Topical Boswellic acids for treatment of photoaged skin

Boswellic acids (BAs) are pentacyclic triterpenes extracted from the gum resins of the tropical tree Boswellia serrata. They are orally administered in traditional Indian medicine for the treatment of several inflammatory disease and cancer because of their anti-inflammatory and immunomodulatory activities as well as stimulatory effects on fibroblasts. The present authors have investigated efficacy, tolerability, and safety of a base cream containing 0.5% BAs in the treatment of clinical manifestations of photoaging of facial skin with a randomized, double-blind, placebo-controlled, split-face study. Fifteen female volunteers applied the creams with or without BAs on the half sides of the face once daily for 30 days. Significant improvements of the Dover's global score for photoaging, tactile roughness, and fine lines, as well as, with noninvasive diagnostic techniques, an increase of elasticity, a decrease of sebum excretion, and a change of echographic parameters were observed with topical BAs in comparison with placebo. The treatment was always well tolerated without adverse effects. The present findings seem to indicate that topical application of BAs may represent a suitable treatment option for selected features of skin photoaging.

Effects of topical boswellic acid on photo and age-damaged skin: clinical, biophysical, and echographic evaluations in a double-blind, randomized, split-face study

Boswellic acids (BAs) are pentacyclic triterpenes with strong anti-inflammatory activity; their most important source is the extract of the gum resin of Boswellia serrata, a tropical tree that grows in India and Africa. In the present randomized, double-blind, split-face, comparative study we have assessed efficacy, tolerability, and safety of a base cream containing 0.5 % BAs as compared to the same cream without these active ingredients in the treatment of clinical manifestations of photoaging of facial skin. Fifteen female volunteers were enrolled; they applied creams once daily for 30 days. At baseline, at the end of the treatment, and after a 2-month follow-up, clinical findings were assessed according to the Dover classification scale for photoaging and by biophysical and ecographic measurements. We registered a significant improvement of tactile roughness and fine lines in the half side of the face treated with BAs; noninvasive instrumental diagnostic investigations showed an improvement of elasticity, a decrease of sebum excretion, and a change of echographic parameters suggesting a reshaping of dermal tissue. The treatment was always well tolerated without adverse effects. The present findings seem to indicate that the topical application of BAs may represent a suitable treatment option for selected features of skin photoaging.

Clinical and echographic analysis of photodynamic therapy using methylaminolevulinate as sensitizer in the treatment of photodamaged facial skin

BACKGROUND AND OBJECTIVE

Photodynamic therapy (PDT) using aminolevulinic acid (ALA) has been previously investigated in the treatment of photodamaged skin. The aim was to assess efficacy and tolerability of methylaminolevulinate (MAL) as a substitute for ALA in PDT treatment of actinic keratosis (AK) and photoaging.

STUDY DESIGN/MATERIALS AND METHODS

Twenty patients with multiple (n = 137) AKs and severe photodamage of the face were treated. Metvix (Galderma, France) was applied under occlusion for 3 hours before exposure to 37 J/cm(2) of red light (Aklilite CL 128, Photocure, Norway). Two treatments were given at monthly intervals.

RESULTS

The clearance rate of AKs was 88.3%, and global score which we use to rate photoaging, mottled hyperpigmentation, fine lines, roughness, and sallowness of the skin showed improvement, but deep wrinkles, teleangiectasia, facial erythema, and sebaceous gland hypertrophy did not change. The treatments were well tolerated. High-resolution echography showed an increase in skin thickness, pixels count and area, as well as a reduction of the subepidermal low-echogenic band (SLEB) thickness.

CONCLUSION

MAL-PDT is an effective treatment for multiple AKs. In addition, it improves clinical signs of photodamage of the surrounding skin.

Photodynamic therapy of interdigital mycoses of the feet with topical application of 5-aminolevulinic acid

BACKGROUND

Findings of in vitro studies have demonstrated that dermatophytes and yeasts can be effectively photosensitized after topical delivery of 5-aminolevulinic acid (ALA). This procedure, called photodynamic therapy (PDT), seems to lack mutagenic activity and hazard of selection of drug-resistant strains.

METHODS

Twenty percent ALA preparation in Eucerin cream was applied under an occlusive dressing to skin lesions of nine patients with clinical and microbiological evidence of interdigital mycosis of the feet. After 4 h, lesions were irradiated with 75 J/cm(2) of broad-band red light. Interdigital lesions of the other foot served as control (treated with only light or only ALA). After 7 days from the first treatment, no further treatment was delivered if lesions were not clinically evident and direct microscopic examination was negative. Otherwise, three additional weekly treatments were delivered. Four weeks after the last treatment, patients had a final follow-up clinical and laboratory examination.

RESULTS

Clinical and microbiological recovery was seen in six out of nine patients after one (four cases) or four (two cases) treatments. However, after 4 weeks, recurrences were seen in four patients. Overall tolerability was always good.

CONCLUSION

Under the conditions employed in the present study, ALA-PDT had good therapeutic effects on interdigital mycosis of the feet. However, recurrences were quick. In vivo environmental conditions, i.e. temperature, humidity and pH of the interdigital skin, could induce a poor cell uptake of ALA and a deficient biosynthesis of photosensitizing protoporphyrin IX. In addition, the irregular tridimensional shape of this peculiar anatomical area could lead to a non-uniform delivery of light and/or ALA cream. However, the present results can stimulate further studies on the PDT of superficial skin mycoses.

Prospects for ultraviolet A1 phototherapy as a treatment for chronic cutaneous graft-versus-host disease

BACKGROUND AND OBJECTIVES

Standard or investigative immunosuppressive therapies for cutaneous chronic graft-versus-host disease (GVHD) may prove not only ineffective but also cause serious adverse effects. Repeated exposure of the skin to ultraviolet radiation in the wavelength range 340-400 nm (so-called ultraviolet A1) was recently reported to have a strong local (intracutaneous) immunomodulatory activity. This study was undertaken to evaluate efficacy and safety of this phototherapy.

DESIGN AND METHODS

Nine patients with cutaneous (4 lichenoid and 5 sclerodermoid) GVHD and mild or no other organ involvement were enrolled. All patients had developed serious drug toxicity and/or opportunistic infections. Phototherapy was administered three times a week.

RESULTS

Complete remission was seen in 5 (2 lichenoid and 3 sclerodermoid) cases and a partial improvement in 4 (2 lichenoid and 2 sclerodermoid) after having received 15.8+/-3.8 (lichenoid GVHD) or 21.6+/-8.0 (sclerodermoid GVHD) sessions of phototherapy. Adverse effects were not registered. At follow-up (range: 6-25 months), two patients with sclerodermoid lesions relapsed after 5 months but responded to another treatment cycle. Patients with lichenoid GVHD showed relapses within one month and prolonged maintenance phototherapy was needed. Problems of drug toxicity and opportunistic infections improved as phototherapy allowed the reduction or interruption of systemic drug therapies.

INTERPRETATION AND CONCLUSIONS

Ultraviolet A1 phototherapy may be considered as an appropriate therapeutic approach for sclerodermoid GVHD with no or mild involvement of internal organs. Patients with lichenoid GVHD should be treated only if they develop serious adverse effects to immunosuppressive therapies and opportunistic infections because of the carcinogenic hazard of high cumulative doses of ultraviolet A1 radiation.

Photosensitive erythema multiforme and erythema multiforme-like polymorphous light eruption

BACKGROUND

Photosensitive erythema multiforme (EM) is a rare disorder. It usually occurs only if a herpes virus infection or ingestion of drugs precedes exposure to sunlight in selected patients.

METHODS

We report a 37-year-old man who had recurrent EM eruptions following sun exposures over a period of 20 years. Lesions were prevalently located on exposed skin, but unexposed skin and mucosa of the oropharynx were also affected. The patient had poor tolerance to sunlight and denied having herpes simplex infection or using drugs.

RESULTS

Provocative phototest induced clinically and histologically similar lesions at low dose thresholds of UVA (10 J/cm2) and UVB (100 mJ/cm2).

CONCLUSION

On the basis of clinical and histological findings and results of phototesting, a diagnosis of photosensitive EM was made. The EM-like variant of polymorphous light eruption is discussed in the differential diagnosis.

Cinnarizine is a useful and well-tolerated drug in the treatment of acquired cold urticaria (ACU)

Old generation H1-type antihistamines are the standard therapeutic option for acquired cold urticaria (ACU), but adverse effects are common. New antihistamines are well tolerated but efficacy is often poor. The present study aims to evaluate efficacy and safety of cinnarizine in the treatment of ACU patients intolerant to old antihistamines and resistant to new drugs. We studied 14 patients (4 males and 10 females). Mean duration of the disease was 48.9 (range 7-102) months. Cold cube test was positive in 78.6 % of patients. Cold urticaria was idiopathic in 10 (71.4 %) patients. Cryoglobulins were detected in the serum of 4 cases (28.6 %). Cinnarizine (25 mg t.i.d.) was administered for 3 months, and then it was gently tapered off and stopped within 2 months. A complete or good response was obtained in 8 (57.1 %) and 2 (14.3 %) patients, respectively. Only two patients were unresponsive (21.4 %). Tapering off or stopping cinnarizine was followed by the relapse of cold urticaria in 7 cases (50.0 %). These patients were amenable to a second treatment cycle. Six patients (42.9 %) had a persistent remission. A patient interrupted the therapy because of severe vertigo. Three patients reported mild and transitory adverse effects including epigastralgia, weight gain and drowsiness. In conclusion, cinnarizine at high doses may be considered as an effective and well-tolerated treatment for ACU.

Medium-dose ultraviolet A1 therapy for pityriasis lichenoides et varioliformis acuta and pityriasis lichenoides chronica

BACKGROUND

Ultraviolet A1 (340-400 nm) was found to be effective in the treatment of cutaneous T-cell-mediated diseases.

OBJECTIVE

The purpose of the present study was to assess the efficacy of UVA1 phototherapy for pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC).

METHODS

Eight patients (3 with PLEVA and 5 with PLC) received 60 J/cm(2) UVA1 daily until remission. Four patients also had lesions inaccessible to UVA1 that were used as control lesions. Immunocytologic studies of skin infiltrates and circulating T cells were done.

RESULTS

Six patients showed complete clinical and histologic recovery. Two patients with PLC had a partial improvement. Unirradiated control lesions never improved. Serious short-term adverse effects were not encountered. No effects on circulating lymphocytes were reported.

CONCLUSION

UVA1 therapy is an effective and well-tolerated treatment for PLEVA and PLC. The therapeutic activity seems to be related to direct effects on cutaneous inflammatory infiltrates because the lesions in nonexposed cutaneous areas did not respond.