Exploring the Metabolic Effects of a Herbal Remedy of Asarum sieboldii, Platycodon grandiflorum, and Cinnamomum cassia Extracts: Unraveling Its Therapeutic Potential as a Topical Application for Atopic Dermatitis Treatment.

Our previous study demonstrated that our novel herbal remedy, a mixture of Asarum sieboldii, Platycodon grandiflorum, and Cinnamomum Cassia extracts, exhibits a therapeutic effect in 1-chloro-2,4-dinitrobenzene (DNCB)-induced mice by inhibiting the Th-2 inflammatory response upon oral administration. It also ameliorated imbalances in lipid metabolism related to the skin barrier function in keratinocytes, indicating its potential as a topical agent. This study aims to further investigate the therapeutic effects and metabolic mechanisms of its topical application. The anti-atopic effect was evaluated using dermatitis scores, histopathological analysis, and immune cell factors in DNCB-induced mice. Metabolomic profiling of serum and lesional skin was conducted to elucidate the metabolic mechanisms. The topical application significantly reduced dermatitis scores, mast cell infiltration, and serum levels of immunoglobulin E (IgE), IFN-γ, interleukin (IL)-4, IL-17, and thymic stromal lymphopoietin (TSLP), demonstrating its effectiveness in treating atopic dermatitis (AD). Serum metabolomics revealed alterations in fatty acid metabolism related to the pro-inflammatory response. In lesional skin, metabolic markers associated with oxidative stress, immune regulation, and AD symptoms were restored. This study demonstrated its potential as a topical agent in suppressing Th-2 inflammatory responses and improving metabolic abnormalities related to AD symptoms, providing crucial insights for developing natural AD treatments.

Chemical Insights into Topical Agents in Intraocular Pressure Management: From Glaucoma Etiopathology to Therapeutic Approaches.

Glaucoma encompasses a group of optic neuropathies characterized by complex and often elusive etiopathology, involvihttng neurodegeneration of the optic nerve in conjunction with abnormal intraocular pressure (IOP). Currently, there is no cure for glaucoma, and treatment strategies primarily aim to halt disease progression by managing IOP. This review delves into the etiopathology, diagnostic methods, and treatment approaches for glaucoma, with a special focus on IOP management. We discuss a range of active pharmaceutical ingredients used in glaucoma therapy, emphasizing their chemical structure, pharmacological action, therapeutic effectiveness, and safety/tolerability profiles. Notably, most of these therapeutic agents are administered as topical formulations, a critical aspect considering patient compliance and drug delivery efficiency. The classes of glaucoma therapeutics covered in this review include prostaglandin analogs, beta blockers, alpha agonists, carbonic anhydrase inhibitors, Rho kinase inhibitors, and miotic (cholinergic) agents. This comprehensive overview highlights the importance of topical administration in glaucoma treatment, offering insights into the current state and future directions of pharmacological management in glaucoma.

Public Interest in Acetyl Hexapeptide-8: Longitudinal Analysis.

BACKGROUND: Acetyl hexapeptide-8, also known as Argireline, is a topical, short-acting, synthetic peptide that has recently gained popularity for its antiwrinkle effects. This agent has emerged as a more accessible alternative to botulinum neurotoxin. OBJECTIVE: This study evaluates the public interest in acetyl hexapeptide-8 in the United States from 2013 to 2023, as described by search volume on Google, the most-used search engine. METHODS: We analyzed the longitudinal relative monthly search volume from January 1, 2013, to January 1, 2023, for acetyl hexapeptide-related terms. We compared the internet search trends for "Botox" during this period to "Argireline." RESULTS: The terms "Argireline" and "Botox in a Bottle" both had substantial increases in search volume in 2022. Although its search volume is drastically increasing, "Argireline" was less searched than "Botox," which had a stable, up-trending search volume over the past decade. CONCLUSIONS: The increasing interest in acetyl hexapeptide-8 may be due to its cost-effectiveness and use as a botulinum neurotoxin alternative. Affordability, over-the-counter availability, and ease of self-application of the agent suggest its potential to enhance accessibility to cosmetic dermatologic care.

Study Comparing Topical Ivermectin Versus Topical Permethrin in the Treatment of Scabies.

Introduction Scabies is a highly contagious skin disease caused by an ectoparasite mite called Sarcoptes scabiei. Ivermectin and permethrin have been commonly used for the treatment of scabies. However, topical ivermectin has been compared to other treatment modalities to a lesser extent. Objective This study aimed to compare the efficacy of topical ivermectin versus topical permethrin in the treatment of uncomplicated scabies. Methods 354 patients with scabies attending the dermatology outpatient department of Pak Emirates Military Hospital Rawalpindi were enrolled. Patients were divided into two groups randomly. The first group and their family contacts received 1% ivermectin lotion whereas the other received 5% permethrin lotion. Patients were evaluated at the end of the second and the fourth week. Results At the end of the second week, initial follow-up showed that 97 out of 159 patients (61.0%) in the ivermectin 1% group, and 107 out of 159 patients (67.3%) in the permethrin 5% group had achieved clinical cure (P=0.24). On the final follow-up at the end of Week 4, the cure rate amounted to 85.5% (136 of 159 patients) in the ivermectin group and 89.9% (143 of 159 patients) in the permethrin group. Differences among both groups remained statistically insignificant (P=0.23). Conclusions The use of ivermectin 1% versus permethrin 5% as topical therapy showed almost identical results for the treatment of uncomplicated scabies. Side effects were minimal and there were no significant differences observed in patients with regard to compliance among both the groups.

Topical Insulin as an Add-On Therapy for Leg Ulcer: A Case Report.

Leg ulcers affect millions of people worldwide, and are a significant cause of morbidity and mortality. Various factors can be etiological agents of leg ulcers such as vascular, neuropathic, infectious, and traumatic factors. Treatment of the leg ulcer can be difficult in some cases despite using different systemic treatments and local wound care, but various newly defined treatment modalities are discussed in the literature and topical insulin application is one of them. Insulin is a hormone that is essential for regulating blood glucose and lipid levels, also insulin can have local effects when applied topically. Various mechanisms like regulation of inflammation, collagen synthesis, and angiogenesis have been explained to understand topical insulin's effects on the wound. There are case reports and studies on the usage of topical insulin on diabetic ulcers and decubitus ulcers. We applied topical insulin as an add-on therapy on a treatment-resistant leg ulcer and observed the healing of the lesion. The use of topical insulin as an add-on therapy may reduce treatment time and speed up wound healing. Topical insulin can be considered as an additional therapy for treatment-resistant ulcers.

Effect of topical agents on skin surface dose in volumetric modulated arc therapy for head and neck cancer.

In volumetric modulated arc therapy (VMAT), the effect of an increase in skin surface dose due to topical agents might be negligible. We investigated the bolus effects of three types of topical agents in VMAT for head and neck cancer (HNC). Topical agents of different thicknesses (0.1, 0.5 and 2 mm) were prepared. When each topical agent was set, the surface doses were measured for the anterior static field and VMAT, with and without a thermoplastic mask. No significant differences were observed among the three topical agents. For topical agent thicknesses of 0.1, 0.5 and 2 mm, the increases in surface dose for the anterior static field without the thermoplastic mask were 7-9, 30-31 and 81-84%, respectively. With the thermoplastic mask, the corresponding increases were 5, 12-15 and 41-43%, respectively. The increases in surface dose for VMAT without the thermoplastic mask were 5-8, 16-19 and 36-39%, respectively, and those with the thermoplastic mask were 4, 7-10 and 15-19%, respectively. The rate of increase in surface dose with the thermoplastic mask was smaller than that without the thermoplastic mask. The increase in surface dose with topical agents of clinical standard thickness (0.02 mm) was estimated to be 2% with the thermoplastic mask. The increase in surface dose with topical agents in dosimetric simulation, compared with control situation, is not significant in clinical conditions for HNC patients.

Difamilast for the treatment of atopic dermatitis.

Atopic dermatitis (AD) is a common chronic relapsing inflammatory skin disease. The pathogenesis of AD is complex and still not fully understood. Despite recent therapeutic developments, the current therapeutic arsenal of AD remains limited and is associated with long-term efficacy and safety issues. Therefore, new topical therapies with different mechanisms of action are required to overcome the limitations of existing treatments. Difamilast is a phosphodiesterase 4 inhibitor currently in phase 3 studies. Difamilast shows antipruritic and anti-inflammatory properties and a rapid onset of action, with significant differences in some parameters from the vehicle within 1 week of treatment. Phase 2 and 3 clinical trials have shown that difamilast ointments are effective and well tolerated in adult and pediatric patients with AD, and are expected to be used for long-term AD treatment. In 2021, difamilast was the first phosphodiesterase 4inhibitor to acquire manufacturing and marketing approval in Japan for the treatment of adult and pediatric patients (2 years of age and older) with AD. This article is a narrative review of the current literature on difamilast in the management of AD.

The Potential of Topical Therapy for Diabetic Wounds: A Narrative Review.

The rising prevalence of diabetes mellitus brings with it a rise in the occurrence of several complications of the disease such as chronic non-healing wounds. Diabetics are more prone to developing chronic wounds due to complications like peripheral neuropathy, poor foot care, hyperglycaemia and peripheral vascular diseases. The aim of this review is to discuss the various imbalances in the cytokine environment of diabetic wounds and to explore the developments in their management with an emphasis on agents that may be used topically to aid the healing process of chronic wounds. A systematic search was conducted on Scopus, PubMed and Google Scholar and relevant articles were shortlisted. We conclude that increased blood sugar impairs most phases of wound healing in several ways. Supplementary therapy with either topical or systemic cytokines is shown to promote wound healing in a diabetic wound.

Topical interventions for the management of pain in chronic wounds: A protocol for a systematic review.

Background: Venous, arterial, diabetic and pressure ulcers, collectively known as chronic wounds, negatively impact individuals across psychological, social and financial domains. Chronic wounds can be painful and the nature, frequency and impact of pain can differ depending on wound aetiology, wound state and on numerous patient factors. While systemic pharmaceutical agents have some effect in managing pain, there is a need to examine topical agents applied to the wound bed for pain relief. The objective of this study is to examine and synthesise existing literature on the effectiveness of topical agents in managing pain in venous, diabetic, pressure, arterial and mixed venous/arterial ulcers. Methods: We will use Cochrane Systematic Review methodology to identify and synthesise eligible randomised controlled trials (RCTs) evaluating the effectiveness of topical agents in reducing pain in chronic wounds. Embase, Medline, PubMed, CENTRAL, CINAHL, Scopus and Web of Science will be searched from inception to end of June 2022 without language limits. We will independently extract data on the pharmaceutical agent, participant demographics, aetiology, condition of the wound, and type, nature and frequency of pain using a pre-designed data extraction form. Subgroup and sensitivity analysis will be performed to address heterogeneity across studies if appropriate. Further stratification and analyses will be based on included study variables and outcomes. Discussion: Wound pain is primarily managed via systemic pharmaceutical agents. However, patients express reluctance regarding systemic analgesic drugs, fearing addiction. Additionally, persons with chronic wounds have co-morbidities including hypertension, diabetes, or cardiovascular disease and are already taking multiple medications. Topical analgesia can potentially mitigate some of the perceived disadvantages of systemic agents but the available range of these agents and their effectiveness in managing pain in chronic wounds is not so well understood. This review will focus on such agents across a range of the most common chronic wounds.

Therapeutic effects of turmeric topical cream in vitiligo: A randomized, double-blind, placebo-controlled pilot study.

BACKGROUND: Vitiligo is an autoimmune and acquired disease characterized by the destruction of epidermal melanocytes leading to depigmentation of the skin. Although vitiligo is a common disease, there is not a definite cure and conventional therapies can lead to serious adverse effects. Turmeric has been widely studied for its anti-inflammatory, antioxidant, and anti-cell proliferation, while it is a cost-benefit and available treatment for a variety of diseases. AIMS: The aim of this study was to evaluate the efficacy of topical turmeric cream on vitiligo's lesion appearance including size and repigmentation. PATIENTS/METHODS: Following the screening, 30 patients were enrolled according to inclusion criteria. The patients received training to apply turmeric and placebo cream at the specified side of their body twice a day for 4 months. Patients were evaluated at the baseline and at monthly intervals to access possible side effects. Lesion size, vitiligo area scoring index (VASI), vitiligo noticeability scale (VNS), and physician global assessment (PGA) were evaluated at the baseline and after four months to compare the changes induced by turmeric and placebo cream. RESULTS: Twenty-four patients completed the trial. Applying turmeric cream reduced the size of lesions and improved lesion's appearance significantly compared to the placebo group (p < 0.001), and also, patient's satisfaction score was higher following applying turmeric cream compared to placebo (p < 0.05). CONCLUSIONS: Turmeric cream can be used as an alternative remedy or adjuvant therapy in mild to moderate vitiligo lesions and in those who cannot tolerate the adverse effects of conventional therapies.

Application of a novel self-assembling peptide to prevent hemorrhage after EMR, a feasibility and safety study.

BACKGROUND: A novel self-assembling peptide (SAP) can be applied to the post-endoscopic mucosal resection (EMR) defect to treat oozing bleedings. It has been suggested to stimulate early healing of damaged vessels. We hypothesized that SAP application could prevent delayed bleeding (DB) after EMR and performed a prospective cohort study to determine feasibility and safety. METHODS: A total of 48 consecutive patients who underwent EMR between June 2018 and August 2019 for large lesions in the esophagus, duodenum (> 1 cm) or colorectum (> 2 cm) were treated with adjuvant SAP application. Duration and ease of SAP application were measured, as well as DB outcome. RESULTS: The EMR defects of 48 patients were treated with SAP; 17 in the esophagus, 13 in the duodenum and 18 in the colorectum. SAP was easy to apply on the EMR defect with a median duration of 2.0 min. A dose of 3 cc was generally enough to cover a defect between 10 and 50 mm. An exploratory analysis of the prophylactic ability of SAP showed that 15.9% of patients (7/44) treated with SAP still had a DB, mostly in the duodenum (4/11). No adverse events related to gel exposure were reported. CONCLUSIONS: SAP application after EMR was found to be feasible and safe, and did not delay the procedure; however, DB was still relatively common. Future comparative studies are needed to evaluate whether SAP is able to reduce DB after EMR, particularly for lesions with an increased bleeding risk, such as in the duodenum.

Risk of toxicity from pediatric topical salicylate ingestions.

INTRODUCTION: Suspected pediatric ingestions of greater than or equal to one teaspoon topical salicylate analgesic are recommended by poison control centers to be managed at healthcare facilities. This cutoff is applied for both liquid and non-liquid (cream, ointment, gel) formulations. METHODS: California poison control cases involving topical salicylate exposures in children less than 6-years-old who were evaluated at a health care facility between 2003 and 2018 were analyzed. RESULTS: Of 599 patient cases, the majority described no or minor symptoms, with gastrointestinal distress being the most common. Signs of salicylate toxicity (metabolic acidosis, tachypnea) occurred in six cases. Seven patients were hospitalized, six of whom were exposed to liquid preparations. DISCUSSION: In line with previous research, liquid salicylate preparations were more frequently associated with the signs of salicylate toxicity and hospitalization. CONCLUSION: There was a low frequency of severe side effects and low hospitalization rates among those referred to a healthcare facility, especially for non-liquid topical salicylate ingestions.

A Novel Promazine Derivative Shows High in vitro and in vivo Antimicrobial Activity Against Staphylococcus aureus.

The emergence of multidrug-resistant bacteria constitutes a significant public health issue worldwide. Consequently, there is an urgent clinical need for novel treatment solutions. It has been shown in vitro that phenothiazines can act as adjuvants to antibiotics whereby the minimum inhibitory concentration (MIC) of the antibiotic is decreased. However, phenothiazines do not perform well in vivo, most likely because they can permeate the blood-brain (BBB) barrier and cause severe side-effects to the central nervous system. Therefore, the aim of this study was to synthesize a promazine derivate that would not cross the BBB but retain its properties as antimicrobial helper compound. Surprisingly, in vitro studies showed that the novel compound, JBC 1847 exhibited highly increased antimicrobial activity against eight Gram-positive pathogens (MIC, 0.5-2 mg/L), whereas a disc diffusion assay indicated that the properties as an adjuvant were lost. JBC 1847 showed significant (P < 0.0001) activity against a Staphylococcus aureus strain compared with the vehicle, in an in vivo wound infection model. However, both in vitro and in silico analyses showed that JBC 1847 possesses strong affinity for human plasma proteins and an Ames test showed that generally, it is a non-mutagenic compound. Finally, in silico predictions suggested that the compound was not prone to pass the BBB and had a suitable permeability to the skin. In conclusion, JBC 1847 is therefore suggested to hold potential as a novel topical agent for the clinical treatment of S. aureus skin and soft tissue infections, but pharmacokinetics and pharmacodynamics need to be further investigated.

Efficacy of topical agents for prevention of postoperative sore throat after single lumen tracheal intubation: a Bayesian network meta-analysis.

BACKGROUND: The optimal choice of prophylactic drugs to decrease postoperative sore throat is unclear. The objective of this network meta-analysis (NMA) was to compare and rank 11 topical agents used to prevent postoperative sore throat. METHODS: Various databases were searched independently for randomized-controlled trials (RCTs) comparing topical agents used for the prevention of postoperative sore throat. Inclusion criteria were parallel group studies comparing intervention with active or inactive control and reporting postoperative sore throat. The primary outcome was postoperative sore throat at 24 hr. Secondary outcomes were early sore throat at 4-6 hr, cough, and hoarseness at 24 hr. RESULTS: Evidence was synthesized from 70 RCTs reporting 7,141 patients. Topical application of lidocaine, corticosteroids, ketamine, magnesium, benzydamine, water-based lubricant, and liquorice applied along the tracheal tube, to the tracheal tube cuff, gargled or sprayed were compared with intracuff air and each other. Bayesian NMA showed that magnesium (odds ratio [OR], 0.10; 95% credible interval [CrI], 0.03 to 0.26), liquorice (OR, 0.14; 95% CrI, 0.03 to 0.55), and steroid application (OR, 0.11; 95% CrI, 0.06 to 0.22) most effectively prevented postoperative sore throat at 24 hr. Topical lidocaine was the least effective intervention. CONCLUSION: Topical application of magnesium followed by liquorice and corticosteroids most effectively prevented postoperative sore throat 24 hr after endotracheal intubation.

RéSUMé: CONTEXTE: Le choix optimal des médicaments prophylactiques pour réduire les maux de gorge postopératoires n'est pas clair. L'objectif de cette méta-analyse en réseau (NMA) était de comparer et classifier 11 agents topiques utilisés pour prévenir les maux de gorge postopératoires. MéTHODE: Des recherches ont été réalisées dans plusieurs bases de données de façon indépendante afin d'en extraire les études randomisées contrôlées (ERC) comparant des agents topiques utilisés pour la prévention des maux de gorge postopératoires. Nos critères d'inclusion étaient des études de groupes parallèles comparant une intervention à un témoin actif ou inactif sur des résultats de maux de gorge postopératoires. Le critère d'évaluation principal était les maux de gorge postopératoires à 24 h. Les critères d'évaluation secondaires comprenaient les maux de gorge précoces à 4-6 h, la toux et l'enrouement à 24 h. RéSULTATS: Les données probantes ont été synthétisées à partir de 70 ERC portant sur 7141 patients. L'application topique de lidocaïne, de corticostéroïdes, de kétamine, de magnésium, de benzydamine, d'un lubrifiant à base d'eau et de la réglisse, appliqués le long du tube endotrachéal, sur le ballonnet du tube endotrachéal, en gargarisme ou en vaporisation, ont été comparées à l'air intra-ballonnet et entre les divers agents. La NMA bayésienne a démontré que l'application de magnésium (rapport de cotes [RC], 0,10; intervalle de crédibilité [CrI] 95 %, 0,03 à 0,26), de réglisse (RC, 0,14; CrI 95 %, 0,03 à 0,55) et de stéroïdes (RC, 0,11; CrI 95 %, 0,06 à 0,22) étaient les méthodes plus efficaces pour prévenir les maux de gorge postopératoires à 24 h. La lidocaïne topique était l'intervention la moins efficace à 24 h. CONCLUSION: L'application topique de magnésium, suivie de celle de réglisse et de corticostéroïdes, est l'approche qui prévient le plus efficacement les maux de gorge postopératoires 24 h après une intubation endotrachéale.

Advances in Topical Hemostatic Agent Therapies: A Comprehensive Update.

Severe hemorrhage causes significant metabolic and cellular dysfunction secondary to deficient tissue perfusion and oxygen delivery. If bleeding continues, hemodynamic destabilization, hypoxemia, multiple organ failure, and death will occur. Techniques employed to promote hemostasis include surgical suture ligatures, cautery, chemical agents, self-assembling nanoparticles, and physical methods, like mechanical pressure. Improved understanding of the natural clotting cascade has allowed newly designed agents to become more targeted for clinical and military use. Topically-applied hemostatic agents have enormous clinical applications in achieving hemostasis. This manuscript describes currently available and developing topical hemostatic materials, including topical active agents, mechanical agents, synthetic/hemisynthetic hemostatic agents, and external hemostatic dressings for clinical practice.

A review of neuropsychiatric adverse events from topical ophthalmic brimonidine.

Brimonidine is a first-line topical medication for increased intraocular pressure and glaucoma which may be used alone or in conjunction with other topical therapies. Its structural and pharmacological comparabilities to clonidine give way to the hypothesis that it may cause neuropsychiatric side effects. The majority of case reports citing brimonidine toxicity, either for topical or peripheral exposure, include pediatric age groups but especially infants. Among the latter, a dose-response phenomenon is evident. Dose-response correlates have also been shown among adults. Case series and prospective double-blind treatment studies also give evidence for the occurrence of several central nervous system adverse reactions. Topical ophthalmic brimonidine use should be followed for the occurrence of neuropsychiatric disturbances generally, and enhanced vigilance should be maintained for at-risk populations.

The efficacy of topical agents used in wounds for managing chronic biofilm infections: A systematic review.

OBJECTIVES: Clinicians have increasingly adopted the widespread use of topical agents to manage chronic wound infections, despite limited data on their effectiveness in vivo. This study sought to evaluate the evidence for commonly employed topical agents used in wounds for the purpose of treating chronic infections caused by biofilm. METHOD: We included in vitro, animal and human in vivo studies where topical agents were tested for their efficacy against biofilms, for use in wound care. For human studies, we only included those which utilised appropriate identification techniques for visualising and confirming the presence of biofilms. RESULT: A total of 640 articles were identified, with 43 included after meeting eligibility. In vitro testing accounted for 90% (n = 39) of all included studies, five studies using animal models and three human in vivo studies. Sixteen different laboratory models were utilised, with the most frequent being the minimum biofilm eradication concentration (MBEC™) / well plate assay (38%, n = 15 of 39). A total of 44 commercially available topical agents were grouped into twelve categories with the most commonly tested agents being silver, iodine and polyhexamethylene biguanide (PHMB). In vitro results on efficacy demonstrated iodine as having the highest mean log10 reductions of all agents (4.81, ±3.14). CONCLUSION: There is large disparity in the translation of laboratory studies to researchers undertaking human trials relating to the effectiveness of commercially available topical agents. There is insufficient human in vivo evidence to definitively recommend any commercially available topical agent over another for the treatment of chronic wound biofilms. The heterogeneity identified between study designs (in vitro to in vivo) further limits the generalisability of results.

Neuropsychiatric Adverse Events from Topical Ophthalmic Timolol.

Timolol is a commonly-used topical antiglaucoma medication and has proven to be highly efficacious for most recipients. Among the reported adverse events, the neuropsychiatric spectrum has been cited, albeit for a small proportion of those treated. This review summarizes the cumulative published experience of such side effects and assesses the quality of evidence. As for other beta-blockers, whether orally or topically administered, various central nervous systems dysfunctions have been detailed in either case reports or larger patient series. The adverse event commonly resolves following drug termination. Rigorous and more definitive studies of causation are lacking, and to some, such paucity has reduced the belief of a cause and effect relationship. Until otherwise proven, deference should be afforded to the potential for topical timolol to cause neuropsychiatric side effects, and at-risk patients should be closely monitored when they are prescribed this pharmacological agent.

Manuka honey sinus irrigations in recalcitrant chronic rhinosinusitis: phase 1 randomized, single-blinded, placebo-controlled trial.

BACKGROUND: Manuka honey (MH) has significant antibiofilm activity in vitro and in vivo against Staphylococcus aureus, methicillin-resistant S aureus (MRSA), and Pseudomonas aeruginosa. This is the first randomized, single-blinded, placebo-controlled phase 1 clinical trial investigating the safety and preliminary efficacy of MH with augmented methylglyoxal (MGO) rinses in recalcitrant chronic rhinosinusitis (CRS). METHODS: Patients were included after previously undergoing endoscopic sinus surgery and presenting with signs and symptoms of sinus infection with positive bacterial cultures on sinus swabs. Patients were randomized to receive 14 days of twice-daily 16.5% MH + 1.3 mg/mL MGO sinonasal rinses and concurrent 10 days of placebo tablets (MH), or 14 days of twice-daily saline sinonasal rinses and concurrent 10 days of culture-directed antibiotic therapy (CON). Safety observations included the University of Pennsylvania Smell Identification Test (UPSIT) and adverse-event (AE) reporting. Efficacy was assessed comparing microbiology results, Lund-Kennedy scores (LKSs), and symptom scores using the visual analog scale (VAS) and 22-item Sino-Nasal Outcome Test (SNOT-22). RESULTS: Twenty-five patients completed the study. MH demonstrated a good safety profile with no major AEs and no changes in UPSIT. Six of 10 (60%) MH patients had a reduction in bacterial culture rate with 1 of 10 of those having negative cultures, compared with 12 of 15 (80%) in the control group with 7 of 15 having negative cultures upon completion of the study. CONCLUSION: This study concludes that twice-daily 16.5% MH augmented with 1.3 mg/mL MGO sinonasal rinses alone for 14 days is safe but not superior to culture-directed oral antibiotics and twice-daily saline rinses.

A novel triple combination in treatment of melasma: Significant outcome with far less actives.

BACKGROUND: Melasma is an acquired hyperpigmentation, often involving the face, and a source of distress for the affected individuals. Although treatment is challenging and frequently a multimodality approach, topical applications are the mainstay of therapy. OBJECTIVE: Due to the frequent relapses, a therapy both acting rapidly and suitable for long-term use, with fewer adverse effects should be administered. In our outpatient clinic, we treated the melasma patients with a previously unreported triple combination which was empirically formulated with lesser amount of active components, regarding the balance between long-term use and safety. METHODS: Sixty-eight female patients with melasma who referred to our hospital dermatology clinic in the years 2016-2017 were retrospectively recruited. They all had completed 6-month treatment with a prescribed cream mixture comprised of azelaic acid (4%), hydroquinone (1.6%), methylprednisolone aceponate (0.04%), and salicylic acid (2%). The outcomes were evaluated both instrumentally (Melanin Index/MI) and by patients (Patient Self-Assessment Scale/PSAS). RESULTS: Adverse effects declared by the patients were transient irritation in three and mild hypertrichosis in two. Both the MI and PSAS values were found extremely significant at the end of 6th month, compared with initial values. Approximately 62% of total decrease in MI was realized in the first 3 months. CONCLUSION: The triple combination containing active ingredients with lesser concentrations than proposed, and with the addition of 2% salicylic acid, may be promising as a quite effective and safe protocol in treatment of melasma for longer durations.