A Brief Review of Vehicles for Topical Therapies.

BACKGROUND: Topical therapy has been a fundamental part of dermatology, evolving from early ointments to advanced transdermal treatments. These formulations allow for effective management of skin conditions by maximizing local drug delivery and minimizing systemic effects. Modern topical therapies continue to benefit from innovations that improve both efficacy and patient outcomes. SUMMARY: Topical formulations consist of a vehicle and active ingredients, with the vehicle enhancing drug absorption and patient experience. Historically categorized by physical properties, vehicles are vital in drug delivery. Recent innovations, such as nanoemulsions and derma-membrane structures, offer improved skin penetration and therapeutic results, representing significant advancements in topical treatment options. KEY MESSAGES: Topical therapies provide targeted, effective treatment in dermatology with minimal systemic side effects. Vehicle choice is essential to therapy success, and innovations such as nanoemulsions are improving drug delivery and patient care. Ongoing research into novel delivery systems continues to enhance the future of dermatological treatments.

Topical corticosteroids for the prevention of severe radiation dermatitis: a systematic review and meta-analysis.

PURPOSE: Radiation dermatitis (RD) is a frequently occurring adverse reaction during radiotherapy in cancer patients. While the use of topical corticosteroids (TCs) is common for the treatment of RD, its role in preventing severe reactions remains unclear. This systematic review and meta-analysis aim to evaluate the evidence on the use of TCs as prophylaxis of RD. METHODS: A systematic search was conducted using OVID MedLine, Embase, and Cochrane databases (between 1946 and 2023) to identify studies examining TC use in the prevention of severe RD. Statistical analysis was completed using RevMan 5.4 to calculate pooled effect sizes and 95% confidence intervals. Forest plots were then developed using a random effects model. RESULTS: Ten RCTs with a total of 1041 patients met the inclusion criteria. Six studies reported on mometasone furoate (MF) and four studies reported on betamethasone. Both TCs were associated with a significant improvement in the prevention of moist desquamation [OR = 0.34, 95% CI [0.25, 0.47], p < 0.00001], but betamethasone was found to be more effective than MF [OR = 0.29, 95% CI [0.18, 0.46], p < 0.00001 and OR = 0.39, 95% CI [0.25, 0.61], p < 0.0001, respectively]. A similar finding was seen in reducing the development of grade 2 or higher RD according to the Radiation Therapy Oncology Group scale. CONCLUSIONS: The current evidence supports the use of TCs in preventing severe reactions of RD. Both MF and betamethasone were found to be effective; however, betamethasone, a higher potency TC, is more effective despite MF being more commonly reported in literature.

Topical non-steroidal agents for the prevention of radiation dermatitis: a systematic review and meta-analysis.

PURPOSE: Radiation dermatitis (RD) is a common side effect of radiation therapy, affecting a majority of breast and head and neck cancer patients with a negative impact on quality of life. Currently, no consensus exists regarding the prevention of RD. METHODS: PubMed, Embase and Cochrane databases (1946 to December 2022) were searched using PRISMA guidelines to identify randomized controlled trials (RCTs) that investigated the use of topical non-steroidal agents in the prevention of RD in patients undergoing radiotherapy. RESULTS: A total of six RCTs were included, comprising 627 patients. Among the topical non-steroidal agents analyzed, only the use of Biafine® in breast cancer patients was significant in preventing grade 4 and 3 + RD as classified by the Radiation Therapy Oncology group (RTOG) scale (OR = 0.07, 95% CI 0.01-0.63, p = 0.02, and OR 0.11, 95% CI 0.03-0.41, p < 0.01, respectively). The remaining agents (trolamine alone and hyaluronic acid/hyaluronan) did not significantly prevent the occurrence of RD. CONCLUSION: The results of this systematic review and meta-analysis indicate that Biafine® can prevent grade 3 + RD in breast cancer patients. The use of trolamine and hyaluronic acid does not significantly affect the incidence of RD.

Focused update: Guidelines of care for the management of actinic keratosis.

BACKGROUND: Actinic keratoses (AKs) are rough scaly patches that arise on chronically UV-exposed skin and can progress to keratinocyte carcinoma. OBJECTIVE: In 2021, the American Academy of Dermatology published guidelines to assist in clinical decision-making for the management of AK. The purpose of this focused guideline update is to incorporate recently available evidence on the use of topical tirbanibulin to treat AK. METHODS: A multidisciplinary work group conducted a systematic review to evaluate data on the use of tirbanibulin for AK and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading a clinical recommendation. The graded recommendation was voted on to achieve consensus. RESULTS: Two trials were identified, and analysis of the evidence resulted in 1 recommendation. LIMITATIONS: This analysis is based on the best available evidence at the time it was conducted. Long-term efficacy and safety data are not currently available. CONCLUSIONS: A strong recommendation for the use of topical tirbanibulin to join the currently recommended list of topical therapies for AK was made on the basis of the available evidence.

The impact of topical agents and dressing on pH and temperature on wound healing: A systematic, narrative review.

To assess the impact of topical agents and dressings on surface wound pH, temperature, and subsequent wound healing. This was a systematic, narrative review of the literature, following the PRISMA (2020) guidelines. The databases searched were Medline PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Embase, Web of Science, and Scopus. Data synthesis and analysis were conducted using a structured narrative synthesis. The quality of the included clinical studies was appraised using the Evidence-Based Literature (EBL) Critical Appraisal Tool. A total of six clinical studies were assessed as eligible for inclusion, A total of six dressings/topical agents were assessed and the types of wounds included non-healing chronic wounds. Of the studies, five explored pH and one explored temperature. The EBL validity of the clinical studies was low (mean quality score was 51.3%). The five clinical studies that explored pH investigated different dressings and topical agents reporting an associated reduction in pH and improved wound outcomes. One clinical study investigated the impact of topical sodium nitrite on temperature and found that sodium nitrite increased peri-wound skin temperature and improved wound outcomes with a reduction in leg ulcer size. Given the low certainty of the evidence, we cannot confidently recommend the use of any particular topical agent or dressing to manipulate pH, or temperature to improve wound outcomes. Thus, there is a need for further research to develop a greater understanding of this topic. Irish Research Council, Enterprise Partnership Scheme.

TOPICAL AGENTS FOR THE PREVENTION AND TREATMENT OF ORAL MUCOSITIS.

OBJECTIVE: The aim: To make a narrative assessment of the agents currently in use, with a particular emphasis on the topical agents that we frequently utilize in our practice. PATIENTS AND METHODS: Materials and methods: The main method of this work is a review of literary sources. We reviewed the literature (PubMed, Google Scholar, Web of Science, Scopus) to support and explain the interventions we use in different cases of oral mucositis patients. We decided to combine our experience with evidence-based data. CONCLUSION: Conclusions: Topical treatments alleviate and prevent oral mucositis. Topical medicines can assist maintain oral balance and moistness by modulating oral bacteria and replacing saliva.

Guidelines of care for the management of actinic keratosis: Executive summary.

BACKGROUND: Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. Treatment options for AK include topical medications, photodynamic therapy, cryosurgery, and laser ablation. OBJECTIVE: This executive summary provides a synopsis of the 18 evidence-based recommendations for the treatment of AK detailed in the Guidelines of Care for the Management of Actinic Keratosis. METHODS: A multidisciplinary workgroup conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations Assessment, Development and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus. RESULTS: Analysis of the evidence resulted in 18 recommendations, suggesting there are several effective treatments available for AK. LIMITATIONS: The analysis informing the recommendations was based on the best available evidence at the time it was conducted. The results of future studies may necessitate a revision of current recommendations. CONCLUSIONS: Strong recommendations are presented for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are presented for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.

Guidelines of care for the management of actinic keratosis.

BACKGROUND: Actinic keratoses (AK) are rough scaly patches that arise on chronically ultraviolet-exposed skin and can progress to keratinocyte carcinoma. OBJECTIVE: This analysis examined the literature related to the management of AK to provide evidence-based recommendations for treatment. Grading, histologic classification, natural history, risk of progression, and dermatologic surveillance of AKs are also discussed. METHODS: A multidisciplinary Work Group conducted a systematic review to address 5 clinical questions on the management of AKs and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of the evidence and formulating and grading clinical recommendations. Graded recommendations were voted on to achieve consensus. RESULTS: Analysis of the evidence resulted in 18 recommendations. LIMITATIONS: This analysis is based on the best available evidence at the time it was conducted. The pragmatic decision to limit the literature review to English language randomized trials may have excluded data published in other languages or limited identification of relevant long-term follow-up data. CONCLUSIONS: Strong recommendations are made for using ultraviolet protection, topical imiquimod, topical 5-fluorouracil, and cryosurgery. Conditional recommendations are made for the use of photodynamic therapy and diclofenac for the treatment of AK, both individually and as part of combination therapy regimens.

Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures.

Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.

The effects of CO2 laser and topical agent combination therapy for onychomycosis: A meta-analysis.

The routine options for onychomycosis are oral, topical, and device-based therapies which are often limited in terms of efficacy and unsatisfactory side effects. Topical agents such as luliconazole, tioconazole, terbinafine, and tazarotene can be more effective when combined with laser therapies. Our aim was to compare the efficacy and satisfaction rates of CO2 laser therapy with topical agents in patients with onychomycosis. PubMed, the Cochrane Library, Embase, and Ovid databases were searched to identify randomized controlled trials (RCTs) evaluating the effects of combined therapies. Selected study data were analyzed for differences expressed as odds ratio (OR) and relative ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes. Efficacy and satisfaction outcomes were assessed using quantitative methods. Our investigations showed that combined CO2 laser and topical treatments significantly increased efficacy 5.38-fold when compared with topical agents alone (OR 5.38; 95% CI; 3.20-9.04; p < 0.00001), with low heterogeneity observed among studies (I2  = 38%). Mycological clearance comparison rates were also improved by combined treatments. The higher satisfaction of the combined group was assessed by pooled effect (OR 4.56; 95% CI; 2.78-7.49; p < 0.00001). Our evidence suggests combined therapy may exert positive effects and satisfactory safety for patients with moderate to severe onychomycosis, however, optimal combination options and appropriate dosages require more comprehensive RCTs.

COVID-19: Topical agents and therapeutic prevention of nasal viral acquisition.

Since the spread of SARS-CoV-2 became a pandemic, the number of cases has been continuously growing worldwide. Numerous recommendations and suggestions have been published to prevent the acquisition and spread of the SARS-CoV-2, especially to protect health workers and front-line caregivers. SARS-CoV-2 is transmitted by aerosol, rendering air defense with suitable ventilation and adequate mask use pivotal. Recently, locally applied antiseptic, antiviral, or structure competitive receptor blockers were suggested to attack the virus at its main point of invasion, the nasal mucosa and nasopharynx. We discuss the most plausible and safe ideas to reduce viral load at the point of entry, and subsequently the spread of SARS-CoV-2 to the lower respiratory tract, lungs, and other organs. In addition, we analyze the value and recommend clinical trials employing topical trichloroacetic acid (TCA), a substance well known from dermatologic and cosmetic procedures. It has been proven to successfully block the nasal entry for airborne allergens, preventing the development of allergic rhinitis and asthma, and to be curative for early stages of viral infections entering through the oral mucosa. For SARS-CoV-2, TCA in a single, short-time application is expected to remodel the nasal and nasopharyngeal epithelia, eliminating both the receptors and cells responsible for viral entry and subsequent viral spread to the lower respiratory tract. Moreover, this may have therapeutic benefits for those recently infected by reducing local viral replication. Such procedures are cheap, safe, and can be conducted in almost every setting, especially in regions with inadequate financial and logistic resources.

Management of acute radiation dermatitis: A review of the literature and proposal for treatment algorithm.

Radiation dermatitis is a common sequela of radiation therapy; up to 95% of patients will develop moderate-to-severe skin reactions. No criterion standard currently exists for the treatment of acute radiation-induced skin toxicity. It is therefore imperative to develop a greater understanding of management options available to allow clinicians to make informed decisions when managing radiation oncology patients. This literature review discusses the topical agents that have been studied for the treatment of acute radiation dermatitis, reviews their mechanisms of action, and presents a treatment algorithm for clinicians managing patients experiencing radiation dermatitis.

Treating hidradenitis suppurativa with photodynamic therapy.

Hidradenitis suppurativa is a chronic, recurring, and disabling inflammatory condition of the skin. There is no cure for hidradenitis suppurativa and treatment must be adapted to each individual patient. Several studies have been published since 2004 on the use of photodynamic therapy to treat hidradenitis suppurativa. The use of superficial or interstitial illumination with 5-amino-levulinic acid (5-ALA) or methylene blue (MB) have been proposed. Injecting 5-ALA or MB followed by illumination with a fiber optic sensor placed inside the lesion appears to be a better method of treating these thick lesions.

Skin hyperpigmentation treatment using herbs: A review of clinical evidences.

Hyperpigmentation of skin is caused by several factors. UV exposure, in addition to oxidative stress, elevates inflammatory mediators stimulating melanogenesis. Herbal-derived compounds for improving skin lightness are gaining interest as they are perceived to be milder, safer, and healthier than fully synthetic products. This review briefly addresses the causes of skin hyperpigmentation and extensively summarizes the status of herbs currently used in skin-lightening cosmetics. The properties of active compounds and their dose rate information are summarized where available, along with human or animal relevant models for activity testing. This review will be of value to cosmetic formulators and dermatologists who are searching for naturally derived ingredients for improving skin lightness, in line with consumer preference and expectations.

Practical Strategies for Optimizing Management of Psoriasis.

Approximately 30% of patients with moderate plaque psoriasis and 20% of those with severe psoriasis have inadequate disease control with their current therapeutic regimens. Among the factors that affect treatment efficacy are drug selection and lack of patient adherence to treatment, which is often due to patient frustration that psoriasis is a chronic, multisystemic, and incurable disease. By forming a strong therapeutic alliance with patients and by asking them about their expectations for treatment, clinicians have a better chance of providing patients with more effective and durable relief from their psoriasis symptoms. Semin Cutan Med Surg 37(supp2):S52-S55.

Glycolic acid peel in disseminated facial verrucae.

Facial warts are a common cause of cosmetic concern and also affect the self-esteem of the affected patients. These are benign skin papillomas caused by human papillomavirus infections. Warts affecting the face are mainly due to HPV-3 and HPV-10. Destructive and caustic agents used for the treatment can produce scarring at these site, hence should be used with care. Earlier, glycolic acid alone as well as in combination with salicylic acid in gel base formulation have been used to treat facial recalcitrant wart with good results. We used glycolic acid peel in aqueous base with dramatic improvement.

Vesicles: Potential nano carriers for the delivery of skin cosmetics.

In the present scenario, consumers are searching for personal care products that supply multiple benefits with minimal efforts. The outcome has been the introduction of nanotechnology-based cosmetic products that are safe to use and results driven. Some topical cosmetics can act efficaciously when they reach their target sites present in the deeper layers of the skin. The main problem with delivering active ingredients across the skin is the barrier function of the skin. Therefore, to get the maximum benefit from cosmetic products and to overcome the problems associated with their skin penetration, scientists are investigating various strategies to overcome these barrier properties. Vesicular carriers have been claimed to improve the topical delivery of active ingredients. This review offers a brief overview of current approaches in the research and development of vesicular carriers to improve the delivery and performance of active ingredients present in the cosmetics.

The effect of recurrent pulsed dye laser treatments in rosacea patients.

BACKGROUND: Rosacea is common chronic skin condition and is known to have a negative impact on patient's quality of life. The use of pulsed dye laser treatment to improve quality of life is well documented in the literature. Prior work has emphasized a single series of laser treatments but we investigated the effect of recurrent pulsed dye laser treatment on patient's symptomatology and quality of life. METHODS: We designed an 8 question survey about patient's rosacea symptoms, prior treatments, effectiveness of prior treatments, benefit of the laser treatments, and number of laser treatments. The survey (Figure 1) was offered to all patients over the age of 18 who were beginning or currently undergoing pulsed dye laser treatments who previously failed medical management for their erythematotelangiectatic rosacea. RESULTS: Fifty patients completed the study. Patients had significant improvement in symptoms and show statistically significant benefit of repeated pulse dye laser treatment for rosacea versus a single series of treatments. CONCLUSION: Our study is unique in that it provides evidence that recurrent pulse dye laser treatments are beneficial to patients by improving quality of life and decreasing symptoms. This finding supports the notion that chronic treatment is needed for this chronic disease.

Curative effects of microneedle fractional radiofrequency system on skin laxity in Asian patients: A prospective, double-blind, randomized, controlled face-split study.

BACKGROUND: To date, no studies compared curative effects of thermal lesions in deep and superficial dermal layers in the same patient (face-split study). OBJECTIVE: To evaluate skin laxity effects of microneedle fractional radiofrequency induced thermal lesions in different dermal layers. METHODS AND MATERIALS: 13 patients underwent three sessions of a randomized face-split microneedle fractional radiofrequency system (MFRS) treatment of deep dermal and superficial dermal layer. Skin laxity changes were evaluated objectively (digital images, 2 independent experts) and subjectively (patients' satisfaction numerical rating). RESULTS: 12 of 13 subjects completed a course of 3 treatments and a 1-year follow-up. Improvement of nasolabial folds in deep dermal approach was significantly better than that in superficial approach at three months (P=.0002) and 12 months (P=.0057) follow-up. Effects on infraorbital rhytides were only slightly better (P=.3531). CONCLUSION: MFRS is an effective method to improve skin laxity. Thermal lesion approach seems to provide better outcomes when applied to deep dermal layers. It is necessary to consider the skin thickness of different facial regions when choosing the treatment depth.

Evaluation of therapeutic laser influences on the healing of third-degree burns in rats according to different wavelengths.

INTRODUCTION: One of the most important innovative methods for tissue repair promotion is therapeutic lasers with photobiomodulution effects. The aim of this study was to investigate the effect of four different wavelengths of therapeutic laser (405, 532, 660 and 810 nm) on healing of third-degree burns from both clinical and pathological standpoints in rats. MATERIALS AND METHODS: 60 male Wistar rats were used. Animals were anesthetized and dorsal hairs were shaved and third-degree skin burns were created by use of a 95°C copper stamp. Lesions were irradiated with 1.5 J/cm2 energy densities and 200 mW/cm2 power densities. RESULTS: Statistical analyses of the "wound contraction" changes between five groups during the study showed more reduction in wound size in all laser groups in comparison with the control group; but these differences were not statistically significant except between red and blue lasers on the last day of experiment. DISCUSSION: Results of our study showed that using therapeutic lasers with green, blue, red, and infrared wavelengths may accelerate healing process. This trend is more obvious in red and infrared groups especially after acute phase, however, this effect was neither statistically nor clinically significant.