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Allergology International : Official... Oct 2022This is an abridged edition of English version of the Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. Atopic dermatitis (AD) is a disease... (Review)
Review
This is an abridged edition of English version of the Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. In Japan, from the perspective of evidence-based medicine, the current strategies for the treatment of AD consist of three primary measures: (i) use of topical corticosteroids, tacrolimus ointment, and delgocitinib ointment as the main treatment of 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. In the present revised guidelines, the description about three new drugs, namely, dupilumab, delgocitinib, and baricitinib, has been added. 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.
Topics: Dermatitis, Atopic; Emollients; Glucocorticoids; Humans; Japan; Ointments; Tacrolimus
PubMed: 36064654
DOI: 10.1016/j.alit.2022.06.009 -
Plastic and Reconstructive Surgery Oct 2023Mastectomy flap necrosis (MFN) is a common complication of immediate breast reconstruction that greatly affects patient satisfaction and cosmetic outcomes. Topical...
BACKGROUND
Mastectomy flap necrosis (MFN) is a common complication of immediate breast reconstruction that greatly affects patient satisfaction and cosmetic outcomes. Topical nitroglycerin ointment, with its low cost and negligible side effects, has been shown to significantly decrease the incidence of MFN in immediate implant-based breast reconstruction, but its utility has not been studied in immediate autologous reconstruction.
METHODS
With institutional review board approval, a prospective cohort study was performed of all consecutive patients undergoing immediate free-flap breast reconstruction by a single reconstructive surgeon at a single institution between February of 2017 and September of 2021. Patients were divided into two cohorts: those who received 30 mg of topical nitroglycerin ointment to each breast at the conclusion of the operation (September of 2019 to September of 2021) and those who did not (February of 2017 to August of 2019). All patients underwent intraoperative SPY angiography, and mastectomy skin flaps were débrided intraoperatively based on imaging. Independent demographic variables were analyzed, and dependent outcome variables included mastectomy skin flap necrosis, headache, and hypotension requiring removal of ointment.
RESULTS
A total of 35 patients (49 breasts) were included in the nitroglycerin cohort and 34 patients (49 breasts) were included in the control group. There was no significant difference in patient demographics, medical comorbidities, or mastectomy weight between cohorts. The rate of MFN decreased from 51% in the control group to 26.5% in the group that received nitroglycerin ointment ( P = 0.013). There were no documented adverse events associated with nitroglycerin use.
CONCLUSION
Topical nitroglycerin ointment significantly decreases the rate of MFN in patients undergoing immediate autologous breast reconstruction without significant adverse effects.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, II.
Topics: Humans; Female; Mastectomy; Nitroglycerin; Ointments; Breast Neoplasms; Prospective Studies; Mammaplasty; Postoperative Complications; Necrosis; Retrospective Studies
PubMed: 36862948
DOI: 10.1097/PRS.0000000000010349 -
The New England Journal of Medicine Feb 2021The tubulin polymerization and Src kinase signaling inhibitor tirbanibulin is being investigated as a topical treatment for actinic keratosis, a precursor of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The tubulin polymerization and Src kinase signaling inhibitor tirbanibulin is being investigated as a topical treatment for actinic keratosis, a precursor of squamous-cell carcinoma.
METHODS
In two identically designed double-blind trials, we randomly assigned, in a 1:1 ratio, adults with actinic keratoses on the face or scalp to receive either topical tirbanibulin or vehicle (placebo) ointment. The ointment was applied by the patients to a 25-cm contiguous area containing four to eight lesions once daily for 5 consecutive days. The primary outcome was the percentage of patients with a complete (100%) reduction in the number of lesions in the application area at day 57. The secondary outcome was the percentage of patients with a partial (≥75%) reduction in the number of lesions within the application area at day 57. The incidence of recurrence was evaluated at 1 year. Local reactions were scored with the use of 4-point scale (ranging from 0 [absent] to 3 [severe]).
RESULTS
A total of 702 patients were enrolled in the two trials (351 patients per trial). Complete clearance in trial 1 occurred in 44% of the patients (77 of 175) in the tirbanibulin group and in 5% of those (8 of 176) in the vehicle group (difference, 40 percentage points; 95% confidence interval [CI], 32 to 47; P<0.001); in trial 2, the percentages were 54% (97 of 178 patients) and 13% (22 of 173), respectively (difference, 42 percentage points; 95% CI, 33 to 51; P<0.001). The percentages of patients with partial clearance were significantly higher in the tirbanibulin groups than in the vehicle groups. At 1 year, the estimated percentage of patients with recurrent lesions was 47% among patients who had had a complete response to tirbanibulin. The most common local reactions to tirbanibulin were erythema in 91% of the patients and flaking or scaling in 82%. Adverse events with tirbanibulin were application-site pain in 10% of the patients and pruritus in 9%, all of which resolved.
CONCLUSIONS
In two identically designed trials, tirbanibulin 1% ointment applied once daily for 5 days was superior to vehicle for the treatment of actinic keratosis at 2 months but was associated with transient local reactions and recurrence of lesions at 1 year. Trials comparing tirbanibulin with conventional treatments and that have longer follow-up are needed to determine the effects of tirbanibulin therapy on actinic keratosis. (Funded by Athenex; ClinicalTrials.gov numbers, NCT03285477 and NCT03285490.).
Topics: Acetamides; Administration, Topical; Aged; Double-Blind Method; Enzyme Inhibitors; Face; Female; Humans; Kaplan-Meier Estimate; Keratosis, Actinic; Male; Middle Aged; Morpholines; Ointments; Polymerization; Pyridines; Scalp; Skin; Tubulin
PubMed: 33567191
DOI: 10.1056/NEJMoa2024040 -
PloS One 2023Glycyrrhetinic acid, a drug with anti-inflammatory effects, enhanced the activity of antipsoriatic efficacy. In this research, an ointment with glycyrrhetinic acid was...
Glycyrrhetinic acid, a drug with anti-inflammatory effects, enhanced the activity of antipsoriatic efficacy. In this research, an ointment with glycyrrhetinic acid was prepaired as the major component and several other herbal monomers (astilbin, osthole, and momordin Ic) have antipsoriatic activity as minor components. Then an Imiquimod-induced psoriasis-like mouse model was established and the damaged skin condition of the administered group, the changes in the spleen index and the secretion of inflammatory factors in mouse skin were observed. Calcipotriol ointment was used as a positive control to compare the efficacy. Glycyrrhizic acid compound ointment significantly improved imiquimod-induced psoriasis in mice and reduced the secretion of TNF-α, IL-12, IL-17, and IL-23 in mouse skin, and showed a stronger therapeutic effect than calcipotriol ointment. Calcipotriol ointment did not significantly alleviate imiquimod-induced splenomegaly and did not significantly reduce the expression of IL-17 and IL-23 in mouse skin. Glycyrrhetinic acid compound ointment was more effective than calcipotriol and was dose-dependent in the treatment of imiquimod-induced psoriatic dermatitis in mice. Meanwhile,calcipotriol was not suitable for the treatment of Imiquimod -induced psoriasis-like mice.
Topics: Animals; Mice; Glycyrrhizic Acid; Imiquimod; Interleukin-17; Ointments; Psoriasis; Glycyrrhetinic Acid; Interleukin-23
PubMed: 37643205
DOI: 10.1371/journal.pone.0290637 -
The Journal of Dermatological Treatment Jun 2022Pityriasis alba is a common skin condition that may be challenging to treat, especially in patients with darker skin type where the hypopigmentation may be more...
BACKGROUND
Pityriasis alba is a common skin condition that may be challenging to treat, especially in patients with darker skin type where the hypopigmentation may be more noticeable and represents a major cosmetic concern.
OBJECTIVES
This study aims to evaluate the efficacy of three cost-effective treatments of PA in comparison with placebo.
PATIENTS/METHODS
This prospective study was conducted on 80 patients complaining from PA and divided into 4 equal groups according the received topical treatment on the target lesions twice daily for 8 weeks (Calcipotriol 0.005% cream, Tacrolimus 0.03% ointment, topical corticosteroid; Clobetasone butyrate 0.05% cream and Petrolatum as Placebo). Clinical evaluation, Physician Global Assessment, Patient's satisfaction levels as well as point counting planimetry were done for evaluation of the response.
RESULTS
Significant improvement of scaling and erythema within 3 weeks after initiation of therapy and hypopigmentation by the 8th week, except for those received placebo. Tarolimus 0.03% ointment showed simple superiority over both Calcipotriol 0.005% cream and topical corticosteroid as regards repigmenation, although, the later received the highest level of patient satisfaction.
CONCLUSION
The three treatments were superior to placebo with relative superiority to Tacrolimus 0.03% due to limited side effects.
Topics: Administration, Topical; Dermatologic Agents; Glucocorticoids; Humans; Hypopigmentation; Ointments; Pityriasis Rosea; Prospective Studies; Tacrolimus; Treatment Outcome
PubMed: 34289784
DOI: 10.1080/09546634.2021.1959014 -
Pakistan Journal of Pharmaceutical... Nov 2022Propolis is a resinous substance containing aromatic acids, esters, volatile compounds, hydrocarbons, steroids, enzymes, flavonoids, vitamins and minerals. In this...
Propolis is a resinous substance containing aromatic acids, esters, volatile compounds, hydrocarbons, steroids, enzymes, flavonoids, vitamins and minerals. In this direction it has nutrient, antibacterial and antioxidant properties due to its complex structure and content. In this study it was aimed to prepare a propolis ointment with a base of occlusive and emollient properties for nourishing and healing of skin damaged by environmental effects. Six formulations were prepared by using vaseline, lanolin, glycerine and different types of crude propolis. According to physical examinations only the ointment formulations prepared with ethanolic propolis extracts at two different concentrations were found as successful. Successful formulation including 1:5 propolis: Ethanol extract was evaluated by physical controls, mechanic tests, antimicrobial tests and stability evaluation. Results showed that prepared propolis ointment has a creamy yellow colour with an acceptable odour, homogeny and a good spreadability texture and has a good stability at 40C and 25C and for 2 and 3 months respectively. And it presented mild antibacterial effects on E. coli and S. aureus strains, which was acceptable for a frequent use for cosmetic purposes. As a conclusion prepared propolis ointment can be a good candidate for a cosmetic ointment for skin nutrition and healing purposes.
Topics: Propolis; Ointments; Staphylococcus aureus; Escherichia coli; Anti-Bacterial Agents; Ethanol; Ascomycota
PubMed: 36789816
DOI: No ID Found -
Journal of Wound Care Jun 2023Infection and pathological disorders, such as cellular disorders, ischaemia, neuropathy and angiogenesis, are considered the most critical factors which cause a delay in...
Infection and pathological disorders, such as cellular disorders, ischaemia, neuropathy and angiogenesis, are considered the most critical factors which cause a delay in the wound healing process in patients with diabetes. This study aimed to investigate the effect of an ointment based on ostrich oil containing honey, beeswax, and ethanolic extracts of , propolis and on the wound healing process of diabetic rats. Gas chromatography/mass spectrometry analysis showed caffeic acid and pinostrobin chalcone molecules present in propolis, giving antibacterial and antifungal properties to the compound. The antibacterial assessment showed the ointment had remarkable antibacterial activity against (8.6±0.28mm), (9.4±0.31mm), (7.2±0.23mm) and (13.9±0.42mm). In vivo results showed the ointment significantly accelerated wound healing and increased collagen deposition compared with the control (p<0.05). Histopathology evaluation also showed hair follicles, sebaceous glands and vessels in the group that used the ointment. These results proved successful and diabetic wound healing was rapid. Therefore, it could be concluded that the fabricated ointment could be a suitable candidate for wound healing.
Topics: Rats; Animals; Propolis; Diabetes Mellitus, Experimental; Ointments; Wound Healing; Anti-Bacterial Agents
PubMed: 37300867
DOI: 10.12968/jowc.2023.32.Sup6.S18 -
BMJ Open Gastroenterology Aug 2023Haemorrhoids are one of the most common gastrointestinal and anal diseases. In olive oil and honey propolis, flavonoids have beneficial effects on improving vascular... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Haemorrhoids are one of the most common gastrointestinal and anal diseases. In olive oil and honey propolis, flavonoids have beneficial effects on improving vascular function and decreasing vascular resistance. In this study, we aimed to produce a combination of these two substances in the form of lotions and assess their healing and side effects in comparison with routine treatment, anti-haemorrhoid ointment (containing hydrocortisone and lidocaine).
DESIGN
In this randomised clinical trial study, 86 patients with grade 2 or more haemorrhoid degrees, diagnosed by colonoscopy, were divided into two groups, the case (n=44) and control (n=42). The case group was treated with flavonoid lotion, and the control group was treated with anti-haemorrhoid ointment two times per day for 1 month. Patients were followed weekly with history and physical examination. The data of the two groups were collected before and after the intervention and statistically analysed.
RESULTS
Post-treatment reduction in haemorrhoid grade was significant in the case group (p=0.02). This ratio was insignificant in the control group (p=0.139). Flavonoid lotion (p<0.05) significantly reduced the signs and symptoms of haemorrhoids more than anti-haemorrhoid ointment.
CONCLUSION
According to the results, flavonoid lotion can be an excellent alternative to topical chemical drugs, such as anti-haemorrhoid ointment, in treating haemorrhoid disease. Besides its effectiveness and safety, it can be easily manufactured and widely available to patien.
Topics: Humans; Ointments; Colonoscopy; Flavonoids
PubMed: 37597875
DOI: 10.1136/bmjgast-2023-001158 -
International Journal of Pharmaceutical... 2023Pharmaceutical foams are gaining in popularity. The use of foam technology now delivers a range of topical active agents, including corticosteroids, other...
Pharmaceutical foams are gaining in popularity. The use of foam technology now delivers a range of topical active agents, including corticosteroids, other anti-inflammatories, sunscreen compounds, and antibacterial, antifungal, and antiviral agents. In addition to the distinct application advantages and improved patient compliance with foams, a real reason for the rapid growth of topical foam technology is that foams are elegant and aesthetically and cosmetically appealing products that provide an alternative to ointments, creams, lotions, and gels in the highly competitive dermatological market. In addition to all this, foams can be easily compounded for patients to take advantage of the uniqueness and applicability of this dosage form in medication administration. As an example, for the treatment of inflamed skin conditions such as sunburn and eczema, topical foams are preferred because they can be spread more easily and thereby minimize the amount of rubbing required to distribute the formulations. Another innovative use of forms is in administering a liquid medication to a bedridden patient. When a liquid is placed in a spoon or measuring device, it may spill. However, if the foam is placed in the spoon, it can be delivered to the patient without spilling. Properly formulated, this foam can be spill resistant, reproducible, easily flavored and taste masked, and pediatric and geriatric friendly.
Topics: Humans; Child; Aged; Drug Compounding; Emollients; Ointments; Skin Diseases; Gels
PubMed: 37816182
DOI: No ID Found -
The Lancet. Child & Adolescent Health Aug 2022To our knowledge, there are no trials comparing emollients commonly used for childhood eczema. We aimed to compare the clinical effectiveness and safety of the four main... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To our knowledge, there are no trials comparing emollients commonly used for childhood eczema. We aimed to compare the clinical effectiveness and safety of the four main emollient types: lotions, creams, gels, and ointments.
METHODS
We did a pragmatic, individually randomised, parallel group, phase 4 superiority trial in 77 general practice surgeries in England. Children aged between 6 months and 12 years with eczema (Patient Orientated Eczema Measure [POEM] score >2) were randomly assigned (1:1:1:1; stratified by centre and minimised by baseline POEM score and age, using a web-based system) to lotions, creams, gels, or ointments. Clinicians and parents were unmasked. The initial emollient prescription was for 500 g or 500 mL, to be applied twice daily and as required. Subsequent prescriptions were determined by the family. The primary outcome was parent-reported eczema severity over 16 weeks (weekly POEM), with analysis as randomly assigned regardless of adherence, adjusting for baseline and stratification variables. Safety was assessed in all randomly assigned participants. This trial was registered with the ISRCTN registry, ISRCTN84540529.
FINDINGS
Between Jan 19, 2018, and Oct 31, 2019, 12 417 children were assessed for eligibility, 550 of whom were randomly assigned to a treatment group (137 to lotion, 140 to cream, 135 to gel, and 138 to ointment). The numbers of participants who contributed at least two POEM scores and were included in the primary analysis were 131 in the lotion group, 137 in the cream group, 130 in the gel group, and 126 in the ointment group. Baseline median age was 4 years (IQR 2-8); 255 (46%) participants were girls, 295 (54%) were boys; 473 (86%) participants were White; and the mean POEM score was 9·3 (SD 5·5). There was no difference in eczema severity between emollient types over 16 weeks (global p value=0·77), with adjusted POEM pairwise differences of: cream versus lotion 0·42 (95% CI -0·48 to 1·32), gel versus lotion 0·17 (-0·75 to 1·09), ointment versus lotion -0·01 (-0·93 to 0·91), gel versus cream -0·25 (-1·15 to 0·65), ointment versus cream -0·43 (-1·34 to 0·48), and ointment versus gel -0·18 (-1·11 to 0·75). This result remained unchanged following multiple imputation, sensitivity, and subgroup analyses. The total number of adverse events did not significantly differ between the treatment groups (lotions 49 [36%], creams 54 [39%], gels 54 [40%], and ointments 48 [35%]; p=0·79), although stinging was less common with ointments (12 [9%] of 138 participants) than lotions (28 [20%] of 137), creams (24 [17%] of 140), or gels (25 [19%] of 135).
INTERPRETATION
We found no difference in effectiveness between the four main types of emollients for childhood eczema. Users need to be able to choose from a range of emollients to find one that they are more likely to use effectively.
FUNDING
National Institute for Health and Care Research.
Topics: Child; Child, Preschool; Dermatitis, Atopic; Eczema; Emollients; Female; Gels; Humans; Infant; Male; Ointments; Severity of Illness Index
PubMed: 35617974
DOI: 10.1016/S2352-4642(22)00146-8