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Journal of Cosmetic Dermatology Jun 2024The foam's structural longevity, linked to the effectiveness of sclerotherapy, depends on preparation conditions. The factors enhancing the treatment's effectiveness and...
BACKGROUND
The foam's structural longevity, linked to the effectiveness of sclerotherapy, depends on preparation conditions. The factors enhancing the treatment's effectiveness and efficacy are still under discussion.
METHODS
We conducted an in vitro preclinical research, which included 144 independent trials. A total of 8 combinations involving 18 trials were designed according to settings of +4°C and room temperature (20-22°C), liquid-to-air ratios of 1/1 and 1/4, and polidocanol concentrations of 0.5% and 1% using the modified Tessari method. Our study aimed to examine the effect of air ratio, agent temperature, and polidocanol concentration on stability by assessing the foam half-time (FHT) and defining the optimal preparation conditions.
RESULTS
The mean FHT was 117 ± 30.4 s. The longest FHT was in a 1:4 air-to-sclerosant ratio at +4°C, regardless of the sclerosant concentration (for %0.5 mean FHT: 146.2 ± 13.9 s, for % 1 mean FHT: 146.9 ± 18 s). There was a significant interaction among the three variables on FHT (p = 0.001). Temperature emerged as the primary factor (F(1, 136) = 124, p < 0.001, ηp = 0.477), with lower temperatures markedly enhancing the longevity (p < 0.001). Preparation at a temperature of 4°C resulted in an extended FHT of 32.5 s compared to 22°C (95% CI: 24.06-41.04 s).
CONCLUSION
The temperature, agent concentration, and gas ratio significantly influence the stability of the physician-compounded foam. The low temperature at +4°C may offer better FHT for sclerotherapy.
PubMed: 38837644
DOI: 10.1111/jocd.16398 -
Jornal Vascular Brasileiro 2017Ulcers are the end result of varicose veins associated with reflux in saphenous veins.
BACKGROUND
Ulcers are the end result of varicose veins associated with reflux in saphenous veins.
OBJECTIVE
To demonstrate the possibility of combining two procedures, foam sclerotherapy of saphenous veins and skin grafting, to treat patients with venous ulcers related to reflux in saphenous vein.
METHODS
20 limbs were treated in 20 patients. All patients had ulcers related to saphenous vein reflux. We performed the grafting with expanded skin, followed by administration of ultrasound guided polidocanol foam sclerotherapy in veins associated with ulcers, accessed by puncture or dissection of the vein.
RESULTS
In all cases there was improvement of ulcer-related symptoms and healing of the lesion. In 11 cases we achieved full skin grafting viability. In four cases there was healing of about 50% of the lesion and in the other five cases approximately 75% of the lesion healed. The first control ultrasonographic examination revealed complete sclerosis of the vessels treated in 19 of 20 cases, with partial sclerosis in one case, but no detectable reflux. The second ultrasonographic examination performed at 45 days showed complete sclerosis in 15 cases. In five cases there was partial sclerosis, without detectable reflux in three and with reflux in isolated segments associated with varicose veins in two. The most common complication was pigmentation along vein paths, observed in 13 patients. In one case there was asymptomatic thrombosis of muscle veins of the leg.
CONCLUSION
This combination of procedures is a valid option, with the potential to provide quicker and less expensive treatment.
PubMed: 29930660
DOI: 10.1590/1677-5449.008217 -
Journal of Cutaneous Medicine and... 2019Itch treatment is a major challenge in the dermatologist's practice. We encounter patients suffering from pruritus on a regular basis, and often lack diverse treatment... (Review)
Review
Itch treatment is a major challenge in the dermatologist's practice. We encounter patients suffering from pruritus on a regular basis, and often lack diverse treatment options to adequately respond to the patients' needs. In the last 20 years, novel pathways have been investigated that were beyond the scope of histamine. Although most did not result in a molecule available on the Canadian market, it is interesting and important as health care providers to stay up to date with new neuronal pathways involved in itch transmission and potential new therapeutic options. In this review, we will discuss pathways targeted in new topical treatments such as antagonist of proteinase-activated receptor-2, the endocannabinoid system, neurotrophins and tropomyosin-related kinase A receptor, the transient receptor potential-vanilloid or transient receptor potential-melastatine ion channels. New systemic therapies are now focusing on antagonizing the neurokinin receptor, modulating the opioidergic system, or targeting itch cytokines such as interleukin-31.
Topics: Administration, Cutaneous; Animals; Aprepitant; Capsaicin; Endocannabinoids; Humans; Interleukins; Menthol; Narcotic Antagonists; Nerve Growth Factor; Neurokinin-1 Receptor Antagonists; Polidocanol; Pruritus; Receptor, PAR-2; Receptor, trkA; TRPM Cation Channels; TRPV Cation Channels
PubMed: 31167547
DOI: 10.1177/1203475419852050 -
Dermatologic Surgery : Official... Dec 2020Foam sclerotherapy is an effective treatment strategy for venous malformations. Both polidocanol (POL) and bleomycin are effective sclerosants; however, no studies have...
BACKGROUND
Foam sclerotherapy is an effective treatment strategy for venous malformations. Both polidocanol (POL) and bleomycin are effective sclerosants; however, no studies have reported POL-bleomycin foam.
OBJECTIVE
To introduce a method for producing POL-bleomycin foam and evaluate the stability of POL-bleomycin foam with bleomycin concentrations.
MATERIALS AND METHODS
Group A: 2 mL of 1% POL + 8 mL of air; Group B: 2 mL of 1% POL + 3 U bleomycin + 8 mL of air; Group C: 2 mL of 1% POL + 6 U bleomycin + 8 mL of air; Group D: 2 mL of 1% POL + 12 U bleomycin + 8 mL of air. Tessari method was used for foam generation. The foam half-life time (FHT) was used to evaluate foam stability. Five recordings were made for each group.
RESULTS
The FHT was 148.6 ± 2.9 seconds in Group A, 148.8 ± 4.0 seconds in Group B, 148.4 ± 2.6 seconds in Group C, and 148.8 ± 1.6 seconds in Group D. The FHT in different groups showed no significant differences.
CONCLUSION
The POL-bleomycin foam was prepared successfully and its FHT was as long as the POL foam.
Topics: Bleomycin; Drug Combinations; Drug Compounding; Drug Stability; Half-Life; Humans; Polidocanol; Sclerosing Solutions; Sclerotherapy; Vascular Malformations; Veins
PubMed: 32769523
DOI: 10.1097/DSS.0000000000002533 -
Journal of Drugs in Dermatology : JDD Nov 2019Polidocanol is an FDA-approved sclerosant indicated for treating uncomplicated spider veins and reticular veins in the lower extremities. Despite restrictions against...
Polidocanol is an FDA-approved sclerosant indicated for treating uncomplicated spider veins and reticular veins in the lower extremities. Despite restrictions against compounding drugs that are essentially copies of FDA-approved or commercially available products, polidocanol is also available from compounding pharmacies and outsourcing facilites. Compounded drug products are not FDA-approved and have not undergone premarket FDA review for safety, effectiveness, and quality. Seven samples of polidocanol were obtained from three compounding pharmacies and analyzed using high pressure liquid chromatography. None of the samples contained the labeled concentration of polidocanol and five contained excessive levels of impurities. Since the potency and purity of compounded polidocanol injection cannot be assured, physicians who use these products should consider FDA-approved products to ensure optimal safety and efficacy. J Drugs Dermatol. 2019;18(11):1124-1127.
Topics: Chromatography, High Pressure Liquid; Drug Compounding; Humans; Polidocanol; Sclerosing Solutions; Varicose Veins
PubMed: 31741355
DOI: No ID Found -
Current Clinical Pharmacology 2017Polidocanol is approved for its competence in the treatment of varicose veins and spider veins; however, unfortunately, many of its off-label uses are still... (Review)
Review
BACKGROUND
Polidocanol is approved for its competence in the treatment of varicose veins and spider veins; however, unfortunately, many of its off-label uses are still underappreciated.
OBJECTIVE
Lack of an appropriate comprehensive review for off-label uses of this medication troubles physicians about making evidence-based decisions on prescribing it for its various outstanding off-label uses. This article attempts to provide physicians with the latest information concerning successful and unsuccessful use of polidocanol as an alternative treatment for esophageal and gastric varices, tendinopathy and epicondylitis, vascular malformations, varicocele, hydrocele and spermatocele, aneurysmal bone cysts, itching, management of gastrointestinal bleeding, simple renal cysts, reducing the incidence and severity of radio-induced dermatitis and hemorrhoids.
METHOD
The two databases of MEDLINE and Cochrane Library were searched for all human English studies, published in January 2006 to November 2017, which contained the keyword of "polidocanol" or its alternative MeSH terms.
RESULTS
Our search identified a total number of 597 articles. Those articles that were only discussing the approved uses of polidocanol were excluded and the remaining 116 articles were reviewed. Eleven major and 30 minor off-label uses were found within included studies.
CONCLUSION
Numerous successful administrations of this drug in a variety of clinical conditions lead to promising perspectives toward it. Sclerotherapy with polidocanol as a minimal-invasive method (having similar outcomes like the prevalent surgeries) may reduce the rate of complications. Furthermore, for determining the most appropriate method and dosage, randomized clinical trials are needed, confirming and providing more clear instructions for different conditions.
Topics: Drug Approval; Esophageal and Gastric Varices; Evidence-Based Medicine; Humans; Off-Label Use; Polidocanol; Sclerosing Solutions; Sclerotherapy
PubMed: 29473522
DOI: 10.2174/1574884713666180223121828 -
Journal of Vascular Surgery. Venous and... Jan 2023Sclerotherapy for venous malformation has been widely used; however, no guidelines are available to assess the effectiveness of different sclerotherapy agents. We... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Sclerotherapy for venous malformation has been widely used; however, no guidelines are available to assess the effectiveness of different sclerotherapy agents. We conducted a systematic review and network meta-analysis to investigate the effectiveness of sclerotherapy agents for venous malformations.
METHODS
Three electronic databases were searched from their inception (1950) to April 29, 2021. Studies comparing the effectiveness of different sclerotherapy agents were included. The risk of bias within and across studies was assessed. Pairwise meta-analyses were conducted, followed by a network meta-analysis. We also assessed inconsistency and publishing bias using various approaches.
RESULTS
Seven studies with 547 patients in six arms were included in the present study. We defined the response and complete response as two separate outcomes. Significant differences were observed in four comparisons with respect to the response (ethanol vs bleomycin, ethanol vs polidocanol, ethanol vs sodium tetradecyl sulfate, polidocanol vs sodium tetradecyl sulfate). No statistically significant differences were found in the other comparisons. The evidence network revealed that for the response outcome, ethanol ranked first, followed by pingyangmycin, polidocanol, sodium morrhuate, bleomycin, and, finally, sodium tetradecyl sulfate. For the complete response outcome, pingyangmycin had the best results, followed by sodium morrhuate, polidocanol, ethanol, bleomycin, and, finally, sodium tetradecyl sulfate. Major complications, such as facial nerve palsy, serious local swelling, and necrosis, had occurred mostly in the ethanol group and rarely in the other groups. Because of the limited data, no further analysis of major complications was conducted. Our confidence in the comparisons and rankings was low. We found no verified inconsistency or publishing bias in the present study using the existing approaches.
CONCLUSIONS
Ethanol showed a significantly better response statistically compared with the other agents. However, ethanol had also resulted in the highest incidence of complications. Pingyangmycin showed the second-best response, best complete response, and a low rate of complications, respectively. Overall, pingyangmycin achieved excellent performance and balance in terms of the different outcomes. However, they could not be adequately recommended from the available data. More superior trials, especially randomized controlled trials, are needed in the future.
Topics: Humans; Sclerotherapy; Polidocanol; Sclerosing Solutions; Sodium Tetradecyl Sulfate; Sodium Morrhuate; Network Meta-Analysis; Treatment Outcome; Vascular Malformations; Bleomycin; Ethanol
PubMed: 36179784
DOI: 10.1016/j.jvsv.2022.08.004 -
Journal of Gastroenterology and... Mar 2019Gastric varices (GVs) are a major complication of portal hypertension in patients with liver cirrhosis. The mortality rate associated with the bleeding from GVs is not... (Review)
Review
Gastric varices (GVs) are a major complication of portal hypertension in patients with liver cirrhosis. The mortality rate associated with the bleeding from GVs is not low. Balloon-occluded retrograde transvenous obliteration (BRTO) was first introduced by Kanagawa et al. as a treatment for isolated GVs in 1994. It has been performed most frequently in Asia, especially in Japan. Ethanolamine oleate was the original sclerosant used in the therapy. Since the late 2000s, BRTO using sodium tetradecyl sulfate foam or polidocanol foam as a sclerosant has been performed in many countries other than Japan. Then, early in the 2010s, modified BRTO techniques including vascular plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration were developed as an alternative treatment for GVs. This article provides a historical overview of BRTO using various sclerosants and modified BRTO techniques, such as plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration.
Topics: Balloon Occlusion; Esophageal and Gastric Varices; Humans; Hypertension, Portal; Liver Cirrhosis; Oleic Acids; Polidocanol; Sclerosing Solutions; Sodium Tetradecyl Sulfate
PubMed: 30170340
DOI: 10.1111/jgh.14463 -
Frontiers in Pediatrics 2022The aim of this study was to investigate the efficacy of polidocanol against venous malformations (VMs).
OBJECTIVE
The aim of this study was to investigate the efficacy of polidocanol against venous malformations (VMs).
METHODS
Studies reporting the treatment of VMs using polidocanol (published until February 15, 2020) were reviewed in the Embase and PubMed databases. After excluding the same literature, part of the studies were excluded by reading the title, abstract, full text. Eleven studies (with 287 participants) that fulfilled the inclusion criteria were included. Systematic meta-analysis was performed using Reviews Manager 5.2, and a fixed-effects model was used to calculate the pooled effective rate of polidocanol against VMs and the 95% confidence intervals (CI).
RESULTS
Lesion reduction of more than 50% was considered effective. A total of 287 patients were treated, and treatment in 271 was considered effective. The efficacy of polidocanol was 0.89 (95% CI = 0.83-0.93). Heterogeneity among the studies was small ( = 0%, = 0.47). T The funnel plot was roughly symmetric.
CONCLUSION
Our study suggested that polidocanol is effective in the treatment of VMs. VMs at different sites can be treated without serious complications. Therefore, we have reason to believe that polidocanol is a safe and an effective drug for VMs.
PubMed: 35967557
DOI: 10.3389/fped.2022.925318 -
Journal of Cutaneous and Aesthetic... 2022Pyogenic granuloma is a commonly occurring inflammatory hyperplasia involving skin and mucous membranes. Various modalities of treatment have been used to treat pyogenic...
INTRODUCTION
Pyogenic granuloma is a commonly occurring inflammatory hyperplasia involving skin and mucous membranes. Various modalities of treatment have been used to treat pyogenic granuloma. However, there is an increased risk of intraoperative bleeding and recurrence of pyogenic granuloma following surgical treatment of pyogenic granuloma. Therefore, sclerotherapy has evolved as an effective alternative treatment modality in excellent safety and efficacy.
AIMS AND OBJECTIVES
The aim of this study was to assess the safety and efficacy of 3% polidocanol in liquid form in pyogenic granuloma as a sclerosant.
SETTINGS AND DESIGN
This was a retrospective study of cases treated between March 2019 and February 2020 at two different private institutes.
MATERIALS AND METHODS
The study included 30 patients with 30 pyogenic granulomas treated with 3% polidocanol liquid. Individuals with comorbid conditions such as diabetes, hypertension, thyroid disorders, and those who were on medications were excluded from the study. Two units of 3% polidocanol solution were injected with an insulin syringe at the base of the lesion. Changes in lesions and adverse events were recorded and injections were repeated after a gap of 2 weeks if needed.
RESULT
In 28 patients, there was complete resolution of the lesion within 4 weeks and 2 patients received a second injection of polidocanol. All the patients tolerated the procedure and the lesions resolved without any significant sequelae.
DISCUSSION
The advantages of 3% polidocanol sclerotherapy are that it is a safe, easy, effective, and minimally invasive procedure with little discomfort to the patient and very minimal complications as compared with other modalities.
CONCLUSION
Polidocanol 3% solution is an effective sclerosant for the treatment of pyogenic granuloma.The aim of this study was to assess the safety and efficacy of 3% polidocanol in the liquid form in PG as a sclerosant.
PubMed: 36561400
DOI: 10.4103/JCAS.JCAS_119_21