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Haghsay Khashechi E, Afaghmehr A, Heydari N, Barfar A, Shokri J. Laser-mediated Solutions: Breaking Barriers in Transdermal Drug Delivery. AAPS PharmSciTech 2024; 25:142. [PMID: 38898170 DOI: 10.1208/s12249-024-02849-z] [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: 12/11/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Skin diseases pose challenges in treatment due to the skin's complex structure and protective functions. Topical drug delivery has emerged as a preferred method for treating these conditions, offering localized therapy with minimal systemic side effects. However, the skin's barrier properties frequently limit topical treatments' efficacy by preventing drug penetration into deeper skin layers. In recent years, laser-assisted drug delivery (LADD) has gained attention as a promising strategy to overcome these limitations. LADD involves using lasers to create microchannels in the skin, facilitating the deposition of drugs and enhancing their penetration into the target tissue. Several lasers, such as fractional CO2, have been tested to see how well they work at delivering drugs. Despite the promising outcomes demonstrated in preclinical and clinical studies, several challenges persist in implementing LADD, including limited penetration depth, potential tissue damage, and the cost of LADD systems. Furthermore, selecting appropriate laser parameters and drug formulations is crucial to ensuring optimal therapeutic outcomes. Nevertheless, LADD holds significant potential for improving treatment efficacy for various skin conditions, including skin cancers, scars, and dermatological disorders. Future research efforts should focus on optimizing LADD techniques, addressing safety concerns, and exploring novel drug formulations to maximize the therapeutic benefits of this innovative approach. With continued advancements in laser technology and pharmaceutical science, LADD has the potential to revolutionize the field of dermatology and enhance patient care.
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Affiliation(s)
| | | | - Niloofar Heydari
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ashkan Barfar
- Faculty of Pharmacy, Tabriz University of Medical Science, Tabriz, Iran
- Department of pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Shokri
- Department of pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
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Donnelly H, Boffa MJ. Topical treatment of pyoderma gangrenosum: A systematic review. Indian J Dermatol Venereol Leprol 2024; 0:1-8. [PMID: 39152834 DOI: 10.25259/ijdvl_700_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/21/2024] [Indexed: 08/19/2024]
Abstract
Systemic immunosuppressants are the mainstay of treatment for pyoderma gangrenosum (PG), but they generally have significant side effects which may be avoided by limiting treatment to topical therapy. This review aimed to assess the efficacy and safety of topical treatments for PG. An extensive literature search identified nineteen suitable publications for analysis, including two open cohort studies, five case series and twelve single case reports. The quality of evidence in the publications was graded and data relating to topical PG treatment was extracted. The lack of randomised clinical trials investigating topical monotherapy for PG means that robust statistical analysis was not possible. The greatest weight of the current evidence for topical therapy favours either corticosteroids or calcineurin inhibitors. According to our review, both these options appear well tolerated with a few side effects and may have similar efficacy in speeding up the resolution of PG ulcers. Topical therapy could be considered for use in combination with systemic treatment. There may also be a role for isolated topical monotherapy in selected patients with PG, especially those with early or mild disease and those with idiopathic PG. However further research is needed to confirm this and establish optimal treatment approaches for this condition.
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Affiliation(s)
- Harry Donnelly
- Department of Medicine, St Bernard's Hospital, Harbour Views Rd, Gibraltar-GX11 1AA, Gibraltar
| | - Michael J Boffa
- Department of Dermatology, Mater Dei Hospital, Triq Dun Karm, Msida-MSD 2090, Malta
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Poudel S, Kaffash E, Zhao L, Pangeni R, Chow WN, Xu Q. Dexamethasone sodium phosphate loaded nanoparticles for prevention of nitrogen mustard induced corneal injury. Exp Eye Res 2024; 243:109902. [PMID: 38641196 PMCID: PMC11184523 DOI: 10.1016/j.exer.2024.109902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
Nitrogen mustard (NM) is a potent vesicating chemical warfare agent that is primarily absorbed through skin, inhalation, or ocular surface. Ocular exposure of NM can cause acute to chronic keratopathy which can eventually lead to blindness. There is a current lack of effective countermeasures against ocular exposure of NM despite their imperative need. Herein, we aim to explore the sustained effect of Dexamethasone sodium phosphate (DSP)-loaded polymeric nanoparticles (PLGA-DSP-NP) following a single subconjunctival injection in the management and prevention of corneal injury progression upon exposure to NM. DSP is an FDA approved corticosteroid with proven anti-inflammatory properties. We formulated PLGA-DSP-NP with zinc chelation ion bridging method using PLGA polymer, with particles of approximately 250 nm and a drug loading of 6.5 wt%. Under in vitro sink conditions, PLGA-DSP-NP exhibited a sustained drug release for two weeks. Notably, in NM injured cornea, a single subconjunctival (SCT) injection of PLGA-DSP-NP outperformed DSP eyedrops (0.1%), DSP solution, placebo NP, and saline, significantly mitigating corneal neovascularization, ulceration, and opacity for the two weeks study period. Through PLGA-DSP-NP injection, sustained DSP release hindered inflammatory cytokine recruitment, angiogenic factors, and endothelial cell proliferation in the cornea. This strategy presents a promising localized corticosteroid delivery system to effectively combat NM-induced corneal injury, offering insights into managing vesicant exposure.
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Affiliation(s)
- Sagun Poudel
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Ehsan Kaffash
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Long Zhao
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Rudra Pangeni
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Woon Nam Chow
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA 23298, USA; Department of Pathology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Qingguo Xu
- Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, USA; Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA 23298, USA; Center for Pharmaceutical Engineering, and Institute for Structural Biology, Drug Discovery & Development (ISB3D), Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Pakfetrat A, Delavarian Z, Malakooti M, Bagheri H, Esmaily H, Ghorbani M, Saeedi P. Comparing the efficacy of a novel mucoadhesive patch containing Nigella sativa 10% with triamcinolone 0.1% in patients with erosive-atrophic oral lichen planus: A pilot study. Clin Exp Dent Res 2024; 10:e886. [PMID: 38798063 PMCID: PMC11128745 DOI: 10.1002/cre2.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE This study evaluates the efficacy of a novel mucoadhesive patch containing Nigella sativa 10% extract compared to triamcinolone 0.1% in alleviating symptoms and reducing lesion severity in patients with erosive-atrophic oral lichen planus. METHODS AND MATERIALS A pilot study comprising two groups, each with 10 patients, was conducted. The intervention group received mucoadhesive patches containing N. sativa 10% extract, while the control group received triamcinolone acetonide 0.1% patches. Pain and burning intensity, measured through visual analog scale, and lesion severity based on the Thongprasom scale were assessed weekly for 4 weeks. Descriptive records were kept for side effects and patient satisfaction. RESULTS Pain and burning intensity decreased in both groups throughout the sessions, with the N. sativa group showing a greater reduction than the triamcinolone group. The reduction in burning intensity within each group was significant (p < .001), and there was a significant difference between groups only in the second session (p = .045). The overall difference between groups was not significant (p > .05). Lesion severity also decreased significantly in both groups (p < .001), with a significant difference between groups observed in the third session (p = .043) and overall throughout the study (p = .006). CONCLUSION The use of N. sativa extract in mucoadhesive patches was as effective as corticosteroids in reducing pain, burning, and lesion severity in patients with oral lichen planus, with N. sativa showing superior results in some sessions. Notably, no significant complications were observed with N. sativa use, making it a promising treatment option for lichen planus.
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Affiliation(s)
- Atessa Pakfetrat
- Oral and Maxillofacial Diseases Research CenterMashhad University of Medical SciencesMashhadIran
| | - Zahra Delavarian
- Oral and Maxillofacial Diseases Research CenterMashhad University of Medical SciencesMashhadIran
| | - Mahshid Malakooti
- Department of Oral Medicine, School of DentistryMashhad University of Medical ScienceMashhadIran
| | - Hossein Bagheri
- Dental Materials Research CenterMashhad University of Medical SciencesMashhadIran
| | - Habibollah Esmaily
- Department of Epidemiology and BiostatisticsMashhad University of Medical SciencesMashhadIran
| | - Mahsa Ghorbani
- School of DentistryMashhad University of Medical SciencesMashhadIran
| | - Pooya Saeedi
- School of DentistryMashhad University of Medical SciencesMashhadIran
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Kaur T, Bassan MS, Bisht M, Kumar N, Saini P, Hazarika N. Hypothalamus-pituitary-adrenal axis (HPA axis) suppression with inappropriate use of steroids in recalcitrant dermatophytosis - A cross-sectional study. J Family Med Prim Care 2024; 13:2026-2031. [PMID: 38948600 PMCID: PMC11213414 DOI: 10.4103/jfmpc.jfmpc_1330_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 07/02/2024] Open
Abstract
Background Improper use of over-the-counter (OTC) steroid medication has been linked to recalcitrant dermatophytosis. There is proven evidence of HPA axis suppression by the use of long-term oral steroids. This study aims to determine the prevalence and pattern of inappropriate OTC steroid use and its effects on the hypothalamus-pituitary-adrenal (HPA) axis in adults with recalcitrant dermatophytosis. Materials and Methods This cross-sectional study of 2 months was conducted in a hospital setting and included patients of recalcitrant dermatophytosis with a history of OTC steroid use. Clinico-demographic details and basal serum cortisol levels were recorded in all and analyzed. Result Of a total of 103 patients, 59.22% (n = 61/103) were males, and the mean duration of steroid abuse was 17.78 months. About 48.54% (n = 50/103), 3.88% (n = 4/103), and 47.57% (n = 49/103) patients reported the use of topical steroids, oral steroids, and both oral and topical steroids, respectively. Among all the topical steroid users (n = 99), clobetasol propionate 48.48% (n = 48/99), while among oral steroid users (n = 53), prednisolone 45.28% (n = 24/53) were the most commonly used agents, respectively. The morning serum cortisol levels (8-9 AM) were found to be decreased in 42.7% (n = 44/103), with a mean value of 44.28 ± 17.34 μg/dL. Conclusion Improper OTC steroid use in recalcitrant dermatophytosis leads to HPA axis suppression. This highlights the need for intervention from apex health officials.
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Affiliation(s)
- Tanureet Kaur
- Department of Pharmacology, AIIMS Rishikesh, Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Manbir S. Bassan
- Department of Pharmacology, AIIMS Rishikesh, Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Manisha Bisht
- Department of Pharmacology, AIIMS Rishikesh, Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Nitish Kumar
- Department of Dermatology, AIIMS Rishikesh, Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Poonam Saini
- Department of Dermatology, AIIMS Rishikesh, Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Neirita Hazarika
- Department of Dermatology, AIIMS Rishikesh, Virbhadra Road, Rishikesh, Uttarakhand, India
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Go N, Arsène S, Faddeenkov I, Galland T, Martis B S, Lefaudeux D, Wang Y, Etheve L, Jacob E, Monteiro C, Bosley J, Sansone C, Pasquali C, Lehr L, Kulesza A. A quantitative systems pharmacology workflow toward optimal design and biomarker stratification of atopic dermatitis clinical trials. J Allergy Clin Immunol 2024; 153:1330-1343. [PMID: 38369029 DOI: 10.1016/j.jaci.2023.12.031] [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: 05/23/2023] [Revised: 11/03/2023] [Accepted: 12/22/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND The development of atopic dermatitis (AD) drugs is challenged by many disease phenotypes and trial design options, which are hard to explore experimentally. OBJECTIVE We aimed to optimize AD trial design using simulations. METHODS We constructed a quantitative systems pharmacology model of AD and standard of care (SoC) treatments and generated a phenotypically diverse virtual population whose parameter distribution was derived from known relationships between AD biomarkers and disease severity and calibrated using disease severity evolution under SoC regimens. RESULTS We applied this workflow to the immunomodulator OM-85, currently being investigated for its potential use in AD, and calibrated the investigational treatment model with the efficacy profile of an existing trial (thereby enriching it with plausible marker levels and dynamics). We assessed the sensitivity of trial outcomes to trial protocol and found that for this particular example the choice of end point is more important than the choice of dosing regimen and patient selection by model-based responder enrichment could increase the expected effect size. A global sensitivity analysis revealed that only a limited subset of baseline biomarkers is needed to predict the drug response of the full virtual population. CONCLUSIONS This AD quantitative systems pharmacology workflow built around knowledge of marker-severity relationships as well as SoC efficacy can be tailored to specific development cases to optimize several trial protocol parameters and biomarker stratification and therefore has promise to become a powerful model-informed AD drug development and personalized medicine tool.
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Lo A, Greenzaid JD, Gantz HY, Chodri K, Feldman SR. Clinical pharmacokinetics and pharmacodynamics of topical non-biological therapies for psoriasis patients. Expert Opin Drug Metab Toxicol 2024; 20:235-248. [PMID: 38553411 DOI: 10.1080/17425255.2024.2337749] [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: 02/06/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory cutaneous disease that causes patients psychosocial distress. Topical therapies are utilized for mild-to-moderate disease and for more severe disease in conjunction with systemic therapies. Topical corticosteroids are a cornerstone of treatment for psoriasis, but long-term use can cause stria and cutaneous atrophy and as well as systemic side effects such as topical steroid withdrawal. Non-steroidal topical therapies tend to be safer than topical corticosteroids for long-term use. AREAS COVERED We conducted a literature review on the pharmacokinetic (PK) and pharmacodynamic (PD) properties of topical therapies for psoriasis. We discuss how the PK and PD characteristics of these therapies inform clinicians on efficacy and toxicity when prescribing for patients. EXPERT OPINION Topical corticosteroids, used intermittently, are very safe and effective. Long-term, continuous use of topical corticosteroids can cause systemic side effects. Several generic and newly approved non-steroidal options are available, but no head-to-head studies compare the effectiveness of the generics (vitamin D analogs, tacrolimus, pimecrolimus) against the newer therapies (roflumilast, tapinarof). Patients often do not respond to topical therapies due to poor adherence to treatment regimens. For patients resistant to topical treatment, phototherapy or systemic therapy may be an option.
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Affiliation(s)
- Angela Lo
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Jonathan D Greenzaid
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hannah Y Gantz
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kamran Chodri
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Godse K, Dethe G, Sawant S, Sharma A, Pereira R, Ghate S, Kuvi S, Pawar V, Parekar R, Khalse M, Patel K. Clinical Evaluation of the Safety and Tolerability of Film-Forming Sprays in Patients With Psoriasis and Eczema. Cureus 2024; 16:e57020. [PMID: 38681303 PMCID: PMC11046363 DOI: 10.7759/cureus.57020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
Background Treating dermatological pathologies under occlusion therapy is a popular adjunct, especially in thickened, lichenified areas of psoriasis where sustained contact with topical corticosteroids plays a pivotal role. Film-forming spray (FFS) can be a novel, alternate approach along with topical treatment in this area for carefully selected cases. This study aimed to evaluate the safety profile and physical characteristics of a novel formulation of an FFS in patients with psoriasis and eczema. Methods This open-label, multicentre, comparative study included subjects diagnosed with chronic plaque psoriasis requiring topical corticosteroid therapy or those with eczema necessitating its application and occlusion therapy. The study product was applied to two groups of subjects. For patients in group 1, the FFS was applied to the skin area affected by the dermatological condition, which was covered with ointment only. In the second group, the FFS was applied to the corresponding unaffected skin area. The FFS was applied for 60-90 seconds and was observed for two hours after the application. The subjects were evaluated for primary outcomes, including safety assessment, overall physical characteristics, and appearance of FFS from local skin effects. The secondary outcomes included physical appearance characteristics and overall patient satisfaction following the application of FFS at the target sites. Further statistical assessments were conducted using the SAS software version 9.4 (2023; SAS Institute Inc., Cary, North Carolina, United States). Result A total of 100 subjects were included in the study across 10 outpatient centers, of which 79% had psoriatic plaques and 21% had eczematous lesions. Primary outcomes showed a lack of appearance of clinical symptoms such as dryness, flakiness, or irritation. A total of 10% of subjects in group 1 had erythema, and 6% had a tingling sensation, which was transient and mild. The secondary outcomes showed that only 12% of subjects in Group 1 and 6% of subjects in Group 2 showed a feeling of stickiness at the application site. In group 1, 8% reported a cooling sensation, which disappeared in one and two minutes, and none experienced a cooling sensation in Group 2. The average drying time for FFS in subjects with dermatological conditions was 5.19 minutes compared to 1.51 minutes on unaffected skin. The film washability results indicated that 96% of subjects in group 1 reported complete removal in less than two minutes. At the end of the study period, the mean satisfaction score was 8.99. No significant adverse events were reported in the patients. Conclusion This study highlights the potential application of a novel formulation of FFS as a safe and well-tolerated option for enhancing uniform skin coverage with the topical corticosteroid in patients affected with psoriasis and eczema.
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Affiliation(s)
- Kiran Godse
- Dermatology, D Y Patil Hospital, Navi Mumbai, IND
| | | | | | - Aseem Sharma
- Dermatology, Skin Saga Centre for Dermatology, Mumbai, IND
| | - Rickson Pereira
- Dermatology, Dr. Rickson's Dermatherapie Clinic, Mumbai, IND
- Dermatology, Holy Family Hospital, Mumbai, IND
| | - Sunil Ghate
- Dermatology, Dr. Ghate's Skin and Laser Centre, Mumbai, IND
| | - Sneha Kuvi
- Dermatology, Dr. Paruchuri Raja Ram Memorial Skin, Hair and Laser Centre, Guntur, IND
| | - Varsha Pawar
- Medical Affairs Division, Lupin Limited, Mumbai, IND
| | | | | | - Kamlesh Patel
- Medical Affairs Division, Lupin Limited, Mumbai, IND
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Shao L, Mo J, Xu Q, He G, Xing C, Chu Z. Preclinical pharmacokinetic investigation of the bioavailability and skin distribution of HY-072808 ointment, a novel drug candidate for the treatment of atopic dermatitis, in minipigs by a newly LC-MS/MS method. Xenobiotica 2024; 54:138-149. [PMID: 38501457 DOI: 10.1080/00498254.2024.2333007] [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: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 03/20/2024]
Abstract
HY-072808 is a novel phosphodiesterase 4 inhibitor clinically used for topical atopic dermatitis treatment. Cytochrome P450 enzymes are involved in transforming it into major metabolite ZZ-24. An efficient UPLC-MS/MS method was established to detect HY-072808 and ZZ-24 in plasma and skin tissues of minipigs.One-step protein precipitation was performed with acetonitrile. Subsequently, elution was served with a methanol and water gradient containing 0.1% formic acid for 3.5 min. The plasma and skin tissue concentrations of HY-072808 and ZZ-24 showed good linearity from 0.200 to 200 ng/mL.The experimental minipigs exhibited low systemic exposure and bioavailability of 3.1-7.6% after transdermal application of 1-4% HY-072808 ointment. Multiple topical administrations over seven consecutive days showed a minor accumulation in systemic exposure, with accumulation factors of 2.3 and 4.0 for HY-072808 and ZZ-24, respectively.The distribution of HY-072808 ointment among different cortical layers in minipigs was studied for the first time. Following transdermal application of 2% HY-072808 ointment, the concentration in plasma and skin tissues in the order of epidermis > dermis > subcutaneous tissue ≈ subcutaneous muscle ≈ plasma; at 48 h after the administration, the epidermis and dermis still had a high concentration of the drug.
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Affiliation(s)
- Li Shao
- Hefei Institute of Pharmaceutical Industry Co., Ltd, Hefei, China
| | - Jiajia Mo
- Hefei Institute of Pharmaceutical Industry Co., Ltd, Hefei, China
| | - Qinlong Xu
- Hefei Institute of Pharmaceutical Industry Co., Ltd, Hefei, China
| | - Guangwei He
- Hefei Institute of Pharmaceutical Industry Co., Ltd, Hefei, China
| | - Chunyu Xing
- WestChina-Frontier, Pharma Tech Co., Ltd, Chengdu, China
| | - Zhaoxing Chu
- Hefei Institute of Pharmaceutical Industry Co., Ltd, Hefei, China
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Lee WH, Kim W. Self-assembled hyaluronic acid nanoparticles for the topical treatment of inflammatory skin diseases: Beyond drug carriers. J Control Release 2024; 366:114-127. [PMID: 38145664 DOI: 10.1016/j.jconrel.2023.12.026] [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: 10/25/2023] [Revised: 12/10/2023] [Accepted: 12/17/2023] [Indexed: 12/27/2023]
Abstract
Inflammatory skin diseases represent a significant health concern, affecting approximately 20-25% of the global population. These conditions not only reduce an individual's quality of life but also impose a huge burden on both humanity and society. However, addressing these challenges is hindered by their chronic nature, insufficient therapeutic effectiveness, and the propensity for recurrence and adverse side effects. Hyaluronic acid (HA) has emerged as a potential solution to these barriers, owing to its excellent attributes such as biocompatibility, non-toxicity, and targeted drug delivery. However, its practical application has been limited because endogenous hyaluronidase (HYAL) rapidly degrades HA in inflamed skin thus reducing its ability to penetrate deep into the skin. Interestingly, recent research has expanded the role of self-assembled HA-nanoparticles (HA-NPs) beyond drug carriers; they are resistant to HYAL, thereby enabling deep skin penetration, and possess inherent anti-inflammatory properties. Moreover, these abilities can be fine-tuned depending on the conditions during particle synthesis. Additionally, their role as a drug delivery system holds potential for use as a multi-target drug or hybrid drug. In conclusion, this review aims to specifically introduce and highlight the emerging potential of HA-NPs as a topical treatment for inflammatory skin conditions.
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Affiliation(s)
- Wang Hee Lee
- Department of Molecular Science & Technology, Ajou University, Suwon 16499, Republic of Korea
| | - Wook Kim
- Department of Molecular Science & Technology, Ajou University, Suwon 16499, Republic of Korea.
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Thaitirarot S, Shuwisitkul D, Udompataikul M, Kamanamool N, Kanokrungsee S. The efficacy of a transdermal hydrogel patch containing betamethasone dipropionate for treatment of chronic hand eczema: A single-blind, randomized and controlled trial. Contact Dermatitis 2024; 90:153-160. [PMID: 37828631 DOI: 10.1111/cod.14438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/08/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Topical corticosteroids under occlusion have been used to enhance the treatment of eczema. However, no study has investigated the efficacy of a steroid-containing transdermal patch for the treatment of chronic hand eczema. METHODS We conducted a randomized, controlled, assessor-blinded trial to determine the efficacy of a transdermal patch containing betamethasone dipropionate compared to topical betamethasone dipropionate ointment in the treatment of mild to moderate chronic hand eczema. The patients were included and assigned to receive either the transdermal patch once daily at night or the ointment twice daily for a period of 8 weeks. The outcomes were assessed using the Hand Eczema Severity Index (HECSI), Physical Global Assessment (PGA) score, self-reported compliance, level of patient satisfaction, quality of life, and side effects. RESULTS Fifty-six patients completed this study. At 8 weeks, there was a significant reduction in the HECSI scores in both the transdermal patch and topical ointment groups compared to those measured at baseline (14.61 to 1.86, p < 0.001; 18.46 to 3.43, p < 0.001, respectively) without a statistically significant difference between the two groups. Similarly, the two groups did not show any significant difference in the PGA scores, quality of life and side effects. However, the transdermal patch group reported better compliance and a higher level of patient satisfaction than the topical ointment group. CONCLUSION The transdermal corticosteroid patch has proven to be a safe and effective treatment, comparable to topical corticosteroids, after 8 weeks of use. Its sustained-release properties, along with once-daily use, can improve patient satisfaction and promote greater adherence to the treatment. TRIAL REGISTRATION This study was registered with the Thai Clinical Trials Registry (www. CLINICALTRIALS in.th) under registration number TCTR20220413003.
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Affiliation(s)
- Sirinan Thaitirarot
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | | | - Montree Udompataikul
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Nanticha Kamanamool
- Department of Preventive and Social Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Silada Kanokrungsee
- Department of Dermatology, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
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Pegoraro NS, Gehrcke M, Camponogara C, Fialho MFP, Cruz L, Oliveira SM. The Association of Oleic Acid and Dexamethasone Acetate into Nanocapsules Enables a Reduction in the Effective Corticosteroid Dose in a UVB Radiation-Induced Sunburn Model in Mice. Pharmaceutics 2024; 16:176. [PMID: 38399236 PMCID: PMC10892665 DOI: 10.3390/pharmaceutics16020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Dexamethasone has a high anti-inflammatory efficacy in treating skin inflammation. However, its use is related to the rebound effect, rosacea, purple, and increased blood glucose levels. Nanotechnology approaches have emerged as strategies for drug delivery due to their advantages in improving therapeutic effects. To reduce dexamethasone-related adverse effects and improve the anti-inflammatory efficacy of treatments, we developed nanocarriers containing this corticosteroid and oleic acid. Nanocapsules and nanoemulsion presented dexamethasone content close to the theoretical value and controlled dexamethasone release in an in vitro assay. Gellan gum-based hydrogels were successfully prepared to employ the nanostructured systems. A permeation study employing porcine skin showed that hydrogels containing non-nanoencapsulated dexamethasone (0.025%) plus oleic acid (3%) or oleic acid (3%) plus dexamethasone (0.025%)-loaded nanocapsules provided a higher amount of dexamethasone in the epidermis compared to non-nanoencapsulated dexamethasone (0.5%). Hydrogels containing oleic acid plus dexamethasone-loaded nanocapsules effectively inhibited mice ear edema (with inhibitions of 89.26 ± 3.77% and 85.11 ± 2.88%, respectively) and inflammatory cell infiltration (with inhibitions of 49.58 ± 4.29% and 27.60 ± 11.70%, respectively). Importantly, the dexamethasone dose employed in hydrogels containing the nanocapsules that effectively inhibited ear edema and cell infiltration was 20-fold lower (0.025%) than that of non-nanoencapsulated dexamethasone (0.5%). Additionally, no adverse effects were observed in preliminary toxicity tests. Our study suggests that nanostructured hydrogel containing a reduced effective dose of dexamethasone could be a promising therapeutic alternative to treat inflammatory disorders with reduced or absent adverse effects. Additionally, testing our formulation in a clinical study on patients with skin inflammatory diseases would be very important to validate our study.
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Affiliation(s)
- Natháli Schopf Pegoraro
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria 97105-900, RS, Brazil; (N.S.P.); (C.C.); (M.F.P.F.)
| | - Mailine Gehrcke
- Graduate Program in Pharmaceutical Sciences, Centre of Health Sciences, Federal University of Santa Maria, Santa Maria 97105-900, RS, Brazil; (M.G.); (L.C.)
| | - Camila Camponogara
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria 97105-900, RS, Brazil; (N.S.P.); (C.C.); (M.F.P.F.)
| | - Maria Fernanda Pessano Fialho
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria 97105-900, RS, Brazil; (N.S.P.); (C.C.); (M.F.P.F.)
| | - Letícia Cruz
- Graduate Program in Pharmaceutical Sciences, Centre of Health Sciences, Federal University of Santa Maria, Santa Maria 97105-900, RS, Brazil; (M.G.); (L.C.)
| | - Sara Marchesan Oliveira
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria 97105-900, RS, Brazil; (N.S.P.); (C.C.); (M.F.P.F.)
- Department of Biochemistry and Molecular Biology, Centre of Natural and Exact Sciences, Federal University of Santa Maria, Santa Maria 97105-900, RS, Brazil
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Akay N, Şanal KO. Can Topical Agents (Arnica and Mucopolysaccharide Polysulfate) Reduce Postoperative Pain, Edema and Trismus Following Mandibular Third Molar Surgery? J Oral Maxillofac Surg 2024; 82:113-121. [PMID: 37913818 DOI: 10.1016/j.joms.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 08/26/2023] [Accepted: 10/07/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Postoperative supplemental maintenance following mandibular third molar surgery remains an area of interest. PURPOSE Topical agents can modulate inflammatory processes. The aim of the present study was to determine if topical application of arnica or mucopolysaccharide polysulfate (MPSP) reduces pain, trismus, and edema following the removal of impacted mandibular third molars. MATERIALS AND METHODS A single center randomized controlled clinical trial was conducted. The patients were randomized into three groups: the control group (standard therapy [ST]: antibiotic + nonsteroidal anti-inflammatory drugs twice a day), the arnica group (arnica + ST), and the MPSP group (MPSP + ST). The patients' pain, trismus, and edema values were measured preoperatively and on postoperative days 1, 3, 5, and 10. Sex, age, and operation time were also included. Analyses included descriptive statistics, analysis of variance, post hoc tests, and determinations of intraclass correlation coefficients. Statistical significance was set at P < .05. RESULTS Sixty patients with a mean age of 26.98 ± 10.88 years were included in the study; 55% were females and 45% were males. The mean operation time was 23.8 ± 3.27 minutes. According to the visual analogue scale scores (in centimeter units), the arnica and MPSP groups felt less pain than the control group until day 5 (0.6 ± 0.88, 3.75 ± 1.16, 4.75 ± 1.29, and 1.05 ± 1.10, respectively, for the arnica group; 0.35 ± 0.59, 3.25 ± 1.62, 5.0 ± 1.65, and 1.50 ± 1.32 for the MPSP group; and 1.30 ± 1.17, 5.75 ± 1.37, 7.05 ± 1.10, and 3.15 ± 1.53 for the control group; P < .05). The trismus was lower on days 1, 3, and 5 in the arnica group (-8.05 ± 2.82, -12.15 ± 3.1, and -2.15 ± 1.81, respectively) than in the control group (-12 ± 3.82, -15.65 ± 4.81, and -4±2.81, respectively) (P < .05). The edema was lower on days 1 and 3 in the MPSP group (0.95 ± 2.2 and 1.75 ± 3.7, respectively) than in the control group (2.45 ± 0.9 and 3.6 ± 0.8, respectively) (P < .05). Arnica and MPSP had similar pain-relieving action, but arnica was more effective at reducing trismus, while MPSP was more effective at reducing edema. CONCLUSIONS Topical application of arnica or MPSP may have a beneficial effect on relieving pain 5 days after surgery, but arnica was also effective at reducing trismus, while MPSP was also effective at reducing edema. Both arnica and MPSP reduced postoperative sequelae.
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Affiliation(s)
- Neşet Akay
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Bolu Abant Izzet Baysal University, Faculty of Dentistry, Bolu, Turkey
| | - Koray Onur Şanal
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Bolu Abant Izzet Baysal University, Faculty of Dentistry, Bolu, Turkey.
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Sarma I, Ray N, Banerjee P, Das S, Brahma DK. A Case Report on Clotrimazole-Induced Localized Erythema. Cureus 2024; 16:e52682. [PMID: 38264180 PMCID: PMC10804214 DOI: 10.7759/cureus.52682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 01/25/2024] Open
Abstract
Clotrimazole, a commonly used antifungal agent, is employed in the treatment of otomycosis and other ear infections. However, its use can lead to adverse drug reactions (ADRs), occasionally manifesting as local irritation or allergic responses. This abstract presents a case study of a patient exhibiting an adverse reaction to clotrimazole ear drops, highlighting the clinical presentation, management, and resolution of the ADR. The patient, a 73-year-old male, presented with itching and erythema over the left pinna extending up to the middle of the sternum following clotrimazole ear drop application. Immediate cessation of the medication and symptomatic treatment led to rapid resolution of symptoms. This case emphasizes the importance of recognizing potential ADRs associated with clotrimazole ear drops and the necessity of prompt intervention to mitigate adverse effects, thereby ensuring optimal patient care.
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Affiliation(s)
- Indrani Sarma
- Pharmacology, All India Institute of Medical Sciences, Guwahati, Guwahati, IND
| | - Namit Ray
- Pharmacology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Priyotosh Banerjee
- Pharmacology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Subhadeep Das
- Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
| | - Dhriti Kumar Brahma
- Pharmacology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, IND
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15
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Cheng YO, Veettil SK, Syeed MS, Shetty NY, Gopinath D. COMPARATIVE EFFICACY OF THERAPEUTIC INTERVENTIONS FOR THE MANAGEMENT OF RECURRENT APHTHOUS ULCERS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. J Evid Based Dent Pract 2023; 23:101918. [PMID: 38035895 DOI: 10.1016/j.jebdp.2023.101918] [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: 11/15/2022] [Revised: 06/26/2023] [Accepted: 08/04/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Recurrent aphthous ulceration (RAU) is an oral condition cavity affecting 2.5 billion people worldwide. We aimed to assess the comparative efficacy and safety of available interventions in the management of RAU. MATERIALS AND METHODS An electronic search of 3 databases (Medline, CENTRAL, Scopus) was performed to identify randomized control trials evaluating the efficacy of RAU interventions published until December 2022. A network meta-analysis (NMA) was conducted on 4 outcomes: reduction in pain, duration of ulceration, the diameter of ulceration, and area of ulceration. The interventions are then arranged using the surface area under cumulative ranking (SUCRA). RESULTS A total of 38 trials involving 2773 patients were included were included in quantitative synthesis by NMA. Our analysis showed that Diode laser [MD, -4.865 ± 1.951 (95%CI = (-8.690, -1.041)] was the most effective in reducing the pain score followed by Amlexanox [MD, -2.673 ± 1.075 (95%CI = -4.779, -0.566)]. Iralvex performed the best in reducing the duration of ulceration [MD, -6.481 ± 1.841 (95%CI = -10.090, -2.872)]. Diode laser, acacia nilotica with licorice formulation, and amlexanox were the most effective interventions for reduction of ulcer diameter. Majority of the trials reported absence of any adverse effects and those reported were mild. CONCLUSION Our NMA has identified several interventions to be more effective than a placebo. Laser therapy may be an option for promoting pain management, however, most have only been tested in 1 or 2 trials. Further studies with rigorous methodology on larger samples are recommended to strengthen the current evidence.
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Affiliation(s)
- Yung On Cheng
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Sajesh K Veettil
- International Medical University, School of Pharmacy, Department of Pharmacy Practice, Kuala Lumpur, Malaysia; School of Medicine, Taylor's University, 47500 Subang Jaya
| | - M Sakil Syeed
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, USA
| | - Naresh Y Shetty
- Department of Clinical Sciences , College of Dentistry, Ajman University, United Arab Emirates; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| | - Divya Gopinath
- Department of Basic Medical and Dental Sciences, College of Dentistry, Ajman University, United Arab Emirates; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates.
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Iijima S. Umbilical Granuloma: Frequency, Associated Factors, 10-Year Treatment Trends, and Effectiveness at a Single Hospital in Japan. J Clin Med 2023; 12:6104. [PMID: 37763044 PMCID: PMC10531942 DOI: 10.3390/jcm12186104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Umbilical granuloma (UG) is a common problem during the neonatal period; however, its epidemiology and etiology are poorly studied, and the best treatment option has not yet been established. We examined the medical records of neonates who were born and underwent 1-month evaluations at our hospital between 2013 and 2022 to investigate the frequency of-and factors associated with-UG, as well as the annual trends of UG treatments and their efficacy. Of the 6680 eligible neonates, 395 (5.9%) had UG. The annual incidence rate ranged from 3.8% to 7.3%. Gestational age, birth weight, and incidence of meconium-stained amniotic fluid were significantly associated with UG. Silver nitrate cauterization was the predominant UG treatment from 2013 to 2016. Silver nitrate cauterization and topical betamethasone valerate were nearly equally applied in 2017. Betamethasone application became predominant in 2018. The healing rates during the initial treatment period were 91% for silver nitrate cauterization, 97.7% for betamethasone application, 60% for ethanol disinfection, and 88% for ligation; these rates were significantly different (p < 0.001). Topical steroid application may be the most effective treatment. If steroid application is ineffective, then silver nitrate cauterization and ligation may be important treatment options.
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Affiliation(s)
- Shigeo Iijima
- Department of Regional Neonatal-Perinatal Medicine, Hamamatsu University School of Medicine, Hamamatsu 4313192, Japan
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17
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Murugan AJ, Ganesan A, Aniyan YK, Lakshmi KC, Asokan K. Comparison of topical purslane & topical 0.1% triamcinolone acetonide in the management of oral lichen planus - a double blinded clinical trial. BMC Oral Health 2023; 23:678. [PMID: 37726676 PMCID: PMC10507837 DOI: 10.1186/s12903-023-03385-1] [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: 05/11/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
AIM AND BACKGROUND Oral lichen planus (OLP) is a chronic autoimmune mucocutaneous disorder of unknown etiology and treatment is targeted at alleviating symptoms. At present, corticosteroids are the mainstay treatment, and their side effects hamper their long-term use, demanding alternative therapy. This study intended to assess the efficacy of topical purslane (Portulaca oleracea) at two concentrations, 5% and 10%, in OLP and to compare the level of clinical improvement in comparison to topical 0.1% triamcinolone acetonide gel. MATERIALS AND METHODS After sample size determination, thirty-four subjects confirmed histopathologically with OLP were included in the study. They were divided into 3 groups, Group 1(Control) was treated with 0.1% triamcinolone acetonide, and Group 2(Case) and 3 (Case) were treated with topical purslane 5% and 10%, respectively. They were examined at baseline, 14 days, 30 days, 60 days, and 90 days. Clinical improvement was then analyzed at the end of 90 days using a visual analog scale (VAS) and Thongprasom's criteria. RESULTS The study was analyzed statistically and a P value of < 0.05 was considered statistically significant. Intragroup comparison revealed a statistically significant difference between the five time periods (baseline, 14 days, 30 days, 60 days, and 90 days) for the study variables (burning sensation, pain, lesion score, clinical response, symptomatic response) for all three groups (p = 0.001). Alleviation of all symptoms and remission of the lesion were noted for all three groups at the end of three months. CONCLUSION Purslane is a magical herb with a plethora of rich nutrients, ease in accessibility and devoid of side effects. It was concluded that its preparation is beneficial and can be a safer alternative long-term drug for the management of OLP. CLINICAL SIGNIFICANCE With available literature evidence, our present study is the first of its kind to formulate a topical gel with purslane to treat symptomatic OLP. Our study had a longer follow-up of 3 months compared to other studies in the literature.
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Affiliation(s)
- Arul Jothi Murugan
- Department of Oral Medicine and Radiology, SRM Dental College, Ramapuram, Chennai, 600089, Tamil Nadu, India.
| | - Anuradha Ganesan
- Department of Oral Medicine and Radiology, SRM Dental College, Ramapuram, Chennai, 600089, Tamil Nadu, India
| | - Yesoda K Aniyan
- Department of Oral Medicine and Radiology, SRM Dental College, Ramapuram, Chennai, 600089, Tamil Nadu, India
| | | | - Kannan Asokan
- Department of Oral Medicine and Radiology, SRM Dental College, Ramapuram, Chennai, 600089, Tamil Nadu, India
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18
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Banerjee A, Munghate G, Bodhanwala M, Bendre PS. Treatment of Umbilical Granuloma in Infants With Topical Application of Common Salt: A Scoping Review. J Pediatr Surg 2023; 58:1843-1848. [PMID: 37024416 DOI: 10.1016/j.jpedsurg.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Common salt is a safe, effective and cheap home-made remedy for umbilical granuloma. The aim of this scoping review is to identify and summarize the available evidence and examine the research conducted on salt treatment for umbilical granuloma. METHODS A literature search was performed in the second week of September, 2022 using Google scholar, PubMed, MEDLINE and EMBASE databases using the keywords 'umbilical granuloma' and 'salt treatment' to identify all English articles pertaining to salt treatment for umbilical granuloma. Tables were made to summarize the methodological characteristics, results and the dosage regimens of salt used by different authors. The Cochrane Collaboration's tool was used for assessing risk of bias in RCTs. The indexing statuses of the journals publishing these studies were also noted. The overall efficacy with the use of common salt was calculated by adding the success rates mentioned in each study. RESULTS Twenty-four articles (2 systematic reviews, 6 Randomized Controlled Trials, 11 prospective cohort studies, 1 case control study, 3 retrospective case series and 1 case report) were included. An overall 93.91% success rate (1033/1100) was seen with common salt application, without any reports of complications/recurrences. CONCLUSION Topical application of common salt for umbilical granulomas is simple, effective and inexpensive. This scoping review provides a broader outlook at the existing level of evidence and may help in planning interventional comparative studies, so that recommendations can be formulated. It also highlights a lack of properly designed randomized controlled trials on this topic. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Arka Banerjee
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Gayatri Munghate
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, India.
| | - Minnie Bodhanwala
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - Pradnya S Bendre
- Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, India
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19
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Sowlati M, Orzan OA, Morariu SH, Etropolska Z, Veraldi S, Dimitrov S. Topical Application of a Formulation Containing Pea Proteins and Xyloglucan in Adult Patients with Atopic Dermatitis: A Double-blind, Parallel, Randomized, Placebo-controlled, Multicenter Study. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:35-41. [PMID: 37560506 PMCID: PMC10409507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Atopic dermatitis (AD) management requires long-term use of drugs that come with side effects. Compounds such as xyloglucan (XG) and pea proteins (PP) are emerging alternatives to corticosteroids that have shown to restore skin barrier function in preclinical studies. This double-blind, parallel, randomized, placebo-controlled clinical trial investigated the efficacy and safety of XG and PP, in adult AD patients. METHODS Fourty-two patients with AD were randomly assigned 1:1 to receive a XG+PP treatment or the vehicle without XG+PP twice/day for 14 consecutive days for assessment at baseline, Day 8 and Day 15; follow-up visit was 14 days after the end of treatment (Day 28). Efficacy was evaluated using the Scoring Atopic Dermatitis (SCORAD) index, AD severity index (ADSI) score and patient-oriented eczema measure (POEM). Safety and tolerability were monitored as the occurrence of Adverse Events (AEs). RESULTS At baseline, both groups exclusively included moderate/severe AD cases. At Day 8, six patients treated with XG+PP displayed complete resolution of AD, while 15 patients had mild AD. At Day 28, 16 patients no longer had eczema, whereas five patients displayed mild AD. Notably, 21 patients in the vehicle group still displayed moderate/severe AD. CONCLUSION XG and PP promote rapid and long-lasting relief, supporting its use as a safe alternative to mainstay corticosteroid treatments for AD management. The study protocol has been registered in the ISRCTN registry (TN66879853).
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Affiliation(s)
- Mehedi Sowlati
- Dr. Sowlati is with the County Clinical Emergency Hospital in Arad, Romania
| | | | | | - Zlatka Etropolska
- Dr. Etropolska is with the Ambulatory Practice for Primary Outpatient Medical Care SANA OOD in Bulgaria
| | - Stefano Veraldi
- Dr. Veraldi is with the Department of Pathophysiology and Transplantation at Università degli Studi, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy
| | - Stefan Dimitrov
- Dr. Dimitrov is with the Medical center Prolet EOOD in Bulgaria
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20
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Shahin TB, Sreekantaswamy SA, Hawkes JE, Butler DC. Treatment Strategies for Chronic Pruritus and Eczema/Dermatitis in Older Adults Under the Category of Chronic Eczematous Eruptions of Aging (CEEA). Am J Clin Dermatol 2023; 24:405-418. [PMID: 36920748 DOI: 10.1007/s40257-023-00767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
Chronic eczematous eruptions of aging (CEEA) refers to a heterogenous group of longstanding, pruritic eczematous dermatoses with an unidentified etiology, or those which do not meet strict disease criteria. The literature has not yet established a single ubiquitous disease or term for these eruptions in adults over the age of 65 years. Instead, CEEA is attributed various names, including immunologic eruption of aging, and eruption of immunosenescence. Atopic dermatitis in the elderly, eczema in the elderly, and late- or adult-onset atopic dermatitis or eczema likely also fall under the umbrella of CEEA, given that older patients often do not meet strict criteria for atopic dermatitis. As a reflection of such terminological heterogeneity, CEEA does not have a standardized workup algorithm. This lack of uniformity can obscure the ability to study and understand appropriate treatments for this condition. Yet, as providers become increasingly aware of CEEA and more comfortable in making this diagnosis in older adults, it is necessary that dermatologists understand the safety and efficacy of common CEEA treatments in this population. Here, we discuss special considerations, challenges, and recommendations for treating older adults with CEEA with topical and systemic therapeutics. We provide an overview of therapeutic strategies and potential barriers to treatment and discuss the essential role of shared decision making when caring for this patient population.
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Affiliation(s)
- Tala B Shahin
- University of Arizona, College of Medicine, 1501 N Campbell Ave, Tuscon, AZ, 85724, USA
| | - Shreya A Sreekantaswamy
- University of Arizona, College of Medicine, 1501 N Campbell Ave, Tuscon, AZ, 85724, USA.,University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Jason E Hawkes
- Department of Dermatology, University of California, Davis, Sacramento, CA, USA
| | - Daniel C Butler
- University of Arizona, College of Medicine, 1501 N Campbell Ave, Tuscon, AZ, 85724, USA.
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Topical Glucocorticoid Use and the Risk of Posttransplant Diabetes. Case Rep Endocrinol 2023; 2023:3648178. [PMID: 36718481 PMCID: PMC9884167 DOI: 10.1155/2023/3648178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
Systemically administered glucocorticoids constitute an essential part of the immunosuppressive regimen for transplant recipients, yet their known risks of causing hyperglycemia or posttransplant diabetes require close monitoring and minimisation of use, when possible, to prevent detrimental effects on patient morbidity and graft survival. Topical glucocorticoids, on the other hand, are rarely considered to affect glucose metabolism and therefore seldomly monitored, despite their wide and in some cases, long-term use. We report a case of a renal transplant recipient presenting with acute hyperosmolar hyperglycemia after treatment with topical glucocorticoids and present a mini review of the literature.
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22
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The Food and Drug Administration's Role in Dermatologic Drug Development. Dermatol Clin 2022; 40:249-263. [PMID: 35750409 DOI: 10.1016/j.det.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The mission of the Food and Drug Administration (FDA) is to ensure the safety and effectiveness of dermatologic drugs, as authorized by the Federal Food, Drug, and Cosmetic Act (FD&CA). In this article, we discuss how the FDA's policies and practices have continued to evolve to incorporate scientific advances and to facilitate approval for dermatologic drugs in a timely manner for a broad spectrum of patients. We provide several examples to highlight areas where the Division of Dermatology and Dentistry found common ground with stakeholders to increase the therapeutic options for dermatologic patients, while still maintaining regulatory standards required for approval.
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A Poly (Caprolactone)-Cellulose Nanocomposite Hydrogel for Transdermal Delivery of Hydrocortisone in Treating Psoriasis Vulgaris. Polymers (Basel) 2022; 14:polym14132633. [PMID: 35808678 PMCID: PMC9269097 DOI: 10.3390/polym14132633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023] Open
Abstract
Psoriasis vulgaris (PV) is a common chronic disease, affecting much of the population. Hydrocortisone (HCT) is currently utilized as a PV treatment; however, it is associated with undesirable side effects. The aim of this research was to create a thermo-responsive nano-hydrogel delivery system. HCT-loaded sorbitan monostearate (SMS)-polycaprolactone (PCL) nanoparticles, encapsulated with thermo-responsive hydrogel carboxymethyl cellulose (CMC), were synthesized by applying the interfacial polymer-deposition method following solvent displacement. The nanoparticles’ properties were evaluated employing Differential Scanning Colorimetry, Thermogravimetric Analysis, Fourier Transform Infrared Spectroscopy, Scanning Electron Microscopy, Zeta sizer, Ultraviolet/Visual spectroscopy, and cytotoxicity testing. The nanoparticle sizes were 110.5 nm, with polydispersity index of 0.15 and zeta potential of −58.7 mV. A drug-entrapment efficacy of 76% was attained by the HCT-loaded SMS-PCL nanoparticles and in vitro drug-release profiles showed continuous drug release over a period of 24 hrs. Keratinocyte skin cells were treated with HCT-loaded SMS-PCL nanoparticles encapsulated with CMC; the results indicated that the synthesized drug-delivery system was less toxic to the keratinocyte cells compared to HCT. The combined trials and results from the formulation of HCT-loaded SMS-PCL nanoparticles encapsulated with CMC showed evidence that this hydrogel can be utilized as a potentially invaluable formulation for transdermal drug delivery of HCT, with improved efficacy and patient conformity.
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The impact of gender and sex in psoriasis: What to be aware of when treating women with psoriasis. Int J Womens Dermatol 2022; 8:e010. [PMID: 35619672 PMCID: PMC9112394 DOI: 10.1097/jw9.0000000000000010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/02/2022] [Indexed: 12/25/2022] Open
Abstract
Psoriasis is a common chronic inflammatory skin disease with an exceptionally high burden for women.
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Weng TH, Ke CC, Huang YS. Anti-Inflammatory Effects of GM1 Ganglioside on Endotoxin-Induced Uveitis in Rats. Biomolecules 2022; 12:biom12050727. [PMID: 35625654 PMCID: PMC9138562 DOI: 10.3390/biom12050727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/05/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023] Open
Abstract
Exogenous ganglioside GM1 has been reported to exert an immunomodulatory effect. We investigated the anti-inflammatory effect of GM1 ganglioside on endotoxin-induced uveitis (EIU) in rats and RAW 264.7 macrophages. Methods: EIU was induced in Lewis rats by administering a subcutaneous injection of lipopolysaccharide (LPS). GM1 was injected intraperitoneally for three consecutive days prior to the LPS injection. Twenty-four hours after the LPS injection, the integrity of the blood-aqueous barrier was evaluated by determining the protein concentration and number of infiltrating cells in the aqueous humor (AqH). Immunohistochemical and Western blot analyses of the iris-ciliary body (ICB) were performed to evaluate the effect of GM1 on the LPS-induced expression of cyclooxygenase-2 (COX-2) and intercellular adhesion molecule-1 (ICAM-1). The effect of GM1 on proinflammatory mediators and signaling cascades was examined in LPS-stimulated RAW 264.7 cells using Western blotting and immunofluorescence staining to further clarify the underlying anti-inflammatory mechanism. Results: GM1 significantly reduced the protein concentration and number of infiltrating cells in the AqH of rats with EIU. GM1 also decreased the LPS-induced expression of the ICAM-1 and COX-2 proteins in the ICB. In RAW 264.7 cells, GM1 inhibited the proinflammatory mediators induced by LPS, including inducible nitric oxide synthase (iNOS), COX-2, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6), and this inhibitory effect was potentially mediated by suppressing transforming growth factor-β-activated kinase 1 (TAK1) and reactive oxygen species (ROS)-mediated activation of nuclear factor-κB (NF-κB) and mitogen-activated protein kinases (MAPKs). Conclusions: Based on this study, GM1 may be a potential anti-inflammatory agent for ocular inflammatory diseases.
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Affiliation(s)
- Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan; (T.-H.W.); (C.-C.K.)
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chang-Chih Ke
- Department of Ophthalmology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan; (T.-H.W.); (C.-C.K.)
- Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yuahn-Sieh Huang
- Department of Biology and Anatomy, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: ; Tel.: +886-87923100 (ext. 18735)
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Vejjabhinanta V, Muangsiri W, Werawatganone P. Fluocinolone Acetonide Microemulsion in Combination with a Fractional Laser for the Treatment of Scalp Psoriasis. AAPS PharmSciTech 2022; 23:122. [PMID: 35460022 DOI: 10.1208/s12249-022-02249-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
This study introduces fluocinolone acetonide (FA) microemulsion in combination with ablative fractional lasering as a new effective treatment for scalp psoriasis. A pseudo-ternary phase diagram was constructed using the aqueous titration method. The suitable ratio of surfactant mixture (Smix):oil mixture (Omix):water was chosen from the microemulsion region of the diagram. FA was loaded into the selected ratio to prepare FA microemulsion. Ex vivo skin permeation study of the FA microemulsion with fractional laser assistance was performed to determine a proper ablative depth. A pilot clinical study was conducted to evaluate the efficacy of FA microemulsion and FA microemulsion combination with lasering at the optimum ablation depth. The selected microemulsion base contained (in wt%) 77% water, 20% Smix (Tween 80:ethanol, 2:1), 3% Omix (10% benzyl benzoate and 1% benzyl alcohol in bergamot oil), and 0.2% sodium carboxymethylcellulose. FA was loaded into this base at a concentration of 0.1%. The skin lasered at an ablation depth of 50 µm was conducted in the pilot clinical study. Scalp psoriasis responded well to the FA microemulsion. Psoriasis scalp severity index (PSSI) scores indicated that the FA microemulsion plus laser treatment provides higher efficacy than the FA microemulsion alone without any topical and systemic side effects. The efficacy of the treatments could be maintained for at least 1 week after treatment discontinuation. FA microemulsion was properly formulated and evaluated. The microemulsion demonstrating the greatest benefits was used in combination with ablative fractional lasering to treat scalp psoriasis.
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Shalaby RA, El-Gazayerly O, Abdallah M. Cubosomal Betamethasone-Salicylic Acid Nano Drug Delivery System for Enhanced Management of Scalp Psoriasis. Int J Nanomedicine 2022; 17:1659-1677. [PMID: 35444415 PMCID: PMC9013920 DOI: 10.2147/ijn.s345430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/07/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Betamethasone dipropionate (BD), a potent corticosteroid, and salicylic acid (SA), a keratolytic agent, have been used in combination to treat scalp psoriasis; however, undesirable side effects associated with their prolonged topical use are inevitable. In this study, BD and SA were loaded into cubosomes, a nanoparticulate system with outstanding biocompatibility, bio-adhesivity and penetration power. Methods Design of experiments (DOE) was utilized to prepare thirteen different cubosomal dispersions by emulsification technique using glycerol monoolein (GMO) as a lipid phase and Poloxamer 407 (P407) as a surfactant, sodium carboxymethyl cellulose (SCMC) was added to enhance the dispersions’ rheological properties. The thirteen dispersions were in-vitro characterized for their particle size, polydispersity index (PDI), zeta potential, BD and SA content and rheological behaviour. The desirability of an optimized formula (OF) was set to the smallest particle size, lowest zeta-potential and highest viscosity. The OF was in-vitro characterized for the same parameters in addition to transmission electron microscope imaging and in-vitro drug release. The OF’s anti-psoriatic activity was evaluated in-vivo using an imiquimod-induced psoriasis model. Results The OF achieved a particle size of 197.4 ± 9.47 nm, a PDI of 0.443 ± 0.025, a zeta potential of −44.4 ± 0.141mv, BD content of 105.85 ± 2.290%, SA content of 88.855 ± 2.920% with shear-thinning rheological behaviour and completed in-vitro drug release within 2–3 hours. The in-vivo studies confirmed the cubosomes’ higher anti-psoriatic efficacy over the commercial product with lower changes in ear thickness, spleen to body weight ratio, psoriasis area severity index score and improved histopathological findings. Conclusion The developed BD SA-loaded cubosomes exhibit promising anti-psoriatic activity attributed to its nano-size and unique lipid content, with enhanced skin penetration and modified rheological properties; increasing the formulation’s in-contact duration with the scalp resulting in lower application frequency and thus reduced BD and SA associated side effects.
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Affiliation(s)
- Rodayna Atef Shalaby
- Department of Pharmaceutics and Industrial Pharmacy, School of Pharmacy, New Giza University, Giza, Egypt
| | - Omaima El-Gazayerly
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
- Correspondence: Omaima El-Gazayerly, Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt, Tel +2-01005840254, Email
| | - Mohammed Abdallah
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Rana K, Pani T, Jha SK, Mehta D, Yadav P, Jain D, Pradhan MK, Mishra S, Kar R, G BR, Srivastava A, Dasgupta U, Patil VS, Bajaj A. Hydrogel-mediated topical delivery of steroids can effectively alleviate psoriasis via attenuating the autoimmune responses. NANOSCALE 2022; 14:3834-3848. [PMID: 35195120 DOI: 10.1039/d1nr06001e] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Psoriasis is a systemic, relapsing, and chronic autoimmune inflammatory disease of the skin. Topical use of betamethasone, a glucocorticoid, in the form of creams is a common treatment for psoriasis. However, topical use of these creams is challenging due to the ineffective entrapment of steroids, burst release of the entrapped drugs, poor skin permeability, and high toxicity. Herein, we present the engineering of a betamethasone-loaded topical hydrogel (B-Gel) that can efficiently entrap steroids with high spreadability, and can also maintain the sustained release of drugs. We used an imiquimod (IMQ) induced ear psoriasis model, and demonstrated that topical application of B-Gel can mitigate the autoimmune inflammation reactions, and leads to a reduction in erythema, induration, scaling, and ear thickness. As interleukin 17 (IL-17) secreting T helper 17 (Th17) cells and γδ+ T cells are responsible for psoriasis, B-Gel treatment witnessed a reduction in the infiltration of leukocytes, CD4+ T cells, Th17 T cells, and dermal γδ+ T cells. We further demonstrated that B-Gel mediated reduction of IL-1β, IL-17, and K16 (marker for keratinocyte proliferation) is responsible for alleviation of psoriasis. Therefore, the non-greasy nature of the hydrogel with a cooling effect provides an alternative for topical application of steroids.
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Affiliation(s)
- Kajal Rana
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad-121001, Haryana, India.
| | - Trishna Pani
- Amity Institute of Integrative Sciences and Health, Amity University Haryana, Panchgaon, Manesar, Gurgaon-122413, Haryana, India
| | - Somesh Kumar Jha
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad-121001, Haryana, India.
| | - Devashish Mehta
- Amity Institute of Integrative Sciences and Health, Amity University Haryana, Panchgaon, Manesar, Gurgaon-122413, Haryana, India
| | - Poonam Yadav
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad-121001, Haryana, India.
| | - Dolly Jain
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad-121001, Haryana, India.
| | - Manas Kumar Pradhan
- Department of Chemistry, Indian Institute of Science Education and Research, Bhauri, Bhopal By-pass Road, Bhopal-462066, India
| | - Sarita Mishra
- CSIR-Institute of Genomics and Integrative Biology, South Campus, Mathura Road, Near to Sukhdev Vihar, New Delhi, Delhi 110025, India
| | - Raunak Kar
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi-110067, India.
| | - Betsy Reshma G
- CSIR-Institute of Genomics and Integrative Biology, South Campus, Mathura Road, Near to Sukhdev Vihar, New Delhi, Delhi 110025, India
| | - Aasheesh Srivastava
- Department of Chemistry, Indian Institute of Science Education and Research, Bhauri, Bhopal By-pass Road, Bhopal-462066, India
| | - Ujjaini Dasgupta
- Amity Institute of Integrative Sciences and Health, Amity University Haryana, Panchgaon, Manesar, Gurgaon-122413, Haryana, India
| | - Veena S Patil
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi-110067, India.
| | - Avinash Bajaj
- Laboratory of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, NCR Biotech Science Cluster, 3rd Milestone, Faridabad-Gurgaon Expressway, Faridabad-121001, Haryana, India.
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Gendrisch F, Völkel L, Fluck M, Apostolova P, Zeiser R, Jakob T, Martin SF, Esser PR. IRE1 and PERK signaling regulates inflammatory responses in a murine model of contact hypersensitivity. Allergy 2022; 77:966-978. [PMID: 34314538 DOI: 10.1111/all.15024] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Contact sensitizers may interfere with correct protein folding. Generation of un-/misfolded proteins can activate the IRE-1 or PERK signaling pathways initiating the unfolded protein response (UPR) and thereby determine inflammatory immune responses. We have analyzed the effect of sensitizers with different potencies on the induction of UPR activation/inhibition and the subsequent generation of a pro-inflammatory micromilieu in vitro as well as the effect of UPR modulation on the inflammatory response in the murine contact hypersensitivity (CHS) in vivo. METHODS Semi-quantitative and quantitative PCR, fluorescence microscopy, ELISA, NF-κB activation and translocation assays, DC/keratinocyte co-culture assay, FACS, and in vivo CHS experiments were performed. RESULTS Sensitizers and irritants activate IRE-1 and PERK in murine and human keratinocytes. Synergistic effects occur after combination of different weak sensitizers / addition of irritants. Moreover, tolerogenic dinitrothiocyanobenzene can be converted into a strong sensitizer by pre-activation of the UPR. Blocking UPR signaling results in decreased NF-κB activation and cytokine production in keratinocytes and in activation marker downregulation in a HaCaT/THP-1 co-culture. Interestingly, not only systemic but also topical application of UPR inhibitors abrogates CHS responses in vivo. CONCLUSION These observations highlight an important role of the UPR in determination of the inflammatory response in vitro and in vivo further underlining the importance of tissue stress and damage responses in the development of ACD and provide mechanistically based concepts as a basis for the development of new therapeutic approaches to treat allergic contact dermatitis.
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Affiliation(s)
- Fabian Gendrisch
- Allergy Research Group Department of Dermatology Medical Center – University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
- Faculty of Biology University of Freiburg Freiburg Germany
- Department of Dermatology Research Center skinitial Medical Center ‐ University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | - Lukas Völkel
- Allergy Research Group Department of Dermatology Medical Center – University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
- Faculty of Biology University of Freiburg Freiburg Germany
| | - Melanie Fluck
- Faculty of Biology University of Freiburg Freiburg Germany
| | - Petya Apostolova
- Department of Medicine I Medical Center ‐ University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | - Robert Zeiser
- Department of Medicine I Medical Center ‐ University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | - Thilo Jakob
- Allergy Research Group Department of Dermatology Medical Center – University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
- Experimental Dermatology and Allergy Research Group Department of Dermatology and Allergology University Medical Center Giessen (UKGM Justus Liebig University Giessen Germany
| | - Stefan F. Martin
- Allergy Research Group Department of Dermatology Medical Center – University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | - Philipp R. Esser
- Allergy Research Group Department of Dermatology Medical Center – University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
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Katsura M, Sato T, Morita K, Ishii T, Kishi K, Hasegawa T. Iatrogenic Cushing syndrome due to topical corticosteroids after skin graft surgery for giant nevus: A case report. Pediatr Dermatol 2022; 39:147-148. [PMID: 34989020 DOI: 10.1111/pde.14910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Abstract
Iatrogenic Cushing syndrome (ICS) may be caused by exposure to corticosteroid therapy. We report a case of ICS caused by topical corticosteroids applied to the skin after skin graft surgery. We presume that the development of ICS, in this case, was attributed to a combination of skin barrier disruption, usage of high-potency corticosteroids, broad application area/ large quantity of the corticosteroid, and the extended treatment period. Patients may be at risk for ICS after extensive skin graft surgery if large amounts of very potent topical corticosteroids are applied for an extended period to prevent scar formation or relieve itching.
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Affiliation(s)
- Minori Katsura
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Sato
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kumiko Morita
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Ishii
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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Hintong S, Phinyo P, Chuamanochan M, Phimphilai M, Manosroi W. Novel Predictive Model for Adrenal Insufficiency in Dermatological Patients with Topical Corticosteroids Use: A Cross-Sectional Study. Int J Gen Med 2021; 14:8141-8147. [PMID: 34803396 PMCID: PMC8594898 DOI: 10.2147/ijgm.s342841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose This study aimed to identify predictive factors and to develop a predictive model for adrenal insufficiency (AI) related to topical corticosteroids use. Methods The research was conducted using a cross-sectional design. Adult patients with dermatological conditions who had been prescribed topical steroids for at least 12 months by the dermatology outpatient departments of the Faculty of Medicine, Chiang Mai University from June through October 2020 were included. Data on potential predictors, including baseline characteristics and laboratory investigations, were collected. The diagnoses of AI were based on serum 8AM cortisol and low-dose ACTH stimulation tests. Multivariable logistic regression was used for the derivation of the diagnostic score. Results Of the 42 patients, 17 (40.5%) had AI. The statistically significant predictive factors for AI were greater body surface area of corticosteroids use, age <60 years, and basal serum cortisol <7 µg/dL. In the final predictive model, duration of treatment was added as a factor based on its clinical significance for AI. The four predictive factors with their assigned scores were: body surface area involvement 10–30% (20), >30% (25); age <60 years old (15); basal serum cortisol of <7 µg/dL (30); and duration of treatment in years. Risk of AI was categorized into three groups, low, intermediate and high risk, with total scores of <25, 25–49 and ≥50, respectively. The predictive performance for the model was 0.92 based on area under the curve. Conclusion The predictive model for AI in patients using topical corticosteroids provides guidance on the risk of AI to determine which patients should have dynamic ACTH stimulation tests (high risk) and which need only close follow-up (intermediate and low risk). Future validation of the model is warranted.
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Affiliation(s)
- Suporntip Hintong
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mati Chuamanochan
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mattabhorn Phimphilai
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worapaka Manosroi
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Mautz TT, Krapf JM, Goldstein AT. Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies. Sex Med Rev 2021; 10:42-52. [PMID: 34226161 DOI: 10.1016/j.sxmr.2021.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
Topical corticosteroids are often utilized as the first-line treatment for vulvar lichen sclerosus (VLS). However, there is wide variability in dosing regimens, as well as a lack of consensus on maintenance dosing. Available guidelines on dosing frequency and regimen continuation for VLS are based on clinical expert opinion and do not necessarily reflect the pharmacokinetics of topical corticosteroids. Over the past few decades, there have been many advances in the techniques used to measure the local and systemic absorption of topical corticosteroids. These techniques have led to a greater understanding of the pharmacokinetics and bioavailabilities of these medications. However, it is not clear how this new information has been applied in evaluating dosing regimens and commonly cited risks when considering short- and long-term use in different vulvar dermatoses. This purpose of this review is to evaluate the available evidence on pharmacokinetics, absorption rates, and concentration levels of topical corticosteroids in lesional and nonlesional skin. Additionally, the evidence regarding commonly cited risks of topical corticosteroid use, including dermal thinning, adrenal suppression, systemic immunosuppression, and tachyphylaxis are reviewed. Differences in the effects of topical corticosteroids on the varied tissues of the vulva are specifically explored. Finally, these considerations are applied to evaluate the current treatment guidelines for VLS to provide direction in determining an evidenced-based dosing regimen and to inform future research in this area. Mautz TT, Krapf JM, Goldstein AT. Topical Corticosteroids in the Treatment of Vulvar Lichen Sclerosus: A Review of Pharmacokinetics and Recommended Dosing Frequencies. Sex Med Rev 2021;XX:XXX-XXX.
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Affiliation(s)
| | - Jill M Krapf
- The Centers for Vulvovaginal Disorders, New York, NY, USA; The George Washington University School of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Washington, DC, USA
| | - Andrew T Goldstein
- The Centers for Vulvovaginal Disorders, New York, NY, USA; The George Washington University School of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Washington, DC, USA
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Tada Y, Iversen L, Koo J. Early efficacy and safety data with fixed-dose combination calcipotriol/betamethasone dipropionate foam attributed to mechanism of absorption and steroid potency. J Eur Acad Dermatol Venereol 2021; 35 Suppl 1:5-9. [PMID: 33619779 PMCID: PMC7986689 DOI: 10.1111/jdv.17027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/27/2020] [Indexed: 01/16/2023]
Abstract
Topical therapy is the mainstay of treatment for the majority of patients with psoriasis vulgaris (chronic plaque psoriasis), with combinations of vitamin D analogues and glucocorticoids having been shown to negate many of the negative effects associated with either monocomponent individually. Following the established efficacy of fixed‐dose combination calcipotriol (Cal; 50 µg/g) plus betamethasone dipropionate (BD; 0.5 mg/g) ointment and gel formulations, a novel Cal/BD foam formulation was developed. When applied, Cal/BD foam forms a supersaturated solution on the skin, increasing the penetration and bioavailability of Cal and BD. Early data indicate that this results in improved efficacy outcomes versus Cal/BD ointment, without negatively affecting safety outcomes (such as the incidence/severity of side effects or impacted calcium homeostasis or hypothalamic‐pituitary‐adrenal axis). This article discusses the potency and absorption of fixed‐dose combination Cal/BD foam, as well as the positive early efficacy and safety data associated with its utilisation in the treatment of psoriasis vulgaris. Video abstract
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Affiliation(s)
- Y Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - J Koo
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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34
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Täubel J, Mazzetti A, Ferber G, Burch W, Fernandes S, Patel A, Spencer CS, Freier A, Graff C, Kanters JK, Camm J. A Phase 1 Study to Investigate the Effects of Cortexolone 17α-Propionate, Also Known as Clascoterone, on the QT Interval Using the Meal Effect to Demonstrate ECG Assay Sensitivity. Clin Pharmacol Drug Dev 2021; 10:572-581. [PMID: 33942574 PMCID: PMC8251570 DOI: 10.1002/cpdd.935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/17/2021] [Indexed: 11/12/2022]
Abstract
Cortexolone 17α‐propionate, also known as clascoterone, is a potent androgen receptor inhibitor intended for the topical treatment of skin diseases associated with androgenic pathway alterations. In nonclinical studies, cortexolone 17α‐propionate was found to have a weak inhibitory effect on human Ether‐à‐go‐go‐Related Gene (hERG) potassium channels, which are vital for normal electrical activity in the heart. When used in a cream formulation, little cortexolone 17α‐propionate is absorbed. However, the solution formulation developed for the treatment of androgenetic alopecia leads to a measurable systemic concentration and accumulation of the antiandrogen. This phase 1 study assessed the effect of cortexolone 17α‐propionate on the QTc interval using concentration‐effect analysis and the effect of a meal on QTc to confirm assay sensitivity. Thirty‐two volunteers were randomly assigned to receive the active drug or a matching vehicle as placebo. Participants were dosed twice daily on days 1 to 3 (225 mg applied topically as a 7.5% solution 12 hours apart) and once on day 4. Pharmacokinetic and electrocardiogram assessments were performed after supratherapeutic doses. Assay sensitivity was successfully confirmed by using the food effect on the QTc interval. The results of this concentration‐QTc analysis demonstrate that cortexolone 17α‐propionate and its metabolite/degradation product had no effect on the QTc interval in the concentration range tested.
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Affiliation(s)
- Jörg Täubel
- Richmond Pharmacology Ltd, London, United Kingdom.,St George's, University of London, London, United Kingdom
| | | | - Georg Ferber
- Statistik Georg Ferber GmbH, Riehen, Switzerland
| | | | | | - Avani Patel
- Richmond Pharmacology Ltd, London, United Kingdom
| | | | - Anne Freier
- Richmond Research Institute, St George's University, London, United Kingdom
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jørgen K Kanters
- Department of Biomedical Sciences, Kobenhavns Universitet, Copenhagen, Denmark
| | - John Camm
- St George's, University of London, London, United Kingdom
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Emeka NCM, Anyanechi CN, Onodugo N, Uduma V, Ozoh N, Adama UB, Udu P, Onyekonwu CL, Ozoh G, Ojinmah UR. Cross-Sectional Review of Prescription Practices of Triple Action Creams Amongst Doctors in South-East. Niger Med J 2021; 62:96-103. [PMID: 38505193 PMCID: PMC10937057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
Background Topical corticosteroids have had an immense impact in the treatment of skin diseases since their advent and are important in the management of corticosteroid-responsive dermatoses. Triple action creams (TAC) on the other hand are a combination of antibiotics, antifungals and corticosteroids in one cream, in an unspecific bid to target infected dermatoses. The use of TAC has constituted a source of corticosteroid misuse and abuse. This study aims to determine the knowledge, attitude, and prescription practices of TACs among doctors in South-Eastern Nigeria. Methodology A section of doctors in the five South Eastern states of Nigeria participated in this study. Data was collected using printed or e-copies of pre-tested questionnaires. Information about sociodemographic, steroid classification, the role of TAC, steroid side effects, duration of prescription of TAC, were sought. Statistical analysis was carried out using the statistical package for social sciences version 20. Good knowledge of TAC was set at >65% and poor knowledge <65%. Results Two hundred and six doctors participated, 59.2% (122) males and 40.8% (84) females. Respondents were distributed as follows: Enugu 28.2% (58), Abia 25.2% (52) Imo 18.4 % (38), Ebonyi 17.5% (36), and Anambra 10.7 % (22). One hundred and seventy-eight (86.4%) work in a tertiary facility while 13.6 % (28) work in primary/secondary facilities. About forty-eight per cent (99) had good knowledge while 51.9 % (107) had poor knowledge. Twenty-five per cent (52) knew that TAC is not useful in managing skin disorders while 66% (136) prescribed TAC as first-line therapy. Conclusion This study has helped uncover the magnitude of poor knowledge and prescription practice of TAC amongst doctors. To curb topical steroid misuse in a given population, doctors should be re-trained.
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Affiliation(s)
- Nigeria Chika Mary Emeka
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Chinaechelum N. Anyanechi
- Dermatology Unit, Department of Internal Medicine, Federal Medical Center, Umuahia, Abia State, Nigeria
| | - Nkiru Onodugo
- Dermatology Division, University of Nigeria Teaching Hospital Ituku Ozala Enugu State, Nigeria
| | - Victor Uduma
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Nnayelugo Ozoh
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | | | - Princewill Udu
- Department of Paediatrics, Iyi-Enu Mission Hospital, Ogidi, Anambra State, Nigeria
| | - Chinwe L. Onyekonwu
- Dermatology Division, University of Nigeria Teaching Hospital Ituku Ozala Enugu State, Nigeria
| | - Gladys Ozoh
- Dermatology Division, University of Nigeria Teaching Hospital Ituku Ozala Enugu State, Nigeria
| | - Uche Rowland Ojinmah
- Dermatology Division, University of Nigeria Teaching Hospital Ituku Ozala Enugu State, Nigeria
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Kalaskar AR, Bhowate RR, Kalaskar RR, Ghonmode S. Novel neem leaves extract mouthwash therapy for oral lichen planus. J Herb Med 2021. [DOI: 10.1016/j.hermed.2020.100408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Didona D, Scarsella L, Fehresti M, Solimani F, Juratli HA, Göbel M, Mühlenbein S, Holiangu L, Pieper J, Korff V, Schmidt T, Sitaru C, Eming R, Hertl M, Pollmann R. Autoreactive Peripheral Blood T Helper Cell Responses in Bullous Pemphigoid and Elderly Patients With Pruritic Disorders. Front Immunol 2021; 12:569287. [PMID: 33841390 PMCID: PMC8027500 DOI: 10.3389/fimmu.2021.569287] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
Bullous pemphigoid (BP) is a prototypic autoimmune disorder of the elderly, characterized by serum IgG autoantibodies, namely anti-BP180 and anti-BP230, directed against components of the basal membrane zone that lead to sub-epidermal loss of adhesion. Pruritus may be indicative of a pre-clinical stage of BP, since a subset of these patients shows serum IgG autoantibodies against BP230 and/or BP180 while chronic pruritus is increasingly common in the elderly population and is associated with a variety of dermatoses. Clinical and experimental evidence further suggests that pruritus of the elderly may be linked to autoimmunity with loss of self-tolerance against cutaneous autoantigens. Thus, the objective of this study was to determine autoreactive T cell responses against BP180 in elderly patients in comparison to patients with BP. A total of 22 elderly patients with pruritic disorders, 34 patients with bullous or non-bullous BP and 34 age-matched healthy controls were included in this study. The level of anti-BP180 and anti-BP230 IgG serum autoantibodies, Bullous Pemphigoid Disease Area Index (BPDAI), and pruritus severity were assessed for all patients and controls. For characterization of the autoreactive T cell response, peripheral blood mononuclear cells were stimulated ex vivo with recombinant BP180 proteins (NH2- and COOH-terminal domains) and the frequencies of BP180-specific T cells producing interferon-γ, interleukin (IL)-5 or IL-17 were subsequently determined by ELISpot assay. Patients with BP showed a mixed Th1/Th2 response against BP180 while autoreactive Th1 cells were identified in a minor subset of elderly patients with pruritic disorders. Furthermore, our T cell characterization revealed that therapeutic application of topical clobetasol propionate ointment in BP patients significantly reduced peripheral blood BP180-specific T cells, along with clinically improved symptoms, strongly suggesting a systemic immunosuppressive effect of this treatment.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Luca Scarsella
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Milad Fehresti
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Farzan Solimani
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hazem A. Juratli
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Manuel Göbel
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Stefan Mühlenbein
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Lily Holiangu
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Josquin Pieper
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Vera Korff
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Thomas Schmidt
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Cassian Sitaru
- Department of Dermatology and Allergology, Universität Freiburg, Freiburg, Germany
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Robert Pollmann
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
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Verma SB, Panda S, Nenoff P, Singal A, Rudramuruthy SM, Uhrlass S, Das A, Bisherwal K, Shaw D, Vasani R. The unprecedented epidemic-like scenario of dermatophytosis in India: I. Epidemiology, risk factors and clinical features. Indian J Dermatol Venereol Leprol 2021; 87:154-175. [PMID: 33769736 DOI: 10.25259/ijdvl_301_20] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/01/2020] [Indexed: 12/21/2022]
Abstract
Dermatophytosis has attained unprecedented dimensions in recent years in India. Its clinical presentation is now multifarious, often with atypical morphology, severe forms and unusually extensive disease in all age groups. We hesitate to call it an epidemic owing to the lack of population-based prevalence surveys. In this part of the review, we discuss the epidemiology and clinical features of this contemporary problem. While the epidemiology is marked by a stark increase in the number of chronic, relapsing and recurrent cases, the clinical distribution is marked by a disproportionate rise in the number of cases with tinea corporis and cruris, cases presenting with the involvement of extensive areas, and tinea faciei.
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Affiliation(s)
| | - Saumya Panda
- Department of Dermatology, Belle Vue Clinic, Kolkata, West Bengal, India,
| | - Pietro Nenoff
- Department of Dermatology and Laboratory Medicine, Laboratory of Medical Microbiology, Moelbis, Germany
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India,
| | - Shivprakash M. Rudramuruthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Silke Uhrlass
- Department of Dermatology and Laboratory Medicine, Laboratory of Medical Microbiology, Moelbis, Germany
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India,
| | - Kavita Bisherwal
- Department of Dermatology, Venereology and Leprosy, Lady Hardinge Medical College and SSK Hospital, Delhi, India,
| | - Dipika Shaw
- Department of Medical Microbiology, PGI, Chandigarh, India,
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Anti-inflammatory drug nanocrystals: state of art and regulatory perspective. Eur J Pharm Sci 2021; 158:105654. [DOI: 10.1016/j.ejps.2020.105654] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
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Makalish TP, Golovkin IO, Oberemok VV, Laikova KV, Temirova ZZ, Serdyukova OA, Novikov IA, Rosovskyi RA, Gordienko AI, Zyablitskaya EY, Gafarova EA, Yurchenko KA, Fomochkina II, Kubyshkin AV. Anti-Rheumatic Effect of Antisense Oligonucleotide Cytos-11 Targeting TNF-α Expression. Int J Mol Sci 2021; 22:ijms22031022. [PMID: 33498456 PMCID: PMC7864158 DOI: 10.3390/ijms22031022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023] Open
Abstract
The urgency of the search for inexpensive and effective drugs with localized action for the treatment of rheumatoid arthritis continues unabated. In this study, for the first time we investigated the Cytos-11 antisense oligonucleotide suppression of TNF-α gene expression in a rat model of rheumatoid arthritis induced by complete Freund’s adjuvant. Cytos-11 has been shown to effectively reduce peripheral blood concentrations of TNF-α, reduce joint inflammation, and reduce pannus development. The results achieved following treatment with the antisense oligonucleotide Cytos-11 were similar to those of adalimumab (Humira®); they also compared favorably with those results, which provides evidence of the promise of drugs based on antisense technologies in the treatment of this disease.
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Affiliation(s)
- Tatyana P. Makalish
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Ilya O. Golovkin
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
- Correspondence: (I.O.G); (V.V.O.); Tel.: +7-978-814-68-66 (V.V.O.)
| | - Volodymyr V. Oberemok
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Russia; (K.V.L.); (O.A.S.); (I.A.N.); (R.A.R.)
- Nikita Botanical Gardens—National Scientific Centre Russian Academy of Sciences, 298648, Simferopol, Russia
- Correspondence: (I.O.G); (V.V.O.); Tel.: +7-978-814-68-66 (V.V.O.)
| | - Kateryna V. Laikova
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Russia; (K.V.L.); (O.A.S.); (I.A.N.); (R.A.R.)
- Research Institute of Agriculture of Crimea, 295005 Simferopol, Russia
| | - Zenure Z. Temirova
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Olesya A. Serdyukova
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Russia; (K.V.L.); (O.A.S.); (I.A.N.); (R.A.R.)
| | - Ilya A. Novikov
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Russia; (K.V.L.); (O.A.S.); (I.A.N.); (R.A.R.)
- Research Institute of Agriculture of Crimea, 295005 Simferopol, Russia
| | - Roman A. Rosovskyi
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Russia; (K.V.L.); (O.A.S.); (I.A.N.); (R.A.R.)
| | - Andrey I. Gordienko
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Evgeniya Yu. Zyablitskaya
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Elvina A. Gafarova
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Kseniya A. Yurchenko
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Iryna I. Fomochkina
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Anatoly V. Kubyshkin
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
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Kalaskar AR, Bhowate RR, Kalaskar RR, Walde SR, Ramteke RD, Banode PP. Efficacy of Herbal Interventions in Oral Lichen Planus: A Systematic Review. Contemp Clin Dent 2020; 11:311-319. [PMID: 33850395 PMCID: PMC8035840 DOI: 10.4103/ccd.ccd_320_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Oral lichen planus (OLP) is a chronic autoimmune condition requiring prompt treatment to alleviate the signs and symptoms. There is weak evidence emphasizing the efficacy of any one therapy. Steroids, of all the therapies, have proved to be effective and hence considered as the standard care for OLP. However, the complications associated with it further worsen the patient's condition. Alternative safe approaches such as herbal interventions (HIs) have been tried in OLP. Their efficacies could only be evaluated from properly designed research protocols such as randomized controlled trials (RCTs). The present systematic review aims to assess the efficacy of HIs compared to steroids in RCTs involving OLP. Materials and Methods: An extensive search for HIs in OLP was conducted in PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and gray literature. Eight studies fulfilled the eligibility criteria. Results: In all the studies, clinical severity was significantly reduced in within-group comparisons, whereas between-group comparisons showed nonsignificant results, except for total glucosides of paeony capsules. Conclusion: Efficacy of herbal therapy in OLP should be weighed against the high bias in the studies.
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Affiliation(s)
- Ashita R Kalaskar
- Department of Oral Medicine and Radiology, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Rahul R Bhowate
- Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Ritesh R Kalaskar
- Department of Pedodontics and Preventive Dentistry, Government Dental College and Hospital, Nagpur, Maharashtra, India
| | - Sheelpriya R Walde
- Department of Quality Assurance, Gurunanak College of Pharmacy, Nagpur, Maharashtra, India
| | - Rachana D Ramteke
- Department of Kaumar Hritya, Shri Ayurvedic College and Hospital, Nagpur, Maharashtra, India
| | - Priyanka P Banode
- Department of Periodontology, Sharad Pawar Dental College, DMIMS DU, Sawangi (Meghe), Wardha, Maharashtra, India
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Shrestha S, Joshi S, Bhandari S. Prevalence of Misuse of Topical Corticosteroid among Dermatology Outpatients. JNMA J Nepal Med Assoc 2020; 58:834-838. [PMID: 34506417 PMCID: PMC7775011 DOI: 10.31729/jnma.5271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Topical corticosteroids misuse has become one of the burning issues in many countries across the globe. They are known to cause a myriad of adverse effects which include local effects commonly and systemic effects rarely. In dermatology practice, one of the common problems we see these days are steroid-induced and steroid aggravated dermatoses. So, this study was done to find the prevalence of misuse of topical corticosteroid among dermatology outpatients. Methods: A descriptive cross-sectional study was done in the outpatient department of dermatology at a tertiary care hospital for 18 months. Ethical clearance was obtained from the Institutional Review Committee of NMCTH (Reference no. 029-076/077). Convenient sampling was done. Statistical Package for the Social Sciences (SPSS) version 16 was used to tabulate the data and analyze the results. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 19464 patients, 614 (3.15%) (2.91%-3.39% at 95% Confidence Interval) gave a history of applying steroid containing creams. Among them, 220 (35.8%) belonged to the age group 21-30 years. Dermatophytoses were the skin disease where TCS was most commonly misused followed by melasma in 425 (69.2%) and 115 (18.7%) respectively. Beclomethasone was the steroid preparation that was misused in the maximum number of patients in 271 (44.1%). Some form of adverse effects was seen in 554 (88.6%) patients. Conclusions: Non-prescription sale of topical corticosteroids is the major cause of topical corticosteroids abuse in Nepal. Creating awareness among the prescribers as well as the patients is the current need.
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Affiliation(s)
- Shristi Shrestha
- Department of Dermatology, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
| | - Smita Joshi
- Department of Dermatology, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
| | - Sajana Bhandari
- Department of Dermatology, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
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Inflammation, HIV, and Immune Quiescence: Leveraging on Immunomodulatory Products to Reduce HIV Susceptibility. AIDS Res Treat 2020; 2020:8672850. [PMID: 33178456 PMCID: PMC7609152 DOI: 10.1155/2020/8672850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/23/2020] [Accepted: 10/15/2020] [Indexed: 12/29/2022] Open
Abstract
The relationship between inflammation and HIV has been a focus of research over the last decade. In HIV-infected individuals, increased HIV-associated immune activation significantly correlated to disease progression. While genital inflammation (GI) has been shown to significantly increase the risk of HIV acquisition and transmission, immune correlates for reduced risk remain limited. In certain HIV-exposed seronegative individuals, an immune quiescent phenotype characterized reduced risk. Immune quiescence is defined by specific, targeted, highly regulated immune responses that hinder overt inflammation or immune activation. Targeted management of inflammation, therefore, is a plausible strategy to mitigate HIV risk and slow disease progression. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as hydroxychloroquine and aspirin have shown encouraging preliminary results in low-risk women by reducing systemic and genital immune activation. A topical NSAID, containing ibuprofen, is effective in treating vulvovaginal inflammation. Additionally, the glucocorticoids (GCs), prednisolone, and dexamethasone are used to treat HIV-associated immune activation. Collectively, these data inform on immune-modulating drugs to reduce HIV risk. However, the prolonged use of these pharmaceutical drugs is associated with adverse effects, both systemically and to a lesser extent topically. Natural products with their reduced side effects coupled with anti-inflammatory properties render them viable options. Lactic acid (LA) has immunomodulatory properties. LA regulates the genital microbiome by facilitating the growth of Lactobacillus species, while simultaneously limiting bacterial species that cause microbial dysbiosis and GI. Glycerol monolaurate, besides being anti-inflammatory, also inhibited SIV infections in rhesus macaques. The proposed pharmaceutical and natural products could be used in combination with either antiretrovirals for treatment or preexposure prophylaxis for HIV prevention. This review provides a summary on the associations between inflammation, HIV risk, and disease progression. Furthermore, we use the knowledge from immune quiescence to exploit the use of pharmaceutical and natural products as strategic interventions to manage inflammation, toward mitigating HIV infections.
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Hesse R, Seedat F, Raal FJ, Snyman T, George JA. Cryptogenic Cushing Syndrome Due to a White Lie. Clin Chem 2020; 66:658-663. [PMID: 32353140 DOI: 10.1093/clinchem/hvaa035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/27/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Reinhardt Hesse
- Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa, University of the Witwatersrand, Johannesburg, South Africa
| | - Faheem Seedat
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frederick J Raal
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tracy Snyman
- Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa, University of the Witwatersrand, Johannesburg, South Africa
| | - Jaya A George
- Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa, University of the Witwatersrand, Johannesburg, South Africa
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Gether L, Thyssen JP, Gyldenløve M, Hartmann B, Holst JJ, Foghsgaard S, Vilsbøll T, Knop FK. Normal insulin sensitivity, glucose tolerance, gut incretin and pancreatic hormone responses in adults with atopic dermatitis. Diabetes Obes Metab 2020; 22:2161-2169. [PMID: 32686877 DOI: 10.1111/dom.14146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
AIM To examine whether adults with mild to moderate atopic dermatitis (AD) had reduced insulin sensitivity and/or exhibited other gluco-metabolic disturbances compared with carefully matched healthy controls. MATERIALS AND METHODS Sixteen adult, non-obese, non-diabetic patients with mild to moderate AD and 16 gender-, age- and body mass index (BMI)-matched healthy controls underwent a hyperinsulinaemic euglycaemic clamp (insulin infusion rate: 40 mU/m2 /minute) and an oral glucose tolerance test (OGTT) with frequent blood sampling for gut and pancreatic hormones. RESULTS The two groups were similar in age (33 ± 3 vs. 33 ± 3 years, mean ± standard error of the mean [SEM]), gender (56% women), BMI (24.5 ± 0.7 vs. 24.4 ± 0.7 kg/m2 ), physical activity level, fasting plasma glucose and HbA1c. Patients with AD had a mean Eczema Area and Severity Index score of 8.5 ± 1.0 (moderate disease) and a mean AD duration of 28 ± 3 years. During the OGTT, circulating glucose, insulin, C-peptide, glucagon and glucose-dependent insulinotropic polypeptide, respectively, were similar in the two groups, except glucagon-like peptide-1, which was higher in patients with AD. The clamp showed no differences in insulin sensitivity between groups (M-value 9.2 ± 0.6 vs. 9.8 ± 0.8, P = .541, 95% CI -1.51; 2.60), or circulating insulin, C-peptide and glucagon levels. CONCLUSIONS Using OGTT and the hyperinsulinaemic euglycaemic clamp technique, we found no difference in insulin sensitivity or other gluco-metabolic characteristics between patients with mild to moderate AD and matched healthy controls, suggesting that the inflammatory skin disease AD has little or no influence on glucose metabolism.
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Affiliation(s)
- Lise Gether
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Gyldenløve
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Signe Foghsgaard
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Tina Vilsbøll
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
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Purser JD, Riachy R, Blanton LS, Belalcazar LM. Rapid Development of Iatrogenic Cushing Syndrome In A Patient On Ritonavir: The Adverse Metabolic Consequence of Topical Steroid Use. AACE Clin Case Rep 2020; 6:e346-e348. [DOI: 10.4158/accr-2020-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/10/2020] [Indexed: 11/15/2022] Open
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Khademi A, Mansuri P, Pahlevan D, Bozorgi M, Nasiri M, Hejazi S, Azizian Z, Shirbeigi L. Efficacy of Pumpkin Ointment in Treatment of Chronic Hand Eczema: A Randomized, Active-Controlled, Double Blind Clinical Trial. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1339-1347. [PMID: 33083301 PMCID: PMC7548497 DOI: 10.18502/ijph.v49i7.3588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Hand Eczema (HE) is chronic skin disease with a high prevalence in population. It has negative impact on the quality of life. Due to the public interest in herbal remedies, we attempt to assess the efficacy of pumpkin ointment in treatment of chronic HE in this research. Methods This study was conducted in an outpatient clinic at Imam-Khomeini Hospital in Tehran (Iran) from May 2015 to Nov 2016. We performed a double-blind trial on 60 patients with chronic HE randomized to four groups included pumpkin, betamethasone, eucerin and almond ointment (n=15 for each group) for 28 days. Patients were ordered to apply ointments twice a day. Hand Eczema Severity Index (HECSI) and Dermatology Life Quality Index (DLQI) of the patients were evaluated by a dermatologist on the 1st, 14th and 28th d after the start of treatment. Results Patients' DLQI scores in pumpkin and betamethasone group was significant and pumpkin group showed a better response in quality of life (P=0.001). Betamethasone and pumpkin ointment were effective and showed significant improvement compared with almond and eucerin and reduce HECSI scores (P=0.002 and P=0.012 respectively). Betamethasone ointment outcome on HECSI scores in comparison with topical pumpkin was significant (P<0.001). No clinically adverse effects were observed. Conclusion Although pumpkin ointment showed a better response in patients' DLQI in HE but it was less effective than betamethasone in decreasing HECSI.
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Affiliation(s)
- Alemeh Khademi
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Mansuri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Daryoush Pahlevan
- Research Center for Social Determinants of Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Mahbubeh Bozorgi
- Department of Traditional Pharmacy, School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Biostatistics, School of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Hejazi
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Azizian
- Department of Dermatology, Iran University of Medical Sciences, Tehran, Iran
| | - Laila Shirbeigi
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Cromarty R, Sigal A, Liebenberg LJ, Mckinnon LR, Abdool Karim SS, Passmore JAS, Archary D. Betamethasone induces potent immunosuppression and reduces HIV infection in a PBMC in vitro model. J Investig Med 2020; 69:28-40. [PMID: 33004468 PMCID: PMC7803916 DOI: 10.1136/jim-2020-001424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 01/15/2023]
Abstract
Genital inflammation is an established risk factor for increased HIV acquisition risk. Certain HIV-exposed seronegative populations, who are naturally resistant to HIV infection, have an immune quiescent phenotype defined by reduced immune activation and inflammatory cytokines at the genital tract. Therefore, the aim of this study was to create an immune quiescent environment using immunomodulatory drugs to mitigate HIV infection. Using an in vitro peripheral blood mononuclear cell (PBMC) model, we found that inflammation was induced using phytohemagglutinin and Toll-like receptor (TLR) agonists Pam3CSK4 (TLR1/2), lipopolysaccharide (LPS) (TLR4) and R848 (TLR7/8). After treatment with anti-inflammatory drugs, ibuprofen (IBF) and betamethasone (BMS), PBMCs were exposed to HIV NL4-3 AD8. Multiplexed ELISA was used to measure 28 cytokines to assess inflammation. Flow cytometry was used to measure immune activation (CD38, HLA-DR and CCR5) and HIV infection (p24 production) of CD4+ T cells. BMS potently suppressed inflammation (soluble cytokines, p<0.05) and immune activation (CD4+ T cells, p<0.05). BMS significantly reduced HIV infection of CD4+ T cells only in the LPS (0.98%) and unstimulated (1.7%) conditions (p<0.02). In contrast, IBF had minimal anti-inflammatory and immunosuppressive but no anti-HIV effects. BMS demonstrated potent anti-inflammatory effects, regardless of stimulation condition. Despite uniform immunosuppression, BMS differentially affected HIV infection according to the stimulation conditions, highlighting the complex nature of these interactions. Together, these data underscore the importance of interrogating inflammatory signaling pathways to identify novel drug targets to mitigate HIV infection.
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Affiliation(s)
- Ross Cromarty
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
| | - Alexander Sigal
- Africa Health Research Institute (AHRI), Durban, KwaZulu-Natal, South Africa
- Max-Planck-Institute for Infection Biology, Berlin, Germany
| | - Lenine Julie Liebenberg
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Lyle Robert Mckinnon
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salim Safurdeen Abdool Karim
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jo-Ann Shelly Passmore
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Derseree Archary
- Mucosal Immunology Laboratory, CAPRISA, Durban, KwaZulu-Natal, South Africa
- Department of Medical Microbiology, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Ramos Campos EV, Proença PLDF, Doretto-Silva L, Andrade-Oliveira V, Fraceto LF, de Araujo DR. Trends in nanoformulations for atopic dermatitis treatment. Expert Opin Drug Deliv 2020; 17:1615-1630. [PMID: 32816566 DOI: 10.1080/17425247.2020.1813107] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Immunological skin dysfunctions trigger the synthesis and release of inflammatory cytokines, which induce recurrent skin inflammation associated with chronic itching, inefficient barrier behavior, and reduced skin hydration. These features characterize a multifactorial chronic inflammatory disease atopic dermatitis (AD). AD therapy includes anti-inflammatory drugs and immunosuppressors as well as non-pharmacological alternatives such as emollients, moisturizers, and lipids (ceramides, phospholipids) for modulating the skin hydration and the barrier repair. However, these treatments are inconvenient with low drug skin penetration and insufficient maintenance on the application site. AREAS COVERED Nanotechnology-based therapies can be a great strategy to overcome these limitations. Considering the particular skin morphological organization, SC lipid matrix composition, and immunological functions/features related to nanocarriers, this review focuses on recent developments of nanoparticulate systems (polymeric, lipid-based, inorganic) as parent or hybrid systems including their chemical composition, physico-chemical and biopharmaceutical properties, and differential characteristics that evaluate them as new effective drug-delivery systems for AD treatment. EXPERT OPINION Despite the several innovative formulations, research in nanotechnology-based carriers should address specific aspects such as the use of moisturizers associated to pharmacological therapies, toxicity studies, scale-up production processes and the nanocarrier influence on immunological response. These approaches will help researchers choose the most appropriate nanocarrier system and widen nanomedicine applications and commercialization.
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Affiliation(s)
| | - Patrícia Luiza De Freitas Proença
- Department of Environmental Engineering, São Paulo State University - UNESP, Institute of Science and Technology , Sorocaba, SP, Brazil
| | - Lorena Doretto-Silva
- Human and Natural Sciences Center, Federal University of ABC , Santo André, SP, Brazil
| | | | - Leonardo Fernandes Fraceto
- Department of Environmental Engineering, São Paulo State University - UNESP, Institute of Science and Technology , Sorocaba, SP, Brazil
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Mohd Ali N, Lee CC, Mohd Akhir NSN, Ahmad Izani AS, Leong CT, Muneswarao J, Verma AK. Effectiveness of color and picture labeling in improving the knowledge on topical medications among patients with psoriasis: A randomized controlled trial. J Pharm Bioallied Sci 2020; 12:201-209. [PMID: 32742120 PMCID: PMC7373111 DOI: 10.4103/jpbs.jpbs_140_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/23/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022] Open
Abstract
Aim and Objective: The success of topical treatment in patients with psoriasis is still below par in Malaysia. The contributing factors include patients’ understanding and knowledge about prescribed topical medications. The aim of this study was to assess the effectiveness of color and picture labeling (C and P labeling) in improving the knowledge about topical medications among patients with psoriasis. Materials and Methods: An unblinded randomized controlled trial was undertaken at the dermatology clinic of a tertiary care hospital. Consent from the patients fulfilling inclusion criteria were obtained, and they were included in this study. They were randomized into two groups, namely Gp-1 (C and P labeling) and Gp-2 (conventional labeling). Both groups were assessed at week 0, 6, and 12 (visit 1, 2, and 3) using knowledge assessment list and psoriasis severity assessment score. For visit 2 (week 6), reinforcement of their understanding of topical treatment was performed. Results: A total of 101 patients were recruited. Only 91 of them completed the study. The mean ages were 44.52 (±16.61) and 45.49 (±15.84) years, with 70.3% males and approximately half Malay ethnics. The changes of knowledge and comparison of Topical Application Assessment Score between the groups showed an incremental raise of significance with every visit (P = 0.006 [week 1], 0.004 [week 6], and 0.002 [week 12]). Psoriasis Area and Severity Index 75 could not draw any conclusion as patients who achieved >75% improvement were inadequate. Conclusion: C and P labeling was effective in improving the understanding and knowledge of patients with psoriasis. Both groups showed improvement in body surface area and Dermatology Life Quality Index for every visit; however, it was statistically insignificant.
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Affiliation(s)
- Norazlima Mohd Ali
- Department of Dermatology, Hospital Pulau Pinang, Penang, Ministry of Health, Malaysia
| | - Chan Chin Lee
- Department of Dermatology, Hospital Pulau Pinang, Penang, Ministry of Health, Malaysia
| | | | | | - Chin Tho Leong
- Clinical Research Centre, Hospital Pulau Pinang, Penang, Ministry of Health, Malaysia
| | - Jaya Muneswarao
- Department of Pharmacy, Hospital Kulim, Kedah, Ministry of Health, Malaysia.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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