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Academic Emergency Medicine : Official... Jan 1995
Topics: Anti-Bacterial Agents; Contraindications; Humans; Ointments; Postoperative Period; Wound Healing; Wound Infection
PubMed: 7606605
DOI: 10.1111/j.1553-2712.1995.tb03069.x -
Health Technology Assessment... Oct 2023Emollients are recommended for children with eczema (atopic eczema/dermatitis). A lack of head-to-head comparisons of the effectiveness and acceptability of the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Emollients are recommended for children with eczema (atopic eczema/dermatitis). A lack of head-to-head comparisons of the effectiveness and acceptability of the different types of emollients has resulted in a 'trial and error' approach to prescribing.
OBJECTIVE
To compare the effectiveness and acceptability of four commonly used types of emollients for the treatment of childhood eczema.
DESIGN
Four group, parallel, individually randomised, superiority randomised clinical trials with a nested qualitative study, completed in 2021. A purposeful sample of parents/children was interviewed at ≈ 4 and ≈ 16 weeks.
SETTING
Primary care (78 general practitioner surgeries) in England.
PARTICIPANTS
Children aged between 6 months and 12 years with eczema, of at least mild severity, and with no known sensitivity to the study emollients or their constituents.
INTERVENTIONS
Study emollients sharing the same characteristics in the four types of lotion, cream, gel or ointment, alongside usual care, and allocated using a web-based randomisation system. Participants were unmasked and the researcher assessing the Eczema Area Severity Index scores was masked.
MAIN OUTCOME MEASURES
The primary outcome was Patient-Oriented Eczema Measure scores over 16 weeks. The secondary outcomes were Patient-Oriented Eczema Measure scores over 52 weeks, Eczema Area Severity Index score at 16 weeks, quality of life (Atopic Dermatitis Quality of Life, Child Health Utility-9 Dimensions and EuroQol-5 Dimensions, five-level version, scores), Dermatitis Family Impact and satisfaction levels at 16 weeks.
RESULTS
A total of 550 children were randomised to receive lotion (analysed for primary outcome 131/allocated 137), cream (137/140), gel (130/135) or ointment (126/138). At baseline, 86.0% of participants were white and 46.4% were female. The median (interquartile range) age was 4 (2-8) years and the median Patient-Oriented Eczema Measure score was 9.3 (SD 5.5). There was no evidence of a difference in mean Patient-Oriented Eczema Measure scores over the first 16 weeks between emollient types (global = 0.765): adjusted Patient-Oriented Eczema Measure pairwise differences - cream-lotion 0.42 (95% confidence interval -0.48 to 1.32), gel-lotion 0.17 (95% confidence interval -0.75 to 1.09), ointment-lotion -0.01 (95% confidence interval -0.93 to 0.91), gel-cream -0.25 (95% confidence interval -1.15 to 0.65), ointment-cream -0.43 (95% confidence interval -1.34 to 0.48) and ointment-gel -0.18 (95% confidence interval -1.11 to 0.75). There was no effect modification by parent expectation, age, disease severity or the application of UK diagnostic criteria, and no differences between groups in any of the secondary outcomes. Median weekly use of allocated emollient, non-allocated emollient and topical corticosteroids was similar across groups. Overall satisfaction was highest for lotions and gels. There was no difference in the number of adverse reactions and there were no significant adverse events. In the nested qualitative study ( = 44 parents, = 25 children), opinions about the acceptability of creams and ointments varied most, yet problems with all types were reported. Effectiveness may be favoured over acceptability. Parents preferred pumps and bottles over tubs and reported improved knowledge about, and use of, emollients as a result of taking part in the trial.
LIMITATIONS
Parents and clinicians were unmasked to allocation. The findings may not apply to non-study emollients of the same type or to children from more ethnically diverse backgrounds.
CONCLUSIONS
The four emollient types were equally effective. Satisfaction with the same emollient types varies, with different parents/children favouring different ones. Users need to be able to choose from a range of emollient types to find one that suits them.
FUTURE WORK
Future work could focus on how best to support shared decision-making of different emollient types and evaluations of other paraffin-based, non-paraffin and 'novel' emollients.
TRIAL REGISTRATION
This trial is registered as ISRCTN84540529 and EudraCT 2017-000688-34.
FUNDING
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (HTA 15/130/07) and will be published in full in ; Vol. 27, No. 19. See the NIHR Journals Library website for further project information.
Topics: Child; Female; Humans; Male; Cost-Benefit Analysis; Dermatitis, Atopic; Eczema; Emollients; Ointments; Quality of Life; Severity of Illness Index; Child, Preschool
PubMed: 37924282
DOI: 10.3310/GZQW6681 -
Scientific Reports Aug 2022The role of angiotensin receptor blocker in wound healing and cutaneous fibrosis has become a hotspot in recent years. We have developed a losartan cream that is...
The role of angiotensin receptor blocker in wound healing and cutaneous fibrosis has become a hotspot in recent years. We have developed a losartan cream that is comparable to triamcinolone ointment in inhibiting scarring. Considering the effects of chitosan and asiaticoside on wound healing and scarring, we added them to the losartan cream this time and improved the formula, expecting to get a better anti-scarring effect. The effects of creams were investigated on mouse scar model with triamcinolone ointment, onion extract gel, and commercial asiaticoside cream set as positive controls. A preliminary exploration of the mechanism involved in TGF-β/Smad pathway was performed in vivo and in vitro. With all results of anti-scarring, the compound losartan cream (containing chitosan, asiaticoside, and losartan) shows the best effect, followed by the chitosan asiaticoside cream. The treatment of the compound losartan cream inhibited expression of TGF-β1, collagen, and Smads, and decreased phosphorylation of Smad in vivo. These inhibitory effects were also confirmed in vitro. Our findings indicated that the compound losartan cream could inhibit scarring via TGF-β/Smad pathway. This cream might be an effective option for scar treatment.
Topics: Animals; Chitosan; Cicatrix; Losartan; Mice; Ointments; Signal Transduction; Smad Proteins; Transforming Growth Factor beta1; Triamcinolone
PubMed: 35995975
DOI: 10.1038/s41598-022-17686-y -
The Journal of Dermatological Treatment Dec 2024This study aims to assess the efficacy and safety of combining the 308-nm Excimer lamp with Tacrolimus 0.1% ointment, compared to Tacrolimus 0.1% ointment monotherapy,... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy and safety of 308-nm Excimer lamp combined with Tacrolimus 0.1% ointment vs Tacrolimus 0.1% ointment as monotherapy in treating children with limited vitiligo: a randomized controlled trial.
OBJECTIVE
This study aims to assess the efficacy and safety of combining the 308-nm Excimer lamp with Tacrolimus 0.1% ointment, compared to Tacrolimus 0.1% ointment monotherapy, for treating pediatric vitiligo involving less than 10% of the body surface area.
METHODS
Fifty pediatric patients with vitiligo were randomly assigned to two groups. Group A received Tacrolimus 0.1% ointment twice daily and Excimer light at 308-nm twice weekly, while Group B received Tacrolimus 0.1% ointment alone, administered twice daily. Repigmentation percentages were evaluated after 30, 90, and 180 days using the rule of nine.
RESULTS
Group A exhibited a significant improvement in repigmentation, increasing from 10% after one month to 65% after six months. In contrast, Group B observed an increase from 10% to 30% over the same timeframe. The efficacy of the treatment was significantly higher in Group A at both the 3-month and 6-month follow-up points (-value < .001). Moreover, Group A achieved notably higher repigmentation rates in the face, trunk, and lower limbs.
CONCLUSION
The combination of Tacrolimus and the 308-nm excimer lamp yielded superior repigmentation results compared to Tacrolimus monotherapy in pediatric vitiligo patients. This combined approach may offer an effective new treatment protocol for pediatric vitiligo.
Topics: Child; Humans; Combined Modality Therapy; Ointments; Tacrolimus; Treatment Outcome; Vitiligo
PubMed: 38124534
DOI: 10.1080/09546634.2023.2296851 -
International Journal of Molecular... Jun 2020Bioshell calcium oxide (BiSCaO) possesses deodorizing properties and broad microbicidal activity. This study aimed to investigate the application of BiSCaO ointment for...
Bioshell calcium oxide (BiSCaO) possesses deodorizing properties and broad microbicidal activity. This study aimed to investigate the application of BiSCaO ointment for the prevention and treatment of infection in chronic wounds in healing-impaired patients, without delaying wound healing. The bactericidal activities of 0.04, 0.2, 1, and 5 wt% BiSCaO ointment, 3 wt% povidone iodine ointment, and control (ointment only) were compared to evaluate the in vivo disinfection and healing of -infected wounds in hairless rats. Treatment of the infected wounds with 0.2 wt% BiSCaO ointment daily for 3 days significantly enhanced wound healing and reduced the in vivo bacterial counts compared with povidone iodine ointment and control (no wound cleaning). Although 5 wt% BiSCaO ointment provided the lowest bacterial counts during 3 days' treatment, it delayed wound healing. Histological examinations showed significantly advanced granulation tissue and capillary formation in wounds treated with 0.2 wt% BiSCaO ointment for 3 days compared to wounds treated with the other ointments. This study suggested that using 0.2 wt% BiSCaO ointment as a disinfectant for infected wounds and limiting disinfection to 3 days may be sufficient to avoid the negative effects of BiSCaO on wound repair.
Topics: Animal Shells; Animals; Anti-Bacterial Agents; Calcium Compounds; Disinfection; Male; Ointments; Oxides; Pectinidae; Povidone-Iodine; Pseudomonas Infections; Pseudomonas aeruginosa; Rats, Hairless; Wound Infection
PubMed: 32545309
DOI: 10.3390/ijms21114176 -
Archives of Razi Institute Oct 2022Skin wound healing, especially in diabetic patients, has been a major medical challenge for decades. In the meantime, the use of traditional medicine has always been...
Skin wound healing, especially in diabetic patients, has been a major medical challenge for decades. In the meantime, the use of traditional medicine has always been questioned. Propolis) resin and wax (is one of the most likely solutions to this problem. The present study aimed to establish an animal model for healing skin wounds and diabetic ulcers. To this aim, rats were randomly allocated into two healthy and diabetic groups (50 mg/kg streptozotocin resulted in diabetes with high BSL to 300 mg/dL), which were divided into four subgroups. The 7 mm full-thickness skin wounds were created on the abdomen region in 80 male Wistar rats using paunch. In the subgroups, the wounds were cleaned with normal 0.9% saline as the control subgroup and dressed with Eucerit, 1.5% honey+eucerit, and 3% propolis +1.5% honey+eucerit, once daily for 14 days in other subgroups, respectively. On days 1, 3, 5, and 7 after the intervention, wound and area contractions were calculated using digital photographs measurement. The histopathological and semi-quantitative studies were performed on days 7 and 14 after wounds creation. The microscopic findings demonstrated that the granulation tissue, fibroblasts, re-epithelization, and angiogenesis increased (≤0.05) in the subgroups treated by propolis and honey combination in healthy and diabetic rats within 7 and 14 days post-injury. Also, less inflammation and a significant reduction in wound contraction were observed in the same subgroups on days 3, 5, and 7 compared to other subgroups (≤0.05). The results indicated that significant healing quality and acceleration were affected by propolis and honey compared to other subgroups on days 3 and 5 (≤0.05).
Topics: Rats; Male; Animals; Propolis; Rats, Wistar; Diabetes Mellitus, Experimental; Honey; Ointments; Wound Healing
PubMed: 37123150
DOI: 10.22092/ARI.2022.357191.1991 -
CMAJ Open 2021Topical nitroglycerin (TNG) ointment has been used for almost 3 decades to treat neonatal peripheral tissue ischemia, but this product is now no longer being produced by...
BACKGROUND
Topical nitroglycerin (TNG) ointment has been used for almost 3 decades to treat neonatal peripheral tissue ischemia, but this product is now no longer being produced by its Canadian manufacturer. Our aim was to investigate the efficacy and safety of TNG products in newborns in neonatal intensive care units.
METHODS
In this systematic review we searched Embase, CINAHL, MEDLINE, PubMed and Web of Science from inception to April 2020 for studies on the use of TNG products (TNG ointment, TNG spray, glyceryl trinitrate [GTN] patch) for the treatment of neonatal tissue ischemia. We did not apply language or study design limitations. Animal studies and duplicate records were excluded. Two reviewers screened and extracted data. The Tool for Evaluating the Methodological Quality of Case Reports and Case Series was used to assess the risk of bias of individual studies.
RESULTS
We included 23 articles (20 case reports, 2 case series and 1 retrospective audit) describing the use of TNG ointment, TNG spray or GTN patch in the treatment of 39 tissue ischemia events in 37 newborns. Twenty-three (62.2%), 12 (32.4%), 1 (2.7%) and 1 (2.7%) infants received TNG ointment, GTN patch, both TNG ointment and GTN patch, and TNG spray, respectively. Nineteen (76.0%) and 7 (53.8%) injuries treated with TNG ointment and GTN patch showed complete recovery, respectively. Two (16.7%) infants treated with GTN patch experienced adverse events (i.e., methemoglobinemia) requiring treatment discontinuation.
INTERPRETATION
TNG ointment presents a safe therapeutic modality for salvage therapy of neonatal tissue ischemia. Engagement of stakeholders is essential to address its recent commercial inaccessibility in Canada.
Topics: Administration, Cutaneous; Catheterization, Peripheral; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Ischemia; Nitroglycerin; Ointments; Salvage Therapy; Vasodilator Agents
PubMed: 33731426
DOI: 10.9778/cmajo.20200129 -
Acta Dermato-venereologica Feb 2021Gentamicin ointment has potential in the treatment of Nagashima-type palmoplantar keratosis. However, there is a lack of reliable study data. The aim of this study was... (Randomized Controlled Trial)
Randomized Controlled Trial
Gentamicin ointment has potential in the treatment of Nagashima-type palmoplantar keratosis. However, there is a lack of reliable study data. The aim of this study was to perform a prospective, randomized, double-blinded, contralateral, vehicle-controlled clinical trial. A total of 20 subjects diagnosed with Nagashima-type palmoplantar keratosis by genetic test, who carried nonsense mutations, enrolled in the 30-day study. Gentamicin ointment was applied to the hand and foot on one side of the body, and vehicle ointment was applied to the hand and foot on the other side. The choice of hand and foot in each subject was randomly allocated. The severity of the patient's skin lesions and quality of life were assessed by a blinded evaluator, using the Dermatology Life Quality Index, visual analogue scale scores and digital photography. Gentamicin ointment treatment resulted in a significant improvement in symptoms of hyperkeratosis and foul smell compared with vehicle. No difference was found in the effect on erythema between gentamicin and vehicle. In conclusion, gentamicin ointment demonstrated positive responses and good tolerance in treating Nagashima-type palmoplantar keratosis caused by nonsense mutations.
Topics: Double-Blind Method; Gentamicins; Humans; Keratoderma, Palmoplantar; Ointments; Prospective Studies; Quality of Life; Serpins
PubMed: 33554268
DOI: 10.2340/00015555-3760 -
Clinical and Experimental Dermatology Jul 2022Emollients are used as maintenance therapy for all severities of eczema but there is a lack of head-to-head comparisons of effectiveness and acceptability.
BACKGROUND
Emollients are used as maintenance therapy for all severities of eczema but there is a lack of head-to-head comparisons of effectiveness and acceptability.
AIM
To determine the validity of a self-report questionnaire designed to assess user satisfaction with a given emollient and to report the findings.
METHODS
Data were analysed from the Choice of Moisturiser for Eczema Treatment trial, which compared four emollient types (Aveeno lotion, Diprobase cream, Doublebase gel and Hydromol ointment) in children aged < 5 years with clinically diagnosed eczema. An emollient satisfaction questionnaire was completed after 12 weeks. Responses for individual items were scored from 0 to 4. Total scores ranged from 0 to 28 (low to high satisfaction). Completion rates and distributions of responses for individual items and total scores, categorized by emollient type, were assessed, and two hypotheses were tested to determine the questionnaire's construct validity.
RESULTS
Data from 77.2% (152 of 197) of participants were analysed. One item was rejected because of a high rate (44.7%) of 'don't know' responses, leaving seven items with high completion rates (98.7%) and weak evidence of floor or ceiling effects. A positive association was observed between total score and overall emollient satisfaction (Spearman correlation 0.78; P < 0.001). Total scores were highest (mean ± SD 23.5 ± 3.9) in the lotion group and lowest (18.4 ± 4.6) in the ointment group.
CONCLUSION
The emollient satisfaction questionnaire appears to have good validity. Further work is required to validate the questionnaire in other settings and to assess its reliability.
Topics: Child, Preschool; Clinical Trials as Topic; Eczema; Emollients; Humans; Ointments; Personal Satisfaction; Reproducibility of Results; Surveys and Questionnaires; Treatment Outcome
PubMed: 35315540
DOI: 10.1111/ced.15189 -
The Cochrane Database of Systematic... Jan 2016Breakdown of the developmentally immature epidermal barrier may permit entry for micro-organisms leading to invasive infection in preterm infants. Topical emollients may... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Breakdown of the developmentally immature epidermal barrier may permit entry for micro-organisms leading to invasive infection in preterm infants. Topical emollients may improve skin integrity and barrier function and thereby prevent invasive infection, a major cause of mortality and morbidity in preterm infants.
OBJECTIVES
To assess the effect of topical application of emollients (ointments, creams, or oils) on the incidence of invasive infection, other morbidity, and mortality in preterm infants.
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), MEDLINE via PubMed (1966 to August 2015), EMBASE (1980 to August 2015), and CINAHL (1982 to August 2015). We also searched clinical trials databases, conference proceedings, previous reviews and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials that assessed the effect of prophylactic application of topical emollient (ointments, creams, or oils) on the incidence of invasive infection, mortality, other morbidity, and growth and development in preterm infants.
DATA COLLECTION AND ANALYSIS
Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported the risk ratio and risk difference for dichotomous data and mean difference for continuous data, with respective 95% confidence intervals. We used a fixed-effect model in meta-analyses and explored the potential causes of heterogeneity in subgroup analyses.
MAIN RESULTS
We identified 18 eligible primary publications (21 trial reports). A total of 3089 infants participated in the trials. The risk of bias varied with lack of clarity on methods to conceal allocation in half of the trials and lack of blinding of caregivers or investigators in all of the trials being the main potential sources of bias.Eight trials (2086 infants) examined the effect of topical ointments or creams. Most participants were very preterm infants cared for in health-care facilities in high-income countries. Meta-analyses did not show evidence of a difference in the incidence of invasive infection (typical risk ratio (RR) 1.13, 95% confidence interval (CI) 0.97 to 1.31; low quality evidence) or mortality (typical RR 0.87, 95% CI 0.75 to 1.03; low quality evidence).Eleven trials (1184 infants) assessed the effect of plant or vegetable oils. Nine of these trials were undertaken in low- or middle-income countries and all were based in health-care facilities rather than home or community settings. Meta-analyses did not show evidence of a difference in the incidence of invasive infection (typical RR 0.71, 95% CI 0.51 to 1.01; low quality evidence) or mortality (typical RR 0.94, 95% CI 0.81 to 1.08; moderate quality evidence). Infants massaged with vegetable oil had a higher rate of weight gain (about 2.55 g/kg/day; 95% CI 1.76 to 3.34), linear growth (about 1.22 mm/week; 95% CI 1.01 to 1.44), and head growth (about 0.45 mm/week; 95% CI 0.19 to 0.70). These meta-analyses contained substantial heterogeneity.
AUTHORS' CONCLUSIONS
The available data do not provide evidence that the use of emollient therapy prevents invasive infection or death in preterm infants in high-, middle- or low-income settings. Some evidence of an effect of topical vegetable oils on neonatal growth exists but this should be interpreted with caution because lack of blinding may have introduced caregiver or assessment biases. Since these interventions are low cost, readily accessible, and generally acceptable, further randomised controlled trials, particularly in both community- and health care facility-based settings in low-income countries, may be justified.
Topics: Administration, Topical; Cross Infection; Dermatitis; Emollients; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Ointments; Randomized Controlled Trials as Topic
PubMed: 26824786
DOI: 10.1002/14651858.CD001150.pub3