[Factors influencing the therapeutic effect of ointment gels]

It is published on new results of research from the institute of the author in which were examined some combined ointment gels putting recently in circulation and new emulsifiers from that may be prepared compositions with suitable rheological stability and large water-absorbing capacity. These systems have suitable thermostability and retentivity of water. The release of many active ingredients were investigated with in-vitro and in-vivo-methods.

Physicopharmaceutical characteristics of an oil-in-water emulsion-type ointment containing diclofenac sodium

The oil-in-water (o/w) emulsion-type ointment was prepared with food additives containing diclofenac sodium. The oil phase and the emulsifier used were 1,2,3- propanetriyl trioctanoate (caprylic acid glyceryl ester) and sugar wax, and sugar ester, respectively. The emulsion stability of the o/w emulsion-type ointment as well as the diclofenac sodium release profile were investigated and compared with those from conventional ointments. The emulsion stability was evaluated in terms of the viscosity of the emulsion product, the particle size distribution of oil droplets, and the zeta potential of the droplets. It was found that sugar esters have excellent properties as emulsifiers, based on the results of viscosity and zeta potential measurements. The in vitro release test revealed that the amount of diclofenac sodium released from o/w emulsion-type ointment was greater than from the hydrophilic and absorptive ointment. Accordingly, it was concluded that o/w emulsion-type bases are suitable for pharmaceutical use in ointment products.

High-performance liquid chromatographic assay for prostaglandin E1 in various ointment vehicles

A high-performance liquid chromatographic method for the determination of prostaglandin E1 (PGE1) incorporated in white petrolatum, white ointment, hydrophilic petrolatum and Plastibase was investigated. The prostaglandin was separated from the oleaginous vehicles with n-hexane-aqueous acetonitrile. Most of white petrolatum, which is a principal component in the vehicles, remained in the n-hexane layer, and the recovery of the drug from any vehicle attained 100%. The method was applied to stability studies of PGE1 in white petrolatum and macrogol ointment. In which pure PGE1 and PGE1-alpha-cyclodextrin complex (PGE1-CD) were incorporated. The drug remained intact for up to 6 months when stored at 5 degrees C. At 25 and 40 degrees C, pure PGE1 was more stable than PGE1-CD and both PGE1 species were more stable in white petrolatum than in macrogol ointment.

[The percutaneous effect of a heparin-allantoin-dexpanthenol combination in a specific ointment base. Anti-allergic, anti-inflammatory effect in the PCA test in the rat]

Local application of a heparin-allantoin-dexpanthenol (Hepathrombin-Adenylchemie) ointment to rats 15 min prior to induction of a passive cutaneous anaphylaxis (PCA) reaction inhibits the anaphylactic reaction as compared to the ointment base. Also, the Evans Blue content as a measure for vascular permeability and the oedema weights are reduced under the heparin containing ointment. The antiallergic/antiinflammatory effect is probably due to heparin.

[The percutaneous action of a heparin-allantoin-dexpanthenol combination in a specific ointment base. Thrombolytic action on the rabbit ear]

Experimentally induced thrombi of ear veins in albino rabbits have been treated locally with heparin-containing ointments in presence or absence of allantoin and dexpanthenol, the heparin concentration varying. While the ointments, containing heparin only, induce no or only minor thrombolytic activity, the combination ointments Hepathrombin Adenylchemie containing heparin, allantoin and dexpanthenol show significant thrombolytic activity. This effect is dependent upon the heparin concentration, yet, heparin doses above 50 000 IU per 100 g of ointment do not enhance the thrombolysis furthermore. Further, the studies show that the effective components of Hepathrombin do penetrate into and through the skin, allantoin and dexpanthenol being important components of the ointment probably supporting the transdermal penetration of heparin. The studies also demonstrate the only local thrombolytic effect of the Hepathrombin ointments because the thrombus of the right ear, always treated with ointment base only, did not show any change in length as contrasted to that of the left ear of the same animal treated with the Hepathrombin ointments. Mechanisms of the locally by Hepathrombin/heparin induced thrombolysis will be discussed.

Comparative efficacy and tolerance of 1% bifonazole cream and bifonazole cream vehicle in patients with tinea versicolor

Bifonazole 1% cream (Mycospor 1) was compared to its cream vehicle in the treatment of tinea versicolor, using a once-a-day application for 2 weeks. Patients were evaluated both clinically and mycologically in order to assess the efficacy and tolerance of the medication. 29 patients were evaluated by statistical analysis. Bifonazole cream 1% was shown to be significantly more effective in the treatment of tinea versicolor when used nightly for 2 weeks than was the vehicle cream.

Topical steroids and UV radiation in psoriasis

This study evaluates the benefits of a potent and midstrength topical steroid compared with simple lubricating agents when used in combination with erythemagenic doses of sunlamp fluorescent UV irradiation in psoriasis. Twenty-six patients were studied in a bilateral symmetrical comparison. No significant differences were observed between topical corticosteroids and lubricants in the number of patients achieving a 75% or greater resolution of psoriasis. Topical corticosteroids did not reduce the number of treatments required for clearing. We did not observe faster recurrences in sites treated with topical corticosteroids. More severe burns and slightly less effectiveness were noted in patients irradiated five times weekly compared with three.

Selection of the acceptor medium in in vitro measurements of drug release from dermatological ointments

Comparative measurements of in vitro agent release using hydrophilic, intermediate, and lipophilic acceptor phases and in vivo measurements of the blanching effect with triamcinolone acetonide are reported. White petrolatum, wool alcohols ointment, and polyethylene glycol ointment served as donator phases. The results demonstrate that the lipophilic acceptor phase (isopropyl palmitate) is most representative for the in vivo acceptor phase. Conclusions cannot be drawn regarding in vivo effectiveness from measurements of agent release to the hydrophilic (phosphate buffer, pH 6) and intermediate (n-octanol) acceptor phases. In vitro measurements of agent release have a screening character and must usually be supplemented by very elaborate penetration models of the human skin for a definitive evaluation of an ointment.

Evaluation of a new halcinonide formulation in the treatment of common dermatoses

An open evaluation of halcinonide 0.1 percent in a hydrophilic vanishing cream base was conducted in one hundred patients with common steroid-responsive dermatoses, including eczema, contact dermatitis, atopic dermatitis stasis dermatitis, and neurodermatitis. Patients applied the cream two or three times a day for two weeks (or less if the clinical response warranted earlier discontinuation). Follow-up assessments were made on days 4, 7, and 14 of the study. Ninety-eight percent of the patients showed some degree of improvement, and eighty-five percent had complete clearing or marked improvement. One patient had no response and one worsened. Seventy-seven percent of the patients who responded achieved their maximum response within the first week of treatment. One case of urticaria was the only side effect noted in this series. Ninety-six percent of the patients rated their acceptance of the new formulation as excellent or good.

[Evaluation of nonsteroidal anti-inflammatory drugs (NSAID) intended for use as topical anti-inflammatory drugs]

A procedure which can serve as a possible basis for the laboratory study of the topical effect of NSAID was investigated in rats or guinea pigs. The effect of NSAID was greatly influenced by physical characteristics of the preparation such as drug particle size, solubility, ointment base and concentration of drug. Moreover, it was also found to be affected by many technical factors such as animal fixation, drug application times and methods (rubbing times or occlusive dressing technique) and amounts applied which play an important role in topical preparation. The topical application of NSAID ointment (1% of indomethacin, ketoprofen or diclofenac sodium) markedly inhibited the paw edema by carrageenin in rats. The inhibitory activity was the same as that of steroidal ointment (0.12% betamethasone 17-valerate or 0.05% fluocinonide), but was less than that by oral administration of these NSAID. Also, the NSAID ointment obviously inhibited the ultraviolet erythema in guinea pigs and the swelling in the hind feet of adjuvant arthritic rats. The inhibitory activities of NSAID ointments on these inflammatory responses were almost the same as those obtained by oral administration of such NSAID and more potent than those of steroidal ointments. Furthermore, NSAID ointments increased the pain threshold in the inflamed foot as determined by the method of Randall and Selitto. The analgesic activity of NSAID ointment was more potent than that of steroidal ointment, but less than that of NSAID administered orally. On the other hand, neither the systemic effects such as decrease in weight of the adrenals and thymus which were noted when steroidal ointment was used, nor the gastrointestinal lesions which were found by oral administration of NSAID, were recognized in rats in which NSAID ointment was applied topically. The anti-inflammatory effects of NSAID ointment correlated well with the drug concentration at the site of inflammation. These findings suggest that NSAID ointment has a clinical use in the treatment of inflammatory diseases.

[Drug liberation from dermatica (author's transl)]

Investigated 0,1% ointments based on oleogels, hydrogels and O/W creams show differences by in-vitro evaluation of dexamethasone sodiumphosphate and dexamethasone release, which we have evaluated concerning the vehicle composition and its viscosity, the internal structure of systems and the drug properties. The results show dependence of drug availability on the vehicle gel structure order on the one, and on the drug activity on the other hand. The presence of a hydrocolloid (Eudispert-Na) in O/W creams improves the drug release.

The role of tar in Goeckerman therapy

Seventeen patients with psoriasis were treated with 5% crude coal tar in an absorbent ointment base (Aquaphor) to one half of the body and with the absorbent ointment base alone to the other half. They received twice-daily erythemogenic doses of ultraviolet irradiation (UVR). Both modalities, crude coal tar and absorbent ointment base alone, combined with UVR were equally effective in improving psoriatic plaques. On the basis of this and previous studies, we question the therapeutic role of tar in the Goeckerman regimen.

The treatment of mycosis fungoides with ointment-based mechlorethamine

The use of topical mechlorethamine hydrochloride in the treatment of skin disease has been restricted because of the frequent development of contact dermatitis. A series of 24 patients with mycosis fungoides in stages 1A (eight patients), 1B (15 patients), and 2 (one patient) were treated with ointment-based mechlorethamine, prepared by an anhydrous method. This preparation was therapeutically effective. Complete clearing occurred in 15 of 18 patients with active disease over evaluation periods of up to 27 months, and one patient had partial clearing. Two patients showed a partial relapse during their evaluation periods. The incidence of contact dermatitis was very low: 8% in individuals with a history of hypersensitivity to mechlorethamine and 0% in patients being exposed to the medication for the first time. This new preparation has been shown to be effective therapy for mycosis fungoides. Patient use is associated with minimal side effects.

The dilution of proprietary corticosteroid ointments--an attempt to evaluate relative clinical potencies

Ten subjects were assessed using the vasoconstrictor assay technique in a double-blind study in order to evaluate the potencies of several diluted and undiluted proprietary corticosteroid ointments. Results showed that clobetasol propionate 0.05% (Dermovate) ointment at a dilution of one part in ten (clobetasol propionate 0.005%) in white soft paraffin was equipotent with betamethasone valerate 0.1% (Betnovate) ointment; and no difference in potency was demonstrated between beclomethasone dipropionate 0.025% (Propaderm), betamethasone valerate 0.1% (Betnovate) and clobetasone butyrate 0.05% (Eumovate).

[On the different release kinetics of water-soluble and lipid-soluble forms of hydroxyquinoline in oleogel ointment bases (author's transl)]

Studies using the model according to Horsch and Kögel showed that the release kinetics of the suspended water-soluble (but not lipid-soluble) drugs hydroxyquinoline sulphate and hydroxy-quinoline sulphate--potassium sulphate from oleogels is of a zero order. Differences in drug dispersity do not affect the release rates. Oleogels containing the lipid-soluble hydroxyquinoline base yielded undersaturated solution ointments, the release kinetics of which can be stated by a semilogarithmic relationship. There exists a linear correlation between the release rates and the product of the lipid solubility of the drug and the reciprocal apparent distribution coefficient.

Vasodilator therapy in refractory congestive heart failure: a comparative analysis of hemodynamic and noninvasive studies

The response to vasodilator therapy was assessed in 12 patients with chronic severe congestive heart failure refractory to conventional treatment. Cardiac output and intraarterial and pulmonary capillary wedge pressures were recorded continuously to assess the hemodynamic response to the vasodilators used. Control and post-treatment M mode echocardiograms and radionuclide angiograms were obtained to assess the change in left ventricular size and ejection fraction concurrent with the hemodynamic improvement. Despite a 33 percent decrease in pulmonary capillary wedge pressure (p less than 0.001) and a 35 percent increase in cardiac index (p less than 0.001), no significant change occurred in left ventricular end-diastolic or end-systolic chamber size on echocardiography or in ejection fraction measured with radionuclide angiography. In this study M mode echocardiography and radionuclide angiography were of no value in monitoring the actual hemodynamic response to vasodilator therapy in this group of patients with a left ventricular ejection fraction of less than 30 percent.

Scabies and genital herpes: a problem in management

A patient who was infested with scabies subsequently developed recurrent herpes genitalis. Scratching the scabetic lesions resulted in self-inoculation with herpes on the lower abdomen and chin. Inoculation herpes is one of the most common complications of HSV-2 infection. The infection can be divided into primary, latent, shedding and recurrent stages. Pruritic lesions such as scabies complicate the management in herpes.

The Duhring chamber assay for corticosteroid atrophy

A new human model for the evaluation of the atrophogenicity of topical corticosteroids is proposed. Formulated corticosteroids (creams and ointments) were applied occlusively to normal forearm skin of human volunteers for 3 weeks using Duhring chambers. Visible atrophy and telangiectasia were rated under a stereomicroscope on a histologically validated five-point scale. There was a close correlation between the parameters of atrophy and telangiectasia. Atrophogenicity varied considerably among the tested corticosteroids, ranging from none (1% hydrocortisone) via moderate (0.1% betamethasone valerate) to very severe (0.05% clobetasol propionate). A dose-response relationship with exposure time and concentration of the corticosteroid could be demonstrated. Furthermore, the vehicle influenced the resulting atrophy and telangiectasia. Fatty ointments seem to pose less risk than oil in water creams.

On the diffusion of chloramphenicol from oleaginous ointment bases

The rate of diffusion of chloramphenicol from oleaginous ointment bases was investigated. It was found that the rate of diffusion of the drug from beeswax is markedly higher than that from hard paraffin. Cetrimide, whether present in the waxy base or in the aqueous diffusion medium, enhances markedly the rate of diffusion of chloramphenicol. The effect of cetrimide is, however, more pronounced in the case of hard paraffin. Incorporation of triolein in the waxy bases markedly increases the diffusion of the drug. This was correlated to changes in certain rheological parameters of the bases in presence of triolein.

[Studies on the release of solubilized drugs from ointment bases. Part 5: Influence of the volume of disperse phase on liberation of chloramphenicol from emulsifying ointments (author's transl)]

It has been shown that liberation of the chloramphenicol emulsive ointments depends on the rate of diffusion in the ointments basis. The rate of the diffusion depends on the volume of dispersion phase, effective coefficient of diffusion and on the concentration gradient.

[Penetration kinetics of fluocortolone from a new base for ointment and creme (author's transl)]

The penetration of fluocortolone from topically administered Syracort ointment and creme was investigated in guinea pigs. Two fluocortolone standards were tested as reference preparations (ointment and creme). 1. Fluocortolone liberation from the ointments and Syracort Creme within 24 h varied between 55% and 62% of the administered dose. The reference creme gave lower drug liberation values (39%). 2. The penetration profile of fluocortolone changed gradually. Non-absorbed portions and the concentrations in the upper layers of the stratum corneum decreased during inunction up to 24 h. Within the same time concentrations in the deeper layers of the skin increased. 3. The two ointments showed comparably good penetration properties, whereas Syracort creme gave flux values higher than those obtained from the reference creme. 4. 24 h after removal of the non-absorbed portion of the ointments a further persistence of the drug could be observed within the skin: 14.3% to 18.5% after additional 6 days. The mean renal elimination rate was found to be 3 days, a total amount between 28% to 30% of the dose was excreted via urine and feaces. Consequently, fluocortolone can be considered a fast penetrating topical which is accumulated especially in the layers of the epidermis and cutis.

A randomized, double-blind therapeutic trial of 0.25% desoxymethasone and 0.1% hydrocortisone 17-butyrate in the treatment of varicose eczema

A double-blind, randomized trial was carried out in 60 patients with varicose (hypostatic) eczema to compare the efficacy and tolerance of treatment with 0.25% desoxymethasone in an oily cream base, the oily cream base alone, and 0.1% hydrocortisone 17-butyrate cream. The creams were applied twice daily and patients' progress followed for up to 38 days. Clinical ratings based on an assessment of individual signs and symptoms, the area of skin involved and the physician's overall impression demonstrated a significant difference from the oily cream base in favour of both active treatments within the first 10 days. No significant difference between the two active treatments was shown. All three treatments were well tolerated by the patients.

Topical erythromycin for acne vulgaris

The clinical response of topical erythromycin (1%) in a new penetrative vehicle was evaluated in a double-blind investigation on 28 patients with severe and moderate acne vulgaris. The verum preparation was superior to the placebo in 21 of the patients, while in 4 the reverse was true and in 3 no differences were seen. It is thus obvious that topical erythromycin in the penetrative vehicle is a potent agent for acne treatment. The risk for development of resistant Propionibacterium acnes strains must, however, be considered in topical as well as in systemic antibiotic therapy of acne vulgaris.