Topical Research Articles

The Efficacy of Silver Diamine Fluoride as a Caries Preventive Agent on Permanent Teeth: A Scoping Review.

Dental caries is a chronic condition that affects people of all ages and has a high prevalence in Indonesia. Applying silver diamine fluoride (SDF) as a topical fluoridation agent is one of the approaches to prevent bacterial interactions that lead to the development of carious lesions. This study aims to determine the efficacy of SDF as a caries preventive agent on permanent teeth. Article searches were conducted using the keywords "silver diamine fluoride" AND "permanent tooth OR permanent teeth" AND "caries OR dental caries" AND "remineralize" through digital databases including PubMed, Cochrane Library, Science Direct, and Google Scholar. Articles with randomized controlled trial or nonrandomized controlled trial designs, articles written in Indonesian or English, publications published within the last 5 years (2016-2021), and aligned with the PCC (population, concept, and context) framework were included. Articles that were not accessible in full text or in a paid format, those that were of the meta-analysis or systematic review study type, and those that did not evaluate the use of SDF as a caries preventive agent were excluded from consideration. This scoping review refers to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions for Scoping Reviews (PRISMA-ScR) guidelines. A total of 8 articles were reviewed, encompassing various locations, designs, and samples, which demonstrated the use of SDF resulted in a high percentage of fluoride release with a high degree of remineralization efficacy. The deposition of crystals or minerals into fissures and crevices caused by demineralization indicated a reduction in lesion depth and influenced the microhardness of enamel. SDF can stimulate the rehardening of tooth structures rich in calcium and phosphate. The solution of SDF has the potential to serve as an alternative substance for preventing caries in permanent teeth because it enhances mineral precipitation and mineral density, promotes the remineralization of hydroxyapatite in enamel by increasing fluoride, and increases tooth structure resistance to acid attack.

Allergic contact dermatitis due to 1,6-hexanediol diacrylate in ostomy patients.

Many people live with ostomies after life-saving surgery. Ostomy patients often suffer from peristomal dermatitis. Allergic contact dermatitis (ACD) has been reported, mostly due to contact allergy (CA) to topical agents. We present three patients with therapy resistant peristomal dermatitis, suggesting ACD caused by different stoma products. Patch testing was performed with baseline series, additional series, and selected allergens. They were also tested with their own ostomy products as is and separate extracts of the products. Extracts were analysed using Gas Chromatography-Mass Spectrometry (GC-MS). In all three patients we diagnosed CA to 1,6-hexanediol diacrylate (HDDA), +++ in case (C) 1 and 3, ++ in C 2. HDDA was detected in C 2's ostomy pouch adhesive and in C 1's and 3's flange extenders used to improve the adhesion of the ostomy pouches. Therapy resistant peristomal dermatitis should always be suspected of ACD and patch testing, especially with the patient's own products, should be performed.

571 - Case series of topical 1.5% ruxolitinib cream for pediatric vitiligo

Abstract Introduction/Background Pediatric Vitiligo affects 1.52% of 4-11-year-olds within the United States and 2.16% of 12-17-year-olds with non-segmental disease affecting 65% and 69% respectively (1). The FDA has not approved any medications for vitiligo for children younger than 12 years of age. Additionally, about one-third of pediatric vitiligo is segmental (1), and there is no FDA-approved topical agent for segmental vitiligo in any pediatric age group (2). Objectives To identify the efficacy of 1.5% ruxolitinib cream for pediatric vitiligo in clinical practice. Methods An IRB-exempted pediatric chart review was conducted addressing the usage of 1.5% ruxolitinib cream, currently FDA-approved for non-segmental vitiligo affecting 10% of body surface area or less for 12 years of age or older. All children and adolescents using topical 1.5% ruxolitinib cream including segmental, non-segmental, and mixed vitiligo including individuals up to age 17 years. Results Twelve children were identified with topical usage of 1.5% ruxolitinib cream for vitiligo ages 3-16 years (average age: 10.75 years). Demographics included 9 males, 3 females and race/ ethnicity included Black (n=1), Hispanic/ Latin X (n=4), Indian (n=1), and White (n=6). Vitiligo subtype included: Non-segmental vitiligo (n=7), Mixed type vitiligo (n=1), and segmental vitiligo (n=4). Regarding treatment subgroup of Non-segmental vitiligo and the non-segmental component of the Mixed type included 8 children, average age of 10.4 years (range 3-15 years), including 5 children under the age of 12 years (one 3-year-old, two 9 year-olds, and two 10 year-olds). Treatment was once daily in 1 child and twice daily in 7 children. One was lost to follow-up. Of the 6 children with documented response, average maximum repigmentation occurred at 6.14 months (range 3-12 months), with five achieving complete repigmentation, one partial repigmentation with only a three-month trial. The average length of disease before treatment began was 1.25 years (1 month to 6 years). The onset of response was 1.57 months on average (range 1-3 months). The initial location of response was the face (n=3), arms (n=2), and abdomen (n=1). No adverse events were reported. Four children had a complete blood count while on medication, with no laboratory abnormalities, including the 3-year-old. Two had a parent with vitiligo. Four patients previously failed tacrolimus topically, two patients failed topical class 2 corticosteroids, and one previously failed narrowband UVB, with no notable difference in response in these patients. Regarding treatment subgroup of Segmental vitiligo including five SV patients average age 11.2 years (range 5-16 years). One had facial segmental, one face and neck lesion (solitary stripe), one chest/back, and one on the lower abdomen. The five year-old did not repigment after 6 months of neck application, but never developed poliosis. The ten-year-old with segmental disease for 6 years had no response. The eleven-year-old SV of the chest/ back failed topical tacrolimus and responded with 40% repigmentation over 3 months, increasing to 90% after 5 months and 12 concurrent sessions of 308-nm laser. The 14-year-old developed slight poliosis, but started repigmenting within 3 weeks, with continuous usage and subtotal repigmentation at 14 months. The 16-year-old began to repigment after 1 month, with a concurrent weekly 308-nm laser, and subtotal repigmentation after 5 months. Repigmentation was One facial SV (12 treatments), one chest/back SV (12 treatments), and one NSV had concurrent 308-nm laser (24 treatments) with pulsed dexamethasone, without any notable adverse events. Two teenage males (ages 15 and 16 years) developed acne on sites of application on the face. Laboratory screening including complete blood count was normal during treatment for 2 patients evaluated. Conclusions NSV responds to 1.5% topical ruxolitinib consistently, with a solitary patient responding to once daily, and efficacy in children as young as three years of age with no notable lab abnormalities in screened patients. Topical 1.5% ruxolitinib cream appears very effective in repigmenting SV in children if used twice-daily and in combination with 308-nm laser sessions in the first 6 months. Topical ruxolitinib can cause acne in teenagers with facial segmental vitiligo. Early institution of topical 1.5% ruxolitinib cream appears to have a rapid onset of repigmentation (average 1.57 months) and rapid complete response (6.14 months). Clinical trials of 1.5% topical ruxolitinib in children are needed to identify outliers and long term outcomes. Early institution of therapy appears to speed up the response. Adjunctive 308-nm laser is promising but requires placebo-controlled trials.

Comparison of the clinical efficacy of topical tretinoin 0.05% cream and tacrolimus 0.1% ointment plus iontophoresis in the management of palmoplantar psoriasis.

Palmoplantar psoriasis (PPP) is a localized variant of psoriasis that may be resistant to topical therapy, owing to the poor penetrability of topical agents at this anatomical site. Modalities that enhance localized cutaneous delivery of drugs could help to solve this problem. Iontophoresis is one such procedure that augments transdermal drug delivery, thus enabling better and expeditious therapeutic outcomes. To compare the therapeutic efficacy and safety of iontophoresis with tretinoin 0.05% cream and tacrolimus 0.1% ointment in treating patients with PPP. Sixty patients with PPP (28 males and 32 females, age range 8-76 years) were enrolled and randomly assigned to one of two groups comprising 30 patients each. One group (12 males and 18 females) received iontophoresis with tretinoin 0.05% cream; the other (16males and 14 females) received iontophoresis treatment with tacrolimus 0.1% ointment. Both groups received treatment weekly from baseline until 4 weeks and then fortnightly at weeks 6 and 8. Clinical images were taken at each visit and improvement of psoriasis was evaluated using the erythema, scaling, induration and fissuring (ESIF) score. The percentage reduction in ESIF score was also assessed on completion of treatment and the grade of improvement noted for each patient. Twenty-seven patients in the iontophoresis with tretinoin 0.05% cream group and 29 in the iontophoresis treatment with tacrolimus 0.1% ointment group completed the study. The mean (SD) ESIF score in the former decreased significantly from 8.7 (2) at baseline to 3.2 (1.7) at the study endpoint (P < 0.001). Similarly, in the latter group, there was a substantial reduction in mean (SD) ESIF score from 8.2 (1.9) at baseline to 3.3 (1.1) at the study end (P < 0.001). No significant adverse effects were encountered in either treatment arm. Iontophoresis using tretinoin and tacrolimus was found to be effective and safe for the treatment of PPP. Although iontophoresis with tretinoin showed slightly better results than with tacrolimus, these were not statistically significant.

HPMC/PVP K90 Dissolving Microneedles Fabricated from 3D-Printed Master Molds: Impact on Microneedle Morphology, Mechanical Strength, and Topical Dissolving Property.

Three-dimensional (3D) printing can be used to fabricate custom microneedle (MN) patches instead of the conventional method. In this work, 3D-printed MN patches were utilized to fabricate a MN mold, and the mold was used to prepare dissolving MNs for topical lidocaine HCl (L) delivery through the skin. Topical creams usually take 1-2 h to induce an anesthetic effect, so the delivery of lidocaine HCl from dissolving MNs can allow for a therapeutic effect to be reached faster than with a topical cream. The dissolving-MN-patch-incorporated lidocaine HCl was constructed from hydroxypropyl methylcellulose (HPMC; H) and polyvinyl pyrrolidone (PVP K90; P) using centrifugation. Additionally, the morphology, mechanical property, skin insertion, dissolving behavior, drug-loading content, drug release of MNs and the chemical interactions among the compositions were also examined. H51P2-L, H501P2-L, and H901P2-L showed an acceptable needle appearance without bent tips or a broken structure, and they had a low % height change (<10%), including a high blue-dot percentage on the skin (>80%). These three formulations exhibited a drug-loading content approaching 100%. Importantly, the composition-dependent dissolving abilities of MNs were revealed. Containing the lowest amount of HPMC in its formulation, H901P2-L showed the fastest dissolving ability, which was related to the high amount of lidocaine HCl released through the skin. Moreover, the results of an FTIR analysis showed no chemical interactions among the two polymers and lidocaine HCl. As a result, HPMC/PVP K90 dissolving microneedles can be used to deliver lidocaine HCl through the skin, resulting in a faster onset of anesthetic action.

Correção: Cuidados de enfermagem na prevenção de quebras de pele no idoso: revisão integrativa da literatura

Introduction Skin tears are considered injuries of traumatic etiology that can result from a variety of mechanical forces, such as shear or friction forces, blunt trauma, falls, improper handling, injury caused by equipment or removal of adherent dressings. These are acute wounds that have a high probability of becoming complex chronic wounds. They cause pain, increase healthcare costs, reduce quality of life and are a source of stress for the person. They lengthen hospital stay and increase the risk of morbidities. Skin Tears are a growing problem, making it crucial to invest in this topic in order to promote their prevention and proper treatment. Objective To identify nursing care and strategies to prevent skin tears in the elderly. Methods A bibliographic survey of publications was carried out in the EBSCOhost search engine, which incorporates the CINAHL Complete, MEDLINE Complete and Cochrane Database of Systematic Reviews databases and in the PubMed database, carried out in June 2022. 26 records were returned, five meeting the inclusion criteria. The included studies (n=5) were carried out between 2012 and 2022. Results In the sample of articles, it was possible to identify the benefits of twice-daily application of topical products, moisturizing creams and emollients, and the relevance of oral administration for 8 weeks of an oral nutritional supplement in the hydration of the stratum corneum and in the elasticity of the skin, as well as the importance of primary prevention and the promotion of health education in elderly skin care. Conclusion Preventive care to avoid skin tears in the elderly focuses on the daily topical application of moisturizing creams and emollients, nutrition (administration of oral nutritional supplements with 10g of collagen peptides) and adequate hydration; to prevent cutaneous traumas by providing a safe environment with adequate devices, and through the promotion of health education.

(123) Preliminary Efficacy of Sildenafil Cream, 3.6% in an Exploratory, Randomized, Placebo-Controlled, Phase 2b Trial for the Treatment of Female Sexual Arousal Disorder

Abstract Introduction Female sexual arousal disorder (FSAD) is a persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement that causes marked distress or interpersonal difficulty. The biologic mechanisms leading to FSAD are similar to male erectile dysfunction. Objective To test the preliminary efficacy of topical Sildenafil Cream, 3.6% among women with FSAD in a randomized, placebo-controlled, double-blind, exploratory Phase 2b study. To describe, using validated 28-day recall instruments, changes in sexual function with treatment, and to validate exploratory sexual function questionnaires in a placebo-controlled trial. Methods Healthy pre-menopausal women, aged 18-years or older and their sexual partners, if applicable, were screened and provided written informed consent. An individual clinical interview with each volunteer was conducted in order to establish that FSAD was present and was the primary sexual dysfunction concern. Women at risk of pregnancy used effective contraception during the study. Women or their partners were excluded if they had un-controlled hypertension, a history of serious cardiac events (e.g. myocardial infarction, stroke), orthostatic hypotension or other serious medical co-morbidities. The co-primary efficacy endpoints were measured by the arousal sensation domain of the sexual function questionnaire (SFQ28) and question 14 of the female sexual distress scale (FSDS). After a one-month, no drug, run-in period, and a one-month, single-blind placebo, run-in period, 200 eligible women were randomized to receive Sildenafil Cream, 3.6% (n=101) versus placebo cream (n=99). Participants applied 2 grams of the investigational product to the clitoris, vestibule, labia minora and anterior distal vagina 10 – 20 minutes prior to each partnered or un-partnered sexual experience. During the 12-week, double-blind treatment period, participants were seen monthly and completed validated, 28-day recall questionnaires. Efficacy was also measured by a 12-question Arousal Diary (AD), completed within 24 hours of each sexual experience. Results Volunteers (n=833) underwent informed consent in this ethics board (Advarra Pro 00049161) and U.S. Food and Drug Administration approved study (IND 119922), registered at ClinicalTrials.gov (#NCT04948151). There were 1131 Sildenafil and 951 placebo exposed sexual experiences recorded in the AD during the double-blind treatment period. Sildenafil Cream, 3.6% treated women had a higher proportion of satisfactory sexual events than placebo users. At 12-weeks of use, there was improvement in the co-primary endpoint of arousal sensation consistent with how women reported meaningful improvement in an exit interview at the end of the study, although this did not achieve statistical significance. Sildenafil Cream, 3.6% treated women showed improvements in pre-specified exploratory endpoints that evaluated various aspects of the sexual experience including desire (p=0.02), arousal lubrication (p = 0.059) and orgasm (p=0.066) after 8 weeks of product use. Conclusions Data from this exploratory, placebo-controlled study of topical Sildenafil Cream, 3.6% for the treatment of FSAD in healthy premenopausal women support further clinical development of this first potential treatment for FSAD. Disclosure Yes, this is sponsored by industry/sponsor: Dare Bioscience and Strategic Sciences and Technologies (SST), LLC. Clarification: Industry initiated, executed and funded study. Any of the authors act as a consultant, employee or shareholder of an industry for: Dare Bioscience and SST LLC.

(266) Miconazole Vaginal Cream-Induced Acquired Neuroproliferative Vestibulodynia

Abstract Introduction The endodermal vestibule lies between the ectodermal vulva and the mesodermal vagina. Unlike the vulvar skin, the vestibular epithelium is thin, non-keratinized, and its submucosal immune cells are more susceptible to activation. Topical pharmaceutical agents that are applied to the genitals for various medical indications are likely to contact the vestibular epithelium. For example, miconazole vaginal cream (MVC) is approved for treatment of vaginal yeast infections and the irritation associated with the yeast infection. Active and inactive ingredients in MVC include miconazole nitrate, benzoic acid, cetyl alcohol, isopropyl myristate, polysorbate 60, potassium hydroxide, propylene glycol, purified water and stearyl alcohol. We have observed cases where individuals, previously without vestibular pain, have applied MVC to their genitals and immediately experienced excruciating burning that resulted in persistent unrelenting severe pain throughout the vestibule, which is a symptom of acquired neuroproliferative vestibulodynia (ANPV). Objective Our objective is to report cases of patients who used MVC and were diagnosed with ANPV in order to provide awareness of this condition. Methods We performed a retrospective chart review of persons with vulvas presenting to a single sexual medicine clinic between 6/2019-6/2023 who were clinically suspected to have ANPV after experiencing an allergic reaction following use of MVC. Patients were included who failed conservative treatments for provoked vestibular pain, underwent vestibulectomy and were histopathlogically diagnosed with ANPV (&amp;gt;8 CD117 stained immunopositive cells per high-power field (HPF), consistent with mast cells, and excess PGP117 stained immunopositive cells, consistent with nerves). Demographic data, prior diagnoses and treatments, and results from validated questionnaires were collected. Results Our patient cohort included 7 individuals who met the criteria for MVC-induced ANPV. Mean age at time of MVC-induced vestibular pain was 23 (range 18-29) years. Mean age of presentation to our sexual medicine facility was 28 (range 22-33) years. Mean years of delay in diagnosis of MVC-induced ANPV was 5 (range 1-12) years. 71% and 29% were previously diagnosed and unsuccessfully managed as hormone-mediated vestibulodynia and interstitial cystitis, respectively. The mean pain score and overall score for the Female Sexual Function Index (FSFI) was 1.2/6 (range 0-3.2/6) and 11.7/36 (range 4.2-18.1/36), respectively. All total FSFI scores were &amp;lt;26 and indicative of sexual dysfunction. The mean Female Sexual Distress Scale-Revised score was 32.2/52 (21-39/52), consistent with significant distress. Conclusions Our cohort of patients with MVC-induced ANPV experienced several years of misdiagnoses, unsuccessful treatments, and significant pain and distress. It is hypothesized that MVC induces ANPV in genetically susceptible individuals possibly due to activation of the innate submucosal immune cells from an allergic reaction to active or inactive ingredients in the MVC. This allergic reaction results in accumulation of mast cells in the subepithelial stroma that release cytokines and growth factors leading to proliferation of nerves with subsequent symptoms of allodynia and hyperalgesia. Avoidance of topical medications and use of systemic antifungal strategies in individuals with yeast infections may be advisable. Disclosure No.

Comparison of the effect of topical triamcinolone 0.1% cream with sulfur 2.0% cream in the treatment of patients with hand eczema: A randomized controlled trial.

Hand eczema (HE) is a common and heterogeneous condition. It has a wide range of etiologies and clinical manifestations. In this study the efficacy of triamcinolone 0.1% cream and sulfur 2% creams was compared in treating patients with HE. This randomized, triple-blind clinical trial was performed on 70 patients with HE (including 70 right and 70 left hands). In this study, two creams were used including triamcinolone 0.1% and sulfur 2.0%. Patients were treated with these creams twice a day (once in every 12 h) for 4 weeks. Follow-up was 4 weeks after treatment. Hand Eczema Severity Index (HECSI), itching, dryness, burning sensation, and erythema scores were collected three times during the study and compared between treatment regimens. Findings showed that both triamcinolone (0.1%) and sulfur (2.0%) creams could significantly reduce the scores of HECSI, itching, dryness, burning sensation, and erythema, and the therapeutic effects lasted for at least 4 weeks after cessation of topical treatment. Topical sulfur cream (2.0%) is as effective as triamcinolone (0.1%) cream in treatment of HE without any prominent adverse reactions.

Moisturizers for the treatment and prophylaxis of atopic dermatitis exacerbations

Atopic dermatitis is a global problem with increasing prevalence. Genetic predisposition to allergies, epidermal barrier dysfunction, and T2 immune response underlie atopic dermatitis. Xerosis, itchy skin, and exacerbation are the main atopic dermatitis symptoms, leading to increased permeability of allergens and microbes through the damaged epidermis and to the development of sensitization. The main purpose of atopic dermatitis therapy is to achieve long-term remission and improve quality of life. Topical treatment includes glucocorticosteroids, topical calcineurin inhibitors, and emollients to reduce inflammation, xerosis, and infection prevention. Daily use of effective emollients as basic skin care can improve epidermal barrier function, provide skin hydration, and reduce the need for topical glucocorticosteroids.

Pooperacinių antriniu būdu gyjančių žaizdų priežiūra: literatūros apžvalga

Abstract. According to the World Health Organisation (WHO) ‘Half the cases of post-operative hard-to-heal wounds can be avoided’ [1]. Foreign authors A. E. Boniakowski, A. S. Kimball, B. N. Jacobs, et al. (2017) state that ‘Wound monitoring and periodic post-operative wound care performed at periodically planned time are important at all stages of wound healing’ [2]. &#x0D; Objective of the literature review. To analyse scientific articles on risk factors and wound management of hard-to-heal wounds. &#x0D; Methods. The literature review was conducted using the PubMed, ECDC, and Google Scholar search in the electronic MEDLINE database. The search was carried out between September and December 2023. Keyword phrases and their combinations were used for the search. Twenty three articles on the examined topic were included in the literature review. &#x0D; Results of the literature review. The present article discusses the main risk factors for wound infection and preventive measures. After analysing scientific articles, the causes of hard-to-heal wounds have been elucidated, which depend on the nature of the surgery, different pathogenic microorganisms, and the selection of dressings at each stage of wound healing.&#x0D; Conclusions. 1. Favourable conditions must be created for wound healing. Regular assessment of the wound healing process based on clinical indicators is attributed to an important factor. 2. Topical antimicrobial agents are used when wound healing is suspected to be impaired; dressings are selected based on the type of wound healing.

Efficacy and safety of topical analgesic agents for the treatment of chronic musculoskeletal pain

According to a prior systematic study, systemic NSAIDs effectively ease pain associated with chronic conditions such as osteoarthritis and tendinitis. A new evaluation is required in light of more trials, improved knowledge reclassification of some drugs, and trial quality and bias evaluation. Electronic database searches and letters to manufacturers assisted in finding studies for adults with persistent pain and discovered randomized, double-anonymized studies contrasting topical NSAID with a successful placebo treatment. At two weeks, 50% less pain was an important result; secondary results included local and systemic problems and withdrawals given negative incidents. Utilizing sensitivity and number-needed-to-harm (NNH) analyses as well as estimations of relative benefit, the impacts of reported outcome, trial size, reported trial quality, and condition treated are still assessed. There are 14 studies total, including 12 new trials and 13 trials of an earlier evaluation. Nearly 1,500 patients were involved in 14 double-blind, placebo-controlled studies. With a relative benefit of 1.9 and an NNT of 4.6, topical NSAID considerably outperformed a placebo. The trial's validity, quality, and size, a given outcome, treated affect findings. There was no difference in effectiveness between oral and topical NSAIDs in three studies, including 764 participants. Topical NSAIDs and placebos caused 6% of local adverse events, 3% of systemic adverse events, and patient withdrawals because of adverse events. Topically applied NSAIDs for two weeks offered a secure and effective treatment for long-term musculoskeletal conditions. Larger and longer studies are required to explain a part of topical NSAIDs in healthcare properly.

A Clinico-Epidemiological Study on Porokeratosis.

Porokeratosis (PK) is a chronic progressive disorder of keratinization characterized clinically by hyperkeratotic papules or plaques surrounded by a threadlike, elevated border that expands centrifugally. Pathogenesis involves heterozygous mutations in mevalonate kinase enzyme. The most common variants are disseminated superficial actinic porokeratosis (DSAP) and PK of Mibelli. All forms show a thin column of parakeratosis, the cornoid lamella, representing the active border. Dermoscopy reveals central brownish discoloration surrounded by a single hypopigmented band and a peripheral 'white track'. Long-standing cases of PK may undergo malignant transformation. UV-protection and topical agents, such as 5-fluorouracil, imiquimod, calcipotriol, tretinoin and oral retinoids are helpful. To study the clinical and epidemiological pattern of PK and the clinico-dermoscopic and histopathological correlation of PK. A prospective cross-sectional study was conducted on the patients attending the dermatology outpatient department (OPD) over 9 months with suspected features of PK. These patients were evaluated clinically and subjected to dermoscopy and histopathology. Statistical Package for the Social Sciences (SPSS) Of 11 patients, there were four (36.36%) males and seven (63.66%) females. The youngest was 18-year-old boy, and the eldest was 63-year-old man. The clinically most common type was PK of Mibelli with five (45.45%) cases. The most common dermoscopic feature observed was double-marginated, white peripheral border. The most common histopathological feature noted was cornoid lamella. PK is a rare skin disorder with a wide spectrum of clinical variants. Dermoscopy and histopathology aid in diagnosis, whereas dermoscopy plays a pivotal role in early and non-invasive diagnosis. Regular follow-up is mandatory to watch for the development of malignancies in a few variants.

Perianal warty dyskeratoma

Warty dyskeratoma is a rare keratinization disorder marked by acantholytic dyskeratosis and belongs to the spectrum of acantholytic dyskeratosis in dermatology. It was first documented in 1954 and typically manifests in the head, neck, oral mucosa, and trunk, with several cases reported since its discovery. A 35-year-old unmarried gentleman presented in April 2022 with a 5-year history of perineal itching and discomfort. His physical examination revealed a 7-8 centimeter perianal grouped papular plaque. His medical history was unremarkable, and he has no family history of similar conditions or other dermatological disorders. Lab results showed non-reactive rapid plasma reagin and human immunodeficiency antigen/antibody combo. Liver and renal function tests were within normal range as well. The microscopic findings revealed features including prominent hyperkeratosis, invagination filled with keratin, and the surrounding area exhibiting acantholysis and intercellular edema. In conjunction with the patient’s clinical presentation, this histological profile led to the diagnosis of warty dyskeratoma. After treatment with calcipotriene and other topical agents, the last presentation showed very good improvement; the physical examination indicated remarkable thin, flat, soft, grayish plaque in the perianal area. This case report presents a unique instance of warty dyskeratoma affecting the perianal area, shedding light on differential diagnosis and clinical management in this atypical context, which significantly broadens the understanding and emphasizing that the Warty dyskeratoma can manifest in diverse body regions, urging its consideration in the differential diagnosis of perianal papular lesions.

Topical Chinese Herbal Medicine Treatment of a Non-healing Leg Wound in a Horse: A Case Report

Wound care in horses, particularly chronic non-healing lesions, pose a major medical challenge for equine practitioners and can result in considerable financial loss as well as missed training goals for owners. The lower equine limb is particularly susceptible to damage due to the lack of protective muscling and superficial synovial and tendinous structures. This paper presents the treatment of a non-healing distal leg wound in a horse by topical application of a Chinese herbal medicine decoction using a traditional Chinese veterinary medicine (TCVM) approach. The patient had sustained damage to the palmar aspect of the flexor tendons on the left thoracic limb caused by jumping off a transport vehicle. This injury was initially treated by cleaning the area, topical erythromycin antibiotic ointment and intramuscular injection of penicillin for 3 days. Over a 2-month period the initial trauma progressed to a chronic non-healing wound. Medical management of the wound was then changed to topical application of a Chinese herbal decoction which was applied 3 times daily. Over a 29-day period, this treatment encouraged normalization of the wound healing process with epithelization, tissue remodeling and normal scar formation. The clinical results achieved in this horse suggest topical treatment with Chinese herbal medicine can decrease complications and speed the healing process of chronic wounds. The use of the topical herbal formula in this case was convenient, simple to use, and cost effective.

Comparative Analysis of Topical Insulin Dressing Vs Normal Saline Dressing in Diabetic Foot Ulcers Wound Healing

Background: Foot ulcers, a dangerous and common consequence of diabetes, currently have no particular therapeutic options. There are many topical medicines and ointments available for wound management.It has been observed that topical insulin dressings effectiveness is better than other dressings. Aim: To determine the effectiveness of Topical Insulin dressing VS Normal saline dressing in diabetic ulcer in terms of rate of reduction in ulcer area in days and need for re debridement Methods: A randomized control trial conducted in Emergency and Outdoor Department of South Surgical ward, Mayo Hospital, Lahore.Study was carried out insix months from Sept 2022 to March 2023. A total 86 patients fulfilling the selection criteria presented to outdoor/Emergency of South surgical department of general surgery of Mayo Hospital, Lahore falling in Wagner’s classification I and IIwere enrolled in the study after taking informed consent. Patients were divided by method of random allocation (lottery method) to Group A (Topical insulin dressing) and Group B (Normal saline soaked dressing) after explaining the procedure. Rate of reduction in ulcer area was measured in days. Need of re-debridement was labeled as ‘yes’ if patient needed re-debridement or ‘no’ if patient did not need re-debridement. Results: Baseline mean wound area in Group A and in Group B was 34.87±29.23 cm2 and 27.45±24.00cm2. After 2 weeks the wound area reduced to 9.35±10.75 cm2 and 7.33±9.29 cm2 respectively. Mean days for rate of reduction in ulcer areas was significantly less in Group A patients than in Group B patients (p-value&lt;0.001). Rate of re-debridement for Group B patients was significantly higher than patients in Group A (Group A: 18.6% vs Group B: 46.5%, p-value= 0.006). Improved wound healing will reduce need of redebridement and minor to major foot amputations. Conclusion: This study concludes that topical insulin dressing is more effective as that of normal saline soaked dressing for management of diabetic ulcer in terms of rate of reduction in ulcer area in term of days and need for re debridement. Keywords: Effectiveness, Normal saline Dressing, Topical Insulin dressing, Diabetic foot ulcer, Ulcer area, Re-debridement.

Sporotrichosis from a tertiary care hospital in the Eastern State of India

Sporotrichosis is a form of subcutaneous or systemic fungal infection caused by Sporothrix schenkii. This is a thermophilic, dimorphic fungus that occurs worldwide in tropical and temperate areas. We report a case series of sporotrichosis in three patients from a tertiary care center in Assam. The source of infection could be identified in each patient. The patients were successfully treated with oral and topical antifungal agents, which included capsule Itraconazole and supersaturated potassium iodide therapy.

Effectiveness of Narrowband Ultraviolet Light in Chronic Kidney Disease-Associated Pruritus.

Chronic kidney disease-associated pruritus (CKDaP) is a prevalent and challenging symptom in individuals suffering from advanced chronic kidney disease (CKD). Its underlying mechanism remains inadequately understood, leading to a limited array of unsatisfactory therapeutic interventions. Despite various attempts, identifying the most effective treatment remains inconclusive. Nevertheless, there is a growing interest in employing ultraviolet phototherapy, particularly for non-responsive patients, although its efficacy is not definitively established. To investigate the potential benefits of narrowband ultraviolet B (NB-UVB) phototherapy on individuals experiencing CKDaP, we report our experience with NB-UVB light in management of CKDaP in dialysis patients. The study group consisted of patients with end-stage chronic kidney disease who underwent hemodialysis. These patients received dermatological consultations and follow-ups for itching. They were all unresponsive to the conventional treatment (emollients and antihistamines). Screening laboratory examinations, including complete blood count, liver function test, thyroid function, electrolytes, and others, were also arranged to exclude systemic etiologies. The main potential pruritogens were dosed: calcium, phosphate, and parathyroid hormone. Itch intensity was evaluated with a numericalrating scale(0-10), based on the worst level ofitchingin the past two weeks.They had sessions of NB-UVB light (311 nm, TL01) twice per week. After UVB exposure, patients were advised to use topical emollients. A questionnaire was employed to document the extent, intensity, frequency, and sleep disruption experienced to evaluate the efficiency of the treatment, using a scale from 0 to 10. Results: In a group of 38 patients, the average age of the patients was 56 years (16-80); 63.2% were female and 36.8% were male. Median duration of pruritus was 4.7 years, and that of dialysis was 8.4 years. Pruritus was intermittent and diffuse in most cases, localized to the arteriovenous fistula site in two cases, and exacerbated by heat in all cases. Itch intensity was evaluated with a numerical rating scale (0-10) based on the worst level of itching in the past two weeks and showed a moderate average score (5/10). Xerosis was found in 63%, and scratch lesions such as excoriation in 34%. NB-UVB phototherapy was used twice per week on nonconsecutive days, with protection of the genital area and also the eyes using UVB-blocking goggles. The initial dose was 0.4 J/cm2and further doses were introduced according to the erythema response until a maximum of 2 J/cm2. No sunburn, hyperpigmentation, or blistering was noted. Emollients were maintained in patients with xerosis. Average number of sessions was 13 (6-24)and reduction of itch intensity was observed starting from the sixth session. Total improvement was obtained at the end of treatment duration except for three patients who required additional sessions. One patient had recurrence one year later. Conclusion: In conclusion, phototherapy represents a significant advancement in the treatment options for CKD-associated pruritus. Its positive impact on reducing itching and improving the quality of life for many patients is undeniable. However, to fully unlock its potential, ongoing research is needed to optimize dosing, understand relapse mechanisms, and identify the patients who will benefit most from this therapy.

Comparison of the Efficacies of Topical Liposomal Amphotericin B and Topical Clotrimazole in the Treatment of Pityriasis Versicolor.

Pityriasis versicolor (PV) often exhibits recurrence even despite treatment, and a standardized therapy with a complete cure rate remains elusive. Given the fungicidal property of amphotericin B, its potential for PV treatment warrants investigation. This study aimed to compare the efficacy of topical liposomal amphotericin B and clotrimazole cream in treating PV. A randomized controlled trial was conducted with 44 PV patients, aged 15 to 70 years, who were equally assigned to either the amphotericin or clotrimazole group. The trial was registered at the Iranian Registry of Clinical Trials on March 7th, 2022. PV diagnosis was confirmed in all patients through positive microscopic results. The amphotericin group received topical gel containing liposomal amphotericin B 0.4%, while the other group received topical cream containing clotrimazole 1%. Both treatments were applied twice daily to the affected skin lesions for 14 days. The primary outcomes assessed were mycologic cure, clinical cure, and complete cure at day 14 post-treatment. Both drugs demonstrated successful treatment outcomes, with comparable rates of mycologic cure (77.3%), clinical cure (63.6%), and complete combined cure (63.6%). There was no significant difference between the groups in terms of the degree of cure (P=0.75). Adjustments for age, sex, lesion extent, and lesion site yielded insignificant risk ratio and risk difference estimates for the complete cure rate (P>0.05).

Efficacy of topical gabapentin in women with primary macular amyloidosis: A side-by-side triple-blinded randomized clinical trial.

Primary cutaneous macular amyloidosis (PCMA) is a chronic pruritic cutaneous disease characterized by heterogeneous extracellular deposition of amyloid protein in the skin. This study aimed to evaluate the efficacy of topical 6% gabapentin cream for the treatment of patients with PCMA. In this triple-blind clinical trial, a total of 34 patients, who were diagnosed with PCMA, treated using two different strategies of topical gabapentin as the active group and vehicle cream as the control group. Pruritus score reduction in both groups was statistically significant compared with the baseline value (p < 0.001). There was a significant pigmentation score reduction in intervention group compared with control group after 1 month of the study (p < 0.001). The differences of pigmentation score changes between the groups were not significant at month 2 (p = 0.52) and month 3 (p = 0.22). The results of this study suggest that topical gabapentin cream may be effective as a topical agent in the treatment of pruritus associated with PCMA without any significant adverse effects. It is recommended to perform similar studies with a larger sample size and longer duration in both sexes.