Sunscreens Part 2: Regulation and Safety.

The second part of this CME article discusses sunscreen regulation and safety considerations for humans and the environment. First, we provide an overview of the history of the United States Food and Drug Administration's regulation of sunscreen. Recent Food and Drug Administration studies clearly demonstrate that organic ultraviolet filters are systemically absorbed during routine sunscreen use, but to date there is no evidence of associated negative health effects. We also review the current evidence of sunscreen's association with vitamin D levels and frontal fibrosing alopecia, and recent concerns regarding benzene contamination. Finally, we review the possible environmental effects of ultraviolet filters, particularly coral bleaching. While climate change has been shown to be the primary driver of coral bleaching, laboratory-based studies suggest that organic ultraviolet filters represent an additional contributing factor, which led several localities to ban certain organic filters.

Management of acute radiation dermatitis: A review of the literature and proposal for treatment algorithm.

Radiation dermatitis is a common sequela of radiation therapy; up to 95% of patients will develop moderate-to-severe skin reactions. No criterion standard currently exists for the treatment of acute radiation-induced skin toxicity. It is therefore imperative to develop a greater understanding of management options available to allow clinicians to make informed decisions when managing radiation oncology patients. This literature review discusses the topical agents that have been studied for the treatment of acute radiation dermatitis, reviews their mechanisms of action, and presents a treatment algorithm for clinicians managing patients experiencing radiation dermatitis.

Design and Evaluation of a Poly(Lactide-co-Glycolide)-Based In Situ Film-Forming System for Topical Delivery of Trolamine Salicylate.

Trolamine salicylate (TS) is a topical anti-inflammatory analgesic used to treat small joint pain. The topical route is preferred over the oral one owing to gastrointestinal side effects. In this study, a poly(lactide-co-glycolide) (PLGA)-based in situ bio-adhesive film-forming system for the transdermal delivery of TS was designed and evaluated. Therefore, varying amounts (0%, 5%, 10%, 20%, and 25% (w/w)) of PLGA (EXPANSORB® DLG 50-2A, 50-5A, 50-8A, and 75-5A), ethyl 2-cyanoacrylate, poly (ethylene glycol) 400, and 1% of TS were dissolved together in acetone to form the bio-adhesive polymeric solution. In vitro drug permeation studies were performed on a vertical Franz diffusion cell and dermatomed porcine ear skin to evaluate the distinct formulations. The bio-adhesive polymeric solutions were prepared successfully and formed a thin film upon application in situ. A significantly higher amount of TS was delivered from a formulation containing 20% PLGA (45 ± 4 µg/cm2) and compared to PLGA-free counterpart (0.6 ± 0.2 µg/cm2). Furthermore, the addition of PLGA to the polymer film facilitated an early onset of TS delivery across dermatomed porcine skin. The optimized formulation also enhanced the delivery of TS into and across the skin.

Meta-analysis of the Effectiveness of Trolamine for Preventing and Treating Radiation Dermatitis and Quality Evaluation of GRADE Evidence / 中国药房

OBJECTIVE： To evaluate the effectiveness of trolamine for preventing and treating radiation dermatitis （RD） and evidence quality， and to provide reference for clinical use. METHODS： Retrieved from PubMed， Cochrane library， Embase， CNKI， Wanfang and VIP database， randomized controlled trials （RCTs） about trolamine （trial group） versus usual care （control group） for preventing and treating RD were collected. After data extraction， Cochrane bias risk assessment tool 5.0.2 was used to assess the bias risk， and Rev Man 5.3 statistical software was used to perform the Meta-analysis. GRADE evidence quality grading system was used to evaluate the evidence quality of outcome indexes. RESULTS： Seven RCTs were included， involving 782 patients. Results of Meta-analysis showed that there was no statistical significance in total incidence of RD [OR＝0.50， 95％CI （0.23， 1.11）， P＝0.09]， and the incidence of grade Ⅰ RD [OR＝1.32， 95％CI（0.96，1.81）， P＝0.09]， grade Ⅱ RD [OR＝1.07， 95％CI（0.80，1.42）， P＝0.66]， grade Ⅲ RD [OR＝0.69， 95％CI（0.45，1.04）， P＝0.07] or grade Ⅳ RD [OR＝0.43， 95％CI（0.17，1.05）， P＝0.07] between 2 groups. Results of Grade evidence quality evaluation showed that total incidence of RD， and the incidence of grade Ⅱ RD and grade Ⅳ RD were recommended by moderate-level evidence in 2 groups， while the incidence of grade Ⅰ and grade Ⅲ RD were recommended by low-level evidence. CONCLUSIONS： Trolamine is not effective in preventing and treating RD， and can not reduce the incidence of RD.

Percutaneous absorption of salicylic Acid after administration of trolamine salicylate cream in rats with transcutol(®) and eucalyptus oil pre-treated skin.

PURPOSE: This study was conducted to assess the effect of skin pre-treatment with Transcutol(®) and eucalyptus oil on systemic absorption of topical trolamine salicylate in rat. METHODS: Pharmacokinetic parameters of salicylic acid following administration of trolamine salicylate on rat skin pre-treated with either Transcutol(®) or eucalyptus oil were determined using both non-compartmental and non-linear mixed effect modeling approaches and compared with those of control group. RESULTS: Median (% of interquartile range/median) of salicylic acid AUC0-8hr (ng/mL/hr) values in Transcutol(®) or eucalyptus oil treated rats were 2522(139%) and 58976(141%), respectively as compared to the 3023(327%) of the control group. Skin pre-treatment with eucalyptus oil could significantly decrease extravascular volume of distribution (V/F) and elimination rate constant (k) of salicylic acid. CONCLUSION: Unlike Transcutol(®), eucalyptus oil lead to enhanced transdermal absorption of trolamine salicylate through rat skin.

Clinical research of trolamine cream in the prevention and treatment of radioactive dermatitis in patients with breast cancer after modified radical mastectomy / 肿瘤研究与临床

Objective To evaluate the efficacy of trolamine cream in the prevention and treatment of acute radioactive dermatitis in patients with breast cancer after modified radical mastectomy.Methods 80 breast cancer patients who received postmastectomy chest-wall irradiation by 6-MeV electron beam were included.40 cases in the treatment group were given trolamine cream combined with the conventional nursing care during radiotherapy,while another 40 cases in the control group were treated with the conventional nursing care.Results In the treatment group,the rates of radiation dermatitis of grade 1,2 and 3 were 70.0 ％ (28/40),22.5 ％(9/40),and 7.5 ％ (3/40),respectively,while they were 52.5 ％ (21/40),32.5 ％ (13/40) and 15.0 ％ (6/40),respectively,in control group (P ＜ 0.05).Grade 1,2 and 3 radiation dermatitis appeared in treatment group when the radiation doses were (21.91±4.39) Gy,(37.43±6.50) Gy and (46.14±6.50)Gy,respectively,while in the control group,it was (12.67±2.16) Gy,(22.61±3.51) Gy,(42.71±8.11) Gy (P ＜ 0.05),respectively.With cumulative doses of 10 Gy and 25 Gy,the rates of radiation dermatitis in the treatment group were 22.5 ％ (9/40) and 47.5 ％ (19/40),respectively,while they were 40.0 ％ (16/40) and 62.5 ％ (25/40),respectively,in the control group (P ＜ 0.05).Conclusions Trolamine cream effectively alleviates radiation skin damage in breast cancer patients after modified mastectomy,thus it is suitable for use in patients with postoperative chest wall radiotherapy.