10% urea cream in senile xerosis: Clinical and instrumental evaluation.

BACKGROUND: Moisturizers represent the mainstay of treatment of xerosis and related pruritus in elderly patients. AIM: In this study, we evaluated the efficacy and tolerability of a 10% urea cream in patients with senile xerosis. METHODS: Twenty patients affected by moderate-to-severe xerosis of the upper or lower extremities were enrolled and instructed to apply twice daily for 2 weeks a cream containing 10% urea. Evaluation was performed at baseline and after 7 and 14 days by: clinical examination, itch assessment using a Visual Analogue Scale (VAS), and dermoscopy. RESULTS: After 7 and 14 days of treatment, the tested urea-based cream resulted in a significant, progressive clinical improvement of xerosis and related pruritus in all patients. The clinical results were supported by dermoscopy that showed the reduction/disappearance of scales. The cream, that had a good cosmetological acceptability, was well tolerated with no report of stinging or burning and/or other side effects. CONCLUSIONS: Urea confirms to represent a key molecule for the treatment of senile xerosis.

Congenital Malalignment of the Great Toenails: A Review.

Congenital malalignment of the great toenail is an under-estimated dystrophic disorder of unknown origin characterized by lateral deviation of the nail plates, which are not parallel to the major axis of the distal phalanx. It usually presents in infancy or childhood, while late onset is uncommon. Treatment depends on the degree of deviation. If minimal, a conservative and expectant attitude, based on prevention and treatment of possible complications, is recommended because of the possibility of spontaneous regression of the nail deviation. Surgical therapy may be considered in patients with severe or complicated forms.

Dermatoscopy of Parasitic and Infectious Disorders.

The use of dermatoscopy in the diagnosis and management of parasitic and infectious skin disorders has been defined as entodermoscopy, and several studies have confirmed its advantages in dermatology. Dermatoscopic patterns of several parasitic, viral, and fungal skin infections have been identified and herein described. A noninvasive, fast, and accurate diagnosis plays an important role in containing the spread of contagious skin disorders.

Evidence-based treatment of atopic dermatitis with topical moisturizers.

Skin barrier restoration represents the mainstay of the treatment of atopic dermatitis and the use of moisturizers is recommended by several international guidelines. The aim of the study was to investigate through an evidence-based medicine analysis the effectiveness and safety of different moisturizing products available for a non-pharmacological treatment of atopic dermatitis. A total of 92 randomized controlled trials (RCTs) have been identified and analyzed. The results confirm the presence of a reasonable number of studies highlighting moisturizers safety and effectiveness in the treatment of atopic dermatitis by improving disease severity, increasing the time of relapse and reducing the time of flares. Moisturizers containing urea, glycerin or glycyrrhetinic acid seem to show the greater evidence of efficacy being supported by more clinical trials. Among the existing moisturizers, those containing a single agent generally work although the heterogeneity of RCTs does not allow reaching more definitive conclusions. Moisturizers made of a mixture of substances seem to be more effective thanks to the presence of different active substances that may exert a synergistic effect. A meta-analysis of 4 RCTs confirms the efficacy of a medical device containing glycyrrhetinic acid, hyaluronic acid, shea butter, telmesteine, and vitis vinifera in the treatment of atopic dermatitis.

Treatment of ichthyosis vulgaris with a urea-based emulsion: videodermatoscopy and confocal microscopy evaluation.

BACKGROUND: Ichthyosis vulgaris is a common disorder of keratinization caused by mutations in the filaggrin gene and clinically characterized by variable degree of xerosis. METHODS: Five patients affected by ichthyosis vulgaris and moderate to severe xerosis of the lower limbs, were treated twice daily for 30 days with an emulsion containing 10% urea, ceramides, and natural moisturizing factors (NMF). Evaluation was performed at baseline and at the end of treatment by clinical examination, Visual Analogue Scale to quantify itch, videodermatoscopy (VD), and reflectance confocal microscopy (RCM). Patients were also asked to provide an acceptability rating of the product based on spreadability, absorbency, odor, pleasantness and ease of application. RESULTS: At the end of treatment the tested urea-based emulsion resulted in a significant clinical improvement of xerosis in all patients. The product determined a remarkable reduction of itch, it was well tolerated and it had a good cosmetic acceptability. VD and RCM objectively confirmed the reduction/disappearance of scales and the improvement/normalization of furrow's size and morphology. CONCLUSIONS: The tested urea-based emulsion represents a valid option for the treatment of xerosis in patients affected by ichthyosis vulgaris. VD and RCM confirmed to be useful non-invasive techniques for the therapeutic monitoring of this condition.

A novel cosmetic antifungal/anti-inflammatory topical gel for the treatment of mild to moderate seborrheic dermatitis of the face: an open-label trial utilizing clinical evaluation and erythema-directed digital photography.

BACKGROUND: Topical cosmetic agents may play a role in the management of facial seborrheic dermatitis by reducing inflammation and scale production. Advanced digital photography, equipped with technology able to provide a detailed evaluation of red skin components corresponding to vascular flare (erythema-directed digital photography), is a useful tool for evaluation of erythema in patients affected by inflammatory dermatoses. The aim of this study was to assess the efficacy and safety of a new cosmetic topical gel containing piroctone olamine, lactoferrin, glycero-phospho-inositol, and Aloe vera for the treatment of facial seborrheic dermatitis by clinical and advanced digital photography evaluation. METHODS: An open-label, prospective, clinical trial was conducted on 25 patients with mild to moderate facial seborrheic dermatitis. Subjects were instructed to apply the gel twice daily for 45 days. The clinical efficacy was evaluated by measuring at baseline, at day 15 and 45 the degree of desquamation (by clinical examination) and erythema (by digital photography technology via VISIA-CR™ system equipped with RBX™), using a 5-point severity scale, and pruritus (by subject-completed Visual Analogue Scale; scale from 0 to 100 mm). Finally, at baseline and at the end of the study, IGA (Investigator Global Assessment) was performed using a 5-point severity scale (from 0 = worsening to 4 = excellent response). RESULTS: At the end of treatment, a significant reduction (P<0.001) of all considered parameters was observed. Moreover, an excellent response (>80% improvement) was recorded in 47.9% of patients, with no case of worsening. No signs of local intolerance were documented. CONCLUSIONS: The tested cosmetic topical gel was effective in treating mild to moderate seborrheic dermatitis of the face. Erythema-directed digital photography may represent a noteworthy tool for the therapeutic monitoring of facial seborrheic dermatitis and an important adjunct aid in the dermatologic clinical practice.

Photoletter to the editor: Exogenous pigmentation of the sole mimicking in situ acral melanoma on dermoscopy.

The parallel ridge pattern, characterized by a parallel band-like pigmentation of the ridges of the surface skin markings, represents the most important dermoscopic feature of in situ acral melanoma. A case of a young girl who showed a plantar pigmented brown macule likely due to prolonged contact with black rubber shoes, revealing a parallel ridge pattern on dermoscopy, is reported and discussed. Although parallel ridge pattern is highly suspicious of early melanoma, exogenous pigmentation should be considered as differential diagnosis in case of rapid onset acral pigmented macules.

Unique antineoplastic profile of Saquinavir-NO, a novel NO-derivative of the protease inhibitor Saquinavir, on the in vitro and in vivo tumor formation of A375 human melanoma cells.

We have recently shown that covalent attachment of the nitric oxide (NO) moiety to the HIV protease inhibitor Saquinavir (Saq) produced a qualitatively new chemical entity, named Saquinavir-NO (Saq-NO), with enhanced anticancer properties and reduced toxicity both in vitro and in vivo. The aim of this study was to address several unanswered questions both on the pharmacological profile of Saq-NO as well as on the in vivo role of NO in the oncogenesis of A375 human melanoma cells. To this end, we have evaluated here the impact of single and combined effects of Saq-NO, Saq, the NO-donor DETA NONOate and the iNOS inhibitor L-NAME on the in vitro as well as in vivo growth of the iNOS positive A375 cells. Our data confirm clear-cut evidence for a strong and powerful anti-melanoma action of Saq-NO that is not duplicable by the combined use of Saq and DETA NONOate. Surprisingly, but also in agreement with the complex and multifaceted role of endogenous NO in A375 cells, both DETA NONOate and L-NAME significantly suppressed the in vivo growth of xenotransplants.

The use of videodermatoscopy to monitor treatment of scabies and pediculosis.

A great pitfall for scabies and pediculosis therapeutic studies to date is that primary and secondary study outcomes are indirectly assessed (presence or absence of live parasites, including eggs, determined by gross clinical inspection) and data time points are non-standardized (highly variable) relative to the time of therapeutic application. Videodermatoscopy (VD) is a non-invasive technique that allows a rapid and magnified in vivo observation of the skin up to × 1000 with the visualization of morphologic features invisible to the naked eye. Utilization of VD in establishing highly definitive and precise quantitative data products used in the treatment of scabies and pediculosis provides enormous advantages in the quest to establish reproducible quantitative methodology for efficacy studies in these parasitoses. VD enhances the monitoring of clinical response to treatment in scabies and pediculosis and allows determination of the optimal timing of drug application both in vivo and ex vivo. This may be particularly important in minimizing risk of overtreatment, reducing the potential for side effects, and enhancing patient compliance.

Use of dermatoscopy and videodermatoscopy in therapeutic follow-up: a review.

Dermatoscopy (DE) is a noninvasive technique that allows a rapid and magnified in vivo observation of the skin surface with the visualization of morphologic features invisible to the naked eye. It is performed using manual devices without computer assistance, which generally allows ×10 magnifications. Videodermatoscopy (VD) represents the evolution of DE and is performed using a video camera equipped with optic fibers and lenses that currently allow magnifications ranging from ×10 to ×1000. Both DE and VD have been demonstrated to have further applications in dermatology apart from their use in differential diagnosis of pigmented skin lesions. In several disorders, they may be useful in differential diagnosis, prognostic evaluation, and in evaluating the response to treatment. This article focuses on the use of DE and VD in therapeutic follow-up. Although VD systems using high magnifications may not be cost-effective in all cases, VD represents a more reliable noninvasive and easy-to-use tool in therapeutic follow-up both for in-office dermatology as well as for clinical investigations.

Treating skin cancer with topical cream.

IMPORTANCE OF THE FIELD: Topical pharmacotherapy is an approach to consider in selected skin cancers. Noninvasive, tissue-sparing, topical, self-administered treatments represent a highly desirable alternative option, both in aged and unhealthy patients who may be poor surgical candidates, as well as in relatively young subjects with lesions located on cosmetically sensitive areas wishing to avoid disfiguring scars. This paper reviews and discusses the use of topical pharmacotherapy in the treatment of skin cancer. AREAS COVERED IN THIS REVIEW: This paper examines the existing literature and updates current knowledge of topical pharmacotherapy for skin cancer using fluorouracil, imiquimod, diclofenac and retinoids. WHAT THE READER WILL GAIN: There is a gap between current and best practice in that the use of pharmacotherapy in the treatment of skin cancer is only partially known. The purpose of this paper is to provide an in-depth knowledge on this topic; consequently, the readers should be able to consider new strategies in their practice. TAKE HOME MESSAGE: Topical pharmacotherapy represents an option for treatment of actinic keratoses and selected basal cell carcinomas. Moreover, preliminary reports indicate imiquimod to be effective for skin or mucosal cancers such as Bowen's disease, erythroplasia of Queyrat and lentigo maligna.