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Molecules (Basel, Switzerland) Mar 2018The comprehensive treatment of pain is multidimodal, with pharmacotherapy playing a key role. An effective therapy for pain depends on the intensity and type of pain,... (Review)
Review
The comprehensive treatment of pain is multidimodal, with pharmacotherapy playing a key role. An effective therapy for pain depends on the intensity and type of pain, the patients' age, comorbidities, and appropriate choice of analgesic, its dose and route of administration. This review is aimed at presenting current knowledge on analgesics administered by transdermal and topical routes for physicians, nurses, pharmacists, and other health care professionals dealing with patients suffering from pain. Analgesics administered transdermally or topically act through different mechanisms. Opioids administered transdermally are absorbed into vessels located in subcutaneous tissue and, subsequently, are conveyed in the blood to opioid receptors localized in the central and peripheral nervous system. Non-steroidal anti-inflammatory drugs (NSAIDs) applied topically render analgesia mainly through a high concentration in the structures of the joint and a provision of local anti-inflammatory effects. Topically administered drugs such as lidocaine and capsaicin in patches, capsaicin in cream, EMLA cream, and creams containing antidepressants (i.e., doxepin, amitriptyline) act mainly locally in tissues through receptors and/or ion channels. Transdermal and topical routes offer some advantages over systemic analgesic administration. Analgesics administered topically have a much better profile for adverse effects as they relieve local pain with minimal systemic effects. The transdermal route apart from the above-mentioned advantages and provision of long period of analgesia may be more convenient, especially for patients who are unable to take drugs orally. Topically and transdermally administered opioids are characterised by a lower risk of addiction compared to oral and parenteral routes.
Topics: Administration, Cutaneous; Administration, Topical; Analgesics; Analgesics, Opioid; Animals; Humans; Pain
PubMed: 29562618
DOI: 10.3390/molecules23030681 -
Skin Health and Disease Feb 2023Ichthyosis vulgaris is an inherited, non-syndromic form of ichthyosis that presents with skin problems. Making up more than 95% cases of ichthyosis, ichthyosis vulgaris... (Review)
Review
Ichthyosis vulgaris is an inherited, non-syndromic form of ichthyosis that presents with skin problems. Making up more than 95% cases of ichthyosis, ichthyosis vulgaris is caused by heterozygous loss-of-function mutation of the filaggrin gene, raising the fragility and permeability of the stratum corneum. It typically presents in infancy as xerosis, skin lesions, keratosis pilaris, palmoplantar hyper linearity, scaly dermatosis, and erythroderma, clearly identifiable by age 5. Although majority of patients have a normal lifespan, possible complications include a vitamin D deficiency and auditory problems due to scaling in the ears, besides a drop in quality of life due to dermatological changes. Urea-based creams with 10% urea, ceramides, and other ceramides are often the first line therapy in ichthyosis vulgaris. There is no known curative treatment for ichthyosis vulgaris, but lifelong treatment can alleviate the symptoms. Urea-based creams are highly therapeutic, whereas ammonium lactate 12% lotion with a physiological lipid-based repair cream can help with scaling and dryness. There is also evidence in favour of propylene glycol solutions. Risankizumab, an anti-interleukin-23 drug, and enhancement of natural moisturizing factors are also two highly promising solutions that require additional research. This review aims to provide updates on the manifestation, evaluation, and treatment of ichthyosis vulgaris.
PubMed: 36751330
DOI: 10.1002/ski2.187 -
The Cochrane Database of Systematic... Aug 2016Vaginal atrophy is a frequent complaint of postmenopausal women; symptoms include vaginal dryness, itching, discomfort and painful intercourse. Systemic treatment for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Vaginal atrophy is a frequent complaint of postmenopausal women; symptoms include vaginal dryness, itching, discomfort and painful intercourse. Systemic treatment for these symptoms in the form of oral hormone replacement therapy is not always necessary. An alternative choice is oestrogenic preparations administered vaginally (in the form of creams, pessaries, tablets and the oestradiol-releasing ring). This is an update of a Chochrane systematic review; the original version was first published in October 2006.
OBJECTIVES
The objective of this review was to compare the efficacy and safety of intra-vaginal oestrogenic preparations in relieving the symptoms of vaginal atrophy in postmenopausal women.
SEARCH METHODS
We searched the following databases and trials registers to April 2016: Cochrane Gynaecology and Fertility Group Register of trials, The Cochrane Central Register of Controlled Trials (CENTRAL; 2016 issue 4), MEDLINE, Embase, PsycINFO, DARE, the Web of Knowledge, OpenGrey, LILACS, PubMed and reference lists of articles. We also contacted experts and researchers in the field.
SELECTION CRITERIA
The inclusion criteria were randomised comparisons of oestrogenic preparations administered intravaginally in postmenopausal women for at least 12 weeks for the treatment of symptoms resulting from vaginal atrophy or vaginitis.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial eligibility and risk of bias and extracted the data. The primary review outcomes were improvement in symptoms (participant-assessed), and the adverse event endometrial thickness. Secondary outcomes were improvement in symptoms (clinician-assessed), other adverse events (breast disorders e.g. breast pain, enlargement or engorgement, total adverse events, excluding breast disorders) and adherence to treatment. We combined data to calculate pooled risk ratios (RRs) (dichotomous outcomes) and mean differences (MDs) (continuous outcomes) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I(2) statistic. We assessed the overall quality of the evidence for the main comparisons using GRADE methods.
MAIN RESULTS
We included 30 RCTs (6235 women) comparing different intra-vaginal oestrogenic preparations with each other and with placebo. The evidence was low to moderate quality; limitations were poor reporting of study methods and serious imprecision (effect estimates with wide confidence intervals)1. Oestrogen ring versus other regimensOther regimens included oestrogen cream, oestrogen tablets and placebo. There was no evidence of a difference in improvement in symptoms (participant assessment) either between oestrogen ring and oestrogen cream (odds ratio (OR) 1.33, 95% CI 0.80 to 2.19, two RCTs, n = 341, I(2) = 0%, low-quality evidence) or between oestrogen ring and oestrogen tablets (OR 0.78, 95% CI 0.53 to 1.15, three RCTs, n = 567, I(2) = 0%, low-quality evidence). However, a higher proportion of women reported improvement in symptoms following treatment with oestrogen ring compared with placebo (OR 12.67, 95% CI 3.23 to 49.66, one RCT, n = 67). With respect to endometrial thickness, a higher proportion of women who received oestrogen cream showed evidence of increase in endometrial thickness compared to those who were treated with oestrogen ring (OR 0.36, 95% CI 0.14 to 0.94, two RCTs, n = 273; I(2) = 0%, low-quality evidence). This may have been due to the higher doses of cream used. 2. Oestrogen tablets versus other regimensOther regimens in this comparison included oestrogen cream, and placebo. There was no evidence of a difference in the proportions of women who reported improvement in symptoms between oestrogen tablets and oestrogen cream (OR 1.06, 95% CI 0.55 to 2.01, two RCTs, n = 208, I(2) = 0% low-quality evidence). A higher proportion of women who were treated with oestrogen tablets reported improvement in symptoms compared to those who received placebo using a fixed-effect model (OR 12.47, 95% CI 9.81 to 15.84, two RCTs, n = 1638, I(2) = 83%, low-quality evidence); however, using a random-effect model did not demonstrate any evidence of a difference in the proportions of women who reported improvement between the two treatment groups (OR 5.80, 95% CI 0.88 to 38.29). There was no evidence of a difference in the proportions of women with increase in endometrial thickness between oestrogen tablets and oestrogen cream (OR 0.31, 95% CI 0.06 to 1.60, two RCTs, n = 151, I(2) = 0%, low-quality evidence).3. Oestrogen cream versus other regimensOther regimens identified in this comparison included isoflavone gel and placebo. There was no evidence of a difference in the proportions of women with improvement in symptoms between oestrogen cream and isoflavone gel (OR 2.08, 95% CI 0.08 to 53.76, one RCT, n = 50, low-quality evidence). However, there was evidence of a difference in the proportions of women with improvement in symptoms between oestrogen cream and placebo with more women who received oestrogen cream reporting improvement in symptoms compared to those who were treated with placebo (OR 4.10, 95% CI 1.88 to 8.93, two RCTs, n = 198, I(2) = 50%, low-quality evidence). None of the included studies in this comparison reported data on endometrial thickness.
AUTHORS' CONCLUSIONS
There was no evidence of a difference in efficacy between the various intravaginal oestrogenic preparations when compared with each other. However, there was low-quality evidence that intra-vaginal oestrogenic preparations improve the symptoms of vaginal atrophy in postmenopausal women when compared to placebo. There was low-quality evidence that oestrogen cream may be associated with an increase in endometrial thickness compared to oestrogen ring; this may have been due to the higher doses of cream used. However there was no evidence of a difference in the overall body of evidence in adverse events between the various oestrogenic preparations compared with each other or with placebo.
Topics: Administration, Intravaginal; Aged; Atrophy; Estradiol; Estrogens; Female; Humans; Hydrogen-Ion Concentration; Isoflavones; Middle Aged; Postmenopause; Randomized Controlled Trials as Topic; Tablets; Vagina; Vaginal Creams, Foams, and Jellies; Vaginitis
PubMed: 27577677
DOI: 10.1002/14651858.CD001500.pub3 -
Oxidative Medicine and Cellular... 2015The exposure to ultraviolet radiations (UVR) is the key source of skin sunburn; it may produce harmful entities, reactive oxygen species (ROS), leading to aging. The... (Review)
Review
The exposure to ultraviolet radiations (UVR) is the key source of skin sunburn; it may produce harmful entities, reactive oxygen species (ROS), leading to aging. The skin can be treated and protected from the injurious effects of ROS by using various pharmaceutical formulations, such as cream. Cream can be loaded with antioxidants to quench ROS leading to photo-protective effects. Moreover, modern medicines depend on ethnobotanicals for protection or treatment of human diseases. This review article summarizes various in vivo antioxidant studies on herbal creams loaded with phyto-extracts. These formulations may serve as cosmeceuticals to protect skin against injurious effects of UVR. The botanicals studied for dermatologic use in cream form include Acacia nilotica, Benincasa hispida, Calendula officinalis, Camellia sinensis, Camellia sinensis, Nelumbo nucifera, Capparis decidua, Castanea sativa, Coffea arabica, Crocus sativus, Emblica officinalis Gaertn, Foeniculum vulgare, Hippophae rhamnoides, Lithospermum erythrorhizon, Malus domestica, Matricaria chamomilla L., Moringa oleifera, Morus alba, Ocimum basilicum, Oryza sativa, Polygonum minus, Punica granatum, Silybum marianum, Tagetes erecta Linn., Terminalia chebula, Trigonella foenum-graecum, and Vitis vinifera. The observed anti-aging effects of cream formulations could be an outcome of a coordinating action of multiple constituents. Of numerous botanicals, the phenolic acids and flavonoids appear effective against UVR-induced damage; however the evidence-based studies for their anti-aging effects are still needed.
Topics: Antioxidants; Humans; Plant Extracts; Skin; Skin Aging; Skin Cream
PubMed: 26448818
DOI: 10.1155/2015/709628 -
Open Access Macedonian Journal of... Nov 2019There are a lot of different types of sunscreen products (oils, sticks, gels, creams, lotions) which can be found on the world's market. Sunscreen product that contains...
BACKGROUND
There are a lot of different types of sunscreen products (oils, sticks, gels, creams, lotions) which can be found on the world's market. Sunscreen product that contains active chemical ingredients sometimes has harmful effects on the skin. Sunflower oil contains vitamin E and acts as a natural sunscreen which can absorb UVB light. The average droplet size of nanoemulsion is between 100 and 500 nm and do not show the problems of stability (creaming, flocculation, coalescence, and sedimentation), which are commonly associated with macroemulsions.
AIM
The aim of this study was to prepare and evaluate the sunflower oil nanoemulsion as a sunscreen.
METHODS
Sunflower oil nanoemulsions were prepared by spontaneous emulsification method with 3 formulas F1 (Tween 80 38%, sorbitol 22%), F2 (Tween 80 36%, sorbitol 24%), F3 (Tween 80 34%, sorbitol 26%) and 5% sunflower oil as a sunscreen substance. The nanoemulsions were evaluated for particle size, physical stability in room temperature (25 ± 2°C), low temperature (4 ± 2°C) and high temperature (40 ± 2°C) during experiment for 12 weeks of storage, centrifugation at 3750 rpm for 5 hours, viscosity, pH, freeze-thaw test and sun protection value (SPF) value by in vitro.
RESULTS
The results of nanoemulsion evaluation showed that nanoemulsion formula F1 had the smallest average particle size of 124.47 nm with yellowish colour, clear, transparent, pH value (6.5 ± 0.1), viscosity value (225 ± 25 cP), did not show any separation or creaming in the centrifugation, and stable during experiment for 12 weeks of storage at room temperature, low temperature and high temperature. The SPF value of all nanoemulsion preparations was higher than that of the emulsion.
CONCLUSION
The preparation of he sunflower oil nanoemulsion with a ratio of Tween 80 and sorbitol (38: 22) produces a stable nanoemulsion during the experiment for 12 weeks storage at the room, low and high temperature. The nanoemulsion preparation has higher SPF values compared to the emulsion. This nanoemulsion formulation could be considered more effective in sunscreen cosmetic use compare to the emulsion.
PubMed: 32127969
DOI: 10.3889/oamjms.2019.497 -
Acta Poloniae Pharmaceutica 2011The aim of this study was to evaluate the effects of newly formulated topical cream of Calendula officinalis extract on the mechanical parameters of the skin by using... (Randomized Controlled Trial)
Randomized Controlled Trial
The aim of this study was to evaluate the effects of newly formulated topical cream of Calendula officinalis extract on the mechanical parameters of the skin by using the cutometer. The Cutometer 580 MPA is a device that is designed to measure the mechanical properties of the skin in response to the application of negative pressure. This non-invasive method can be useful for objective and quantitative investigation of age related changes in skin, skin elasticity, skin fatigue, skin hydration, and evaluation of the effects of cosmetic and antiaging topical products. Two creams (base and formulation) were prepared for the study. Both the creams were applied to the cheeks of 21 healthy human volunteers for a period of eight weeks. Every individual was asked to come on week 1, 2, 3, 4, 5, 6, 7, and 8 and measurements were taken by using Cutometer MPA 580 every week. Different mechanical parameters of the skin measured by the cutometer were; R0, R1, R2, R5, R6, R7, and R8. These were then evaluated statistically to measure the effects produced by these creams. Using ANOVA, and t-test it was found that R0, and R6 were significant (p <0.05) whereas R1, R2, R5, R7, R8 were insignificant (p > 0.05). The instrumental measurements produced by formulation reflected significant improvements in hydration and firmness of skin.
Topics: Adult; Biomechanical Phenomena; Calendula; Chemistry, Pharmaceutical; Cosmetics; Elasticity; Emollients; Emulsions; Humans; Male; Plant Extracts; Skin; Skin Aging; Young Adult
PubMed: 21928714
DOI: No ID Found -
Clinical and Experimental Dermatology Jun 2022Eczema (atopic dermatitis; AD) is a very common itchy skin condition affecting 1 in 5 children and up to 1 in 10 adults worldwide. The skin of eczema sufferers is prone... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Eczema (atopic dermatitis; AD) is a very common itchy skin condition affecting 1 in 5 children and up to 1 in 10 adults worldwide. The skin of eczema sufferers is prone to redness, irritation and dryness because it does not form an effective barrier, i.e. the ability of the skin to stop irritants, allergens and microorganisms getting into the body. Skin barrier dysfunction is a hallmark of AD. The regular and liberal (600 g/week for an adult) use of emollients is recommended for all patients with eczema), even between episodes of itching and redness, to soften and soothe the skin. In England alone, almost 9 million prescriptions for emollient creams were issued in 2018, at a cost of over £50 million. Despite this widespread use, relatively little is known about how commonly prescribed emollient creams affect the skin's barrier, and thus the role of moisturizers in AD development and progression remains unclear. We set out to compare three different types of emollient cream and a no-treatment control.
AIM
To compare the barrier-strengthening properties of a new moisturizer containing urea and glycerol (urea-glycerol cream; UGC), with those of a glycerol-containing moisturizer (glycerol cream; GC), a simple paraffin cream (PC) with no humectant, and a no-treatment control (NTC).
METHODS
This was an observer-blinded prospective Phase 2 within-subject multilateral single-centre randomized controlled trial in adults with AD (Clinical Trials #NCT03901144). The intervention involved 4 weeks of treatment, twice daily, with the three products applied to one of four areas on the forearms the (the fourth area was the untreated control, randomized allocation). Skin properties [dryness, transepidermal water loss (TEWL), hydration and natural moisturizing factor (NMF) levels] were assessed before, during and after treatment to see what happened to the skin's barrier. The primary outcome was skin sensitivity to the irritant sodium lauryl sulfate (SLS) after treatment. We performed tests on the skin before and after treatment to see what happened to the skin's barrier.
RESULTS
In total, 49 patients were randomized, completed treatment and included in the analysis. UGC significantly reduced the response to SLS as indicated by a reduction in TEWL compared with NTC (-9.0 g/m /h; 95% CI -12.56 to -5.49), with PC (-9.0 g/m /h; 95% CI -12.60 to -5.44) and with GC -4.2 g/m /h; 95% CI 7.76 to -0.63). Skin moisturization improved at sites treated with UGC compared with NTC and PC, and this was accompanied by concordant changes in dryness and NMF levels. Subgroup analysis suggested FLG-dependent enhancement of treatment effects.
CONCLUSION
The study showed that not all emollient creams for eczema are equal. The simple paraffin-based emollient, which represents the most widely prescribed type of emollient cream in England, had no effect on the skin's barrier and reduced the skin's NMF. UGC markedly improved the skin's barrier and protected against irritation. GC performed better than PC, but not as well as UGC. UGC strengthened the skin barrier through a mechanism involving increased NMF levels in the skin, and imparted protection from SLS-induced irritation. By helping correct a major pathophysiological process, UGC has the potential to improve the long-term control of AD. The results show that different emollient creams have different effects on our skin, and only certain types have the ability to improve the skin's barrier and protect against irritants that trigger eczema.
Topics: Adult; Child; Dermatitis, Atopic; Eczema; Emollients; Glycerol; Humans; Irritants; Paraffin; Prospective Studies; Pruritus; Skin Cream; Urea; Water Loss, Insensible
PubMed: 35167133
DOI: 10.1111/ced.15141 -
Foods (Basel, Switzerland) Feb 2022Ice cream is a popular dessert product across the world. Structure, body, taste, and odor properties are created by adding non-milk ingredients and milk ingredients. The...
Ice cream is a popular dessert product across the world. Structure, body, taste, and odor properties are created by adding non-milk ingredients and milk ingredients. The main aim of the study is to decrease the caloric value of ice cream by using sugar and fat replacements. Ice cream treatments were investigated based on microstructural, chemical, physical, microbiological, sensory, and calorific values. Four different ice creams were used (control ice cream (SC1), ice cream with stevia (SC2), ice cream with sucralose (SC3), and ice cream with sorbitol (SC4)). The chemical properties in all treatments of ice cream were significantly recorded ( < 0.05). The highest sucrose and fat levels were detected in the SC1 treatment compared with the other treatments ( < 0.05). The lowest fat and sugar amounts were observed in the SC2, SC3, and SC4 treatments ( < 0.05). The highest viscosity, overrun, and hardness values ( < 0.05) were detected in the control ice cream. Total aerobic mesophilic bacterial counts were not significantly recorded between different ice cream treatments ( < 0.05). The sensory scores were not significantly affected by sweeteners and bulk agents in the different treatments. The highest calorific value was calculated in the SC1 samples ( < 0.05). On the other hand, the lowest calorific value was calculated in SC2, followed by the SC3 and SC4 treatments. In scanning electron microscopy (SEM), the gel exhibited a homogeneous structure with a fine network within the SC2, SC3, and SC4 treatments, as it contained a cohesive structure with small-sized pores.
PubMed: 35159640
DOI: 10.3390/foods11030490 -
Journal of Taibah University Medical... Jun 2022Facemask use is essential for managing the COVID-19 pandemic, but may cause facial dermopathy. Topical creams may minimise facemask complications. This clinical study...
OBJECTIVES
Facemask use is essential for managing the COVID-19 pandemic, but may cause facial dermopathy. Topical creams may minimise facemask complications. This clinical study explores the impact of different topical creams on facemask tolerability and complications.
METHODS
This was a prospective observational study involving 80 adults. Participants voluntarily chose and used topical creams during facemask use. Data were collected using validated scales before and after topical cream application.
RESULTS
About 23.8% of the participants used lidocaine gel, 17.5% used petrolatum, 16.2% used hydrocortisone cream, 16.2% used diphenhydramine cream, 13.8% used arnica cream, and 12.5% used zinc oxide cream. Duration of facemask use was 6 h amongst staff and 4 h amongst patients, and was similar both with and without topical cream. Facial temperature rise was lower with all creams ( = 0.033), as was facial redness ( = 0.037) and facial pain ( = 0.025). Facemask compliance was better for all creams ( = 0.015). The facial temperature rise was the lowest with topical lidocaine ( = 0.021). Early facial redness was lowest with topical hydrocortisone or diphenhydramine ( = 0.042). Severe redness was lowest with topical hydrocortisone or zinc oxide ( = 0.044). Facemask pain was lowest with topical lidocaine ( = 0.035), and facemask compliance was best with topical lidocaine ( = 0.001). Petrolatum had the best user satisfaction and odour ratings ( = 0.041).
CONCLUSION
Topical creams minimise facemask complications, thereby promoting compliance; topical lidocaine was the most effective in reducing pain and enabling facemask compliance. Topical hydrocortisone, diphenhydramine, and zinc oxide were effective in reducing facial redness, and topical petrolatum produced the best user satisfaction.
PubMed: 35250427
DOI: 10.1016/j.jtumed.2021.12.012