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Oral Diseases Oct 2017The main objective of oral lichen planus management is to control symptomatic outbreaks via eliminating lesions and alleviating symptoms. Corticosteroids, calcineurin... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The main objective of oral lichen planus management is to control symptomatic outbreaks via eliminating lesions and alleviating symptoms. Corticosteroids, calcineurin inhibitors, and most of the available modalities are associated with adverse effects, which may limit their use. The aim of this review was to assess the effect of aloe vera on pain alleviation and/or clinical improvement in patients with symptomatic oral lichen planus.
METHODS
MEDLINE-PubMed; CENTRAL, and LILACS were searched in May 2016 to identify all clinical trials evaluating aloe vera vs placebo or corticosteroids for treatment of oral lichen planus. The included studies were five clinical trials and two case reports.
RESULTS
From the included studies, there is weak evidence that aloe vera is more efficient than placebo and has comparable effect to triamcinolone acetonide. The meta-analyses show heterogeneity and reveals that aloe vera is inferior to the control in general.
CONCLUSION
Although corticosteroids are still the gold standard, aloe vera shows promising results especially with no adverse effects compared with various adverse effects of corticosteroids. We recommend conducting new randomized clinical trials with larger sample size, sufficiently long follow-up period as well as standardized aloe vera formulations and outcome measures.
Topics: Aloe; Humans; Lichen Planus, Oral; Mouthwashes; Ointments; Pain; Plant Preparations
PubMed: 28029732
DOI: 10.1111/odi.12631 -
Journal of Investigative Medicine : the... Feb 2021Several published studies have evaluated the safety and effectiveness of oral and intravenous tacrolimus for the management of patients with inflammatory bowel disease... (Review)
Review
Several published studies have evaluated the safety and effectiveness of oral and intravenous tacrolimus for the management of patients with inflammatory bowel disease (IBD). However, little is known about the effectiveness of topical tacrolimus in this patient population. The aim of this systematic review was to evaluate the current state of literature to evaluate the safety and effectiveness of rectal administration of topical tacrolimus, in the form of suppository, ointment, and/or enema in patients with ulcerative proctitis, perianal Crohn's disease (CD), and chronic refractory pouchitis. Electronic database searches were conducted in international databases since their inception until February 2020. Study subjects were categorized into three groups: topical tacrolimus for patients with proctitis, perianal CD, and chronic refractory pouchitis. The primary end point of this study was the remission rate. Secondary end points were response rate and the incidence of AEs. Eleven studies were included in the final assessment in this systematic review. This provided information from 188 patients. Tacrolimus was administered topically as suppositories, ointment, or enema. Clinical remission was achieved in 57.1%, 57.14%, and 70.0% in patients with proctitis, fistulizing perianal CD, and chronic pouchitis. The most commonly reported side effect was perianal itching and burning. Reversible nephrotoxicity occurred in a single patient. No clear correlation was found between blood levels and clinical outcomes. Topical tacrolimus is effective for a subset of patients with IBD. The adverse effects were minimal and tolerable. Well-designed randomized clinical trials are warranted to establish the appropriate dose and administration method.
PubMed: 33622709
DOI: 10.1136/jim-2020-001699 -
Dermatologic Therapy Dec 2022Despite the considerably high prevalence of cutaneous warts, no optimally effective and safe treatment is available. Leaves of date palm (Phoenix dactylifera L.;...
Despite the considerably high prevalence of cutaneous warts, no optimally effective and safe treatment is available. Leaves of date palm (Phoenix dactylifera L.; Arecaceae) have long been used in Iran's folk medicine as a remedy for warts. To assess the state-of-the-art evidence on using P. dactylifera L. for warts, we conducted a systematic review using CINAHL (via EBSCO), Embase, Medline (via PubMed), ProQuest, Scopus, and Web of Science. We conducted an open-label uncontrolled pilot clinical study to evaluate the efficacy and safety of a proprietary topical date palm leaf-based ointment for the treatment of various types of nongenital warts. This study consisted of an 8-week treatment phase and a 4-week follow-up phase. The assessed outcomes included complete clearance, patient satisfaction (on Likert scale), and the occurrence of any adverse effect. The systematic review demonstrated that the effects of date palm on warts have not been scientifically studied. Thirty patients entered the study with a mean age of 29.5 years (SD = 14.04); among which 17 were female and 13 were male. The patients presented diverse types of warts: verruca vulgaris 15 (50%), plantar 9 (30%), plane 2 (7%), periungual 2 (7%), and warts at multiple sites 2 (7%). In this trial, 19 patients (63.3%) experienced complete clearance and 5 patients (16.6%) experienced partial clearance. Eight patients (26.67%) dropped out during the study. 21 (70%) patients were very satisfied (score on Likert scale = 5) while 1 (3.3%) patient with partial clearance was somewhat satisfied (score on Likert scale = 4). No adverse effect was observed. The results of this pilot study indicate that the date palm leaf-based ointment is a promising treatment whose efficacy and safety should be further investigated in a randomized controlled clinical trial.
Topics: Humans; Male; Female; Adult; Phoeniceae; Ointments; Pilot Projects; Warts; Plant Leaves; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 36346021
DOI: 10.1111/dth.15968 -
Journal of Dermatological Science May 2009To build a critical appraisal of the available literature to evaluate the effectiveness of topical calcineurin inhibitors in treatment of atopic dermatitis (AD), in... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES
To build a critical appraisal of the available literature to evaluate the effectiveness of topical calcineurin inhibitors in treatment of atopic dermatitis (AD), in comparison to topical corticosteroids (TCs) and/or placebo.
DESIGN
systematic review and meta-analysis.
DATA SOURCES
electronic search of MEDLINE Pubmed along the last 10 years (1997-2006).
STUDY SELECTION
randomized control trials of TCIs reporting efficacy outcomes, in comparison to TCs or vehicle (placebo) or both.
DATA SYNTHESIS
of 210 articles, 19 studies were included, 10 for tacrolimus and 9 for pimecrolimus, involving 7378 patients of whom 2771 applied tacrolimus, 1783 applied pimecrolimus, and 2824 were controls. Both drugs were significantly more effective than a vehicle. However, two long-term trials comparing demonstrated the value of pimecrolimus in reduction of flares and steroid-sparing effect after 6 months. Compared to TCs, both 0.1% and 0.03% tacrolimus ointments were as effective as moderate potency TCs, and more effective than a combined steroid regimen. Tacrolimus was more effective than mild TCs.
CONCLUSIONS
TCIs in AD are more effective than placebo. Although less effective than TCs, pimecrolimus has its value in long-term maintenance and as a steroid-sparing agent in AD, whenever used early enough, at first appearance of erythema and/or itching. In treatment of moderate to severe AD, topical tacrolimus is as effective as moderately potent TCs, and more effective than mild preparations. Chronic AD lesions of the face and flexures are the most justified indication for topical calcineurin inhibitors.
Topics: Adrenal Cortex Hormones; Calcineurin Inhibitors; Dermatitis, Atopic; Enzyme Inhibitors; Humans; Immunosuppressive Agents; Tacrolimus
PubMed: 19303745
DOI: 10.1016/j.jdermsci.2009.02.002 -
The Journal of Hospital Infection Nov 2015Chronic haemodialysis patients are a high-risk population for meticillin-resistant Staphylococcus aureus (MRSA) colonization, which is a precursor of infection. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic haemodialysis patients are a high-risk population for meticillin-resistant Staphylococcus aureus (MRSA) colonization, which is a precursor of infection.
AIM
To summarize the effect of nasal (± whole-body wash) MRSA decolonization in haemodialysis patients by means of a systematic review and meta-analysis.
METHODS
We identified eligible studies using Medline, Embase, the Cochrane database, clinicaltrials.org, and conference abstracts investigating the success of MRSA decolonization in haemodialysis patients. For the statistical analysis, we used Stata 13 to express study-specific proportions with 95% confidence intervals. A likelihood ratio test was used to assess inter-study heterogeneity.
FINDINGS
Six published prospective cohort studies and one study described in a conference abstract met our inclusion criteria. From 1150 haemodialysis patients enrolled in these studies, MRSA was isolated from nasal swabs of 147 (12.8%) patients. Six of the trials used mupirocin nasal ointment and combined it with chlorhexidine body washes for decolonization. The most widely used protocol was a five-day course of mupirocin nasal ointment application three times a day, and chlorhexidine body wash once daily. The pooled success rate of decolonization was 0.88 (95% confidence interval: 0.75-0.95). A likelihood ratio test of the fixed versus the random-effects model showed significant inter-study heterogeneity (P = 0.047). Four of seven studies determined subsequent MRSA infections in 94 carriers overall, two (2%) of which experienced infection.
CONCLUSION
The use of mupirocin together with whole-body decolonization is highly effective in eradicating MRSA carriage in haemodialysis patients. The current literature, however, is characterized by a lack of comparative effectiveness studies for this intervention.
Topics: Anti-Infective Agents, Local; Carrier State; Chlorhexidine; Disinfection; Humans; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nasal Mucosa; Renal Dialysis; Staphylococcal Infections; Treatment Outcome
PubMed: 26443485
DOI: 10.1016/j.jhin.2015.08.015 -
Journal of Wound, Ostomy, and... 2009Debridement is an essential component of wound bed preparation. Various techniques of debridement are commonly used in clinical practice. This systematic review... (Review)
Review
Debridement is an essential component of wound bed preparation. Various techniques of debridement are commonly used in clinical practice. This systematic review summarizes and ranks evidence concerning the safety and efficacy of the selective enzymatic debriding agent collagenase. Studies were identified comparing collagenase to inactive (sham) ointment and to alternate techniques for debridement including autolytic and surgical. A preponderance of evidence from this systematic review confirms that collagenase ointment is a safe and effective choice for debridement of cutaneous ulcers and burn wounds.
Topics: Burns; Collagenases; Debridement; Humans; Ointments; Safety; Skin Ulcer
PubMed: 19918148
DOI: 10.1097/WON.0b013e3181bfdf83 -
Archives of Dermatological Research Apr 2013This systematic review examines the current state of the evidence for the efficacy and safety of herbal medicines (HMs) used topically in conjunction with anti-psoriatic... (Meta-Analysis)
Meta-Analysis Review
This systematic review examines the current state of the evidence for the efficacy and safety of herbal medicines (HMs) used topically in conjunction with anti-psoriatic pharmacotherapy (APP) in the treatment of psoriasis. Searches were conducted in September 2012 of PubMed, EMBASE, Cochrane Library, two Chinese databases (China National Knowledge Infrastructure and Chinese Scientific Journals Full Text Database) and of article reference lists. We included randomized controlled trials published in English, Chinese or Japanese that investigated topical HM combined with APP used systemically and/or topically compared to pharmacotherapy alone. Studies employing phototherapy were excluded. Two authors conducted searches, extracted data on study characteristics and outcomes, and assessed Risk of Bias. Disagreements were resolved by discussion with a third author. Eight studies met the inclusion criteria. All used multi-herb formulae, four in herbal baths, three in herbal ointments or creams, and one as herbal steam. The pooled data indicated a benefit for the add-on effect of herbal therapy to APP. Adding these topical HMs to conventional pharmacotherapy appeared to produce short-term additional clinical benefits. No serious adverse events were reported. Experimental studies suggest that some of the herbs possess anti-inflammatory, anti-pruritic, and/or anti-proliferative activities. However, these results need to be interpreted with caution due to methodological weaknesses and the lack of replicated studies. Studies that address the identified methodological deficiencies are required to further investigate the efficacy and safety of these HMs as adjunct therapies for psoriasis.
Topics: Administration, Topical; Cnidium; Humans; Phytotherapy; Plant Preparations; Plant Roots; Plants, Medicinal; Psoriasis; Sophora
PubMed: 23354931
DOI: 10.1007/s00403-013-1316-y -
The Journal of Dermatological Treatment Apr 2015Topical antibiotics are not indicated for postsurgical wound infection prophylaxis in clean and clean-contaminated dermatologic surgeries, yet many dermatologists... (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Topical antibiotics are not indicated for postsurgical wound infection prophylaxis in clean and clean-contaminated dermatologic surgeries, yet many dermatologists continue to prescribe them. The objective of our systematic review and meta-analysis was to critically assess the efficacy of topical antibiotics in terms of preventing postsurgical wound infections in the dermatology outpatient setting.
METHODS
PubMed, Embase, MD Consult, Science Direct, Springer Link, DynaMed and Cochrane online medical databases were searched from 1980 to 2013.
RESULTS
Using random effects modeling, the pooled odds ratio of developing a postsurgical wound infection was 0.71 (95% CI, 0.42-1.19).
DISCUSSION
Pooled data of the four trials in the meta-analysis did not show a statistically significant difference in incidence of postsurgical wound infections between topical antibiotics and petrolatum/paraffin. In the setting of moist occlusive dressings, there is no statistically significant difference in prophylactic efficacy between applying and not applying ointment to surgical wounds. Wounds at increased risk of developing surgical site infections include wounds in diabetics, wounds located in certain anatomic regions, and wounds created by some surgical procedures.
CONCLUSIONS
Petrolatum should be used instead of topical antibiotics as a prophylactic measure to prevent postsurgical wound infections in the outpatient dermatologic setting.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Dermatologic Surgical Procedures; Humans; Occlusive Dressings; Surgical Wound Infection
PubMed: 24646178
DOI: 10.3109/09546634.2014.906547 -
Dermatology and Therapy Apr 2021
Letter to the Editor Regarding 'Crisaborole Ointment, 2%, for Treatment of Patients with Mild-to-Moderate Atopic Dermatitis: Systematic Literature Review and Network Meta-Analysis'.
PubMed: 33660231
DOI: 10.1007/s13555-021-00503-1 -
Clinical and Experimental Dermatology Apr 2010This review summarizes clinically important findings from systematic reviews indexed in bibliographical databases between August 2007 and August 2008 that dealt with... (Review)
Review
This review summarizes clinically important findings from systematic reviews indexed in bibliographical databases between August 2007 and August 2008 that dealt with disease prevention (six reviews) and treatment of atopic eczema (seven reviews). Regarding disease prevention, two independent systematic reviews found some clinical trial evidence that ingestion of probiotics by mothers during pregnancy might reduce the incidence of subsequent eczema. Another review failed to find any clear benefit of prebiotics in eczema prevention. Although furry pets are often cited as causing allergic disease, a systematic review of observational studies found no evidence that exposure to cats or dogs at birth increases eczema risk. One very large review of studies of breastfeeding found some evidence of a protective effect on eczema risk, although all the studies were limited by their observational nature. A German group has attempted an overview of eczema prevention studies with a view to informing national guidelines. In terms of eczema treatment, two systematic reviews have confirmed the efficacy of topical tacrolimus ointment. Another review of 31 trials confirms the efficacy of topical pimecrolimus, although many of those trials were vehicle controlled, which limits their clinical utility. A review of 23 studies of desensitization therapy for allergic diseases found some evidence of benefit for eczema, which needs to be explored further. Despite the popularity of antistaphylococcal therapies for eczema, a Cochrane Review of 21 trials failed to show any clear benefit for any of the therapies for infected or clinically noninfected eczema. Another Cochrane Review dealt with dietary exclusions for people with eczema and found little evidence to support any dietary exclusion, apart from avoidance of eggs in infants with suspected egg allergy supported by evidence of sensitization. A review of 13 studies of probiotics for treating established eczema did not show convincing evidence of a clinically worthwhile benefit, an observation that has been substantiated in a subsequent Cochrane Review.
Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Animals; Anti-Infective Agents; Breast Feeding; Cats; Dermatitis, Atopic; Dermatologic Agents; Desensitization, Immunologic; Diet; Dogs; Female; Humans; Immunosuppressive Agents; Male; Pets; Prebiotics; Probiotics; Randomized Controlled Trials as Topic; Risk Factors; Tacrolimus
PubMed: 19874342
DOI: 10.1111/j.1365-2230.2009.03734.x