Effectiveness and safety of topical amphotericin B in 30% dimethyl sulfoxide cream versus 30% dimethyl sulfoxide cream for nondermatophyte onychomycosis treatment: A pilot study.

Background Although topical amphotericin B cream is effective for the treatment of nondermatophyte mold onychomycosis in vitro, studies of its effectiveness and safety in vivo are limited. Objectives We studied the effectiveness and safety of topical 0.3% amphotericin B in 30% dimethyl sulfoxide cream (amphotericin B cream) in nondermatophyte mold onychomycosis using the vehicle cream 30% dimethyl sulfoxide cream as control. Methods This randomized controlled study was conducted between January 2019 and November 2020. Patients diagnosed with nondermatophyte mold onychomycosis were randomly divided into two groups of ten patients each: one treated with amphotericin B cream and the other with the vehicle cream. Clinical and mycological cure as well as safety were evaluated. Results Ten patients each treated with amphotericin B cream and the vehicle cream were included in the study, but only nine patients in the vehicle cream group were available for follow up. All the 19 evaluable patients had distal lateral subungual onychomycosis and the great toenails were affected in 18 (94.7%) of these. Mycological cure was achieved in 8 (80%) patients treated with amphotericin B cream and in 4 (44.4%) patients using the control (vehicle) cream. Clinical cure was achieved in 7 (70%) patients treated with amphotericin B cream, but only in 2 (22.2%) patients on the control cream. No adverse events were observed. Limitations The small sample size and the fact that PCR fungal identification that provides accurate identification of fungal species was not performed are limitations of our study. Conclusion Topical amphotericin B cream was both very effective and safe in the treatment nondermatophyte mold onychomycosis. The control (vehicle) cream containing 30% dimethyl sulfoxide also demonstrated some antifungal activity.

Sunscreen application to the face persists beyond 2 hours in indoor workers: an open-label trial.

Background: The American Academy of Dermatology recommends reapplication of sunscreen every two hours for adequate sun protection when outdoor. However, the frequency of reapplication needed to achieve adequate protection in indoor workers remains unknown. Objective: To investigate the persistence of sunscreen applied once in the morning on the face of indoor workers throughout a normal 8-hour workday. Methods: This open-label trial included 20 healthy volunteers who work indoors. Volunteers applied 1 g of sunscreen (2 mg/cm2) mixed with 2% invisible blue fluorescent agent on the face in the morning. Photographs were taken by VISIA-CR booth in UV mode at 8 am and then every 2 hours thereafter until 4 pm with limited outdoor activity less than 1 hour. Six areas of the face were analyzed using digital image analysis software. The primary outcome was the total amount of sunscreen diminution during the 8-hour study period. Results: The amount of sunscreen decreased with mean peak reduction of 16.3% at 2 hours, and minimal reduction thereafter. Total sunscreen reduction was 28.2% at the end of the 8-hour day. Limitations: Small study population. Conclusion: For indoor workers who applied adequate amount of sunscreen once in the morning, reapplication of sunscreen may be unnecessary.

Effectiveness of Chlorhexidine Wipes for the Prevention of Multidrug-Resistant Bacterial Colonization and Hospital-Acquired Infections in Intensive Care Unit Patients: A Randomized Trial in Thailand.

OBJECTIVE: To determine the effectiveness of daily bathing with 2% chlorhexidine-impregnated washcloths in preventing multidrug-resistant (MDR) gram-positive bacterial colonization and bloodstream infection. METHODS: A randomized, open-label controlled trial was conducted in 4 medical intensive care units (ICUs) in Thailand from December 2013 to January 2015. Patients were randomized to receive cleansing with non-antimicrobial soap (control group) or 2% chlorhexidine-impregnated washcloths used to wipe the patient's body once daily (chlorhexidine group). Swabs were taken from nares, axilla, antecubital, groin, and perianal areas on admission and on day 3, 5, 7, and 14. The 5 outcomes were (1) favorable events ( all samples negative throughout ICU admission, or initially positive samples with subsequent negative samples); (2) MDR bacteria colonization-free time; (3) hospital-acquired infection; (4) length of ICU and hospital stay; (5) adverse skin reactions. RESULTS: A total of 481 patients were randomly assigned to the control group (241) or the chlorhexidine group (240). Favorable events at day 14 were observed in 34.8% of patients in the control group and 28.6% in the chlorhexidine group (P=.79). Median MDR bacteria colonization-free times were 5 days in both groups. The incidence rate of hospital-acquired infection and the length of the ICU and hospital stay did not differ significantly between groups. The incidence of adverse skin reactions in the chlorhexidine group was 2.5%. CONCLUSION: The effectiveness of 2% chlorhexidine-impregnated washcloths for the prevention of MDR gram-negative bacteria colonization and hospital-acquired infection in adult patients in ICU was not proven. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01989416.

Assessment of nickel and cobalt release from jewelry from a non-nickel directive country.

BACKGROUND: A directive restricting nickel release from jewelry and other skin-contact products has not been initiated in Thailand or in the United States. The prevalence of nickel and cobalt allergies is increasing, and the main cause of sensitization seems to be jewelry. OBJECTIVES: We aimed to investigate nickel and cobalt release from jewelry available in Thai marketplaces and to study the factors associated with nickel and cobalt release. METHODS: Used costume jewelry items were collected from volunteers. They were tested with the dimethylglyoxime and cobalt tests. RESULTS: Five hundred fifty-one items, including belt buckles, bracelets, earrings, necklaces, rings, and watches, were tested; 216 (39.2%) gave positive dimethylglyoxime tests, and 206 (37.4%) gave positive cobalt tests. The factors that determined nickel or cobalt release were shopping location and jewelry price. Cobalt-containing jewelry could be identified by its dark color. CONCLUSIONS: A large proportion of the jewelry sold in Thai markets release nickel or cobalt.