Use Of Topical Products Research Articles

Assessment of ethanol exposure from hand sanitizer use and potential for developmental toxicity in nursing infants

Ingestion of ethanol during pregnancy is known to have detrimental effects on the fetus. Although the potential developmental effects of maternal ethanol intake during lactation are less well characterized, public health guidelines recommend avoidance of alcohol or, if alcohol is consumed, to allow for 1–2 h to pass before nursing. A proposal to classify ethanol as potentially harmful to breast‐fed children warrants an investigation of the potential adverse neurodevelopmental effects of low‐dose ethanol exposure during lactation. There currently are no studies that have examined neurodevelopmental outcomes from lactational exposure to ethanol from the use of topical products that contain ethanol, such as alcohol‐based hand sanitizers (ABHS). Furthermore, the epidemiological literature of lactational ethanol exposures from maternal alcohol consumption is limited in design, provides equivocal evidence of neurological effects in infants, and is insufficient to characterize a dose–response relationship for developmental effects. Toxicological studies that observed neurodevelopmental effects in pups from ethanol via lactation did so at exceedingly high doses that also caused maternal toxicity. In this investigation, blood ethanol concentrations (BECs) of breastfeeding women following typical‐to‐intense ABHS use were computationally predicted and compared to health benchmarks to quantify the risk for developmental outcomes. Margins of 2.2 to 1000 exist between BECs associated with ABHS use compared to BECs associated with neurotoxicity adverse effect levels in the toxicology literature or oral ethanol intake per public health guidelines. Neurodevelopmental effects are not likely to occur in infants due to ABHS use by breastfeeding women, even when ABHSs are used at intense frequencies.

Practical view of the topical treatment of peripheral venous catheter-related phlebitis: A scoping review.

To identify and analyse topical treatments for peripheral venous catheter (PVC)-related phlebitis. The methodological framework used to make this scoping review was developed by Arksey and O'Malley (2005; (International Journal of Social Research Methodology, 8, 2005 and 19)). A literature search was performed in various databases such as PubMed, Scopus, CINAHL, Cochrane, Cuiden, Web of Science, WorldWideScience and Joanna Briggs. Additionally, articles from informal sources were incorporated. A search and selection were made of experimental, quasi-experimental and pre-experimental studies published between January 2015 and September 2020 that consider the use of topical products for the treatment of hospital in-patients with PVC-related phlebitis. Appraisal of the methodological quality of the study was performed independently by pairs of reviewers on the basis of the Cochrane Collaboration tool. The review was based on the guidelines in the PRISMA-ScR statement. Twenty-two articles were selected (8 randomised controlled trials (RCTs), 12 quasi-RCTs and 2 pre-experimental studies) which considered treatments applied to a total of 2042 adult patients. The topical treatments described were classified into physical measures and phytotherapeutic and pharmacological treatments. The physical measures are easy to apply, but their effectiveness is limited. The main limitation of the phytotherapeutic treatments is their marketing and use in eastern culture. The best performing pharmacological treatment is the application of magnesium sulphate either with or without glycerine. These products can be presented in different pharmaceutical formulas: ointment, solution and oil. The evidence currently available on this issue is limited and often of dubious methodological rigour. Further studies are required on the treatment and follow-up of intravenous therapy-related phlebitis in different national and international contexts.

Clinical efficacy of spray-based heat-treated lactobacilli in canine atopic dermatitis: a preliminary, open-label, uncontrolled study.

Canine atopic dermatitis (cAD) is a common inflammatory and pruritic skin disease, with various treatment options. The use of topical products containing natural ingredients has proven increasingly popular. To evaluate the effects of a spray solution containing heat-killed Lactobacillus rhamnosus and L.reuteri, on the clinical signs and cutaneous microbiota of atopic dogs. Ten privately owned, mildly affected, nonseasonally atopic dogs. The spray was applied to the ventrum every 24h for 28 days. Clinical scores, skin barrier function and owner assessment were evaluated on day (D)0, D14, D28 and D42. The cutaneous microbiota was analysed on D0 and D28. A reduction in the total clinical score was seen at each time point (D14, P=0.03; D28, P=0.04; D42, P=0.001). A reduction in the regional clinical scores was seen after D28 (P=0.01) and D42 (P=0.003). A significant reduction in the pruritus score was seen on D42 (P=0.01). A lower hydration value was seen on D28 (P=0.02) and D42 (P=0.02) on the pinnae. A good-to-excellent response and an easy-to-use administration was reported by owners. There were no significant changes in the cutaneous microbiota after 28 days. There was a significant and rapid decrease in the clinical signs associated with cAD after use of the spray. Future larger, randomized, controlled studies are needed to confirm these results and to assess the effects on the cutaneous immunity and microflora of atopic dogs.

Topical treatment of radiation-induced dermatitis: current issues and potential solutions.

Approximately 95% of patients receiving radiotherapy (RT) will ultimately develop radiation-induced dermatitis (RID) during or after the course of treatment, with major consequences on quality of life and treatment outcomes. This paper reviews the pathophysiology of RID and currently used topical products for the prevention and treatment of RID. Although there is no consensus on the appropriate management, recent evidence suggests that the use of topical products supports to protect and promote tissue repair in patients with RID. Basic recommendations include advice to wear loose clothing, using electric razors if necessary, and avoiding cosmetic products, sun exposure or extreme temperatures. Based on mechanisms involved and on the clinical characteristics of oncological patients, the profile of the ideal topical product for addressing RID can be designed; it should have limited risk of adverse events, systemic adsorption and drug–drug interactions, should be characterized by multiple clinical activities, with a special focus on localized pain, and should have a careful formulation as some vehicles can block the RT beam.

Diaper dermatitis prevalence and severity: Global perspective on the impact of caregiver behavior.

ObjectivesTo compare prevalence and severity of diaper dermatitis (DD) in infants and toddlers (babies) across three countries (China, USA, and Germany), including diapered skin measures and caregiver practices.MethodsA cross‐sectional study of 1791 babies (~600 from each country) was recruited at each clinical site. Based on regional toilet‐training habits, exclusively diaper‐wearing infants were recruited between ages 2‐8 months in China and 2‐18 months in the USA and Germany. DD was measured, as well as skin pH, transepidermal water loss (TEWL), and relative humidity (RH) in the diapered region. Caregiver habits were collected via a questionnaire and included information on hygienic practices.ResultsDiaper dermatitis was highest in the perianal area, followed by the intertriginous, genital, and buttock regions. In general, DD was significantly lower in babies in China, highest in Germany, and intermediate in the USA. This rank ordering of DD by geography was also observed in baby age 2‐8 months. The lower DD observed in China was associated with lower skin pH and TEWL on diapered skin and decreased RH in the diaper. Chinese caregivers had the highest rate of prophylactic topical product usage, the most robust cleaning of the diapered area, lack of cleansing after urine‐only diaper changes, and Chinese infants spent the least time in an overnight diaper.ConclusionsThese data suggest caregiver behaviors including prophylactic use of topical products, thorough cleaning after stooling and reduced time in an overnight diaper are associated with less DD, lower superficial skin pH, and enhanced skin barrier.

A topical regimen improves skin healing and aesthetic outcomes when combined with a radiofrequency microneedling procedure.

Novel topical products formulated using tri- and hexapeptide technology (TriHex Technology® ; Alastin Skincare® , Inc) are used to clear the extracellular matrix, stimulate neocollagenesis and elastogenesis, decrease inflammation, and accelerate the epidermal healing process. This study assessed the efficacy of two topical tri- and hexapeptide-containing products pre- and post-treatment with radiofrequency (RF) microneedling of the photoaged neck with respect to healing and aesthetic outcomes. In this open-label, nonrandomized study, eligible subjects underwent one screening visit, one RF microneedling procedure and follow-up visits on post-treatment Days 3, 7, 30, and 90. Subjects were instructed to apply one product to the neck for 2weeks prior to treatment and 7days post-treatment. On post-treatment Day 7, subjects switched to the other product until the end of the study. At each visit, subject and investigator questionnaires were completed and standardized digital images were obtained. Female subjects (N=10) with a mean age of 51.3years (range, 44-59years) completed the study. All subjects achieved statistically significant improvements in Investigator Global Assessment scales at post-treatment Day 90 and reported improvement in all Skin Quality Assessments. Among Subjective Tolerability Assessments, all post-treatment reports of tingling and burning resolved by Day 3. 90% of stinging resolved by Day 3 with 100% resolving by Day 7. 40% of subjects had minimal itching on Day 3 which resolved by Day 7. Among the Investigator Post-treatment Tolerability Assessments, edema resolved in all subjects by Day 3 and erythema settled between Day 3 and Day 7. Pre- and post-treatment use of topical products formulated with tri- and hexapeptide technology appears to hasten healing and complement aesthetic outcomes associated with RF microneedling of the neck.

The Impact of Ultraviolet Radiation on Barrier Function in Human Skin: Molecular Mechanisms and Topical Therapeutics.

A competent epidermal barrier is crucial for terrestrial mammals. This barrier must keep in water and prevent entry of noxious stimuli. Most importantly, the epidermis must also be a barrier to ultraviolet radiation (UVR) from the sunlight. Currently, the effects of ultraviolet radiation on epidermal barrier function are poorly understood. However, studies in mice and more limited work in humans suggest that the epidermal barrier becomes more permeable, as measured by increased transepidermal water loss, in response UVR, at doses sufficiently high to induce erythema. The mechanisms may include disturbance in the organisation of lipids in the stratum corneum (the outermost layer of the epidermis) and reduction in tight junction function in the granular layer (the first living layer of the skin). By contrast, suberythemal doses of UVR appear to have positive effects on epidermal barrier function. Topical sunscreens have direct and indirect protective effects on the barrier through their ability to block UV and also due to their moisturising or occlusive effects, which trap water in the skin, respectively. Some topical agents such as specific botanical extracts have been shown to prevent the loss of water associated with high doses of UVR. In this review, we discuss the current literature and suggest that the biology of UVR-induced barrier dysfunction, and the use of topical products to protect the barrier, are areas worthy of further investigation.

Products based on olive oil, betaine, and xylitol in the post-radiotherapy xerostomia

AimThe objective of this study was determining if the use of products based in olive oil, betaine and xylitol are efficacious to decrease the impact of the dry mouth in the quality of life of the patients with xerostomia due to radiotherapy treatment. BackgroundFollowing therapeutic irradiation of the head and neck, patients with profound xerostomia have complaints associated with oral dryness, speech, and taste. There is no strong evidence that any topical therapy is effective for relieving the symptom of dry mouth. Material and methods40 patients who had been treated with radiotherapy for head and neck carcinoma and reported symptoms of dry mouth were included in the study. A xerostomia-related quality of life questionnaire, visual analogue scale questionnaire for subjective assessment of salivary dysfunction and salivary flow were reported before and 15 days after the use of topical products based on olive oil, betaina and xylitol. ResultsThe four primary quality of life areas demonstrated significantly greater improvement after the use of topical products and all eight VAS items had favourable changes. The reduction of symptoms was statistically significant in 7 of the 8 items. After the use of the products, there were improvements in salivary flow in 45%. ConclusionsThe use of products based on olive oil, betaine and xylitol, shaped like collutory, toothpaste, gel and spray significantly improved most symptoms and the quality of life limitations produced by dry mouth in patients treated with radiotherapy.

A functional mechanistic study of the effect of emollients on the structure and function of the skin barrier.

Preventing relapses of atopic dermatitis (AD) through the regular use of topical products to repair the skin barrier defect is an emerging concept. It is still unclear if some commonly used emollients exert a positive effect on the skin barrier. To determine the skin barrier effects of emollients commonly prescribed in the U.K. Two cohorts of volunteers with quiescent AD undertook observer-blind forearm-controlled studies. The first cohort (18 volunteers) treated the volar side of one forearm with two fingertip units of Doublebase™ gel twice daily for 4weeks. The second cohort (19 volunteers) undertook the same regimen using Diprobase® cream. Transepidermal water loss (TEWL), stratum corneum integrity and hydration, skin surface pH and redness were determined at the test sites before and after treatment. Neither Diprobase® cream nor Doublebase™ gel significantly affected the underlying skin barrier function. Both emollients were associated with significantly increased skin surface pH immediately after application (by 0·8±0·19 and 1·0±0·18 units, respectively), and no erythema. Diprobase® cream artificially and transiently (6h) improved permeability barrier function by 2·9-3·1gm-2 h-1 TEWL and increased skin hydration by 6·0-6·2 units. Doublebase™ gel, containing humectants, was associated with a greater (between 10·1 and 13·0 units during the first 6h) and more sustained increase in hydration, lasting more than 12h following repeated use. Diprobase® cream and Doublebase™ gel are not associated with skin barrier harm and appear to be appropriate for AD treatment. While displaying emollient properties, neither formulation displayed an ability to actively improve sustained skin barrier function.

The multiple factors affecting the association between atopic dermatitis and contact sensitization

Atopic dermatitis and allergic contact dermatitis are both common skin diseases having an immune pathogenesis. There has been considerable interest about their inter-relationships with regard to altered susceptibility. Recent investigations have shed new light on this important question, and in this article, we explore whether there is evidence that atopic dermatitis affects the risk of contact sensitization and allergic contact dermatitis. The use of topical products to treat xerotic and inflamed skin in atopic dermatitis often results in a higher prevalence of sensitization to, for example, fragrances and other ingredients in emollients. Moreover, the prevalence of metal allergy seems to be increased, probably due to compromised chelation of the metals in the stratum corneum of patients with atopic dermatitis. However, conversely, the T-helper cell 2 bias that characterizes immune responses in atopic dermatitis appears to lower the risk of contact sensitization compared to healthy controls. Based on these observations, we conclude that multiple factors affect the association between atopic dermatitis and contact sensitization, and that these need to be appreciated in the clinical management of atopic dermatitis patients.

Patient interpretations of prescription order quantitative statements

ObjectivesTo characterize the variability in patient understanding and interpretation of quantitative statements from prescription orders and to evaluate the influence of sociodemographic characteristics on how patients interpret quantitative statements. MethodsParticipants were recruited in both a clinic and pharmacy setting in Kentucky. Patients were given a survey that asked for general background information and two questions pertaining to their experience with topical products. Then, patients were read a scenario and asked to use a provided tube of cream and squeeze out what they considered a small amount. Results100 eligible patients participated in the study, with the majority having previous counseling on the use of topical products. The mean (±SD) cream weight representing a small amount was 0.36± g. Regression analysis demonstrated a significant nonlinear relationship for two of the patient characteristics, age and body mass index (BMI), with the greatest effect in the middle of age and BMI distributions (at approximately age 50 years and BMI 30 kg/m2). No evidence indicated that gender, race, education, or previous experience with or education about topical products had any effect on cream weight perception. ConclusionPatients demonstrated tremendous variability in the interpretation of a small amount of topical product cream. Further research should be conducted to determine whether policy changes are warranted to require more specific prescription order instructions in the outpatient setting.

Dermatitis alérgica de contacto no profesional a propóleo

Abstract—Propolis is produced by bees from the resinous secretion of some vegetal species. Allergic contact dermatitis from propolis was originally reported as an occupational disease affecting beekeepers but today involves patients who use «natural» products containing propolis with cosmetic or therapeutical purposes.A case of nonoccupational allergic contact dermatitis from propolis affecting a 44-year-old woman is reported. The patient treated a labial herpes simplex with a solution containing propolis. Some hours later she developed an acute dermatitis on the lip and perioral area. Patch test with the commercial propolis solution was very positive (+ + +) at 48 and 96 hours. Patch test with True Test® showed a positive reaction to balsam of Peru among others. This result may be due to cross reaction, since balsam of Peru shares some components with propolis.The increasing use of topical products marketed as natural cosmetics and drugs could induce a higher frequency of sensitization to propolis in Spain.

Behandlung der oberflächlichen Thrombophlebitis

Superficial thrombophlebitis is a frequently occurring disease which, because of risk factors, affects women to a greater extent than men. The presence of deep venous thrombosis should be excluded by imaging procedures. Heparin or low-molecular weight heparins are indicated for treatment, if deep venous thrombosis is present or threatening. In the acute stage non-steroidal antiinflammatory drugs can be taken orally in order to alleviate pain and inflammation. In the case of concomitant chronic venous insufficiency, edema protective drugs (e. g. preparations containing horse chestnut extract and flavonoids) can support the therapy. For the treatment of inflammatory conditions in relatively short superficial vein segments without involvement of the deep venous system, a limitation to topical treatment is possible. In addition to compression therapy, the application of creams or gels containing heparin or heparinoids are the usual treatment approach. The use of topical products containing mucopolysaccharide polysulfate (MPS) has been proven to be beneficial. The problem of providing evidence of the efficacy of topical products in the therapy for superficial thrombophlebitis under the current strict demands of our regulatory authorities and of developing new products under these conditions is discussed.

Percutaneous Absorption of Salicylic Acid after Repeated (14-day) In Vivo Administration to Normal, Acnegenic or Aged Human Skin

The objective of the present work was to determine the relative bioavailability of salicylic acid (SA) after repeated (14-day) topical application to subjects who presented normal, acnegenic, or photodamaged facial skin. To emulate exposure characteristics likely to be encountered by subjects in these two subpopulations, individuals presenting facial acne were treated with 2% SA in a hydroalcoholic vehicle, and volunteers with aged or photodamaged skin received a comparable topical dose of SA in a cream (moisturizer-like) vehicle. Plasma concentration-time profiles and cumulative urinary excretion of SA were measured after the last dose in subjects who had received 15 consecutive daily topical applications of 27mg of SA or oral doses of 81mg of acetylsalicylic acid (ASA). The rate and extent of percutaneous absorption of SA were not affected by facial skin condition. Faster rates of absorption (Cmax) were obtained with a hydroalcoholic compared with a cream vehicle. Systemic SA exposures were at least five-fold higher with oral ASA than topical SA. Based on systemic salicylate concentrations resulting from ingestion of 81mg of ASA, these results support that patients without gross skin disorders are at minimal risk of adverse systemic effects from routine use of topical products containing 2% SA.