Angular cheilitis-an oral disease with many facets.

Cheilitis is a common inflammatory disorder of the vermillion and adjacent skin of the lips. A special type is angular cheilitis. The disease has a mixed etiology, mostly with bacterial and fungal components. Angular cheilitis may be a clinical sign of an underlying disease. It has two age peaks: one during childhood and another in adults. It becomes more frequent with aging. Clinical presentation, differential diagnoses, and treatment are discussed. Angular cheilitis is of importance in primary care of patients, in geriatrics, dentistry, pediatrics, internal medicine, and in dermatology.

Lip creams with propolis special extract GH 2002 0.5% versus aciclovir 5.0% for herpes labialis (vesicular stage) : Randomized, controlled double-blind study.

A lip cream with special propolis extract GH 2002 at a concentration of 0.5% (199 patients) was tested against aciclovir 5% (198 patients) in the treatment of episodes of herpes labialis under double-blind conditions. Upon inclusion, all patients were in the vesicular phase. Application was five times daily of approximately 0.2 g of cream to the entire upper and lower lip. The primary parameter was the difference in time between groups to complete encrustation or epithelization of the lesions. Secondary endpoints were the course of typical herpes symptoms (pain, burning and itching, tension and swelling), the global assessment of efficacy and the safety of application. The predefined clinical situation was reached after a (median) 3 days with propolis and 4 days with aciclovir (p < 0.0001). Significant differences in favor of propolis were also found for all secondary parameters. No allergic reactions, local irritations or other adverse events occurred.

Clinical efficacy of emollients in atopic dermatitis patients - relationship with the skin microbiota modification.

BACKGROUND: We speculated that an emollient supplemented with a biomass of nonpathogenic bacteria such as Vitreoscilla filiformis (Vf), grown in a medium containing thermal spring water (LRP-TSW); (LRP-Vitreoscilla filiformis biomass [LRP-VFB]), could have a beneficial effect for patients with atopic dermatitis (AD). PATIENTS AND METHODS: This double-blind, randomized, comparative study was conducted with 60 patients with moderate AD. Before starting the study, participants were pretreated for 15 days with drug therapy to improve their SCORing Atopic Dermatitis (SCORAD) by at least 25%. On Day 1, the eligible patients were randomized to either the emollient containing LRP-VFB associated with mannose (Product A) or another emollient (product B) and were treated twice daily for 1 month. Recurrence of flare-ups and microbial communities were characterized from swabs taken at Day 1 and Day 28, under axenic conditions, from affected (AF) and proximal unaffected (UAF) skin areas. RESULTS: At Day 1, the average SCORAD of each group and the microbial communities of AF and UAF areas for each participant were similar. One month after the end of the therapeutic treatment (Day 28), the average evolution of SCORAD at Day 28 compared to Day 1 of patients treated with product A was significantly lower than that of the patients treated with product B. A significantly increased level of Xanthomonas genus was noticed in the group treated with product A (versus product B). On the other hand, the level of Staphylococcus genus increased between Day 1 and Day 28 in the group treated with product B, but not in the group treated with product A. Interestingly, these differences were more pronounced for patients in relapse, and the associated SCORAD worsening was less in the group treated with product A versus the group treated with product B. CONCLUSION: This study demonstrated that a specific emollient containing a biomass of non-pathogenic bacteria Vf grown in a medium containing TSW and associated with a selected carbon source is able to normalize skin microbiota and significantly reduce the number and severity of flare-ups compared with another emollient.

Microbiome of affected and unaffected skin of patients with atopic dermatitis before and after emollient treatment.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder that results in areas of dry, itchy skin. Several cultivation-dependent and -independent studies have identified changes in the composition of microbial communities in these affected areas over time and when compared to healthy control individuals. However, how these communities vary on affected and unaffected skin of the same individual, and how these communities respond to emollient treatment, remains poorly understood. Here we characterized the microbial communities associated with affected and unaffected skin of 49 patients with AD before and after emollient treatment using high-throughput sequencing of the 16S rRNA gene. We found that microbial diversity and community composition was different between affected and unaffected skin of AD patients prior to treatment. Differences were driven primarily by the overabundance of Staphylococcus species on affected skin and a corresponding decrease in bacterial diversity. After 84-days of emollient treatment, the clinical symptoms of AD improved in 72% of the study population. Microbial communities associated with affected skin of these treatment responders more closely resembled unaffected skin after treatment as indicated by increased overall diversity and a decrease in the abundance of Staphylococcus species. Interestingly, Stenotrophomonas species were significantly more abundant in the communities of 'responders', suggesting a possible role in restoration of the skin microbiome in patients with AD. We demonstrated that the comparison of affected and unaffected skin from the same individual provides deeper insight into the bacterial communities involved in the skin dysbiosis associated with AD. These data support the importance of emollients in the management of AD although future studies should explore how emollients and other treatments help to restore skin dysbioses.

Management of rosacea-prone skin: evaluation of a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay Thermal spring water as monotherapy or adjunctive therapy.

OBJECTIVE: The objective of these studies was to investigate whether a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging can have an impact in the management of rosacea-prone skin subjects. METHODS: Several studies were performed to evaluate the efficacy of this product in the management of rosacea prone skin, as either monotherapy or adjunctive therapy or to maintain the efficacy of a Metronidazole treatment. The first study was performed on 37 women aged 18-45 with added stage 2 erythro-couperosis, who applied test formula as monotherapy twice a day for 4 weeks. During a second study, a dermatological evaluation was performed on patients with stage I or II rosacea, a questionnaire containing information about patient characteristics, tolerance, clinical signs, symptoms and skin reactivity to "trigger factors" was completed by dermatologists at baseline and 2 months after treatment with the test formula as either monotherapy or adjunctive therapy. Finally, in a third study, 65 patients finishing a Metronidazole treatment applied once daily and the tested formula twice daily were divided into 2 groups using the test formula or vehicle control, twice a day for 8 weeks for the evaluation of efficacy as adjunctive therapy. RESULTS: We noted that the test formula, as an adjunctive therapy, helped prolong the efficacy of a Metronidazole treatment. In monotherapy, there was a significant efficacy of the test formula associated with an excellent tolerance. A significant improvement of all the clinical signs and symptoms of rosacea and a reduction of the skin reactivity to "trigger factors" were shown. CONCLUSIONS: These studies highlight the interest value and impact of a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging in monotherapy or in combination with or after a therapeutic treatment in the management of patients suffering from rosacea.

Effectiveness of glycyrrhizinic Acid (glizigen) and an immunostimulant (viusid) to treat anogenital warts.

Genital warts are benign proliferations of skin and mucosa caused by the human papillomavirus infection (hereinafter referred to as HPV). It is one of the most common sexually transmitted diseases in the world, whose incidence rate has increased in the last three decades. Current treatment involves the physical destruction of the infected cells. The fact that there are many different types of treatment goes to show that none of them are uniformly effective or directly antiviral. Objective. Demonstrate the efficacy of Glizigen in the III-phase clinical trial combined with a food supplement (VIUSID) formulated to boost the immune system when treating external anogenital warts. Design. 100 patients clinically diagnosed with anogenital lesions were included in the trial and assigned to two groups of 50 individuals. Those from one group where treated with Glizigen and Viusid and those from the other group with 25% podophyllin in alcohol, the results from each were then compared. Results. The combined Glizigen-Viusid treatment was seen to have an 87.5% efficacy rate, which was slightly more than that of the treatment with podophyllin, and there were hardly any adverse reactions reported during the treatment. Conclusions. the combined Glizigen-Viusid treatment was effective in treating genital warts.

Geomyces pannorum as a possible causative agent of dermatomycosis and onychomycosis in two patients.

Chrysosporium pannorum (Link) Hughes is a soil keratinophilic fungus present in organic residues, on human skin surface and in the general environment of human beings. Clear evidence for the pathogenicity of this fungus for human beings was lacking. In 1999, a case of fungal infection in a chow-chow dog and its owner was published, where Chrysosporium pannorum (Link) Hughes was determined as the only possible infection trigger. The State Hygiene Institute in Bratislava repeatedly confirmed the cultivation results. Chrysosporium pannorum (Link) Hughes was detected in the material provided by a ZOO: camel, tiger and antelope hair, whereby the same finding as in the dog mentioned above was described, i.e. extensive alopecic foci of various size. Since 2000 the cultivations have been monitored with due care. Eight positive cultivations of Chrysosporium pannorum (Link) Hughes have been detected until now, two of them in patients with a flair for horticulture. In a male patient, fingernail onychomycosis with affected skin on forearms, hands and fingers was determined. In a female patient only nail plates were affected. Chrysosporium pannorum was confirmed to be the only possible pathogen. Therapy with itraconazole produced excellent results in both patients and no relapses were recorded. Based on our repeated findings it is concluded that the evidence for non-pathogenicity of Chrysosporium pannorum should be revised.

Efficacy of topical pale sulfonated shale oil in the treatment of venous leg ulcers: a randomized, controlled, multicenter study.

BACKGROUND: Venous leg ulcers are a growing socioeconomic burden. Pale sulfonated shale oils (PSSO) are used for therapy of inflammatory skin diseases and have been shown to enhance wound healing in vitro and in vivo. The aim of this study was to investigate whether PSSO is capable of enhancing venous ulcer healing beyond compression therapy alone. METHODS: One hundred nineteen patients were enrolled in this randomized, multicenter, observer-blind study. In the treatment group, PSSO 10% was applied daily for 20 weeks, and the control group received the vehicle only. Wounds were covered by a nonadherent gauze dressing, and compression therapy with short-stretch elastic bandages was performed in an outpatient setting. The primary study end point was defined as cumulative reduction in wound area; the secondary study end point was treatment success as assessed by both physicians and patients. Additionally, adverse events, including changes with respect to physical examination and vital signs, were documented. RESULTS: At the end of the study period, ulcer size was significantly more reduced in the PSSO group compared with the vehicle group (15 +/- 15.9 to 6.2 +/- 12.9 cm(2) vs 11.4 +/- 14.5 to 10.8 +/- 15.7 cm(2); P = .0005). The cumulative relative reduction in ulcer area was significantly higher in the PSSO group (-4391 +/- 4748.7 vs -231.9 +/- 6283.6 % x days; P < .0001). Relative reduction in wound area was significantly greater in the PSSO group as early as 6 weeks after the beginning of treatment (-47.4 +/- 28.4 vs -23.8 +/- 42.2%; P < .001). PSSO was judged successful both by physicians and patients. There were no significant differences in adverse events (PSSO, 9 [12.2%]; vehicle, 7 [11.1%]. Similarly, tolerability of PSSO was equal to the tolerability of the vehicle. CONCLUSION: Pale sulfonated shale oils were capable of favoring venous ulcer healing in addition to compression therapy. PSSO should be considered for future wound care protocols for treatment of venous leg ulcers.