Effects of Malaysian thermal spring water as adjunct therapy for mild to moderate acne vulgaris - a prospective, randomised, controlled, split face study.

INTRODUCTION: Acne is a common skin disease with a high psychosocial burden, affecting mostly adolescents and youth worldwide. Management of acne is often challenged by cutaneous side effects that leads to therapeutic intolerance, poor compliance and impaired efficacy. MATERIALS AND METHODS: This was a single-centre, evaluatorblinded, split-face, randomised study investigating the effects of thermal spring water (TSW) in improving efficacy and tolerability of standard acne therapy. Total of 31 participants with mild-to-moderate acne were recruited and subjected to TSW spray to one side of the face 4 times daily for 6 weeks in addition to standard therapy. The other side received standard therapy only. RESULTS: Six (19.4%) males and 25 (80.6%) female with mean age 25.1±6.13 participated, 15 (48.4%) had mild acne while 16 (51.6%) had moderate acne. Seven (22.6%) were on oral antibiotics, 25 (80.6%) used adapalene, 6 (19.4%) tretinoin and 21 (67.7%) benzoyl peroxide. Skin hydration improved and better on spring water treated side with mean difference12.41±30.31, p = 0.04 at the forehead, 39.52±65.14, p < 0.01 at the cheek and 42.172±71.71, p < 0.01 at the jaw at week 6. Participants also report significant reduction in dryness at the treated side at week 6, mean difference 0.93±0.10, p < 0.001. TEWL, sebum and pH were comparable on both sides with no significant differences. Tolerability towards standard therapy improved as early week 2 with reduction of stinging following application of topical therapy (mean difference 0.62±1.43, p = 0.03), increase in skin feeling good (-1.79±1.70, p < 0.001) and skin suppleness (0.62±1.43, p < 0.001). These improvements were significantly maintained till week 6. Cardiff acne disability index significantly improved at week 6 (p<0.001) despite no significant changes in Comprehensive Acne Severity Scale score before and after treatment. CONCLUSION: TSW may have a role as an adjunct to standard acne therapy by improving hydration, acne disability index and tolerability towards standard topical treatment.

Interventions for cutaneous molluscum contagiosum.

BACKGROUND: Molluscum contagiosum is a common skin infection that is caused by a pox virus and occurs mainly in children. The infection usually resolves within months in people without immune deficiency, but treatment may be preferred for social and cosmetic reasons or to avoid spreading the infection. A clear evidence base supporting the various treatments is lacking.This is an update of a Cochrane Review first published in 2006, and updated previously in 2009. OBJECTIVES: To assess the effects of specific treatments and management strategies, including waiting for natural resolution, for cutaneous, non-genital molluscum contagiosum in people without immune deficiency. SEARCH METHODS: We updated our searches of the following databases to July 2016: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched six trial registers and checked the reference lists of included studies and review articles for further references to relevant randomised controlled trials. We contacted pharmaceutical companies and experts in the field to identify further relevant randomised controlled trials. SELECTION CRITERIA: Randomised controlled trials of any treatment of molluscum contagiosum in people without immune deficiency. We excluded trials on sexually transmitted molluscum contagiosum and in people with immune deficiency (including those with HIV infection). DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed methodological quality, and extracted data from selected studies. We obtained missing data from study authors where possible. MAIN RESULTS: We found 11 new studies for this update, resulting in 22 included studies with a total of 1650 participants. The studies examined the effects of topical (20 studies) and systemic interventions (2 studies).Among the new included studies were the full trial reports of three large unpublished studies, brought to our attention by an expert in the field. They all provided moderate-quality evidence for a lack of effect of 5% imiquimod compared to vehicle (placebo) on short-term clinical cure (4 studies, 850 participants, 12 weeks after start of treatment, risk ratio (RR) 1.33, 95% confidence interval (CI) 0.92 to 1.93), medium-term clinical cure (2 studies, 702 participants, 18 weeks after start of treatment, RR 0.88, 95% CI 0.67 to 1.14), and long-term clinical cure (2 studies, 702 participants, 28 weeks after start of treatment, RR 0.97, 95% CI 0.79 to 1.17). We found similar but more certain results for short-term improvement (4 studies, 850 participants, 12 weeks after start of treatment, RR 1.14, 95% CI 0.89 to 1.47; high-quality evidence). For the outcome 'any adverse effect', we found high-quality evidence for little or no difference between topical 5% imiquimod and vehicle (3 studies, 827 participants, RR 0.97, 95% CI 0.88 to 1.07), but application site reactions were more frequent in the groups treated with imiquimod (moderate-quality evidence): any application site reaction (3 studies, 827 participants, RR 1.41, 95% CI 1.13 to 1.77, the number needed to treat for an additional harmful outcome (NNTH) was 11); severe application site reaction (3 studies, 827 participants, RR 4.33, 95% CI 1.16 to 16.19, NNTH over 40).For the following 11 comparisons, there was limited evidence to show which treatment was superior in achieving short-term clinical cure (low-quality evidence): 5% imiquimod less effective than cryospray (1 study, 74 participants, RR 0.60, 95% CI 0.46 to 0.78) and 10% potassium hydroxide (2 studies, 67 participants, RR 0.65, 95% CI 0.46 to 0.93); 10% Australian lemon myrtle oil more effective than olive oil (1 study, 31 participants, RR 17.88, 95% CI 1.13 to 282.72); 10% benzoyl peroxide cream more effective than 0.05% tretinoin (1 study, 30 participants, RR 2.20, 95% CI 1.01 to 4.79); 5% sodium nitrite co-applied with 5% salicylic acid more effective than 5% salicylic acid alone (1 study, 30 participants, RR 3.50, 95% CI 1.23 to 9.92); and iodine plus tea tree oil more effective than tea tree oil (1 study, 37 participants, RR 0.20, 95% CI 0.07 to 0.57) or iodine alone (1 study, 37 participants, RR 0.07, 95% CI 0.01 to 0.50). Although there is some uncertainty, 10% potassium hydroxide appears to be more effective than saline (1 study, 20 participants, RR 3.50, 95% CI 0.95 to 12.90); homeopathic calcarea carbonica appears to be more effective than placebo (1 study, 20 participants, RR 5.57, 95% CI 0.93 to 33.54); 2.5% appears to be less effective than 5% solution of potassium hydroxide (1 study, 25 participants, RR 0.35, 95% CI 0.12 to 1.01); and 10% povidone iodine solution plus 50% salicylic acid plaster appears to be more effective than salicylic acid plaster alone (1 study, 30 participants, RR 1.43, 95% CI 0.95 to 2.16).We found no statistically significant differences for other comparisons (most of which addressed two different topical treatments). We found no randomised controlled trial evidence for expressing lesions or topical hydrogen peroxide.Study limitations included no blinding, many dropouts, and no intention-to-treat analysis. Except for the severe application site reactions of imiquimod, none of the evaluated treatments described above were associated with serious adverse effects (low-quality evidence). Among the most common adverse events were pain during application, erythema, and itching. Included studies of the following comparisons did not report adverse effects: calcarea carbonica versus placebo, 10% povidone iodine plus 50% salicylic acid plaster versus salicylic acid plaster, and 10% benzoyl peroxide versus 0.05% tretinoin.We were unable to judge the risk of bias in most studies due to insufficient information, especially regarding concealment of allocation and possible selective reporting. We considered five studies to be at low risk of bias. AUTHORS' CONCLUSIONS: No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. We found moderate-quality evidence that topical 5% imiquimod was no more effective than vehicle in terms of clinical cure, but led to more application site reactions, and high-quality evidence that there was no difference between the treatments in terms of short-term improvement. However, high-quality evidence showed a similar number of general side effects in both groups. As the evidence found did not favour any one treatment, the natural resolution of molluscum contagiosum remains a strong method for dealing with the condition.

Emerging topical antimicrobial options for mild-to-moderate acne: a review of the clinical evidence.

Topical antimicrobial agents are commonly used as first-line agents for the management of mild to moderate acne vulgaris. Agents with antibacterial activity (eg, benzoyl peroxide and clindamycin), reduce counts of Propionibacterium acnes, while also decreasing the numbers of inflammatory and noninflammatory lesions. In order to optimize efficacy, topical antibiotics are most commonly used in combination with benzoyl peroxide, an approach which also reduces the emergence of strains of P acnes that are less sensitive to antibiotics. Other topical antiacne options include retinoids (with or without an antimicrobial agent), sulfacetamide, sulfacetamide-sulfur, and azelaic acid. Certain formulations of benzoyl peroxide offer improved tolerability, while a new micronized form may enhance efficacy by optimizing follicular penetration. This wide array of options allows dermatologists to tailor topical treatments to the needs of individual patients.

Utilizing combination therapy for ethnic skin.

A major issue in treating acne in individuals of color is the need to treat and prevent postinflammatory hyperpigmentation (PIH), which is common in this population. This subset analysis reports the pigmentary changes in subjects of color with acne who were enrolled in a community-based trial comparing 3 different topical therapeutic regimens. All subjects received combination clindamycin 1%-benzoyl peroxide (BPO) 5% topical gel containing glycerin and dimethicone. Subjects were randomized to receive this combination therapy in addition to either a tretinoin microsphere (RAM) gel at concentrations of either 0.04% or 0.1% or adapalene (AP) gel 0.1%. There was a trend toward better resolution of hyperpigmentation in the subjects receiving the clindamycin-BPO topical gel in combination with RAM gel 0.04%.

Polymeric micellar nanocarriers of benzoyl peroxide as potential follicular targeting approach for acne treatment.

The aim of this work was to optimize polymeric nano-sized micellar carriers of the anti-acne compound benzoyl peroxide (BPO) and to examine the ability of these carriers to deposit into hair follicles with the objective of improving skin delivery of BPO. BPO loaded polymeric micelles composed of Pluronic(®) F127 were prepared by the thin film hydration method and characterized in terms of size, loading capacity, morphology and physical stability. The optimized micelle formulation was then selected for skin delivery studies. The penetration of BPO loaded micellar carriers into skin and skin appendages across full thickness porcine skin was examined in vitro. Confocal microscopy images confirmed the penetration of Nile Red into hair follicles, which was loaded into micellar carriers as a model fluorescent compound. The relative safety of the polymeric micelles was evaluated with the MTT viability test using mouse embryonic fibroblasts. The results indicated that nano-sized polymeric micelles of BPO composed of Pluronic(®) F127 offer a potential approach to enhance skin delivery of BPO and that targeting of micelles into hair follicles may be an effective and safe acne treatment.

Granulomatous Rosacea and Periorificial Dermatitis: Controversies and Review of Management and Treatment.

Granulomatous rosacea and periorificial dermatitis are common skin conditions affecting the face. This article examines the historical origin, causes, clinical presentation, and management strategies for these entities.

Biocement--a new material. Results of its experimental use for osseous repair of skull cap defects with lesions of the dura mater and liquorrhea, reconstruction of the anterior wall of the frontal sinuses and fixation of alloimplants.

A newly developed material, which we call biocement, consisting of bisphenol-a-glycidyl methacrylate ("epoxide methacrylate') as organic matrix and Bioceramic Battelle, Bioglass Hench and/or pentacalcium hydroxide triphosphate ("tri-calcium phosphate') powder as filling particles is presented. In an extension of previous experiments, various types of this biocement, containing different admixtures of particulate matter, were employed to test their usefulness in head surgery, in particular maxillo-facial reconstruction, on dogs and a rhesus monkey. Encouraging results were obtained with regard to (a) fixing a titanium alloimplant under some degree of mechanical stress; (b) covering a defect in the skull cap, including the closure of an artificially induced meningeal fistula with liquorrhea; and (c) reconstruction of defects in the anterior wall of frontal sinuses. Special emphasis is placed on direct contact between biocement and bone, interdigitations between these two, reactions of meningeal tissue, and regeneration of ciliated epithelium underneath fixed reimplants over the frontal sinus.

Development of surface coating material for discolored tooth equipped with bleaching effect.

It is attempted to augment a coating resin with a bleaching effect to provide both short- and long-term whitening effects. Base resin containing sodium percarbonate (SPC) effectively bleached bovine teeth discolored by the Maillard reaction. SPC did not reduce Vickers hardness, but hardness in the hybrid material increased. The shear bonding strength of SPC-containing resin was low. No inflammation was apparent in hamster cheek pouch mucosa when exposed to SPC resin covered with a layer of base resin. H(2)O(2) was released into buffer from this resin, but when placed onto tooth tissue with a protective layer of base resin, penetration of H(2)O(2) into the pulp chamber was undetectable. It is concluded that SPC resin equipped with a bleaching aid can be safely used as a coating material for discolored teeth.

Moist wound healing under a vapor permeable membrane.

Ten ambulatory patients with unilateral and eight with bilateral ulcers of various etiologies were studied to determine the effects of keeping a wound bed moist under a water vapor and oxygen permeable membrane (VPM). In the bilateral group, VPM healing was compared with a debriding enzyme ointment and 10% benzoyl peroxide in the same patient. The faster healing rate with VPM was compared to the healing rate with control substances by the paired t test, with significance at less than 0.05 level. In the unilateral group two patients with ulcers to bone or joint capsule and one patient who had failed grafting healed without surgery. Two patients failed to heal with the VPM. All healing occurred in the face of gross bacterial contamination. Three patients treated with VPM developed cellulitis. Wound healing under a vapor permeable membrane occurs with an increase of the average healing rate by a factor of 2.6 when compared to control substances in ambulatory patients.

Preparation and comparative clinical evaluation of liposomal gel of benzoyl peroxide for acne.

A novel topical benzovl peroxide (BP) gelformulation containing liposomal BP was shown to significantly reduce local irritation relative to its nonliposomal BP gel (plain BP gel) preparation and also to improve clinical efficacy (almost twofold) in the treatment of acne. BP liposomes were prepared, optimized, and formulated into a carbopol 934gel base. Drug release evaluated using dialysis membrane has repeatedly shown that a new topical gel formulation containing liposomal BP (liposomal BP gel) significantly reduced BP penetration. Clinical evaluation data were also compared with those obtained with liposomal tretinoin (TRE) gel in an earlier investigation of ours. The overall improvement in terms of percentage reduction in total number of skin lesions demonstrated almost similar results for both BP and TRE. However, variation was observed in the treatment of separate types of lesions in which liposomal TRE gel was found to be more effective in treating comedones and liposomal BP gel in treating papules and pustules. Also, the liposomal gel formulation of both the drugs significantly reduced the local adverse effects, thereby improving patient compliance.

[Clinico-experimental studies on the effect of benzoylperoxide]. / Klinisch-experimentelle Untersuchungen zum Wirkungsnachweis von Benzoylperoxid.

Clinical and experimental investigations to characterize therapeutic effects of topically applied benzoyl peroxide (5 and 10% in alcohol-free gel formulation) were performed with: quantitative determination of bacteria in the follicular filaments with the cyanoacrylate technique (P. acnes and micrococcaceae); agar diffusion method for bacteriostatic effects; semi-quantitative determination of skin surface lipids (ground glass method); lipid solvent and thin-layer chromatography (free fatty acids vs. triglycerides); scanning electron microscopy of the skin surface; exfoliative cytology with corneocyte counts in a Fuchs-Rosenthal chamber (corneocytes/cm2 skin surface); determination of corneocyte surface are in micrometer2; and a clinical trial concerning efficacy and tolerance of the gel formulation. Topically applied benzoyl peroxide acts antibacterially and keratolytically, has anti-lipolytic activity, reduces bacteria in the follicular infundibula, but does not inhibit sebum production as measured by skin surface lipids. Benzoyl peroxide stimulates the epidermopoiesis with reduction of corneocytes/cm2 from 87,400 +/- 29,000 to 36,000 +/- 19,000 (day 15 of treatment) with diminution in size of corneocytes from 1,018 micrometers2 +/- 74 to 865 micrometers2 +/- 65 vs. 832 micrometers2 +/- 85 (5% vs. 10% benzoyl peroxide). Alcohol-free gels of benzoyl peroxide are better tolerated by acne patients than those containing alcohol, in particular when combined with topical tretinoin (vitamin A acid) treatment.

Digital image analysis of microcomedones.

OBJECTIVE: Developing a technique for quantifying the number and size of follicular casts and microcomedones. BACKGROUND: There is no human testing that is validated up to now to predict comedogenesis and comedolysis following topical applications of drugs or cosmetics. DESIGN: Evaluations are performed by digital image analysis of cyanoacrylate follicular biopsies. The effects of two topical products are compared. RESULTS: Microcomedogenesis was disclosed after a 2-month period of application of a cosmetic product aimed at treating acne. Microcomedolysis occurred following usage of a topical preparation containing benzoyl peroxide 5% and miconazole nitrate 2%. CONCLUSION: Digital image analysis of skin surface biopsies is a sensitive method documenting microcomedo formation and dissolution.

Antibacterial efficacy of benzoyl peroxide in phospholipid liposomes. A vehicle-controlled, comparative study in patients with papulopustular acne.

BACKGROUND: Literature reports indicate that phospholipid liposomes facilitate the accumulation of active agents in the infundibulum. OBJECTIVE: The study hypothesis of an improved antibacterial efficacy of benzoyl peroxide (BPO) in phospholipid liposomes was tested in comparison with a commercial and a pharmacopoeial BPO preparation. METHODS: The infundibular bacterial samples were obtained with the Permabond technique from 20 acne patients who had been treated with the test substances (vehicle-controlled) for 2 weeks twice per day in a single-blinded, comparative study on the upper back. RESULTS: A significant antibacterial effect in the infundibula (Propionibacteria and Micrococcaceae, both: p < 0.001) for a BPO phospholipid liposome formulation could be demonstrated. In comparison to the other significantly efficacious BPO formulations which were also tested (commercial product and pharmacopoeial formulation), the BPO phospholipid liposome formulation showed a significantly greater antibacterial efficacy for Propionibacteria and Micrococcaceae (both: p < 0.01). CONCLUSION: A BPO formulation in phospholipid liposomes may represent an improvement of the conventional external BPO treatment of acne.