A cream containing omega-3-fatty acids, humectants and emollients as an aid in the treatment of equine Culicoides hypersensitivity.

BACKGROUND: Topical application of polyunsaturated fatty acids (PUFAs) has shown satisfactory results in dogs and humans with allergic skin diseases. Urea and glycolic acid act as keratolytics and moisturizers. Culicoides hypersensitivity is the most common equine hypersensitivity disorder and only limited treatment options exist. OBJECTIVES: To evaluate the effect of a cream containing topical PUFAs, humectants and emollients on clinical signs of equine Culicoides hypersensitivity. ANIMALS: Privately owned horses (n = 28) with clinical signs of Culicoides hypersensitivity. METHODS AND MATERIALS: For a period of four weeks, one half of the horse's body (left or right) was treated with a cream containing concentrated fish oil and several moisturizing and emollient ingredients in a randomized, single-blinded fashion to evaluate the influence of the treatment on skin lesions. In the subsequent four weeks, the lesional areas of the entire body were treated to assess the treatment effect on pruritus. Additionally, the quality of the hair coat, an overall assessment and adverse effects were recorded. RESULTS: Twenty-one horses completed the study. Skin lesions on the treated side improved significantly between days 0 and 28 (P < 0.0001) in comparison to the untreated side. Neither pruritus scores nor coat quality improved significantly between days 0 and 56. Overall condition improved during the study. Five horses showed adverse effects. CONCLUSIONS AND CLINICAL IMPORTANCE: The cream improved Culicoides-induced skin lesions in affected horses, but anti-pruritic effects were less prominent.

Adverse reaction after hyaluronan injection for minimally invasive papilla volume augmentation. A report on two cases.

OBJECTIVES: To report two cases of adverse reaction after mucosal hyaluronan (HY) injection around implant-supported crowns, with the aim to augment the missing interdental papilla. MATERIAL AND METHODS: Two patients with single, non-neighbouring, implants in the anterior maxilla, who were treated within the frames of a randomized controlled clinical trial testing the effectiveness of HY gel injection to reconstruct missing papilla volume at single implants, presented an adverse reaction. Injection of HY was performed bilaterally using a 3-step technique: (i) creation of a reservoir in the mucosa directly above the mucogingival junction, (ii) injection into the attached gingiva/mucosa below the missing papilla, and (iii) injection 2-3 mm apically to the papilla tip. The whole-injection session was repeated once after approximately 4 weeks. RESULTS: Both patients presented with swelling and extreme tenderness with a burning sensation on the lip next to the injection area, after the second injection session. In one of the cases, a net-like skin discoloration (livedo reticularis) was also noted. The symptoms lasted for up to 7 days, and in both cases, symptoms resolved without any signs of skin or mucosal necrosis or any permanent damage. CONCLUSION: Most likely, water attraction over time by the highly hygroscopic HY, exerted progressively an external vascular compression and at least partial occlusion of neighbouring blood vessels. An infection or an allergic reaction seems unlikely, since all symptoms gradually disappeared within a week irrespective use of antimicrobials, while an allergic reaction most likely would not have been restricted to one side.

Natural (Mineral, Vegetable, Coconut, Essential) Oils and Contact Dermatitis.

Natural oils include mineral oil with emollient, occlusive, and humectant properties and the plant-derived essential, coconut, and other vegetable oils, composed of triglycerides that microbiota lipases hydrolyze into glycerin, a potent humectant, and fatty acids (FAs) with varying physico-chemical properties. Unsaturated FAs have high linoleic acid used for synthesis of ceramide-I linoleate, a barrier lipid, but more pro-inflammatory omega-6:-3 ratios above 10:1, and their double bonds form less occlusive palisades. VCO FAs have a low linoleic acid content but shorter and saturated FAs that form a more compact palisade, more anti-inflammatory omega-6:-3 ratio of 2:1, close to 7:1 of olive oil, which disrupts the skin barrier, otherwise useful as a penetration enhancer. Updates on the stratum corneum illustrate how this review on the contrasting actions of NOs provide information on which to avoid and which to select for barrier repair and to lower inflammation in contact dermatitis genesis.

A topical desiccant agent in association with ultrasonic debridement in the initial treatment of chronic periodontitis: a clinical and microbiological study.

Effective sub-gingival debridement is crucial to prevent serious systemic infections in hospitalized patients. Lack of compliance and the impracticality of repeated treatment in a short span of time are identified barriers to the performance of full mouth scaling and root planing (SRP). The aim of this randomized study was to evaluate the clinical and microbiological effects of the adjunctive administration of a locally delivered desiccant liquid with molecular hygroscopic properties (HYBENX® Oral Tissue Decontaminant™; HBX) in association with sub-gingival ultrasonic debridement (UD) in a hospital setting. Sixteen patients presenting moderate to severe chronic periodontitis were followed in a randomized 3 month, split mouth, single-blind, prospective study. At baseline (T1) control and test sides were treated with supra and subgingival UD with or without the association of a locally delivered desiccant liquid (HBX). Treatment was repeated after 6 weeks (T2). Clinical and microbiological parameters were assessed at T1, T2 and at 3 months (T3). The test group sites presented a significantly greater reduction in visible plaque index (VPI), bleeding on probing scores (BOP) and gingival index (GI) at T2 and T3 compared to the control group sites. HBX as monotherapy reached the same bacterial load reduction as UD. Compared to UD, a combined HBX-UD treatment resulted in a statistically significant greater bacterial load reduction immediately after treatment. A significantly lower anaerobic bacterial load was still present at T2. Data obtained show that decreased inflammatory signs and reduction of the bacterial load can be obtained in the short term by topical association of the desiccant agent HBX with UD.

Foundation products have a measureable impact on moisturization.

Multifunctional products are becoming more prevalent in the color cosmetics market. We evaluated four foundation products for in vivo moisturizing benefits using the mini-regression test method. We found that statistically significant long-lasting moisturization was provided by the foundations tested, but only if hygroscopic moisturizing ingredients were present.

The influence of a humectant-rich mixture on normalz skin barrier function and on once- and twice-daily treatment of foot xerosis. A prospective, randomized, evaluator-blind, bilateral and untreated-control study.

BACKGROUND: Moisturizers are often used to overcome dry skin conditions. However, cosmetic moisturizers may lack in efficiency and may also deteriorate skin barrier function. The objective of this study was to generate data on a new humectant-rich formulation (15% alfahydroxy acids and 15% urea) in the treatment of normal skin as well as in dry feet with hyperkeratosis and cracked skin with fissures. Changes in permeability and effectiveness of the product after once- and twice-daily applications to the feet will be monitored. METHODS: The study was randomized, bilateral, controlled and evaluator-blind. The first part of the study included 12 healthy volunteers and the second part 50 patients with hyperkeratotic feet. The changes in the skin was evaluated by an expert, the patients and using non-invasive biophysical measurements of skin barrier function (transepidermal water loss, TEWL), erythema, thickness (ultrasound) and hydration (conductance). RESULTS: The humectant-rich formulation increased skin hydration, removed scales and reduced thickness of hyperkeratotic skin. Skin barrier function was improved in normal skin, but no changes in TEWL were noted in the feet. No difference between once and twice-daily applications was found. Some smarting and stinging was noted. CONCLUSION: The humectant-rich formulation efficiently relieved the xerosis on the feet without inducing any weakening of the skin barrier function. Instead the normal skin became more resistant to external insults by the treatment.

Fixing the skin barrier: past, present and future--man and dog compared.

Skin barrier dysfunction exists in both human and canine atopic dermatitis, leading to increased water loss and potentially facilitating allergen penetration and sensitization. Both lipid (e.g. ceramides) and protein (e.g. filaggrin) abnormalities have been described. Some are genetically inherited (e.g. filaggrin mutations are one of the major risk factors in humans) and some are secondary and linked to inflammation. In humans, numerous studies have shown efficacy of emollients and moisturizers in barrier restoration, and this approach has been for years the mainstay of therapy. Recently, this strategy has shown promise as a preventative function. In veterinary medicine, evidence regarding skin barrier impairment is rapidly building. Decreased ceramides and filaggrin (in some subsets of dogs) have been described. Altered metabolism of ceramides has also been proposed. Despite these preliminary data and the availability of products marketed to improve the skin barrier, evidence regarding the clinical benefit of skin repair intervention is still limited. Preliminary studies have demonstrated that topical application of fatty acids and ceramides and systemic administration of fatty acids improve lipid deficiencies in the skin of dogs with atopic dermatitis, but limited clinical evidence exists. Disease remission in humans is paralleled by an improved skin barrier, both with calcineurin inhibitors and glucocorticoids. In veterinary medicine, a preliminary study on ciclosporin and prednisone failed to detect significant improvement of water loss, while successful immunotherapy correlated with an improved skin barrier. Controlled, large studies are needed to address the question of which skin repair approach is clinically most effective and whether this can be used as a preventative strategy.

Preparation and characterization of tablet formulation based on solid dispersion of glimepiride and poly(ester amide) hyperbranched polymer.

The feasibility of incorporating a solid dispersion containing poorly soluble antidiabetic drug glimepiride and poly(ester amide) hyperbranched polymer into a tablet using a direct-compression tabletting technique was investigated. Tablet cores were additionally coated with hydroxypropyl methylcellulose phthalate in order to protect the extremely hygroscopic solid dispersion from atmospheric moisture. Preliminary stability studies show that glimepiride, which is in amorphous form within solid dispersion, is chemically stable, even if tablets are exposed to elevated temperature and/or moisture. In-vitro dissolution studies show some impact of storage conditions on the tablet cores disintegration time and, consequently, drug release rate. Glimepiride solubility also deteriorates somewhat, most probably due to its partial recrystallization. Storage conditions much less affect the physical stability of coated tablets, which was ascribed to reduced tablet hygroscopicity due to the presence of protecting coating. The hyperbranched polymers are rather new and complex macromolecules. Therefore, we addressed also the biocompatibility of hyperbranched polymer, i.e., its impact on haemolysis of the red blood cells. The concentration required for the haemolytic effect on the red blood cells is around 100-times higher than its expected gastrointestinal luminal concentration, which makes the occurrence of hyperbranched polymer mediated cytotoxicity very unlikely.

Moisturizers: reality and the skin benefits.

The function of the skin as a barrier protects underlying tissues from infection, desiccation, chemicals, and mechanical stress. Disruption of this function results in increased transepidermal water loss or TEWL and is associated with conditions like atopic dermatitis and other chronic skin diseases. Moisturizers have been shown to improve these conditions through restoration of the integrity of the stratum corneum, acting as a barrier to water loss and replacement of skin lipids and other compounds. Also, moisturizers are commonly used to reduce fine lines and make skin appear smooth and soft. While many products make extensive claims of skin rejuvenation, many of the beneficial effects of these products are actually due to the moisturizers they contain: ingredients like glycerin, petrolatum, and dimethicone. Some newer formulations like prescription-device moisturizers, which received 510 K approval on the basis of reducing TEWL, are significantly more expensive than traditional moisturizers and recent literature does not indicate that they are more effective than their over-the-counter counterparts.

Tratamiento de la dermatitis atópica / No disponible

En este artículo se revisan las recomendaciones sobre los hábitos de vida en los pacientesatópicos, así como el tratamiento más apropiado según la gravedad de la enfermedad.Su elaboración está basada en guías clínicas y revisiones sistemáticas. Además se resume laexperiencia existente en la bibliografía en el uso de nuevos tratamientos para la dermatitisatópica(AU)

In this article, we review the recommendations of life style in the patients with atopicdermatitis and the most suitable treatment in relation to the severity of the disease. This documentis based in clinical guidelines and systematic reviews. Furthermore, we resume the experienceavailable in the bibliography about the use of new treatments in atopic dermatitis(AU)

Tratamiento de la dermatitis atópica. Una perspectiva desde la medicina basada en pruebas / No disponible

En este artículo se resumen las principales intervenciones utilizadas para el tratamientoy prevención de la dermatitis atópica (DA). Para ello, se han revisado bases dedatos secundarias y guías de práctica clínica de buena calidad metodológica con el objetivode ofrecer una visión general de la eficacia de estas medidas. Para la redacción deeste artículo se han utilizado principalmente dos recursos, Clinical Evidence y la guía depráctica clínica de NICE. Se ha complementado su información, cuando se ha estimadopreciso, con otras fuentes de información, principalmente revisiones sistemáticas de laColaboración Cochrane(AU)

This article summarizes the most important interventions used in the treatment andprevention of atopic dermatitis (DA). Secondary databases and good methodological qualityclinical guidelines have been reviewed in order to offer a general overview of the availableevidence of these measures. Two resources have mainly been used: Clinical Evidenceand the clinical guideline NICE.Its information has been completed, when necessary, with other information resources,mainly systematic reviews of the Cochrane Collaboration(AU)

Estudio clínico para evaluar el efecto de dos cremas humectantes con protector solar en la piel de pacientes que utilizan tretinoína0, 025% para el tratamiento del fotodaño / Clinical study to evaluate the effect of two facial moisturizer test products

Introducción: La exposición a la radiación ultravioleta (RUV) produce un deterioro en la piel denominado fotodaño, que puede mejorarse con la aplicaciónde tretinoína. Este tratamiento, sin embargo, puede causar efectos colaterales.El objetivo es comparar las diferencias en la eficacia, tolerancia y preferencias al utilizar tretinoína al 0,025%, junto con dos productos hidratantes diferentes.Materiales y métodos: Estudio abierto, prospectivo, doble ciego, randomizado. Cincuenta y siete mujeres de 35 a 55 años, con daño solar, se aplicaronen el período de pre-condicionamiento, una crema humectante en cada hemicara: una con niacinamida y otra sólo con componentes hidratantes.Luego, se agregó tretinoína tópica al 0,025%. Se evaluó fotodaño, tolerancia y preferencias.Resultados: En el período de precondicionamiento no se hallaron diferencias significativas en la tolerancia. La pérdida trans epidérmica de agua(PTEA) fue significativamente peor para el humectante B. La textura de la piel mejoró significativamente para ambos humectantes. En el período detratamiento la tolerancia disminuyó más para el humectante B en las semanas 2 y 4, mejorando al final del estudio. Los parámetros relacionados confoto daño mejoraron, más para el humectante A.La PTEA aumentó en las semanas 2 y 4, más para el humectante B; para luego disminuir.Comentario: La tretinoína tópica es bien tolerada, cuando se la utiliza en combinación con cremas humectantes. La niacinamida agrega beneficios ala acción hidratante de un producto, ya que cumple un rol en la prevención de efectos adversos y en la potenciación de los efectos beneficiosos delretinoide (AU)

Introduction: Ultraviolet radiation exposure cause a deleterious effect in the skin called photodamage. Tretinoin application can improve this damage,however it can also cause adverse effects. The objective of this paper is to compare the differences in tolerance and patient preference when usingtretinoin 0.025% along with two different moisturizers.Material and methods: It was and open, prospective, randomized, double blinded study. Fifty sevenwomen, 35 to 55 year old with photodamagedskin, applied during a preconditioning period a different moisturizer in each side of the face. One of them contained niacinamide and the other onlyhydrating components. After 15 days topical tretinoin 0,025% was added. Efficacy, tolerance and preferences were evaluated.Results: We didn’t find significative differences in tolerance during the preconditioning period. Transepidermal water loss (TEWL) was significativelyworse for moisturizer B. Skin texture improved for both used products. During the treatment period, tolerance was worse for moisturizer B in weeks 2 and 4. There was a more important improvement in photodamage related items for moisturizer A. TEWL were high for both products in weeks 2 and4, diminishing afterwards. This elevation was higher for moisturizer B.Comment: topical tretinoin is well tolerated when used in combination with moisturizer creams. Niacinamide adds benefits because it helps preventingadverse events and promote desirable anti age effects of the retinoid (AU)

Refuerzo epidérmico de la impermeabilidad actínica y oposición a la deshidratación: Uso de vehículos multifásicos / Epidermic reinforcement of the actinic permeability and resistance to dehydration: Use of multiphasic vehicles

Dada la necesidad de reforzar la capa corneal en relación con los rayos solares evitando su penetración en la epidermis viable y la pérdida de agua fisiológica, se propone la inclusión de filtros e hidratantes en un vehículo multifásico selectivo. La estabilidad y la eficacia del sistema traducidas en la selectividad de cesión dependen de la elección de los materiales que determinan las características individuales de las fases presentes y de la conjugación fases/interfases (AU)

Sindrome de Netherton / Netherton Syndrome

Presentamos dos pacientes con la triada disgnostica del Sindrome de Netherton:ictiosis lineal circunfleja,tricorresis invaginada y diatesis atopica.En ambos casos la biopsia de las lesiones de piel y la microscopia por barrido electronico,fueron decisivas para el diagnostico.Los hallazgos histopatologicos del borde externo de las lesiones fueron compatibles con dermatitis psoriasiforme.La tricorresis invaginada o pelo en caña de bambu,se encontro presente a lo largo del pelo.Las manifestaciones atopicas fueron inconstantes.La edad de los pacientes exigio el planteo de terapeuticas poco agresivas.AU