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Niezgoda A, Winnicki A, Krysiński J, Niezgoda P, Nowowiejska L, Czajkowski R. Topical application of simvastatin acid sodium salt and atorvastatin calcium salt in vitiligo patients. Results of the randomized, double-blind EVRAAS pilot study. Sci Rep 2024; 14:14612. [PMID: 38918590 PMCID: PMC11199485 DOI: 10.1038/s41598-024-65722-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/24/2024] [Indexed: 06/27/2024] Open
Abstract
Contemporary treatment of vitiligo remains a great challenge to practitioners. The vast majority of currently conducted clinical trials of modern therapeutic methods are focused on systemic medications, while there is only a very limited number of reports on new topical treatment in vitiligo. With their pleiotropic activities statins turned out to be efficient in the treatment of various autoimmune/autoinflammatory disorders. The randomized, double-blind placebo-controlled study of topical administration of the active forms of simvastatin and atorvastatin has been designed to evaluate their efficacy in patients with vitiligo. The study was registered in clinicaltrials.gov (registration number NCT03247400, date of registration: 11th August 2017). A total of 24 patients with the active form of non-segmental vitiligo were enrolled in the study. The change of absolute area of skin lesions, body surface area and vitiligo area scoring index were evaluated throughout the 12 week application of ointments containing simvastatin and atorvastatin. Measurements were performed with planimetry and processed using digital software. Use of active forms of simvastatin and atorvastatin did not result in a significant repigmentation of the skin lesions throughout the study period. Within the limbs treated with topical simvastatin, inhibition of disease progression was significantly more frequent than in the case of placebo (p = 0.004), while the difference was not statistically significant for atorvastatin (p = 0.082). Further studies of topical simvastatin in vitiligo patients should be considered.
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Affiliation(s)
- Anna Niezgoda
- T. Browicz Provincial Observation and Infectious Diseases Hospital Anna Niezgoda, Gajowa 78/17, 85-087, Bydgoszcz, Poland.
| | - Andrzej Winnicki
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Jerzy Krysiński
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Piotr Niezgoda
- Department of Cardiology and Internal Medicine, Faculty of Medicine, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Laura Nowowiejska
- Department of Cosmetology and Aesthetic Dermatology, Faculty of Pharmacy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Rafał Czajkowski
- Department of Dermatology and Venerology, Faculty of Medicine, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Cuiavian-Pomeranian, Poland
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Zartab H, Aflatoonian M, Shamsi-Meymandi S, Pardakhty A, Isazadeh A, Firooz A, Amiri R. Assessing effectiveness of adding niosomal atorvastatin 1% ointment to topical calcineurin inhibitor treatment in non-segmental vitiligo. J Cosmet Dermatol 2024; 23:2103-2108. [PMID: 38348697 DOI: 10.1111/jocd.16227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/14/2024] [Accepted: 02/02/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Treatment of vitiligo is still a big challenge for dermatologists. The efficacy of statins in the treatment of vitiligo is controversial. AIM AND OBJECTIVE We studied possible therapeutic effect of topical 1% niosomal atorvastatin ointment combined with topical 0.1% tacrolimus in treatment of non-segmental vitiligo. METHODS This is a triple blind, pilot, randomized placebo-controlled trial (RCT) that was performed in dermatology clinic. All the patients used topical 0.1% tacrolimus cream twice daily (BD). Moreover, the intervention group participants used topical 1% niosomal atorvastatin ointment, and control group participants were prescribed placebo ointment, BD. Patients were evaluated using vitiligo area surface index (VASI) score and patients' satisfaction at baseline and after 3 months treatment. RESULTS The mean patient satisfaction in the intervention and control groups were 5 ± 1.4 and 3.5 ± 1.9; the difference between groups was not statistically significant (p = 0.9). We found statistically significant difference in VASI score before and after treatment in both intervention and control groups (p = 0.01 and p = 0.03, respectively). However, comparison of the VASI score between groups was not statistically significant (p = 0.62). We also found no significant correlation between VASI score and other variables. CONCLUSION The result of this study indicates that adding of niosomal atorvastatin 1% ointment to topical calcineurin inhibitor has no additional effect on non-segmental type of vitiligo. Further large studies with different combinations are recommended before any conclusive result can be concluded on efficacy of statins in vitiligo.
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Affiliation(s)
- Hamed Zartab
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
- Taleghani Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Mahin Aflatoonian
- Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Simin Shamsi-Meymandi
- Pathology and Stem Cells Research Center, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Pardakhty
- Neuropharmacology Institute, Pharmaceutics Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahdie Isazadeh
- Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Rezvan Amiri
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Khoury DM, Ghaoui N, El Tayar E, Dagher R, El Hawa M, Rubeiz N, Abbas O, Kurban M. Topical statins as antifungals: a review. Int J Dermatol 2024; 63:747-753. [PMID: 38344878 DOI: 10.1111/ijd.17068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/29/2023] [Accepted: 01/18/2024] [Indexed: 05/25/2024]
Abstract
Cutaneous fungal infections affect millions around the world. However, severe, multi-resistant fungal infections are increasingly being reported over the past years. As a result of the high rate of resistance which urged for drug repurposing, statins were studied and found to have multiple pleiotropic effects, especially when combined with other already-existing drugs. An example of this is the synergism found between several typical antifungals and statins, such as antifungals Imidazole and Triazole with a wide range of statins shown in this review. The main mechanisms in which they exert an antifungal effect are ergosterol inhibition, protein prenylation, mitochondrial disruption, and morphogenesis/mating inhibition. This article discusses multiple in vitro studies that have proven the antifungal effect of systemic statins against many fungal species, whether used alone or in combination with other typical antifungals. However, as a result of the high rate of drug-drug interactions and the well-known side effects of systemic statins, topical statins have become of increasing interest. Furthermore, patients with dyslipidemia treated with systemic statins who have a new topical fungal infection could benefit from the antifungal effect of their statin. However, it is still not indicated to initiate systemic statins in patients with topical mycotic infections if they do not have another indication for statin use, which raises the interest in using topical statins for fungal infections. This article also tackles the different formulations that have been studied to enhance topical statins' efficacy, as well as the effect of different topical statins on distinct dermatologic fungal diseases.
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Affiliation(s)
- Dana M Khoury
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nohra Ghaoui
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Ruby Dagher
- American University of Beirut, Beirut, Lebanon
| | - Mariana El Hawa
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nelly Rubeiz
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama Abbas
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Kurban
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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Leroy AK, Cortez de Almeida RF, Obadia DL, Frattini S, Melo DF. Scalp Seborrheic Dermatitis: What We Know So Far. Skin Appendage Disord 2023; 9:160-164. [PMID: 37325288 PMCID: PMC10264915 DOI: 10.1159/000529854] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/13/2023] [Indexed: 06/04/2024] Open
Abstract
Scalp seborrheic dermatitis (SSD) is a prevalent chronic, relapsing inflammatory skin disease. The etiology is related to sebum production, bacterial proliferation - Staphylococcus sp., Streptococcus, and M. restricta - and host immunity factors - NK1+, CD16+ cells, IL-1, and IL-8. Trichoscopy features include mostly arborizing vessels and yellowish scales. New trichoscopic findings were described to guide the diagnosis as dandelion vascular conglomerate, "cherry blossom" vascular pattern, and intrafollicular oily material. Antifungals and corticosteroids constitute the essential therapy, but new treatments have been described. This article aims to review and discuss the etiology, pathophysiology, trichoscopy, histopathologic findings, main differential diagnoses, and therapeutic options of SSD.
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Affiliation(s)
- Anne Kelly Leroy
- Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | | | - Daniel Lago Obadia
- Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Sidney Frattini
- The Mole Clinic, Private Practice, Ancaster, Ontario, Canada
| | - Daniel Fernandes Melo
- Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
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Molania T, Akbari J, Babaei A, Lotfizadeh A, Moosazadeh M, Mesgarani A, Baasl A, Salehi M. Atorvastatin mucoadhesive tablets in the management of recurrent aphthous stomatitis: a randomized clinical study. BMC Oral Health 2023; 23:285. [PMID: 37179286 PMCID: PMC10182658 DOI: 10.1186/s12903-023-02846-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/28/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Aphthous stomatitis is one of the most common oral mucosal diseases. Due to the commonness of recurrent aphthous stomatitis and considering the anti-inflammatory, analgesic, and tissue regenerative properties of atorvastatin and the lack of a study on the effect of statins on minor recurrent aphthous stomatitis, this study investigates the effect of atorvastatin mucoadhesive tablets as a topical treatment on reduction of symptoms and duration of this disease. METHODS This study is a randomized, double-blinded clinical trial. Patients were divided into two groups, atorvastatin and, placebo; each of the patients received three mucoadhesive tablets daily in the morning, noon, and night. Finally, the patients were examined on days 0 (baseline), 3, 5, and 7 to determine the diameter of the inflammatory halo. The VAS scale was used to evaluate pain intensity for up to 7 days after each meal. The data was entered into SPSS 24 software and analyzed. RESULTS The halo diameter did not significantly differ between the two groups on baseline (P > 0.05). However, on the study's third, fifth, and seventh days, the difference between the two groups was remarkable, so in the atorvastatin group, the size of the lesions decreased in shorter healing time (P < 0.05). In addition, the patient's pain intensity (VAS) also showed a significant decrease in the atorvastatin group except on the first, second, and seventh days of the study (P < 0.05). CONCLUSION Atorvastatin mucoadhesive tablets effectively reduce the pain of patients with minor recurrent aphthous stomatitis and reduce the size and healing time of the lesions, so their application should be considered in treating minor recurrent aphthous stomatitis. The present study was approved by the Medical Ethics Committee of Mazandaran University of Medical Sciences with the ethics code IR.MAZUMS.REC.1400.8346. Also, this study received code IRCT20170430033722N4.
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Affiliation(s)
- Tahereh Molania
- Department of Oral Medicine, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jafar Akbari
- Department of Pharmaceutics, Faculty of Pharmacy, Pharmaceutical Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirhossein Babaei
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Anahita Lotfizadeh
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestitional Cancer Research Center, Non-communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abbas Mesgarani
- Department of Oral Endodontics, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Anahita Baasl
- Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maede Salehi
- Department of Oral Medicine, Dental Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
- Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.
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Yu R, Lin Q, Zhai Y, Mao Y, Li K, Gao Y, Liu Y, Fu L, Fang T, Zhao M, Guan L, Hou L, Xu J, Chen W. Recombinant human thymosin beta-4 (rhTβ4) improved scalp condition and microbiome homeostasis in seborrheic dermatitis. Microb Biotechnol 2021; 14:2152-2163. [PMID: 34318587 PMCID: PMC8449661 DOI: 10.1111/1751-7915.13897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
Seborrheic dermatitis (SD) is a recurrent common inflammatory skin disease that affects all ethnic groups in all regions worldwide. However, no specific treatment or preventive measure is yet available. Identifying effective treatments with acceptable safety and tolerability is desirable. In this study, scalp microbiota alterations were measured in SD, showing significantly greater abundance of Malassezia and Staphylococcus and diminished fungal and bacterial diversity compared with healthy controls. We investigated the benefit of a 4‐week treatment with 0.5 mg ml‐1 recombinant human thymosin β4 (rhTβ4) gel or 2% ketoconazole lotion on the scalp condition of 71 patients with SD compared with 21 healthy individuals. Clinical assessment (Adherent Scalp Flaking Score, and the Maximum Erythema Area) and physiological conditions (transepidermal water loss, hydration, and sebum secretion) were evaluated. The rhTβ4 treatment provided significantly greater efficacy than ketoconazole and a sustained effect in the treatment of scalp SD. More importantly, rhTβ4 dramatically improved the microbiome homeostasis and prompted a shift of scalp microflora towards healthy composition, helping symptoms and ameliorating physiological conditions more effectively and durably than ketoconazole. Our research demonstrated the scalp microbe dysbiosis of SD and highlighted rhTβ4 as a promising therapeutic strategy in the prevention and treatment of SD.
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Affiliation(s)
- Rui Yu
- Beijing Institute of Biotechnology, Beijing, China
| | - Qingbin Lin
- Beijing Institute of Biotechnology, Beijing, China
| | - Yanfang Zhai
- Beijing Institute of Biotechnology, Beijing, China
| | - Yunyun Mao
- Beijing Institute of Biotechnology, Beijing, China
| | - Kai Li
- Beijing Institute of Biotechnology, Beijing, China
| | - Yuemei Gao
- Beijing Institute of Biotechnology, Beijing, China
| | - Yanhong Liu
- Beijing Institute of Biotechnology, Beijing, China
| | - Ling Fu
- Beijing Institute of Biotechnology, Beijing, China
| | - Ting Fang
- Beijing Institute of Biotechnology, Beijing, China
| | - Mengsu Zhao
- Beijing Institute of Biotechnology, Beijing, China
| | - Lei Guan
- Guangzhou Landproof testing technology Co., Ltd., Guangzhou, China
| | - Lihua Hou
- Beijing Institute of Biotechnology, Beijing, China
| | - Junjie Xu
- Beijing Institute of Biotechnology, Beijing, China
| | - Wei Chen
- Beijing Institute of Biotechnology, Beijing, China
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Shahraeini SS, Akbari J, Saeedi M, Morteza-Semnani K, Abootorabi S, Dehghanpoor M, Rostamkalaei SS, Nokhodchi A. Atorvastatin Solid Lipid Nanoparticles as a Promising Approach for Dermal Delivery and an Anti-inflammatory Agent. AAPS PharmSciTech 2020; 21:263. [PMID: 32978691 PMCID: PMC7519004 DOI: 10.1208/s12249-020-01807-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022] Open
Abstract
In the current research, the main focus was to overcome dermal delivery problems of atorvastatin. To this end, atorvastatin solid lipid nanoparticles (ATR-SLNs) were prepared by ultra-sonication technique. The prepared SLNs had a PDI value of ≤ 0.5, and the particle size of nanoparticles was in the range 71.07 ± 1.72 to 202.07 ± 8.40 nm. It was noticed that, when the concentration of lipid in ATR-SLNs increased, the size of nanoparticles and drug entrapment efficiency were also increased. Results showed that a reduction in the HLB of surfactants used in the preparation of SLN caused an increase in the particle size, zeta potential (better stability), and drug entrapment efficiency. Despite Tween and Span are non-ionic surfactants, SLNs containing these surfactants showed a negative zeta potential, and the absolute zeta potential increased when the concentration of Span 80 was at maximum. DSC thermograms, FTIR spectra, and x-ray diffraction (PXRD) pattern showed good incorporation of ATR in the nanoparticles without any chemical interaction. In vitro skin permeation results showed that SLN containing atorvastatin was capable of enhancing the dermal delivery of atorvastatin where a higher concentration of atorvastatin can be detected in skin layers. This is a hopeful promise which could be developed for clinical studies of the dermal delivery of atorvastatin nanoparticles as an anti-inflammatory agent.
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Affiliation(s)
- Seyed Sadegh Shahraeini
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jafar Akbari
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Katayoun Morteza-Semnani
- Department of Medicinal Chemistry, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shidrokh Abootorabi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Milad Dehghanpoor
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyyed Sohrab Rostamkalaei
- Department of Pharmaceutics, Faculty of Pharmacy, Islamic Azad University, Ayatollah Amoli Branch, Amol, Iran.
- Medicinal Plant Research Center, Faculty of Pharmacy, Islamic Azad University, Ayatollah Amoli Branch, Amol, Iran.
| | - Ali Nokhodchi
- Pharmaceutics Research Laboratory, School of Life Sciences, University of Sussex, Brighton, BN1 9QJ, UK.
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