Topical Research Articles

Preliminary Efficacy of Topical Sildenafil Cream for the Treatment of Female Sexual Arousal Disorder: A Randomized Controlled Trial.

To assess the efficacy of topical sildenafil cream, 3.6% among healthy premenopausal women with female sexual arousal disorder. We conducted a phase 2b, exploratory, randomized, placebo-controlled, double-blind study of sildenafil cream. Coprimary efficacy endpoints were the change from baseline to week 12 in the Arousal Sensation domain of the SFQ28 (Sexual Function Questionnaire) and question 14 of the FSDS-DAO (Female Sexual Distress Scale-Desire, Arousal, Orgasm). Two hundred women with female sexual arousal disorder were randomized to sildenafil cream (n=101) or placebo cream (n=99). A total of 174 participants completed the study (sildenafil 90, placebo 84). Among the intention-to-treat (ITT) population, which included women with only female sexual arousal disorder and those with female sexual arousal disorder with concomitant sexual dysfunction diagnoses or genital pain, although the sildenafil cream group demonstrated greater improvement in the SFQ28 Arousal Sensation domain scores, there were no statistically significant differences between sildenafil and placebo cream users in the coprimary and secondary efficacy endpoints. An exploratory post hoc subset of the ITT population with an enrollment diagnosis of female sexual arousal disorder with or without concomitant decreased desire randomized to sildenafil cream reported significant increases in their SFQ28 Arousal Sensation domain score (least squares mean 2.03 [SE 0.62]) compared with placebo cream (least squares mean 0.08 [SE 0.71], P =.04). This subset achieved a larger mean improvement in the SFQ28 Desire and Orgasm domain scores. This subset population also had significantly reduced sexual distress and interpersonal difficulties with sildenafil cream use as measured by FSDS-DAO questions 3, 5, and 10 (all P ≤.04). Topical sildenafil cream improved outcomes among women with female sexual arousal disorder, most significantly in those who did not have concomitant orgasmic dysfunction. In particular, in an exploratory analysis of a subset of women with female sexual arousal disorder with or without concomitant decreased desire, topical sildenafil cream increased sexual arousal sensation, desire, and orgasm and reduced sexual distress. ClinicalTrials.gov , NCT04948151.

A Giant Panda's Skin and Hairs Infection of Nannizzia Gypsum on Lumbosacral Region Successfully Treated by Oral Terbinafine and Topic Naftifine-ketoconazole Cream.

A Giant Panda's Skin and Hairs Infection of Nannizzia Gypsum on Lumbosacral Region Successfully Treated by Oral Terbinafine and Topic Naftifine-ketoconazole Cream.

Tolnaftate-Loaded Ethosomal Gel for Topical Delivery: Formulation and In Vitro Evaluation

Abstract Objectives Tolnaftate (TOL) is used as a topical antifungal agent but has poor skin penetration. Therefore, the present study is designed to formulate an ethosomal gel of TOL to enhance drug penetration through the skin. Methods Using the cold method ethosomal formulations with different concentrations of ethanol and soy phosphatidylcholine (SPC) were formulated. The formulation of ethosomes was characterized by vesicle size, polydispersity index and zeta potential, % drug entrapment efficiency (EE), and scanning electron microscopy (SEM). The optimized ethosomal formula was incorporated in a 1% Carbopol hydrogel dosage. Evaluation of in vitro penetration of prepared gel was performed on goat skin using Franz diffusion cells and compared with conventional gel. Result The ethosomal formulation EF5 showed the highest % EE (76.82%) with a small vesicle size of 210.1 nm and was selected as the optimized formulation. The SEM result shows that the vesicles were spherical, smooth, and in the 200-nm range. In vitro, permeability study shows that steady-state flux of TOL from ethosomal and conventional gels were 6.667 and 3.685 µg/cm/h, respectively (p < 0.001). It indicated that the flux of Ethosomal hydrogel (EHG) is 2.0-fold higher than conventional hydrogel (CHG); this may be due to the flexible nature of ethosomes and ethosomal core containing ethanol, which dissolves the lipid bilayer of skin and overcomes the barrier. In vitro, an antifungal study shows that the incorporation of TOL in ethosomal hydrogel retains their activity. Conclusion From the results, it was concluded that TOL topical ethosomal gel for antifungal activity will possibly be a good choice.

(132) MICONAZOLE VAGINAL CREAM AND ACQUIRED NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract Introduction The vestibular epithelium is non-keratinized and is thus susceptible to injury from an allergic reaction. Topical pharmaceutical agents applied to the genitals for various medical indications, such as miconazole vaginal cream to treat vaginal yeast infections, may absorb through the non-keratinized vestibular epithelium. Active and inactive ingredients in miconazole vaginal cream include miconazole nitrate, benzoic acid, cetyl alcohol, isopropyl myristate, polysorbate 60, potassium hydroxide, propylene glycol, purified water and stearyl alcohol. Patients without vestibular pain previously have reported applying miconazole vaginal cream to their genitals and immediately experienced excruciating burning that resulted in persistent unrelenting severe pain throughout the vestibule, symptoms consistent with acquired neuroproliferative vestibulodynia (NPV). Objective To review reports of clinic patients who used miconazole vaginal cream prior to a diagnosis of acquired NPV to provide awareness of the management of this condition. Methods We performed a chart review of individuals with vulvas presenting to a single sexual medicine clinic between June 2019 and June 2023 to identify those who met the following inclusion criteria. They were clinically suspected to have acquired NPV after an allergic reaction following use of miconazole vaginal cream. They failed conservative treatments for provoked vestibular pain and underwent vestibulectomy. Their excised vestibular specimens revealed an excess of CD117 immunopositive stained cells (>8 per high-power field), consistent with mast cells, and PGP9.5 immunopositive stained area, consistent with nerves, histopathologically confirming the diagnosis of NPV. In addition, demographic data, prior diagnoses and treatments, results from validated questionnaires, pertinent physical exam findings and treatment outcomes were collected. Results A total of 7 individuals met inclusion criteria. Mean age at the time of exposure to miconazole vaginal cream was 23 (range 18-29) years. Mean age at presentation to our sexual medicine facility was 28 (range 22-33) years, thus a delay in diagnosis of miconazole vaginal cream-induced acquired NPV of 5 (range 1-12) years. 71% were previously diagnosed and unsuccessfully managed as hormonally-mediated vestibulodynia and 29% as interstitial cystitis. The mean pain domain score and overall score for the Female Sexual Function Index was 1.2/6 (range 0-3.2/6) and 11.7/36 (range 4.2-18.1/36), respectively. A total score of <26 is indicative of sexual dysfunction. The mean Female Sexual Distress Scale-Revised score was 32.2/52 (range 21-39/52), consistent with significant distress. Conclusions Our cohort of patients with miconazole vaginal cream-induced acquired NPV experienced several years of misdiagnoses, unsuccessful treatments, significant pain, and distress. It is hypothesized that miconazole vaginal cream induces NPV in genetically susceptible individuals in part because the vestibular epithelium is non-keratinized and therefore more easily absorbs the ingredients in the miconazole vaginal cream, which may result in an allergic response in the subepithelial region of the vestibule. This allergic reaction results in accumulation of mast cells in the subepithelial stroma that release nerve growth factor leading to neuroproliferation with subsequent allodynia and hyperalgesia. In individuals who develop yeast infections, use of systemic strategies and rather than topical medication is encouraged to avoid potential allergic reactions and resultant acquired NPV. Disclosure No.

Cutaneous lupus subtypes

A broad spectrum of dermatologic manifestations, known as cutaneous lupus erythematosus (CLE), may or may not be linked to the development of systemic disease. There are numerous subtypes of cutaneous lupus, such as acute cutaneous lupus (ACLE), subacute cutaneous lupus (SCLE), and chronic cutaneous lupus (CCLE). CCLE encompasses lupus tumidus, chilblain cutaneous lupus, LE profundus (LEP), and discoid lupus erythematosus (DLE). In order to diagnose these diseases, it is necessary to accurately classify the subtype. This is achieved through a combination of physical examination, laboratory studies, histology, antibody serology, and occasionally direct immunofluorescence, while also excluding systemic disease. The treatment of cutaneous lupus involves the provision of appropriate topical and systemic agents, as well as patient education regarding solar protection. In cases where the disease is pervasive, scarring, or treatment-refractory, systemic agents are recommended. In this chapter, we address the classification and diagnosis of the diverse subtypes of CLE and offer a comprehensive update on therapeutic management.

(091) EXPOSURE OF THE VESTIBULE TO A POSSIBLE ALLERGIC TRIGGER AT A VERY YOUNG AGE: LIFELONG NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract Introduction Vestibular fibroblasts from patients with neuroproliferative vestibulodynia (NPV) versus age-matched controls produced higher proinflammatory cytokine levels of various interleukins when provoked with candida albicans in vitro. In genetically susceptible patients, this enhanced cytokine synthesis is hypothesized, in part, to lead to neuroproliferation in vestibular tissue resulting in allodynia/hyperalgesia. Patients with acquired NPV, who initially experienced pain-free penetration in their early adult reproductive life, may experience persistent severe vestibular burning following an allergic reaction to a topical agent applied to the non-keratinized vestibular epithelium. In contrast, patients with lifelong NPV present with the classic history of inability to insert a tampon at menarche (mean age 12.4 years). Patients with lifelong NPV may have unknowingly been exposed to an allergen early in their childhood, potentially even triggered from ointments used in infancy to protect from diaper rash, resulting in local vestibular mast cell accumulation in genetically susceptible patients. Agents commonly used to prevent are zinc oxide 40%, (Desitin) with inactive ingredients petrolatum, cod liver oil, lanolin, talc, glycerin, sorbitan sesquioleate, beeswax, tocopheryl acetate and fragrance and A+D ointment that includes petroleum jelly, lanolin, lavender oil, light liquid paraffin, vitamin A and vitamin D. It is possible an allergic reaction could result from any of these ingredients when applied to the non-keratinized vestibular epithelium. Objective We wished to better understand the possible triggering event in patients with lifelong NPV. Methods A chart review was performed of patients who presented between January 2019 and June 2023 who were clinically suspected to have lifelong NPV based on a history of inability to use tampons and inability to have pain-free penetration and histopathlogically confirmed to have NPV. Information was obtained from a parent or caregiver who regularly changed patient’s diapers as to what agents were utilized to manage diaper rash. Results Our patient cohort included 14 individuals with vulvas, mean age 25 (range 18-37) years. One patient prone to diaper rash was treated with A+D baby diaper rash ointment and Flanders buttocks ointment (zinc oxide, white petrolatum, white beeswax, Peruvian balsam). One patient had a “bad” yeast infection as a baby and received “topical antibiotics”. Five patients claimed Desitin and Vaseline were used while six patients claimed Desitin alone, two of whom cryied every time they Desitin was applied. One patient from Puerto Rico, received “a sock filled with cornstarch that dabbed the vaginal area and crevices after wiping the area clean”. Conclusions The endodermal vestibular epithelium is not protected by a keratin layer, including in babies at a very young age. In genetically susceptible babies, an allergic reaction to an active/inactive agent used to prevent or treat diaper rash could have potentially triggered mast cell accumulation in the baby’s vestibule leading to increased synthesis of cytokines and growth factors resulting in neuroproliferation consistent with lifelong NPV, evidenced by the inability to place a tampon at menarche. More research into this concern is needed. Disclosure No.

Activated zinc pyrithione in topical treatment of atopic dermatitis: a case report

Atopic dermatitis is a systemic multifactorial genetically determined inflammatory skin condition characterized by an impairment of the epidermal barrier and Type 2 inflammation. Atopic dermatitis is highly prevalent, especially among children. Many authors consider atopic dermatitis as the initial stage of the atopic march, which typically manifests in the first year of life. Topical agents such as topical glucocorticosteroids and topical calcineurin inhibitors are the first-line treatments for atopic dermatitis. In recent years, there has been an increasing use of modern systemic anti-inflammatory agents, such as monoclonal antibodies and Janus kinase inhibitors. Therapy of patients with atopic dermatitis is aimed at relieving itching, improving skin barrier function, reducing inflammation, preventing skin infection and exacerbations. The effectiveness of treatment lies not only in improving the symptoms and quality of life of patients with atopic dermatitis, but also in preventing them from developing chronic or severe symptoms. Modern topical glucocorticosteroids and their combinations, have a proven high safety profile. However, available data on adverse events associated with their use often lead patients and their parents to develop a negative, phobic attitude towards treatment with these drugs. Zinc pyrithione, an activated form of zinc, is a safe and highly effective medication with anti-inflammatory, antifungal, and antibacterial properties. This article presents two clinical cases of moderate to severe atopic dermatitis in children, demonstrating the effectiveness of using activated zinc pyrithione in comprehensive therapy for this condition.

Method development and validation of a new stability indicating HPLC and LC-ESI-MS/MS methods for the determination of Tavaborole

Tavaborole, a topical antifungal agent containing Boron is used for the treatment of onychomycosis, an infection of the nail and nail bed caused by Trichophyton rubrum or Trichophyton mentagrophytes infection. Tavaborole is chemically known as 5 - Fluoro -1,3 - dihydro -2,1-benzoxaborol -1-ol. It acts by inhibiting Leucyl-tRNA synthetase an essential fungal enzyme required for protein synthesis. AB SCIEX Instruments LC-ESI-MS/MS (Model no. 5068379-Y) QTRAP Enabled Triple Quad 5500+ with Agilent Zorbox C18 (150 mm x 4.6 mm x 3 µm) column and PDA detector was employed for the present study. The total run time was 10 mins and the detection wavelength was 254 nm. A mixture of 5 mM Ammonium formate: Methanol (30: 70) was used as mobile phase on isocratic mode with 1 ml/min as flow rate. Tavaborole has shown linearity over the concentration range 0.5-100 μg/ml and the proposed method was validated as per ICH guidelines. The proposed method is found to be simple, precise, accurate and suitable for the quantification of the marketed formulations of Tavaborole. Stress degradation studies were performed and the method is found to be selective and specific. Keywords: Tavaborole, Stability indicating, LC-ESI-MS/MS, Validation.

Neuropathy in pruritus medicine : Recommended diagnostics and therapy

Chronic itch is afrequent and debilitating condition that greatly affects the quality of life of those affected. In asubset of patients, damage to the peripheral or central nervous system constitutes the cause of the itch. Small-fiber neuropathy, nerve compression syndromes, post-herpetic neuralgia, scars and burns are possible conditions affecting the peripheral nervous system potentially causing itch, whereas space-occupying lesions affecting the spinal cord and stroke are examples of conditions that may induce central itch. Neuropathic itch starts on normal appearing skin, is often accompanied by pain sensations and other dysesthesias, and usually relieved by local cold application. Its distribution depends on the affected site of the somatosensory system. Acomprehensive medical history is paramount to reach the diagnosis, while complementary diagnostics with skin biopsies for the investigation of cutaneous neuromorphological alterations or medical imaging to rule out nerve impingement may be advised in selected cases. Topical agents such as capsaicin or local anesthetics as well as systemic drugs such as gabapentinoids, antidepressants and opioid receptor modulators are used in the treatment of neuropathic itch. This review article provides an overview of the clinical features, underlying causes, diagnostic workup and therapeutic approach in neuropathic itch.

Peceleganan Spray for the Treatment of Skin Wound Infections

Peceleganan spray is a novel topical antimicrobial agent targeted for the treatment of skin wound infections. However, its efficacy and safety remain unclear. To assess the safety and efficacy of peceleganan spray for the treatment of wound infections. This multicenter, open-label, phase 3 randomized clinical trial recruited and followed up 570 adult patients diagnosed with secondary open wound infections from 37 hospitals in China from August 23, 2021, to July 16, 2022. Patients were randomized to 2 groups with a 2:1 allocation. One group received treatment with 2% peceleganan spray (n = 381) and the other with 1% silver sulfadiazine (SSD) cream (n = 189). The primary efficacy outcome was the clinical efficacy rate (the number of patients fulfilling the criteria for efficacy of the number of patients receiving the treatment) on the first day following the end of treatment (day 8). The secondary outcomes included the clinical efficacy rate on day 5 and the bacterial clearance rate (cases achieving negative bacteria cultures after treatment of all cases with positive bacteria cultures before treatment) on days 5 and 8. The safety outcomes included patients' vital signs, physical examination results, electrocardiographic findings, blood test results, and adverse reactions. Among the 570 patients randomized to 1 of the 2 groups, 375 (98.4%) in the 2% peceleganan treatment group and 183 (96.8%) in the 1% SSD control group completed the trial (n = 558). Of these, 361 (64.7%) were men, and the mean (SD) age was 48.6 (15.3) years. The demographic characteristics were similar between groups. On day 8, clinical efficacy was achieved by 339 patients (90.4%) in the treatment group and 144 (78.7%) in the control group (P < .001). On day 5, clinical efficacy was achieved by 222 patients (59.2%) in the treatment group and 90 (49.2%) in the control group (P = .03). On day 8, bacterial clearance was achieved by 80 of 334 patients (24.0%) in the treatment group and in 75 of 163 (46.0%) in the control group (P < .001). On day 5, bacterial clearance was achieved by 55 of 334 patients (16.5%) in the treatment group and 50 of 163 (30.7%) in the control group (P < .001). The adverse events related to the application of peceleganan spray and SSD cream were similar. This randomized clinical trial found that peceleganan spray is a safe topical antimicrobial agent with a satisfactory clinical efficacy rate for the treatment of skin wound infections, while the effectiveness of bacterial clearance remains uncertain. Chinese Clinical Trial Registry Identifier: ChiCTR2100047202.

Effectiveness of additional topical antibiotics for recurrent or refractory exit-site infection: a case series

BackgroundJapanese peritoneal dialysis (PD) guidelines do not suggest applying mupirocin/gentamicin ointment to the exit sites of PD patients to prevent exit-site infection (ESI). The guidelines do not mention topical antimicrobials as a treatment for ESI.MethodsWe retrospectively investigated the additional use of topical antibiotic ointments on patients receiving oral or intravenous antibiotics for recurrent and/or refractory ESI at Aichi Medical University and Nagoya University Hospitals between 2017 and 2022.ResultsA total of 13 patients (11 men, 2 women) were included in this study. Median age was 69.0 years, median duration of PD was 26.0 months, two patients had diabetes as a complication, and ESI incidence was 2.7 episodes per patient-year. Systemic antibacterial treatment had been administered for a median of 27.0 days before application therapy. Mupirocin was used in eight cases and gentamicin in five cases, with complete resolution in all cases. No adverse effects such as skin symptoms, antibiotic resistance, or non-tuberculous mycobacterial infections were observed. Cases were divided into two groups based on the duration of topical antibiotic use: short-term group < 90 days and long-term group ≥ 90 days. All patients in both groups achieved complete resolution, with no significant differences in time to resolution, number of recurrent ESIs, or occurrence of ESIs after discontinuation of application therapy.ConclusionAdditional use of topical antibiotic for recurrent and/or refractory ESI appears safe and effective. This study suggests that future randomized controlled trials are warranted.

Phyto-fabrication and characterization of gold nanoparticles by using Timur (Zanthoxylum armatum DC) and their effect on wound healing

Abstract Nanotechnology has revolutionized the drug delivery approaches to improve the existing issues of conventional drug delivery systems, especially, the green synthesis of nanoparticles is becoming more suitable for different activities. In this study, phyto-fabricated gold nanoparticles (GNPs) were synthesized using Zanthoxylum armatum aqueous extract. GNPs were characterized by different techniques using UV-Vis absorption spectroscopy, X-Ray diffraction (XRD), Fourier transformation infrared spectroscopy (FTIR), Dynamic light scattering (DLS), and scanning electron microscopy (SEM). UV-Vis spectroscopy showed peak at 550 nm. XRD confirmed the crystalline nature of nanoparticles. FTIR showed presence of different functional groups such as C–O, N–H, C═O, C–H, and O–H. SEM and DLS have shown particle size of 30 nm. The antibacterial activity of plant extract and green synthesized GNP were tested against Staphylococcus aureus, Bacillus cereus, Escherichia coli, and Klebsiella pneumonia which revealed remarkable inhibition of these microorganisms. Burn wound was created on 16 rats and randomized into four groups. Group I was untreated. Group II rats were treated by applying topical ointment cream. Group III rats were treated by applying Zanthoxylum armatum cream, and group IV rats were treated by applying GNPs-based cream. Treatment was carried out for 14 days. Wounds treated with GNPs-based cream decreased consistently and almost completely. It can be concluded that GNPs-based cream can be used as an ointment to treat wounds especially burn wounds.

Pioneering Topical Ointment Intervention for Unprecedented Antimicrobial and Diabetic Wound Management with Phenylpropanoids and Nano-Silver.

Addressing the intertwined challenges of antimicrobial resistance and impaired wound healing in diabetic patients, an oil/water emulsion-based nano-ointment integrating phenylpropanoids-Eugenol and Cinnamaldehyde-with positively-charged silver nanoparticles was synthesized. The process began with the synthesis and characterization of nano-silver, aimed at ensuring the effectiveness and safety of the nanoparticles in biological applications. Subsequent experiments determined the minimum inhibitory concentration (MIC) against pathogens such as Streptococcus aureus, Pseudomonas aeruginosa and Candida albicans. These MIC values of all three active leads guided the strategic formulation of an ointment base, which effectively integrated the bioactive components. Evaluations of this nano-ointment revealed enhanced antimicrobial activity against both clinical and reference bacterial strains and it maintained stability after freeze-thaw cycles. Furthermore, the ointment demonstrated superior in-vitro diabetic wound healing capabilities and significantly promoted angiogenesis, as shown by enhanced blood vessel formation in the Chorioallantoic Membrane assay. These findings underscore the formulation's therapeutic potential, marking a significant advance in the use of nanotechnology for topical wound care.

Milia en plaque secondary to chilblain treated with topical heparin sodium cream

Milia en plaque secondary to chilblain treated with topical heparin sodium cream

Comparative study between efficacy of Excimer light with topical Tacrolimus 0.1% versus excimer light with topical Bimatoprost 0.01% in treatment of facial Vitiligo

Loss and absence of melanocytes due to a number of factors is responsible for vitiligo; known to be the commonest disorder of pigmentation. The aim of the current work was to compare the efficacy and safety of excimer light with topical tacrolimus ointment 0.1% versus excimer light with topical bimatoprost gel 0.01% in treatment of facial vitiligo. The study was carried out on 48 patients presented with facial vitiligo. The patients were divided randomly using sealed envelope method into two groups (24 patients each). Group 1 were treated with excimer light plus topical tacrolimus ointment 0.1% and group 2 treated with excimer light plus topical bimatoprost gel 0.01%. Clinical improvement based on the quartile grading scale at the end of treatment did not show any statistically significant difference between groups. The majority of subjects in both groups experienced good to excellent improvement. Only 20.9% of patients in group 1 and 33.3% of subjects in group 2 achieved less than 50% repigmentation (p = 0.889). Our study demonstrated that 0.01% topical bimatoprost gel in combination with excimer light is considered safe and effective as treatment of nonsegmental facial vitiligo with comparable results to 0.1% tacrolimus.

Cutaneous pharmacokinetics-based bioequivalence: A clinical dermal open flow microperfusion verification study using lidocaine and prilocaine combination topical products

BackgroundUsing accurate, sensitive, reproducible and efficient in vivo cutaneous pharmacokinetics (PK)-based bioequivalence (BE) approaches can promote the development of topical generic drug products. A clinical dermal open flow microperfusion (dOFM) study has previously demonstrated the BE of topical drug products containing a hydrophilic drug. However, the utility of dOFM to evaluate the topical BE of drug products containing moderately lipophilic drugs, more representative of most topical drugs, has not yet been established. ObjectiveTo evaluate the ability of a clinical dOFM study to assess BE of topical products containing two moderately lipophilic drugs that have only minor differences in chemical and physical properties. MethodsThe study included 20 healthy subjects. Four application sites on each thigh were treated with fixed dose lidocaine/prilocaine combination products, and dermal drug concentrations were monitored with two dOFM probes per application site for 12 h. A reference cream was compared to itself and to an approved generic cream (both serving as positive controls for BE), and to a gel (negative control). BE was established based on AUC0to12h and Cmax using the scaled-average-BE approach. Systemic exposure of both drugs was assessed throughout the study. ResultsBE was successfully demonstrated for the positive controls, and not for the negative control, for both drugs. The systemic exposure of both drugs was negligible. ConclusionsdOFM accurately demonstrated BE between bioequivalent topical creams, sensitively discriminated between different formulations and differentiated the cutaneous PK of both study drugs, even though they differ only slightly in chemical and physical properties. These results support the utility of dOFM as a cutaneous PK-based BE approach for topical lipophilic drugs, including lidocaine and prilocaine.

Formulation and Evaluation of Topical Herbal Ointment from Euphorbia Royleana Latex Linn. for Psoriasis

Psoriasis is an inflammatory skin disease characterized by scaling ant inflammation (pain, swelling, heat and Redness) resulting in thick, redskin with silvery scales. These spots may be itchy or painful.Psoriasisis now treated with Systemic, local treatment and light therapy. These treatments have some negative and potentially fatal side effects. Patients With psoriasis are more likely to develop other diseases such as psoriatic arthritis, anxiety and depression, cancer, metabolic Syndrome, cardiovascular disease and Crohn’s disease. Most people use herbal medicine because it is readily available, Cheap and effective. Many plants have promising properties, including remarkable results in the treatment of psoriasis. The Aim of this study is to identify plants, herbal preparations and related therapies that could add value to the development of A better, safe and effective psoriasis drug which can help new researchers in the field (1).

Preclinical development of ATR04-484, an auxotrophic strain of Staphylococcus epidermidis, for the topical treatment of epidermal growth factor receptor (EGFR) inhibitor-induced dermal toxicity.

e24074 Background: Agents targeting the EGFR-mediated signaling pathway are commonly used for the treatment of advanced lung, pancreatic, colorectal, and head and neck cancers. Significant dermal toxicities, which occur in up to 90% of patients treated with EGFR inhibitors (EGFRis) and other therapies inhibiting downstream signaling pathways, may be disruptive to a patient’s quality of life and adherence to therapy. Inhibition of the EGFR pathway may suppress host defenses and lead to opportunistic pathogenic colonization or infection. EGFRi-induced dermal toxicity is associated with elevated levels of Staphylococcus aureus and IL-36γ. ATR04-484 is a topical ointment containing S. epidermidis strain SE484, isolated from a healthy human volunteer that was selected for its ability to inhibit S. aureus and IL-36γ . Methods: Reconstructed human epidermis (RHE) and ex vivo pig skin were used to measure the effect of ATR04-484 on S. aureus in therapeutic and prophylactic settings with S. aureus added prior to or after ATR04-484, respectively. To evaluate the anti-inflammatory effects of ATR04-484, IL-36γ levels were measured on untreated RHE and RHE treated with erlotinib alone or in combination with ATR04-484. 104 colony-forming units (CFU) of methicillin-resistant (MRSA) or methicillin-sensitive (MSSA) S. aureus were used. Toxicology was assessed by measuring cell viability in three in vitro toxicology assays: the eye irritant potential was tested on 3D reconstituted human cornea-like epithelium (RhCE), the skin irritant potential of the strain in the ointment was assessed on 3D RHE, and the skin corrosive potential was evaluated on RHE. Results: ATR04-484 comparably inhibited growth of both MRSA and MSSA in therapeutic and prophylactic settings. In a therapeutic setting, ATR04-484 inhibited MRSA growth by 1 log (90%) compared to untreated MRSA in both RHE and pig skin. In a prophylactic setting, ATR04-484 inhibited MRSA growth by approximately 5 logs on RHE and 2 logs on pig skin. Additionally, application of ATR04-484 reduced IL-36γ to a level comparable to untreated RHE. The effect was dose-dependent; application of 109CFU/cm2 of ATR04-484 showed more potent IL-36γ reduction compared to 108 CFU/cm2. The three toxicology assays indicate that ATR04-484 does not cause irritation or corrosion. Conclusions: In these preclinical studies, ATR-04-484 showed a promising preclinical profile for the treatment of EGFRi-induced dermal toxicity by significantly reducing S. aureus growth, completely ameliorating IL-36γ levels, and showing no safety concerns.

A CASE SERIES AND LITERATURE REVIEW: MANAGEMENT STRATEGIES FOR RADIATION-INDUCED ULCERS OF THE CHEST

Highlights: Radiotherapy leads to a high occurrence of skin alterations and can advance to different levels of tissue damage, presenting challenges in treatment. Management can be effective employing diverse wound treatment methods, although severe cases may necessitate surgical intervention. Surgery takes into several key considerations to increase chances of success and tackle specific issues of chest wall instability and breast reconstruction. Abstract: Introduction: Radiotherapy as an adjunct to cancer treatment causes a high incidence of radiation-induced tissue injury, ranging from radiation dermatitis to severe osteoradionecrosis. Currently, no gold standard exists in the management of radiation injury. Various strategies ranging from modern wound treatment to surgical management have been studied. Case Illustration: Three women presented with varying degrees of ulceration in the chest during or shortly following radiotherapy. Each case followed different approaches to management. One case solely received wound treatment, another received wound treatment and a sequestrectomy, and the third required surgical reconstruction of the chest wall and defect. Discussion: Methods of wound treatment range from topical agents, barrier films and dressings, hydrogel and hydrocolloid dressings, miscellaneous treatments, and biodressings. Surgery is required in severe cases, particularly with osteoradionecrosis. This may include wound debridement, biopsy, chest wall stabilization, closure using various flaps, and potential breast reconstruction. Conclusion: Radiation-induced ulcers of the chest pose a complex issue. Understanding effective treatment methods and key surgical principles is important for ensuring better outcomes. Further studies are needed to provide a complete guide to treatment.

Efficacy and safety of topical NSAIDs combined with physiotherapy for frozen shoulder: a randomized controlled trial.

Frozen shoulder is a prevalent condition among individuals in their middle and later years. Invasive therapy has shown promising results in the treatment of frozen shoulders, but its widespread adoption has been hampered by high costs and the need for advanced medical technology. As a result, patients with frozen shoulders often turn to non-steroidal anti-inflammatory drugs (NSAIDs) for symptomatic relief. However, the oral administration of NSAIDs can lead to troublesome adverse effects on the gastrointestinal, cardiovascular, and urinary systems. In contrast, topical NSAIDs have gained attention for their excellent efficacy and lower adverse effects in various chronic pain conditions. Therefore, our study aimed to investigate the efficacy and safety of topical NSAIDs in improving pain and mobility among patients with frozen shoulders. A total of 108 patients experiencing moderate to severe pain and mobility impairment due to frozen shoulder were enrolled in this study. The participants were randomly assigned to either the experimental group (n=72) or the control group (n=36). The experimental group received daily treatment with the loxoprofen hydrogel patch (LOX-P) in addition to basic rehabilitation physiotherapy. The control group was treated with flurbiprofen cataplasm (FLU-C) twice a day, along with rehabilitation physiotherapy. The primary endpoint for evaluating the efficacy of the two patches was the Constant-Murley score (CMS). Clinical symptom data, adverse events, and patient satisfaction were also recorded. After 14 days of treatment, the effective rate was 66.67% (n=48) in the experimental group and 41.67% (n=15) in the control group. The overall difference in the effective rates was 25.00% (95% CI=5.20-42.52; p=0.013). The safety profiles of the two topical agents were similar, with only a few adverse events reported. The loxoprofen hydrogel patch demonstrates a significant ability to alleviate shoulder pain and restore shoulder function in the treatment of frozen shoulder, with minimal adverse reactions. Chictr.org.cn ID: ChiCTR2100052375.