Aquagenic wrinkling of the palms: a case report and literature review.

Aquagenic wrinkling of the palms (AWP) is an unusual and rare dermatological condition characterized by excessive palmar wrinkling, occurring within a few minutes of water exposure. Cystic fibrosis (CF) or CF carrier state associated forms, drug induced cases, and idiopathic forms have been described. We report the case of a 27-year-old woman with a 7-year history of transient excessive wrinkling of her palms after brief exposure to water. We present also a comprehensive review of the literature. We believe that AWP has been underdiagnosed thus far and we would like to encourage investigations such as sweat chloride test or genetic studies in these patients because of the association with CF or CF carrier state, particularly when AWP appears in younger ages.

Confirmed efficacy of topical nifedipine in the treatment of facial wrinkles.

INTRODUCTION: Over the past two decades, there has been increasing demand for aesthetic procedures to reverse the effects of aging, particularly in the facial area. Recently, topical nifedipine has been proposed for its anti-wrinkle efficacy. OBJECTIVE: To confirm the anti-wrinkle efficacy of a 0.5% nifedipine-based topical formulation. MATERIALS AND METHODS: A randomized study was conducted in 20 healthy female volunteers, aged between 45 and 60 years, with moderate to moderately severe facial wrinkles. 10 volunteers applied a 0.5% nifedipine cream and 10 volunteers applied a good moisturizer twice daily for 90 days. The aesthetic improvement was evaluated by a blinded investigator using the Wrinkle Severity Rating Scale (WSRS). Anti-wrinkles effectiveness was also objectively assessed by measuring transepidermal water loss (TEWL), moisture levels of the stratum corneum, skin viscoelasticity and skin folding capacity by instrumental analysis. RESULTS: Post-treatment WSRS score was significantly lower than the baseline WSRS score only in the nifedipine group. The mean WSRS score at T0 was 3.85 and at T3 1.84 in the nifedipine group, while the mean WSRS score at T0 was 3.78 and at T3 3.36 in the control group. Corneometry showed significant increases in measures of skin hydration and TEWL values decreased in all the patients of both groups, indicating a trend toward improved integrity of skin. Dermolab® recorded significant increases in measures of skin hydration in the nifedipine group and a lower increase in the control group. The colorimetric evaluation showed that use of the tested product resulted in significant overall lightening of the skin during use compared with baseline, while the moisturizer didn't produce any change of skin lightening parameters. CONCLUSION: The tested topical preparation is effective in reducing facial wrinkles' depth and in increasing skin hydration and elasticity.

Topical delivery of active principles: the field of dermatological research.

To be effective an active drug or principle must cross the stratum corneum barrier; this process can be influenced to obtain better functional and therapeutical effects. In spite of the wide variety of the methods studied in order to improve the transdermal transfer to obtain systemic effects, the applicability is limited in this field. Attention to the epidermal barrier and penetration of active principles has been reported mostly in studies concerning dermocosmetics. Studies regarding methods of penetration are gaining experimental and clinical interest. Cutaneous bioavailability of most commercially available dermatological formulations is low. Increase of intradermal delivery can relate to chemical, biochemical, or physical manipulations. Chemical enhancers have been adopted to: (a) increase the diffusibility of the substance across the barrier; (b) increase product solubility in the vehicle; (c) improve the partition coefficient. Moreover methods of interference with the biosynthesis of some lipids allow the modification of the structure of the barrier to increase the penetration. The main physical techniques that increase cutaneous penetration of substances are: iontophoresis (that increases the penetration of ionized substances), electroporation (that electrically induces penetration through the barrier), and sonophoresis, based on 20 to 25 KHz ultrasound that induces alterations of the horny barrier, allowing penetration of active principles. Recent development of these methods are here reported and underline the importance and role of vehicles and other factors that determine effects of partition and diffusion, crucial to absorption.

Cutaneous alternariosis in a kidney transplantation recipient: report of a case.

Phaeohyphomycoses are induced by dematiaceous or darkly pigmented fungi. Alternaria species are the most important causative agents. Factors such as immunosuppression, local wounds or systemic disease are generally present. We report a case of phaeohyphomycosis induced by Alternaria alternata in an immunocompromised patient. The main interest in this case is the rareness of the cutaneous alternariosis and of its clinical aspects and the good response to therapy. Recognition of Alternaria spp. as potential opportunistic pathogens is important for the differential diagnosis of dermatological lesions, such as granulomatous or ulcerative lesions in immunocompromised patients.

Intradermal drug delivery by low-frequency sonophoresis (25 kHz).

UNLABELLED: Ultrasound waves (US) have been proposed to facilitate the absorption of active compounds (transdermal delivery) stimulating some disaggregation of the horny layer and promoting convective movements within the epidermis. Drugs used for alopecia areata, melasma, and lentigo, although proved effective, have limited effects resulting from only partial penetration into the skin. This study has evaluated the efficacy of low-frequency sonophoresis (LFS) at 25 kHz produced by a sonicator apparatus for treatment of alopecia areata, melasma, and solar lentigo. Thirty patients affected by alopecia areata were treated by application of methylprednisolone or cyclosporine solution followed by LFS. In a case-control study 48 women with melasma and 48 with solar lentigo were also treated by depigmenting emulsion and LFS application. For alopecia areata after 36 applications with LFS and 3-month treatment, the results were 57 percent partial regrowth and 29 percent total with methylprednisolone, and 33 percent partial regrowth and 34 percent total when cyclosporine was used. For melasma and solar lentigines the results when the drug application was followed by LFS, were (after twice-a-week application for 3 months) 75 percent complete depigmentation and 25 percent partial for melasma, 43 percent total regression and 57 percent partial for solar lentigo. CONCLUSION: This is the first report of sonophoresis at a frequency of 25 kHz in dermatocosmetology. The study shows that LFS, a not aggressive technique, enhance penetration of topic agents obtaining effects at the level of the epidermis, dermis and appendages (intradermal delivery), giving better results in the treatment of some cosmetic skin disorders.

In vitro effect of 5-aminolaevulinic acid plus visible light on Candida albicans.

Photodynamic therapy, currently used as an alternative technique for the treatment of superficial non-melanoma skin cancers, has been employed in vitro to kill different species of microorganisms. Here the development of Candida albicans colonies has been measured after application of 5-aminolaevulinic acid (ALA) plus visible light (VIS) irradiation. C. albicans suspensions (10 colony forming units microl(-1)) have been prepared. For the experiment 30 microl of suspension have been incubated in the dark for 3 h, with increasing concentrations of ALA (125, 250, 300, 350, 400, 450, 500, 550, 600, 750, 1000 mg ml(-1)) and then irradiated with a fixed dose (40 J cm(-2)) of VIS. Immediately after the irradiative session, the C. albicans suspensions were disseminated on dishes containing a Sabouraud agar + CAF medium and cultured in the dark at 27 degree C; after 48 h colony development has been measured. In the same way four controls have been prepared: (i)C. albicans suspensions not treated with ALA-PDT; (ii)C. albicans suspensions incubated with increasing ALA concentrations without VIS; (iii)C. albicans suspensions irradiated with 40 J cm(-2) of VIS without ALA; (iv)C. albicans suspensions irradiated immediately after the addition of increasing concentrations of ALA without the 3 h incubation. Colonies treated with ALA-PDT have been studied with electron microscopy (E.M.). It was found that: (i) none of the controls prepared modified the development of C. albicans colonies; (ii) ALA plus VIS inhibited C. albicans growth in a concentration-dependent way: up to 250 mg ml of ALA concentrations did not affect C. albicans cells, 300 mg ml(-1) induced a 50% reduction in the number of colonies, a complete inhibition started from concentrations of 600 mg ml(-1); (iii) after ALA-PDT E.M. showed modifications of the cell membranes. From the results it is concluded ALA plus VIS light is able to kill C. albicans colonies, at least in vitro. Although other pharmacological approaches are available, further studies could show that PDT is a potential treatment for candidosis.