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Ointment
Kinds of Ointment Selected AbstractsFlow injection analysis of tetracyclines using inhibited Ru(bpy)32+/tripropylamine electrochemiluminescence systemLUMINESCENCE: THE JOURNAL OF BIOLOGICAL AND CHEMICAL LUMINESCENCE, Issue 1 2005Yong-Qiang Pang Abstract Tetracyclines (TCs) were found to strongly inhibit the electrochemiluminescence (ECL) from the Ru(bpy)32+,tripropylamine system when a working Pt electrode was maintained at 1.05 V (vs. Ag[sol ]AgCl) in pH 8.0 carbonate buffer solution. On this basis, a flow injection (FI) procedure with inhibited electrochemiluminescence detection has been developed for the determination of tetracycline (TC) and oxytetracycline (OTC). Under the optimized condition, the linear ranges of 2.0 × 10,8,1.0 × 10,5 and 1.0 × 10,8,1.0 × 10,5 g[sol ]mL and the detection limits of 4.0 × 10,9 and 3.8 × 10,9 g[sol ]mL were obtained for TC and OTC, respectively. The relative standard deviations (RSD) were 0.68% and 1.18% for 5.0 × 10,7 g[sol ]mL TC and OTC (n = 13), respectively. The method showed higher sensitivity than most of the reported methods. It was successfully applied to the determination of tetracycline in a Chinese proprietary medicine, Tetracyclini and Cortisone Eye Ointment, and the residues of tetracycline in honey products. The inhibition mechanism has been proposed due to an energy transfer between electrogenerated Ru(bpy)32+* and benzoquinone derivatives at the electrode surface. Copyright © 2005 John Wiley & Sons, Ltd. [source] The Safety and Efficacy of Tacrolimus Ointment in Pediatric Patients with Atopic DermatitisPEDIATRIC DERMATOLOGY, Issue 5 2010Alexandra D. McCollum M.D. It is a chronic disorder, characterized by intermittent flares and phases of remission. Treatment regimens often require multiple therapies. These can vary between patients, and in an individual patient, depending on the state of disease. The traditional treatment for AD flares is topical corticosteroids, which are fast acting and effective for relief of symptoms, but may cause adverse effects, including those resulting from systemic absorption, particularly in children. Topical calcineurin inhibitors (TCIs) are alternative treatments for AD. Tacrolimus ointment, a TCI, is approved for patients aged 2 years and older. Multiple studies have shown that tacrolimus is effective for short-term relief of symptoms in pediatric patients with AD. Long-term trials have demonstrated that the effectiveness of tacrolimus is maintained for up to 4 years in children. Additional studies have revealed that long-term intermittent use of tacrolimus as part of maintenance therapy can prevent AD flares. Tacrolimus has a low potential for systemic accumulation, and analysis of long-term studies indicates that it has a good safety profile. Treatment with tacrolimus, alone or in combination with topical corticosteroids for acute flares, may be a useful option for long-term management of AD in pediatric patients. [source] Successful Treatment of Pediatric Psoriasis with Indigo naturalis Composite OintmentPEDIATRIC DERMATOLOGY, Issue 5 2006Yin-Ku Lin M.D. Many modes of therapy are currently in use but the disease is often resistant to treatment owing to the unacceptable toxicity that leads to poor compliance. Therefore, to develop an alternative treatment is indispensable. Traditional Chinese medicine has been documented for over 1000 years to provide various effective treatments for inflammatory skin diseases. Herein, we report an 8-year-old boy with recalcitrant pediatric psoriasis who, after multiple treatment failures with conventional antipsoriatic medications, showed remarkable clinical improvement with 8 weeks of topical treatment with Indigo naturalis composite ointment. Remission has lasted for over 2 years until now. Our patient's response suggests that topical Indigo naturalis composite ointment may provide a safe and effective alternative treatment for pediatric psoriasis. [source] Rheological properties of three different vitamin D ointments and their clinical perception by patients with mild to moderate psoriasisJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 2005JP Marty ABSTRACT Background, Ointments, classically used for the treatment of dermatological diseases, are monophasic viscous semisolid formulations. According to the proportion of their compounds, they have physicochemical and organoleptic properties and when applied on skin show a specific behaviour allowing to be spread more or less easily. Objective, To measure in vitro rheological characteristics of three vitamin D derivative ointments prescribed for the treatment of psoriasis, and to compare their viscosity and clinical acceptability when applied on the diseased skin. Methods, Rheological characteristics of tacalcitol 4 µg/g, calcipotriol 50 µg/g and calcitriol 3 µg/g ointments were assessed by measuring the oscillatory viscoelastic parameters and the permanent flow analysis. Clinical acceptability was studied in 20 psoriatic male or female subjects, aged 18 years or older. A survey evaluated the acceptability of calcitriol vs. tacalcitol and calcipotriol. Questions included information about fluidity, spreading capacity and stickiness after application. Results, We demonstrated that viscoelastic parameters were four times higher for ointment tacalcitol than for calcipotriol and calcitriol, corresponding to a higher consistency of ointment tacalcitol compared to calcipotriol and calcitriol showing both similar results; better fluidity was demonstrated by calcitriol than by tacalcitol and calcipotriol. Comparable results were obtained for the quality to be spread. The sensation of stickiness, significantly different between tacalcitol and calcitriol, was not different between calcipotriol and calcitriol. Conclusion, The above results confirm the relationship between rheological in vitro and sensorial in vivo results: variations between different formulations may have an important influence on non-adherence and treatment failure. [source] Characterization of Vernix Caseosa as a Natural Biofilm: Comparison to Standard Oil-Based OintmentsPEDIATRIC DERMATOLOGY, Issue 4 2000Maria Imelda B. Bautista M.D. Such infants have a structurally immature stratum corneum and lack a surface coating of vernix caseosa. In this study we examined the short-term effects of topical application of vernix caseosa to human skin and contrasted these effects with commonly used ointments and water-in-oil emulsions. Specifically, vernix, Eucerin®, Aquaphor®, and petrolatum were applied to the volar skin surface of adult volunteers. Surface electrical capacitance (SEC) and transepidermal water loss (TEWL) were measured as indices of surface hydration. Sorption-desorption profiles were performed to determine skin surface hydrophobicity. Particular attention was given to monitoring the acute (0,120 minutes) changes following vernix treatment in order to compare these effects with earlier reports on the rate of skin surface drying in newborn infants following birth. Immediately after vernix application there was an increase in the rate of water loss from the skin surface. Relative to control skin and skin treated with the ointments and water-in-oil emulsions, the application of vernix to freshly bathed human skin resulted in a unique profile of temporal change in baseline surface hydration, moisture accumulation, and water-holding capacity. These results demonstrate major differences between human vernix and standard oil-based topical ointments. The results provide a framework for discussing the various properties of topical barriers applied to the very low birthweight infant. [source] Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurseBRITISH JOURNAL OF DERMATOLOGY, Issue 3 2003M.J. Cork Summary Background The failure of patients to take medicines in a way that leads to clinical benefit is a major challenge. A consensus has emerged that, on average, compliance sufficient to obtain therapeutic objectives occurs about half the time, with noncompliance contributing to therapeutic failure in the other half. These figures refer to simple oral regimens. There has been little work assessing compliance/concordance with complex treatment regimens for atopic eczema. Asthma schools led by specialist nurses have been shown to improve knowledge, use of therapies and clinical outcome. Objectives To determine the effect of education and demonstration of topical therapies by specialist dermatology nurses on therapy utilization and severity of atopic eczema. Methods Fifty-one children with atopic eczema attending a paediatric dermatology clinic were followed for up to 1 year. At each visit the parent's knowledge about atopic eczema and its treatment and therapy utilization was recorded. The severity of the eczema was recorded using the six area, six sign atopic dermatitis severity score (SASSAD) and parental assessment of itch, sleep disturbance and irritability. At the first visit a specialist dermatology nurse explained and demonstrated how to use all of the topical treatments. This education was repeated at subsequent visits depending on the knowledge of the parent. Results At baseline less than 5% of parents had received/recalled receiving any explanation of the causes of eczema or demonstration of how to apply topical treatments. The eczema was poorly controlled in all children (mean SASSAD 42·9). Of the children, 24% were not being treated with any emollient cream/ointment; the mean use was 54 g weekly. Of the children, 25% were being inappropriately treated with potent or very potent topical steroids. Following repeated education and demonstration of topical therapies by a specialist dermatology nurse, there was an 89% reduction in the severity of the eczema. The main change in therapy utilization was an 800% increase in the use of emollients (to 426 g weekly of emollient cream/ointment) and no overall increase in the use of topical steroids, accounting for potency and quantity used. Conclusions, This study reinforces the importance of specialist dermatology nurses in the management of atopic eczema. It also confirms the opinion of patients, patient support groups, dermatologists and best practice guidelines that the most important intervention in the management of atopic eczema is to spend time to listen and explain its causes and demonstrate how to apply topical therapies. [source] Allergic contact cermatitis to retapamulin ointmentCONTACT DERMATITIS, Issue 2 2009Peter C. Schalock No abstract is available for this article. [source] Allergic contact dermatitis from iodine in a topical ointmentCONTACT DERMATITIS, Issue 6 2006Naoki Oiso No abstract is available for this article. [source] P44 A case of contact dermatitis caused by a NSAID's soluble agentCONTACT DERMATITIS, Issue 3 2004Yoshimi Kato A fifty five year-old man had experienced itching sensation when he applied analgesic plasters for his lumbago. He tried to use several kinds of analgesic plasters, however he felt itching sensation whenever he used them. He applied a plaster containing ferbinac for his left elbow joint's pain on April 2003. On the next day, an itching erythema developed on the area where the plaster was applied. He was treated with a difluprednate ointment, and his dermatitis gradually improved. He visited our clinic for precise medical examination for finding out the causative agent of his dermatitis on May 13, 2003. We conducted 48 hours closed patch testing with the plaster he used and it's ingredients. He reacted positively to the plaster containing ferbinac and crotamiton 5%p that was used for dissolute the active drug. He also reacted positively to a cream containing ketoprofen, however he reacted negatively to ketoprofen 1%p. Crotamoton was also used in the ketoprofen cream. [source] Clinically relevant contact urticaria caused by Thrombocid® ointmentCONTACT DERMATITIS, Issue 4 2003Ricardo Gonzifez Peréz No abstract is available for this article. [source] Placebo-controlled evaluation of the irritant potential of tacalcitol (1,, 24-dihydroxyvitamin D3) in healthy volunteersCONTACT DERMATITIS, Issue 5 2000K. Schlotmann In the treatment of psoriasis with topical vitamin D3 analogues, lesional and perilesional irritation is the main side-effect. The aim of this study was to investigate whether local side-effects generated by tacalcitol, a vitamin D3 analogue, show concentration dependence. 3 different concentrations of tacalcitol (0.4; 4; 40 ,g/g ointment) and the vehicle were applied on normal skin of the back of 25 healthy volunteers under occlusive conditions for 5 days. Assessment of erythema, infiltration and scaling as well as measurement of transepidermal water loss (TEWL) was performed on days 1 to 5. On day 5, additional skin barrier tests (DMSO test, alkali resistance test) were performed. Erythema and slight infiltration, but no scaling, were observed in a number of subjects without significant differences. TEWL also did not show significant differences for the test formulations, though there was a tendency towards lower values in the untreated areas. In the skin barrier tests, a tendency towards higher alkali resistance in the test areas treated with 40 ,g tacalcitol/g ointment was detected. Thus, under occlusive conditions, the irritant potential of tacalcitol is very low. There is no convincing evidence of concentration dependence in irritation generated by tacalcitol when applied under occlusive conditions. [source] Safety of Lidocaine 15% and Prilocaine 5% Topical Ointment Used as Local Anesthesia for Intense Pulsed Light TreatmentDERMATOLOGIC SURGERY, Issue 7 2010J. ALASTAIR CARRUTHERS MD BACKGROUND Literature cautions against applying lidocaine 15%/prilocaine 5% over an area larger than 300 cm2. The area of the face, neck, and chest is 400 cm2 or greater. OBJECTIVE To investigate the safety of lidocaine 15%/prilocaine 5% topical anesthetic ointment used as anesthesia for intense pulsed light (IPL) treatment. METHODS AND MATERIALS Lidocaine 15%/prilocaine 5% ointment was applied to the face only (n=10) for 30 ± 15 minutes or to the face, neck, and chest (n=10) for a total of 60 ± 15 minutes before IPL. Blood lidocaine and prilocaine levels were measured. Adverse events were recorded. RESULTS For the entire cohort, blood was drawn 25.6 ± 6.6 minutes after IPL was completed. In the face only group, the mean lidocaine level was 0.122 ± 0.125 ,g/mL, and the mean prilocaine level was 0.048 ± 0.029 ,g/mL. In the face, neck, and chest group, the mean lidocaine level was 0.272 ± 0.208 ,g/mL, and the mean prilocaine level was 0.087 ± 0.060 ,g/mL. No adverse events related to systemic toxicity were observed or reported to the nurse. At the 24-hour follow-up, no subject reported symptoms of systemic toxicity after leaving the clinic. CONCLUSION Under the conditions of this study, topical lidocaine 15%/prilocaine 5% produces low levels of systemic absorption. The authors have indicated no significant interest with commercial supporters. [source] Combined Excimer Laser and Topical Tacrolimus for the Treatment of Vitiligo: A Pilot StudyDERMATOLOGIC SURGERY, Issue 2 2004Adam Z. Kawalek BA Background. Vitiligo is an acquired skin disorder that is characterized by well-defined, often symmetric white patches. Although current therapeutic modalities are directed toward increasing melanocyte melanin production, few treatment modalities address the immunologic nature of the disease. Objective. To determine whether excimer laser, a known therapeutic modality, in combination with tacrolimus, a topical immunomodulator, accelerate response time and/or improve the degree of response in patients with this disorder. Methods. Eight subjects diagnosed with vitiligo were recruited to participate in this institutional review board,approved double-blind, placebo-controlled study. Twenty-four symmetric vitiliginous patches (elbows, knees) from eight subjects received excimer laser treatment three times per week for 24 treatments or 10 weeks. Additionally, topical tacrolimus 0.1% ointment (Protopic) and placebo (Aquaphor) were applied to randomized patches (left or right) twice daily throughout the length of the trial. Vitiliginous patches were monitored with photographs at baseline, every 2 weeks, and 6 months after treatment. Biopsies were performed on subjects with significant results. Results. Twenty vitiliginous patches from six subjects qualified for evaluation. Fifty percent of patches treated with combination excimer laser and tacrolimus achieved a successful response (75% repigmentation) compared with 20% for the placebo group. Subjects who responded successfully repigmented faster (19%) with combination therapy compared with excimer laser alone. Additionally, three subjects experienced transient hyperpigmentation in lesions treated with combination therapy. Conclusion. Combining topical immunomodulators with known phototherapeutic modalities may represent a key advancement in the treatment of disease. [source] Cosmetic Color Improvement of the Nipple-Areola Complex by Optimal Use of Tretinoin and HydroquinoneDERMATOLOGIC SURGERY, Issue 12 2002Kotaro Yoshimura MD background. A successful treatment to improve the color of nipple-areola complex (NAC) has never been reported, although the number of women seeking the more attractively colored NAC is not small. objective. To determine the effectiveness of our bleaching protocol for cosmetic improvement of the NAC. methods. The protocol was composed of two phases: bleaching phase (4,8 weeks) and healing phase (4,6 weeks). 0.2,0.4% tretinoin aqueous gel was applied concomitantly with 5% hydroquinone, 7% lactic acid ointment for bleaching twice a day. Tretinoin was applied to the NAC with a small cotton applicator, while hydroquinone was widely applied beyond the NAC area. After obtaining sufficient improvement in NAC color, the application of tretinoin was discontinued and hydroquinone alone was continually applied in the healing phase until the reactive erythema was eliminated. Fifteen female patients were involved in this study. results. The average treatment period was 16.6 weeks. Improvement of NAC color was obtained in 12 patients (80%) by the physician's estimation, and 11 patients (73%) satisfied with their final results. The treatment was repeated after a 1-month interval of tretinoin application in 4 patients: 2 desired further improvement in color, and 2 had the second course conducted to treat the postinflammatory hyperpigmentation on the surrounding mound induced by the first course. conclusion. This approach appeared to be most effective for cosmetic improvement of NAC color among treatments available so far. [source] Limbal conjunctival plaques and idiopathic eosinophilic conjunctivitisEQUINE VETERINARY EDUCATION, Issue 8 2010J. E. Wolfe Summary A 4-year-old Welsh pony crossbred gelding was examined for acute onset of blepharospasm, epiphora and corneal oedema. Ophthalmic examination identified 2 conjunctival plaques located near the superior limbus of the left eye. The plaques did not resolve following treatment with topical triple antibiotic ointment, topical atropine ointment and oral flunixin meglumine and therefore a conjunctival biopsy was performed. Histology of the biopsy resulted in a diagnosis of eosinophilic conjunctivitis, which was treated with a topical corticosteroid ointment. Plaques resolved after 73 days of therapy but lesions did not improve with concurrent treatment with anthelmintics early in the course of therapy. Failure to identify an aetiological agent led to a diagnosis of idiopathic eosinophilic conjunctivitis. The conjunctival plaques have not recurred in the 10 months following discontinuation of therapy. [source] Herbal ointment may help mild,moderate atopic dermatitis symptoms in cold, dry weather conditionsFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 2 2008Article first published online: 3 JUN 2010 [source] Effective interventions with chlorhexidine gluconate (CHG) to decrease hemodialysis (HD) tunneled catheter-related infectionsHEMODIALYSIS INTERNATIONAL, Issue 1 2005N. Redman Purpose:,Identify practices to reduce HD catheter access related bacteremias (ARB). Methods:,Data was collected per the CDC Dialysis Surveillance Network protocol. ARB was defined as a patient with a positive blood culture with no apparent source other than the vascular access catheter. ARB's were calculated in events per 100 patient months with 3 cohorts. Cohort 1 was observed for 12 months, Cohort 2 for the subsequent 10 months, and Cohort 3 for the final 10 months. Cohort 1 had weekly transparent dressing changes, cleansing of the skin and 5 minute soaking of the connection lines with 10% povidone-iodine (PI) solution, and HCW use of clean gloves and face shield without a mask. Cohort 2 changes consisted of thrice weekly gauze dressing changes, skin cleansing with ChloraPrep, a 2% CHG/70% isopropyl alcohol applicator, masks on the patients, adding a face mask to the shield, and application of 10% PI ointment to the exit site. Cohort 3 changes included weekly application of BioPatch (BioP), an antimicrobial dressing with CHG, sterile glove use, and replacing the PI line soaks with 4% CHG. Results:,The catheter-associated ARB rate per 100 patient months was 7.9 (17ARB/216 patient months) in Cohort 1, 8.6 (13/151) in Cohort 2, and 4.7 (5/107) in Cohort 3(p = 0.31 compared with Cohorts 1 and 2 combined). During the last 2 months, in Cohort 3, 9 catheter lumen cracks occurred, with one of the patients having a bacteremia. Conclusions:,Addition of CHG line soaks and BioP reduced tunneled catheter infections, although this is not statistically significant. The increased number of catheter lumen cracks raises concern with the use of CHG line soaks. Further investigation with use of CHG line soaks and the BioP for decreasing ARB is needed. [source] Topical tacrolimus in the treatment of perianal Crohn's disease: Exploratory randomized controlled trialINFLAMMATORY BOWEL DISEASES, Issue 3 2007Ailsa L. Hart PhD Abstract Background The aim of this study is to evaluate the efficacy of topical tacrolimus in treating perianal Crohn's disease. Methods Nineteen patients, stratified into 7 with ulcerating, and 12 with fistulizing, perianal Crohn's disease were randomized to topical tacrolimus 1 mg/g (1 g ointment twice a day [bid]) or placebo for 12 weeks. Sixteen patients had been on, or were currently taking, azathioprine/6-MP, and 6 had received infliximab. The primary outcome in ulcerating disease was global improvement in perianal/anal lesions, as assessed by the attending physician; for fistulas, it was reduction of ,50% of actively draining fistulas on 2 consecutive visits. Blood tacrolimus levels and adverse events were assessed. Results Three of 4 patients treated with topical tacrolimus for ulcerating disease improved compared with none of 3 in the placebo group. Complete healing was not achieved. In fistulizing disease, topical tacrolimus was not beneficial. Two tacrolimus-treated patients developed perianal abscesses, 1 after improvement in fistula drainage. Adverse events were otherwise infrequent and mild. Whole blood tacrolimus levels were detectable in only 2 patients and were low. Conclusions These preliminary data suggest that topical tacrolimus is effective and safe in the treatment of perianal or anal ulcerating Crohn's disease. This therapy is unlikely to be beneficial in fistulizing perianal Crohn's disease, although a larger study is required to confirm this. (Inflamm Bowel Dis 2006) [source] Pseudoepitheliomatous hyperplasia , an unusual reaction following tattoo: report of a case and review of the literatureINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2007Wei Cui MD A 59-year-old woman presented with an itchy and uncomfortable raised lesion at a tattoo site (Fig. 1) on the lateral aspect of the left leg, just above the ankle. The tattoo had been placed 2 years before her presentation and the tattoo site was sun exposed. Immediately after she had the tattoo, she noticed redness of the skin. After a week, a pruritic and red scaly nodule developed that continued to gradually enlarge until her presentation. The patient had tried topical vitamin A and D ointment with no relief. The patient also had tattoos on the arms without any noticeable skin changes. The patient reported that the tattoo procedure on her leg was more painful than that on her arms, and was performed by a different (and perhaps inexperienced) tattoo artist. The original tattoo contained red, green, and yellow pigments. Figure 1. Raised nodular lesion with irregular margins A diagnosis of tattoo granuloma was considered; squamous cell carcinoma and fungal infection were included in the differential diagnosis. A punch biopsy was performed, followed by complete surgical excision of the lesion with a split-thickness skin graft from the right thigh. The skin excision specimen showed a 3 × 2.5-cm granular and pitted pink lesion with well-demarcated, somewhat irregular borders. The lesion was raised 0.5 cm above the skin surface. The lesion was present in the center of the original tattoo. Portions of the original tattoo with green and blue,green pigmentation were visible on either side of the lesion. No satellite lesions were identified. Microscopically, the raised lesion demonstrated striking pseudoepitheliomatous hyperplasia, with irregular acanthosis of the epidermis and follicular infundibula, hyperkeratosis, and parakeratosis (Fig. 2). Follicular plugging was present with keratin-filled cystic spaces. There was a brisk mononuclear inflammatory infiltrate in the dermis, composed primarily of lymphocytes, with admixed plasma cells and histiocytes. Giant cells were occasionally identified. Dermal pigment deposition was noted both within the lesion and in the surrounding skin, corresponding to the original tattoo. Variable dermal fibrosis was noted, with thick collagen bundles in some areas. There was no evidence of epidermal keratinocytic atypia, dyskeratosis, or increased suprabasal mitotic activity. Special stains (periodic acid,Schiff and acid-fast) for microorganisms were negative. Figure 2. (a) Raised lesion with marked pseudoepitheliomatous hyperplasia and follicular plugging (hematoxylin and eosin; magnification, ×2.5). (b) Irregularly elongated and thickened rete pegs with blunt ends associated with dermal chronic inflammation (hematoxylin and eosin; magnification, ×5). (c) Follicular dilation and plugging with keratin-filled cystic spaces (hematoxylin and eosin; magnification, ×5). (d) Dermal pigment and fibrosis (hematoxylin and eosin; magnification, ×10) [source] "Unknown Risks" of non-steroid topical medications for atopic dermatitisINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2007Anne Marie McNeill PhD Introduction, Tacrolimus ointment is a nonsteroid treatment for atopic dermatitis which is both effective and has a minimal side-effect profile. However, some clinicians may be reluctant to use tacrolimus ointment due to the "unknown risks", meaning those that have not been uncovered in human studies conducted thus far. Therefore, the available animal data regarding the "unknown risks" of topical tacrolimus therapy are reviewed, and a discussion of the interpretation of this available but limited data is presented. Animal studies, Some of the fear on the part of clinicians regarding the use of topical tacrolimus may come from the results of animal studies which showed an increase in lymphoma and UV-induced skin cancer after treatment with topical tacrolimus in animal models of carcinogenesis. However, rigorous assessment of these studies suggest that it is somewhat likely that these represent a species-specific response to tacrolimus in an animal already predisposed to tumor formation, and therefore may not be relevant in assessing the possibility of an increased human health risk. Conclusions, Animal and human studies suggest that topical tacrolimus is a safe alternative to topical steroids, with the major known adverse effect being a transient burning sensation, compared with the known adverse effects of topical steroids, including long-lasting ones. Therefore, in the opinion of the authors, currently available data, including animal studies, does not suggest that "unknown risks" of topical tacrolimus need be any more concerning than the known side-effects of the topical steroids. [source] Quality of life in patients with atopic dermatitis: Impact of tacrolimus ointmentINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2006Makoto Kawashima MD Background, Atopic dermatitis (AD), a significant problem in Japan, has a major impact on health-related quality of life (QOL). The development of steroid phobia in patients with AD may restrict the therapeutic options available to these patients. Tacrolimus ointment is a safe and effective nonsteroid treatment for AD. It may be an appropriate alternative for patients with AD and steroid phobia. The aim of this study was to determine the impact of AD on QOL and to investigate the effect of tacrolimus ointment on QOL in patients with steroid phobia. Methods, Firstly, QOL scores were investigated in patients with AD and steroid phobia using the World Health Organization Quality of Life instrument, WHOQOL-26, and were compared with QOL scores from a previous study in volunteers from Tokyo, Japan. Secondly, patients with steroid phobia received tacrolimus ointment treatment for 12 weeks. Quality of life scores were assessed using WHOQOL-26 at baseline and study end. Results, The overall mean QOL score of 106 patients with AD was significantly lower than that of 708 volunteers (3.1 ± 0.5 vs. 3.3 ± 0.5, P < 0.001). The overall QOL score improved from 2.9 ± 0.4 at baseline to 3.3 ± 0.4 following 12 weeks' tacrolimus ointment treatment in 35 patients with AD and steroid phobia (P < 0.001). Conclusions, Atopic dermatitis significantly lowers QOL. Tacrolimus ointment is associated with a significant improvement in QOL in patients with steroid phobia, indicating that it is an effective alternative to topical corticosteroids in these patients. [source] Milia in regressing plaques of mycosis fungoides: provoked by topical nitrogen mustard or not?INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2004Aylin Kalayciyan MD Objective, To report three cases of mycosis fungoides with milia formation in the regressing lesions. Patients and setting, Dermatology clinic of a university hospital (referral center). Three patients with mycosis fungoides with body surface involvement of 10% in one case (stage IIb) and exceeding 30% in two cases (stages IIb and III). All patients were treated with photochemotherapy and topical nitrogen mustard ointment in a concentration of 0.01%. After approximately 3 months multiple milia erupted on regressing plaques. Results, The presence of milia was evident and was confirmed by histopathology. Regression of mycosis fungoides was noted in these plaques both clinically and in comparison with the pretreatment histologic appearance. Two of the patients showed a histological picture of follicular mucinosis. Conclusions, We do not know the significance of milia in mycosis fungoides (MF). However, we suggest that follicular rupture or a degenerative process might result in milia formation. [source] Successful treatment of eosinophilic pustular folliculitis with topical tacrolimusINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 8 2004Masakazu Kawaguchi We present two cases of Eosinophilic pustular folliclulitis (EPF) who were successfully treated with topical tacrolimus. Indomethacin is the most frequently used agent for the treatment of EPF, however, tacrolimus ointment may become the treatment of choice for patients with EPF. [source] Calcipotriol ointment versus clobetasol ointment in localized vitiligo: an open, comparative clinical trialINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 9 2002Osman Köse MD No abstract is available for this article. [source] An interesting case of colocalization of segmental lichen planus and vitiligo in a 14-year-old boyINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 8 2002Kabir Sardana MD A 14-year-old boy had segmental vitiligo (L3,4) on the right thigh and leg for 4 years, and was advised to apply topical clobetasol propionate, 0.05%, in the night, with daily sun exposure for 10 min, as he refused to comply with topical psoralens. As there was no response to therapy even after 3 months, the patient stopped the steroid cream but continued with the sun exposure. Subsequently, the patient noticed gradual-onset, itchy, violaceous, pigmented, raised lesions superimposed on the vitiligo macules. Cutaneous examination revealed violaceous, polygonal papules, 0.5 × 0.5 cm in size, some of which coalesced to form discrete violaceous plaques, confined to areas of vitiligo, with a clear-cut demarcation from normal skin (Fig. 1). The scalp, palms, soles, nails, and mucosa were normal. Histopathology of the polygonal papules revealed hyperkeratosis, wedge-shaped hypergranulosis, irregular acanthosis with saw toothing of the rete ridges, basal cell liquefaction, and a band-like lymphocytic infiltrate (Fig. 2), consistent with lichen planus. The patient was subsequently prescribed fluticasone propionate (0.05%) ointment once daily for the lesions of lichen planus. There was a marked improvement in the lesions of lichen planus after 1 month. Figure 1. Violaceous papules of lichen planus colocalized on vitiligo macules with associated leukotrichia seen on the right leg Figure 2. Histopathology reveals hyperkeratosis, wedge-shaped hypergranulosis, irregular acanthosis with saw toothing of the rete ridges, basal cell liquefaction, and a band-like lymphocytic infiltrate (hematoxylin and eosin, × 40) [source] Hereditary palmoplantar keratoderma (four cases in three generations)INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2001Virendra N. Sehgal MD A 39-year-old man reported with progressive thickening of the skin of the hands and feet and an inability to flex his hand. It was largely asymptomatic; however, brisk walking caused excessive sweating, pain, and widening of the fissures on the soles of the feet. He was unable to walk barefooted. According to his mother, the first episode presented with blistering at 7 days of age. Ever since, the condition has steadily worsened to acquire the current status. He was married at the age of 18 years, and had a stillborn child 18 months afterwards. Presently, he has three children, two girls aged 14 and 12 years and a son aged 10 years. Both the daughters are similarly affected. While cataloguing the details of the pattern of inheritance, the mother of the index case was also found to be affected (Fig. 1). The natural history of the disease was identical. Figure 1. Palmoplantar keratoderma: pattern of inheritance; black indicates affected individuals Examination of the palms was marked by pronounced thickening of the skin resulting in the masking of palmar creases. The thickening was well demarcated and its margins were prominent and surrounded by an erythematous halo. The color of the skin was yellow and waxy (Fig. 2a). Contractures were present on all the fingers; nevertheless, the deformity of the middle and distal interphalangeal joints of the little finger was prominent. The soles of the feet had a similar morphology. In addition, marked fissuring was obvious (Fig. 2b). His daughters had an identical affliction of the palms and soles. The texture and morphology of the nails were normal. Light microscopy performed on scrapings from the fissures, mounted on 10% potassium hydroxide, revealed mycelia (hyphae) and spores. Figure 2. Well-demarcated hyperkeratosis depicting the yellow, waxy color of the palms, with masking of creases (a). Marked fissuring on the soles was prominent (b) Hematoxylin and eosin-stained microsections from the palms and soles showed exquisite changes in the epidermis characterized by considerable uniform orthohyperkeratosis. Hypergranulosis and acanthosis were other associated changes. In addition, perinuclear vacuolization and keratohyalin granules of varying sizes and shapes were located at the periphery of the cells. A sparse mononuclear infiltrate was located at the dermo-epidermal junction. Hyphae and spores of fungi were also identified in the stratum corneum (Fig. 3). Figure 3. Orthohyperkeratosis, hypergranulosis, and acanthosis. Perinuclear vacuolization and keratohyalin granules at the periphery of the cells; a sparse mononuclear infiltrate was also present (hematoxylin and eosin, ×,40 (a), ×,400 (b)) Itraconazole, 400 mg/day in two equally divided doses, was administered with major meals for 7 days. In addition, high doses of vitamin A (100,000 IU) were given daily for 2 weeks, supplemented by 12% salicylic acid (Salicylix SF12) ointment for daytime application and an ointment containing 6% coal tar and 3% salicylic acid (Salytar) for night-time application. This treatment is useful in recalcitrant cases. [source] New and innovative therapies for Behcet's diseaseINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2004Fereydoun DAVATCHI Abstract Background:, Behcet's disease (BD) is a vasculitis progressing by attacks and remissions. Not all patients will respond even to the classical treatments. New treatments are emerging with the hope to overcome this failure. Biologic agents:, Interferon-, (IFN-,), anti-tumour necrosis factor-, (TNF-,), and tolerization have been used in BD. IFN-, is mainly used for ocular manifestations of BD. The result seems impressive, 92% of cases had good or excellent results. It was less impressive for mucocutaneous and joint manifestations. The dosage is 6,9 million IU/day for 4 weeks, then 4.5 million daily for 4 weeks, and then 3 million/day. The maintenance dose is 3 millions, three times/week, to continue for 8 weeks after complete remission. Etanercept (anti-TNF-,) was effective in mucocutaneous lesions of BD at the dosage of 25 mg twice weekly for 3 months (double-blind control study). Attacks relapsed after discontinuation. Etanercept was ineffective in ocular lesions (open study). Infliximab (anti-TNF-,) was very effective in many studies of ocular lesions. It dramatically suppressed the inflammatory attack. The dosage is one injection of 5 mg/kg (intravenous infusion) at weeks 0, 2, 6, and then every 8 weeks. Tolerization with oral administration of HSP peptide 336,351 seems to protect from uveitis relapse. Pentoxifylline is not particularly effective unless for oral aphthae (50% response rate). Pimecrolimus ointment may be of help in resistant genital aphthosis, reducing the healing time. [source] Conservative treatment of childhood phimosis with topical conjugated equine estrogen ointmentINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2000Naoko Yanagisawa Abstract Purpose: To assess the application of topical conjugated equine estrogen for the treatment of boys with phimosis. Methods: Fifteen boys with phimosis were included in the study. Conjugated equine estrogen (Premarin®) 0.1% ointment was applied on the prepuce once daily. The treatment was continued until the prepuce was fully retractable. The patient was examined each second week up to a maximum treatment of 8 weeks. Retractability and the appearance of the foreskin were graded before and after treatment. Results: Thirteen of 15 boys (87%) referred with phimosis were successfully treated with conjugated equine estrogen ointment. An adverse effect of gynecomastia was seen in one boy (7%). Conclusion: Conjugated equine estrogen ointment application for phimosis may be an alternative to surgery. [source] Repigmentation of pretibial vitiligo with calcineurin inhibitors under occlusionJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 5 2008Anke Hartmann Summary Treatment of vitiligo is a challenge, especially in children. Recently, topical calcineurin inhibitors have been introduced in the management of vitiligo, but significant repigmentation is not achieved except on the face. Large pretibial lesions of a 15-year-old female with progressive vitiligo were treated twice daily over six months with 0.1% tacrolimus ointment on the right and 1% pimecrolimus cream on the left side without effect. Additional overnight occlusion with polyurethane and hydrocolloid foils during the following 18 months led to substantial repigmentation on both sides (tacrolimus-treated side, 88% repigmented area; pimecrolimus-treated side, 73%). Tacrolimus serum levels measured at four different time points did not exceed 1.8 ng/ml. This case report on a direct comparison of topical tacrolimus and pimecrolimus in vitiligo shows that on the shins considerable improvement could be induced with both agents only by additional long-term occlusion and that tacrolimus was somewhat more effective than pimecrolimus. [source] Treatment of actinic keratoses with birch bark extract: a pilot studyJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 2 2006Constance Huyke aktinische Keratosen; Betulinsäure; Betulin; Oleanolsäure Summary Background: Birch bark contains a variety of apoptosis-inducing and anti-inflammatory substances such as betulinic acid, betulin, oleanolic acid and lupeol. Therefore, birch bark extract may be effective in the treatment of actinic keratoses. To address this issue, a pilot study using a standardized birch bark ointment was performed. Methods: Twenty-eight patients with actinic keratoses were enrolled in this prospective, non-randomized pilot study. Fourteen patients were treated with birch bark ointment only; fourteen patients received a combination therapy with cryotherapy and birch bark ointment. Treatment response was assessed clinically after two months. Results: Clearing of more than 75 % of the lesions was seen in 79 % of the patients treated with birch bark ointment monotherapy. The response rate of the combined treatment modality was 93 %. Therapy with birch bark ointment was well tolerated. Conclusion: In this pilot study, a standardized birch bark extract was effective in the treatment of actinic keratoses. This therapy is easy to perform and it has no side effects. Birch bark ointment may be a new therapeutic option for actinic keratoses. Zusammenfassung Hintergrund: Birkenkork ist reich an Triterpenen (Betulin, Betulinsäure, Oleanolsäure, Lupeol, Erythrodiol), für die Apoptose induzierende und antientzündliche Wirkungen beschrieben sind. Deshalb könnte sich ein Extrakt aus Birkenkork für die Therapie von aktinischen Keratosen eignen. Mit der hier untersuchten Birkenkork-Creme liegt erstmals eine galenische Formulierung vor (Birkenkorkextrakt, pflanzliche Öle, Wasser), in der die Wirkstoffe des Birkenkorks in therapeutisch ausreichender Menge vorhanden sind. Methoden: Im Rahmen der prospektiven, nicht randomisierten Pilotstudie wurden 28 Patienten mit aktinischen Keratosen behandelt. 14 Patienten erhielten eine Creme mit Birkenkorkextrakt als Monotherapie, 14 Patienten wurden zusätzlich kryotherapeutisch behandelt. Die Birkenkork-Creme wurde von den Patienten zweimal täglich aufgetragen. Das klinische Ansprechen wurde nach zwei Monaten erfasst. Ergebnisse: Bei Behandlung mit Birkenkorkextrakt als Monotherapie zeigten 79 % der Patienten nach einem Beobachtungszeitraum von zwei Monaten eine klinische Abheilung von über 75 % der Läsionen. Bei der Kombinationsbehandlung mit Kryotherapie kam es bei 93 % der Patienten zu einem Ansprechen auf die Behandlung. Die Verträglichkeit der Birkenkork-Creme war in allen Fällen sehr gut. Schlussfolgerung: Im Rahmen dieser Pilotstudie zeigte die lokale Anwendung eines standardisierten Birkenkorkextraktes eine gute Wirksamkeit bei der Behandlung aktinischer Keratosen. Die Anwendung ist einfach und die Verträglichkeit sehr gut. Deshalb stellt Birkenkorkextrakt eine interessante neue Therapieoption für aktinische Keratosen dar. [source] | ||||||||||||||||||||||||||||||||||