The randomized trials of 10% urea cream and 0.025% tretinoin cream in the treatment of acanthosis nigricans.

BACKGROUND: Acanthosis nigricans is characterized as hyperpigmented skin and velvety surface on posterior and lateral folds of the neck and the intertriginous areas. This study aimed to assess the efficacy of topical 10% urea cream compared to 0.025% tretinoin cream in the treatment of acanthosis nigricans. MATERIAL AND METHODS: This was an 8-week trial, double-blind, randomized, comparative study of topical 10% urea and 0.025% tretinoin for the treatment of the neck hyperpigmentation. The Mexameter MX18 was used for assessing treatment efficacy. The global evaluation scale was also used to evaluate the overall success rate at weeks 2, 4, and 8 of the study. RESULTS: There was a statistically significant difference between 10% urea and 0.025% tretinoin in the treatment of acanthosis nigricans (p < 0.01). The efficacy of 10% urea and 0.025% tretinoin treatment shows 11.4 ± 5.7% and 20.1 ± 9.7% improvement, respectively. The treatment efficacy using the investigator's global evaluation found that 36.8% of participants treated with 10% urea and 63.2% of participants treated with 0.025% tretinoin had more than 75% skin improvement. CONCLUSION: Both medications significantly improved neck hyperpigmentation. However, the efficacy of 0.025% tretinoin was significantly better than 10% urea in the treatment of acanthosis nigricans. CLINICAL TRIALS REGISTRY: TCTR20180703003.

Comparison of the efficacy and safety of 0.1% adapalene gel and 0.025% tretinoin cream in the treatment of childhood acanthosis nigricans.

BACKGROUND: There have been few published randomized controlled trials for the treatment of childhood acanthosis nigricans (AN) to date. OBJECTIVE: To assess the efficacy of topical 0.1% adapalene gel compared to 0.025% tretinoin cream in the treatment of childhood AN. METHODS: An 8-week, randomized, split-neck, comparative study between topical 0.1% adapalene gel and 0.025% tretinoin cream for the treatment of neck hyperpigmentation associated with AN was performed. M index measured by a narrowband reflectance spectrophotometer and both investigator's global evaluation (IGE) and parent's global evaluation (PGE) scales were used to evaluate efficacy. RESULTS: There was no statistically significant difference between 0.1% adapalene gel and 0.025% tretinoin cream in the treatment of AN-associated hyperpigmentation (P = 0.56). Mean differences in M indices between week 0 and week 8 of 0.1% adapalene and 0.025% tretinoin treatment were 24.2 ± 7.9% and 23.8 ± 8.3% improvement, respectively. Regarding treatment efficacy, 90.0% and 85.0% of participants had more than 75% improvement in IGE in 0.1% adapalene and 0.025% tretinoin treatment sides, respectively. In addition, 75.0% and 65.0% of participants had more than 75.0% improvement in PGE in 0.1% adapalene and 0.025% tretinoin treatment sides, respectively. LIMITATIONS: Lack of histopathological evaluations. CONCLUSIONS: We found no significant difference between topical 0.1% adapalene gel and 0.025% tretinoin in the treatment of AN.

Comparative Study between Talcum and Zinc Oxide Cream for the Prevention of Irritant Contact Diaper Dermatitis in Infants.

Background: Baby powder which consists of talcum powder (magnesium silicate) as an active ingredient has been popularly used for prevention of irritant contact diaper dermatitis for a long time because it has water absorbent and friction-decreased properties. There are some case reports of its side effects of pulmonary complication from massive inhalation and the risk of ovarian tumors in adult. However the clinical research on the effectiveness of talcum powder for the prevention of diaper dermatitis has not been investigated. Objective: To compare the effectiveness between talcum powder with topical zinc oxide cream for the prevention of irritant diaper dermatitis. Materials and Method: Fifty Thai infants at the age of 6-12 months old were randomized. Either topical talcum powder or zinc oxide cream was topically applied to their skin before changing new diapers. The follow-up were conducted at week 0, 2 and 8 to evaluate an occurrence of diaper dermatitis and to collect the median time-to-event data (the duration of disease occurrence). The clinical severity was assessed by using diaper dermatitis severity scoring scale and the side effects were recorded. Results: The average age of the infants was 8.8 months old. The incidence of irritant contact diaper dermatitis from the talcum group was 4 per 1,000 persons-day (95% confidence interval, 95% CI: 2-7) while the incidence of diaper dermatitis from the zinc oxide group was 2 per 1,000 persons-day (95% CI: 1-5). The median time-to-event outcome of diaper dermatitis for the talcum group was 19 days (interquartile range, IQR: 7-29) which was earlier than that of zinc oxide group, which was 39 days (IQR: 30-59). This showed statistically significant difference (p = 0.03, Log rank test). The average of disease duration of the talcum group (mean + SD) was 2.7+0.5 days whereas that of the zinc oxide group was 3.7+3.3 days. There is no significant difference between the two groups (p = 0.34). Most of the severity of the disease found in both groups is mild. The risk evaluation of diaper dermatitis at week 8, determined by using Cox proportional hazard analysis showed that the talcum group had 5.3 times greater risk than the zinc oxide group (hazard ratio, HR; 5.3, 95% confidence interval, CI: 1.4-20.0), with significant group difference (p = 0.01). There was no adverse effect detected on both groups. Conclusion: Topical zinc oxide cream was better than talcum powder for the prevention of irritant contact diaper dermatitis.

The efficacy of topical 0.1% adapalene gel for use in the treatment of childhood acanthosis nigricans: a pilot study.

AIMS: To assess the degree of improvement of neck hyperpigmentation in childhood acanthosis nigricans (AN) after treatment with topical 0.1% adapalene gel and the assessment of localized tissue tolerance to the gel. SUBJECTS AND METHODS: A split comparison study of the hyperpigmentation on the neck was conducted in patients diagnosed with childhood AN. Patients were treated with topical 0.1% adapalene gel for a period of 4 weeks. The skin color of their neck was evaluated at baseline, 2 weeks and 4 weeks using a skin color chart. Skin color ratio (the skin on their necks compared with the skin on their backs) was calculated for all subjects. The investigator's global evaluation (IGE) scale and the parent's global evaluation (PGE) scale were used to assess the efficacy of the patients' treatment at the end of the 4(th) week. RESULTS: The mean skin color ratio of therapeutic side was significantly decreased from the baseline scores, at weeks 2 and 4, respectively (30.1%, 18.3%, and 12.9%, P < 0.001), with marked skin improvement at 60.7% ± 28.5%. The percentage of changes of skin color ratio was consistent with the efficacy evaluations as performed by the IGE and PGE scales. Treatment-related cutaneous irritation was minimal, predominantly in the first 2 weeks of treatment and was shown to be well-tolerated at week 4 following a modification of the treatment regimen. CONCLUSIONS: The study has shown the efficacy of topical 0.1% adapalene gel in the treatment of AN, specifically, in regards to the skin darkening with minimal cutaneous irritation.

Unusual Skin Manifestations in Neonatal Lupus Erythematosus.

Neonatal lupus erythematous (NLE) is a rare autoimmune disease caused by placental transfer of maternal anti-SSA/Ro or anti-SSB/La antibodies. It usually presents with transient cutaneous lesions, congenital heart block and other systemic symptoms. The authors report a case of neonatal lupus erythematosus who presented with targetoid-like lesions on both feet.

Self-Medication for Dermatologic Diseases among Children Treated at the HRH Princess Maha Chakri Sirindhorn Medical Center.

BACKGROUND: Skin diseases are one of the common problems in Pediatrics Outpatient Department. Because self-medication is practiced, it raises concerns of incorrect self-diagnosis, adverse drug reactions, and the cost of self-treatment. The aim of this study was to investigate the prevalence and the features of self-medicating for skin diseases among children who were observed at the dermatology clinic. MATERIAL AND METHOD: This prospective study was conducted in the Pediatric Outpatient Department. All patients seen on a first visit for skin problems were recruited, interviewed, and examined. RESULTS: Four hundred thirty seven patients were recruited in the study and the mean age was 4.6 years of age. Eczema was the most common diagnosis (43.7%), followed by fungal skin infections (7.1%), insect bites and infestations (6.9%), and bacterial skin infections (6.2%). Of all the patients, 204 (46.7%) had used self-medication. The most common reasons for self-medicating were convenience (82.3%), a friend and/or relative's recommendation (15.2%), and avoiding the cost of doctors' visits (2.0%). The most frequently encountered categories of medicines were topical corticosteroids (25.4%), antifungal agents (13.4%), antibacterial agents (8.2%), and others. Most products were obtained from pharmacies (66.2%). The average cost for self-medications was 204.7 Thai baht. Products applied by the topical route were the most common medications used (81.3%) and most patients had reported dissatisfaction with the results (95.1%). Adverse reactions resulting from self-medications were found to be at a rate of 17.1%. There were no significant relationships (p > 0.05) between the practice of self-medication and the potential factors. CONCLUSION: Self-medication use is most prevalent. Most patients had reported dissatisfaction from the use of self-medications. Adverse reactions resulting from self-medication were also found.

Feeding problems in healthy young children: prevalence, related factors and feeding practices.

The aim of this study was to determine the prevalence, characteristics, and factors related to feeding problems among normal children, and the differences in feeding practices between those with and without feeding problems. Caregivers of 402 healthy children aged between one and four years of age were interviewed by pediatricians involved in the research. Data included the child's medical history, food intake within a day, and feeding behaviors and practices. Parental socio-economic and demographic information, as well as information on parental education and occupation, and their concerns about feeding their children, was collected. Physical examination and anthropometric measurements were taken. The percentage of children identified as having feeding problems was 26.9%. The first child of a family had an increased risk of having feeding problems [P=0.032, odds ratio 1.68, 95% confidence interval (95%CI) 1.04-2.71]. Children with feeding problems were fed less frequently, were less likely to be fed at their own table or at the family table, and had mealtimes longer than 30 min when compared with children without feeding problems (P=0.015, 0.004 and 0.025, respectively). The results highlight that feeding problems in normally developing children are common. During consultations about feeding issues, pediatricians should focus on families with a first child. Topics such as frequency of meals per day, duration of mealtimes, and appropriate places for feeding should be discussed.

A survey of birthmarks and cutaneous skin lesions in newborns.

BACKGROUND: The prevalence of birthmarks and cutaneous skin lesions in newborns vary among sex and race. There are limited reports of birthmarks and cutaneous lesions among Thai neonates. OBJECTIVE: To determine the prevalence of birthmarks and cutaneous lesions in Thai newborns and evaluate the association between age, gender maturity, route of delivery, birth weight and skin lesions. MATERIAL AND METHOD: All of the subjects were healthy newborn infants, who were born between September 2008 to September 2009. They were enrolled and examined for cutaneous lesions by two dermatologists. RESULTS: 574 neonates were included in this report. The most common pigmentary birthmarks were Mongolian spots (100%), followed by congenital melanocytic nevi (2.4%) and Cafe-au-lait spots (0.3%). The most common vascular birthmarks were salmon patch (16.6%), hemangiomas (0.30%) and vascular malformations (0.3%). Among the cutaneous lesions; the three most common skin lesions were sebaceous gland hyperplasia (78%), Epstein's pearls (71.3%), and erythema toxicum neonatorum (46.5%). CONCLUSION: Mongolian spot was the most frequent birthmark while sebaceous gland hyperplasia was the most frequent cutaneous lesions found among Thai neonates. The prevalence of the cutaneous lesions of newborns differ among countries could possibly be due to race, the age of the infants and the period of observation of the study subjects.

Early onset and rapid progression of glaucoma in a neonate with Sturge-Weber syndrome.

Sturge-Weber syndrome (SWS) is an uncommon neurocutaneous syndrome usually presenting with a triad of cutaneous, neurological, and ophthalmological symptoms. The cutaneous lesion can be observed at birth in most cases while the symptoms of the nervous and ocular systems involvement usually appear later in life. The most common ocular manifestation in SWS is glaucoma, which can occur in the early-life period. The authors reported a case of SWS in which the symptoms of glaucoma rapidly developed within two weeks following an ophthalmologic evaluation that was initially negative at the age of one week.