... 21 Food and Drugs 5 2010-04-01 2010-04-01 false Ophthalmic emollients. 349.14 Section 349.14 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR.... (4) Petrolatum, up to 100 percent. (5) White ointment, up to 100 percent. (6) White petrolatum, up to...
Kam Lun Hon
Full Text Available Aim: To review current classes of emollients in the market, their clinical efficacy in atopic dermatitis (AD and considerations for choice of an emollient. Methods: PubMed Clinical Queries under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow and Systematic Reviews were used as the search engine. Keywords of ‘emollient or moisturizer’ and ‘atopic dermatitis’ were used. Overview of findings: Using the keywords of ‘emollient’ and ‘atopic dermatitis’, there were 105 and 36 hits under Clinical Study Categories (with Category limited to Therapy and Scope limited to Narrow and Systematic Reviews, respectively. Plant-derived products, animal products and special ingredients were discussed. Selected proprietary products were tabulated. Conclusions: A number of proprietary emollients have undergone trials with clinical data available on PubMed-indexed journals. Most moisturizers showed some beneficial effects, but there was generally no evidence that one moisturizer is superior to another. Choosing an appropriate emollient for AD patients would improve acceptability and adherence for emollient treatment. Physician’s recommendation is the primary consideration for patients when selecting a moisturizer/ emollient; therefore, doctors should provide evidence-based information about these emollients.
Saw, N; Hindmarsh, J
Antiseptic bath emollients are commonly prescribed for treatment of eczema and are generally safe for frequent application. Although acute irritant reactions are uncommon it is nevertheless recognised and could have significant morbidity. This case describes a young male patient who developed an acute irritant reaction localised to the external genitalia, mimicking Fournier's gangrene, after overnight application of Oilatum Plus antiseptic bath emollients.
Saw, N; Hindmarsh, J
Antiseptic bath emollients are commonly prescribed for treatment of eczema and are generally safe for frequent application. Although acute irritant reactions are uncommon it is nevertheless recognised and could have significant morbidity. This case describes a young male patient who developed an acute irritant reaction localised to the external genitalia, mimicking Fournier's gangrene, after overnight application of Oilatum Plus antiseptic bath emollients. PMID:15701748
Asztalos, Manuela L; Heller, Misha M; Lee, Eric S; Koo, John
When treating psoriasis, various topical emollients exist that can affect the penetration of ultraviolet radiation in phototherapy. Compared with normal-appearing skin with a reflectance of 4% to 5%, psoriatic skin has higher reflectance as a result of its increased air-to-corneocyte interfaces. Studies have tested the effect of emollients on light penetration by assessing psoriatic plaque clearance, differences in minimal erythema dose, and physical properties of the emollient (eg, monochromatic protection factor and absorbance). Psoriatic plaque clearance was found to improve with serous (thin liquid)-based emollients (eg, Vaseline oil [Unilever, Blackfriars, London, UK], mineral oil, and glycerol), whereas clearance decreased with salicylic acid and viscous-based emollients (eg, petrolatum). Emollients with high ultraviolet absorbance properties increased minimal erythema dose, and those with low absorbance properties decreased minimal erythema dose. Interestingly, when a liquid emollient with a refractive index close to that of normal-appearing skin was applied, there was a net increase in light absorption, or a reduction in reflection that exceeded the emollient's innate ability to absorb light. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
Shukla V A
Full Text Available Dry skin is a common problem both in healthy individuates and in patients with skin diseases. In all cases, emollients play important role in rehydrating the stratum corneum. To evaluate the efficacy of a new emollient, thirty-six patients with symptomatic dry skin disorders were enrolled. They were given the test emollient cream for topical application twice daily for 3 weeks and followed up weekly. Subjective complaints included pruritus and discomfort while objective parameters included scaling, erythema, roughness of skin, fissuring and hypopigmentation. Treatment with the test emollient cream reduced the severity in a majority of patients. Moreover, being free of perfume, co lour, urea and lanolin, the test cream was well tolerated by all participants.
Douguet, Marine; Picard, Céline; Savary, Géraldine; Merlaud, Fabien; Loubat-Bouleuc, Nathalie; Grisel, Michel
The study focuses on the impact of structural and physicochemical properties of emollients on their spreadability. Fifty-three emollients, among which esters, silicones, vegetable and mineral oils, have been characterized. Their viscosity, surface tension, density and spreadability have been measured. Vitro-skin ® , an artificial skin substitute, was used as an artificial porous substrate to measure spreadability. Two different methods have been selected to characterize spreadability, namely contact angle and spreading value. Dynamic contact angle measurements showed that emollient spreadability is first governed by spontaneous spreading and that, in a second phase, absorption and migration into the porous substrate becomes the driver of the extension of the spreading area. Statistical analysis of physicochemical and spreading value data revealed that viscosity has a major impact on the spreading behavior of emollients whatever their chemical type. A special emphasis was placed on the ester family in which chemical diversity is very wide. The results highlighted a difference between "high viscosity esters" for which viscosity is the main factor impacting spreadability and "low viscosity esters" for which structural variations (mono/diester, saturated/unsaturated chain, linear/branched chain) have to be considered in addition to viscosity. Linear regressions were used to express spreading value as a function of viscosity for each of the four emollient families tested (esters, silicones, vegetable and mineral oils). These regressions allowed the development of reliable predictive models as a powerful tool for formulators to forecast spreadability of emollients. Copyright © 2017 Elsevier B.V. All rights reserved.
Oakley, Robert; Lawton, Sandra
Background: The mainstay treatment for eczema is leave-on emollients. The aim of this study was to find out more about unwanted effects that have been reported with their use, as little is known due to a lack of formal reporting.\\ud \\ud Aims: To gain a greater understanding of eczema patients’ experiences of unwanted effects such as stinging, what influence unwanted effects had on their therapy, why subsequent variations in leave-on emollient adherence followed and what patients desire in the...
M. Catherine Mack Correa
Full Text Available Atopic dermatitis is a common inflammatory skin disorder that afflicts a growing number of young children. Genetic, immune, and environmental factors interact in a complex fashion to contribute to disease expression. The compromised stratum corneum found in atopic dermatitis leads to skin barrier dysfunction, which results in aggravation of symptoms by aeroallergens, microbes, and other insults. Infants—whose immune system and epidermal barrier are still developing—display a higher frequency of atopic dermatitis. Management of patients with atopic dermatitis includes maintaining optimal skin care, avoiding allergic triggers, and routinely using emollients to maintain a hydrated stratum corneum and to improve barrier function. Flares of atopic dermatitis are often managed with courses of topical corticosteroids or calcineurin inhibitors. This paper discusses the role of emollients in the management of atopic dermatitis, with particular emphasis on infants and young children.
Brooks, Christina; Khatau, Tejas
Prescribing is an essential element of health visiting practice. This initiative used the payment framework of Commissioning for Quality and Innovation (CQUIN) to develop health visiting practice across a large health visiting workforce in the East Midlands. A focus on emollient prescribing practice was agreed and a guidance booklet regarding preferred emollient products was produced, based on the local formulary Each health visitor benefitted from receiving additional training and was given a guidance booklet to inform their practice. Targets were set for each quarter to demonstrate an improved prescribing adherence to the preferred product list.The targets were achieved for each quarter. Prescribing rates and confidence improved across the service. Therefore, it was demonstrated that specific guidance and ongoing support can improve prescribing practice within the health visiting service.
Schleider, N.R.; Moskowitz, R.S.; Cort, D.H.; Horwitz, S.N.; Frost, P.
Several commonly used emollients were studied as to their effectiveness in absorbing and filtering erythema-causing ultraviolet radiation in the 280 to 315 nm range (UVB). Planter's Peanut Oil (Standard Brands) and Mazola Corn Oil (Best Foods Inc.) had no effect; Alpha Keri Bath Oil (Westwood Pharmaceuticals), mineral oil, and Johnson's Baby Oil (Johnson and Johnson Co) had minimal effects. Vaseline Petroleum Jelly (Chesebrough-Ponds Inc.), petrolatum, and hydrophilic ointment substantially reduced the erythema that was induced by exposure to low doses of UVB radiation. Therefore, these emollients may interfere with the therapeutic effects of the ultraviolet radiation component of the Goeckerman treatment when it is administered in low doses to patients with psoriasis
Djokic-Gallagher, Jasmina; Rosher, Phil; Oliveira, Gabriela; Walker, Jennine
Introduction Healthcare professionals tend to recommend emollients based primarily on patient/consumer preference and cost, with cheaper options assumed to be therapeutically equivalent. The aim of this study was therefore to compare the effects on skin hydration of two emollients prescribed in the UK, Doublebase Dayleve? gel (DELP) and a cheaper alternative, Zerobase Emollient? cream (ZBC). Methods This was a single-centre, randomised, double-blind, concurrent bi-lateral (within-patient) com...
Tiplica, George Sorin; Kaszuba, Andrzej; Malinauskienė, Laura; Konno, Pille; Boralevi, Franck; Garrigue, Eric; Saint-Aroman, Markéta; Delarue, Alain
Emollients are part of the standard treatment for atopic dermatitis (AD), although there is limited evidence that regular use of emollients as management therapy reduces the frequency of flares and corticosteroid consumption. The objective of this study was to evaluate the benefit of emollient use in the management of mild to moderate AD in children by assessing the ability of two different emollients (particularly V0034CR) to prevent flares and to reduce the use of corticosteroids. In this randomized, open-label study, patients with a current flare were treated with a potent topical corticosteroid. After flare resolution, patients were centrally randomized to V0034CR emollient, reference emollient, or no emollient (1:1:1 ratio) for 12 weeks. New flares were medically assessed before being treated with a moderately potent corticosteroid. A total of 335 children 2 to 6 years of age were randomized. At 12 weeks, the percentage of patients with one or more flares was statistically significantly lower with V0034CR (35.1%) than without emollient (67.6%; p < 0.001). Fewer patients treated with V0034CR required any corticosteroids or immunosuppressants (23.6%) than patients with no emollient (43.3%) at 12 weeks. The difference was significant at all time points (p = 0.002). Patients treated with emollients had a longer time to first flare, fewer flares, higher complete remission rates, less corticosteroid consumption, lower Investigator Global Assessment scores, and lower Scoring Atopic Dermatitis scores than those who were not. V0034CR was well tolerated, with no specific safety concerns. Regular emollient use in children with mild to moderate AD reduces flares and corticosteroid consumption. © 2017 Wiley Periodicals, Inc.
You, Chung Eui; Moon, Seok Hoon; Lee, Kwang Hoon; Kim, Kyu Han; Park, Chun Wook; Seo, Seong Joon; Cho, Sang Hyun
Atopic dermatitis (AD) is a common, complex disease that follows a chronic relapsing course and significantly affects the quality of life of patients. Skin barrier dysfunction and inflammatory processes induce and aggravate this skin condition. Proper use of an emollient for hydration is a keystone of AD treatment. Bee venom is known to have anti-inflammatory effects and has been widely used in traditional medicine to treat various inflammatory disorders. To find out the beneficial effect of an emollient containing bee venom in the treatment of patients with AD. This study included 136 patients with AD who were randomized to receive either an emollient containing bee venom and silk-protein or a vehicle that was identical except for the bee venom for 4 weeks. The patients were instructed to apply the emollient twice daily on their entire body and not to use other medications, including topicals, during the course of the study. The eczema area and severity index (EASI) score, transepidermal water loss, and visual analogue scale (VAS) score of itching were evaluated at the first visit and after 2 and 4 weeks. The investigator global assessment was evaluated at 2 and 4 weeks after the application of emollient containing bee venom or vehicle. Patients applying emollient containing bee venom showed significantly lower EASI score and VAS value compared to patients applying emollient without bee venom. Emollient containing bee venom is a safe and effective option for patients with AD.
Lachapelle, Jean-Marie; Gimenez-Arnau, Ana; Metz, Martin; Peters, Jill; Proksch, Ehrhardt
Contact dermatitis (CD) is caused by environmental agents, irritants, and allergens that penetrate the epidermis and lead to inflammation. An intact skin barrier prevents penetration and is important in maintaining healthy skin. Classical diagnosis of CD is made using the patch test, and traditional treatment strategies for CD promote skin barrier integrity and resolve the inflammatory component of the condition. This can be achieved by using emollient-based therapy, which is most important for skin barrier repair, and in addition to topical glucocorticosteroids, which are used in severe cases of CD and are most effective in reducing inflammation. Preventative measures, such as irritant and allergen avoidance in the workplace, also play a pivotal role in effective CD management. Moreover, CD management necessitates a holistic approach that incorporates prevention, barrier repair, and inflammatory resolution to ensure optimized efficacy. It is also important to consider potential barriers to optimal management when evaluating individuals with CD, such as limited patient education or poor access to care. Finally, key literature and our own clinical practice experience have highlighted the value of patient preference, as well as safety, efficacy and simplicity, in building the perfect emollient.
Antonijević, M D; Owusu-Ware, S; Sanchon-Lopez, B
The choice of prescribed emollients is usually based on cost and patient preference. Differences in formulations can affect user acceptability. To compare the physical performance, user acceptability and various product design features of two emollient gels that are prescribed in the UK and alleged to be therapeutically interchangeable because their formulations are described as having the same contents of oily ingredients. We found that here are in fact significant measurable differences between the structure and performance of the two formulations, which materially affect their user acceptability. These differences are attributed to the use of different types of gelling agents and other ingredients of differing grades/quality and concentrations, and probably due to the formulations being made by different manufacturing processes. We also identified other product design features that are important to user appeal, including the type of container in which the formulations are presented, the type of dispensing devices provided, and the nature and form of the supplied user instructions. Patients and prescribers should be aware that there can be important differences in performance and user appeal between emollients, even between products that, superficially, may appear to be very similar. These important performance aspects should be characterized for new emollient introductions to encourage better informed product selection. © 2018 The Authors. Clinical and Experimental Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists, North American Clinical Dermatologic Society and St Johns Dermatological Society.
Scalp psoriasis is a common life-altering skin condition causing a great deal of distress. It significantly affects quality of life and is difficult to manage. Treatment can provide variable results, often impacting patient compliance with therapy. Salicylic acid is used as adjunctive therapy to other topical treatments because of its marked keratolytic effect. Its effectiveness as a monotherapy is not fully understood. An emollient foam formulation of 6% salicylic acid (Salkera) in an ammonium lactate vehicle has recently become available. Efficacy, tolerability and patient acceptability of salicylic acid 6% emollient foam were assessed in an open-label pilot study of 10 subjects with scalp psoriasis. All psoriasis severity parameters were reduced with a significant decrease in Psoriasis Scalp Severity Index (PSSI) score from 15.3 to 3.0 after four weeks of monotherapy (Poiliness severity and patient-reported burning tolerability. Salicylic acid 6% emollient foam provides a useful option in the treatment of psoriasis that is highly effective, well tolerated and acceptable to patients.
Virgili, Annarosa; Minghetti, Sara; Borghi, Alessandro; Corazza, Monica
The chronic and relapsing nature of vulvar lichen sclerosus (VLS) represents a challenge for its long-term management after an effective treatment with topical corticosteroids. To compare the effect of topical vitamin E with that of an emollient in reducing the risk of VLS relapse over a 52-week maintenance treatment. 156 patients with VLS were enrolled in a 12-week active treatment phase on topical 0.1% mometasone furoate ointment once daily. Those who achieved disease remission entered a 52-week maintenance phase in which patients were randomized to apply either an emollient or topical vitamin E once daily. 80 patients entered the maintenance phase. At 52 weeks, for the vitamin E maintenance group, the cumulative crude relapse rate was 27.8% and the cumulative modified crude relapse rate was 55.6%. For the emollient maintenance group, the cumulative crude relapse rate was 22.7% and the cumulative modified crude relapse rate was 50.0%. The median time to relapse was 20 weeks for the vitamin E group and 18.7 weeks for the emollient group. Once VLS has been stabilized with topical corticosteroids, long-term treatment with both vitamin E and emollients may be considered in maintain LS remission.
Koppes, Sjors A.; Charles, Frank; Lammers, Laureen; Frings-Dresen, Monique; Kezic, Sanja; Rustemeyer, Thomas
The aim of this randomized controlled trial was to assess the efficacy of a cream containing ceramides and magnesium (Cer-Mg) in the treatment of mild to moderate atopic dermatitis and to compare it with hydrocortisone and a commonly used emollient (unguentum leniens; cold cream). A total of 100
Hon, Kam Lun; Pong, Nga Hin; Wang, Shuxin Susan; Lee, Vivian W; Luk, Nai Ming; Leung, Ting Fan
Atopic eczema or dermatitis (AD) is associated with atopy and is characterized by reduced skin hydration and an impaired skin barrier in the epidermis. We investigated the patient acceptability and efficacy of an emollient containing ceramide-precursor lipids and moisturizing factors (LMF) in AD. Consecutive AD patients were recruited. Swabs and cultures were obtained from the right antecubital fossa and the worst-affected eczematous area, and disease severity [according to the SCORing Atopic Dermatitis (SCORAD) Index], skin hydration, and transepidermal water loss (TEWL) were measured prior to and after 2 weeks' use of the LMF moisturizer. The general acceptability of treatment was documented as being 'very good', 'good', 'fair', or 'poor'. Twenty-four AD patients [mean age 13.8 (standard deviation 5.7) years] were recruited. Two thirds of the patients reported very good or good acceptability of the LMF moisturizer, whereas one third reported fair or poor acceptability. There were no inter-group differences in the pre-use clinical parameters of age, objective SCORAD score, pruritus score, sleep disturbance score, skin hydration, TEWL, topical corticosteroid use, oral antihistamine use, or acceptability of previously used proprietary emollients. However, patients in the fair/poor acceptability group were more likely to have Staphylococcus aureus colonization and to be female (odds ratio 13, 95 % confidence interval 1.7-99.4; p = 0.021). Following use of the LMF moisturizer, the objective SCORAD score, pruritus score, and sleep disturbance score were lower in the very good/good acceptability group than in the fair/poor acceptability group. The mean objective SCORAD score improved (from 31.5 to 25.7; p = 0.039) and skin hydration improved [from 30.7 arbitrary units (a.u.) to 36.0 a.u.; p = 0.021] in the very good/good acceptability group. When the data were analyzed for the strength of the agreement of the rating of acceptability, the κ values were 0.338 (fair) for
Djokic-Gallagher, Jasmina; Rosher, Phil; Oliveira, Gabriela; Walker, Jennine
Healthcare professionals tend to recommend emollients based primarily on patient/consumer preference and cost, with cheaper options assumed to be therapeutically equivalent. The aim of this study was therefore to compare the effects on skin hydration of two emollients prescribed in the UK, Doublebase Dayleve™ gel (DELP) and a cheaper alternative, Zerobase Emollient™ cream (ZBC). This was a single-centre, randomised, double-blind, concurrent bi-lateral (within-patient) comparison in 18 females with atopic eczema and dry skin on their lower legs. DELP gel and ZBC cream were each applied to one lower leg twice daily for 4 days and on the morning only on day 5. The efficacy of both products was assessed by hydration measurements using a Corneometer CM825 probe (Courage-Khazaka Electronic). The measurements were made three times daily on days 1 to 5. The primary efficacy variable was the area under the curve (AUC) of the change from baseline corneometer readings over the 5 days. Skin hydration using DELP gel was significantly higher than using ZBC cream (p skin hydration observed for DELP gel was substantial and long lasting. In contrast, for ZBC cream, there was no significant improvement of the cumulative skin hydration as measured by the AUC (p = 0.22). DELP gel achieved substantial, long-lasting and cumulative skin hydration, whilst ZBC cream achieved no measurable improvement in skin hydration compared to before treatment. Healthcare professionals should be aware that different emollients can perform differently. Dermal Laboratories Ltd. EudraCT number:2014-001026-16.
Overgaard, L E K; Main, K M; Frederiksen, H
BACKGROUND: Parabens may be added to cosmetic and personal care products for preservation purposes. Low-molecular weight (LMW) phthalate diesters function as plasticizers, fixatives or solvents in such products, but may also be found in small quantities as contaminants from plastic containers...... whether the difference is explained by increased use of the specific emollients that are used to treat pruritic and inflamed skin, and/or whether the impaired skin barrier allows chemicals to penetrate more easily. Moreover, the putative toxicological burden is unknown....
Santer, Miriam; Ridd, Matthew J; Francis, Nick A; Stuart, Beth; Rumsby, Kate; Chorozoglou, Maria; Becque, Taeko; Roberts, Amanda; Liddiard, Lyn; Nollett, Claire; Hooper, Julie; Prude, Martina; Wood, Wendy; Thomas, Kim S; Thomas-Jones, Emma; Williams, Hywel C; Little, Paul
To determine the clinical effectiveness and cost effectiveness of including emollient bath additives in the management of eczema in children. Pragmatic randomised open label superiority trial with two parallel groups. 96 general practices in Wales and western and southern England. 483 children aged 1 to 11 years, fulfilling UK diagnostic criteria for atopic dermatitis. Children with very mild eczema and children who bathed less than once weekly were excluded. Participants in the intervention group were prescribed emollient bath additives by their usual clinical team to be used regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued with standard eczema management, including leave-on emollients, and caregivers were given standardised advice on how to wash participants. The primary outcome was eczema control measured by the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe) weekly for 16 weeks. Secondary outcomes were eczema severity over one year (monthly POEM score from baseline to 52 weeks), number of eczema exacerbations resulting in primary healthcare consultation, disease specific quality of life (dermatitis family impact), generic quality of life (child health utility-9D), utilisation of resources, and type and quantity of topical corticosteroid or topical calcineurin inhibitors prescribed. 483 children were randomised and one child was withdrawn, leaving 482 children in the trial: 51% were girls (244/482), 84% were of white ethnicity (447/470), and the mean age was 5 years. 96% (461/482) of participants completed at least one post-baseline POEM, so were included in the analysis, and 77% (370/482) completed questionnaires for more than 80% of the time points for the primary outcome (12/16 weekly questionnaires to 16 weeks). The mean baseline POEM score was 9.5 (SD 5.7) in the bath additives group and 10.1 (SD 5.8) in the no bath additives group. The mean POEM score
Berents, Teresa Løvold; Rønnevig, Jørgen; Søyland, Elisabeth; Gaustad, Peter; Nylander, Gro; Løland, Beate Fossum
Public health nurses report on effects of fresh human milk as treatment for conjunctivitis, rhinitis and atopic eczema (AE), the latter being highly prevalent in early childhood. Emollients and topical corticosteroids are first line treatment of AE. As many caregivers have steroid phobia, alternative treatment options for mild AE are of interest. The aim of this small pilot study was to assess the potential effects and risks of applying fresh human milk locally on eczema spots in children with AE. This was a split body, controlled, randomized and physician blinded pilot study, of children with AE with two similar contralateral eczema spots having a mother breastfeeding the child or a sibling. Fresh expressed milk and emollient was applied on the intervention spot and emollient alone on the control area, three times a day for four weeks. The severity and area of the eczema spots was evaluated weekly, and samples from milk and the spots were analysed weekly with respect to bacterial colonisation. Of nine patients included, six completed the study. Mean age at inclusion was 18.5 months. The spots examined were localized on the arms, legs or cheeks. The spots were similar in severity, but differed in area. In one patient the eczema ceased after inclusion. In four patients both control and intervention areas increased during the intervention. The relative change in eczema area compared to baseline showed less increase in the intervention spots in two patients, whereas the opposite was observed in three. In four children Staphylococcus aureus was found in their eczema once or more. In three of the 28 human milk samples, Staphylococcus aureus, alfa haemolytic streptococci or coagulase negative staphylococci were detected. Staphylococcus aureus was found once both in human milk and in the eczema spots, no clinical signs of infection were however observed. No secondary infection due to milk application was detected. In this small pilot study, no effect was found on eczema
Iraji, Fariba; Farhadi, Sadaf; Faghihi, Gita; Mokhtari, Fatemeh; Basiri, Akram; Jafari-Koshki, Tohid; Nilforoushzadeh, Mohammad Ali
Background: Atopic dermatitis is a chronic skin disease with increasing prevalence worldwide and a considerable burden especially among children. To circumvent the problems related to oral azathioprine (AZT) we aimed to evaluate its topical variant and assess its efficacy in patients aged 2–18. Materials and Methods: In a single-blind trial, we randomized the patients into two groups, one treated with topical emollient containing AZT and betamethasone (BM), and the other treated solely with topical emollient of BM. The treatments were administered twice a day for 8 weeks in both groups. The efficacy, recurrence, and the presence of side effects were evaluated using SPSS 20. Results: The amount of reduction in severity scoring for atopic dermatitis (SCORAD) score was significantly greater in the group treated with the topical AZT (P = 0.024). Incidentally, there were no difference between two treatments in difference in proportions of recurrence and adverse effects as well as SCORAD reduction in subgroups of sex and age (all P > 0.05). Conclusions: Our results showed the superiority of topical AZT over BM with a low recurrence and adverse effects. No expectation of severe side effects, like those of oral AZT, is the major advantage of topical AZT. The sample size was an issue in uncovering the value of AZT in the subgroups. Conducting prolonged studies of quality-of-life and comparing the topical AZT potency relative to the common alternatives are recommended areas of future work. PMID:26623403
van Zuuren, Esther J; Fedorowicz, Zbys; Christensen, Robin
-quality evidence), satisfaction (one study, 50 participants, RR 1.06, 95% CI 0.74 to 1.52; very low-quality evidence), and investigator-assessed disease severity (three studies, 272 participants, standardised mean difference (SMD) -0.23, 95% CI -0.66 to 0.21; low-quality evidence). In the oat group, there were...... (seven studies, 749 participants, SMD -1.10, 95% CI -1.83 to -0.38) than control. Participants in both treatment arms reported comparable satisfaction (three studies, 296 participants, RR 1.35, 95% CI 0.77 to 2.26; low-quality evidence). Moisturisers led to lower investigator-assessed disease severity...... (12 studies, 1281 participants, SMD -1.04, 95% CI -1.57 to -0.51; high-quality evidence) and fewer flares (six studies, 607 participants, RR 0.33, 95% CI 0.17 to 0.62; moderate-quality evidence), but there was no difference in adverse events (10 studies, 1275 participants, RR 1.03, 95% CI 0.82 to 1...
An urea, arginine and carnosine based cream (Ureadin Rx Db ISDIN shows greater efficacy in the treatment of severe xerosis of the feet in Type 2 diabetic patients in comparison with glycerol-based emollient cream. A randomized, assessor-blinded, controlled trial
Full Text Available Abstract Background Xerosis is a common skin disorder frequently observed in diabetic patients. An effective hydration of foot skin in diabetics is a relevant preventive strategy in order to maintain a healthy foot. Urea is considered an effective hydrating and emollient topical product. The aim of the present study was to evaluate the efficacy of topical urea 5% with arginine and carnosine (Ureadin Rx Db, ISDIN Spain (UC in comparison with glycerol-based emollient topical product (Dexeryl, Pierre Fabre (EC, in Type 2 diabetic patients. Methods We assessed the effect of UC on skin hydration in a randomized, evaluator-blinded comparative study in 40 type II diabetic patients, aged 40–75 years, treated with UC or the comparator for 28 days with a twice-daily application. The principal outcomes were the Dryness Area Severity Index (DASI Score and the Visual Analogue Score (VAS for skin dryness evaluated at baseline and at the end of study period by an investigator unaware of treatment allocation. Results UC induced significantly greater hydration than EC with an 89% reduction in DASI score (from 1.6 to 0.2; p Conclusion Application of urea 5%, arginine and carnosine cream increases skin hydration and alleviates the condition of skin dryness in Type 2 diabetic patients in comparison with a control glycerol-based emollient product. (Dutch Trials Register trial number 3328.
A potent steroid cream is superior to emollients in reducing acute radiation dermatitis in breast cancer patients treated with adjuvant radiotherapy. A randomised study of betamethasone versus two moisturizing creams
Ulff, Eva; Maroti, Marianne; Serup, Jörgen; Falkmer, Ursula
Background and purpose: The aim was to investigate whether treatment with potent local steroids can reduce signs and symptoms of acute radiation dermatitis in breast cancer patients undergoing adjuvant radiotherapy (RT) compared to emollient creams. Material and methods: The study was randomised and double-blinded. Patients with breast cancer who had undergone mastectomy or breast-conserving surgery were included when they started adjuvant 3-D planned RT. In all, 104 patients were randomised 2:1:1 to three treatment groups, i.e. betamethasone + Essex® cream, Essex® cream or Canoderm® cream. The patients themselves treated the irradiated area during the radiation period (5 weeks) and two weeks after cessation of RT. Signs of RT dermatitis were measured qualitatively with RTOG clinical scoring and quantitatively by colorimeter. In addition, the patients’ symptoms were recorded as well as the Fitzpatrick skin type. There was a statistically significant difference (p = 0.05) in skin reactions when assessed with RTOG in favour of the group treated with the potent steroid. Patient-related symptoms did not differ between the treatment groups. The effect of the steroid was prominent in three subgroups, i.e. (i) patients treated with ablation of the breast, (ii) patients receiving RT to the armpit and the supraclavicular fossa, and (iii) patients with Fitzpatrick skin type 1. Conclusions: Treatment with betamethasone cream is more efficient than moisturizers for the control of acute RT dermatitis in patients treated with adjuvant RT for breast cancer
Samuel Pereira Simonato
Full Text Available The present study aimed at developing an Aloe vera-based formula for topical use on horse hoof and evaluating whether the treatment affects hooves growth and balance. Six healthy male horses between the ages of 3 and 17 years (12±5.25 were used, all semi-confined animals for breeding purposes. Before beginning A. vera treatment, animals underwent two trimming procedures with a 45 days-interval. After the second trimming, one of the forelimbs and one of the hindlimbs of 4 horses was weekly treated by topical application of the glycolic extract of A. vera at 20%. The contralateral limb, randomly chosen, received the extract at 50%. The hooves of the other animals were treated with propylene glycol. Treatment was done for 225 days and, during this time, animals underwent periodic trimming. Variables related to growth and balance of the hooves were measured before and after trimming. Data were analyzed using chi-square test and regression analysis at 5% significance. Growth rate of the hooves was not related to treatment. On the other hand, the 50% extract was related to the majority of the hooves in balance (p<0.05. Results suggest that a weekly topical treatment with A. vera glycolic extract does not improve the growth rate of the hooves; however, when applied at a high concentration, it improves their balance.
... product contains the established name of the drug(s), if any, and identifies the product as a “lubricant... the eye or to exposure to wind or sun.” (3) “For use as a protectant against further irritation or to...
Kroft, Ilse; Groeneveld, T.J.; Seyger, M.M.B.; Jong, E.M.G.J. de
BACKGROUND: Tacrolimus, a calcineurin inhibitor, is an immunomodulating and anti-inflammatory drug that inhibits T-cell activation and production of cytokines. The elevated level of cytokines in morphea causes fibroblast proliferation and subsequent overproduction of collagen. Theoretically,
Beyens, Urielle; Yu, Hongbo; Han, Ting; Zhang, Li; Zhou, Xiaolin
Apology from the offender facilitates forgiveness and thus has the power to restore a broken relationship. Here we showed that apology from the offender not only reduces the victim's propensity to react aggressively but also alters the victim's implicit attitude and neural responses toward the offender. We adopted an interpersonal competitive game which consisted of two phases. In the first, "passive" phase, participants were punished by high or low pain stimulation chosen by the opponents when losing a trial. During the break, participants received a note from each of the opponents, one apologizing and the other not. The second, "active" phase, involved a change of roles where participants could punish the two opponents after winning. Experiment 1 included an Implicit Association Test (IAT) in between the reception of notes and the second phase. Experiment 2 recorded participants' brain potentials in the second phase. We found that participants reacted less aggressively toward the apologizing opponent than the non-apologizing opponent in the active phase. Moreover, female, but not male, participants responded faster in the IAT when positive and negative words were associated with the apologizing and the non-apologizing opponents, respectively, suggesting that female participants had enhanced implicit attitude toward the apologizing opponent. Furthermore, the late positive potential (LPP), a component in brain potentials associated with affective/motivational reactions, was larger when viewing the portrait of the apologizing than the non-apologizing opponent when participants subsequently selected low punishment. Additionally, the LPP elicited by the apologizing opponents' portrait was larger in the female than in the male participants. These findings confirm the apology's role in reducing reactive aggression and further reveal that this forgiveness process engages, at least in female, an enhancement of the victim's implicit attitude and a prosocial motivational change toward the offender.
Chiang, Charles; Eichenfield, Lawrence F
Standard recommendations for skin care for patients with atopic dermatitis stress the importance of skin hydration and the application of moisturizers. However, objective data to guide recommendations regarding the optimal practice methods of bathing and emollient application are scarce. This study quantified cutaneous hydration status after various combination bathing and moisturizing regimens. Four bathing/moisturizer regimens were evaluated in 10 subjects, five pediatric subjects with atopic dermatitis and five subjects with healthy skin. The regimens consisted of bathing alone without emollient application, bathing and immediate emollient application, bathing and delayed application, and emollient application alone. Each regimen was evaluated in all subjects, utilizing a crossover design. Skin hydration was assessed with standard capacitance measurements. In atopic dermatitis subjects, emollient alone yielded a significantly (p hydration over 90 minutes (206.2% baseline hydration) than bathing with immediate emollient (141.6%), bathing and delayed emollient (141%), and bathing alone (91.4%). The combination bathing and emollient application regimens demonstrated hydration values at 90 minutes not significantly greater than baseline. Atopic dermatitis subjects had a decreased mean hydration benefit compared with normal skin subjects. Bathing without moisturizer may compromise skin hydration. Bathing followed by moisturizer application provides modest hydration benefits, though less than that of simply applying moisturizer alone.
ment of dental caries and childhood obe- sity. ... symptoms associated with viral illnesses. ... paradoxical reactions with hyperac- tivity in ... clearing mucus and preventing sec- ... these products are emollients ... ments are best for dry skin while.
CLEMENT O BEWAJI
thermogenic, emollient, stimulant, purgative, aphrodisiac and diuretic. .... It is probable that the extract may have caused destruction or impaired production of .... Hypoglycemic action of an oral fig-leaf decoction in type-1 diabetic patients ...
Dudzina, T.; Goetz, N. von; Bogdal, C.; Biesterbos, J.W.H.; Hungerbuhler, K.
Low molecular weight cyclic volatile methylsiloxanes (cVMSs) are widely employed as emollients and carrier solvents in personal care formulations in order to acquire desired performance benefits owing to their distinctive physicochemical properties. Under current European legislation cosmetic
Presidential Green Chemistry Challenge 2009 award winner, Eastman Chemical Co., makes esters for emollients and emulsifiers in cosmetics with immobilized enzymes, saving energy and avoiding strong acids and organic solvents.
Full Text Available DG01764 DGroup Emollient laxative ... DG00067 ... Liquid paraffin ... D05042 ... Mineral oil (USP); Liquid paraffin... (JP17) ... D05043 ... Light liquid paraffin (JP17); Mineral oil, light (NF) DG01771 ... Doc
Full Text Available DG01770 DGroup Laxative ... DG01764 ... Emollient laxative ... DG00067 ... Liquid paraffin ... ...D05042 ... Mineral oil (USP); Liquid paraffin (JP17) ... D05043 ... Light liquid paraffin (JP17); Mineral oil, li
Bostroem, Aasa; Lindman, Henrik; Swartling, Carl; Berne, Berit; Bergh, Jonas
Purpose: Radiation-induced dermatitis is a very common side effect of radiation therapy, and may necessitate interruption of the therapy. There is a substantial lack of evidence-based treatments for this condition. The aim of this study was to investigate the effect of mometasone furoate cream (MMF) on radiation dermatitis in a prospective, double-blind, randomized study. Material and methods: The study comprised 49 patients with node-negative breast cancer. They were operated on with sector resection and scheduled for postoperative radiotherapy using photons with identical radiation qualities and dosage to the breast parenchyma. The patients were randomized to receive either MMF or emollient cream. The cream was applied on the irradiated skin twice a week from the start of radiotherapy until the 12th fraction (24 Gy) and thereafter once daily until 3 weeks after completion of radiation. Both groups additionally received non-blinded emollient cream daily. The intensity of the acute radiation dermatitis was evaluated on a weekly basis regarding erythema and pigmentation, using a reflectance spectrophotometer together with visual scoring of the skin reactions. Results: MMF in combination with emollient cream treatment significantly decreased acute radiation dermatitis (P=0.0033) compared with emollient cream alone. There was no significant difference in pigmentation between the two groups. Conclusions: Adding MMF, a potent topical corticosteroid, to an emollient cream is statistically significantly more effective than emollient cream alone in reducing acute radiation dermatitis
Paquet, F; Piérard-Franchimont, C; Fumal, I; Goffin, V; Paye, M; Piérard, G E
A number of menopausal women experience skin sensitive to various environmental threats. Two panels of 15 menopausal women on or without HRT were compared. We studied the response of their stratum corneum to variations in environmental humidity, either in air or in response to an emollient. Environment dew point and electrometric measurements on the skin were recorded to search for correlations. Data show that the baseline stratum corneum hydration is influenced by the dew point. HRT improves the barrier function of the skin. The use of emollient further extends the improvement in the functional properties of skin in menopausal women. Both HRT and an emollient can counteract in part some of the deleterious effects of cold and dry weather.
Jungersted, Jakob Mutanu; Høgh, Julie Kaae; Hellegren, Lars I
twice daily for one week with betamethasone, tacrolimus, emollient, or left untreated, respectively. After one week each area was challenged with a 24 h sodium lauryl sulphate patch test. The lipids were collected using the cyanoacrylate method and evaluated by high performance thin layer chromatography......The skin barrier, located in the stratum corneum, is influenced mainly by the lipid and protein composition of this layer. In eczematous diseases impairment of the skin barrier is thought to be of prime importance. Topical anti-inflammatory drugs and emollients are the most widely used eczema...
Jungersted, Jakob Mutanu; Høgh, Julie Kaae; Hellgren, Lars
twice daily for one week with betamethasone, tacrolimus, emollient, or left untreated, respectively. After one week each area was challenged with a 24 h sodium lauryl sulphate patch test. The lipids were collected using the cyanoacrylate method and evaluated by high performance thin layer chromatography...... found between treatment regimes. Pretreatment with betamethasone (p = 0.01) or with tacrolimus (p = 0.001) causes a decreased inflammatory response to sodium lauryl sulphate compared with emollient. In conclusion, treatment with betamethasone and tacrolimus has a positive effect on the ceramide...
L. Lünnemann, MD
Conclusion: A daily application of both emollients was associated with increased SCH levels and a stable course of TEWL, pH, and sebum on the forehead except for the forehead when compared with the forearm and leg. Clinically, improved SCORAD scores were noted.
Jojoba liquid wax is a mixture of esters of long chain fatty acids and fatty alcohols, mainly (C38:2-C46:2). The oil exhibits excellent emolliency on the skin and therefore is a component in many personal care cosmetic formulations. The virgin oil is a component of the seed of the Jojoba (Simmondsia...
... on the elbows and knees in younger children, and the cubital and popliteal fossae in older children and adults. Treatment modalities include emollients, topical corticosteroids, calcineurin inhibitors, phototherapy and immunosuppressive therapy. This article provides a brief overview of topical treatments for atopic eczema.
The infant was managed using stringent thermoregulation, optimal hydration, use of topical emollient and antibiotics. Although, the skin disorder resolved within fifteen days of treatment, the infant thereafter developed inguinoscrotal hernia and hydrocephalus necessitating surgical consult. The case is reported to highlight ...
Perennial Stems, Leaves. Internal. Anti-calculus, anti-septic, kidney problems, urine tube infection and laxative (for baby). 5. Allium akaka Gmelin. Aliaceae or ..... Tragopogon graminifolius. DC. Asteraceae. Haplook. Shang. Salsify. H. Annual Root, Flowers. Internal/. External. Emollient, sore throat and wound healing. 111.
This report describes a desk study into the effects of predipping on udder health and milk quality. An additional desk study is described about the risks for human health and milk quality if residues from active components, additive components and emollients get into the milk
human diet. Mucilage from West African Okra has been reported as plasma replacement or blood volume expander and the leaves are used as a basis for poultice, as an emollient, sudorific, antiscorbutic and to treat dysuria (Siemonsma and Hamon, 2002). Osawaru and Dania-Ogbe (2010) reported the use of the mucilage ...
Full Text Available Collodion baby is a rare congenital disorder characterized by parchment like taught membrane covering the whole body. Other findings in our case include ectropion, eversion of lips, and flattening of nose and ears. Skin biopsy showed features consistant with the diagnosis of collodion baby. The child was treated with supportive measures like antibiotics, intravenous fluids, humidification, and application of emollients.
dermatitis (AD). Emollients. Dry skin is a very common feature of AD and is a diagnostic criterion for the disease. The consequences of dry skin include: .... Psychosocial factors. Although stress and psychological factors appear to influence AD, evidence of their impact is limited.. References. 1. Marks R. How to measure ...
Overgaard, Line E K; Bonefeld, Charlotte M.; Frederiksen, Hanne
Phthalate diesters are widely used as emollients in plastic and cosmetics as well as in food packaging and perfumes, potentially leading to prolonged and repeated dermal, oral and airborne exposure. We here review published articles that have evaluated the putative role of phthalate diesters...
Full Text Available Context Atopic dermatitis is a chronic, relapsing skin disorder that affects all ages including infancy and childhood. There are many proved and unproved treatments for atopic dermatitis. Evidence Acquisition Data sources of this narrative review included studies about pediatric atopic dermatitis with the following keywords, pediatric, atopic dermatitis, immunity, acute, chronic, pruritic inflammatory skin disorder, infancy, childhood, diagnosis, management and treatment. All of the articles were written in English language with full text on management or treatment. Results Innate and adaptive immune system involved atopic dermatitis. Major characteristics of atopic dermatitis include pruritus, chronic or relapsing lesions and personal or family history of atopic disease. There is no specific treatment for atopic dermatitis. The treatment included rehydration, emollients, topical steroid, calcineurin inhibitors and immunosuppressant. Crisaborole topical ointment, a PDE4 anti-inflammatory topical agent (phase three of the research could be effective in atopic dermatitis. Conclusions Avoidance from trigger factors and emollients are basic treatments of atopic dermatitis.
Kirova, Youlia M.; Fromantin, Isabelle; De Rycke, Yann; Fourquet, Alain; Morvan, Esra; Padiglione, Solene; Falcou, Marie-Christine; Campana, Francois; Bollet, Marc A.
Purpose: Radio-induced early skin reactions still remain a clinical challenge. Preliminary results with Hyaluronic acid, one of the most recent topical products used in this indication are proving interesting. To evaluate the efficacy of Hyaluronic acid compared to placebo. Material and methods: Breast cancer patients with grade 1-2 radio-induced dermatitis during postoperative radiotherapy were eligible. They were randomised to receive either hyaluronic acid (A) or a simple emollient (B). The primary endpoint was the clinical evaluation of the erythema (success versus failure). Secondary endpoints were the evaluation of skin colorimetry, pain, and quality of life. Results: Two-hundred patients were enroled (A = 99, B = 101). Ninety-five patients per treatment arm could be evaluated. Failures occurred in 23 patients (24%) in the hyaluronic acid arm, and 32 (34%) in the emollient arm (p = 0.15). Seventy-three patients (36.5%) prematurely stopped the treatment without any ensuing difference between the two arms. Body mass index and the size of the epithelitis were both independently associated with the failure of the local treatment. The relative reduction of colorimetric levels was 20% in the hyaluronic acid group, and 13% in the emollient group (p = 0.46). Concerning the quality of life assessment, there was a trend towards a lower level of pain in patients receiving hyaluronic acid (p = 0.053). Conclusions: The present study showed no significant difference between hyaluronic acid and simple emollient in the treatment of acute radio-induced dermatitis. There was however a trend towards an improvement in both pain level and skin colorimetry.
Khodaie, Laleh; Sadeghpoor, Omid
Context: Ginger is the rhizome of Zingiber officinale, a perennial plant, used alone or in compounds as a spice or remedy in ancient recipes of Iranian traditional medicine (ITM) as an effective tonic for the memory and digestive system, the opener of hepatic obstructions, aphrodisiac, for expelling compact wind from stomach and intestines, diluting, desiccating and emollient of phlegmatic and compact humor sticking to body organs, stomach, intestine, brain and throat. The ITM scholars believ...
Full Text Available Specialized literature studies show that the species from the gender Parietaria have therapeutic usage in traditional medicine, which have diuretic, depurative, emollient, antitussive, antirheumatic, cholagogue, pectoral and laxative properties. In human medicine the aerial part of the plant is used externally for treating hemorrhoids and anal fissures. In this respect a pharmacognostic and phytochemical study of the species Parietaria lusitanica L. was initiated, species frequently used by the inhabitants from around Toulouse, France.
Bogdan, Cătălina; Moldovan, Mirela L; Man, Ioana Manuela; Crișan, Maria
Striae distensae represent the result of the failure of the dermis to sustain intrinsic mechanical forces. Intensive moisturization of the lesions and use of emollient oils have been recommended for the prevention and treatment of striae distensae rubra. The aim of this research was to formulate an emollient water-in-oil cosmetic cream containing argan oil, which may be helpful in the prevention or early treatment of striae distensae. Sensory evaluation of the consistency, firmness, adhesiveness, oiliness, spreadability, and rapidity of penetration into the skin was evaluated by 22 volunteers using 10-point scales for each descriptor. The instrumental characterization of the cream was performed using Brookfield(®) CT3 Texture Analyzer. The cutaneous changes induced by the topical use of the cream were evaluated by assessing the thickness of the epidermis, hydration, and elasticity of the skin using DermaLab(®) Combo scanner. Ultrasound measurements showed an improvement in the elasticity of the epidermis following the application of cream. The product was well tolerated and appreciated by the consumers in terms of its spreadability, penetration ability, and lack of stickiness. The values recorded for texture analysis were firmness 10.16±0.15 mJ, adhesiveness 30.94±6.87 g, consistency 1229.50±119.78 g, spreadability 481.50±39 g, and stringiness 0.56±0.09 mJ. A water-in-oil cream containing argan oil and emollient ingredients with appropriate physical characteristics was obtained. In vivo study of clinical efficacy revealed a positive effect on increasing the skin elasticity, suggesting that the cream may be helpful in the prevention or early treatment of striae distensae.
Hon, K L; Wang, Susan S; Lau, Zoe; Lee, H C; Lee, Kenneth K C; Leung, T F; Luk, N M
Atopic eczema is a chronic relapsing skin disease associated with atopy, and characterised by reduced skin hydration, impaired skin integrity (transepidermal water loss), and poor quality of life. Proper emollient usage is an important facet of its management. This study aimed to establish an approach to evaluate the efficacy of using an emollient over a 4-week period. Prospective observational study. A paediatric dermatology out-patient clinic of a university teaching hospital in Hong Kong. Consecutive new patients aged 5 to 18 years with atopic eczema diagnosed according to Hanifin and Rajka's criteria were recruited from March to August 2009. They or their parents were instructed to liberally apply the test emollient to the flexures and areas affected with eczema, twice daily. Outcome assessments were repeated 2 and 4 weeks later. Skin hydration and transepidermal water loss in the right forearm (2 cm below antecubital flexure), and disease severity (SCORing Atopic Dermatitis index) and Children's Dermatology Life Quality Index. At the end of the study period, a global assessment of treatment was recorded. Thirty-three patients with atopic eczema were recruited and treated with applications of a pseudoceramide-containing cream (Curel, Kao, Japan). The mean age of the patients (16 males and 17 females) was 12 (standard deviation, 4) years. Four weeks following the use of the cream, skin hydration improved significantly and fewer patients were using topical corticosteroids. In these patients, there was no deterioration in transepidermal water loss, eczema severity, or quality of life. The pseudoceramide cream improved skin hydration but not severity or quality of life over a 4-week usage.
Ibler, Kristina Sophie; Agner, Tove; Hansen, Jane L.
. The experimental group undergoes patch and prick testing; classification of the hand eczema; demonstration of hand washing and appliance of emollients; individual counselling, and a skin-care programme. The control group receives no intervention. All participants are reassessed after six months. The primary...... strategies are needed to reduce occupational hand eczema. METHODS/DESIGN: We describe the design of a randomised clinical trial to investigate the effects of classification of hand eczema plus individual counselling versus no intervention. The trial includes health-care workers with hand eczema identified...
Ubogui, J; Stengel, F M; Kien, M C; Sevinsky, L; Rodríguez Lupo, L
Our study took place in the region of the Copahue Volcano in the Andes Mountain range, 1900 m above sea level. Fifty-five patients who came to the Copahue Thermal Basin Complex (Neuquén, Argentina) for treatment of psoriasis vulgaris were clinically evaluated for participation in this study. Thermal products--waters, mud, and/or algae--were the only therapeutic agents used, except for bland emollients for xerosis. Treatment for brief periods (10 +/- 3 days) resulted in notable improvement.
Full Text Available We wish to report two cases of rickets due to vitamin D deficiency secondary to underlying ichthyotic skin disorder. The first case is of an 8-year-old male with history of multiple fluid-filled lesions over the body that would rupture to heal with thickening and scaling of skin, suggestive of epidermolytic hyperkeratosis, and the second is of a 14-year-old female with thick, large, quadrilateral scales over the extremities and back clinically consistent with lamellar ichthyosis. Both showed improvement with parenteral vitamin D3 and oral calcium supplements in addition to topical emollients.
L. S. Namazova-Baranova
Full Text Available Article is devoted to atopic dermatitis (AD in children. The high prevalence of this pathology and significant social and economic burden are responsible for the relevance of search for new medications for the treatment of AD, which will accelerate the achievement of remission. Inclusion of emollient in basic therapy for patients with atopic dermatitis of any severity is necessary element of improvement treatment efficacy, shorten duration of steroid consumption, lengthen the period of remission and reduce the number of exacerbations.
Full Text Available There is a clear consumer need for new textures and for natural and food inspired ingredients in cosmetics. Natural butters are fully in line with these trends. As a result, more and more products containing butters are launched on the European cosmetic market. They are found mainly in skincare and colour cosmetic products. Butters are used as emollients, texturing agents or to perfume finished products. Depending on their composition, their sensorial profiles will vary. Butters are also very effective marketing tools.
Modesto, A.; Faivre, J.C.; Granel-Brocard, F.; Tao, Y.G.; Pointreau, Y.
Acute radiation dermatitis remains one of the most commonly observed side effect during radiation therapy leading to complication such as superinfection or treatment disruption. Its management is characterized by a great heterogeneity. Few strategies have demonstrated a benefit in preventing radiation dermatitis, which relies mostly on decreasing dose delivered to the skin and skin care practices. Simple emollients and use of topical steroids can be useful in early stages. The singularity of the skin toxicity seen with cetuximab and radiotherapy warrants a specific grading system and distinctive clinical treatment with use of antibiotics. (authors)
Becker, Lillian C; Bergfeld, Wilma F; Belsito, Donald V; Hill, Ronald A; Klaassen, Curtis D; Liebler, Daniel C; Marks, James G; Shank, Ronald C; Slaga, Thomas J; Snyder, Paul W; Andersen, F Alan; Heldreth, Bart
The Cosmetic Ingredient Review (CIR) Expert Panel (Panel) assessed the safety of 39 polyether lanolin ingredients as used in cosmetics. These ingredients function mostly as hair conditioning agents, skin conditioning agent-emollients, and surfactant-emulsifying agents. The Panel reviewed available animal and clinical data, from previous CIR safety assessments of related ingredients and components. The similar structure, properties, functions, and uses of these ingredients enabled grouping them and using the available toxicological data to assess the safety of the entire group. The Panel concluded that these polyether lanolin ingredients are safe in the practices of use and concentration as given in this safety assessment.
Atopic eczema affects up to 20% of children in the UK. It is a disease of varying severity, and health visitors and school nurses have a vital role in educating and supporting children and their parents and carers in its management. Diagnosis and assessment needs to consider atopic eczema severity, effect on quality of life and contributing trigger factors. Treatment should be tailored to the individual child and should include education on emollient therapy, the use of topical corticosteroids and other measures. A case study is included to highlight practical issues and the support of the child and family in coping with atopic eczema at home and in school.
D. Sh. Macharadze
Full Text Available Atopic dermatitis is a chronic inflammatory cutaneous disease, which demands a prolonged treatment. A modern views on the main approaches to treatment of atopic dermatitis in children and adults are analyzed in this article. The treatment is based on the permanent use of emollients in order to achieve an anti-inflammatory effect — topical calcineurin inhibitors (tacrolimus and pimecrolimus, and short courses (5 days of topical corticosteroids during relapses. For the 10-year period of topical calcineurin inhibitors usage in treatment of atopic dermatitis a great amount of experimental and clinical data have been accumulated. Two the most important changes and additions in the treatment of atopic dermatitis in recent times were related to a new hypothesis of proactive therapy with the use of topical tacrolimus and closing of «black box» warnings, associated to malignization risk due to the long-term usage of topical calcineurin inhibitors. Since atopic dermatitis is characterized by relapsing course, nowadays topical tacrolimus should be considered the most appropriate treatment approach, both in adults and children. The results of investigations confirmed more than 6-times decrease in relapse rate, as well as the significant improvement of quality of life, when the above-mentioned treatment scheme is used, both in children and adults.Key words: children, atopic dermatitis, emollients, treatment, tacrolimus.
Atopic dermatitis is today the most common chronic disease of children in Europe, the US and Japan. The 'golden standard' of therapy is topical glucocorticosteroids and emollients. The steroids have been on the market for four decades, are efficacious, but only advised for short-term treatment due to their risks of side effects. More than 16,000 persons suffering from atopic dermatitis have been enrolled in clinical studies of tacrolimus. One third of patients with moderate to severe atopic dermatitis experience over 90% improvement in their disease over a 12-week treatment period and up to 70% of patients have over 50% improvement. A 1-year treatment leads to more than 90% improvement in 75% of patients. The most pronounced side effect is a burning sensation occurring in up to 60% of patients. Atopic dermatitis is a chronic skin disease leading to a demand for long-term treatment control. Such treatment options have not previously been available--except for emollients which are not efficacious for controlling skin inflammation. Tacrolimus and pimecrolimus are new treatment options, free from the potential side effects of topical steroids, which are known for their efficacy in short-term treatment. The new treatment modalities prevent the eczema from relapsing and at the same time they control active eczema. The future will see a shift towards the long-term use of tacrolimus which is able to control the skin inflammation and, hopefully, shorten the course of the eczema.
Full Text Available Only ~270 cases of collodion babies have been reported in the literature since 1892. As the name suggests, the term “collodion baby” refers to a phenotype that can be characterized by a yellow, shiny, tight parchment-like membrane stretched over the skin. Although the collodion membrane is only an evanescent condition of the newborn, neonatal complications can occur in 45% of all collodion babies, leading to a mortality rate of ~11% in the first few weeks of life. Most children born as collodion babies will spontaneously desquamate within 2 weeks, but may be as long as 3 months. Eventually, these children develop signs of one of several types of ichthyosis, which gives the skin the appearance of “fish scales.” We report a unique case of a Caucasian male that was born as a Collodion baby at the University of Kentucky Children's Hospital in Lexington, Kentucky. Although the impairment of the skin barrier function put the patient at risk for a number of complications, he improved significantly after being treated with emollients and antibiotics. In contrast to previous findings, we found that skin emollients were beneficial and did not increase the risk of infection.
Overgaard, Line E K; Bonefeld, Charlotte M; Frederiksen, Hanne; Main, Katharina M; Thyssen, Jacob P
Phthalate diesters are widely used as emollients in plastic and cosmetics as well as in food packaging and perfumes, potentially leading to prolonged and repeated dermal, oral and airborne exposure. We here review published articles that have evaluated the putative role of phthalate diesters in the pathogenesis of atopic dermatitis and discuss possible pathogenic pathways. A literature search resulted in 563 articles in Embase and 263 articles in Pubmed. After identification of relevant articles based on screening of titles, abstracts and reference lists, a total of 39 articles were selected and included. While no clear association has been shown between systemic phthalate levels and atopic dermatitis in human studies, animal data suggests that phthalates may worsen dermatitis and in vitro data suggests that interleukin-4 could be upregulated. Moreover, both loss-of-function mutations in the filaggrin gene and atopic dermatitis have been associated with elevated systemic phthalate levels. There is a need for prospective studies to clarify the possible pathogenic role of phthalate diesters in atopic dermatitis and the associated health risk, especially with the general trend towards barrier restoration with emollients in infants at risk of developing atopic dermatitis. In summary, we conclude that the results from published studies are controversial and inconclusive.
Crowther, J M
Methods that assess skin hydration based on changes in its electrical properties are widely used in both cosmetic and medical research. However, the devices themselves often give results which are significantly different to each other. Although some work has previously been carried out to try and understand what these devices are actually reading, it was based on a technique for measuring the devices' responses to filter discs impregnated with different liquids, which could in itself be influencing the measurements. Presented here is a new method for measuring the devices' direct responses to different materials and solutions which removes any other confounding effects, thereby providing a clearer insight into their operation. The responses of a variety of different liquids and solutions were measured using the Corneometer ® and Skicon ® . A new method is presented, based on the use of a custom-designed PTFE block to hold the liquids, allowing their measurement without using a filter paper. This method was developed and tested against the existing filter paper-based approach. Differences were observed in results between filter paper- and PTFE block-based approach, indicating that the filter paper itself is capable of influencing the measurements and as such is not to be recommended for assessing how different liquids impact on results from the devices. A positive correlation was observed between Corneometer ® and Skicon ® readings for certain solutions and under certain conditions. A large influence of salt concentration was noted for the Skicon ® device with no or minimal impact from the actual water itself, humectants and emollients. Salts, emollients, water and humectants were observed to have an effect on Corneometer ® readings. Both the Corneometer ® and Skicon ® were influenced to different extents by chemicals other than water and therefore cannot be seen purely as measures of skin 'hydration'. Although there is strong evidence that the devices do
Full Text Available Cătălina Bogdan,1 Mirela L Moldovan,1 Ioana Manuela Man,2 Maria Crișan,2 1Department of Dermopharmacy and Cosmetics, Faculty of Pharmacy, 2Department of Histology, Faculty of Medicine, University of Medicine and Pharmacy “Iuliu Hațieganu”, Cluj-Napoca, Romania Purpose: Striae distensae represent the result of the failure of the dermis to sustain intrinsic mechanical forces. Intensive moisturization of the lesions and use of emollient oils have been recommended for the prevention and treatment of striae distensae rubra. The aim of this research was to formulate an emollient water-in-oil cosmetic cream containing argan oil, which may be helpful in the prevention or early treatment of striae distensae. Patients and methods: Sensory evaluation of the consistency, firmness, adhesiveness, oiliness, spreadability, and rapidity of penetration into the skin was evaluated by 22 volunteers using 10-point scales for each descriptor. The instrumental characterization of the cream was performed using Brookfield® CT3 Texture Analyzer. The cutaneous changes induced by the topical use of the cream were evaluated by assessing the thickness of the epidermis, hydration, and elasticity of the skin using DermaLab® Combo scanner. Results: Ultrasound measurements showed an improvement in the elasticity of the epidermis following the application of cream. The product was well tolerated and appreciated by the consumers in terms of its spreadability, penetration ability, and lack of stickiness. The values recorded for texture analysis were firmness 10.16±0.15 mJ, adhesiveness 30.94±6.87 g, consistency 1229.50±119.78 g, spreadability 481.50±39 g, and stringiness 0.56±0.09 mJ. Conclusion: A water-in-oil cream containing argan oil and emollient ingredients with appropriate physical characteristics was obtained. In vivo study of clinical efficacy revealed a positive effect on increasing the skin elasticity, suggesting that the cream may be helpful in the
Full Text Available Squalene is a triterpene that is an intermediate in the cholesterol biosynthesis pathway. It was so named because of its occurrence in shark liver oil, which contains large quantities and is considered its richest source. However, it is widely distributed in nature, with reasonable amounts found in olive oil, palm oil, wheat-germ oil, amaranth oil, and rice bran oil. Squalene, the main component of skin surface polyunsaturated lipids, shows some advantages for the skin as an emollient and antioxidant, and for hydration and its antitumor activities. It is also used as a material in topically applied vehicles such as lipid emulsions and nanostructured lipid carriers (NLCs. Substances related to squalene, including ÃŽÂ²-carotene, coenzyme Q10 (ubiquinone and vitamins A, E, and K, are also included in this review article to introduce their benefits to skin physiology. We summarize investigations performed in previous reports from both in vitro and in vivo models.
Halling-Overgaard, A-S; Kezic, S; Jakasa, I
Patients with atopic dermatitis have skin barrier impairment in both lesional and non-lesional skin. They are typically exposed to emollients daily and topical anti-inflammatory medicaments intermittently, hereby increasing the risk of developing contact allergy and systemic exposed to chemicals...... ingredients found in these topical preparations. We systematically searched for studies that investigated skin absorption of various penetrants, including medicaments, in atopic dermatitis patients, but also animals with experimentally induced dermatitis. We identified 40 articles, i.e. 11 human studies...... examining model penetrants, 26 human studies examining atopic dermatitis drugs and 3 animal studies. We conclude that atopic dermatitis patients have nearly two-fold increased skin absorption when compared to healthy controls. There is a need for well-designed epidemiological and dermato...
Pai, Sunil B; Sudershan, Bhuvaneshwari; Kuruvilla, Maria; Kamath, Ashwin; Suresh, Pooja K
Erythroderma is characterized by diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface area. Drug-induced erythroderma has rarely been reported with hydroxychloroquine. We report a case of a 50-year-old female patient, with systemic lupus erythematosus, who developed itchy lesions all over the body 1 month after starting treatment with hydroxychloroquine. Drug-induced erythroderma was suspected. Hydroxychloroquine was withdrawn and the patient was treated with emollients, mid-potency corticosteroids, and oral antihistamines. A biopsy was done which confirmed the diagnosis of erythroderma. She recovered with treatment and was discharged. A careful history and clinical examination to search for potential causative factors will help prevent disabling sequelae in erythroderma.
Ana Dulce Amorim Santos Soares
Full Text Available The objective was to analyze the scientific collection on nursing care with the skin of hospitalized newborns. In order to reach the objective, an integrative review was conducted. The search for primary studies was performed in the databases LILACS, MEDLINE, BDENF and PUBMED. The included studies (n=10 were grouped into thematic categories: risk factors for skin lesions in hospitalized newborns and their consequences; and nursing care to promote the integrity of the skin of hospitalized newborns. The main care identified were lubrication with emollient agents, use of hydrocolloids and transparent film, changes in decubitus, hygiene techniques, phototherapy and invasive procedures. The results of the review offer guidance for the conduction of researches that investigate interventions that are more effective in the prevention and treatment of skin injuries and their consequences. Key words: Nursing Care, Newborn, Skin.
Vadgama, Rajeshkumar N; Odaneth, Annamma A; Lali, Arvind M
Isopropyl myristate finds many applications in food, cosmetic and pharmaceutical industries as an emollient, thickening agent, or lubricant. Using a homogeneous reaction phase, non-specific lipase derived from Candida antartica, marketed as Novozym 435, was determined to be most suitable for the enzymatic synthesis of isopropyl myristate. The high molar ratio of alcohol to acid creates novel single phase medium which overcomes mass transfer effects and facilitates downstream processing. The effect of various reaction parameters was optimized to obtain a high yield of isopropyl myristate. Effect of temperature, agitation speed, organic solvent, biocatalyst loading and batch operational stability of the enzyme was systematically studied. The conversion of 87.65% was obtained when the molar ratio of isopropyl alcohol to myristic acid (15:1) was used with 4% (w/w) catalyst loading and agitation speed of 150 rpm at 60 °C. The enzyme has also shown good batch operational stability under optimized conditions.
Saeki, Hidehisa; Nakahara, Takeshi; Tanaka, Akio; Kabashima, Kenji; Sugaya, Makoto; Murota, Hiroyuki; Ebihara, Tamotsu; Kataoka, Yoko; Aihara, Michiko; Etoh, Takafumi; Katoh, Norito
Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. Most patients have an atopic predisposition. The definitive diagnosis of AD requires the presence of all three features: (i) pruritus; (ii) typical morphology and distribution of the eczema; and (iii) chronic and chronically relapsing course. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice. © 2016 Japanese Dermatological Association.
Veje, Pia; Larsen, Palle
is: What is the effectiveness of traditional towel bed bath practice compared to other innovate bed bath practices on maintaining skin integrity, skin barrier function and reduction of pathogen microbial counts on skin among adult patients in all settings? Inclusion criteria: Types of participants...... practices, including all bag bath interventions, not limited to any specific type or brand. For the purpose of this systematic review, bag bath interventions include bathing patients with pre-packaged disposal washcloths by use of a different cloth to wash each part of the patient's body. The washcloths...... typically comprise rayon/polyester cloth pre-moistened with an evaporating no-rinse cleanser and emollients. Comparator: The comparator is the traditional bed bath (towel bed bath) intervention, regardless of type and frequency. For the purposes of this systematic review, traditional bed bath refers...
Castela, Emeline; Chiaverini, Christine; Boralevi, Franck; Hugues, Rosalind; Lacour, Jean Philippe
Keratosis pilaris (KP) is a frequent and benign condition in children characterized by the presence of rough, follicular papules and varying degrees of erythema. Different variants have been described, including simple KP and red KP. Between September 2007 and October 2010, 11 children with profuse and precocious KP seen at the department of pediatric dermatology were included. They defined an underemphasized clinical variant of childhood KP: the papular, profuse, and precocious KP characterized by early age of onset (<18 mos), extensive involvement of the limbs and cheeks, and papular nature of lesions. No clinical association has been found. The main complication was episodes of folliculitis. Diagnosis was delayed for all patients. Treatment is difficult, but association between emollient and keratolytic agents can provide some help. © 2011 Wiley Periodicals, Inc.
Full Text Available Terra firma-forme dermatosis is characterized by ′dirty′ brown-grey cutaneous patches and plaques that can simply be eradicated by forceful swabbing with alcohol pads. The pathogenesis has been attributed to abnormal and delayed keratinization. Although affected patients present with typical lesions, the disorder is not well-known by dermatologists. In this report, we describe two patients with terra firma-forme dermatosis in the setting of xerosis cutis and atopic dermatitis. From a clinical point of view, we lay emphasis on its unique expression and diagnosis/treatment. From a histological perspective, we highlight its resemblance to dermatosis neglecta and speculate on the role of ′neglect′ in a patient with seemingly adequate hygiene. The role of urea containing emollients in the development of this disorder remains to be determined.
Agbo-Godeau, Scarlette; Nicolas-Virelizier, Emmanuelle; Scotté, Florian
The advent of targeted therapies in the treatment of renal cancer has shown different types of lesions of the oral cavity, which appear to be specific to the drug classes used (mTOR inhibitors, anti-angiogenic agents and conventional cytotoxic drugs). Before starting treatment with targeted therapy, it is essential to have an oral and a dental examination. The treatment of mucositis induced by targeted therapies is based on bicarbonate-based mouthwash, with the optional addition of an antifungal or a local antiseptic. It is possible to use topical or systemic analgesics for the pain. Dietary advice for patients is also useful. Most cases of epistaxis caused by anti-angiogenics stop spontaneously and require no medical intervention. Regular application of an emollient can be used to prevent the formation of scabs. Copyright © 2011 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.
El-Heis, S; Abadie, Al
Habit tic nail deformity is a nail dystrophy resulting from habitual, repetitive trauma to the nail. It is usually acquired in adulthood, however, we report a case of habit tic nail deformity in an 8 year old boy. The diagnosis was made clinically with further history revealing that the boy repeatedly rubbed his thumbnails and pushed the cuticles. Emollient cream (Balneum®) was recommended twice daily and both the patient and his mother were educated on the behavioral nature of this condition. There was marked improvement at 6 months of treatment and further improvement at 12 months.We note that habit tic nail deformity is not exclusive to adults. Diagnosis can be made clinically. History and physical examination provide valuable clues and psychosocial links must be explored and addressed. Management is challenging and compliance with treatment is variable. Patient education, barrier methods, and behavioral therapy can be helpful in preventing further trauma to the nails.
Pham, Ba'; Stern, Anita; Chen, Wendong; Sander, Beate; John-Baptiste, Ava; Thein, Hla-Hla; Gomes, Tara; Wodchis, Walter P; Bayoumi, Ahmed; Machado, Márcio; Carcone, Steven; Krahn, Murray
Pressure ulcers are common in many care settings, with adverse health outcomes and high treatment costs. We evaluated the cost-effectiveness of evidence-based strategies to improve current prevention practice in long-term care facilities. We used a validated Markov model to compare current prevention practice with the following 4 quality improvement strategies: (1) pressure redistribution mattresses for all residents, (2) oral nutritional supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry skin, and (4) foam cleansing for high-risk residents requiring incontinence care. Primary outcomes included lifetime risk of stage 2 to 4 pressure ulcers, quality-adjusted life-years (QALYs), and lifetime costs, calculated according to a single health care payer's perspective and expressed in 2009 Canadian dollars (Can$1 = US$0.84). Strategies cost on average $11.66 per resident per week. They reduced lifetime risk; the associated number needed to treat was 45 (strategy 1), 63 (strategy 4), 158 (strategy 3), and 333 (strategy 2). Strategy 1 and 4 minimally improved QALYs and reduced the mean lifetime cost by $115 and $179 per resident, respectively. The cost per QALY gained was approximately $78 000 for strategy 3 and $7.8 million for strategy 2. If decision makers are willing to pay up to $50 000 for 1 QALY gained, the probability that improving prevention is cost-effective is 94% (strategy 4), 82% (strategy 1), 43% (strategy 3), and 1% (strategy 2). The clinical and economic evidence supports pressure redistribution mattresses for all long-term care residents. Improving prevention with perineal foam cleansers and dry skin emollients appears to be cost-effective, but firm conclusions are limited by the available clinical evidence.
Full Text Available Psoriasis generally does not affect survival but has significant detrimental effect on quality of life (QOL, which may be comparable to that of ischemic heart disease, diabetes, depression, and cancer. The foremost important thing in the management of psoriasis is counseling of the patient. The clinician needs to be empathetic and spend adequate time with the patient and educating the patient about psoriasis. Clinicians should make it clear to the patient that the primary goal of treatment is control of the disease rather than cure. Eating a balanced and low glycemic diet could be an important adjuvant factor in the prevention and treatment of moderate nonpustular psoriasis. Obese people are more likely to have severe psoriasis and psoriatic arthritis than people with an average body mass index. Dietary supplementation with oily fish, rich in n-3 fatty acids, in psoriasis had shown mixed results in trials. Promising results have been documented for parenteral application of n-3 fatty acid, but not with oral supplementation. Increased smoking or alcohol abuse increases the risk of developing psoriasis and may influence disease severity, and hence must be avoided. Soaking in warm water with bath oil can be done in extensive psoriasis for hydration and emollient effect, and bland soaps or soap substitutes should be used; antiseptics should be avoided as they may irritate the skin. Relatively small, localized patches of psoriasis may improve with occlusion, i.e., waterproof adhesive dressings. The use of emollients is an internationally accepted standard adjunctive to the treatment of psoriasis. Dermatology Life Quality Index is a psychometrically sound and responsive measure of psoriasis-specific outcomes and most comprehensively captures the impact of clinical signs and symptoms on patient's well-being.
Francis, Nick A; Ridd, Matthew J; Thomas-Jones, Emma; Butler, Christopher C; Hood, Kerenza; Shepherd, Victoria; Marwick, Charis A; Huang, Chao; Longo, Mirella; Wootton, Mandy; Sullivan, Frank
Eczema may flare because of bacterial infection, but evidence supporting antibiotic treatment is of low quality. We aimed to determine the effect of oral and topical antibiotics in addition to topical emollient and corticosteroids in children with clinically infected eczema. We employed a 3-arm, blinded, randomized controlled trial in UK ambulatory care. Children with clinical, non-severely infected eczema were randomized to receive oral and topical placebos (control), oral antibiotic (flucloxacillin) and topical placebo, or topical antibiotic (fusidic acid) and oral placebo, for 1 week. We compared Patient Oriented Eczema Measure (POEM) scores at 2 weeks using analysis of covariance (ANCOVA). We randomized 113 children (40 to control, 36 to oral antibiotic, and 37 to topical antibiotic). Mean (SD) baseline Patient Oriented Eczema Measure scores were 13.4 (5.1) for the control group, 14.6 (5.3) for the oral antibiotic group, and 16.9 (5.5) for the topical antibiotic group. At baseline, 104 children (93%) had 1 or more of the following findings: weeping, crusting, pustules, or painful skin. Mean (SD) POEM scores at 2 weeks were 6.2 (6.0) for control, 8.3 (7.3) for the oral antibiotic group, and 9.3 (6.2) for the topical antibiotic group. Controlling for baseline POEM score, neither oral nor topical antibiotics produced a significant difference in mean (95% CI) POEM scores (1.5 [-1.4 to 4.4] and 1.5 [-1.6 to 4.5] respectively). There were no significant differences in adverse effects and no serious adverse events. We found rapid resolution in response to topical steroid and emollient treatment and ruled out a clinically meaningful benefit from the addition of either oral or topical antibiotics. Children seen in ambulatory care with mild clinically infected eczema do not need treatment with antibiotics. © 2017 Annals of Family Medicine, Inc.
Siegfried, Elaine C; Jaworski, Jennifer C; Mina-Osorio, Paola
Treatment guidelines endorse a variety of strategies for atopic dermatitis (AD) which may vary from published data and clinical practice patterns. The objective of this review was to quantify the volume of available medical literature supporting pediatric AD treatments and compare these patterns to those recommended by published guidelines and/or clinical practice patterns. Searches of Embase (2005-2016) and abstracts from selected meetings (2014-2016) related to AD treatment in patients younger than 17 years of age yielded references that were assessed by study design, primary treatment, age groups, and AD severity. Published literature partially supports clinical guidelines, with emollients and topical medications being the most investigated. There were disproportionately more publications for topical calcineurin inhibitors (TCI) compared with topical corticosteroids (TCS); however, the search interval may have biased the results toward treatments approved near the beginning of the time frame. In contrast, publications documenting clinical practice patterns reflect greater use of emollients and TCS (over TCI), as well as systemic corticosteroids. Data is relatively limited for long-term and combination treatment, treatment of severe AD, and patients younger than 2 years of age, and completely lacking for systemic corticosteroids. This scoping review demonstrates that available medical literature largely supports published guidelines for topical therapy; however, clinical practice patterns are less aligned. There is a lack of data for older, more frequently used generic treatments, including oral antihistamines, oral antibiotics, and systemic corticosteroids. Overall, literature is lacking for long-term treatment, treatment for patients younger than 2 years of age, and for systemic treatment for severe disease. Regeneron Pharmaceuticals Inc.
Balaskas, Elias; Szepietowski, Jacek C.; Bessis, Didier; Ioannides, Dimitrios; Ponticelli, Claudio; Ghienne, Corinne; Taberly, Alain
Summary Background and objectives Uremic xerosis is a bothersome condition that is poorly responsive to moisturizing and emollient therapy. Design, setting, participants, & measurements A randomized, double-blind, intraindividual (left versus right comparison), multicentric clinical study was performed on 100 patients with moderate to severe uremic xerosis for 7 days, during which the patients applied twice daily an emulsion combining glycerol and paraffin (test product) on one allocated lower leg, and the emulsion alone (comparator) on the other lower leg. This was followed by an open-labeled use of the test product on all of the xerotic areas for 49 days. The main efficacy parameter was treatment response on each lower leg, as defined by a reduction from baseline of at least two grades in a five-point clinical score on day 7. Results Among the 99 patients analyzed, the test product was highly effective with a treatment response in 72 patients (73%), whereas 44 patients (44%) responded to the comparator (P < 0.0001, intergroup analysis). This was associated with an objective reduction in the density and thickness of the scales on day 7 (P < 0.0001 compared with the comparator) and a substantial improvement of the uremic pruritus (75%) and quality of life of the patients at study end (P < 0.001, intragroup analysis). The test product was very well tolerated, with product-related local intolerance (exacerbated pruritus, local burning, or erythema) occurring in only five patients (5%). Conclusions Uremic xerosis can be managed successfully when an appropriate emollient therapy is used. PMID:21258039
Y. S. Kondratyeva
Full Text Available The research goal is to assess clinical dynamics and morphofunctional skin parameters of patients with facial allergic dermatoses on the background of combined topical therapy. Materials and methods. 45 patients with various facial allergic dermatoses in dry and sensitive skin took part in the research. The methods included anamnesis taking, poll, objective examination and assessment of morphofunctional parameters of skin, as well as estimation of life quality dynamic index (LQDI. Main results. After a course of treatment with 0,05% solution of alclometasone dipropionate inflammation of dermatosis ceased in 45 (100% patients, itching and pains in 39 (86,7% patients, but complaints about dryness and peeling of facial skin remained in 41 (91,1% and 40 (88,8% patients respectively. On the background of therapy including emollient Aflocream the above mentioned symptoms did not appear in 43 (95,6% patients, wherein maximum effect was achieved in patients with allergic contact dermatitis - 14 (93,3%. After a course of topical therapy all patients showed statistically significant increase of epidermal moisture level, alongside with reduction of skin relief and degree of keratinization. During the assessment of LQDI a tendency to reduction of proportion of patients on whom the disease has a strong and extremely strong impact was noted in 10 patients (i.e. 22,2%, moderate influence - in 5 of them (11,45%, insignificant influence or its absence - in 30 (66,7% people. Conclusion. Combined therapy including the use of a topical corticosteroid Afloderm and an emollient Aflocream showed good clinical efficiency in patients with facial allergic dermatoses. The efficiency is also confirmed with improvements in morphofunctional characteristics of patients’ skin on the background of therapy.
Kampf, Günter; Kramer, Axel
The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data
Urgent consultations at the dermatology department of Basel University Hospital, Switzerland: characterisation of patients and setting - a 12-month study with 2,222 patients data and review of the literature.
Ruzza, N; Itin, P H; Beltraminelli, H
Urgent consultations for skin disorders are commonly done in different settings. Scarce data exist about the characteristics of these patients. The aim of this study was to analyse specific characteristics of patients receiving an urgent consultation at a dermatology department in a university hospital. We prospectively recorded the data of all patients having had an urgent consultation during a period of 12 months. We registered 2,222 urgent consultations. The most frequent diagnoses were eczemas (24.8%), dermatomycoses (5.1%) and dermatitis not otherwise specified (4.8%). The most frequent treatments were topical steroids, emollients, topical antibiotics, systemic antihistamines, antibiotics and virostatics. 2.2% of patients were hospitalized, 78.8% asked for a consultation for a disease lasting less than 4 weeks, and 6.9% presented the same day as the skin disease appeared. This study shows the characteristics of patients receiving an urgent dermatologic consultation. It underlines the need for collaboration between dermatologists, other physicians, general practitioners and nurses. © 2014 S. Karger AG, Basel.
Rajeshkumar N. Vadgama
Full Text Available Isopropyl myristate finds many applications in food, cosmetic and pharmaceutical industries as an emollient, thickening agent, or lubricant. Using a homogeneous reaction phase, non-specific lipase derived from Candida antartica, marketed as Novozym 435, was determined to be most suitable for the enzymatic synthesis of isopropyl myristate. The high molar ratio of alcohol to acid creates novel single phase medium which overcomes mass transfer effects and facilitates downstream processing. The effect of various reaction parameters was optimized to obtain a high yield of isopropyl myristate. Effect of temperature, agitation speed, organic solvent, biocatalyst loading and batch operational stability of the enzyme was systematically studied. The conversion of 87.65% was obtained when the molar ratio of isopropyl alcohol to myristic acid (15:1 was used with 4% (w/w catalyst loading and agitation speed of 150 rpm at 60 °C. The enzyme has also shown good batch operational stability under optimized conditions.
Full Text Available Skin is considered as an important route of administration of drugs for both local and systemic effects. The effectiveness of topical therapy depends on the physicochemical properties of the drug and adherence of the patient to the treatment regimen as well as the system's ability to adhere to skin during the therapy so as to promote drug penetration through the skin barrier. Conventional formulations for topical and dermatological administration of drugs have certain limitations like poor adherence to skin, poor permeability and compromised patient compliance. For the treatment of diseases of body tissues and wounds, the drug has to be maintained at the site of treatment for an effective period of time. Topical film forming systems are such developing drug delivery systems meant for topical application to the skin, which adhere to the body, forming a thin transparent film and provide delivery of the active ingredients to the body tissue. These are intended for skin application as emollient or protective and for local action or transdermal penetration of medicament for systemic action. The transparency is an appreciable feature of this polymeric system which greatly influences the patient acceptance. In the current discussion, the film forming systems are described as a promising choice for topical and transdermal drug delivery. Further the various types of film forming systems (sprays/solutions, gels and emulsions along with their evaluation parameters have also been reviewed.
Kanti, Varvara; Günther, Malise; Stroux, Andrea; Sawatzky, Sabine; Henrich, Wolfgang; Abou-Dakn, Michael; Blume-Peytavi, Ulrike; Garcia Bartels, Natalie
Skin care influences skin barrier function during the first postnatal weeks. Although the use of natural oils in preterms has been investigated, there are currently no data comparing the effect of sunflower oil to an emollient on barrier development in healthy term newborns. In a prospective, randomized clinical study, 50 healthy full-term newborns aged ≤72 h were randomly assigned to two groups: group baby lotion (L, n=22) and sunflower seed oil (SSO, n=24). The skin barrier function was evaluated in three anatomical areas (front, abdomen, and thigh) by noninvasive assessment of transepidermal water loss (TEWL), stratum corneum hydration (SCH), sebum, and skin pH at inclusion and after five weeks. In both groups, skin pH decreased and SCH increased statistically significantly in all measured areas at W5 compared to baseline. TEWL decreased statistically significantly on the forearm in both groups, on the upper leg in group L, and on the abdomen in group SSO. Both skin care regimes did not harm skin barrier function adaptation in healthy term neonates during the first five weeks of life. © 2017 Wiley Periodicals, Inc.
Hon, Kam Lun E.; Luk, David Chi Kong; Leong, Kin Fon; Leung, Alexander K. C.
Eczema is a common childhood atopic condition and treatment is with emollients, topical corticosteroids, and avoidance of possible triggers. S. aureus colonization is a common complication. As there is no immediate cure, many parents seek alternative therapies that claim unproven therapeutic efficacy. We report a girl with long history of treatment noncompliance. After practicing a long period of dietary avoidance and supplementation, the grandparents took her to an alternative medicine practitioner. Following cupping therapy and acupuncture, the child developed blistering and oozing over her back the next day, which rapidly evolved to two large irregular-edge deep ulcers. She was treated with intravenous antibiotics and received multidisciplinary supportive intervention. Using search words of “cupping,” “eczema,” and “atopic dermatitis,” only two reports were found on PubMed. Therapeutic efficacy was claimed but not scientifically documented in these reports. Childhood eczema is an eminently treatable atopic disease. Extreme alternative therapy seems not to be efficacious and may even be associated with serious undesirable sequelae. Physicians should be aware of various alternative treatment modalities and be prepared to offer evidence-based advice to the patients with eczema and their families. PMID:24282650
Kam Lun E. Hon
Full Text Available Eczema is a common childhood atopic condition and treatment is with emollients, topical corticosteroids, and avoidance of possible triggers. S. aureus colonization is a common complication. As there is no immediate cure, many parents seek alternative therapies that claim unproven therapeutic efficacy. We report a girl with long history of treatment noncompliance. After practicing a long period of dietary avoidance and supplementation, the grandparents took her to an alternative medicine practitioner. Following cupping therapy and acupuncture, the child developed blistering and oozing over her back the next day, which rapidly evolved to two large irregular-edge deep ulcers. She was treated with intravenous antibiotics and received multidisciplinary supportive intervention. Using search words of “cupping,” “eczema,” and “atopic dermatitis,” only two reports were found on PubMed. Therapeutic efficacy was claimed but not scientifically documented in these reports. Childhood eczema is an eminently treatable atopic disease. Extreme alternative therapy seems not to be efficacious and may even be associated with serious undesirable sequelae. Physicians should be aware of various alternative treatment modalities and be prepared to offer evidence-based advice to the patients with eczema and their families.
Trayes, Kathryn P; Studdiford, James S; Pickle, Sarah; Tully, Amber S
Edema is an accumulation of fluid in the interstitial space that occurs as the capillary filtration exceeds the limits of lymphatic drainage, producing noticeable clinical signs and symptoms. The rapid development of generalized pitting edema associated with systemic disease requires timely diagnosis and management. The chronic accumulation of edema in one or both lower extremities often indicates venous insufficiency, especially in the presence of dependent edema and hemosiderin deposition. Skin care is crucial in preventing skin breakdown and venous ulcers. Eczematous (stasis) dermatitis can be managed with emollients and topical steroid creams. Patients who have had deep venous thrombosis should wear compression stockings to prevent postthrombotic syndrome. If clinical suspicion for deep venous thrombosis remains high after negative results are noted on duplex ultrasonography, further investigation may include magnetic resonance venography to rule out pelvic or thigh proximal venous thrombosis or compression. Obstructive sleep apnea may cause bilateral leg edema even in the absence of pulmonary hypertension. Brawny, nonpitting skin with edema characterizes lymphedema, which can present in one or both lower extremities. Possible secondary causes of lymphedema include tumor, trauma, previous pelvic surgery, inguinal lymphadenectomy, and previous radiation therapy. Use of pneumatic compression devices or compression stockings may be helpful in these cases.
Alam, N.; Shinwari, Z.K.; Ilyas, M.; Ullah, Z.
Indigenous knowledge of medicinal plants was recorded during summer 2004, in 22 villages of Chagharzai valley, District Buner. The study revealed 141 plant species belonging to 120 genera and 26 families are being used as medicine. The local people know the prospect and nature of the plant utilization, through personal experiences and ancestral prescriptions. The study also revealed that old aged people particularly women posses strong folk love of medicinal plants in comparison to young people. It was concluded that some plants are used singly while many other are used in combination. Similarly few plant species are used for the treatment of a specific disease, while several other have multiple uses. The plants were mainly used as stomachic, anti-allergic, antineuralgia, vermifuge, narcotic, laxative, anti jaundice, emollient, hypnotic, diuretic, digestive, demulcent, carminative, astringent, aphrodisiac, anti-spasmodic, anti-emetic, anti-diabetic, anthelmentic, anodyne and alterative. The present investigation will help in the preservation of indigenous knowledge of the local people, which is depleting day by day. (author)
Amichai, B; Grunwald, M H
Atopic dermatitis (AD) is a common chronic skin disease, which mainly affects children. Xerosis is one of the most troublesome signs of the disease. The aim of this study was to evaluate the efficacy of liquid soap containing 12% ammonium lactate + 20% urea in patients with AD. In a randomized, double-blind study, 36 patients (both male and female patients; age range 3-40 years) with mild to moderate AD were enrolled. Patients were divided randomly into two groups, in a ratio of 2:1 (active:placebo). The prescribed soap was used on a daily basis during a shower for 3 weeks. All patients continued all other systemic or topical medication but avoided any other soap or emollients. After 3 weeks of treatment, efficacy was assessed both by clinician and patient. There were significant improvements in scaling (P liquid soap was found to be effective in patients with AD, as use of this soap in patients with stable mild to moderate AD improved the parameters studied.
Ana Rodríguez Trabado
Full Text Available Background. Maltitol is a sugar alcohol that is frequently used as a noncaloric sweetener, although it is also used as an excipient, a plasticizer in gelatin capsules, and an emollient. It has not been previously described as an agent involved in immediate hypersensitivity reactions. Methods. We report on an anaphylactoid reaction with pharyngeal occlusion suffered by a 60-year-old man after ingestion of a candy containing maltitol syrup. A prick-to-prick test was performed with the candy and maltitol powder. Other allergens were excluded as causative agents of the adverse reaction, although the patient refused to undergo an oral challenge test with the candy. A basophil activation test (BAT was performed with maltitol powder, and a dose-response curve was generated. The test was also performed in 3 healthy controls. Results. Both prick-to-prick tests were negative. The result of the BAT was positive at all the concentrations tested in the patient’s blood and negative in all the controls. Conclusions. The BAT can help to clarify the agents implicated in an adverse reaction and can reduce the risk involved in diagnosis. The BAT can also prove useful in the study of reactions caused by low-molecular-weight antigens, for which routine diagnostic tests are not feasible.
Full Text Available Squalene (SQ possesses a wide range of pharmacological activities (antioxidant, drug carrier, detoxifier, hydrating, emollient that can be of benefit to the ocular surface. It can come in contact with human meibum (hMGS; the most abundant component of the tear film lipid layer as an endogenous tear lipid or from exogenous sources as eyelid sebum or pharmaceuticals. The aims of this study were to determine (i if SQ is in tear lipids and (ii its influence on the surface properties of hMGS films. Heteronuclear single quantum correlation NMR confirmed 7 mol % SQ in Schirmer’s strips extracts. The properties of SQ/hMGS pseudo-binary films at the air/water interface were studied with Langmuir surface balance, stress-relaxation dilatational rheology and Brewster angle microscopy. SQ does not possess surfactant properties. When mixed with hMGS squalene (i localized over the layers’ thinner regions and (ii did not affect the film pressure at high compression. Therefore, tear SQ is unlikely to instigate dry eye, and SQ can be used as a safe and “inert” ingredient in formulations to protect against dry eye. The layering of SQ over the thinner film regions in addition to its pharmacological properties could contribute to the protection of the ocular surface.
Bressani, Ana Paula P; Garcia, Karen C A; Hirata, Daniela B; Mendes, Adriano A
The present study deals with the enzymatic synthesis of alkyl esters with emollient properties by a sequential hydrolysis/esterification process (hydroesterification) using unrefined macaw palm oil from pulp seeds (MPPO) as feedstock. Crude enzymatic extract from dormant castor bean seeds was used as biocatalyst in the production of free fatty acids (FFA) by hydrolysis of MPPO. Esterification of purified FFA with several alcohols in heptane medium was catalyzed by immobilized Thermomyces lanuginosus lipase (TLL) on poly-hydroxybutyrate (PHB) particles. Under optimal experimental conditions (mass ratio oil:buffer of 35% m/m, reaction temperature of 35 °C, biocatalyst concentration of 6% m/m, and stirring speed of 1,000 rpm), complete hydrolysis of MPPO was reached after 110 min of reaction. Maximum ester conversion percentage of 92.4 ± 0.4% was reached using hexanol as acyl acceptor at 750 mM of each reactant after 15 min of reaction. The biocatalyst retained full activity after eight successive cycles of esterification reaction. These results show that the proposed process is a promising strategy for the synthesis of alkyl esters of industrial interest from macaw palm oil, an attractive option for the Brazilian oleochemical industry.
Khodaie, Laleh; Sadeghpoor, Omid
Ginger is the rhizome of Zingiber officinale, a perennial plant, used alone or in compounds as a spice or remedy in ancient recipes of Iranian traditional medicine (ITM) as an effective tonic for the memory and digestive system, the opener of hepatic obstructions, aphrodisiac, for expelling compact wind from stomach and intestines, diluting, desiccating and emollient of phlegmatic and compact humor sticking to body organs, stomach, intestine, brain and throat. The ITM scholars believed that ginger was a vermifuge as well as a remedy for paralysis and obstructive jaundice. They also revealed that this phytomedicine cures diarrhea due to corrupted food. This study aimed to compare the medicinal properties (afaal) of ginger in ITM with those indicated in modern research. Results of this study showed that the modern phytotherapy confirmed some of the properties of ginger. In addition, some of the properties of this phytomedicine have not been studied yet. By studding the ITM literature, herb elements or in other words ITM keywords, researchers can predict and state some unknown or less known potential pharmacologic effects of medicinal plants.
Nicolas, B; Moiziard, A S; Barrois, B; Colin, D; Michel, J M; Passadori, Y; Ribinik, P
Implementation of a prevention strategy after the identification of risk factors is essential at the entrance in a care unit or in a medical-social unit. Determine which medical devices and which treatments may be used in order to prevent pressure sore in 2012. Systematic review of the literature using databases: Pascal, Biomed, PubMed, and Cochrane library between 2000 and 2010. Nursing care including use of soft product, non-irritating for the cleaning, hydration of the skin with emollients, protection of fragile skin in case of incontinence by applying a skin protector and application of dressings in front of bony prominences to reduce shear forces, remain valid (level C). Nursing cares and use of dressing in patients with high risks of pressure sores are the responsibility of the nurses. The engagement of health care teams involves screening of risk factors and the knowledge of treatments and local devices. Local preventive treatment in a patient with risk factors of pressure sore is of great interest at entrance in a care unit or in a medical-social unit. Copyright © 2012. Published by Elsevier Masson SAS.
Iyer, Swaminathan; Kievsky, Yaroslav; Sokolov, Igor
The efficacy of skin care products depends on the time and dynamics of their absorbance by the skin, and its spatial distribution on the skin. Regular scrape-based methods may depend on the operator and are destructive and invasive in nature. Here, we describe a novel method based on non-contact optical measurements to trace the location and dynamics of skin care products on the skin. We use fluorescent silica colloidal particles of micron sizes at a rather small concentration as non-invasive tracers. As an example of skin care products, we use two base materials: either glycerin or vaseline. A mixture of each product with fluorescent particles is applied on human skin. The amount of fluorescence is monitored by means of a fluorescent spectrometer. The scraping method is used to compare with the spectroscopic measurements. Fluorescent tracers make the skin care product visible under UV light. This allows obtaining an optical image of the spatial distribution of the product on the skin. The quantitative data of fluorescence are well correlated with the scrape data. Comparison of the difference in the spectral and scraped mass data reveals the details of accumulation of the skin products in skin cracks and crevices. We described an efficient non-invasive benign method to quantify dynamics and to perform mapping of emollients and humectants on the skin.
Ana Patrícia Tavares
Full Text Available Incontinence-associated dermatitis (IAD it is a common complication in people with loss of continence sphincters, which induces irritation and disruption of the skin, with impact on quality of life and increase vulnerability to pressure ulcers and secondary infections. Objective: Identify which nursing interventions aimed at the prevention and healing of IAD in acute and long-term care. Method: We conducted a retrospective survey between January 2010 and September 2016 by formulating a question in PI[C]O format in databases MEDLINE (with full text e CINAHL (with full text, and 9 articles having been selected for analysis of a total of 537. Results: The observation of the skin is the gold standard. IAD Prevention: cleanse the skin with products with pH acid (step 1; apply emollients/ moisturizers on intact skin (step 2; protect the skin with barrier products (step 3. IAD Healing: clean the skin (step 1; skin protection (step 2; exudate management (if severe IAD (step 3. The identified interventions can be applied to other body regions affected by humidity. Conclusions: prevention, diagnosis and IAD healing is a nursing-sensitive indicators. Implications for the nursing profession: Nursing practice based on evidence, in a continuous improvement logic, contributed to the improvement of results in the incidence and prevalence of IAD.
Kuller, Joanne McManus
Infant skin is susceptible to dryness and irritation from external factors, including topical skin care products not formulated for the infant's skin. This may increase the risk of contact dermatitis. Parents frequently express concern regarding potential harm from ingredients in skin care products and seek information. This is complicated by several skin care myths. The purpose of this literature review was to provide evidence-based information to educate parents on the use of products for preterm and term infants. Multiple searches using PubMed were conducted including the search terms "infant skin care," "infant products," "infant bath," "emollients," "diaper skin care," and "diaper wipes." Reference lists of comprehensive reviews were also scanned. Google searches were used to assess consumer information, product information, and regulatory guidelines. There is little scientific evidence to support safety of natural/organic products on infant skin. Raw materials originate from different sources, complicating testing and comparisons of ingredients. Research shows that cleansers formulated for infant skin do not weaken the skin barrier the way harsher soaps and detergents can. Oils with the lowest oleic acid content provide a lower risk of irritant contact dermatitis. Nurses must be informed about natural and organic products, preservatives, and fragrances and know the definition of commonly used marketing terms. Decisions regarding the use of infant products in preterm and term infants should be evidence based. More research is needed to support claims regarding the safety of products used on infant skin.
Full Text Available The aim of the proposed study is to demonstrate the benefits of using specialized cosmetic products as part of basic skin care for children with Atopic Dermatitis (AD. The epidermal barrier dysfunction is known to be the leading factor in pathogenesis of atopic dermatitis and it manifests as dry skin, imbalance in the composition of lipids of the stratum corneum and water-lipid mantle and alterations in the activity of proteases. Due to xerosis, the skin gets easily affected by allergens, irritants and pathogenic microorganisms, which triggers the "itch-scratch" cycle and can lead to AD exacerbation and significantly deteriorate the quality of life of the patient. The basic skin care using the moisturizing and soothing cosmetic products (emollients is acknowledged by all major Guidelines for treatment of AD as an important part of therapy. Significant improvements in skin status as well as the child's well-being can be achieved with use of this simple to understand skin care algorithm that includes proper skin cleansing, moisturizing and itch prevention.
Harry-O'kuru, Rogers E; Biresaw, Girma; Gordon, Sherald; Xu, Jingyuan
Jojoba liquid wax is a mixture of esters of long-chain fatty acids and fatty alcohols mainly C38:2-C46:2. The oil exhibits excellent emolliency on the skin and, therefore, is a component in many personal care cosmetic formulations. The virgin oil is a component of the seed of the jojoba ( Simmondsia chinensis ) plant which occurs naturally in the Sonora Desert in the United States and northwestern Mexico as well as in the northeastern Sahara desert. The seed contains 50-60% oil by dry weight. The plant has been introduced into Australia, Argentina, and Israel for commercial production of the jojoba oil. As a natural lubricant, we are seeking to explore its potential as a renewable industrial lubricant additive. Thus, we have chemically modified the carbon-carbon double bonds in the oil structure in order to improve its already good resistance to air oxidation so as to enhance its utility as well as its shelf life in nonpersonal care applications. To achieve this goal, we have hydroxylated its -C=C- bonds. Acylation of the resulting hydroxyl moieties has generated short-chain vicinal acyl substituents on the oil which keep the wax liquid, improving its cold flow properties and also protecting it from auto-oxidation and rancidity.
Thakur, Naresh Kumar; Bharti, Pratibha; Mahant, Sheefali; Rao, Rekha
The present investigation was carried out with the objective of formulating a gellified emulsion of benzoyl peroxide, an anti-acne agent. The formulations were prepared using four different vegetable oils, viz. almond oil, jojoba oil, sesame oil, and wheat germ oil, owing to their emollient properties. The idea was to overcome the skin irritation and dryness caused by benzoyl peroxide, making the formulation more tolerable. The gellified emulsions were characterized for their homogeneity, rheology, spreadability, drug content, and stability. In vitro permeation studies were performed to check the drug permeation through rat skin. The formulations were evaluated for their antimicrobial activity, as well as their acute skin irritation potential. The results were compared with those obtained for the marketed formulation. Later, the histopathological examination of the skin treated with various formulations was carried out. Formulation F3 was found to have caused a very mild dysplastic change to the epidermis. On the other hand, the marketed formulation led to the greatest dysplastic change. Hence, it was concluded that formulation F3, containing sesame oil (6%w/w), was the optimized formulation. It exhibited the maximum drug release and anti-microbial activity, in addition to the least skin irritation potential. PMID:23264949
Rogers E. Harry-O’kuru
Full Text Available Jojoba liquid wax is a mixture of esters of long-chain fatty acids and fatty alcohols mainly C38:2–C46:2. The oil exhibits excellent emolliency on the skin and, therefore, is a component in many personal care cosmetic formulations. The virgin oil is a component of the seed of the jojoba (Simmondsia chinensis plant which occurs naturally in the Sonora Desert in the United States and northwestern Mexico as well as in the northeastern Sahara desert. The seed contains 50–60% oil by dry weight. The plant has been introduced into Australia, Argentina, and Israel for commercial production of the jojoba oil. As a natural lubricant, we are seeking to explore its potential as a renewable industrial lubricant additive. Thus, we have chemically modified the carbon-carbon double bonds in the oil structure in order to improve its already good resistance to air oxidation so as to enhance its utility as well as its shelf life in nonpersonal care applications. To achieve this goal, we have hydroxylated its –C=C– bonds. Acylation of the resulting hydroxyl moieties has generated short-chain vicinal acyl substituents on the oil which keep the wax liquid, improving its cold flow properties and also protecting it from auto-oxidation and rancidity.
Lorette, G.; Machet, L.
Acute and long term effects are frequent after radiotherapy. They may alter the general status and quality of life of the patients. Chronic radiodermatitis may result in ulceration and in transformation into a squamous cell carcinoma. There is a correlation of the frequency of acute dermatitis with the total dose. Chronic radiodermatitis may develop after repeated small doses of ionizing radiation for cardiac catheterization and coronary angio-plasties. The other prognostic factors for the level of acute and late skin reactions are volume of tissue treated, total daily dose, fractionations schemes... but there are some variation in the degree of reaction in patients treated with identical radiotherapy schedules. There is a patient - to- patient variability. Several diseases as systemic sclerosis, some genetic diseases, perhaps some drugs may increase the cutaneous reactions. So both acute and chronic irradiation injury is a complex process with many regulations. Chronic fibrosis may be caused by mechanism of cell activation (and particularly fibroblasts). Cytokines e.g transforming growth factor β (TGF-β) might be involved in the induction of fibrosis. Treatment use emollients. Superoxide dismutase was used as an ointment for radio-fibrosis therapy and obtains a reduction of the fibrosis. In late phases plastic surgery or sometimes cryo-surgery can be used. (authors)
Sucgang, Raymond J.; Manalili, Jenalyn; Mañago, Sarah; Janio, Jonick; Ching, Maricar; Moya, Esperanza; Cruz, Luzviminda
Three inhouse developed skin care formulations and four commercial formulations were tried out on dermatomed porcine skins for wettability and emoliency. Surface applied skin care formulations are alleged to reduce transepidermal water loss (TEWL). Sunscreens/sunblocks absorb or reflect the sun’s ultraviolet (UV) radiation on skin exposed to sunlight and thus helps protect against sunburn. Measurements of water resistance of topical application are normally done using contact angle measurements and swimming pool immersion approaches. TEWL is measured using vapometers. None of the conventional methods directly measure TEWL and water wash out rates. In this study, the effectiveness of skin moisturizers to inhibit TEWL was tested using tritiated water as radioactive tracer on degreased porcine skins. Topical emollients were applied on the epidermises of the skins and the skins were mounted epidermis facing down. Tritiated water was dropped on the top side of the skins and tritium activity concentrations of the moisture that passed through were measured. A modified immersion method was also developed as a screening tool to identify water resistant formulations. Sunscreens labelled with tritiated water were applied on the skin surfaces. The skins were immersed in water (distilled and sea water were compared) and aliquots of the water were counted for tritium every hour for 3 hours. Hydrophobicities of the formulations were predicted by the amounts of tritium that leached out from the skins. (author)
Laércio Wanderley dos Santos
Full Text Available http://dx.doi.org/10.5902/1980509812341Erythrina velutina Willd. (Fabaceae is used in traditional medicine in northeastern Brazil for its sudorificproperties, soothing, emollient, pectoral and local anesthetic. The aim of this study was to evaluate theeffect of substrate and shading on seedlings of Erythrina velutina. The experimental design was completelyrandomized in factorial scheme 5 x 2 (five substrates and two shades, with four replications and 10 plantsin each plot. The substrates were arisco, arisco + cattle manure 2:1 v/v, arisco + cattle manure 3:1 v/v, sand+ cattle manure 2:1 v/v, sand + cattle manure 3:1 v/v. The shadings were 0% shading (full sunlight and50% shading. The characteristics evaluated were stem diameter, height, leaf area, green and dry biomass ofroots and shoots, height/diameter and Dickson quality index.There was no significant difference in diameterbetween the different substrates. The environment in full sun favored the diameter and the root biomasswhereas the height was favored by shade. The substrates with cattle manure in its composition favorsthe development of plants of Erythrina velutina and higher seedling quality are produced in full sun andsubstrate arisco + cattle manure in the ratio 2:1
Hulshof, Lies; Van't Land, Belinda; Sprikkelman, Aline B; Garssen, Johan
The pathophysiology of atopic dermatitis (AD) is multifactorial and is a complex interrelationship between skin barrier, genetic predisposition, immunologic development, skin microbiome, environmental, nutritional, pharmacological, and psychological factors. Several microbial modulations of the intestinal microbiome with pre- and/or probiotics have been used in AD management, with different clinical out-come (both positive, as well as null findings). This review provides an overview of the clinical evidence from trials in children from 2008 to 2017, aiming to evaluate the effect of dietary interventions with pre- and/or pro-biotics for the treatment of AD. By searching the PUBMED/MEDLINE, EMBADE, and COCHRANE databases 14 clinical studies were selected and included within this review. Data extraction was independently conducted by two authors. The primary outcome was an improvement in the clinical score of AD severity. Changes of serum immunological markers and/or gastrointestinal symptoms were explored if available. In these studies some dietary interventions with pre- and/or pro-biotics were beneficial compared to control diets in the management of AD in children, next to treatment with emollients, and/or local corticosteroids. However, heterogeneity between studies was high, making it clear that focused clinical randomized controlled trials are needed to understand the potential role and underlying mechanism of dietary interventions in children with AD.
Full Text Available The pathophysiology of atopic dermatitis (AD is multifactorial and is a complex interrelationship between skin barrier, genetic predisposition, immunologic development, skin microbiome, environmental, nutritional, pharmacological, and psychological factors. Several microbial modulations of the intestinal microbiome with pre- and/or probiotics have been used in AD management, with different clinical out-come (both positive, as well as null findings. This review provides an overview of the clinical evidence from trials in children from 2008 to 2017, aiming to evaluate the effect of dietary interventions with pre- and/or pro-biotics for the treatment of AD. By searching the PUBMED/MEDLINE, EMBADE, and COCHRANE databases 14 clinical studies were selected and included within this review. Data extraction was independently conducted by two authors. The primary outcome was an improvement in the clinical score of AD severity. Changes of serum immunological markers and/or gastrointestinal symptoms were explored if available. In these studies some dietary interventions with pre- and/or pro-biotics were beneficial compared to control diets in the management of AD in children, next to treatment with emollients, and/or local corticosteroids. However, heterogeneity between studies was high, making it clear that focused clinical randomized controlled trials are needed to understand the potential role and underlying mechanism of dietary interventions in children with AD.
Full Text Available Natural waxes such as Beeswax, Carnauba wax and Candelilla wax are widely used in the Cosmetic and Food industries. Thanks to their composition, and besides a compulsory high safety, they provide desirable properties such as strength, gloss, emolliency, barrier effect, making them essential in numerous applications. For example, lots of candies are coated with either one or a mix of these 3 waxes, while for Cosmetics, the waxy part of lipsticks contains various combinations of such waxes. Within the cosmetic industry, the “green wave” – natural products – which is developing to the detriment of synthetic or mineral raw materials, has generated know-hows to enlighten new values to natural resources. Several types of developments have occurred: managing to substitute materials facing bad press (ex: petrolatum, lanolin, mimicking trendy “butter-like” textures either by adequate mixture or by chemical reaction to offer alternatives to overused Shea or Cupuaçu Butter, or as a result of more recent research programs, identifying natural waxes acting more like active ingredients than “just” like excipients (Mimosa Flower wax, Lemon Peel or Orange Peel waxes, etc..
Paudel, Keshav Raj; Panth, Nisha
Nelumbo nucifera Gaertn. (Nymphaeaceae) is a potential aquatic crop grown and consumed throughout Asia. All parts of N. nucifera have been used for various medicinal purposes in various systems of medicine including folk medicines, Ayurveda, Chinese traditional medicine, and oriental medicine. Many chemical constituents have been isolated till the date. However, the bioactive constituents of lotus are mainly alkaloids and flavonoids. Traditionally, the whole plant of lotus was used as astringent, emollient, and diuretic. It was used in the treatment of diarrhea, tissue inflammation, and homeostasis. The rhizome extract was used as antidiabetic and anti-inflammatory properties due to the presence of asteroidal triterpenoid. Leaves were used as an effective drug for hematemesis, epistaxis, hemoptysis, hematuria, and metrorrhagia. Flowers were used to treat diarrhea, cholera, fever, and hyperdipsia. In traditional medicine practice, seeds are used in the treatment of tissue inflammation, cancer and skin diseases, leprosy, and poison antidote. Embryo of lotus seeds is used in traditional Chinese medicine as Lian Zi Xin, which primarily helps to overcome nervous disorders, insomnia, and cardiovascular diseases (hypertension and arrhythmia). Nutritional value of lotus is as important as pharmaceutical value. These days' different parts of lotus have been consumed as functional foods. Thus, lotus can be regarded as a potential nutraceutical source.
Giacomin, Maria F A; França, Camila M P; Oliveira, Zilda N P; Machado, Maria C R; Sallum, Adriana M E; Silva, Clovis A
Harlequin ichthyosis (HI) is a severe and rare hereditary congenital skin disorder characterized by excessive dryness, ectropion and eclabion. The association of ichthyosis with systemic sclerosis has been described in only three children. No patient with generalized morphea (GM) associated with harlequin ichthyosis was described. A 4-years and 6-months girl, diagnosed with harlequin ichthyosis based on diffuse cutaneous thickening, scaling, erythema, ectropion and eclabium since the first hours of birth was described. She was treated with acitretin (1.0mg/kg/day) and emollient cream. At 3 years and 9 months, she developed muscle contractures with pain on motion and limitation in elbows and knees, and diffuse sclerodermic plaques on the abdomen, back, suprapubic area and lower limbs. Skin biopsy showed rectified epidermis and mild hyperorthokeratosis, reticular dermis with perivascular and periadnexal infiltrates of lymphocytes and mononuclear cells, and reticular dermis and sweat gland sclerosis surrounded by a dense collagen tissue, compatible with scleroderma. The patient fulfilled the GM subtype criteria. Methotrexate and prednisone were introduced. At 4 years and 3 months, new scleroderma lesions occurred and azathioprine was associated with previous therapy, with no apparent changes after two months. A case of harlequin ichthyosis associated with a GM was reported. The treatment of these two conditions is a challenge and requires a multidisciplinary team. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.
Menter, A.; Korman, N.J.; Elmets, C.A.; Feldman, S.R.; Gelfand, J.M.; Gordon, K.B.; Gottlieb, A.; Koo, J.Y.M.; Lebwohl, M.; Lim, H.W.; Van Voorhees, A.S.; Beutner, K.R.; Bhushan, R. [University of Texas South West Medical Center Dallas, Dallas, TX (United States)
Psoriasis is a common, chronic, inflammatory, multi-system disease with predominantly skin and joint manifestations affecting approximately 2% of the Population. In this third of 6 sections of the guidelines of care for psoriasis, we discuss the use of topical medications for the treatment of psoriasis. The majority of patients with psoriasis have limited disease (<5% body surface area involvement) and can be treated with topical agents, which generally provide a high efficacy-to-safety ratio. Topical agents may also be used adjunctively for patients with more extensive psoriasis undergoing therapy with either ultraviolet light, systemic or biologic medications. However, the use of topical agents as monotherapy in the setting of extensive disease or in the setting of limited, but recalcitrant, disease is not routinely recommended. Treatment should be tailored to meet individual patients' needs. We will discuss the efficacy and safety of as well as offer recommendations for the use of topical corticosteroids, vitamin D analogues, tazarotene, tacrolimus, pimecrolimus, emollients, salicylic acid, anthralin, coal tar, as well as combination therapy.
Moravkova, T; Filip, P
Evaluation of sensory attributes of cosmetic products is traditionally based on sensory panels. However, in some cases, a suitable candidate method that can reduce time and costs is the use of instrumental analysis that can detect relatively very small changes of entry ingredients. Such approach has been already applied for emollients, salt content, stabilizers, etc. The aim of this contribution is to apply the relations between sensory analysis and rheology to a series of body lotions differing in the contents of emulsifiers and viscosity regulators. Sensory and rheological analyses are related. Rheological analysis can represent a good alternative to basic orientation in chosen customer's feelings. A rotational rheometer is the only instrumental device required for the measurements. An empirical rheological model was proposed by means of which the selected sensory attributes were evaluated using the numerical values of adjustable model parameters. This approach exhibited a very good agreement with the results obtained by the sensory panel. It was shown that a description of chosen sensory attributes can be responsibly carried out by rheological measurements, that is through the attained numerical values of the parameters appearing in a proposed empirical model characterizing shear viscosity of body lotions. © 2016 Society of Cosmetic Scientists and the Société Française de Cosmétologie.
Jang, Yong Hyun; Lee, Jin Sub; Kim, Sang Lim; Song, Chang Hyun; Jung, Hong Dae; Shin, Dong Hoon; Cho, Jae We; Chung, Hyun; Suh, Moo Kyu; Kim, Do Won
It is important to educate families of pediatric patients with atopic dermatitis (AD) so that they have a correct understanding of AD. The purpose of this study is to introduce, evaluate, and improve our family-engaged educational program. Children suffering from AD and their families have participated in a half-day educational program called "AD school" with catchy slogans such as "Enjoy with AD Families!" every year since 2005. Educational lectures were conducted for parents. For children with AD, various entertaining programs were provided. A feedback survey about AD school was administered for the purpose of evaluation. A total of 827 people (376 patients and 451 family members) participated in this program over 7 years. On-site surveys showed a positive response (i.e., "excellent" or "good") for the prick test (95.1%), emollient education (78.4%), educational lecture (97.0%), drawing contest and games (90.2%), and recreation (magic show; 99.0%) respectively. Telephone surveys one year later also elicited a positive response. We herein introduce the experience of a half-day, family-engaged educational program for AD. Family-engaged education programs for AD such as this AD school encourage and validate family participation in the treatment of their children's AD.
Gomez-Berrada, M P; Ficheux, A S; Galonnier, M; Rolfo, J E; Rielland, A; Guillou, S; De Javel, D; Roudot, A C; Ferret, P J
The container, also known as primary package or inner package, could be defined as the packaging designed to come into direct contact with the cosmetic product. To author's knowledge, no study was available regarding the effect of the primary package on the consumption of cosmetic products. The aim of the study was to assess the impact of the container on the consumption of three cosmetic products widely used, i.e. shampoo, shower gel and emollient cream. The three products were contained in a tube with a flip top cap and in a bottle with a pump. The study was conducted on 221 French adults: 108 women and 113 men. Results showed that the consumption of each cosmetic product was slightly higher when the product was packaged in tube with a flip top cap than in bottle with a pump. The difference of consumption could vary from 5 % to 23 % when calculated with mean values. This information could be interesting for safety evaluators, safety agencies and commercial services of cosmetic manufacturers. Copyright © 2017 Elsevier Ltd. All rights reserved.
Lee, Melissa; Van Bever, Hugo
The skin of individuals with atopic dermatitis has a susceptibility to be colonized with Staphylococcus aureus. This has been associated with increased frequency and severity of exacerbations of atopic dermatitis. Therefore, there is a growing interest in the use of antiseptic agents to target primary bacterial colonization and infection. Antiseptic agents have been found to be better tolerated and less likely to induce bacterial resistance as compared to antibiotics. There is also a wide variety of antiseptic agents available. The efficacy of antiseptic agents has yet to be established as the studies reviewed previously have been small and of suboptimal quality. This review discusses the rationale behind targeting S. aureus with antiseptic agents and presents findings from a review of studies assessing the efficacy of antiseptics in atopic dermatitis in the last five years. Four studies were found, including a bleach bath study which has already been reviewed elsewhere. The remaining 3 studies assessed the efficacy of sodium hypochlorite containing cleansing body wash, sodium hypochlorite baths and 1% triclosan in leave on emollient. These studies suggested some benefit for the inclusion of antiseptic use with the mainstay management of atopic dermatitis, including a potential steroid sparring effect. However, there are many limitations to these studies which therefore warrant further investigation on the impact of antiseptic use in atopic dermatitis.
Strunk, Tobias; Pupala, Sameer; Hibbert, Julie; Doherty, Dorota; Patole, Sanjay
The immature fragile skin of preterm infants represents an inadequate protective barrier. The emollient and anti-infective properties of coconut oil make it a potentially beneficial topical agent for this population. Our aim was to evaluate feasibility, safety, and the effects of topical coconut oil on skin condition in very preterm infants. An open-label randomised controlled trial in preterm infants coconut oil (5 mL/kg) twice daily for 21 days, starting within 24 h of birth. The neonatal skin condition was the primary outcome, and was assessed using the Neonatal Skin Condition Score (NSCS) on days 1, 7, 14, and 21. The number of coconut oil applications was recorded to assess clinical feasibility and all enrolled infants were monitored for adverse effects of topical coconut application, such as skin irritation. A total of 72 infants born coconut oil was feasible and without adverse effects. The NSCS was maintained in the coconut oil group throughout the intervention period, but deteriorated from a median (IQR) of 3 (3-4) on day 1 to 4 (4-4) on day 21 in the control group (p = 0.01). There were no differences in common neonatal outcomes, including sepsis, necrotising enterocolitis, retinopathy of prematurity, chronic lung disease, and mortality. Topical coconut oil maintained a better skin condition in very preterm infants without adverse effects. This simple, safe, and affordable intervention warrants further investigation. © 2017 S. Karger AG, Basel.
Verallo-Rowell, Vermén M; Katalbas, Stephanie S; Pangasinan, Julia P
Natural oils include mineral oil with emollient, occlusive, and humectant properties and the plant-derived essential, coconut, and other vegetable oils, composed of triglycerides that microbiota lipases hydrolyze into glycerin, a potent humectant, and fatty acids (FAs) with varying physico-chemical properties. Unsaturated FAs have high linoleic acid used for synthesis of ceramide-I linoleate, a barrier lipid, but more pro-inflammatory omega-6:-3 ratios above 10:1, and their double bonds form less occlusive palisades. VCO FAs have a low linoleic acid content but shorter and saturated FAs that form a more compact palisade, more anti-inflammatory omega-6:-3 ratio of 2:1, close to 7:1 of olive oil, which disrupts the skin barrier, otherwise useful as a penetration enhancer. Updates on the stratum corneum illustrate how this review on the contrasting actions of NOs provide information on which to avoid and which to select for barrier repair and to lower inflammation in contact dermatitis genesis.
Manche, Monique; Foligné, Benoît; Sauty, Mathieu; Platel, Anne; Vercauteren, Eric; Rauwel, Gaétan; Catoire, Sophie; Ficheux, Hervé; Criquelion, Jacques; Nesslany, Fabrice
Hand hygiene plays a key role in nosocomial infection prevention. To achieve users' adherence, products' dermal tolerance is essential. We aimed at making a comparative assessment of skin irritation and phototoxicity of the 3 alcohols commonly used in alcohol-based hand rubs (Ethanol, Propan-2-ol, Propan-1-ol) at 60, 70, 80 or 85% w/w in water or with co-formulates (hydrating, emollient and skin protective agents). In vitro validated OECD methods 439 and 432 were used. For irritation, EpiSkin™ Small Model was the chosen Reconstructed Human Epidermis (RhE). For phototoxicity, co-formulates alone or in mixture with and without alcohol were tested using BALB/c 3T3 cell cultures. Whilst Ethanol and Propan-2-ol could not be differentiated and displayed good skin tolerance profiles, Propan-1-ol based products lead to significant viability impairments of RhE at 60, 70 or 80% and at 60% in the presence of co-formulates. However, these results could not be reproduced in another RhE model. Taking also into account bibliographic data on Propan-1-ol, this suggests that our results are probably related to a lack of specificity of the used RhE. Therefore, it can be relevant in case of significant results to use two different RhE models before performing any classification and/or performing any complementary tests. Copyright © 2017 Elsevier Ltd. All rights reserved.
D’Souza, Maria Mathew; D’Souza, Paschal; Sharma, Rajnish; Jaimini, Abhinav; Mondal, Anupam
A 58-year-old woman, diagnosed as a case of mycosis fungoides (MF), underwent [18F]-fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT) examination. The study revealed intense FDG uptake in a large ulceroproliferative right thigh lesion, indurated plaques in the chest wall and left thigh, along with multiple sites of cutaneous involvement, axillary and inguinal lymphadenopathy. The patient underwent chemotherapy with CHOP regimen, radiotherapy for the right thigh lesion, along with topical corticosteroids and emollients for the disseminated cutaneous involvement. Repeat [18F]-FDG PET/CT study performed a year later, showed near complete disease regression specifically of the ulceroproliferative lesion and indurated cutaneous plaques, no change in lymphadenopathy, and a subtle diffuse progression of the remaining cutaneous lesions. A multidisciplinary approach to the diagnosis, staging and treatment of MF has long been suggested for optimizing outcomes from management of patients with this disease. This case highlights the potential role of incorporating PET/CT as a single modality imaging technique in the staging and assessment of response to therapy
Full Text Available Colloidon baby is a rare congenital disorder characterized clinical-ly by parchment like taught membrane covering the whole body at the time of birth, which subsequently develops Non bullous ichthyosiform erythroderma or Lamellar ichthyiosis in most cases and in few cases other ichthyosiform disorders. The colloidon membrane spontaneously desquamates within 2 weeks or up to 3 months in few cases. Herein, we present 2 cases of colloidon babies born to consanguineously married couples of which the first baby was born at term by normal vaginal delivery and second baby born prematurely by caesarean section. Both 1st & 2nd baby were delivered in different private hospitals in villages of Nizamabad district, Telangana state and reported to tertiary level children’s hospital in Hyderabad city on 4nd and 6th day of life respectively with complaints of colloidon membrane and macera-tion of skin in diaper area, was admitted in Neonatal intensive care unit (NICU in humidified incubator, treated with emollients, intra-venous fluids and prophylactic antibiotics to avoid complications. Nursing care is of prime importance. This presentation was aimed at stressing not only the importance of early recognition by pedia-trician & timely referral to dermatologist and ophthalmologist for saving life of affected baby but also equal importance to proper nursing care.
Gómez Chabala, Luisa Fernanda; Cuartas, Claudia Elena Echeverri; López, Martha Elena Londoño
Aloe vera is a perennial plant employed for medical, pharmaceutical and cosmetic purposes that is rich in amino acids, enzymes, vitamins and polysaccharides, which are responsible for its therapeutic properties. Incorporating these properties into a biopolymer film obtained from alginate and chitosan allowed the development of a novel wound dressing with antibacterial capacity and healing effects to integrate the antibacterial capacity of silver nanoparticles with the healing and emollient properties of Aloe vera gel. Three alginate-chitosan matrices were obtained through blending methods using different proportions of alginate, chitosan, the Aloe vera (AV) gel and silver nanoparticles (AgNps), which were incorporated into the polymeric system through immersion methods. Physical, chemical and antibacterial characteristics were evaluated in each matrix. Interaction between alginate and chitosan was identified using the Fourier transform infrared spectroscopy technique (FTIR), porosity was studied using scanning electron microscopy (SEM), swelling degree was calculated by difference in weight, Aloe vera gel release capacity was estimated by applying a drug model (Peppas) and finally antibacterial capacity was evaluated against S. Aureus and P. aeruginosa . Results show that alginate-chitosan (A (1:3 Chit 1/Alg 1); B (1:3 Chit 1.5/Alg 1) and C (3:1 Chit 1/Alg 1/B12)) matrices with Aloe vera (AV) gel and silver nanoparticles (AgNps) described here displayed antibacterial properties and absorption and Aloe vera release capacity making it a potential wound dressing for minor injuries.
FRAZ M. KHAN
Full Text Available A study on the ethno-veterinary usage of wild medicinal plants of Greater Cholistan desert of Pakistan was conducted from January, 2007 to December, 2008. Information regarding 35 plant species was collected. According to the results, Blepharis sindica was used as galactagogue. Butea monosperma, Calotropis procera and Phyllanthus nirurii were used as emollient, demulcent and antiphlogistic. Amaranthus trilocular, Capparis decidua, Clerodendron phlomoides, Phyllanthus nirurii and Ricinus communis were used as carminative and stomachic. Capparis decidua and Calotropis procera were used as appetizer. Prosopis glandulosa had anodyne properties, Achyranthes aspera had antilithic, while Pedalium murex, Tribulus terrestris and Barleria prionites had diuretic value. Achyranthes aspera, Argemone mexicana, Balanites aegyptiaca, Butea monosperma, Cassia senna, Citrullus colocynthis and Vitex negundo were used as vermifuge. Alhagi camelorum and Balanites aegyptiaca had aperient properties. Barleria prionites and Mollugo nudicaulis had their role in the ripening of an abscess. Ricinus communis and Salvadora oleoides aided in the removal of placenta and lochia. Anamitra cocculus and Argemone mexicana were used as febrifuge. Aerva javanica, Ailanthus excelsa, Amaranthus trilocular, Capparis decidua were used in diarrhoea and dysentery. Argemone mexicana and Ailanthus excelsa were used in ague.
Scott, D W; Miller, W H
Primary seborrhoea was diagnosed in 14 English springer spaniels over a 17-year period. Seven of the dogs developed clinical signs by two years of age. The dermatosis began as a generalised non-pruritic dry scaling which gradually worsened. Some dogs remained in this dry (seborrhoea sicca) stage, but in most cases the dermatosis became greasy and inflamed (seborrhoea oleosa and seborrhoeic dermatitis). Eight of the dogs suffered from recurrent episodes of superficial or deep bacterial pyoderma. Histological findings in skin biopsy specimens included marked orthokeratotic hyperkeratosis of surface and infundibular epithelium, papillomatosis, parakeratotic capping of the papillae, and superficial perivascular dermatitis in which lymphocytes and mast cells were prominent. The dogs with seborrhoea sicca responded more satisfactorily to therapy with topical emollient-humectant agents or oral omega-3/omega-6 fatty acid supplementation. Dogs with seborrhoea oleosa and seborrhoeic dermatitis did not respond satisfactorily to topical therapy. One dog, however, responded well to etretinate and omega-3/omega-6 fatty acid administration. No dog was cured.
Keshav Raj Paudel
Full Text Available Nelumbo nucifera Gaertn. (Nymphaeaceae is a potential aquatic crop grown and consumed throughout Asia. All parts of N. nucifera have been used for various medicinal purposes in various systems of medicine including folk medicines, Ayurveda, Chinese traditional medicine, and oriental medicine. Many chemical constituents have been isolated till the date. However, the bioactive constituents of lotus are mainly alkaloids and flavonoids. Traditionally, the whole plant of lotus was used as astringent, emollient, and diuretic. It was used in the treatment of diarrhea, tissue inflammation, and homeostasis. The rhizome extract was used as antidiabetic and anti-inflammatory properties due to the presence of asteroidal triterpenoid. Leaves were used as an effective drug for hematemesis, epistaxis, hemoptysis, hematuria, and metrorrhagia. Flowers were used to treat diarrhea, cholera, fever, and hyperdipsia. In traditional medicine practice, seeds are used in the treatment of tissue inflammation, cancer and skin diseases, leprosy, and poison antidote. Embryo of lotus seeds is used in traditional Chinese medicine as Lian Zi Xin, which primarily helps to overcome nervous disorders, insomnia, and cardiovascular diseases (hypertension and arrhythmia. Nutritional value of lotus is as important as pharmaceutical value. These days’ different parts of lotus have been consumed as functional foods. Thus, lotus can be regarded as a potential nutraceutical source.
Weidinger, Stephan; Novak, Natalija
Atopic dermatitis (also known as atopic eczema) is a chronic inflammatory skin disease that is characterised by intense itching and recurrent eczematous lesions. Although it most often starts in infancy and affects two of ten children, it is also highly prevalent in adults. It is the leading non-fatal health burden attributable to skin diseases, inflicts a substantial psychosocial burden on patients and their relatives, and increases the risk of food allergy, asthma, allergic rhinitis, other immune-mediated inflammatory diseases, and mental health disorders. Originally regarded as a childhood disorder mediated by an imbalance towards a T-helper-2 response and exaggerated IgE responses to allergens, it is now recognised as a lifelong disposition with variable clinical manifestations and expressivity, in which defects of the epidermal barrier are central. Present prevention and treatment focus on restoration of epidermal barrier function, which is best achieved through the use of emollients. Topical corticosteroids are still the first-line therapy for acute flares, but they are also used proactively along with topical calcineurin inhibitors to maintain remission. Non-specific immunosuppressive drugs are used in severe refractory cases, but targeted disease-modifying drugs are being developed. We need to improve understanding of the heterogeneity of the disease and its subtypes, the role of atopy and autoimmunity, the mechanisms behind disease-associated itch, and the comparative effectiveness and safety of therapies. Copyright © 2016 Elsevier Ltd. All rights reserved.
Full Text Available Guar (Cyamopsis tetragonoloba L. is a spring-summer legume with a high drought tolerance, grown mainly in India, Pakistan, United States and South Africa, whose seeds contain galactomannans. These can be used as an emollient, softening or thickening agent, a flocculant, as well as in hydraulic fracturing, and as a stabiliser in a wide range of other industrial activities: the production of cosmetics, paper, textiles, paints and varnishes, detergents, in construction, and in food products (jams, jellies, yogurt, mayonnaise, ketchup, diet foods, foods for coeliacs, etc.. In the light of a growing industrial demand for guar flour, in May 2012 a trial was carried out in southern Italy. Seeds from South Africa were sown in large plots on two farms with different soil characteristics. The crop showed yields varying between 1.8 and 2.2 t ha–1. Agronomic results were then used to conduct an integrated sustainability analysis using the production cost analysis and the life cycle assessment, in order to assess, respectively, the cost-effectiveness and the environmental impact of the production process of guar in a Mediterranean environment. Compared to other competitive crops, guar, with less than 3000 kg of CO2 eq. emissions, can be considered as a low-emission crop. Given the above-mentioned yield, guar growing is economically sustainable when the purchase price of seeds is not less than 0.96 € kg–1.
Full Text Available Palmoplantarkeratodermas (PPKs are a heterogeneous group of hereditary and acquired disorders with underlying gene defects, and characterized by hyperkeratosis of palms and soles with or without other ectodermal and systemic abnormalities. Huriez syndrome is a rare autosomal dominant transgradient type of PPK with high frequency of squamous cell carcinoma in the affected skin. We hereby describe a case of a very rare autosomal dominant PPK in a 40-year-old male patient presenting since birth with PPK extending onto the dorsal aspects of hands and feet with peeling of the skin. The complaints were associated with sclerodactyly, hyperhidrosis, and nail abnormalities. Also superadded dermatophyte infection was observed involving abdomen. No history of loss of any digit. No mucosal, dental, or any systemic involvement was present. No sign of malignancy was noted. Baseline investigations, including ultrasonography of abdomen were normal. Histological findings were nonspecific with only orthohyperkeratosis and acanthosis. Diagnosis was mainly done on clinical grounds. The patient is better with oral retinoids and topical emollients and keratolytics along with antifungal treatment for dermatophyte infection. He is under follow up.
Full Text Available The tree popularly known in Brazil as mulateiro or pau-mulato (Calycophyllum spruceanum (Benth. K. Schum. is deeply embedded in the herbal medicine of the Amazon region. Different preparations of the bark are claimed to have anti-aging, antioxidant, antimicrobial, emollient, wound healing, hemostatic, contraceptive, stimulant, and anti-diabetic properties. The current study aims to provide the first step towards a science-based evidence of the beneficial effects of C. spruceanum in the promotion of longevity and in the modulation of age-related markers. For this investigation, we used the model system Caenorhabditis elegans to evaluate in vivo antioxidant and anti-aging activity of a water extract from C. spruceanum. To chemically characterize the extract, HPLC MS (High Performance Liquid Chromatography Mass Spectrometry/MS analyses were performed. Five secondary metabolites were identified in the extract, namely gardenoside, 5-hydroxymorin, cyanidin, taxifolin, and 5-hydroxy-6-methoxycoumarin-7-glucoside. C. spruceanum extract was able to enhance stress resistance and to extend lifespan along with attenuation of aging-associated markers in C. elegans. The demonstrated bioactivities apparently depend on the DAF-16/FOXO pathway. The data might support the popular claims of mulateiro as the “tree of youth”, however more studies are needed to clarify its putative benefits to human health.
Full Text Available Context: Oils and butter of seed from Brazilian biodiversity are extending the range of innovative products for cosmetics development. They have a fat potential similar to skin composition, leading to the improved performance of these product. Aims: Improve the emulsions spreadability through prior screening of grease composition and studying the viscosity, and the emulsions accelerated stability. Methods: Emulsions were formulated using oils from semiarid plants from Bahia: Syagrus coronate, Pachira retusa, and Pachira aquatica, so as to compare them with oils already standard in the production of cosmetics. Spreadability and stability tests were made comparing the results. The same criteria were used with Amazon seed butter: Virola surinamensis, Butyrospermum parkii, Astrocaryum murumuru, Theobroma cacao and Theobroma grandiflorum. For the emulsions screening and performance, a system was developed for oil/ butter, following tests of accelerated stability, viscosity, and spreadability. Results: The combined system of spreadability was optimized using screening. Emollients containing oleic and palmitic acids, and light chain fatty acids obtained good spreadability. The oil emulsion containing Pachira retusa and Virola surinamensis butter had a higher viscosity. Conclusions: With high content of fatty acids such as oleic, palmitic or the light chain fatty acids obtain an appropriated appearance, texture, and spreadability for cosmetic use. Thus, oils with a low fatty acid content may be combined with butter that have a high fatty acid content and vice-versa. Analyzing and strategically combining grease composition, one can optimize the performance of cosmetic formulations.
Coyer, Fiona M; O'Sullivan, Judy; Cadman, Nicola
The provision of the patient bed-bath is a fundamental nursing care activity yet few quantitative data and no qualitative data are available on registered nurses' (RNs) clinical practice in this domain in the intensive care unit (ICU). The aim of this study was to describe ICU RNs current practice with respect to the timing, frequency and duration of the patient bed-bath and the cleansing and emollient agents used. The study utilised a two-phase sequential explanatory mixed method design. Phase one used a questionnaire to survey RNs and phase two employed semi-structured focus group (FG) interviews with RNs. Data was collected over 28 days across four Australian metropolitan ICUs. Ethical approval was granted from the relevant hospital and university human research ethics committees. RNs were asked to complete a questionnaire following each episode of care (i.e. bed-bath) and then to attend one of three FG interviews: RNs with less than 2 years ICU experience; RNs with 2-5 years ICU experience; and RNs with greater than 5 years ICU experience. During the 28-day study period the four ICUs had 77.25 beds open. In phase one a total of 539 questionnaires were returned, representing 30.5% of episodes of patient bed-baths (based on 1767 bed occupancy and one bed-bath per patient per day). In 349 bed-bath episodes 54.7% patients were mechanically ventilated. The bed-bath was given between 02.00 and 06.00h in 161 episodes (30%), took 15-30min to complete (n=195, 36.2%) and was completed within the last 8h in 304 episodes (56.8%). Cleansing agents used were predominantly pH balanced soap or liquid soap and water (n=379, 71%) in comparison to chlorhexidine impregnated sponges/cloths (n=86, 16.1%) or other agents such as pre-packaged washcloths (n=65, 12.2%). In 347 episodes (64.4%) emollients were not applied after the bed-bath. In phase two 12 FGs were conducted (three FGs at each ICU) with a total of 42 RN participants. Thematic analysis of FG transcripts across the three
measured before, and 2 and 4 weeks after, treatment. Results: Four weeks of treatment with the LA-containing product resulted in a significant decrease in local SCORAD, TEWL, erythema, and echo density of dermis, as well as an increase in SC hydration compared to baseline. The urea-containing product also reduced the local SCORAD and echo density of dermis and increased SC hydration. In contrast to the LA-containing product, changes in TEWL and erythema were not significant. Moreover, the reduction of erythema was significantly higher in the LA-containing product-treated side compared to the urea-containing product-treated side (p = 0.006. Conclusion: Both LA- or urea-containing w/o emulsions can significantly improve barrier dysfunction and clinical severity of AD. In agreement with literature, it was confirmed that an LA-containing w/o emulsion exhibited erythema-reducing effects. Since emollients should be used on a regular basis, patients should choose a product by individual preference following recommendation by their dermatologists. Keywords: emollient, moisturizer, humectants, epidermal barrier, erythema
This article describes topical therapies and treatment guidelines for psoriasis and is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. The highly variable nature of psoriasis and its individual presentation in patients can make it difficult to choose the most appropriate treatment. There are many treatment options, from topical treatment with emollients for very mild psoriasis, to systemic therapy with fumaric acid esters, methotrexate or biologics for severe disease. For the treatment of mild-to-moderate psoriasis, topical therapy is generally the most appropriate and a variety of options, both historical and recent, are available. Newer therapies offer greater convenience and fewer side-effects. Of the more recently available therapies, vitamin D analogues and topical corticosteroids are the two with the greatest proven efficacy in randomized clinical trials. A recent Cochrane review showed the highest efficacy overall with the fixed combination vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate). Indeed, clinical trials have shown that two-compound calcipotriol\\/betamethasone dipropionate ointment has higher efficacy than calcipotriol or betamethasone dipropionate alone. With regard to safety, two-compound calcipotriol\\/betamethasone dipropionate was shown to be suitable for intermittent long-term treatment of mild-to-moderate psoriasis. The findings of the Cochrane review are reflected in the current treatment guidelines from the USA and Germany regarding the treatment of mild-to-moderate psoriasis. In both these guidelines, which will be discussed in this article, the recommended treatments for this patient group are vitamin D analogues and corticosteroids, particularly when used in combination.
This article describes topical therapies and treatment guidelines for psoriasis and is based on a presentation given by the authors at a satellite symposium held during the 19th Congress of the European Academy of Dermatology and Venereology, 6-10 October, 2010, in Gothenburg, Sweden. The highly variable nature of psoriasis and its individual presentation in patients can make it difficult to choose the most appropriate treatment. There are many treatment options, from topical treatment with emollients for very mild psoriasis, to systemic therapy with fumaric acid esters, methotrexate or biologics for severe disease. For the treatment of mild-to-moderate psoriasis, topical therapy is generally the most appropriate and a variety of options, both historical and recent, are available. Newer therapies offer greater convenience and fewer side-effects. Of the more recently available therapies, vitamin D analogues and topical corticosteroids are the two with the greatest proven efficacy in randomized clinical trials. A recent Cochrane review showed the highest efficacy overall with the fixed combination vitamin D analogue (calcipotriol) and corticosteroid (betamethasone dipropionate). Indeed, clinical trials have shown that two-compound calcipotriol\\/betamethasone dipropionate ointment has higher efficacy than calcipotriol or betamethasone dipropionate alone. With regard to safety, two-compound calcipotriol\\/betamethasone dipropionate was shown to be suitable for intermittent long-term treatment of mild-to-moderate psoriasis. The findings of the Cochrane review are reflected in the current treatment guidelines from the USA and Germany regarding the treatment of mild-to-moderate psoriasis. In both these guidelines, which will be discussed in this article, the recommended treatments for this patient group are vitamin D analogues and corticosteroids, particularly when used in combination.
Le Roux, Emma; Powell, Kingsley; Banks, Jonathan P; Ridd, Mathew J
Eczema is common among children, and in the UK the majority are managed by GPs. The most common cause of poor disease control is incorrect use of topical treatments. There is a lack of research into the challenges faced by GPs in diagnosing and managing this condition. To explore the experiences of GPs in assessing and managing children with eczema. Qualitative study in primary care in England. Semi-structured interviews with 15 GPs were audiorecorded, transcribed verbatim, and analysed thematically using the framework method. GPs described a paucity of dermatology training. Although most GPs were confident diagnosing uncomplicated eczema, they reported using a trial-and-error approach to prescribing emollients, and were uncertain about quantities of topical treatments to issue. Mild and moderate potency topical corticosteroids (TCS) were commonly used, but most GPs lacked confidence in recommending potent TCS, and viewed parents or carers to be fearful of using all strengths of TCS. GPs perceived adherence to treatments to be low, but provision of information to support self-care was variable. Routine review of medication use or disease control was uncommon, which GPs attributed to service constraints. Participants' views on the causes and management of eczema were perceived to be at odds with parents and carers, who were said to be overly focused on an underlying cause, such as allergy. GP uncertainty in managing eczema, lack of routine information and review, and perceived dissonance with parents around causation and management may be contributing to low concordance with treatments. © British Journal of General Practice 2018.
Berksoy Hayta, Sibel; Durmuş, Kasim; Altuntaş, Emine Elif; Yildiz, Esin; Hisarciklıo, Mehmet; Akyol, Melih
Numerous growth factors, cytokine, mitogen and chemotactic factors are involved in wound healing. Even though inflammation is important for the stimulation of proliferative phase, excessive inflammation also causes impairment in wound healing. Strontium salts suppress keratinocyte-induced TNF-alpha and interleukin-1 and interleukin-6 in in vitro cultures. This study was conducted to determine the effects of administration of topical strontium chloride hexahydrate on wound healing through TNF-alpha and TGF-beta in surgical wound healing model of in-vivo rat skin. Twenty-four rats were used in the study. After approximately 2 cm cutaneous-subcutaneous incision was horizontally carried out on the mid-neckline of the rats, the incision was again closed using 2.0 vicryl. The rats were assigned into three groups including eight rats in each group. Placebo emollient ointment and also the ointments, which were containing 5% and 10% strontium chloride hexahydrate and were prepared at the same base with placebo ointment, were administered to the groups by a blind executor twice a day for a week. At the end of seventh day, the rats were sacrificed and cutaneous and subcutaneous tissue of their wound site was resected for histopathological examination. Scoring of histopathological wound healing and scoring of tissue TNF-alpha and TGF-beta level with immunohistochemical staining were performed. The groups, to which both 5% and 10% strontium chloride hexahydrate was administered, had lower immunohistochemical TNF-alpha levels and histopathological wound scores compared to controls, which was statistically significant (p < 0.05). Strontium chloride hexahydrate can lead to impairment in wound healing by suppressing inflammation through TNF-alpha.
G K Singh
Full Text Available Background : Low humidity, high-velocity wind, excessive ultraviolet (UV exposure, and extreme cold temperature are the main causes of various types of environmental dermatoses in high altitudes. Materials and Methods: A retrospective study was carried out in patients visiting the lone dermatology department in Ladakh between July 2009 and June 2010. The aim was to identify the common environmental dermatoses in high altitudes so that they can be treated easily or prevented. The patients were divided into three demographic groups, namely, lowlanders, Ladakhis (native highlanders, and tourists. Data was analyzed in a tabulated fashion. Results: A total of 1,567 patients with skin ailments were seen, of whom 965 were lowlanders, 512 native Ladakhis, and 90 were tourists. The skin disorders due to UV rays, dry skin, and papular urticaria were common among all groups. The frequency of melasma ( n = 42; 49.4%, chronic actinic dermatitis (CAD ( n = 18; 81.81% of total CAD cases, and actinic cheilitis ( n = 3; 100% was much higher among the native Ladakhis. The frequency of cold-related injuries was much lesser among Ladakhis ( n = 1; 1.19% than lowlanders ( n = 70; 83.33% and tourists ( n = 13; 15.47% ( P < 0.05. Conclusion: Dryness of skin, tanning, acute or chronic sunburn, polymorphic light reaction, CAD, insect bite reactions, chilblain, and frostbite are common environmental dermatoses of high altitudes. Avoidance of frequent application of soap, application of adequate and suitable emollient, use of effective sunscreen, and wearing of protective clothing are important guidelines for skin care in this region.
Ibler, Kristina Sophie; Agner, Tove; Hansen, Jane Lindschou; Gluud, Christian
Hand eczema is the most frequently recognized occupational disease in Denmark with an incidence of approximately 0.32 per 1000 person-years. Consequences of hand eczema include chronic severe eczema, prolonged sick leave, unemployment, and impaired quality of life. New preventive strategies are needed to reduce occupational hand eczema. We describe the design of a randomised clinical trial to investigate the effects of classification of hand eczema plus individual counselling versus no intervention. The trial includes health-care workers with hand eczema identified from a self-administered questionnaire delivered to 3181 health-care workers in three Danish hospitals. The questionnaire identifies the prevalence of hand eczema, knowledge of skin-protection, and exposures that can lead to hand eczema. At entry, all participants are assessed regarding: disease severity (Hand Eczema Severity Index); self-evaluated disease severity; number of eruptions; quality of life; skin protective behaviour, and knowledge of skin protection. The patients are centrally randomised to intervention versus no intervention 1:1 stratified for hospital, profession, and severity score. The experimental group undergoes patch and prick testing; classification of the hand eczema; demonstration of hand washing and appliance of emollients; individual counselling, and a skin-care programme. The control group receives no intervention. All participants are reassessed after six months. The primary outcome is observer-blinded assessment of disease severity and the secondary outcomes are unblinded assessments of disease severity; number of eruptions; knowledge of skin protection; skin-protective behaviour, and quality of life. The trial is registered in ClinicalTrials.Gov, NCT01012453.
Norrman, Gunilla; Tomicić, Sara; Böttcher, Malin Fagerås; Oldaeus, Göran; Strömberg, Leif; Fälth-magnusson, Karin
To evaluate common methods of investigation and treatment in children younger than 2 y of age with eczema, with or without sensitization to food allergens. One hundred and twenty-three children younger than 2 y of age with eczema and suspected food allergy were included in this prospective study. The children underwent skin-prick test with cow's milk, fresh hen's egg white and wheat. Specific IgE to milk and egg white was analysed. The eczema extent and severity was estimated with SCORAD before and after treatment. Children with a positive skin-prick test were instructed to exclude that food item from their diet. All children were treated with emollients and topical steroids when needed. Sixty-two of the children were skin-prick positive to at least one of the allergens; 62% had mild, 30% moderate and 8% severe eczema at their first visit. After treatment, 90% had mild, 10% moderate and 0% severe eczema. Forty-six per cent of the children had circulating IgE antibodies to milk or egg white. Ten per cent had specific IgE but negative skin-prick test to the same allergen. This subgroup improved their eczema significantly without elimination diet. The conventional treatments for children with eczema, i.e. skin care and food elimination, are effective. The beneficial effect of skin care as the first step should not be neglected, and it may not be necessary to eliminate food allergens to relieve skin symptoms in all food-sensitized children with eczema.
Waris, Waris; Naik, Seeta; Idrees, Imran; Taha, Hesham; Camosino, Linda; Mehrishi, Anshu; Saif, Muhammad Wasif
The management of locally advanced head and neck cancer remains a challenge to most oncologists and their patients. Treatment with epithelial growth factor receptor inhibitors (EGFRIs) is associated with a good response. Cetuximab, a chimeric monoclonal antibody directed against epithelial growth factor receptor (EGFR), in combination with radiation therapy is indicated for the treatment of locally advanced squamous cell carcinoma of the head and neck. Although a mild acneiform skin rash (Grade 1, 2) is very common in these patients, severe rash (Grade 3) is uncommon. A 61-year-old African American man with locally advanced oropharyngeal cancer was treated with cetuximab and radiation. He developed a sudden flare-up of a skin rash after the 5th cycle of cetuximab following use of over-the-counter (OTC) skin care remedies. The rash manifested with severe maculopapular eruption and erythematous rash, along with desquamation and exfoliation of the skin, mainly on the face and neck area. The patient denied any extraordinary sun exposure. Cetuximab and radiation therapy were held for 1 week and the rash was treated with doxycycline, diphenhydramine, and continued use of natural emollient (Vaseline petroleum jelly). After 1 week, a dramatic improvement of the facial rash was noticed. Our report describes a sudden flare-up of a skin rash (Grade 3) after the 5th cycle of cetuximab following use of OTC skin care remedies, which was unusual for this patient, suggesting a possible relation to the therapy. Skin crucially depends on EGFR for its normal function and becomes extremely sensitive during cetuximab therapy. Topical OTC acne and dry skin remedies can suddenly change the mild acneiform rash into severe skin toxicity associated with marked desquamation and exfoliation. Avoidance of further skin damage caused by topical applications and the use of doxycycline and diphenhydramine show a significant success in the management of skin toxicity.
Full Text Available Justin J Gandy, Jacques R Snyman, Constance EJ van RensburgDepartment of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South AfricaBackground: The purpose of this study was to evaluate the efficacy and safety of carbohydrate-derived fulvic acid (CHD-FA in the treatment of eczema in patients two years and older.Methods: In this single-center, double-blind, placebo-controlled, parallel-group comparative study, 36 volunteers with predetermined eczema were randomly assigned to receive either the study drug or placebo twice daily for four weeks.Results: All safety parameters remained within normal limits, with no significant differences in either group. Significant differences were observed for both severity and erythema in the placebo and CHD-FA treated groups, and a significant difference was observed for scaling in the placebo-treated group. With regard to the investigator assessment of global response to treatment, a significant improvement was observed in the CHD-FA group when compared with the placebo group. A statistically significant decrease in visual analog scale score was observed in both groups, when comparing the baseline with the final results.Conclusion: CHD-FA was well tolerated, with no difference in reported side effects other than a short-lived burning sensation on application. CHD-FA significantly improved some aspects of eczema. Investigator assessment of global response to treatment with CHD-FA was significantly better than that with emollient therapy alone. The results of this small exploratory study suggest that CHD-FA warrants further investigation in the treatment of eczema.Keywords: fulvic acid, eczema, anti-inflammatory, efficacy, safety
Full Text Available Psoriasis is a common dermatosis in children with about one third of all patients having onset of disease in the first or second decade of life. A chronic disfiguring skin disease, such as psoriasis, in childhood is likely to have profound emotional and psychological effects, and hence requires special attention. Psoriasis in children has been reported to differ from that among adults being more frequently pruritic; plaque lesions are relatively thinner, softer, and less scaly; face and flexural involvement is common and guttate type is the characteristic presentation. Whether onset in childhood predicts a more severe form of psoriasis is a matter of controversy, it may cause significant morbidity particularly if it keeps relapsing. Most children have mild form of psoriasis which can be generally treated effectively with topical agents such as emollients, coal tar, corticosteroids, dithranol, calcipotriol etc. according to age and the sites affected. Narrow band UVB is the preferred form of phototherapy in children for moderate to severe disease or in patients not responding to topical therapy alone. Systemic therapies are reserved for more severe and extensive cases that cannot be controlled with topical treatment and/or phototherapy such as severe plaque type, unstable forms like erythrodermic and generalized pustular psoriasis and psoriatic arthritis. There are no controlled trials of systemic therapies in this age group, most experience being with retinoids and methotrexate with favorable results. Cyclosporine can be used as a short-term intermittent crisis management drug. There is an early promising experience with the use of biologics (etanercept and infliximab in childhood psoriasis. Systemic treatments as well as phototherapy have limited use in children due to cumulative dose effects of drugs, low acceptance, and risk of gonadal toxicity. More evidence-based data is needed about the effectiveness and long-term safety of topical
Shafiei, Alireza; Moin, Mostafa; Pourpak, Zahra; Gharagozlou, Mohammad; Aghamohammadi, Asghar; Aghamohamadi, Asghar; Sajedi, Vahid; soheili, Habib; Sotoodeh, Soheila; Movahedi, Masoud
Despite preliminary evidence, the role of probiotic and synbiotic in treatment of the atopic dermatitis has shown varying results. We aimed to evaluate whether synbiotic supplementation decrease severity of atopic dermatitis (AD) in childhood. In a randomized double blind-placebo controlled trial, we evaluated the synbiotic supplementation efficiency on the treatment of atopic dermatitis. Infants aged 1-36 months with moderate to severe atopic dermatitis were randomized (n=41) and received either synbiotic (probiotic plus prebiotic) (n=20) or placebo (n=21) daily as a powder for two months. Emollient (Eucerin) and topical corticosteroid (Hydrocortisone) were permitted. Children were scored for severity of atopic dermatitis (SCORAD). Also allergen Skin Prick Tests (SPT), IgE blood level and eosinophil count were measured at first visit. Patients' SCORAD were reevaluated at the end of intervention. We followed 36 out of 41 subjects for two months (drop out rate = 9%). In the whole group, the mean Total SCORAD (at base line 40.93) decreased by 56% (p=0.00). The mean Objective SCORAD (at base line 31.29) decreased by 53% (p=0.00). There was no significant difference in the mean decrease of total SCORAD between placebo (22.3) and synbiotic groups (24.2). There was also no difference between two intervention groups in the mean decrease of total SCORAD regarding to different demographic, clinical and para clinical subgroups. This study could not confirm synbiotic as an effective treatment for childhood atopic dermatitis and further studies are needed. These findings challenge the role of synbiotics in the treatment of childhood atopic dermatitis.
A dental health care worker (DHCW) has an obligation to prevent the spread of health care associated infections. Adhering to proper hand hygiene procedures, selecting appropriate hand hygiene products and the use of gloves are all important elements of infection control. The CDC Guidelines for Hand Hygiene state that improved hand hygiene practices can reduce transmission of pathogenic microorganisms to patients and personnel in health care settings. DHCWs must also protect themselves by recognizing pitfalls such as irritants or allergies that may pose obstacles to proper hand hygiene. Occupational irritants and allergies can be caused by frequent hand washing, exposure to hand hygiene products, exposure to chemicals and shear forces associated with wearing or removing gloves. Since the primary defense against infection and transmission of pathogens is healthy, unbroken skin, DHCWs must take steps to ensure that their skin remains healthy and intact. These steps include evaluating different types of hand hygiene products, lotions and gloves for the best compatibility. If the DHCW sees a breakdown of his or her skin barrier, steps should be taken to determine the cause and remedy. Remedies can include the use of alcohol-based hand sanitizers containing emollients and moisturizers and regular use of a medical grade hand lotion. The bottom line: healthy skin protects you at work and at home. Selection and use of appropriate hand hygiene products, including moisturizers, are an essential part ofa dental office infection control program. My coworker lost the use of her thumb for several months due to complications of a staph infection. She was unable to work and found even simple tasks such as closing a button hard to do. Think of how difficult your work would be if something happened to your hands. Injury, irritation or allergies could alter your ability to work or even perform routine tasks. Our hands provide us with the ability to work in clinical dentistry. It makes
Tirant, M; Bayer, P; Hercogovấ, J; Fioranelli, M; Gianfaldoni, S; Chokoeva, A A; Tchernev, G; Wollina, U; Novotny, F; Roccia, M G; Maximov, G K; França, K; Lotti, T
Lamellar ichthyosis (LI) is a genetically heterogeneous group of disorders of keratinization that are inherited in an autosomal recessive fashion, occurring in approximately 1 in 300,000 live births. The treatment of the large, dark, plate-like scales that characterize the classic manifestation of the disease are still a challenge. The aim of this study was to evaluate the efficacy and tolerability of Dr. Michaels® skin-care products for the management of LI. A multi-centre European prospective study was conducted, including 10 patients (3 female/7 male) with lamellar ichthyosis, aged 38-54 years old (mean age: 46). Each patient had been treated with emollients plus other different systemic therapies, such as corticosteroids, Cyclosporin A or retinoids in the past. All patients were treated with Dr Michaels® product family including both topical and oral herbal supplements. The topical treatments used were the cleansing gel, activator formula and ointment. The oral medications were PSC 200, PSC 400 and PSC 900. Within 3 weeks of initiation of treatment, there were improvements observed on the skin including a reduction in scaling, fissuring, and intensity in erythema and pruritus with thinning of the hyperkeratotic plate. After 12-15 weeks, most of the plates and scales had been removed to reveal a normalised skin colour. Evidence of hair, eyelash and eyebrow growth was observed. There was partial nail resolution with a reduction in subungual hyperkeratosis. No adverse reactions were observed. Our patients showed excellent symptomatic response to treatment within a 14-week period, follow-up by an on-going regular assessment on a quarterly basis. The results show that Dr Michaels® product family is an effective and safe treatment option for LI.
Meyer, Jaimi; Marshall, Brooke; Gacula, Maximo; Rheins, Lawrence
Glycerol has long served the topical prescriptive and personal care industry as a versatile and functional active and inactive ingredient. In skin care products, it acts primarily as an emollient, softening the skin through robust humectant hydration action. Hydrolyzed Jojoba Esters K-20W (K-20W) have been shown to increase skin hydration and improve sensory skin "feel" when included in a variety of skin, hair, and nail care cosmetic/personal care formulations. The addition of glycerol and hydrolyzed jojoba esters provides a substantial long-acting 24 h (moisturizing) skin hydration effect for topical products. A small pilot study was conducted to support the "proof of concept" that an enhanced, additive role exists between these two ingredients resulting in a long-term (24 h) skin moisturization effect. Topical treatments were applied to the skin (lower leg) of subjects, and evaluations were made at baseline and 8- to 24-h post-application. Skin hydration data were obtained via bio-instrumental transepidermal water loss (TEWL) measurements and expert clinical skin grading, including standardized digital clinical photography. Clinical skin grading evaluations and TEWL measurements found that significantly lower evaporative (P jojoba esters) than with glycerol alone in a standard base skin care lotion at 8 and 24 h posttreatment. This preliminary data "proof of concept" supports the position that glycerol and hydrolyzed jojoba esters work in tandem to enhance skin moisturization for at least 24 h. This unique moisturizing potential may prove valuable in the future development of cosmetic and over-the-counter/prescriptive topical products, including new medicaments containing botanicals. This fact is further reinforced with the recent greater commercial use and demand for defined safe botanicals in cosmetic as well as pharmaceutical topical formulations. Additional mechanistic studies are underway.
Hobart W Walling
Full Text Available Hobart W Walling1, Brian L Swick21Private Practice of Dermatology, Coralville IA, USA; 2University of Iowa Hospitals and Clinics, Departments of Dermatology and Pathology, Iowa City, IA, USAAbstract: Atopic dermatitis (AD is a common disease with worldwide prevalence, affecting up to 20% of children and 3% of adults. Recent evidence regarding pathogenesis has implicated epidermal barrier defects deriving from filagrin mutations with resulting secondary inflammation. In this report, the authors comprehensively review the literature on atopic dermatitis therapy, including topical and systemic options. Most cases of AD will benefit from emollients to enhance the barrier function of skin. Topical corticosteroids are first-line therapy for most cases of AD. Topical calcineurin inhibitors (tacrolimus ointment, pimecrolimus cream are considered second line therapy. Several novel barrier-enhancing prescription creams are also available. Moderate to severe cases inadequately controlled with topical therapy may require phototherapy or systemic therapy. The most commonly employed phototherapy modalites are narrow-band UVB, broadband UVB, and UVA1. Traditional systemic therapies include short-term corticosteroids, cyclosporine (considered to be the gold standard, methotrexate, azathioprine, mycophenolate mofetil, and most recently leflunamide. Biologic therapies include recombinant monoclonal antibodies acting on the immunoglobulin E / interleukin-5 pathway (omalizumab, mepolizumab, acting as tumor necrosis factor-a inhibitors (infliximab, etanercept, adalimumab, and acting as T-cell (alefacept and B-cell (rituxumab inhibitors, as well as interferon γ and intravenous immunoglobulin. Efficacy, safety, and tolerability are reviewed for each medication.Keywords: topical corticosteroids, phototherapy, dermatitis
population can be minimized by reassurance, regular use of emollients and proper education regarding routine care of skin.
Full Text Available Therapeutic strategy in late 20th century to prevent allergic diseases was derived from a conceptual framework of allergens elimination which was as same as that of coping with them after their onset. Manifold trials were implemented; however, most of them failed to verify the effectiveness of their preventive measures. Recent advancement of epidemiological studies and cutaneous biology revealed epidermal barrier dysfunction plays a major role of allergen sensitization and development of atopic dermatitis which ignites the inception of allergy march. For this decade, therapeutic strategy to prevent the development of food allergy has been confronted with a paradigm shift from avoidance and delayed introduction of allergenic foods based on the theoretical concept to early introduction of them based on the clinical and epidemiological evidences. Especially, prevention of peanut allergy and egg allergy has been established with the highest evidence verified by randomized controlled trials, although application in clinical practice should be done with attention. This paradigm shift concerning food allergy was also due to the discovery of cutaneous sensitization risk of food allergens for an infant with eczema revealed by prospective studies. Here we have recognized the increased importance of prevention of eczema/atopic dermatitis in infancy. Two randomized controlled trials using emollients showed successful results in prevention of atopic dermatitis in infancy; however, longer term safety and prognosis including allergy march should be pursued. To establish more fundamental strategy for prevention of the development of allergy, further studies clarifying the mechanisms of interaction between barrier dysfunction and microbial milieu are needed with macroscope to understand the relationship between allergic diseases and a diversity of environmental influences.
Background Podoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine podoconiosis patient’s willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia. Methods A cross-sectional study was conducted among randomly selected untreated podoconiosis patients (n = 393) in Baso Liben woreda, northwestern Ethiopia. The contingent valuation method was used with a pre-tested interviewer-administered questionnaire. Results The majority of podoconiosis patients (72.8%) were willing to pay for treatment services. The median WTP amount was 64 Birr (US$ 3.28) per person per year. More than one-third of patients (36.7%) were willing to pay at least half of the full treatment cost and 76.2% were willing to pay at least half of the cost of shoes. A multivariate analysis showed that having a higher monthly income, being a woman, older age, being aware of the role of shoes to prevent podoconiosis, and possession of a functional radio were significantly associated with higher odds of WTP. Conclusions The considerable WTP estimates showed that podoconiosis treatment could improve sustainability and service utilization. A subsidized cost recovery scheme could reduce treatment costs and more feasibility integrate podoconiosis treatment service with other NTDs and the government’s primary health care system. PMID:24642085
Edward Chia-Cheng Lai
Full Text Available PURPOSE: Previous studies have demonstrated sulpiride to be significantly more effective than haloperidol, risperidone and olanzapine in schizophrenic treatment; however, only limited information is available on the potential risks associated with sulpiride treatment. This study attempts to provide information on the potential risks of sulpiride treatment of schizophrenia, especially with regard to unexpected adverse effects. MATERIALS AND METHODS: Patients with schizophrenia aged 18 and older, newly prescribed with a single antipsychotic medication from the National Health Insurance Research Database of Taiwan in the period from 2003 to 2010 were included. A within-subject comparison method, prescription sequence symmetry analysis (PSSA was employed to efficiently identify potential causal relationships while controlling for potential selection bias. RESULTS: A total of 5,750 patients, with a mean age of 39, approximately half of whom were male, constituted the study cohort. The PSSA found that sulpiride was associated with EPS (adjusted SR, 1.73; 95% CI, 1.46-2.06 and hyperprolactinemia (12.04; 1.59-91.2. In comparison, EPS caused by haloperidol has a magnitude of 1.99 when analyzed with PSSA, and hyperprolactinemia caused by amisulpride has a magnitude of 8.05, respectively. Another finding was the unexpected increase in the use of stomatological corticosteroids, emollient laxatives, dermatological preparations of corticosteroids, quinolone antibacterials, and topical products for joint and muscular pain, after initiation of sulpiride treatment. CONCLUSIONS: We found sulpiride to be associated with an increased risk of EPS and hyperprolactinemia, and the potential risk could be as high as that induced by haloperidol and amisulpride, respectively. Additionally, our study provides grounds for future investigations into the associations between sulpiride and the increased use of additional drugs for managing adverse effects, including
Gutierrez, Rosa Martha Perez; Gonzalez, Adriana Maria Neira; Hoyo-Vadillo, Carlos
Piper has been used for long timelike condiment and food, but also in traditional medicine around of the world. This work resumes the available and up to date work done on members of the Piperaceae family and their uses for therapeutic purposes. Information on Piper genus was gathered via internet using scientific databases such as Scirus, Google Scholar, CAB-abstracts, MedlinePlus, Pubmed, SciFinder, Scopus and Web of Science. The largeleafed perennial plant Piper is used for its spicy aromatic scent and flavor. It has an important presence in the cuisine of different cultures. Another quality of these plants is their known medicinal properties. It has been used as emollient, antirheumatic, diuretic, stimulant, abortifacient, anti-inflammatory, antibacterial, antifungal and antidermatophytic. A survey of the literature shows that the genus Piper is mainly known for its alkaloids with cytotoxic, chemopreventive, antimetastatic and antitumor properties in several types of cancer. Studies of its alkaloids highlight the existence of various potential leads to develop new anti-cancer agents. Modern pharmacology studies have demonstrated that its crude extracts and active compounds possess wide pharmacological activities, especially asantioxidant, anti-depressive, hepatoprotective, antimicrobial, anti-obesity, neuropharmacological, to treat cognitive disorders, anti-hyperlipidemic, anti-feedant, cardioactive, immuno-enhancing, and anti-inflamatory. All this evidence supporting its traditional uses. This review summarizes the up-to-date and comprehensive information concerning the botany, traditional use, phytochemistry and pharmacology of Piper together with its toxicology, and discusses the possible trend and scope for further research on Piper in the future.
Full Text Available Psoriasis is a lifelong condition which is caused by the negative signals produced by immune system, which leads to hyper proliferation and other inflammatory reactions on the skin. In this case, keratinocytes which are the outermost layer of skin possess shortened life cycle and results in the alteration of desquamation process where the cytokines will come out through lesions of affected patients and as a result, scaling marks appears on the skin. These conditions may negatively affect the patient’s quality of life and lead to psychosocial stress. Psoriasis can be categorized as mild, moderate and severe conditions. Mild psoriasis leads to the formation of rashes, and when it becomes moderate, the skin turns into scaly. In severe conditions, red patches may be present on skin surface and becomes itchy. Topical therapy continues to be one of the pillars for psoriasis management. Drug molecules with target effect on the skin tissues and other inflammations should be selected for the treatment of psoriasis. Most of the existing drugs lead to systemic intoxication and dryness when applied in higher dose. Different scientific approaches for topical delivery are being explored by researches including emollient, modified gelling system, transdermal delivery, spray, nanogels, hydrogels, micro/nano emulsion, liposomes, nano capsules etc. These topical dosage forms are evaluated for various physico chemical properties such as drug content, viscosity, pH, extrudability, spreadability, toxicity, irritancy, permeability and drug release mechanism. This review paper focus attention to the impact of these formulation approaches on various anti-psoriasis drugs for their successful treatment.
Contestable, James J
Occupational contact dermatitis is a ubiquitous problem. Sailors onboard U.S. Navy vessels are at high risk given the multitude of potential workplace exposures. Solvents, petrochemicals, and fuels are abundant and can cause irritant or allergic contact dermatitis. Symptoms of contact dermatitis can cause inability to work and, if chronic, may require a change in rating or job. Prevention of this issue requires patient education about the risks and correct personnel protective equipment. Even with preventative strategies in place, exposures and cases of contact dermatitis will occur. Treatment consists of topical steroids and immunomodulators, as well as barrier creams and emollients. The goal of treatment is to fully restore the skin's natural barrier and prevent further exposure. A classic case of jet fuel-associated contact dermatitis is reviewed. A literature review utilizing PubMed, Google Scholar, and Google Search was conducted to elucidate our understanding of this issue, current occupational health guidelines, preventative approaches, and treatments. This case report provides guidance and recommendations for providers who encounter contact dermatitis related to petrochemicals, such as jet fuel. The literature review revealed limited knowledge surrounding in vivo human skin effects of jet fuel, specifically JP-5. Even larger gaps were found in our understanding of, and guidelines for, protective modalities against jet fuel exposure and dermatitis. A case is presented to facilitate recognition of jet fuel contact dermatitis and guidance for treatment and prevention. Given our current limited knowledge and guidelines concerning protective equipment and skin protectants, multiple proposals for future studies are suggested. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
Berardesca, Enzo; Mortillo, Susan; Cameli, Norma; Ardigo, Marco; Mariano, Maria
Atopic dermatitis is a chronic, pruritic inflammatory skin disease that adversely affects quality of life. The current study evaluates the efficacy of a shower cream and a lotion, each with skin-identical lipids and emollients, in the treatment of atopic dry skin of subjects with a history of atopic condition. In all, 40 healthy females with clinically dry skin on the lower legs were enrolled in the study and underwent 4 weeks of daily use of the shower cream and 2 additional weeks of both the shower cream and the body lotion. Subjects were evaluated at day 0, week 4, and week 6. Skin barrier function was assessed by Tewameter ® , skin hydration by Corneometer ® , smoothness and desquamation by Visioscan ® , and stratum corneum architecture by reflectance confocal microscopy (RCM). The investigator assessed the degree of dryness, roughness, redness, cracks, tingling and itch, and subjective self-assessment evaluated the perception of skin soothing, smoothness, and softness. Skin barrier function and skin moisture maintenance were significantly improved using the shower cream. The lotion with physiological lipids, together with the shower cream, also improved skin barrier function and moisture. Both the shower cream and the body lotion reduced clinical dryness, roughness, redness, cracks, tingling and itch, according to the dermatologist, and increased soothing, smoothness, and softness, according to the subjects of the study. The combination of a shower cream and a lotion with physiological lipids efficiently restores skin barrier function and increases skin hydration, becoming an effective skin-care option for patients with atopic dry skin. © 2018 Wiley Periodicals, Inc.
Greenspoon, Jill; Herrmann, Nathan; Adam, David N
Alzheimer's disease is a chronic neurodegenerative disorder resulting in part from the degeneration of cholinergic neurons in the brain. Rivastigmine, a cholinesterase inhibitor, is commonly used as a treatment for dementia due to its ability to moderate cholinergic neurotransmission; however, treatment with oral rivastigmine can lead to gastrointestinal adverse effects such as nausea and vomiting. Transdermal administration of rivastigmine can minimize these adverse effects by providing continuous delivery of the medication, while maintaining the effectiveness of the oral treatment. While the transdermal form of rivastigmine has been found to have fewer systemic adverse effects compared with the oral form, cutaneous reactions, such as contact dermatitis, can lead to discontinuation of the drug in its transdermal form. Lack of patient compliance with regard to applying the patch to the designated site, applying the patch for the correct length of time or rotating patch application sites increases the risk of cutaneous adverse reactions. This article outlines the diagnosis and management of irritant contact dermatitis and allergic contact dermatitis secondary to transdermal rivastigmine. The large majority of reactions to transdermal patches are of an irritant type, which can be diagnosed clinically by the presence of a pruritic, erythematous, eczematous plaque strictly confined to the borders of the patch. In contrast, an allergic reaction can be differentiated by the presence of vesicles and/or oedema, erythema beyond the boundaries of the transdermal patch and lack of improvement of the lesion 48 hours after removal of the offending treatment. By encouraging the patient to follow a regular rotation schedule for the patch, and using lipid-based emollients for irritant dermatitis and pre- and post-treatment topical corticosteroids for allergic dermatitis, cutaneous reactions can often be alleviated and patients can continue with their medication regimen. Other
Full Text Available Environmental factors play a major role on atopic dermatitis (AD which shows a constant rise in prevalence in western countries over the last decades. The Hygiene Hypothesis suggesting an inverse relationship between incidence of infections and the increase in atopic diseases in these countries, is one of the working hypothesis proposed to explain this trend.This study tested the efficacy and safety of oral administration of the bacterial lysate OM-85 (Broncho-Vaxom®, Broncho-Munal®, Ommunal®, Paxoral®, Vaxoral®, in the treatment of established AD in children.Children aged 6 months to 7 years, with confirmed AD diagnosis, were randomized in a double-blind, placebo-controlled trial to receive, in addition to conventional treatment with emollients and topical corticosteroids, 3.5mg of the bacterial extract OM-85 or placebo daily for 9 months. The primary end-point was the difference between groups in the occurrence of new flares (NF during the study period, evaluated by Hazard Ratio (HR derived from conditional Cox proportional hazard regression models accounting for repeated events.Among the 179 randomized children, 170 were analysed, 88 in the OM-85 and 82 in the placebo group. As expected most children in both treatment groups experienced at least 1 NF during the study period (75 (85% patients in the OM-85 group and 72 (88% in the placebo group. Patients treated with OM-85 as adjuvant therapy had significantly fewer and delayed NFs (HR of repeated flares = 0.80; 95% confidence interval (CI: 0.67-0.96, also when potential confounding factors, as family history of atopy and corticosteroids use, were taken into account (HR = 0.82; 95% CI: 0.69-0.98. No major side effect was reported, with comparable and good tolerability for OM-85 and placebo.Results show an adjuvant therapeutic effect of a well standardized bacterial lysate OM-85 on established AD.
Lecomte, J; Lemli, J; Marganne, M H; Melard, M
The 12th of July 1635, Jan van Beverwyck wrote a letter from Dordrecht to his esteemed friend Luis Nunez, in Antwerp. He asked him for indications about the cure of kidney stones of which he was suffering. He had just passed two calculi very painfully. Nunez answered on July 31. His letter summarized his own experience with this disease. In such cases, temperate diuretics and emollients are well indicated: ingestion of light decoctions of Malva and Viola, Caerefolium and Parieteria as well as Marshmallow syrup. No purge and no 'chemicals'. However, the best remedy was drinking Spa water. Usually the best way to absorb it is to come to the springs, in the Ardennes, part of the independent Principality of Liège. However, considering the horrors of the war (the Thirty Years War) endangering the country, van Beverwyck would be wise to drink imported water during 40 or 50 days, while staying home quietly, in Dordrecht. The letter points out the importance of provoked diuresis in the treatment of kidney stones. On the other hand the letter is an illustration of the continuing contacts between the United Provinces and the Spanish territories and of the commercial traffic between Antwerp, Dordrecht and Spa. The exported water was bottled from many 'pouhons'. It was acid, ferruginous, sulfurous and saturated with carbon dioxide; no pathogen germs, at least at the spring. Nunez quoted the large number of his patients cured with Spa water in Antwerp. This is an illustration of its commercial expansion even during this critical period.
Jackson, J Mark; Grove, Gary L; Allenby, Kent; Houser, Tim
In plaque psoriasis, the benefit of topical steroids is well established. The vehicle formulation of topical steroids may also provide benefit in addition to the effects of the steroid itself. DFD-01 (betamethasone dipropionate spray, 0.05%) is a formulation composed of a topical steroid in an emollient-like vehicle that enhances penetration to the target site of inflammation in the skin. The aim of this study was to assess the effect of DFD-01 and its vehicle on skin hydration and barrier function in compromised skin and to evaluate its effect on flexibility in healthy skin. Eighteen healthy white volunteers were enrolled in each of two studies. In Study 1, dry shaving of volar forearms created a compromised skin barrier, through which transepidermal water loss (TEWL) was measured using an evaporimeter. Capacitance, a measure of epidermal hydration, was also measured at baseline and at 1, 2 and 4 h after application of DFD-01 or its vehicle formulation. In Study 2, intact skin flexibility was tested with a cutometer before and at 1, 2 and 4 h after application of DFD-01 or vehicle. In Study 1, both DFD-01 and its vehicle were effective at reducing TEWL through the compromised stratum corneum. Capacitance measurements confirmed this finding; razor-chafed skin treated with either DFD-01 or vehicle exhibited levels of skin hydration similar to unshaved control skin. Study 2 found softening and greater flexibility of normal skin treated with either DFD-01 or vehicle compared with nontreated control skin samples. These tests suggest that the DFD-01 formulation and its vehicle are each effective at retaining moisture within a damaged skin barrier and for softening and increasing the flexibility of intact skin. Dr. Reddy's Laboratories.
Full Text Available In order to restore the original aesthetic aspect, to improve the state of the age patina and of the gold halo, similar processes are required. The cleaning process is one of the most important aspects for an artwork and is considering a series of deteriorations and degradations, like dirt deposits (clogged or unclogged opalescent varnish, colors blackening, burns, blisters, gaps (missing ground, painting layer or varnish. This step in the restoration process includes physical and mechanical proceedings like dusting (with a vacuum, brushing (with a brush, scraping (with a scalpel, removal or polishing etc. The scalpel and the milling process are rough unconventional means that are used only in exceptional cases. The wet cleaning of dirt includes classic washing processes, with water or other complex systems of organic solvents (emollients, surface additives or surfactants, mixtures of solvents. Cleaning the clogged dirt deposits with unconventional methods can be done by means of electronic laser, ion and thermal exchange or ultrasounds. Laser cleaning is often used in removing unwanted dirt deposits from different layers of the art piece. A lot of attention goes towards the controlled elimination of the exterior protection layer (varnish, which can be photo- degraded and oxidized by atmospheric exposure. Visual analysis, with enlargers (OM, SEM, AFM etc. combined with transmission or penetration techniques (radiography, endoscopy, X-ray diffraction etc. provides information on the superficial structures of the art work. In order to determine the modifications of the desiccant oils, SEM was used to observed the changes in the morphology of the oil painting layers. Gas chromatography/mass spectrometry (GC/MS can be used to detrmine detergent residues on the painting layer.
Effect of provision of an integrated neonatal survival kit and early cognitive stimulation package by community health workers on developmental outcomes of infants in Kwale County, Kenya: study protocol for a cluster randomized trial.
Pell, Lisa G; Bassani, Diego G; Nyaga, Lucy; Njagi, Isaac; Wanjiku, Catherine; Thiruchselvam, Thulasi; Macharia, William; Minhas, Ripudaman S; Kitsao-Wekulo, Patricia; Lakhani, Amyn; Bhutta, Zulfiqar A; Armstrong, Robert; Morris, Shaun K
Each year, more than 200 million children under the age of 5 years, almost all in low- and middle-income countries (LMICs), fail to achieve their developmental potential. Risk factors for compromised development often coexist and include inadequate cognitive stimulation, poverty, nutritional deficiencies, infection and complications of being born low birthweight and/or premature. Moreover, many of these risk factors are closely associated with newborn morbidity and mortality. As compromised development has significant implications on human capital, inexpensive and scalable interventions are urgently needed to promote neurodevelopment and reduce risk factors for impaired development. This cluster randomized trial aims at evaluating the impact of volunteer community health workers delivering either an integrated neonatal survival kit, an early stimulation package, or a combination of both interventions, to pregnant women during their third trimester of pregnancy, compared to the current standard of care in Kwale County, Kenya. The neonatal survival kit comprises a clean delivery kit (sterile blade, cord clamp, clean plastic sheet, surgical gloves and hand soap), sunflower oil emollient, chlorhexidine, ThermoSpot(TM), Mylar infant sleeve, and a reusable instant heater. Community health workers are also equipped with a portable hand-held electric scale. The early cognitive stimulation package focuses on enhancing caregiver practices by teaching caregivers three key messages that comprise combining a gentle touch with making eye contact and talking to children, responsive feeding and caregiving, and singing. The primary outcome measure is child development at 12 months of age assessed with the Protocol for Child Monitoring (Infant and Toddler version). The main secondary outcome is newborn mortality. This study will provide evidence on effectiveness of delivering an innovative neonatal survival kit and/or early stimulation package to pregnant women in Kwale County
Grivet-Seyve, Mathieu; Santoro, Francine; Lachmann, Nadège
Rosacea-prone sensitive skin requires high sun-protection factor (SPF) moisturizers. This study evaluated Daylong Extreme SPF 50+ lotion, a novel cream containing five ultraviolet filters, two emollients, and three skin conditioners. This was an open-label, single-center study. On day 1, before treatment, subjects answered a questionnaire on their skin conditions and sunscreen habits, and both subjects and dermatologist evaluated skin status. Subjects applied the product once daily in the morning to the face for 21 days, and after approximately 3-5 minutes they assessed tolerability and short-term cosmetic acceptability in a questionnaire and daily diary. On day 22, the dermatologist and subjects evaluated skin status for long-term tolerance and cosmetic acceptability. The study enrolled 44 individuals (mean age 58.8 years, 91% female). At baseline, most subjects (39 of 44) showed erythema, and ~30% showed dryness and scaling. Dermatologists noted four cases of pustules and one case of papules. After 21 days' treatment with the product, the dermatologist reported significantly less erythema, dryness and scaling, three cases of pustules and two cases of papules. At baseline, ~75% of subjects noted a feeling of dryness, >50% reported tension, and nearly 25% reported tickling. After using the product for 21 days, subjects reported significantly less tension, dryness, and tickling. Some subjects noted itching and burning before and after using the product. One subject noted papules during treatment. Most subjects said that the product was pleasant, did not irritate the skin or cause stinging/burning, was easy to apply, quickly absorbed, and nongreasy, improved skin moisturization, helped prevent sun-provoked facial redness, did not worsen rosacea, and was easily incorporated into their skincare regimen. Half would switch to the product, and 80% of subjects would buy and recommend the product. The product was well tolerated in rosacea-prone subjects, producing objective
Ajose, Frances O A
remedies was mostly by heating and boiling, infusion, and maceration. In most cases, mixtures of plants or other substances were used. The preparations were applied as poultices, ointments, baths, soaks and soaps, and oral fluids. The plants used included Adansonia digitata, Aframomum melegueta, Aloe species, Azadirachta indica, Cassia alata, Alstonia boonei, Ficus asperifolia, Cocos nucifera, Jatropha gossypyfolia, Ocimum gratissimum, Ricinus communis. A literature search on 38 of the plants used by herbal prescribers revealed the presence of established antimicrobial agents, immune modulating agents, antioxidants, other vitamins and minerals, volatile oils and emollients, and anti-inflammatory agents. Some of the plants may be contaminated by mycotoxins because of poor storage. There appears to be clinical, scientific, and pharmacologic basis for the use of herbal preparations. Nigeria needs to provide effective coordination of the practice of herbal medicine to ensure safety, standardization, and preservation of the flora.
Full Text Available Podoconiosis is a non-filarial elephantiasis caused by long-term barefoot exposure to volcanic soils in endemic areas. Irritant silicate particles penetrate the skin, causing a progressive, debilitating lymphoedema of the lower leg, often starting in the second decade of life. A simple patient-led treatment approach appropriate for resource poor settings has been developed, comprising (1 education on aetiology and prevention of podoconiosis, (2 foot hygiene (daily washing with soap, water and an antiseptic, (3 the regular use of emollient, (4 elevation of the limb at night, and (5 emphasis on the consistent use of shoes and socks.We did a 12-month, non-comparative, longitudinal evaluation of 33 patients newly presenting to one clinic site of a non-government organization (the Mossy Foot Treatment & Prevention Association, MFTPA in southern Ethiopia. Outcome measures used for the monitoring of disease progress were (1 the clinical staging system for podoconiosis, and (2 the Amharic Dermatology Life Quality Index (DLQI, both of which have been recently validated for use in this setting. Digital photographs were also taken at each visit. Twenty-seven patients completed follow up. Characteristics of patients completing follow-up were not significantly different to those not. Mean clinical stage and lower leg circumference decreased significantly (mean difference -0.67 (95% CI -0.38 to -0.96 and -2.00 (95% CI -1.26 to -2.74, respectively, p<0.001 for both changes. Mean DLQI diminished from 21 (out of a maximum of 30 to 6 (p<0.001. There was a non-significant change in proportion of patients with mossy lesions (p = 0.375.This simple, resource-appropriate regimen has a considerable impact both on clinical progression and self-reported quality of life of affected individuals. The regimen appears ideal for scaling up to other endemic regions in Ethiopia and internationally. We recommend that further research in the area include analysis of cost
Olufunmilola A. Ogun
Full Text Available Background Ocular manifestations of thyroid dysfunction constitute a wide clinical spectrum ranging from minor ocular discomfort, lid retraction, lid lag and ocular injection, to sight threatening eyeball protusion and optic nerve compression. Thyroid-related eye disorders are most commonly associated with Graves' disease, and this most frequently occurs in the setting of hyperthyroidism. However, in 10% of cases, typical eye signs have also been reported in euthyroid and hypothyroid states. The severity of thyroid eye disease has been linked to cigarette smoking. There is very little data specifically reporting the ocular manifestations of thyroid disease among black African patients and there is no known report from Nigeria. This pilot study therefore focused on documenting the ocular signs accompanying thyroid dysfunction in a black African population. Aim To evaluate the pattern of ocular complications, among patients treated for thyroid disorders, in a major Nigerian teaching hospital. Results A total of 75 patients with thyroid dysfunction, were evaluated, comprising 63 females and 12 males. There was a very low prevalence of smoking among patients (<5%. Graves' disease was the commonest thyroid disorder, representing 70% of cases. Seventy-eight percent of patients were hyperthyroid, 11.8% were euthyroid and only 9.8% of patients were hypothyroid. Commonest systemic symptoms were neck swelling (68.6%, weight loss (63.8%, tremors (60.9% and palpitations (59.4%. Two-thirds of patients reported ocular symptoms consisting mainly of painless eye swelling (66.7% and ocular irritation (58%. Conjunctival injection, lid lag and lid retraction were the commonest ocular signs. Chemosis, severe proptosis and ocular motility disorder were very rare. Optic neuropathy was found in 4 patients but was related to pre-existing glaucoma. Majority of patients required only ocular emollients and tear supplements. Conclusion Severe ocular complications of
Cooke, Alison; Bedwell, Carol; Campbell, Malcolm; McGowan, Linda; Ersser, Steven J; Lavender, Tina
to identify what skin practices are important for the protection of baby skin in healthy term babies (0-6 months) and generate evidence-based conclusions to inform health professionals and parents. eleven databases were searched for all empirical quantitative and qualitative research published between 2000-2015 which explored baby skin care for bathing and cleansing, nappy care, hair and scalp care, management of dry skin or baby massage, for healthy term babies up to 6 months old. Papers not published in English were excluded. A total of 3062 papers were identified. Pairs of reviewers assessed all citations and extracted data independently. There were 26 included papers: 16 RCTs, 3 non-randomised experimental studies, 1 mixed-methods study and 6 qualitative studies. Primary and secondary outcome measures were analysed using meta-analysis or narrative descriptive statistics. Synthesis of qualitative data was not possible due to disparity of the evidence. from the small numbers of studies with comparable data, there was no evidence of any significant differences between tested wash products and water or tested baby wipes and water. There was some evidence to suggest that daily use of full-body emollient therapy may help to reduce the risk of atopic eczema in high risk babies with a genetic predisposition to eczema; however, the use of olive oil or sunflower oil for baby dry skin may adversely affect skin barrier function. There was no evidence about hair/scalp care or baby massage. Qualitative research indicates that parents and health professionals believe that water alone is best. meta-analysis was restricted due to the lack of consistency of study outcome measures. Although there is considerable RCT evidence comparing the use of specific products against water alone, or another product, for bathing, cleansing and nappy care, the power of this evidence is reduced due to inconsistency of outcome measures in terms of outcome, treatment site or time-point. The
Full Text Available Annalisa Patrizi, Beatrice Raone, Giulia Maria RavaioliDepartment of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, ItalyAbstract: Atopic dermatitis (AD is a common chronic inflammatory skin disease that can affect all age groups. It is characterized by a relapsing course and a dramatic impact on quality of life for patients. Environmental interventions together with topical devices represent the mainstay of treatment for AD, in particular emollients, corticosteroids, and calcineurin inhibitors. Systemic treatments are reserved for severe cases. Phototherapy represents a valid second-line intervention in those cases where non-pharmacological and topical measures have failed. Different forms of light therapy are available, and have showed varying degrees of beneficial effect against AD: natural sunlight, narrowband (NB-UVB, broadband (BB-UVB, UVA, UVA1, cold-light UVA1, UVA and UVB (UVAB, full-spectrum light (including UVA, infrared and visible light, saltwater bath plus UVB (balneophototherapy, Goeckerman therapy (coal tar plus UVB radiation, psoralen plus UVA (PUVA, and other forms of phototherapy. In particular, UVA1 and NB-UVB have gained importance in recent years. This review illustrates the main trials comparing the efficacy and safety of the different forms of phototherapy. No sufficiently large randomized controlled studies have been performed as yet, and no light modality has been defined as superior to all. Parameters and dosing protocols may vary, although clinicians mainly refer to the indications included in the American Academy of Dermatology psoriasis guidelines devised by Menter et al in 2010. The efficacy of phototherapy (considering all forms in AD has been established in adults and children, as well as for acute (UVA1 and chronic (NB-UVB cases. Its use is suggested with strength of recommendation B and level of evidence II. Home phototherapy can also be performed
include information on the machine, possible postoperative course expected and postoperative complications. Preoperative photography should be carried out in all cases of resurfacing. A close-up front and 45-degree lateral photographs of both sides must be taken. Laser parameters: There are different machines based on different technologies available. Choice parameters depend on the type of machine, location and type of lesion, and skin color. Physician needs to be familiar with these requirements before using the machine. Anesthesia: Fractional laser treatment can be carried out under topical anesthesia with eutectic mixture of lidocaine and prilocaine. Some machines can be used without any anesthesia or only with topical cooling or cryospray. But for maximal patient comfort, a topical anesthetic prior to the procedure is recommended. Postoperative care: Proper postoperative care is important in avoiding complications. Post-treatment edema and redness settle in a few hours to a few days. A sunscreen is mandatory, and emollients may be prescribed for the dryness and peeling that could occur.
Teixeira Rosangela de Oliveira
Full Text Available The use of medicinal plants by the general population is an old and still widespread practice, which makes studies of their genotoxicity essential. Psidium guajava L. and Achillea millefolium L. are examples of plants commonly used in popular medicine. P. guajava L. is indicated for diarrhea and also as an antiseptic, while A. millefolium L. is indicated as an analgesic, antispasmodic, digestive, diuretic, antiseptic, astringent, emollient, wound healer and hemorrhoid medication. The aim of this study was to determine the effects of the infusions of these two plant species on chromosomes and the cell cycle. Leaves from the plants were used to prepare infusions, in the same manner as teas, but at two different concentrations. Allium cepa L. root-tip cells (P. guajava L. - 2.62 and 26.2 mg/mL, and A. millefolium L. - 3.5 and 35.0 mg/mL and Wistar rat bone marrow cells (P. guajava L. - 2.62 and 26.2 mg/100g body weight, and A. millefolium L. - 3.5 and 35.0 mg/100g body weight were used as in vivo plant and animal test systems, respectively. Human peripheral blood lymphocytes (P. guajava L. - 0.262 and 2.62 mg/mL culture medium, and A. millefolium L. - 0.35 and 3.5 mg/mL culture medium were used as in vitro test system. The P. guajava L. infusion at the higher concentration caused a statistically significant inhibition of cellular division in the onion root-tip cells, not observed in onion root-tip cells treated with A. millefolium L. No statistically significant alterations were found, as compared to untreated controls, in either the cell cycle or the number of chromosome alterations, after treatments with either plant, in rat cells or in cultured human lymphocytes. These results regarding the cytotoxicity and mutagenicity of these plants provide valuable information about the safety of using them as therapeutic agents.
Sanfilippo, Angela M; Barrio, Victoria; Kulp-Shorten, Carol; Callen, Jeffrey P
Skin lesions are encountered in all areas of medicine, and it is therefore important for physicians to understand the fundamentals of explaining and diagnosing common skin conditions. This article begins with a discussion of description and documentation of skin lesions based on color, size, morphology, and distribution. Pigmentation disorders such as vitiligo are depicted. Cutaneous growths that are found in the pediatric and adolescent population include acrochordons, dermatofibromas, keloids, milia, neurofibromas, and pyogenic granulomas. Treatment of these growths usually involves observation or curettage with electrodessication.Psoriasis, atopic dermatitis, poison ivy, and eczema are comprised of scaling patches and plaques; poison ivy and atopic dermatitis may also present with bullous and vesicular changes. Therapy typically consists of topical emollients and corticosteroids; phototherapy is reserved for refractory cases. Acne vulgaris is the most common skin disease of the pediatric and adolescent population. This condition can be psychologically debilitating and, therefore, proper treatment is of paramount importance. Therapeutic options include topical as well as oral antibiotics and retinoids. Extreme caution must be used when prescribing retinoids to post-pubescent females, as these agents are teratogenic. Vascular anomalies are most commonly exemplified as port wine stains and hemangiomas. Port wine stains may be treated with pulsed dye laser or may be observed if they are not of concern to the patient or physician. Hemangiomas typically spontaneously regress by age ten; however, there has been recent concern that certain cases may need to be treated. Dermal rashes may be localized or generalized. Treatment of generalized drug eruptions involves elimination of the inciting agent, topical antipruritics, and systemic corticosteroids for severe reactions. Infectious etiologic agents of skin disease include bacteria, fungi, and viruses. Many sexually
Rossi, A; Pranteda, G; Iorio, A; Mari, E; Milani, M
This work has the aim to test the sensibility of VSCAPSI method in the evaluation of effectiveness of a medicated shampoo for the treatment of scalp psoriasis. Psoriasis is a chronic inflammatory skin disease histologically characterized by proliferation and loss of differentiation of keratinocytes, angiogenesis with vasodilatation and increased permeability, and inflammation. Scalp involvement is a common clinical feature of psoriasis, that is present in the 25% of patients who suffer of it. Videodermoscopy (VD) permits a magnified view of the surface components of the epidermis and papillary dermis, which are not visible to the naked eye, together with the ability to capture digitally the viewed images and to store them for later use. Moreover videodermoscopy is a non-invasive technique, used to analyze cutaneous peripheral microcirculation. Therefore VD could be an useful tool in evaluating the efficacy of treatments for scalp psoriasis. The clinical benefit of currently available medicated shampoos for the treatment of scalp psoriasis is restricted, due to their limited efficacy, low cosmetic appeal and safety and tolerability problems. Therefore effective and safe products are needed especially for the long term management of scalp psoriasis. A specific shampoo designed for the scalp hygiene in psoriatic patients has been recently developed. This shampoo contains urea, glycolic acid, salicylic acid, icthyol pale and laureth 9 (polidocanol). Aim of the study was to evaluate in a 12-week prospective monocenter, open-study the efficacy and tolerability of an emollient, keratolytic shampoo (Iralfaris shampoo ISDIN, Barcelona; Ir-S) applied three times a week in patients with scalp psoriasis. The efficacy of the shampoo has been valuated with VSCAPSI. Seventy subjects with mild to moderate/severe scalp psoriasis were enrolled in the trial, after their informed consent. Efficacy was assessed using a specific and validated videodermoscopy scalp psoriasis severity
Langenbruch, A; Radtke, M; Franzke, N; Ring, J; Foelster-Holst, R; Augustin, M
The successful treatment of atopic eczema (AE) should result in the improvement of both physical symptoms and patient's quality of life (QoL). This study was conducted using a sample of dermatologists throughout Germany. This is due to dermatologists being the main health care providers of AE. Obtaining reliable data on quality of care of AE from both the patient's and the physician's perspective. This cross-sectional study assessed: the individual clinical history; dermatology-specific QoL (DLQI); state of health (EQ-5d-VAS); treatments; burden caused by disease and treatment; patient-defined treatment benefit (PBI). Data from 1678 adult patients (60.5% female, mean age: 38.4 ± 15.9) were analysed. The most frequently used treatments during the last five years were emollients (90.4%) and topical corticosteroids (85.5%). In this study, 75.8% of the patients felt only moderately or not at all impaired by their treatment. The mean DLQI (0 = minimum-30 = maximum QoL impairment) was 8.5 ± 6.5. The EQ-5d-VAS (100 = best possible) was 63.6 ± 22.0 on average. 26.6% reported suffering 'often' or 'every night' from sleeplessness due to severe itching. Mean PBI was 2.4 ± 1.1 (4 = maximum benefit). This study provides first data on the health care of adults with AE in Germany at a national level and reveals the need for a more effective care. Whereas most patients consider their treatment-related burden as low, the daily burden of the disease seems to be high: one third reports sleeplessness due to itching which indicates insufficient therapeutic regimes in these cases. A better implementation of the German national guideline for AE and a systematic analysis of the difficulties causing its limited effects is needed. © 2013 The Authors Journal of the European Academy of Dermatology and Venereology © 2013 European Academy of Dermatology and Venereology.
Wannaz, Cedric; Franco, Antonio; Kilgallon, John; Hodges, Juliet; Jolliet, Olivier
This paper analyzes spatially ecosystem exposure to home and personal care (HPC) chemicals, accounting for market data and environmental processes in hydrological water networks, including multi-media fate and transport. We present a global modeling framework built on ScenAT (spatial scenarios of emission), SimpleTreat (sludge treatment plants), and Pangea (spatial multi-scale multimedia fate and transport of chemicals), that we apply across Asia to four chemicals selected to cover a variety of applications, volumes of production and emission, and physico-chemical and environmental fate properties: the anionic surfactant linear alkylbenzene sulphonate (LAS), the antimicrobial triclosan (TCS), the personal care preservative methyl paraben (MeP), and the emollient decamethylcyclopentasiloxane (D5). We present maps of predicted environmental concentrations (PECs) and compare them with monitored values. LAS emission levels and PECs are two to three orders of magnitude greater than for other substances, yet the literature about monitored levels of LAS in Asia is very limited. We observe a good agreement for TCS in freshwater (Pearson r=0.82, for 253 monitored values covering 12 streams), a moderate agreement in general, and a significant model underestimation for MeP in sediments. While most differences could be explained by uncertainty in both chemical/hydrological parameters (DT50 water , DT50 sediments , K oc , f oc , TSS) and monitoring sites (e.g. spatial/temporal design), the underestimation of MeP concentrations in sediments may involve potential natural sources. We illustrate the relevance of local evaluations for short-lived substances in fresh water (LAS, MeP), and their inadequacy for substances with longer half-lives (TCS, D5). This framework constitutes a milestone towards higher tier exposure modeling approaches for identifying areas of higher chemical concentration, and linking large-scale fate modeling with (sub) catchment-scale ecological scenarios; a
Full Text Available Introduction . Atopic dermatitis is a frequent chronic skin disease in children. The major clinical manifestations include itching and dryness of the skin. The pathomechanism of skin changes results from an interaction of genetic and environmental factors as well as impairments of skin barrier function and immune response. Despite chronic treatment the disease is characterized by exacerbation and remission periods and lowers the quality of life of patients and their families. Objective. To evaluate treatment satisfaction in children with atopic dermatitis, identify components of medical care which contribute to treatment satisfaction, and evaluate the relationship between satisfaction and adherence to a doctor’s recommendations. Material and methods. One hundred and nineteen children (6 months to 12 years old, mean age 4.9 years with atopic dermatitis were enrolled in the study. The doctor performed physical examinations and history taking and filled in questionnaires evaluating the course and exacerbation of the disease, the type of administered therapy and diagnostics. The patients’ parents completed two questionnaires: a questionnaire assessing satisfaction with the therapy (the type of recommended therapy, adherence to recommendations, contact with the doctor, obtained information, degree of psychological support, role of parents in taking decisions regarding the therapy and a quality of life questionnaire. Results. The authors observed that 56% of parents were dissatisfied with the administered treatment, and 40% failed to adhere to at least one therapeutic recommendation. Parents of children with mild atopic dermatitis significantly more often stop using emollients. It was also observed that lack of treatment satisfaction in children with severe atopic dermatitis whose parents are insufficiently educated contributes to decreased adherence. The authors identified independent factors of lack of treatment satisfaction: failure to obtain
Conocimientos, actitudes y prácticas sobre fascioliasis en madres de una zona rural andina del norte peruano Knowledge, attitudes and practices about fascioliasis among mothers from an andean rural area of north Peru
Full Text Available Se realizó una encuesta para determinar los conocimientos, actitudes y prácticas sobre fascioliasis en 62 madres de familia de una zona rural endémica de la región andina de Cajamarca, Perú. Sólo el 37,0% reconoce a la alicuya (nombre popular de la Fasciola hepática como parásito responsable de la enfermedad; 56,5 y 85,5% conocen que afecta el hígado de humanos y de los animales respectivamente; 98,4% tiene predisposición positiva para participar de charlas informativas sobre la enfermedad y 75,8% para apoyar activamente a sus autoridades en la solución del problema. El 38,7% indica que bebe emolientes en la calle y 75,6% cría animales considerados huéspedes del parásito. En conclusión, las actitudes de las encuestadas son mayoritariamente favorables para realizar actividades de prevención y control, pese a que sus conocimientos son incorrectos y el entorno familiar realiza ciertas prácticas de riesgo para la enfermedad.A survey to determine knowledge, attitudes and practices about fascioliasis was administered to 62 mothers from a rural endemic zone of Cajamarca’s Andean Region, Peru. Only 37.0% recognized the alicuya (local name for Fasciola hepatica as the parasite responsible for the disease; 56.5% knows that the disease affects the liver in the humans and 85.5% knows affects also animals; 98.4% have a positive predisposition to attend informative talks about the disease and 75.8% to support their authorities actively to solve of the problem. 38.7% referred drinking emollients in the street, 75.6% have domestic animals considered host for the parasite. In conclusion, attitudes of mothers are mostly favourable for prevention and control activities, despite their mistaken knowledge risky practices for fasciolasis among members of their families.
Licari, Amelia; Ruffinazzi, Giulia; DE Filippo, Maria; Castagnoli, Riccardo; Marseglia, Alessia; Agostinis, Fabio; Puviani, Mario; Milani, Massimo; Marseglia, Gian L
Atopic dermatitis (AD) is a very common chronic inflammatory and eczematous skin condition characterized by flares and remissions. Skin barrier alteration or dysfunction is the most relevant patogenetic factor. Topical corticosteroids are the mainstay treatment of AD, especially during flare periods. The daily use of emollients and moisturizers is also considered a relevant adjunctive strategy to improve skin barrier function and skin appearance in AD patients. Long-term use of topical corticosteroids is associated with important drawbacks and side effects. A corticosteroid-free cream containing starch, glycyrretinic acid, zinc oxide and bisabolol (Dermamid™; Difa Cooper, Caronno Pertusella, Varese, Italy) has been designed for the treatment of acute eczematous conditions like diaper dermatitis. However, this formulation could be particularly suitable also for AD. We evaluated in a three-center, assessor-blinded prospective 6-week treatment trial the efficacy and tolerability of this cream in children with chronic mild-to-moderate atopic dermatitis. A total of 30 children (mean age 5 years, 18 males and 12 females) with chronic mild to moderate AD, affecting face, lower and upper limbs or trunk, were enrolled after parents' written informed consent. Exclusion criteria were a condition of immunosuppression, acute flares or a positive history of allergy to one of the components of the cream. The primary outcome was the evolution total eczema severity score (TESS) calculated as the sum of the single eczema severity score for each body area involved. Single area Eczema Severity Score (ESS) was calculated assessing eczema, infiltration, lichenification and scraching lesions using a 4-point scale grade (with 0=no sign, and 4=severe sign). A secondary endpoint was the percentage of subjects reaching at least 50% of TESS reduction at week 6 in comparison with baseline. The TESS was evaluated at baseline and after 3 and 6 weeks of treatment (twice daily application) in an
Contemporary paediatric practices of Australian Aboriginal men and women, in more than 100 Aboriginal Language Groups, comprise a living discipline whose origins predate Western medicine by tens of millennia. The history of paediatrics acknowledges this surviving continuum of the world's oldest child-care practices. Because of the inextricable nexus between Aboriginal men and women and the land in which they live, medical ethnobotany forms a major part of the medical aspects of Aboriginal child care. Traditional tribal healers, called 'Nungungi' in some language groups of Central Australia, are identified as such whilst still young children and are given special education in the healing arts, especially that of medical ethnobotany, by older healers. Distinct from this specialized role, all Aboriginal men and women (and in particular grandmothers) in traditional communities use a sophisticated botanical materia medica in the treatment of sick and injured children. In cultures in transition, medical ethnobotanical practices may persist long after the local use of flora as sources of traditional food, weaponry, totemic identity and religious rites have disappeared. Some selected botanical 'cures' were adopted by early European settlers and a number of such relict uses have become part of mainstream Western life today, particularly as this applies to self-medication. Drugs and medicaments used in the treatment of children are obtained from leaves, bark, roots and flowers, usually as fresh preparations. They are prepared as infusions, decoctions and macerations and may be enjoined with emollients such as emu or kangaroo fat for topical application. Botanical drugs and medicaments are usually prepared fresh for each administration and are rarely stored. Contemporary Australian ethnobotany exploits the medicinal properties of more than 100 genera - using such extracts as antiseptics, analgesics, astringents, antipyretics, sedatives, hypnotics, expectorants and
Full Text Available Mathieu Grivet-Seyve,1 Francine Santoro,2 Nadège Lachmann2 1Galderma Research and Development, Sophia Antipolis, France; 2Galderma Research and Development, Egerkingen, Switzerland Background/objective: Rosacea-prone sensitive skin requires high sun-protection factor (SPF moisturizers. This study evaluated Daylong Extreme SPF 50+ lotion, a novel cream containing five ultraviolet filters, two emollients, and three skin conditioners.Subjects and methods: This was an open-label, single-center study. On day 1, before treatment, subjects answered a questionnaire on their skin conditions and sunscreen habits, and both subjects and dermatologist evaluated skin status. Subjects applied the product once daily in the morning to the face for 21 days, and after approximately 3–5 minutes they assessed tolerability and short-term cosmetic acceptability in a questionnaire and daily diary. On day 22, the dermatologist and subjects evaluated skin status for long-term tolerance and cosmetic acceptability.Results: The study enrolled 44 individuals (mean age 58.8 years, 91% female. At baseline, most subjects (39 of 44 showed erythema, and ~30% showed dryness and scaling. Dermatologists noted four cases of pustules and one case of papules. After 21 days’ treatment with the product, the dermatologist reported significantly less erythema, dryness and scaling, three cases of pustules and two cases of papules. At baseline, ~75% of subjects noted a feeling of dryness, >50% reported tension, and nearly 25% reported tickling. After using the product for 21 days, subjects reported significantly less tension, dryness, and tickling. Some subjects noted itching and burning before and after using the product. One subject noted papules during treatment. Most subjects said that the product was pleasant, did not irritate the skin or cause stinging/burning, was easy to apply, quickly absorbed, and nongreasy, improved skin moisturization, helped prevent sun-provoked facial
Ahuja, Rajeev B; Gupta, Gaurav K
Post-burn itch is a distressing symptom in burns rehabilitation and its treatment often proves frustrating for the patient and the multidisciplinary burns team. Traditionally, the mainstay of antipruritic therapy for decades has been antihistamines and massage with emollients. With a better understanding of the neurophysiology of itch emerged a new dimension in the treatment of post-burn pruritus. Gabapentin, a centrally modulating anti-epileptic agent and α2δ ligand, proved in clinical trials to be immensely better in the treatment of post-burn pruritus. Pregabalin is a newer structural analog of gabapentin. It has a much better anxiolytic effect and pharmacokinetic profile as compared to gabapentin. The current study was initiated to specifically study the role of pregabalin in relieving post-burn itch as this has never been investigated before. This double blind, randomized and placebo controlled study had four arms and was carried out on 80 adult patients (20 each). The four arms were: pregabalin, cetirizine with pheniramine maleate, combination of pregabalin, cetirizine and pheniramine maleate, and placebo (vit. B comp.). Massage with coconut oil was integral to all groups. Drug dosage was determined by initial VAS (visual analog scale) scores. All groups matched in demographic data and initial VAS scores. VAS scores were evaluated over next 28 days (days 3, 7, 14, 21 and 28). In patients with mild itch (VAS scores 2-5) or moderate itch (VAS scores 6-8) near complete remission of itch was seen in combination group and pregabalin group where the response was comparable and close to 95%. This was significantly better response than antihistaminic combination or massage alone. However, massage alone was sufficient in decreasing mean scores in mild itch, in a large percentage of patients. Amongst the patients with severe itch (VAS scores 9-10), 3/6 and 6/7 patients dropped out of trial in the antihistaminic and placebo groups, respectively. Combination therapy
Efficacy and Safety of a Traditional Herbal Medicine, Hochu-ekki-to in the Long-Term Management of Kikyo (Delicate Constitution Patients with Atopic Dermatitis: A 6-Month, Multicenter, Double-Blind, Randomized, Placebo-Controlled Study
Full Text Available Hochu-ekki-to is a traditional herbal (Kampo medicine that has been shown to be effective for patients with Kikyo (delicate, easily fatigable, or hypersensitive constitution. Previous case reports have suggested that this herbal drug was effective for a certain subgroup of patients with atopic dermatitis (AD. We aimed to evaluate the efficacy and safety of Hochu-ekki-to in the long-term management of Kikyo patients with AD. In this multicenter, double blind, randomized, placebo-controlled study, 91 Kikyo patients with AD were enrolled. Kikyo condition was evaluated by a questionnaire scoring system. All patients continued their ordinary treatments (topical steroids, topical tacrolimus, emollients or oral antihistamines before and after their protocol entry. Hochu-ekki-to or placebo was orally administered twice daily for 24 weeks. The skin severity scores, total equivalent amount (TEA of topical agents used for AD treatment, prominent efficacy (cases with skin severity score = 0 at the end of the study rate and aggravated rate (more than 50% increase of TEA of topical agents from the beginning of the study were monitored and evaluated. Seventy-seven out of 91 enrolled patients completed the 24-week treatment course (Hochu-ekki-to: n = 37, placebo: n = 40. The TEA of topical agents (steroids and/or tacrolimus was significantly (P < 0.05 lower in the Hochu-ekki-to group than in the placebo group, although the overall skin severity scores were not statistically different. The prominent efficacy rate was 19% (7 of 37 in the Hochu-ekki-to group and 5% (2 of 40 in the placebo group (P = 0.06. The aggravated rate was significantly (P < 0.05 lower in the Hochu-ekki-to group (3%; 1 of 37 than in the placebo group (18%; 7 of 39. Only mild adverse events such as nausea and diarrhea were noted in both groups without statistical difference. This placebo-controlled study demonstrates that Hochu-ekki-to is a useful adjunct to conventional treatments for AD
Jain, M.; Sisodia, R.; Bhatia, A. I.
India has a rich heritage of medicinal plants, many of which have been explored for the various bioactivities since ages, but the radioprotective potential of the plants have been hardly explored. Since Amaranthus, a common weed and very often caten as vegetable by rural population, has been used as emollient, astringent, diuretic, blood purifier, hemorrhagic diathesis and biliousness from time immemorial. Hence the present study aims to judge whether Amaranthus paniculatus (Linn) has the antiradiation efficacy against radiation induced histopathological and biochemical alterations in mice liver. Amaranthus paniculatus (Linn) belongs to family Amaranthaceae and commonly called as Amaranth, has good natural sources of carotenoids (beta carotene-1490 μg/100 gm of edible portion), vitamin C and high level of critical lysine and methionine, protein content (22 gm/100 gm of edible portion). Swiss albino mice of 6-8 weeks weighing 22 ± 3 gm were selected from an inbred colony and divided into four groups. One group served as normal and two groups were administered with alcoholic extract at a dose of 600 mg/Kg-body weight/day dissolved in distilled water for fifteen days. Fourth group was given distilled water, orally and ad libitum. Then two groups, one with drug treated and another with distilled water treated, were exposed to 5 Gy of gamma radiation at the dose rate of 1.07 Gy/min with a source to surface distance (SSD) of 77.5 cm. The animals were autopsied at 1, 3, 7, 15 and 30 days post exposure. the optimum dose was calculated to be 600mg/kg b.wt/day after treating mice with AE for fifteen consecutive days prior to irradiation (9 Gy) to get maximum protection against radiation injury. By the survival assay, DRF 1.43 was calculated with different doses of gammas radiation (6, 9, 12 Gy). The radiation induced augmentation in MDA, protein, glycogen, alkaline and acid phosphatase content of liver is significantly ameliorated by the drug. The radiation induced
Rafael Pinto Vieira
Full Text Available Peel off facial masks, based on polyvinyl alcohol (PVA, are formulations that, after application and drying, form an occlusive film over the face. After removing, they provide cleanness, tensor and moisturizing effects, removing dead cells, residues and other materials deposited on the stratum corneous. The soybean extract fermented by Bifidobacterium animalis has sugars, amino acids, peptides, proteins and free isoflavonoids in high concentrations, when compared to the unfermented extract, providing benefits to the cosmetic formulations like anti-aging effect, moisture, tensor action and emollience. The cosmetic bases of peel off facial masks, added with 5.0% w/w of fermented soybean extract, were submitted to Preliminary and Accelerated Stability Studies. Eight (8 preparations were evaluated in several conditions of temperature (-10.0, 5.0, 22.0 and 45.0 ºC and time (maximum of 15 days, comparing the results with the initial condition (48 h after preparation. The variables observed were: organoleptic characteristics, pH and appearing viscosity value and film drying time. The preparation containing 17.0% w/w of PVA and 0.5% w/w of guar gum was selected between the eight preparations initially prepared, because it presented the best performance in the stability test, being recommended storage at low temperatures (5.0 ºC.As máscaras faciais peel off a base de álcool polivinílico (PVA são formulações que, após a aplicação e secagem, formam um filme oclusivo sobre a face e, após sua remoção, conferem limpeza, ação tensora e hidratação à pele, retirando células mortas do estrato córneo, resíduos e outros materiais depositados. O extrato de soja fermentado por Bifidobacterium animalis possui açúcares, aminoácidos, peptídeos, e alto teor de isoflavonas na forma livre, quando comparado ao leite não fermentado, propiciando benefícios às formulações cosméticas, como ação antienvelhecimento, hidratação, efeito tensor e
Francis, Nick A; Ridd, Matthew J; Thomas-Jones, Emma; Shepherd, Victoria; Butler, Christopher C; Hood, Kerenza; Huang, Chao; Addison, Katy; Longo, Mirella; Marwick, Charis; Wootton, Mandy; Howe, Robin; Roberts, Amanda; Haq, Mohammed Inaam-ul; Madhok, Vishnu; Sullivan, Frank
Secondary skin infection is common during eczema exacerbations and many children are treated with antibiotics when this is suspected, although there is little high-quality evidence to justify this practice. To determine the clinical effectiveness of oral and topical antibiotics, in addition to standard treatment with emollients and topical corticosteroids, in children with clinically infected eczema. Multicentre randomised, double-blind, placebo-controlled trial. General practices and dermatology clinics in England, Wales and Scotland. Children (aged 3 months to children (36 to oral antibiotic, 37 to topical antibiotic and 40 to placebo), which was fewer than our revised target sample size of 282. A total of 103 (92.0%) children had one or more clinical features suggestive of infection and 78 (69.6%) children had Staphylococcus aureus cultured from a skin swab. Oral and topical antibiotics resulted in a 1.52 [95% confidence interval (CI) -1.35 to 4.40] and 1.49 (95% CI -1.55 to 4.53) increase (worse subjective severity) in POEM score at 2 weeks, relative to placebo and controlling for baseline POEM score. Eczema Area and Severity Index (objective severity) scores were also higher (worse) in the intervention groups, at 0.20 (95% CI -0.12 to 0.52) and 0.42 (95% CI 0.09 to 0.75) for oral and topical antibiotics, respectively, at 2 weeks. Analyses of impact on the family, quality of life, daily symptom scores, and longer-term outcomes were all consistent with the finding of no or limited difference and a trend towards worse outcomes in the intervention groups. Sensitivity analyses, including adjusting for compliance and imputation for missing data, were consistent with the main findings. Our data suggest that oral and topical antibiotics have no effect, or a harmful effect, on subjective eczema severity in children with clinically infected eczema in the community. The CIs around our estimates exclude a meaningful beneficial effect (published minimal clinically
Hoare, C; Li Wan Po, A; Williams, H
forms, with discrepancies resolved by discussion. The quality assessment of retrieved RCTs included an assessment of: a clear description of method and concealment of allocation of randomisation, the degree to which assessors and participants were blinded to the study interventions, and whether all those originally randomised were included in the final main analysis. Where possible, quantitative pooling of similar RCTs was conducted using the Cochrane Collaboration's methods. Where statistical heterogeneity was found, sources of heterogeneity in terms of study participants, formulation or posology of intervention, and use of co-treatments were explored. Where pooling was not deemed to be appropriate, detailed descriptions of the study characteristics and main reported results were presented along with comments on study quality. A total of 1165 possible RCTs were retrieved in hard copy form for further scrutiny. Of these, 893 were excluded from further analysis because of lack of appropriate data. The 272 remaining RCTs of atopic eczema covered at least 47 different interventions, which could be broadly categorised into ten main groups. Quality of reporting was generally poor, and limited statistical pooling was possible only for oral cyclosporin, and only then after considerable data transformation. There was reasonable RCT evidence to support the use of oral cyclosporin, topical corticosteroids, psychological approaches and ultraviolet light therapy. There was insufficient evidence to make recommendations on maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, topical coal tar and topical doxepin. (ABSTRACT TRUNCATED)
Polyisobutene and Hydrogenated Polyisobutene are homopolymers of isobutene. These ingredients are produced in a wide range of molecular weights. Polybutene is a chemically related cosmetic ingredient previously determined to be safe as used in cosmetic products. Polyisobutene is used in cosmetic products as a binder, film former, and nonaqueous viscosity-increasing agent. Hydrogenated Polyisobutene functions as a skin-conditioning agent-emollient and nonaqueous viscosity-increasing agent with a wide range of uses in cosmetic formulations. The estimated octanol water partition coefficient for Hydrogenated Polyisobutene and Polybutene is log K(ow) of 13.27 and the estimated water solubility was 5.6 x 10(-3) ng/L for Hydrogenated Polyisobutene and Polybutene. Acute oral toxicity testing demonstrated no effects other than lethargy in one rat study. The oral LD(50) was > 5.0 g/kg in rats. No short-term or subchronic animal toxicity data were available. A 2-year chronic oral toxicity study of Polybutene revealed no gross or microscopic pathological changes, and no changes in body weights or food consumption, hematological results, urology, or tumor formation that could be correlated with Polybutene ingestion, except that in the 20,000 ppm group, three out of six males that died between weeks 17 and 24 exhibited hematuria. In a 2-year chronic oral toxicity study of Polybutene in Beagle dogs, no abnormalities in body weight, food consumption, survival, behavioral patterns, hematology, blood chemistry, urinalysis, liver function, gross and histopathologic examinations, or organ weights and ratios were reported. In a three-generation reproductive study in Charles River albino rats that ingested Polybutene, none of the animals in successive generations differed from controls with regard to weight gain, litter size, the number of stillborn, and the number of viable pups during lactation. The survival, body weights, and reactions of test animals were comparable to those of
Wahn, Ulrich; Bos, Jan D; Goodfield, Mark; Caputo, Ruggero; Papp, Kim; Manjra, Ahmed; Dobozy, Attila; Paul, Carle; Molloy, Stephen; Hultsch, Thomas; Graeber, Michael; Cherill, Robert; de Prost, Yves
Pimecrolimus cream (SDZ ASM 981), a nonsteroid inhibitor of inflammatory cytokines, is effective in atopic dermatitis (AD). We assessed whether early treatment of AD signs/symptoms with pimecrolimus could influence long-term outcome by preventing disease flares. Early intervention with pimecrolimus was compared with a conventional AD treatment strategy (ie, emollients and topical corticosteroids). In this 1-year, controlled, double-blind study, 713 AD patients (2-17 years) were randomized 2:1 to a pimecrolimus-based or conventional regimen. Both groups used emollients for dry skin. Early AD signs/symptoms were treated with pimecrolimus cream or, in the conventional treatment group, vehicle to prevent progression to flares. If flares occurred, moderately potent topical corticosteroids were mandated. The primary efficacy endpoint was ranked flares at 6 months. Safety was monitored clinically, and a skin recall-antigen test was performed at study completion. BASELINE CHARACTERISTICS OF THE PATIENTS: The mean age for both groups was approximately 8 years, and the majority of patients had moderate disease at baseline. PATIENT FOLLOW-UP AND EXPOSURE TO STUDY MEDICATION: The mean duration of follow-up (+/-standard error) was 303.7 (+/-5.30) days in the pimecrolimus group and 235.2 (+/-9.40) days in the control group. The discontinuation rate was significantly higher in the control group than in the pimecrolimus group (51.5% vs 31.6% at 12 months), and proportionately more patients with severe or very severe disease discontinued in the control group. The main reason for the higher discontinuation rate in the control group was unsatisfactory therapeutic effect (30.4% vs 12.4%). This resulted in a substantially higher mean number of study medication treatment days in the pimecrolimus group compared with the control group: 211.9 (69.8% of study days) versus 156.0 (66.3% of study days). Of those patients who completed 12 months on study, 14.2% and 7.0% of patients in the
Mahović, Darija; Mrsić, Fanika
clinical evaluation and considering the medical history and clinical findings, the diagnosis of chronic migraine was established and prophylactic therapy with dual antidepressant was introduced. On follow-up examinations, a reduction in the frequency and intensity of migraine headaches was observed. After one year there was a progression of symptoms, and treatments with acupuncture were started. Stainless steel filiform needles of 25 mm in length were inserted perpendicularly into points on the head, arm, and legs and retained for 30 minutes. The treatment was administered once a day for 10 days with an interval of 2-3 days between treatments. The patient showed significant improvement for a period of 6 months after the acupuncture treatment, which is why the treatment with acupuncture was repeated. The patient stated that very soon after the beginning of each acupuncture treatment, she had noticed a significant improvement regarding psoriatic lesions as a "side effect". On the first day of acupuncture, extensive erythematosquamous plaques were noticed on the skin of the dorsum of the feet (Figure 1), palms, and elbows. It is important to emphasize that the patient did not use any specific topical antipsoriatic therapies during the acupuncture treatment, but only bland emollients. During the third week of treatment, a significant improvement was observed, or according to the patient, "she has not had such a good skin for a long time" (Figure 2). The improvement of the clinical status can be explained by overlapping acupuncture points used in the treatment of pain syndromes and psoriasis or to the holistic effect of acupuncture. In recent years, several high-quality evidence-based Western medicine guidelines have been developed for the treatment of psoriasis (6,7). In addition to that modern approach, several studies confirmed the effectiveness of acupuncture in the treatment of psoriasis. The recent review by Coyle et al. (4) indicates promising evidence of the efficacy of
of acute respiratory viral infections the medicinal plants of several pharmacological groups mainly used are: plants with a tonic effect (plants containing vitamins and minerals — rose hips, black currant, sea buckthorn, citrus fruits, adaptogens and immune modulators should be used in pediatric practice with caution (Ginseng, Rhodiola Rosea, Aralia Manchurian, plants containing biogenic stimulators — the aloe latex, kalanchoe, plant with bactericidal and bacteriostatic effect (sage leaves drug, eucalyptus switchgrass, plants with anti-inflammatory effect, containing tannins — oak bark, Potentilla rhizome, rhizome of Polygonum snake, burnet, alder cones, etc; plants containing essential oils, azulene derivatives — Chamomile flowers; plants containing mucus — Farfara leaves, Plantain; Linden flowers; plants with antipyretic and diaphoretic action — plants containing vitamins (fruits of raspberry, black currant fruit, cranberry; plants containing salicylic acid derivatives — Viola tricolor, raspberry fruit; plants with protective, emollient, expectorant action containing mucus — Farfara leaves; Linden flowers, plantain leaves are large; containing alkaloids, with antitussive effect —codeine phosphate; glaucine hydrochloride grass of Thermopsis lancet; bronchodilators plants; plants with anti-allergic effect, containing flavonoids — herb of Viola tricolor, the roots of Licorice. The article presents the recommendation of professor O.D. Barnaulov, a pediatric phytotherapist O.A. Daniluk on herbal medicine using in children, the rules of the certain medicinal plants use by Y.I. Korshikova, dosage regimen for herbal remedies for children, proposed by N.P. Menshikova, as well as practical advice on drafting phytospecies for the treatment and prophylaxis of acute respiratory viral infections and prescribing proposed by phytotherapist O.V. Kostareva.
to assess everything by `attainment target' - of which there were twenty-odd in Science. It took the emollient genius of Lord Dearing to rescue the system from the ultimate ramifications of that decision. Several years down the line a new Curriculum appears which is to be an improvement on the previous versions. In many ways it is. Lots of things have been tidied up, but it is still organized as slightly neater piles of bricks. There must come a time when the powers that be will realize that what they are doing is getting better and better at doing the wrong thing, and begin the agonizing reappraisal required to start doing the right thing (however badly). The bottom line, of course, is whether the National Curriculum works. I am depressed to hear so many teachers complaining about how difficult it has become to interest children in Science - especially Physics - at secondary level. League tables and exam results do not reveal this kind of deep-seated failure. The impulse for a national curriculum came from a justified desire and need to give all children an appropriate, effective and balanced education. Politicians felt that this was not happening, and spoke of the `secret garden of the curriculum', the preserve of entrenched `experts' who never had need to justify or explain their doings. But we will not have improved upon this if the garden, however secret, changes to a dry and lifeless desert.