Topical trametinib for epidermal and sebaceous nevi in a child with Schimmelpenning-Feuerstein-Mims syndrome.

We present the case of a 20-month-old girl with Schimmelpenning-Feuerstein-Mims (SFM) syndrome with extensive head, neck, and torso skin involvement successfully managed with topical trametinib. Trametinib interferes downstream of KRAS and HRAS in the MAPK signaling pathway, of which KRAS was implicated in our child's pathogenic variant. Although other dermatologic conditions have shown benefit from oral trametinib, its topical use has not been well reported. Our patient showed benefit from the use of twice-daily topical trametinib, applied to the epidermal and sebaceous nevi over a 16-month period, leading to decreased pruritus and thinning of the plaques.

Amphetamine or skin cream? The impact of the sampling site on the concentration of controlled substances: a case report.

This case report demonstrates the impact of different sampling sites on the quantification of narcotic substances. In 2020, officers secured a syringe containing a light-yellow paste-like substance, for which a drug pre-test indicated a positive result for amphetamine, inducing subsequent analyses of the sample by means of a gaschromatographic-mass spectrometric method (GC-MS) and liquid chromatography-(tandem) mass spectrometry (LC-MS/MS). Depending on the sample location, different results were obtained, with amphetamine not being detected in each sample. Amphetamine was particularly found at the outlet of the syringe, while amphetamine detection on the inside of the syringe at the plunger seal was only possible occasionally and, moreover, in lower concentrations. Based on this and with regard to the comparatively small amphetamine concentrations, contamination of the syringe (especially on the tip of the syringe) was assumed. Hence, the results strengthened the importance of the implication of different sampling sites, when either homogenization of the sample is not feasible or is not performed for reasons of plausibility checks concerning possible contamination of the sample.

Cutaneous Permeation of a Percutaneously Applied Glucocorticoid Using Plant-Based Anionic Phospholipids in Hydrogenated Vegetable Oil: A Preliminary Study.

Purpose: It is important that, when corticosteroids are used therapeutically, concentrations be reduced as much as possible to mitigate potential adverse events and side effects. This preliminary study compares the permeation for the delivery of a corticosteroid in a 1% hydrocortisone-supplemented topical cream containing anionic polar phospholipids (APP) in hydrogenated vegetable oil (triglyceride) versus a market-leading 1% hydrocortisone in a mineral hydrocarbon-based skin cream. Methods: Using the Franz diffusion cell method with cadaveric skin, the permeation of a 1% hydrocortisone-supplemented cream containing APP (test preparation) was compared with a commercially available 1% hydrocortisone cream (control preparation). The principal APP in the test preparation were phosphatidylinositol, phosphatidylserine and phosphatidylglycerol. Permeation was determined at 4 and 8 h time intervals. Results: The permeation values for the 1% hydrocortisone supplemental APP cream (test preparation) were comparatively very high 1180 ng/cm2 at 4 h and 2173 ng/cm2 at 8 h, in contrast to the 1% hydrocortisone cream (control preparation) values of 13 ng/cm2 at 4 h and 98 ng/cm2 at 8 h. Permeation of skin cream increased significantly from 0 to 4 and 8 h, when comparing the APP test preparation with the control preparation (p < 0.001). This translates, respectively, into the 90-fold greater and a 20-fold greater penetration of the test preparation APP cream over the 1% hydrocortisone cream at 4 h and 8 h time points. Conclusions: This preliminary study demonstrates the enhanced permeation of 1% hydrocortisone when applied topically to the skin in an APP skin cream vehicle. This enhanced permeation suggests the potential use of APP technology to deliver therapeutically effective hydrocortisone treatment to the skin at markedly reduced concentrations of steroid. As such, APP technology may offer an improved approach to the treatment of dermatoses associated with inflammatory diseases and conditions requiring prolonged topical corticosteroid therapy.

Scope and limitations of nuclear magnetic resonance techniques for characterisation and quantitation of vitamin D in complex mixtures.

BACKGROUND: The accurate determination of vitamin D in skin is of considerable importance in evaluating penetration of skin health products through the different layers of the skin. OBJECTIVE: We report on the characterisation and quantitation of vitamin D in an idealised sample and in complex mixtures which mimic that of a typical skin cream, using qNMR, 2D NMR and DOSY techniques. METHODS: The characterisation and quantitation conditions were acquired over several heterogeneous samples, allowing for analysis of how the dynamic range and complexity of the different sample mixtures affect the limits of detection (LOD) and limits of quantitation (LOQ) of vitamin D. NMR is of particular value to this task as it is non-destructive, uses a primary ratio method for quantification, and tolerates a wide variety of hydrophilic and hydrophobic components within a given matrix. RESULTS: In this investigation, we have attained a trueness level <10%, repeatability values of <1% and brought the limit of quantitation down to 100 nmol/L (≈limit of baseline range of vitamin D2 and D3 per litre seen in vivo), commenting on the limitations observed, such as peak overlap and sensitivity limits. CONCLUSIONS: Pure shift optimised sequences allow us to reduce peak overlapping, allowing further characterisation of individual compounds and the separation of complex mixtures using NMR.

Protection against summer solar lentigo over-pigmentation with a SPF30 daily cream.

BACKGROUND/PURPOSE: The aim of this study was to measure lentigines' pigmentation over a long period of time and evaluate if summer over-pigmentation can be avoided by the use a SPF30 day skin cream. METHODS: Seventeen healthy female volunteers aged 50 and over and presenting lentigines participated in the study from spring to summer. Throughout the study, all subjects applied a SPF30 daily skin cream to only one hand. Color measurements of the target lesions were performed with a chromameter and with a color-calibrated camera. Target lesions were also imaged with in vivo reflectance confocal microscopy (RCM). A specific procedure for re-registering the images was developed to ensure that the same papillae were measured over time. RESULTS: Both color measurement methods, chromametry and color-calibrated camera, showed that lentigines treated over time with the SPF30 day skin cream were significantly lighter than the non-treated lentigines. The RCM images showed a decrease in the papillary contrast for the treated lentigines. CONCLUSION: This study shows that this over-pigmentation can be avoided using a SPF30 day skin cream. Moreover, we have demonstrated that very fine re-registration of the RCM images is possible and ensures a more robust analysis.

Inhibition of bcl-2 and cox-2 Protein Expression after Local Application of a New Carmustine-Loaded Clinoptilolite-Based Delivery System in a Chemically Induced Skin Cancer Model in Mice.

Our research has focused on in vitro and in vivo evaluations of a new Carmustine (BCNU)-loaded clinoptilolite-based delivery system. Two clinoptilolite ionic forms-hydrogen form (HCLI) and sodium form (NaCLI)-were prepared, allowing a loading degree of about 5-6 mg BCNU/g of zeolite matrix due to the dual porous feature of clinoptilolite. Clinoptilolite-based delivery systems released 35.23% of the load in 12 h for the BCNU@HCLI system and only 10.82% for the BCNU@NaCLI system. The BCNU@HCLI system was chosen to develop gel and cream semisolid dosage forms. The cream (C_BCNU@HCLI) released 29.6% of the loaded BCNU after 12 h in the Nylon synthetic membrane test and 31.6% in the collagen membrane test, higher by comparison to the gel. The new cream was evaluated in vivo in a chemically induced model of skin cancer in mice. Quantitative immunohistochemistry analysis showed stronger inhibition of B-cell lymphoma-2 (bcl-2) and cyclooxygenase 2 (cox-2) protein expression, known markers for cancer survival and aggressiveness, after the treatment with C_BCNU@HCLI by comparison to all the control treatment types, including an off-label magistral formula commercially available Carmustine cream as reference, bringing evidence that a clinoptilolite-based delivery systems could be used as a cancer drug carriers and controlled release systems (skin-targeted topical delivery systems).

Sensory properties analysis of a calcipotriol and betamethasone dipropionate cream vehicle formulated with an innovative PAD Technology for the treatment of plaque psoriasis on the skin and scalp.

Background: In psoriasis, poor treatment adherence is frequently related to low efficacy and limited cosmetic acceptability from the patients' perspective. This study aimed to characterize the sensorial attributes of a calcipotriol (CAL) and betamethasone dipropionate (BDP)-cream vehicle based on polyaphron dispersion (PAD) Technology and to compare them with the conventional ointment and oleogel formulations for psoriasis. Methods: A panel of 16 experts assessed sensory properties at four different stages: appearance, pick up, rub out and afterfeel. Descriptive sensory analysis was used to evaluate relevant attributes. Each attribute was rated on a line scale (range 0-100%). Active ingredients were not used because panellists were healthy volunteers, and vehicle formulations needed to be used instead. Results: CAL/BDP PAD-cream vehicle was evaluated as having a low stickiness, low grease behaviour, good wetness, and good spreadability. Ointment showed the least desirable behaviour regarding these properties. Moreover, once CAL/BDP PAD-cream vehicle was absorbed, the gloss disappeared quickly, leaving low stickiness and a low amount of residue. This afterfeel behaviour was not observed with ointment. The oleogel formulation had good sensory properties, similar to CAL/BDP PAD-cream vehicle, but with lower integrity of shape, lower wetness and higher greasiness. Conclusion: Overall, CAL/BDP PAD-cream vehicle has the desirable requirements for a topical product for the treatment of psoriasis, with better sensory properties than ointment and easier manipulation than oleogel, which may lead to greater acceptance and adherence.

Skin scarring: Latest update on objective assessment and optimal management.

Although skin scarring is considered by some to be a minor, unavoidable consequence in response to skin injury, for many patients, cosmetically unsightly scars may cause uncomfortable symptoms and loss of function plus significant psycho-social distress. Despite their high prevalence and commonality, defining skin scars and their optimal management has proven problematic. Therefore, a literature search to assess the current evidence-base for scarring treatment options was conducted, and only those deemed Levels of Evidence 1 or 2 were included. Understanding the spectrum of skin scarring in the first instance is imperative, and is mainly comprised of four distinct endotypes; Stretched (flat), Contracted, Atrophic, and Raised for which the acronym S.C.A.R. may be used. Traditionally, scar assessment and response to therapy has employed the use of subjective scar scales, although these are now being superseded by non-invasive, objective and quantitative measurement devices. Treatment options will vary depending on the specific scar endotype, but fall under one of 3 main categories: (1) Leave alone, (2) Non-invasive, (3) Invasive management. Non-invasive (mostly topical) management of skin scarring remains the most accessible, as many formulations are over-the-counter, and include silicone-based, onion extract-based, and green tea-based, however out of the 52 studies identified, only 28 had statistically significant positive outcomes. Invasive treatment options includes intralesional injections with steroids, 5-FU, PDT, and laser with surgical scar excision as a last resort especially in keloid scar management unless combined with an appropriate adjuvant therapy. In summary, scar management is a rapidly changing field with an unmet need to date for a structured and validated approach.

Implications of a Diabetic Foot Xerosis Treatment With an Emulsion Containing the Plant-Based Anionic Phospholipids.

PURPOSE: This study compares and contrasts a skin cream containing plant-based anionic polar phospholipid (APP) technology with a mineral oil hydrocarbon (petrolatum)-based (MHB) skin cream technology in the treatment of skin xerosis (dryness) in diabetic feet. Skin cream with APP technology promotes phospholipid absorption, reparation of intercellular lamellae, and organization of water promoting hydration; whereas skin cream with mineral hydrocarbon-based (MHB) technology principally covers skin, preventing dehydration. METHODS: Subjects (n = 54) with diagnoses of diabetes mellitus and foot skin dryness were studied using a multicenter, double-blind, masked-study design. An emulsion cream containing 0.05% APP in triglycerides (APP preparation) was compared to MHB skin cream, Eucerin® (MHB preparation) applied topically to skin of the feet. Graded measurements were recorded on 4 efficacy variables including dryness, erythema, fissures, and itching and neurovascular assessments. Implications of the plant-based and mineral-based skin creams in the context of skin xerosis are contrasted. RESULTS: APP and MHB preparations were similar in effectiveness and safety. There was no significant difference among any of the 4 efficacy variables (P < .5) including neurovascular measurements. The APP preparation is absorbed into the skin, whereas the MHB skin cream leaves detectable residues after each application. CONCLUSION: Although the APP and MHB preparations were not significantly different in effectiveness and safety, distinctively, application of the APP skin cream preparation absorbed into the skin leaving no discernible residue in contrast to the MHB preparation leaving residues potentiating textile damage. Both of these technologies function in the hydration of skin; however, they differ in their modes of action. The plant-based APP preparation functions actively by phospholipid and triglyceride absorption, reparation of skin lamellae, and in the consequent delivery and organization of waters of hydration in skin. The MHB preparation functions passively, hydrating the skin it covers by sealing the skin against dehydration.

Green Synthesis of Copper Oxide Nanoparticles using Cucumis Sativus (Cucumber) Extracts and their Bio-Physical and Biochemical Characterization for Cosmetic and Dermatologic Applications.

BACKGROUND & OBJECTIVE: Nanoparticles are used in cosmetic and dermatologic products, due to better skin penetration properties. Incorporation of natural products exhibiting medicinal properties in nano-preparations could significantly improve the efficacy of these products and improve the quality of life without the side effects of synthetic formulations. METHODS: We here report the green synthesis of Copper Oxide nanoparticles, using Cucumber extract, and their detailed bio-physical and bio-chemical characterization. RESULTS: These Copper Oxide-Cucumber nanoparticles exhibit significant anti-bacterial and anti-fungal properties, Ultra Violet-radiation protection ability and reactive-oxygen species inhibition properties. Importantly, these nanoparticles do not exhibit significant cellular toxicity and, when incorporated in skin cream, exhibit skin rejuvenating properties. CONCLUSION: Our findings have implications for nanoparticle-based cosmetics and dermatologic applications.

Exogenous Ochronosis (EO): Skin lightening cream causing rare caviar-like lesion with banana-like pigments; review of literature and histological comparison with endogenous counterpart.

Ochronosis is a cutaneous disorder caused by the accumulation of phenols, either endogenously as homogentisic acid in patients with alkaptonuria (autosomal recessive disorder with deficiency of the enzyme homogentisic acid oxidase), or exogenously in patients using phenol products such as topical creams containing hydroquinone or the intramuscular application of antimalarial drugs. Exogenous ochronosis (EO) typically affects the face and was reported in patients with dark skin such as Black South Africans or Hispanics who use skin-lightening products containing hydroquinone for extended periods. Recently more cases have been reported worldwide even in patients with lighter skin tones, to include Eastern Indians, Asians, and Europeans. However, just 39 cases of EO have been reported in the US literature from 1983 to 2020. Here we present two cases; a 69 and a 45-year-old female who were seen for melasma, given hydroquinone 4% cream daily and tretinoin 0.05%. Both patients noticed brown spots on their cheeks, which progressively enlarged and darkened in color. The diagnosis of ochronosis was confirmed by characteristic histopathological features on the punch biopsy. Unfortunately, neither patient responded to multiple treatments (to include, tazarotene 0.1% gel and pimecrolimus ointment, topical corticosteroids, and avoidance of hydroquinone containing products). We also present a case of classic (endogenous) ochronosis in a patient with alkaptonuria to picture the histological similarities of these two entities. EO is an important clinical consideration because early diagnosis and treatment may offer the best outcome for this notoriously refractory clinical diagnosis.

Anticancer activity of topical ointments with histone deacetylase inhibitor, trichostatin A.

BACKGROUND: Trichostatin A (TSA), being a strong specific histone deacetylase (HDAC) inhibitor, may lead to the inhibition of growth, differentiation and/or apoptosis of cells in a number of tumors. Semisolid drug formulations for topical release of anticancer agents may be an alternative strategy or a supplement of the systemic therapy. OBJECTIVES: To prepare semisolid formulations with TSA to be used directly on the skin and to assess the anticancer effect in vivo on a mouse model with L1 neoplastic tumors. MATERIAL AND METHODS: Twenty-four formulations were prepared in the form of semisolid systems containing TSA as the active ingredient. Then, an in vitro study was performed concerning the release of the active substance from the prepared formulations. Four formulations were selected for in vivo studies: oil-in-water cream, hydrogel, w/o emulsion ointment on the absorptive hydrophobic medium, and o/w emulsion gel. The tumor size and mouse body weight were measured during the experiment. The tumors and healthy skin of the mice were assessed regarding the skin barrier function with the Corneometer and Tewameter probes. RESULTS: The semisolid formulation with TSA applied on the skin reduced the growth of neoplastic tumors as compared with the control group. This is especially pronounced in the case of w/o emulsion ointment and o/w emulsion gel. The Corneometer shows that neoplastic tumor growth and formulations on the skin have no effect on the skin condition in comparison with the mouse skin without tumor. The measurement performed with the Tewameter has revealed impaired skin barrier function of neoplastic tumors. CONCLUSIONS: Semisolid formulations with TSA fit well in the mainstream of research into topical medicines applied directly on neoplastic tumors, which may support and supplement current oncological treatment.

The Delivery of α1-Antitrypsin Therapy Through Transepidermal Route: Worthwhile to Explore.

Human α1-antitrypsin (AAT) is an abundant acute phase glycoprotein expressing anti-protease and immunomodulatory activities, and is used as a biopharmaceutical to treat patients with inherited AAT deficiency. The pleiotropic properties of AAT provide a rationale for using this therapy outside of inherited AAT deficiency. Therapy with AAT is administrated intravenously, yet the alternative routes are being considered. To examine the putative transepidermal application of AAT we used epiCS®, the 3D human epidermis equivalents reconstructed from human primary epidermal keratinocytes. We topically applied various concentrations of AAT protein with a constant volume of 50 µl, prepared in Hank's balance solution, HBSS, to epiCS cultured under bas\al condition or when culture medium supplemented with 100 µg/ml of a combined bacterial lipopolysaccharide (LPS) and peptidoglycan (PGN) mixture. AAT freely diffused across epidermis layers in a concentration and time-dependent manner. Within 18 h topically provided 0.2 mg AAT penetrated well the stratum corneum and localizes within the keratinocytes. The treatments with AAT did not induce obvious morphological changes and damages in keratinocyte layers. As expected, LPS/PGN triggered a strong pro-inflammatory activation of epiCS. AAT exhibited a limited capacity to neutralize the effect of LPS/PGN, but more importantly, it lowered expression of IL-18 and IL-8, and preserved levels of filaggrin, a key protein for maintaining the epidermal barrier integrity. Our findings suggest that the transepidermal route for delivering AAT is worthwhile to explore further. If successful, this approach may offer an easy-to-use therapy with AAT for skin inflammatory diseases.

Safety and Efficacy of a Novel Antiaging Skin Care Regimen Containing Neutraceuticals and Growth Factors on the Facial Skin of Women: A 12-Week Open-label Study.

BACKGROUND: Due to both intrinsic and extrinsic damage, the skin is where easily noticable signs of aging manifest. OBJECTIVE: We sought to assess the effects of two complex novel topical formulations, L'Unique Miracular Facial Serum (LMFS) and L'Unique Skin Essence (LSE) (Nourishing Biologicals LLC, St. Augustine, Florida) on hydration, firmness, elasticity, wrinkling, and pore size of facial skin after initial application and then after four, eight, and 12 weeks of use. METHODS: An open-label study was conducted on subjects (N=32) between the ages of 45 and 65 years (mean: 57 years). Subjects were treated with a twice-daily application of LMFS and LSE for a total of 12 weeks following a one-week washout period. The test products were gently applied in a circular motion to the face each morning and evening. Measurements of skin hydration, transepidermal water loss (TEWL), and skin elasticity and firmness and three-dimensional skin surface evaluations were performed at each visit. Skin lift and pore size assessments were also completed using clinical photography. Subjective outcomes were assessed by a posttreatment product efficiency survey at the end of each visit. RESULTS: Objective instrumental measurements showed statistically significant improvements in skin hydration (20.19%), TEWL (25.96% at 15 minutes), firmness (24.77%), skin elasticity (11.40%), and skin lift (5.41%) with product use. Improvements in pore size and wrinkle depth were not statistically significant. CONCLUSION: Use of the test products produced significant improvements in skin hydration, TEWL, firmness, and skin elasticity with associated improvements in facial skin appearance.

Tolerability and Efficacy of a Medical Device Repairing Emollient Cream in Children and Adults with Mild to Moderate Atopic Dermatitis.

INTRODUCTION: Regular emollient application is recommended for managing atopic dermatitis (AD). Although many emollients are available, only AD-tested medical device repairing emollient creams (MDRECs) can be recommended for treating and preventing AD skin lesions. Here, we evaluated the tolerability and benefit of a new MDREC in an open-label study in infants, young children, and adults with mild to moderate AD. METHODS: Subjects (or their parents or guardians) were instructed to apply the MDREC to AD lesions or areas of dry skin twice daily for 3 weeks. Investigators assessed tolerability and AD severity at days 1, 8, and 22. Subjects assessed AD severity weekly, recorded any adverse events, and reported their satisfaction with the MDREC at day 22. RESULTS: Sixty-one subjects (19 infants, 22 children, and 20 adults) were included and 59 completed the study. At inclusion, 49% of the infants and young children and 15% of the adults were experiencing flares of AD. At day 22, the local tolerability of the MDREC was judged by the investigators as excellent in all the children and in 18 of the 20 adult subjects (90%). All adverse events were mild and transient. Investigator- and subject-assessed AD severity progressively decreased at each assessment for each age subgroup. CONCLUSION: This study shows that the MDREC was well tolerated when applied to AD skin lesions in infants, young children, and adults and suggests this product can be used daily to control the signs and symptoms of AD. FUNDING: Laboratoires Dermatologiques Ducray, Pierre Fabre Dermo-Cosmétique.

Tolerability and efficacy of a medical device repairing emollient cream in adults with chronic hand dermatitis.

BACKGROUND: Emollients are recommended for managing chronic hand dermatitis (CHD). Medical device repairing emollient creams (MDRECs) are suitable for treating CHD-associated skin lesions, unlike most cosmetic emollient products that can only be used on healthy skin. OBJECTIVES: The aim of this study was to examine the tolerability and benefit of a MDREC, Dexyane MeD® , in adults with CHD. METHODS: In an open-label study, adults aged 18-65 years with mild-to-moderate CHD were instructed to apply the MDREC on both hands twice daily for 3 weeks. Investigators assessed tolerability and CHD severity on days 1, 8, and 22. Subjects assessed CHD severity weekly and completed the Dermatology Life Quality Index on days 1, 8, and 22. Differences from baseline were compared by Wilcoxon matched-pairs signed-rank test or paired t test. Satisfaction with the MDREC was assessed by subjects. RESULTS: Forty subjects were included and completed the study. Tolerability was good to excellent for all subjects. Subjects and investigators reported decreased severity of CHD at days 8 and 22 compared with Day 1 (P < 0.001), and subjects reported decreased pain and pruritus (P < 0.001). Quality of life improved, and most subjects were satisfied with the MDREC's characteristics and application. CONCLUSIONS: The MDREC was well tolerated and may help manage mild-to-moderate CHD.

Topical heat shock protein 70 prevents imiquimod-induced psoriasis-like inflammation in mice.

Psoriasis is a chronic inflammatory skin disease with systemic manifestations and potential genetic etiology. The newest treatments utilize antibodies against one of several cytokines known to underlie the inflammatory signaling molecules that produce the skin and systemic symptoms. However, these agents must be regularly injected, and they may compromise the normal responses of the immune system. Furthermore, they do not address the causes of the abnormal immunoregulatory responses of the disease because the etiology is not yet completely understood. In this short-term treatment study, the potential anti-inflammatory activity of an alfalfa-derived Hsp70-containing skin cream (aHsp70) was tested on imiquimod (IMQ)-induced psoriasis-like lesions in wild-type mice. Treatment of the mice with the aHsp70 skin cream simultaneously with the imiquimod application mitigated the induction of psoriatic-like lesions and correlated with altered expression of various skin cytokines.

Terapia tópica para prevenção e tratamento da radiodermatite aguda das mamas: revisão integrativa da literatura / Topical treatment for prevention and management of acute radiation dermatitis in breast cancer patients: an integrative review

Introdução: A radioterapia desempenha um importante papel adjuvante ao tratamento cirúrgico do câncer de mama, pois diminui as taxas de recorrência local e aumenta a sobrevida global. Entretanto, até 95% das pacientes expostas à radiação ionizante desenvolverão algum grau de radiodermatite. O presente estudo revisa a literatura referente às terapias tópicas disponíveis para prevenção e tratamento da radiodermatite aguda das mamas, sintetizando as evidências disponíveis e auxiliando a tomada de decisão clínica. Métodos: Revisão integrativa da literatura publicada nos últimos 10 anos, utilizando as bases de dados LILACS, Medline e Biblioteca Cochrane. Foram utilizados os descritores neoplasias da mama, radiodermatite, higiene da pele e creme para a pele. Resultados: Dos 158 artigos encontrados, 48 foram incluídos nesta revisão. Foram identificadas 40 diferentes terapias tópicas que foram agrupadas em sete categorias para facilitar a análise e interpretação dos dados: fitoterápicos, hormônios/vitaminas/fatores de crescimento, corticoesteroides, barreira (filme ou creme), ácido hialurônico, curativos à base de prata e outros. Conclusões: Existe evidência científica proveniente de ensaios clínicos randomizados de boa qualidade embasando a indicação dos corticosteroides tópicos de alta (valerato de 17-betametasona) e média potência (furoato de mometasona 0,1%), assim como de filmes barreira como Mepitel®, Mepilex Lite® e Hydrofilm®, no manejo da radiodermatite aguda das mamas. As demais terapias não mostraram benefícios na prevenção e/ou tratamento da radiodermatite ou têm evidência científica limitada, contraindicando ou restringindo sua utilização na prática clínica.

Introduction: Radiotherapy plays an important adjuvant role in the surgical treatment of breast cancer by reducing locoregional recurrence and improving overall survival. However, up to 95% of patients experience some degree of radiodermatitis. This study aims to review the literature regarding topical agent therapies in preventing and treating acute radiation dermatitis in breast cancer patients. Methods: Integrative review of LILACS, Medline and Cochrane Library databases. We searched for original articles published between 2010 and 2020, including the descriptors breast neoplasms, radiodermatitis, skincare, and skin cream. Results: The initial search returned 158 articles. After screening for eligibility, 48 articles were included. Forty different topical agent therapies were identified and grouped into seven categories to facilitate data analysis: herbal medicines, hormones/vitamins/growth factors, topical corticosteroids, barrier products (film or cream), hyaluronic acid, silver-based dressings and others. Conclusions: This review identifies that topical corticosteroids of high (betamethasone-17-valerate) and medium potency (mometasone furoate 0.1%), as well as barrier films such as Mepitel®, Mepilex Lite®, and Hydrofilm®, are effective in managing acute breast radiodermatitis. The other topical agent therapies did not show benefits in preventing and/or treating acute radiodermatitis or have limited evidence.

O efeito do ácido ascórbico tópico na cicatrização cutânea / The effect of topical ascorbic acid on cutaneous healing

Introdução: A ferida cirúrgica apresenta altos níveis de radicais livres em resposta ao dano cutâneo, o que gera a hipótese de um possível benefício do uso de antioxidantes no reparo destas feridas, tal como a aplicação tópica do ácido ascórbico. No entanto, pesquisas recentes obtiveram conclusões discrepantes para este tipo de tratamento. O objetivo é avaliar o efeito do ácido ascórbico tópico na cicatrização cutânea por meio de uma revisão de escopo. Métodos: A revisão de escopo foi realizada na base de dados Medline, Lilacs e Cochrane, com os descritores: ácido ascórbico, creme para a pele e cicatrização de feridas. Foram definidos como critérios de inclusão: ensaios clínicos randomizados, observacionais e revisões sistemáticas, em humanos, com data de publicação de até 5 anos, nas línguas inglesa, portuguesa ou espanhola. Foram excluídas: revisões narrativas, dissertações, teses, editoriais, estudos in vitro e em animais. Por fim, foi realizada a classificação dos estudos através da metodologia GRADE. Resultados: Foram encontrados 83 estudos e, após triagem, seis artigos foram selecionados. Destacou-se o uso do ácido ascórbico na concentração de 5 a 20% e de seus derivados (0,075% a 9,55%). Apresentaram a qualidade GRADE moderada os desfechos: aumento da firmeza cutânea e redução da vermelhidão, e alta qualidade: melhora na hidratação, elasticidade, colorometria das manchas e melhora do fechamento das feridas. Conclusão: O ácido ascórbico promove melhor elasticidade cutânea, diminuição do eritema e melhor fechamento das feridas. Apesar destes fortes indícios, ensaios clínicos randomizados com menor risco de viés de aferição e com maior casuística ainda se fazem necessários.

Introduction: The surgical wound has high levels of free radicals in response to skin damage, which raises the hypothesis of a possible benefit from using antioxidants in repairing these wounds, such as the topical application of ascorbic acid. However, recent research has found conflicting conclusions about this type of treatment. The objective is to evaluate the effect of topical ascorbic acid on skin healing through a scope review. Methods: The scope review was carried out in the Medline, Lilacs and Cochrane databases, with the descriptors: ascorbic acid, skin cream, and wound healing. Inclusion criteria were defined as randomized clinical trials, observational and systematic reviews, in humans, with a publication date of up to 5 years, in English, Portuguese or Spanish. The following were excluded: narrative reviews, dissertations, theses, editorials, in vitro and animal studies. Finally, the studies were classified using the GRADE methodology. Results: 83 studies were found, and six articles were selected after screening. The use of ascorbic acid in the concentration of 5 to 20% and its derivatives (0.075% to 9.55%) stood out. The outcomes presented a moderate GRADE quality: increased skin firmness and reduced redness, and high quality: improved hydration, elasticity, colorimetry of the stains and improved wound closure. Conclusion: Ascorbic acid promotes better skin elasticity, reduced erythema and better wound closure. Despite these strong indications, randomized clinical trials with a lower risk of measurement bias and greater casuistry are still necessary.

Influence of artificial sebum on the dermal absorption of chemicals in excised human skin: A proof-of-concept study.

In an initial diffusion cell study, the influence of artificial sebum on dermal penetration and intradermal reservoir of ethanol and toluene was investigated in comparison with the effects of a skin cream (o/w- and w/o-emulsion) and untreated (control) skin. Human skin was exposed to neat ethanol and toluene for 4h, respectively. During the experiments, the penetration of the compounds was assessed in the receptor fluid. The amounts of the test compounds in the skin were determined at the end of exposure. In the control experiments, 42% of the total resorbed ethanol amounts were found in the intradermal reservoir after 4h, whereas 82% of the toluene amounts were found in the skin compartments. The treatment with artificial sebum showed no significant differences in dermal absorption of both test compounds compared to control skin. In contrast, the treatment with skin cream increased the percutaneous penetration (p<0.001) and the intradermal reservoir of ethanol ~2-fold but not of toluene. In all exposure scenarios, a relevant intradermal reservoir was formed. The results indicate that sebum does not influence the percutaneous penetration and the intradermal reservoir of epidermally applied chemicals, whereas the application of skin creams may increase the dermal penetration of the compounds.