cases, LI can be inherited in an autosomal dominant manner. Thorough management is necessary to prevent a poor prognosis in patients.

Efficacy and Safety of Topical Urea for Treatment Atopic Dermatitis as a Reference in the National Drugs Formulary

Atopic dermatitis (AD) is a chronically relapsing skin disease that occurs most commonly during early infancy and childhood. One of the most important clinical features of AD which results from a dysfunctional epidermal barrier (EB) is very dry skin (xerosis). Moisturizers are often used as supplements to topical and/or systemic anti-inflammatory drugs in various types of skin conditions and disorders. Humectan, this class of moisturizer is used to improve the appearance and texture of skin by filling in the crevices between corneocytes. One of the humectant included in the list of the National Drugs Formulary that is needed and must be available at health service facilities as a reference in the implementation of National Health Insurance (NHI) is urea. The literature searches using Pubmed, Academia, Google scholar and published in the last 10 years. Urea is effectively increasing skin hydration as well as niacinamide, significantly reducing local Scoring Atopic Dermatitis (SCORAD) and stratum corneum (SC) hydration. Urea had a decrease in transepidermal water loss (TEWL) which was not significantly better than lanolin and ceramide. The ceramide had a lower mean Visual Analogue Scale (VAS) score for irritation compared with the urea. More participants also preferred the ceramide-based cream over the urea. Urea is an effective and safe treatment although not as well as ceramide. Ceramide has been shown to be more effective and less irritating than urea. Ceramid can be quite expensive, while urea is a moisturizer that is easily found and accessible to the public.

Part 1 results from NOVA-II, a randomized, double-blind, vehicle-controlled phase II study evaluating the safety and efficacy of OQL011 on VEGFR inhibitor associated hand-foot skin reaction in cancer patients.

TPS396 Background: Hand-foot skin reaction (HFSR) is associated with the use of multi-targeted tyrosine kinase inhibitors sharing vascular endothelial growth factor receptor inhibitory (VEGFRi) activity (e.g., cabozantinib, regorafenib, sorafenib, sunitinib). HFSR affects the palms and soles with edema, erythema, hyperkeratosis, pain, and bullae/blisters impacting quality-of-life, activities of daily living, and consistent VEGFRi dosing. HFSR incidence differs among VEGFRi, ranging from 5-69% (all grades) and 1-19% (grade 3). Topical urea has marginal benefit, and to date, there are no regulatory authority approved HFSR treatments. The pathogenesis of HFSR has been partially associated with impaired vascular repair mechanisms resulting from inhibition of VEGF signaling. Nitric oxide (NO) has been reported to induce VEGF upregulation at a moderate concentration. We hypothesized that topical stimulation of VEGF signaling through OQL011, an NO donor, will safely and effectively mitigate HFSR. Methods: NOVA-II is a phase 2, double-blind, randomized vehicle-controlled trial evaluating the safety and efficacy of OQL011 for the treatment of moderate to severe HFSR. Subjects receiving a VEGFRi (either mono- or combination therapy) and have Grade ≥2 HFSR per NCI CTCAE v5.0 for palmar plantar erythrodysesthesia (PPE) were eligible. For Part 1, 31 subjects were randomized (2:1) and received 0.2% OQL011 topical ointment or vehicle TID for 6 weeks. The primary endpoint is the proportion of patients who achieve an NCI CTCAE v5.0 for PPE Grade 0 or 1 by Week 3. An investigator global assessment (IGA) scale is being developed to assess HFSR recovery, and a secondary endpoint will measure the proportion of patients who have improvement in HFSR severity and achieve an IGA score of clear (0) or almost clear (1) by Week 3 and/or Week 6. A Chi-square test will be used to detect a difference between the treatment arm and the vehicle-control arm. Additionally, the IGA score will be validated by assessing the inter- & intra-rater reliability. The correlation between IGA, NCI CTCAE v5.0 for PPE, and patient outcomes including Visual Analog Scale of Pain, HFSR Quality of Life questionnaire will also be reported. This study began enrolling patients in December 2019 and completed the last patient Visit in August 2021. Data lock, unblinding and data analysis will be completed by mid-November. Clinical trial information: NCT04088318.

Effect of Urea Cream on Hand-Foot Syndrome in Patients Receiving Chemotherapy: A Meta-analysis.

Hand-foot syndrome (HFS) is a specific adverse effect of certain chemotherapy that may lead to dosage reduction or chemotherapy discontinuation in patients with cancer. Topical urea cream may reduce symptom severity in patients with HFS. However, these studies have not provided consonant results. To determine the effectiveness of urea cream, we conducted a meta-analysis of clinical trials to evaluate the prevention and treatment of HFS. PubMed, EMBASE, and Cochrane Library databases were searched for studies published before September 2020. The study registered at PROSPERO (CRD 42020203164). Incidence of HFS reported in studies at any grade and at second grade or greater was assessed within 3 to 12 weeks. Secondary outcomes were time to HFS, incidence of skin-related adverse events, chemotherapy dose reduction, and quality of life. Seven trials involving 1387 patients were reviewed. In the prophylactic subgroup, patients with urea cream intervention showed a significantly lower incidence of HFS at second grade or greater (risk ratio, 0.72; 95% confidence interval, 0.58-0.90) and a nonsignificant lower incidence of any-grade HFS (risk ratio, 0.79; 95% confidence interval, 0.58-1.08) than those not receiving urea cream intervention. Urea cream has advantages to reduce the incidence of severe HFS. Urea cream is a safe and viable topical prevention strategy that can reduce the incidence of high-grade HFS in patients undergoing chemotherapy. We recommend a routine treatment option before chemotherapy for the patients.

A phase II study to evaluate the safety and efficacy of OQL011 on VEGFR inhibitor-associated hand-foot-skin reaction in cancer patients.

TPS12132 Background: Hand-Foot Skin Reaction (HFSR) is frequently associated with the use of multi-targeted tyrosine kinase inhibitors of the vascular endothelial growth factor receptor (VEGFRi) such as cabozantinib, regorafenib, sunitinib, and lenvatinib. HFSR affects the skin on the palms and soles and is manifested as edema, erythema, hyperkeratosis, and bullae, leading to a decrease in quality of life and interruptions in dosing. The incidence of HFSR differs among VEGFRi, ranging from 5-60% (all grades) and 1-18% (grade 3). To date, there is no FDA approved treatment for HFSR, and marginal benefit has been shown with topical urea or steroids. Although not fully elucidated, the pathogenesis of HFSR has been associated with impaired vascular repair mechanisms, caused by inhibition of VEGF signaling pathways. We hypothesize that topical stimulation of VEGFR through OQL011 will decrease the severity of HFSR symptoms via local upregulation of the VEGF/VEGFR related signaling pathways. Methods: NCT04088318 is a phase 2, double-blind, randomized controlled trial to evaluate the safety and efficacy of OQL011 compared to vehicle control in the treatment of moderate to severe HFSR in patients on VEGFRi therapy. Eligible patients will have ≥ grade 2 palmar plantar erythrodysesthesia (PPE). The study is expected to enroll 112 patients in two parts. In the first part, 42 patients will apply 0.2% OQL011 topical ointment or vehicle control (2:1 randomization) TID for six weeks. In Part 2, 70 subjects will be randomized into two additional dose levels or vehicle control in a 2:2:1 ratio. The two dose levels selected will be based on the efficacy and safety results of Part 1. The primary efficacy endpoint is improvement of NCI CTCAE v5.0 PPE to grade ≤1 by week 3. Photographs of the affected areas will be taken at Day 0, 7, 14, 21 and 42 timepoints. Superiority test will be performed to compare treatment groups, and the exposure-response relationship will be explored. In addition, an investigator global assessment (IGA) for HFSR will be used in this trial to specifically assess skin recovery and is proposed to be a new evaluation tool. The validity of IGA criteria will be evaluated by assessing the inter-rater and intra-rater reliability. The correlation between IGA, NCI CTCAE v5.0 for PPE, and patient reported outcomes including Visual Analog Scale of Pain, Hand-foot Quality of Life questionnaire will also be evaluated. This study began enrolling patients in December 2019 and is ongoing. Clinical trial information: NCT04088318.

Clinical description of a rare dermatological disease, acne Keloidalis Nuchae, and successful homoeopathic management: A case report

Acne Keloidalis Nuchae (AKN), also known as Folliculitis Keloidalis Nuchae (FKN), is a rare dermatological disease characterised by persistent folliculitis at the nape of the neck that forms keloid like scars and finally leads to cicatricial alopecia, and mainly affects the African ethnic group ranging from 0.45 to 9% prevalence rate. The exact aetiology is indistinct, but it is supposed to be triggered by chronic irritation or occlusion of the hair follicles due to different causes, which leads to the inflammation of the affected parts. If untreated, fibrosis and keloid formation can be evident, presented with chronic scarring and/or scarring alopecia without active inflammation. Pruritis, pain, contact bleeding and alopecia are some of the clinical presentations of this illness. If the secondary bacterial infection is present, pustules, sinuses and abscesses may be seen. Conventional medical management includes topical or oral antibiotics, corticosteroids, retinoids, topical fusidic acid and topical urea, intralesional injection of triamcinolone, surgical excision, electrosurgery, cryotherapy, light and laser therapy. This article aims to deliver all the relevant information of AKN presented in literary works and present the successful case treated with Calcarea Phosphoricum and individualised Homoeopathic medicine. This article will highlight the need for the Individualisation of a case, althoughrare, required to treat any named ailment with the help of Homoeopathy.

Pegylated liposomal doxorubicin-induced hand-foot syndrome predicted by serum metabolomic profiling and prevented by calcium dobesilate

Pegylated liposomal doxorubicin-induced hand-foot syndrome predicted by serum metabolomic profiling and prevented by calcium dobesilate

Particular photo-therapy with hydrogen peroxide for the treatment of Hairy Tongue: a case report

Event Abstract Back to Event Particular photo-therapy with hydrogen peroxide for the treatment of Hairy Tongue: a case report Maria Giulia Nosotti1*, Riccardo Botta2, Luca Viganò3 and Cinzia Casu4 1 Private practice, Italy 2 San Raffaele Hospital (IRCCS), Departement of Dentistry, Italy 3 University of Milan, Departement of Radiology, Italy 4 Private practice, Italy Aim. Black hairy tongue (BHT) is a benign condition characterized by a discolored, hairy appearance of the dorsal tongue. The prevalence of BHT is highly variable among different and dependent on many factors; however, studies have shown that the prevalence may be as high as 11.3% in some populations. BHT is more common in men, elderly patients, smokers, HIV-positive, edentulous patients, and patients with cancer. On a clinical evaluation it appears as a dark film on the tongue, but different colours are reported such as yellow, green, white, anterior to the circumvallate papillae. The lesion does not involve the lateral and the tip site of the tongue, and it reveals hypertrophy and lengthening of the filiform papilla. BHT is a benign, self-limiting condition,often asymptomatic, but sometimes halitosis, tingling or burning sensation were reported. In the literature for its therapy it was been proposed avoiding associated medications, practicing good oral hygiene, discontinuing habits predisposing to BHT, and gentle brushing or scraping of the tongue. Second-line treatments are oral retinoids, antifungals, antibiotics, trichloroacetic acid, topical urea solution, topical triamcinolone acetonide, vitamin B complex, gentian violet, salicylic acid, and thymol. The use of lights in the treatment of this condition is not described in the literature. Association of hydrogen peroxide and diode laser and LED light for the management of periodontal disease is documented. Periodontal bacteria were found in the tongue with BHT. The aim of this study is to report a case of BHT successfully treated with a 460 nm LED light in combination with hydrogen peroxide. Materials and Methods. A 60 years old female patient with a history of mild hypertension went to the private practice for tingling sensation of the tongue, present from about 3 months. There was a discolored hairy appareance of the tongue and a diagnosis of hairy tongue was made. The patient declared to have performed cleaning of the tongue during this period, without improvement. We decided to treat the condition reducing the bacterial load with application of hydrogen peroxide solution at 3% 12 volumes activated with a 460 nm LED light, with a power of 4 W (FlashMax, CMS Dental, Copenhagen, Denmark). The hydrogen peroxide was applied rubbing a cotton pellet soaked in hydrogen peroxide on the dorsal surface and 15 applications of 3 seconds with the LED light were performed, in the left side of the tongue (that was the symptomatic side). After the hydrogen peroxide was removed with a vacuum cleaner. Results. One week later there was an important clinical improvement and the patient was asymptomatic. We treated the right side of the tongue with the same protocol, and after another week the patient healed. Discussion. Previous studies have indicated that the use of hydrogen peroxide associated with Photodynamic Therapy (PDT) gives increased killing of microorganisms, such as S. Mutans, and periodontal bacteria. The results of a study conducted by Feuerstein et al. indicated a synergistic antibacterial effect of noncoherent blue light, often used in restorative dentistry, and hydrogen peroxide (H2O2) on S. mutans under planktonic conditions. The results of this study also suggested a potential bactericidal mechanism in which the synergistic effect on bacterial vitality is the result of the generation of the highly reactive hydroxyl radical. The results of an Iranian study suggested that visible blue light in the presence of hydrogen peroxide would be consider as a potential approach of PDT to kill the main gram negative periodontal pathogens. We proposed a new type of non invasive treatment for this frequent oral disease that could be effective in the management of refractory BHT, without adverse events.

Topical urea in skincare: A review.

Alterations in barrier function are associated with a number of skin diseases, including xerosis, atopic dermatitis, and psoriasis. Urea, a component of the natural moisturizing factor of the skin, plays an important role in the preservation of skin hydration and integrity. Several studies have investigated the effects of urea in the clinical setting. Here, we summarize the available clinical evidence regarding the effects of urea in the maintenance of healthy skin and management of skin disorders. At lower doses (≤10%), urea-containing topical formulations act as a skin moisturizer, while at higher concentrations (>10% urea), urea-based preparations exert a keratolytic action. Urea is also useful in combination therapies with anti-inflammatory and anti-fungal drugs, due to its activity as a penetration enhancer.

Man With Bumps on His Shin

A 37-year-old man presented to the emergency department with “bumps” that had been present on his right shin for 2 months. The papular rash spread over the anterior lower leg and was very pruritic. There was no known exposure to irritants, allergens, or infectious agents. A 10×20-cm area of hyperpigmented papules that coalesced was present at the anterior right shin, with some excoriations (Figure 1). The edges were well demarcated, without tenderness or purulence. No ulcerations, erosions, or other dermatoses were present (Figure 2).Figure 2Anterior right lower extremity.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Lichenoid amyloidosis or local cutaneous amyloidosis. The diagnosis was made clinically because lichenoid amyloidosis typically begins with multiple discrete, very pruritic, hyperpigmented, brownish-red papules on the pretibial area that coalesce into a rippled pattern. Vascular and adnexal structures are never involved.1Ladizinski B. Lee K.C. Lichen amyloidosis.CMAJ. 2014; 186: 532Crossref PubMed Scopus (8) Google Scholar In this case, the patient’s lichenoid amyloidosis was limited to just the right shin, although lesions can present on the upper legs, back, and arms. The cause is thought to be due to scratching. It is not associated with systemic amyloidosis.2Tanaka A. Arita K. Lai-Cheong J.E. et al.New insight into mechanisms of pruritus from molecular studies on familial primary localized cutaneous amyloidosis.Br J Dermatol. 2009; 161: 1217-1224Crossref PubMed Scopus (59) Google Scholar The differential diagnosis includes prurigo nodularis (larger papules up to 2 cm with erosions and ulcerations), lichen sclerosis et atrophicus (pink papules with central white atrophic scarring), and lichen simplex chronicus (typically observed along with atopic dermatitis, exhibiting smaller papules with accentuation of skin lines). When the diagnosis is unclear, biopsy is used for confirmation.1Ladizinski B. Lee K.C. Lichen amyloidosis.CMAJ. 2014; 186: 532Crossref PubMed Scopus (8) Google Scholar The patient was successfully treated with topical clobetasol 0.05% ointment twice daily during 6 months.3Chandran N.S. Goh B.K. Lee S.S. et al.Case of primary localized cutaneous amyloidosis with protean clinical manifestations: lichen, poikiloderma-like, dyschromic and bullous variants.J Dermatol. 2011; 38: 1066-1071Crossref PubMed Scopus (14) Google Scholar Topical urea under occlusion was also prescribed to help break down the keratin in the thickened epithelium.

NORWEGIAN SCABIES IN AIDS PATIENT: A CASE REPORT

Scabies is a skin infection caused by Sarcoptes scabiei var. hominis. This disease may present severe clinical manifestations in immune-compromised patient, well-known as Norwegian scabies or crusted scabies.A 36-year old man with AIDS had chief complaint thick crust almost all over his body in this case. History of household member infected by scabies before was present. Clinical findings show hyperpigmented macules unsharply marginated, covered with thick scales and accompanied by papules, fissures, and erotion. T cell CD4 level was 12 cell/ µL. Scraping examination showed scabies infection and so did the histopathology examination. This patient was treated by topical Permethrin 5% combined with 2-4 ointment application in between permethrin usage. Before topical scabicide was given, thick crust was previously treated by topical urea 10% and wet dressing by normal saline. On day 14 after the patient first came there was lesion improvement.

Efficacy of 5% amorolfine nail lacquer in Neoscytalidium dimidiatum onychomycosis

Background: Amorolfine nail lacquer was mentioned as an effective treatment for non-dermatophyte nail infection. Onychomycosis that caused by Neoscytalidium dimidiatum is considered recalcitrant onychomycosis. Objective: This study aimed to demonstrate efficacy and treatment outcomes of amorolfine nail lacquer in N. dimidiatum onychomycosis, compared with topical urea treatment. Methods: This was a retrospective study of patients daiagnosed as N. dimidiatum onychomycosis at dermatologic clinic between April 2010 and August 2014. Clinical manifestations and laboratory results were collected. The evaluation included 50% improvement, which meant 50% decrease in subungual hyperkeratosis thickness from original untreated nails. Mycological cure is defined by negative result of both KOH and fungal culture. Moreover, complete cure means infected nails return to its normal condition as well as KOH and fungal culture yield negative results. Results: Among 53 outpatients of N. dimidiatum infection, 28 (52.8%) were treated by amorolfine nail lacquer and other 26 (47.2%) by conventional topical urea cream with occlusion. Comparison between amorolfine and topical urea groups, mycological cure rate was significantly shown in amorolfine group (89.3% vs. 32%; p < 0.0001). Moreover, 50% clinical improvement and complete cure rate of amorolfine group were significantly higher than those of topical urea group (85.7% vs. 48%; p = 0.003 and 50% vs. 20%; p = 0.023, respectively). Median time to mycological cure and complete cure in amorolfine group was significantly shorter than that of topical urea group (p = 0.001 and p = 0.013, respectively). Conclusion: This study supported that amorolfine nail lacquer provided promising efficacy in the treatment of Neoscytalidium onychomycosis as a novel monotherapy regimen which were superior to topical urea cream with occlusion in every aspect.

An urea, arginine and carnosine based cream (Ureadin Rx Db ISDIN) shows greater efficacy in the treatment of severe xerosis of the feet in Type 2 diabetic patients in comparison with glycerol-based emollient cream. A randomized, assessor-blinded, controlled trial.

BackgroundXerosis is a common skin disorder frequently observed in diabetic patients. An effective hydration of foot skin in diabetics is a relevant preventive strategy in order to maintain a healthy foot. Urea is considered an effective hydrating and emollient topical product. The aim of the present study was to evaluate the efficacy of topical urea 5% with arginine and carnosine (Ureadin Rx Db, ISDIN Spain) (UC) in comparison with glycerol-based emollient topical product (Dexeryl, Pierre Fabre) (EC), in Type 2 diabetic patients.MethodsWe assessed the effect of UC on skin hydration in a randomized, evaluator-blinded comparative study in 40 type II diabetic patients, aged 40–75 years, treated with UC or the comparator for 28 days with a twice-daily application. The principal outcomes were the Dryness Area Severity Index (DASI) Score and the Visual Analogue Score (VAS) for skin dryness evaluated at baseline and at the end of study period by an investigator unaware of treatment allocation.ResultsUC induced significantly greater hydration than EC with an 89% reduction in DASI score (from 1.6 to 0.2; p < 0.001) in comparison with baseline values. After 4 weeks, compared with the control group, DASI score in UC treated group was significantly lower (0.2 vs. 1.0; p = 0.048). VAS score (high values mean better hydration) significantly increased in both groups during treatment. VAS score at the end of treatment period was significantly higher in UC group in comparison with EC group (9.8 vs. 8.2; p = 0.05).ConclusionApplication of urea 5%, arginine and carnosine cream increases skin hydration and alleviates the condition of skin dryness in Type 2 diabetic patients in comparison with a control glycerol-based emollient product. (Dutch Trials Register trial number 3328).

Nursing and effect of honeysuckle lotion on the patients taking sorafenib with the complication of hand and foot blisters

Objective To explore the effect of honeysuckle lotion on the primary hepatic cancer patients taking sorafenib with the complication of hand and foot blisters.Methods Totals of 45 patients who took sorafenib and complicated with the hand and foot blisters were randomly divided into experimental group ( n =23 ) and control group( n =22).The experimental group were soaked in honeysuckle lotion accompany with topical urea ointment,while control group received topical urea ointment.Then,the clinical effective and healing time of two groups were observed.Results There was no significant difference detected in age,lesion and general between two groups.The clinical treatment effective rate of experimental group was 91.3％ significantly better than 59.1％ that of control group ( x2 =8.494,P ＜ 0.05 ).The healing time of experimental group was (8.5 ± 4.2)d and that of control group was (11.8 ± 6.3 )d,and the difference was statistically significant (t =2.92,P ＜ 0.05 ).Conclusions The honeysuckle lotion application can promote wound healing for primary hepatic cancer patients taking sorafenib with the complication of hand and foot blisters.And it is worthy for clinical application. Key words: Nursing; Hand and foot blisters; Honeysuckle lotion; Sorafebin

Urea Uptake Enhances Barrier Function and Antimicrobial Defense in Humans by Regulating Epidermal Gene Expression

Urea is an endogenous metabolite, known to enhance stratum corneum hydration. Yet, topical urea anecdotally also improves permeability barrier function, and it appears to exhibit antimicrobial activity. Hence, we hypothesized that urea is not merely a passive metabolite, but a small-molecule regulator of epidermal structure and function. In 21 human volunteers, topical urea improved barrier function in parallel with enhanced antimicrobial peptide (LL-37 and β-defensin-2) expression. Urea both stimulates expression of, and is transported into keratinocytes by two urea transporters, UT-A1 and UT-A2, and by aquaporin 3, 7 and 9. Inhibitors of these urea transporters block the downstream biological effects of urea, which include increased mRNA and protein levels for: (i) transglutaminase-1, involucrin, loricrin and filaggrin; (ii) epidermal lipid synthetic enzymes, and (iii) cathelicidin/LL-37 and β-defensin-2. Finally, we explored the potential clinical utility of urea, showing that topical urea applications normalized both barrier function and antimicrobial peptide expression in a murine model of atopic dermatitis (AD). Together, these results show that urea is a small-molecule regulator of epidermal permeability barrier function and antimicrobial peptide expression after transporter uptake, followed by gene regulatory activity in normal epidermis, with potential therapeutic applications in diseased skin.

A randomized multicenter phase II trial on efficacy of high-slip skin care pad for hand-foot skin reaction caused by sorafenib in patients with renal cell carcinoma.

TPS233 Background: Hand-foot skin reaction (HFSR) is the most clinically significant dermatologic toxicity in patients (pts) with metastatic renal cell carcinoma (mRCC) who receive sorafenib. HFSR was found to occur in 72 of 131 Japanese pts (Akaza et al, JJCO, 2007). Since HFSR is reported to be associated with significant tenderness affecting function and quality of life (especially difficulty in walking), prevention and management of HFSR would be mandatory. Although treatment with topical urea cream is frequently performed, the control of pain is not completely established. HFSR may be attributed to keratinous disorders of the skin and tends to develop in particular in areas on the soles of the feet subject for strong pressure. Since high-slip skin care pad (Remois pad) is a protective dressing on pressure ulcer to reduce surface pressure and to result in the prevention of skin damage, the characteristics of this material may prevent the development and worsening of HFSR. The purpose of the study is to investigate the usefulness of a high-slip skin care pad for HFSR on the soles. Methods: This randomized, prospective, open-label trial intends to enroll 100 pts with mRCC who received 400 mg bid of sorafenib. Eligibility criteria include pts with confirmed RCC, within 8 weeks after the initiation of sorafenib treatment, with ECOG-PS 0 or 1, and with grade 1 HFSR on their sole. Exclusion criteria are pts who had previously treated with other molecular targeted drugs, with a systemic dermatological disease, or with > grade 3 adverse events other than HFSR. Pts are randomized into two groups: high-slip skin care pad group versus 10% urea cream group. High slip skin care pad is recommended to change every 2-3 days, and 10% urea cream is ordered to apply and rub to affected sites 2 or 3 times per day. Their subsequent progress will be monitored every 2 weeks by 4 weeks after the initiation of these supportive therapy. Primary endpoint is incidence of Grade 2 or 3 HFSR during these supportive therapy. Secondary endpoints are treatment compliance (dose reduction/discontinuation of sorafenib), pain assessment (visual analogue scale), and safety. Currently 19 pts have enrolled.

Two cases of lamellar ichthyosis

Two patients presented with skin lesions characterized by beige or grayish brown, polygonal,rhombic or sheeted scales over the body. The scales were adherent in the center, free and elevated at the edges. Some scales were thick as armor. Ectropion palpebrarum, eclabium and hyperkeratosis of palms and soles were observed in both patients. Histopathology of lesions in patient 2 revealed hyperkeratosis,hypergranulosis, acanthosis, elongation of trochanterellus, and small inflammatory infiltrates around blood vessels in upper dermis. Symptoms were relieved in both patients after treatment with oral tretinoin, topical urea cream and cod liver oil ointment. Key words: Ichthyosis, lamellar; Case reports

Hand foot skin reaction in cancer patients treated with the multikinase inhibitors sorafenib and sunitinib

BackgroundThis study examined clinicopathological findings and management of hand foot skin reaction (HFSR) to sorafenib and sunitinib in a dermatology referral center for cancer-related toxic effects. Patients and methodsWe identified 12 patients who developed HFSR in a 1-year period (2007). Medical records and histological specimens were investigated for clinicopathological data and results on management. ResultsWe identified 12 patients developing HFSR on treatment with sorafenib (83%) or sunitinib (17%). Majority presented with grade 3 (75%) HFSR and a median Skindex score of 43. Biopsies in seven patients showed horizontal layers of keratinocyte necrosis, which correlated to time of drug exposure: early (<30 days from initiation) leading to stratum granulosum–spinosum alterations and late (≥30 days) resulting in stratum corneum pathology. Treatment with topical urea singly (n = 3), plus tazarotene (n = 7), or fluorouracil (n = 2) resulted in ≥2 grade improvement in the majority of patients (58%), with five patients (42%) improving one grade (P = 0.007). Median Skindex score at follow-up was 32 (P = 0.22). ConclusionsThere are unique clinicopathological characteristics of HFSR due to the multikinase inhibitors that correlate with time of agent initiation. Treatment with topical agents having keratolytic, antiproliferative, and anti-inflammatory properties showed benefit.