Treatment and management strategies of onychomycosis.

Onychomycosis is one of the most prevalent and severe nail fungal infections, which is affecting a wide population across the globe. It leads to variations like nail thickening, disintegration and hardening. Oral and topical drug delivery systems are the most desirable in treating onychomycosis, but the efficacy of the results is low, resulting in a relapse rate of 25-30%. Due to systemic toxicity and various other disadvantages associated with oral therapy like gastrointestinal, hepatotoxicity, topical therapy is commonly used. Topical therapy improves patient compliance and reduces the cost of treatment. However, due to poor penetration of topical therapy across the nail plate, research is focused on different chemical, mechanical and physical methods to improve drug delivery. Penetration enhancers like Thioglycolic acid, Hydroxypropyl-ß-cyclodextrin (HP-ß-CD), Sodium lauryl sulfate (SLS), carbocysteine, N-acetylcysteine etc. have shown results enhancing the drug penetration across the nail plate. Results with physical techniques such as iontophoresis, laser and Photodynamic therapy are quite promising, but the long-term suitability of these devices is in need to be determined. In this article, a brief analysis of the treatment procedures, factors affecting drug permeation across nail plate, chemical, mechanical and physical devices used to increase the drug delivery through nails for the onychomycosis management has been achieved.

Recent advances in physical delivery enhancement of topical drugs.

The skin has evolved to resist the penetration of foreign substances and particles. Effective topical drug delivery into and/or through the skin is hindered by these epidermal barriers. A range of physical enhancement methods has been developed to selectively overcome this barrier. This review discusses recent advances in physical drug delivery by broadly separating the techniques into two main areas; indirect and direct approaches. Indirect approaches consist of electrical, vibrational or laser instrumentation that creates pores in the skin followed by application of the drug. Direct approaches consist of mechanical disruption of the epidermis using techniques such as microdermabrasion, biolistic injectors and microneedles. Although, in general, physical techniques are yet to be established in a clinical setting, the potential gains of enhancing delivery of compounds through the skin is of great significance and will no doubt continue to receive much attention.

Iontoforesis transdérmica con verapamilo y dexametasona para la fase aguda de la Enfermedad de La Peyronie. Nuestra experiencia / Transdermal iontophoresis with verapamil and dexamethasone in the acute phase of peyronie's disease. Our experience

OBJETIVO: Evaluar el resultado del tratamiento de la Enfermedad de Peyronie (EP) mediante iontoforesis de verapamilo y dexametasona. MÉTODOS: Tratamiento de 29 pacientes con EP en 3 sesiones semanales durante cuatro semanas consecutivas mediante un dispositivo Miniphysionizer©. Administrando 5 mL de una combinación de 10mg de verapamilo y 4mg de dexametasona, aplicado transdérmico a través de una corriente de 2.5 mA durante ciclos de 20 min. Se evalúa la eficacia del tratamiento mediante corrección de curvatura peneana (test de Kelami), tamaño de la placa (ecografía peneana), mejoría del dolor y otros parámetros, como, la función eréctil, capacidad de penetración o efectos secundarios del tratamiento, que fueron valorados mediante cuestionarios. RESULTADO: Todos los pacientes completaron el protocolo de tratamiento (12 sesiones) y se efectuaron un total de 348 sesiones de iontoforesis. Tras finalizar el tratamiento completo, 3 pacientes (10.7%) continuaron presentando dolor, mientras que remitió en 25 de ellos (89.3%). En 13 pacientes (44.8%) se observó una disminución del tamaño de la placa, desapareciendo incluso totalmente en 4 pacientes (13.8%). La curvatura no se disminuyó en ninguno de los pacientes tras el tratamiento. Sin embargo, la función eréctil mejoró en 3 pacientes (10.3%) según la puntuación del IIEF, y la capacidad para la penetración mejoró en 4 pacientes (13.8%). CONCLUSIONES: La iontoforesis con verapamilo y dexametasona es un tratamiento seguro y eficaz en la resolución del dolor con las erecciones en la fase aguda de la EP. Sin embargo la eficacia en la resolución de la curvatura y la DE es más limitado (AU)

OBJECTIVES: To evaluate the treatment of Peyronie's disease (PD) with verapamil and dexamethasone iontophoresis. METHODS: Twenty nine patients with PD were treated by means of a Miniphysionizer” dispositive 3 sessions a week during 4 consecutive weeks. 5mL of a combination of verapamil (10mg.) and dexamethasone (4mg.) were transdermally administered with a 2.5 mA current during 20 min. The aim is to evaluate treatment efficacy in correcting penile curvature (Kelami test), plaque size (penis ultrasound (US)) improvement of pain and, other parameters like erectile function (EF), intercourse capacity or adverse effects of the treatment, which were evaluated with questionnaires. RESULTS: All patients completed the treatment protocol (12 sessions) and a total number of 348 sessions of iontophoresis were performed. After treatment, 3 patients (10.7%) continued with pain, but it disappeared in 25 of them (89.3%). A decrease of the size of the plaque was observed in 13 patients (44.8%), even disappearance in 4 patients (13.8%). No patient had curvature decrease after treatment. However, EF (IIEF score) and ability for intercourse improved in 3 (10.3%) and 4 patients (13.8%) respectively. CONCLUSION: Verapamil and dexamethasone iontophoresis is a safe and reliable treatment resolving painful erections in the acute phase of PD. However its efficacy in solving penile curvature and erectile dysfunction (ED) is more limited (AU)

Primum non nocere / No disponible

No disponible

Actualización en hiperhidrosis / Hyperhidrosis update

La hiperhidrosis afecta casi al 3% de la población. Hay una disminución de la calidad de vida que perjudica las relaciones sociales y las actividades profesionales, presentándose ocasionalmente fobia social. En esta revisión se analiza el concepto y las causas de hiperhidrosis, así como la evaluación clínica del paciente que la padece. Tras discutir los distintos aspectos clínicos de la hiperhidrosis se revisan los diferentes tratamientos médicos y quirúrgicos. Actualmente disponemos de varios tratamientos de tipo médico y quirúrgico. Se resalta la aportación de la toxina botulínica como opción intermedia en ciertas formas de hiperhidrosis, entre los tratamientos clásicos y el tratamiento quirúrgico. También se destaca la contribución de las técnicas quirúrgicas de acceso mínimo (videotoracoscopia), que se han consolidado en esta última década como una opción efectiva permanente y segura para el tratamiento de esta afección en los casos indicados (AU)

Nearly 3% of the population has hyperhidrosis. Quality of life is affected, impacting on social relationships and professional activity, and social anxiety disorder can sometime develop. We review the definition and causes of hyperhidrosis and the clinical evaluation of patients. After describing the different clinical aspects of the condition, we discuss the medical and surgical treatments. Of such treatments currently available, particular mention is made of the use of botulinum toxin in some forms of hyperhidrosis as an intermediate option between the traditional treatments and surgery. We also draw attention to the use of minimal access surgical techniques (videothoracoscopy), which, over the past decade, have become established as an effective, safe, and permanent approach for the treatment of hyperhidrosis when indicated (AU)

New techniques for drug delivery to the posterior eye segment.

Ocular drug delivery has become an increasingly important field of research especially when treating posterior segment diseases of the eye, such as age-related macular degeneration, diabetic retinopathy, posterior uveitis and retinitis. These diseases are the leading causes of vision loss in developed countries which require repeated long-term administration of therapeutic agents. New drugs for the medication of the posterior ocular segment have emerged, but most drugs are delivered by repeated intravitreal injections associated with ocular complications. Advances in ocular drug delivery system research are expected to provide new tools for the treatment of the posterior segment diseases, providing improved drug penetration, prolonged action, higher efficacy, improved safety and less invasive administration, resulting in higher patient compliance. This review provides an insight into the recent progress and trends in ocular drug delivery systems for treating posterior eye segment diseases, with an emphasis on transscleral iontophoresis.

Interés del tratamiento osteopático en la enfermedad de De Quervain. A propósito de un caso / Interest of the osteopathic treatment in ''De Quervain'' disease. '' A case report

Diseño: estudio de casos. Objetivos: describir la aplicación de técnicas osteopáticas en el tratamiento fisioterápico en un caso de enfermedad de De Quervain. Paciente y método: mujer de 29 años que presenta enfermedad de De Quervain bilateral de 8 meses de evolución. La paciente refería dolor constante de intensidad 7/10 en escala visual analógica (EVA). La movilidad estaba conservada. El balance muscular era doloroso para la extensión y abducción del pulgar y la prueba Filkenstein positiva bilateral. Los tests osteopáticos mostraron lesión de la cabeza radial en anterioridad en el codo derecho y en posterioridad en el izquierdo. El tratamiento consistió en iontoforesis con diclofenaco, ejercicios activos y tratamiento manual de elastificación de los músculos afectados. A partir de la quinta sesión se incluyeron técnicas osteopáticas de ambos codos, que consistieron en bombeos, técnicas articulatorias y manipulación. Resultados: tras 8 sesiones de tratamiento se alcanzó una importante reducción del dolor (2/10 en EVA) y normalización de la exploración. Conclusiones: la aplicación de un tratamiento fisioterapéutico consistente en iontoforesis, tratamiento manual, ejercicios de flexibilización durante 4 sesiones, seguido de 4 sesiones en las que se realiza además tratamiento con técnicas osteopáticas consistentes en bombeos, técnicas articulatorias y manipulación, ha demostrado, en este caso clínico, ser de gran utilidad en la resolución de los síntomas de la paciente. Dados los escasos efectos secundarios de este tratamiento, pensamos que podría plantearse como una opción terapéutica previa al tratamiento quirúrgico(AU)

Objectives: Describe the application of osteopathic techniques in the physiotherapytreatment of a case of De Quervain Disease.Patient and method: A 29-year old woman who had bilateral De Quervain Disease of 8month’s evolution. The patient reported constant pain, scoring 7/10 intensity on the VisualAnalogue Scale (VAS). Mobility was conserved. Muscular balance was painful for extensionand abduction of the thumb and Filkenstein test was positive for bilateral involvement.The osteopathic tests showed a lesion in the anterior position in the right elbow and posterior one in the left elbow. The treatment consisted of iontophoresis with dichlofenac,active exercises and manual treatment of elasticity of the muscles affected. After the 5th sessions, osteopathic techniques for both elbows were included. These consisted inpumping, articulation and manipulation techniques.Results: There was a significant reduction in pain after 8 treatment sessions (2/10 onVAS), normalization being found in the examination.Conclusions: Application of a physiotherapy treatment, that consisted in iontophoresis,manual treatment, flexibility exercises for 4 sessions, followed by 4 sessions in which treatment was performed with osteopathic techniques, that consisted in pumping, articulation and manipulation techniques, has been demonstrated to be of great use in this clinical case to resolve the patient’s symptoms. Given the scarce side effects of thistreatment, we consider that it should be proposed as a therapeutic option prior to surgical treatment(AU)

Emerging trends and new approaches to acute pain management.

New approaches to the management of acute perioperative pain have focused on ways to improve the risk/benefit profile of various analgesics, enhance the consistency of pain control, address interpatient differences in responses to pain and treatments, and avoid periods of ineffective pain relief (analgesic gaps). Although intravenous patient-controlled analgesia has been the "gold standard" for acute pain management, there are now more analgesic options and compelling data to support combinations of analgesics or multimodal therapy, timing of analgesic interventions, and the use of newer drug delivery systems. Maximizing pain control with preemptive analgesia and multimodal therapy, and the availability of transdermal fentanyl by iontophoresis and extended-release epidural morphine have expanded the armamentarium of effective options for perioperative pain control. This article explores emerging trends in acute pain therapy, and discusses their implications for improving patient care.

Iontophoretic drug delivery system: a review.

Among the recent developments in the field of transdermal drug delivery, iontophoresis has emerged as a very promising tool for this purpose. Various studies have been performed on drug delivery through the skin using electric current. Iontophoresis has thereby been found to be effective in particular in transdermal protein and peptide drug delivery. This article reviews the principle, potential benefits, and applications of drug delivery based on iontophoresis. It focuses furthermore on current research and future trends in the field of iontophoretic drug delivery.

Percutaneous lidocaine administration via a new iontophoresis system in children: tolerability and absence of systemic bioavailability.

OBJECTIVE: Rapid achievement of dermal anesthesia in pediatric practice without discomfort is both desirable and difficult. The Northstar Iontophoretic Drug Delivery System (IDDS) is designed to achieve this objective in 10 minutes using a current of 1.78 mA, compared with the 40 to 60 minutes required for traditional percutaneous methods (eg, eutectic mixture of local anesthetics or EMLA cream). For evaluating the tolerance of this IDDS in pediatrics, 12 healthy children (5-15 years, 4 girls and 8 boys, 10 white, weight 19-79 kg) were evaluated. METHODS: An open-label trial with random applications of IDDS containing lidocaine (100 mg of 10%) and epinephrine (1.05 mg of 1:10,000) to 3 of the 4 possible sites (back, chest, dorsum of hand, and antecubital fossa) was conducted. Three successive applications (time = 0, 3 hours and 3.5 hours) were performed in each subject, with repeated blood sampling (n = 12 over 10 hours) for assessment of plasma lidocaine concentrations. Skin evaluation (by Draize scoring) at both anode and cathode sites was performed at 10 and 24 hours. RESULTS: Few of the subjects (0%-28%) experienced any dermal abnormalities at 10 hours. These findings were maintained at the 24-hour follow-up evaluation with the vast majority of subjects (92%-100%) having no evidence of erythema or edema irrespective of application site. Erythema associated with the anode seemed to be more prominent when the study device was applied to either the chest or the back as compared with the antecubital fossa or dorsum of the hand. No subjects complained of pain/discomfort associated with IDDS delivery. Plasma lidocaine levels in all subjects were below 10 ng/mL at all time points. CONCLUSIONS: The IDDS seems not to deliver a significant, systemic dose of lidocaine and to be well tolerated and potentially suitable for clinical use in pediatric subjects.

Physical enhancement of dermatologic drug delivery: iontophoresis and phonophoresis.

Iontophoresis and phonophoresis are emerging technologies capable of enhancing drug penetration through the stratum corneum, the principal barrier to percutaneous absorption. With utilization of applied electric current or ultrasonic waves, respectively, iontophoresis and phonophoresis have shown efficacy in an increasing number of clinical applications. This article reviews the underlying principles, current status, and potential of iontophoresis and phonophoresis in dermatologic therapy.

Iontoforesis en el diagnóstico de fibrosis quística

La fibrosis quística es un desorden autosómico recesivo en el cual se compromete el transporte del cloro a través de las células epiteliales de diferentes órganos. Las manifestaciones son diversas, ya que se pueden afectar diferentes órganos. La prueba del sudor o iontoforesis continúa siendo uno de los exámenes más específicos e importantes para el diagnóstico de fibrosis quística. Esta prueba debe ser realizada en todo niño que presente un enfermedad pulmonar recurrente, infecciones a repetición, manifestaciones obstructivas bronquiales, enfermedad hepática, pólipos nasales, pancreatitis o malabsorción. Es importante tener en cuenta las implicaciones que tiene un diagnóstico oportuno en el niño; mientras más temprano se sospeche y se compruebe el diagnóstico, mejor calidad de vida se le podrá brindar al paciente.