1
|
Bronte J, Zhou C, Vempati A, Tam C, Khong J, Hazany S, Hazany S. A Comprehensive Review of Non-Surgical Treatments for Hypertrophic and Keloid Scars in Skin of Color. Clin Cosmet Investig Dermatol 2024; 17:1459-1469. [PMID: 38911337 PMCID: PMC11193462 DOI: 10.2147/ccid.s470997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/02/2024] [Indexed: 06/25/2024]
Abstract
Hypertrophic and keloid scars are fibroproliferative growths resulting from aberrant wound healing. Individuals with Fitzpatrick skin types (FSTs) IV-VI are particularly predisposed to hypertrophic and keloid scarring, yet specific guidelines for these populations are still lacking within the literature. Therefore, this comprehensive review provides a list of various treatments and considerations for hypertrophic and keloid scarring in patients with skin of color. We constructed a comprehensive PubMed search term and performed quadruple-blinded screening on all resulting studies to achieve this objective. Our findings demonstrate 1) the lack of efficacious treatments for raised scars within this population and 2) the need to empirically investigate individualized and multimodal therapeutic options for those with skin of color.
Collapse
Affiliation(s)
- Joshua Bronte
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Crystal Zhou
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Abhinav Vempati
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Curtis Tam
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Khong
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sanam Hazany
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Salar Hazany
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| |
Collapse
|
2
|
Yee DA, Zhou AE, Khachemoune A. Examining treatment strategies for xanthelasma palpebrarum: a comprehensive literature review of contemporary modalities. Arch Dermatol Res 2024; 316:149. [PMID: 38724802 DOI: 10.1007/s00403-024-02863-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 01/29/2024] [Accepted: 04/07/2024] [Indexed: 06/05/2024]
Abstract
Xanthelasma palpebrarum (XP) is the predominant form of cutaneous xanthoma, as it accounts for greater than 95% of cases. It is characterized by the presence of foam cell clusters containing a large amount of low-density lipoprotein (LDL), which are located in the connective tissue of skin, tendons, and fascia. XP lesions commonly present as distinctive yellow-orange macules, papules, or nodules, and are primarily on the upper eyelids as well as the inner canthus. Women are affected twice as often as men, with lesions typically emerging between the ages of 35 and 55. The pathophysiology of XP involves abnormal lipid metabolism and is often associated with hyperlipidemic states like Type II and IV hyperlipidemia, hypothyroidism, weight gain, and fatty diet. Despite the availability of various treatment methods, current XP management lacks standardization, particularly due to limited comparative research. To address this gap, we conducted an extensive literature review of 45 studies published between 2012 to 2023, which provides an updated overview of current XP treatment modalities. This comprehensive analysis will inform researchers and clinicians on the evolving landscape of XP management.
Collapse
Affiliation(s)
- Danielle A Yee
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Albert E Zhou
- Department of Dermatology, UConn Health, Farmington, CT, USA
| | - Amor Khachemoune
- Department of Dermatology, State University of New York Downstate and Veterans Affairs Medical Center, 800 Poly Pl, Brooklyn, NY, 11209, USA.
| |
Collapse
|
3
|
Mozafari N, Mollaabasi F, Mansouri P, Robati RM. The Combined Application of Bleomycin and Triamcinolone for Treating Refractory Keloids. Dermatol Surg 2024; 50:267-271. [PMID: 38113179 DOI: 10.1097/dss.0000000000004056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Triamcinolone acetate injections are considered the first treatment option for keloids, but quite high proportions of keloids either do not respond to triamcinolone or develop recurrence. Beneficial effects of intralesional bleomycin have been recently shown in the treatment of keloids and hypertrophic scars. However, the efficacy of combination therapy using intralesional triamcinolone and bleomycin remains undetermined. OBJECTIVE The purpose of this study was to evaluate the efficacy of using bleomycin and triamcinolone mixture to treat refractory keloids. MATERIALS AND METHODS In total, 33 patients with resistant keloids (including 8 men and 25 women) and a mean age of 36.52 years (age range of 18-65 years) were enrolled in this study. A mixture of bleomycin (1 u/cc) with triamcinolone acetonide (13.3 mg/cc) was injected intralesionally into the keloids every 4 to 6 weeks for a maximum of 6 cycles. The clinical improvement was evaluated using the Japan Scar Scale (JSS) and the physician's global assessment of the flattening of the lesions. Side effects were also noted and recorded. RESULTS In all patients, the total JSS scores decreased significantly after treatment (2.33 ± 1.05), compared with baseline (11.61 ± 2.59), ( p < .001); 26 keloids (78.8%) showed an excellent response (75%-100% flattening), 7 keloids (21.2%) showed a fair response (25%-75% flattening), and 0 keloids (0%) showed a poor response (<25% flattening). Observed side effects were ulceration (33.3%), hyperpigmentation (33.3%), hypopigmentation (15.15%), secondary infection (33.3%), and telangiectasis (15.15%). CONCLUSION The combined use of bleomycin and triamcinolone offers a promising treatment option for individuals who have not responded well to traditional therapies.
Collapse
Affiliation(s)
- Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faeghe Mollaabasi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mansouri
- Medical Laser Research Centers, Academic Center of Education, Culture and Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Tedesco G, Noli LE, Griffoni C, Ghermandi R, Facchini G, Peta G, Papalexis N, Asunis E, Pasini S, Gasbarrini A. Electrochemotherapy in Aggressive Hemangioma of the Spine: A Case Series and Narrative Literature Review. J Clin Med 2024; 13:1239. [PMID: 38592093 PMCID: PMC10932223 DOI: 10.3390/jcm13051239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: this case series and literature review aims to evaluate the efficacy and safety of electrochemotherapy in the management of aggressive spinal hemangiomas, presenting two distinct cases. (2) Methods: we present two cases of spinal aggressive hemangioma which were refractory to conventional treatments and underwent electrochemotherapy. Case 1 involves a 50-year-old female who presented with an aggressive spinal hemangioma of L1, who previously underwent various treatments including surgery, radio-chemotherapy, and arterial embolization. Case 2 describes a 16-year-old female with a T12 vertebral hemangioma, previously treated with surgery and stabilization, who faced limitations in treatment options due to her young age and the location of the hemangioma. (3) Results: in Case 1, electrochemotherapy with bleomycin was administered following the failure of previous treatments and resulted in the reduction of the lesion size and improvement in clinical symptoms. In Case 2, electrochemotherapy was chosen due to the risks associated with other treatments and was completed without any adverse events. Both cases demonstrated the potential of electrochemotherapy as a viable treatment option for spinal hemangiomas, especially in complex or recurrent cases. (4) Conclusions: electrochemotherapy with bleomycin is a promising treatment for aggressive spinal hemangiomas when conventional therapies are not feasible or have failed. Further research is needed to establish definitive protocols and long-term outcomes of electrochemotherapy in spinal hemangioma management.
Collapse
Affiliation(s)
- Giuseppe Tedesco
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Luigi Emanuele Noli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche Bologna, Bellaria Hospital, 40139 Bologna, Italy;
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Riccardo Ghermandi
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Giuliano Peta
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.F.); (G.P.); (N.P.)
| | - Emanuela Asunis
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Stefano Pasini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| | - Alessandro Gasbarrini
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (G.T.); (C.G.); (E.A.); (S.P.); (A.G.)
| |
Collapse
|
5
|
Kim S, Woo YR, Cho SH, Lee JD, Kim HS. Clinical Efficacy of 5-Fluorouracil and Bleomycin in Dermatology. J Clin Med 2024; 13:335. [PMID: 38256469 PMCID: PMC10816055 DOI: 10.3390/jcm13020335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Bleomycin and 5-fluorouracil (5-FU) are widely used in various dermatological disorders. Both drugs are well-recognized as antineoplastic drugs and exert their effect by blocking the cell cycle. Topical and intralesional formulations are available and have been studied in both non-neoplastic and cancerous lesions. However, data comparing the effect of bleomycin and 5-FU in the dermatological disorders are limited. This review outlines the action mechanisms of both drugs and compares their clinical efficacies in a wide range of dermatologic diseases including hypertrophic scar, wart, skin cancer, vascular malformation, hemangioma, and vitiligo, and discusses the overall safety of the drugs. Intralesional bleomycin treatment is effective in hypertrophic scars and warts, but intralesional 5-FU may also be considered since it is cheaper and less painful. Moreover, intralesional 5-FU and bleomycin injection is a viable option for premalignant lesions (i.e., actinic keratosis) and inoperable skin cancers. Both bleomycin and 5-FU have been applied as treatment adjuncts for vitiligo, with 5-FU showing a slightly better outcome. Both agents have a good safety profile, and no serious side effects have been reported following their use in the field of dermatology.
Collapse
Affiliation(s)
| | | | | | | | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (Y.R.W.); (S.H.C.); (J.D.L.)
| |
Collapse
|
6
|
Kadunc BV, Brunner CHM. Treatment of keloids with intralesional bleomycin and electroporation. Int J Dermatol 2024; 63:e20-e22. [PMID: 37830302 DOI: 10.1111/ijd.16875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/08/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Bogdana V Kadunc
- Dermatologia, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - Carlos H M Brunner
- Instituto de Ciências da Saúde - Medicina Veterinária, Universidade Paulista, São Paulo, Brazil
| |
Collapse
|
7
|
Bekkers VZ, Khan F, Aarts P, Zdunczyk K, Prens EP, Wolkerstorfer A, Rissmann R, van Doorn MBA. Needle-free electronically-controlled jet injector treatment with bleomycin and lidocaine is effective and well-tolerated in patients with recalcitrant keloids. Lasers Surg Med 2024; 56:45-53. [PMID: 37933762 DOI: 10.1002/lsm.23737] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The treatment of recalcitrant keloids is challenging. Although intralesional bleomycin using conventional needle injectors (CNI) is effective, it has important drawbacks, such as the need for repetitive and painful injections. Therefore, we aimed to evaluate the effectiveness, tolerability and patient satisfaction of intralesional bleomycin with lidocaine administered with a needle-free electronically-controlled pneumatic jet-injector (EPI) in recalcitrant keloids. METHODS This retrospective study included patients with recalcitrant keloids who had received three intralesional EPI-assisted treatments with bleomycin and lidocaine. Effectiveness was assessed using the Patient and Observer Scar Assessment Scale (POSAS) at baseline and four to six weeks after the third treatment. Additionally, treatment related pain scores numeric rating scale, adverse effects, patient satisfaction and Global Aesthetic Improvement Scale (GAIS) were assessed. RESULTS Fifteen patients with a total of >148 recalcitrant keloids were included. The median total POSAS physician- and patient-scores were respectively 40 and 41 at baseline, and reduced with respectively 7 and 6-points at follow-up ( p < 0.001; p < 0.001). The median pain scores during EPI-assisted injections were significantly lower compared to CNI-assistant injections, (2.5 vs. 7.0, respectively ( p < 0.001)). Adverse effects were mild. Overall, patients were "satisfied" or "very satisfied" with the treatments (14/15, 93.3%). The GAIS was "very improved" in one patient, "improved" in nine patients and "unaltered" in four patients. CONCLUSIONS EPI-assisted treatment with bleomycin and lidocaine is an effective, well tolerated, patient-friendly alternative for CNI in patients with recalcitrant keloid scars. Randomized controlled trials are warranted to confirm our findings and improve the clinical management of recalcitrant keloids.
Collapse
Affiliation(s)
- Vazula Zulfra Bekkers
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fatima Khan
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pim Aarts
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katarzyna Zdunczyk
- Centre for Human Drug Research, Leiden, The Netherlands
- Division of BioTherapeutics, Leiden Academic Center for Human Drug Research, Leiden, The Netherlands
| | - Errol Prospero Prens
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Robert Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands
- Division of BioTherapeutics, Leiden Academic Center for Human Drug Research, Leiden, The Netherlands
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn Bastiaan Adriaan van Doorn
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Centre for Human Drug Research, Leiden, The Netherlands
| |
Collapse
|
8
|
Rimmer SN, Chandy RJ, Khan D, Feldman SR. Recurrence rates in the treatment of keloids and hypertrophic scars with intralesional triamcinolone combined with other intralesional agents. Arch Dermatol Res 2023; 315:2757-2767. [PMID: 37432467 DOI: 10.1007/s00403-023-02662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/10/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
Hypertrophic scars (HTS) and keloids are pathologic scars that are products of a wound healing pathway error attributed to genetic and inflammatory causes (Leventhal et al., Arch Facial Plast Surg 8(6):362-368. https://doi.org/10.1001/archfaci.8.6.362 , 2006). Methods of pathologic scar treatment include intralesional agents, cryotherapy, surgical excision, pressure dressings, topical agents, laser resurfacing, radiotherapy, and other investigational therapies (Leventhal et al. 2006). The recurrence of pathologic scar is high across all treatment modalities, including the use of intralesional agents (Trisliana Perdanasari et al., Arch Plast Surg 41(6):620-629. https://doi.org/10.5999/aps.2014.41.6.620 , 2014). In the treatment of pathologic scar, combination approaches using intralesional agents, such as triamcinolone (TAC), 5-fluorouracil (5FU), verapamil (VER), bleomycin (BLM), and botulinum toxin (BTX), are superior therapies when compared to monotherapy (Yosipovitch et al., J Dermatol Treat 12(2):87-90. https://doi.org/10.1080/095466301317085363 , 2001; Yang et al., Front Med 8:691628. https://doi.org/10.3389/fmed.2021.691628 , 2021; Sun et al., Aesthetic Plast Surg 45(2):791-805. https://doi.org/10.1007/s00266-019-01570-8 , 2021). This review assesses recurrence and the reporting of recurrence in pathologic scar after treatment with intralesional triamcinolone (TAC) in combination with another intralesional agent. A literature review was conducted using research journals from PubMed using the following search terms: [(keloid) AND (triamcinolone) AND (combination) AND (intralesional)], as well as [(keloid) AND (triamcinolone) AND (combination)]. Articles were reviewed and included if the article analyzed or compared intralesional agents for pathologic scar treatment within the last 10 years. The average follow-up period of included articles (n = 14) that utilized combination intralesional therapy (TAC-X) was approximately 11 months (range 1-24 months). Consistent recurrence rate reporting across studies was lacking. The combination agent with the highest recurrence rate was TAC-5FU (23.3%). The range of reported recurrence rates was 7.5-23.3%. Six studies using various intralesional combination regimens reported 0% recurrence over the follow-up period (TAC-5FU, TAC-BTX, TAC-BLM, TAC-CRY). Three studies did not report recurrence rates. While the efficacy of combination therapy is typically assessed via scar scales, the assessment of recurrence across studies of combination therapy is inconsistent and inadequate, with truncated follow-up periods. While scar recurrence can take place during 1-year post-treatment, long-term follow-up (18-24 months) is needed to characterize recurrence in the treatment of pathologic scar using various intralesional agents. Long-term follow-up periods allow patients to receive accurate prognostic information regarding recurrence after combination intralesional therapy. There are limitations to this review in that comparisons were made across studies with varying outcome variables, including scar size, injection concentration and interval, and follow-up period. Standardized follow-up periods and recurrence rate reporting are integral to furthering the understanding of these therapies and enhancing patient care.
Collapse
Affiliation(s)
- Sarah N Rimmer
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rithi J Chandy
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Danyaal Khan
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
9
|
Pacola PR, Rostey RRL, Rizzo FDFA. Chemotherapeutical treatment of basal cell carcinoma with bleomycin via microinfusion of the drug into the skin (MMP®). An Bras Dermatol 2023; 98:587-594. [PMID: 37169644 PMCID: PMC10404503 DOI: 10.1016/j.abd.2022.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/07/2022] [Accepted: 09/01/2022] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Bleomycin is a chemotherapeutical drug used to treat several neoplasias, including non-melanoma skin cancer; it is effective in the treatment of basal cell carcinoma (BCC) via intralesional infiltration. Transdermal drug delivery, which includes technologies such as CO2 Laser, Dermapen, Dermaroller and MMP®, delivers the desired medication to treat skin neoplasias and also acts in skin rejuvenation. OBJECTIVE To treat BCC lesions using bleomycin via MMP®. METHODS Ninety-eight BCC lesions in different anatomical areas were treated using MMP® technology to administer and uniformly distribute bleomycin throughout the lesion and in the established safety margin. RESULTS The cure rate after six months was 96.94%; and recurrences were not associated with lesion size and/or depth. Adverse effects were the expected ones. STUDY LIMITATIONS The follow-up time was only six months. CONCLUSION This therapeutic route showed to be promising and effective.
Collapse
Affiliation(s)
- Paulo Rodrigo Pacola
- Department of Dermatology, Hospital Universitário Júlio Muller, Cuiabá, MT, Brazil.
| | | | | |
Collapse
|
10
|
Li P, Xie Z, Zhuang L, Deng L, Huang J. DNA-templated copper nanocluster: A robust and universal fluorescence switch for bleomycin assay. Int J Biol Macromol 2023; 234:123756. [PMID: 36812975 DOI: 10.1016/j.ijbiomac.2023.123756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
Bleomycin (BLM) is widely utilized for cancer treatment due to the outstanding antitumor activity, but BLM with imprecisely controlled dosage may lead to lethal consequences. It is thus a profound task to accurately monitor the BLM levels in clinical settings. Herein, we propose a straightforward, convenient, and sensitive sensing method for BLM assay. Poly-T DNA-templated copper nanoclusters (CuNCs) are fabricated with strong fluorescence emission and uniform size distribution and served as fluorescence indicators for BLM. The high binding affinity of BLM for Cu2+makes it able to inhibit fluorescence signals generated from CuNCs. This is the underlying mechanism rarely explored and can be utilized for effective BLM detection. A detection limit of 0.27 μM (according to 3σ/s rule) is achieved in this work. And the precision, producibility, and practical useability are also confirmed with satisfactory results. Furthermore, the accuracy of the method is verified by high-performance liquid chromatography (HPLC). To sum up, the established strategy in this work exhibits the advantages of convenience, rapidness, low cost, and high precision. The construction of BLM biosensors is important to achieve the best therapeutic effect with minimal toxicity, which opens a new avenue for monitoring antitumor drugs in clinical settings.
Collapse
Affiliation(s)
- Peng Li
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, PR China; Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, PR China
| | - Zhuohao Xie
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, PR China; Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, PR China
| | - Liuyan Zhuang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, PR China
| | - Liehua Deng
- Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, PR China.
| | - Jiahao Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, PR China; Department of Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, PR China.
| |
Collapse
|
11
|
Morelló-Vicente A, Antoñanzas J, España A. Microneedling with bleomycin as a treatment for periungueal and subungueal warts. Med Clin (Barc) 2023:S0025-7753(23)00109-4. [PMID: 37012170 DOI: 10.1016/j.medcli.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 04/04/2023]
|
12
|
Ana M OR, Silvia GL, Alba GS, Sara ZG, Esther CL. Treatment efficacy of 0.9% saline and mepivacaine infiltration with Dermojet® in eliminating plantar warts. J Cosmet Dermatol 2023. [PMID: 36798042 DOI: 10.1111/jocd.15680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Plantar warts are benign, epidermal neoformations, viral, and easily transmitted. Although 30% of these warts disappear spontaneously, the American Association of Dermatology recommends treatment if they cause pain or bleeding. OBJECTIVES The aim of this study was to determine the efficacy of Dermojet® infiltration using a solution composed of equal parts of 0.9% saline and 2% mepivacaine in the treatment of plantar warts, and to identify the type of necrosis achieved at 7-10 days after the infiltration (M1 sample) and at 15-17 days (M2 sample). METHOD In this analytical prospective observational study, 102 histories were reviewed by the same researcher. The patients were treated with this technique at four private podiatry clinics. RESULTS A total of 61.8% of the patients were male. The patients' mean age was 26.6 ± 14.10 years. A total percentage of 78.4% of the patients achieved complete elimination of the lesion by the second evaluation and after a single infiltration. Bivariate analysis revealed a significant inverse relationship between treatment efficacy and a history of previous disease (p < 0.001) and the period of evolution of the lesion (p < 0.001; 95% CI [0.78-7.91]). Multivariate linear regression analysis revealed an association with the number of evaluation sessions (p < 0.001) and with previous illnesses (p = 0.014). A total percentage of 82.35% presented partial necrosis in the M1 sample and 76.92% had complete necrosis in the M2 sample. CONCLUSIONS In 78.4% of the patients considered, the plantar warts treated disappeared after a single infiltration. The variables associated with treatment efficacy were the number of follow-up visits and the existence of associated diseases.
Collapse
Affiliation(s)
- Oltra-Romero Ana M
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Spain
| | - Garcia-Lázaro Silvia
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Spain
| | - Gracia-Sánchez Alba
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Spain
| | - Zúnica-García Sara
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Spain
| | - Chicharro-Luna Esther
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Spain
| |
Collapse
|
13
|
Borgia F, Custurone P, Li Pomi F, Vaccaro M, Alessandrello C, Gangemi S. IL-33 and IL-37: A Possible Axis in Skin and Allergic Diseases. Int J Mol Sci 2022; 24:ijms24010372. [PMID: 36613827 PMCID: PMC9820694 DOI: 10.3390/ijms24010372] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Interleukin (IL)-37 and IL-33 are among the latest cytokines identified, playing a role in several inflammatory conditions, spanning from systemic conditions to tumors to localized diseases. As newly discovered interleukins, their role is still scarcely understood, but their potential role as therapeutic targets or disease activity markers suggests the need to reorganize the current data for a better interpretation. The aim of this review is to collect and organize data produced by several studies to create a complete picture. The research was conducted on the PubMed database, and the resulting articles were sorted by title, abstract, English language, and content. Several studies have been assessed, mostly related to atopic dermatitis and immunologic pathways. Collective data demonstrates a pro-inflammatory role of IL-33 and an anti-inflammatory one for IL-37, possibly related to each other in an IL-33/IL-37 axis. Although further studies are needed to assess the safety and plausibility of targeting these two interleukins for patients affected by skin conditions, the early results indicate that both IL-33 and IL-37 represent markers of disease activity.
Collapse
Affiliation(s)
- Francesco Borgia
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy
- Correspondence:
| | - Paolo Custurone
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy
| | - Clara Alessandrello
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| |
Collapse
|
14
|
Chen J, Ren H, Zhou P, Zheng S, Du B, Liu X, Xiao F. Microneedle-mediated drug delivery for cutaneous diseases. Front Bioeng Biotechnol 2022; 10:1032041. [PMID: 36324904 PMCID: PMC9618658 DOI: 10.3389/fbioe.2022.1032041] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Microneedles have garnered significant interest as transdermal drug delivery route owing to the advantages of nonselective loading capacity, minimal invasiveness, simple operation, and good biocompatibility. A number of therapeutics can be loaded into microneedles, including hydrophilic and hydrophobic small molecular drugs, and macromolecular drugs (proteins, mRNA, peptides, vaccines) for treatment of miscellaneous diseases. Microneedles feature with special benefits for cutaneous diseases owing to the direct transdermal delivery of therapeutics to the skin. This review mainly introduces microneedles fabricated with different technologies and transdermal delivery of various therapeutics for cutaneous diseases, such as psoriasis, atopic dermatitis, skin and soft tissue infection, superficial tumors, axillary hyperhidrosis, and plantar warts.
Collapse
Affiliation(s)
- Jian Chen
- Clinical Translational Center for Targeted Drug, Department of Pharmacology, School of Medicine, Jinan University, Guangzhou, China
| | - Hui Ren
- Clinical Translational Center for Targeted Drug, Department of Pharmacology, School of Medicine, Jinan University, Guangzhou, China
| | - Pan Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Shuai Zheng
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Bin Du
- Department of Pathology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Bin Du, ; Xiaowen Liu, ; Fei Xiao,
| | - Xiaowen Liu
- Clinical Translational Center for Targeted Drug, Department of Pharmacology, School of Medicine, Jinan University, Guangzhou, China
- *Correspondence: Bin Du, ; Xiaowen Liu, ; Fei Xiao,
| | - Fei Xiao
- Clinical Translational Center for Targeted Drug, Department of Pharmacology, School of Medicine, Jinan University, Guangzhou, China
- *Correspondence: Bin Du, ; Xiaowen Liu, ; Fei Xiao,
| |
Collapse
|
15
|
Tellado M, Mir LM, Maglietti F. Veterinary Guidelines for Electrochemotherapy of Superficial Tumors. Front Vet Sci 2022; 9:868989. [PMID: 35968026 PMCID: PMC9363792 DOI: 10.3389/fvets.2022.868989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Electrochemotherapy (ECT) consists in the application of electric pulses to increase chemotherapeutic drug intake (bleomycin, cisplatin, or calcium) into the tumor cells. It has become a very valuable treatment option in veterinary oncology. It is an effective and safe treatment modality, which is not only beneficial as a palliative treatment, but also for a curative approach. Performing the treatment adequately will ensure the best results possible, in the minimum number of sessions, and reduce complications. Usually, only one session is enough to achieve excellent results, but the treatment can be repeated. Several sessions can be necessary in the case of incompletely treated or very extended lesions, as well as in the occurrence of new lesions. ECT is effective for superficial or oral tumors of any histology that are accessible to the electrodes. Intravenous bleomycin is the preferred drug and route of administration, leaving other ways of administration and drugs for selected cases. The guidelines presented here are destined to veterinarians who want to develop their understanding of the basis of ECT and wish to perform it adequately and effectively. In this paper, we also discuss common problems and how to solve them, and we include practical tips to improve the treatment results based on common questions and mistakes of beginner users.
Collapse
Affiliation(s)
| | - Lluis M. Mir
- Université Paris-Saclay, CNRS, Gustave Roussy, Metabolic and Systemic Aspects of Oncogenesis (METSY), Île-de-France, France
| | - Felipe Maglietti
- Instituto Universitario del Hospital Italiano-CONICET, Buenos Aires, Argentina
- *Correspondence: Felipe Maglietti
| |
Collapse
|
16
|
Chun YY, Tan WWR, Vos MIG, Chan WK, Tey HL, Tan NS, Tan TTY. Scar prevention through topical delivery of gelatin-tyramine-siSPARC nanoplex loaded in dissolvable hyaluronic acid microneedle patch across skin barrier. Biomater Sci 2022; 10:3963-3971. [PMID: 35708018 DOI: 10.1039/d2bm00572g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Currently, there is no effective method to prevent the formation of hypertrophic scars and keloids, which can cause severe physical and psychological burdens to patients. Secreted protein acidic and cysteine-rich (SPARC) is involved in wound fibrosis by modulating fibroblast functions, causing excessive collagen deposition during wound healing. Thus, the reduction in SPARC gene expression after wounding can contribute to the downstream reduction in collagen production at the wound site and prevent scar formation. In this study, a dissolvable and biocompatible hyaluronic acid (HA) microneedle patch loaded with nanoplexes containing tyramine-modified gelatin and siRNA for SPARC (siSPARC/Gtn-Tyr) was investigated for topical scar prevention. Tyramine-modified gelatin (Gtn-Tyr) provides electrostatic protection and enhances cell internalization for siSPARC. In vitro studies using human dermal fibroblasts showed that both siSPARC/Gtn-Tyr nanoplexes and siSPARC/Gtn-Tyr-loaded microneedle patches can significantly reduce SPARC gene expression (P < 0.05) and do not cause discernable cytotoxic effects. Further studies using a mouse wound model demonstrate that the siSPARC/Gtn-Tyr-loaded microneedle patch can reduce collagen production during wound healing without triggering an immune response. When Gtn-Tyr-siSPARC is administered transdermally at the wound site, effective collagen reduction is achieved through silencing of the matricellular SPARC protein, thus promising the reduction of scar formation. Overall, the siSPARC/Gtn-Tyr loaded microneedle patch can potentially provide an effective transdermal anti-fibrotic treatment.
Collapse
Affiliation(s)
- Yong Yao Chun
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 62 Nanyang Dr, Singapore 637459.
| | - William Wei Ren Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232
| | - Marcus Ivan Gerard Vos
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232
| | - Wen Kiat Chan
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 62 Nanyang Dr, Singapore 637459.
| | - Hong Liang Tey
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232.,National Skin Centre, 1 Mandalay Road, Singapore 308205.,Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228
| | - Nguan Soon Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232.,School of Biological Sciences, Nanyang Technological University, 60 Nanyang Dr, Singapore 637551
| | - Timothy Thatt Yang Tan
- School of Chemical and Biomedical Engineering, Nanyang Technological University, 62 Nanyang Dr, Singapore 637459.
| |
Collapse
|
17
|
Qin L, Feng B, Luo Q, Zeng Z, Zhang P, Ye X, Qing T. Copper ion and G-quadruplex-mediated fluorescent sensor for highly selective detection of bleomycin in actual samples. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 267:120572. [PMID: 34753707 DOI: 10.1016/j.saa.2021.120572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
Improper dosage of Bleomycin (BLM) can easily lead to a series of side effects such as pulmonary fibrosis and pulmonary toxicity. Therefore, detecting the content of BLM in actual sample is very helpful to make full use of its therapeutic efficacy and reduce its toxicity. Herein, we constructed a copper ion and G-quadruplex mediated label-free sensor to detect BLM. The strategy mainly relies on the chelation of BLM to copper ions, which makes the copper ions lose the quenching ability to the fluorescent dye N-methylmesoporphyrin (NMM) after chelation. With the assistance of the G-quadruplex, the BLM content in the sample can be detected by observing the change in fluorescence. A good linear relationship can be clearly observed within the BLM concentration range of 0.1 nM-75 nM, and the limit of detection was derived as 0.1 nM. This sensor did not involve any labeling or addition of Fe2+, even in the presence of 10 different antibiotics and 11 different metal ions, it still has a good monitoring effect, and can be successfully applied to the detection of BLM in serum and wastewater. Thus, we believe that this work hold great potential in antibiotic monitoring and environmental protection.
Collapse
Affiliation(s)
- Lingfeng Qin
- College of Environment and Resources, Xiangtan University, Xiangtan 411105 Hunan Province, China
| | - Bo Feng
- College of Environment and Resources, Xiangtan University, Xiangtan 411105 Hunan Province, China
| | - Qi Luo
- College of Environment and Resources, Xiangtan University, Xiangtan 411105 Hunan Province, China
| | - Zihang Zeng
- College of Environment and Resources, Xiangtan University, Xiangtan 411105 Hunan Province, China
| | - Peng Zhang
- College of Environment and Resources, Xiangtan University, Xiangtan 411105 Hunan Province, China
| | - Xiaosheng Ye
- Xiangya School of Public Health, Central South University, Changsha 410078 Hunan Province, China.
| | - Taiping Qing
- College of Environment and Resources, Xiangtan University, Xiangtan 411105 Hunan Province, China.
| |
Collapse
|
18
|
Bik L, van Doorn M, Hansen ACN, Janfelt C, Olesen UH, Haedersdal M, Lerche CM, Hendel K. In vivo dermal delivery of bleomycin with electronic pneumatic injection: drug visualization and quantification with mass spectrometry. Expert Opin Drug Deliv 2022; 19:213-219. [PMID: 35107046 DOI: 10.1080/17425247.2022.2035719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intralesional bleomycin (BLM) administration by needle injection is effective for keloids and common warts but has significant drawbacks, including treatment-related pain and highly operator-depended success rates. Electronic pneumatic injection (EPI) is a promising, less painful, needle-free delivery method that potentially enables more precise and controlled dermal drug delivery. Here, we aimed to explore the cutaneous pharmacokinetics, biodistribution patterns and tolerability of BLM administered by EPI in vivo. RESEARCH DESIGN AND METHODS In a pig model, EPI with BLM or saline (SAL) were evaluated after 1, 48 and 216 hours. Mass spectrometry quantification and imaging were used to assess BLM concentrations and biodistribution patterns in skin biopsies. Tolerability was assessed by scoring local skin reactions (LSR) and measuring transepidermal water loss (TEWL). RESULTS Directly after BLM injection a peak concentration of 109.2 µg/cm3 (43.9-175.2) was measured in skin biopsies. After 9 days BLM was undetectable. EPI resulted in a focal BLM biodistribution in the mid-dermal delivery zone resembling a triangular shape. Mild LSRs were resolved spontaneously and TEWL was unaffected. CONCLUSIONS BLM administered by EPI resulted in quantifiable and focal mid-dermal distribution of BLM. The high skin bioavailability holds a great potential for clinical effects and warrants further evaluation in future human studies.
Collapse
Affiliation(s)
- Liora Bik
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martijn van Doorn
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anders C N Hansen
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Christian Janfelt
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Uffe H Olesen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Catharina M Lerche
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark.,Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Hendel
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
19
|
Parry D, Allison K. Is the future scarless? - Fibroblasts as targets for scarless wound healing: a narrative review. Scars Burn Heal 2022; 8:20595131221095348. [PMID: 36082315 PMCID: PMC9445533 DOI: 10.1177/20595131221095348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Scarless healing is the ideal outcome of wound healing and is exhibited in some species. This narrative review assembles the current understanding of fibroblast heterogenicity along with the latest fibroblast-related targets for scar reduction therapies. Human regenerative wound healing is deemed possible due to the wound regeneration already seen in the early gestation foetus. Methods: This literature narrative review was undertaken by searching PubMed and Web of Science databases and Google Scholar to find articles concerning the fibroblast involvement in wound healing. We evaluated and collated these articles to form a consensus of the current understanding of the field. Discussion: This article describes current understanding of fibroblast heterogenicity and involvement in wound healing, focusing on the role of fibroblasts during physiological scarring. We also present the current most promising targets involving fibroblasts in the reduction of scarring and how we can manipulate the behaviour of fibroblasts to mimic the wound regeneration models in the human foetus. These targets include the pro-fibrotic EN1 positive fibroblast lineage, TGFβ1 inhibition, and genetic therapies utilising miRNAs and siRNAs. Conclusion: No therapies are currently available to eradicate scarring; however, treatment options are available to reduce the appearance of scarring. Further research into the heterogenicity and interactions of fibroblasts in both the foetus and adult is needed, and this may lead to the development of novel treatments against scarring.
Collapse
Affiliation(s)
- Dylan Parry
- Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Keith Allison
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| |
Collapse
|
20
|
Russano F, Del Fiore P, Di Prata C, Pasqual A, Marconato R, Campana LG, Spina R, Gianesini CM, Collodetto A, Tropea S, Dall’Olmo L, Carraro S, Parisi A, Galuppo S, Scarzello G, De Terlizzi F, Rastrelli M, Mocellin S. The Role of Electrochemotherapy in the Cutaneous and Subcutaneous Metastases From Breast Cancer: Analysis of Predictive Factors to Treatment From an Italian Cohort of Patients. Front Oncol 2021; 11:772144. [PMID: 34993137 PMCID: PMC8724516 DOI: 10.3389/fonc.2021.772144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
The treatment of cutaneous and subcutaneous localizations from breast cancer (BC) is still a therapeutic challenge. Electrochemotherapy (ECT) is one of the available options, and it is characterized by the association between the administration of a chemotherapic agent (Bleomycin) with the temporary raise of permeability of the cellular membrane induced by the local administration of electrical impulses (electroporation). ECT represents an effective therapy for loco-regional control of this disease. This study aimed to investigate the predictive factors of response in cutaneous and subcutaneous localizations from breast cancer treated with ECT. We decided to evaluate the response to this treatment in 55 patients who underwent ECT between January 2013 and March 2020 at our Institute. We performed a monocentric retrospective cohort study. ECT was administered following the ESOPE (European Standard Operative Procedure of Electrochemotherapy) guidelines, a set of criteria updated in 2018 by a panel of European experts on ECT who defined the indications for selecting the patients who can benefit from the ECT treatment and the ones for technically performing the procedure. The responses were evaluated with the RECIST criteria (Response Evaluation Criteria in Solid Tumor). We found after 12 weeks of treatment a complete response (CR) in 64% of our patients. From the analysis divided for subgroups of covariates is emerged that lower BMI, reduced body surface, and absence of previous radiation treatment could be predictive for a better complete response. This study suggests that the efficacy of the ECT treatment is related to the concurrent systemic therapies while administering ECT. The association between ECT and immunotherapy has offered better results than the association between ECT and chemotherapy (p-value = 0.0463). So, ECT is a valuable tool in the treatment of cutaneous and subcutaneous metastases from breast cancer and its efficacy in local control of these lesions improves when it is well planned in a therapeutic scenario.
Collapse
Affiliation(s)
- Francesco Russano
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
- *Correspondence: Paolo Del Fiore,
| | - Claudia Di Prata
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Andrea Pasqual
- Department of Medicine, University of Padua, Padua, Italy
| | - Roberto Marconato
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Luca Giovanni Campana
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Romina Spina
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Carlo Maria Gianesini
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Alessandra Collodetto
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Saveria Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Luigi Dall’Olmo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Sabrina Carraro
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Alessandro Parisi
- Radiotherapy Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Sara Galuppo
- Radiotherapy Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Giovanni Scarzello
- Radiotherapy Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | | | - Marco Rastrelli
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| |
Collapse
|
21
|
Bik L, Wolkerstorfer A, Bekkers V, Prens EP, Haedersdal M, Bonn D, van Doorn MBA. Needle-free jet injection-induced small-droplet aerosol formation during intralesional bleomycin therapy. Lasers Surg Med 2021; 54:572-579. [PMID: 34931319 PMCID: PMC9303553 DOI: 10.1002/lsm.23512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/14/2021] [Accepted: 12/04/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Needle-free jet injectors are frequently used in dermatological practice. Injection-generated small-droplet aerosols could be harmful upon inhalation when chemotherapeutics, like bleomycin, are used. Here, we aim to explore jet injector-induced small-droplet aerosol formation of bleomycin in relation to air ventilation and to provide safety measures for clinical practice. MATERIALS AND METHODS With a professional particle sensor, we measured airborne aerosol particles (0.2-10.0 µm) after electronic pneumatic injection (EPI), spring-loaded jet injection (SLI), and needle injection (NI) of bleomycin and saline (100 μl) on ex vivo human skin. Three levels of air ventilation were explored: no ventilation, room ventilation, and room ventilation with an additional smoke evacuator. RESULTS EPI and SLI induced significant small-droplet aerosol formation compared with none after NI (0.2-1.0 µm; no ventilation). The largest bleomycin aerosol generation was observed for the smallest particles (0.2-1.0 µm) with 673.170 (528.802-789.453) aerosol particles/liter air (EPI; no ventilation). Room ventilation and smoke evacuation led to a reduction of ≥99% and 100% of measured aerosols, respectively. CONCLUSION Jet injectors generate a high number of small-droplet aerosols, potentially introducing harmful effects to patients and healthcare personnel. Room ventilation and smoke evacuation are effective safety measures when chemotherapeutics are used in clinical practice.
Collapse
Affiliation(s)
- Liora Bik
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam UMC Medical Center, Amsterdam, The Netherlands
| | - Vazula Bekkers
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg hospital, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Bonn
- Van der Waals-Zeeman Institute, Institute of Physics, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
22
|
Fenton C, Kang C. Don’t despair over difficult-to-treat warts. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00871-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Yang S, Luo YJ, Luo C. Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid. Front Med (Lausanne) 2021; 8:691628. [PMID: 34568361 PMCID: PMC8458741 DOI: 10.3389/fmed.2021.691628] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background: There is no uniform treatment for pathological scars, including keloids and hypertrophic scars, in clinic currently. Previously, multiple randomized controlled trials have examined the clinical efficacy of different treatments. Nonetheless, the results are inconsistent, and many treatments have not been directly compared. This makes it difficult to conclude which approach is more favorable, in terms of efficacy and safety, for the treatment of pathological scarring. This study aimed at evaluating the efficacy of different injection and topical treatment strategies for hypertrophic scar and keloid. Methods: Relevant literature from PubMed, Medline, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CCRCT), and WHO International Clinical Trials Registry Platform (WHO-ICTRP) were searched, from database inception through November 2020. Randomized clinical trials evaluating different treatment strategies of pathological scars, including triamcinolone acetonide (TAC), verapamil (VER), 5-fluorouracil (5-FU), botulinum toxin A (BTA), bleomycin (BLM), and silicone gels were included in the study. Results: The network meta-analysis included a total of 2,009 patients from 29 studies. A network meta-analysis of injection and topical treatment strategies showed that the efficacy of TAC combined with BTA was best in the treatment of pathological scars. Combination therapies of TAC with 5-FU and TAC with BTA significantly improved the clinical efficiency. However, there was no statistically significant difference between other treatment strategies. The order of efficacy predicted by the surface under the cumulative ranking (SUCRA) curve was as follows: TAC+BTA (82.2%) > TAC+5-FU (69.8%) > BTA (67.3%) > 5-FU+silicone (59.4%) > TAC+silicone (58.3%) > 5-FU (49.8%) > BLM (42.0%) > TAC (26.7%) > VER (26.2%) > silicone (18.3%). There was no publication bias revealed based on the funnel diagram. Conclusion: This study recommends intralesional injection of TAC-BTA and TAC-5-FU combined therapies. But for patients who cannot tolerate the side effects, the use of silicone gels in combination with TAC is recommended. However, these conclusions need to be further confirmed by more randomized controlled trials.
Collapse
Affiliation(s)
- Sha Yang
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yujia J Luo
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Neurosurgeons, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Cong Luo
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
24
|
Omidifar N, Nili-Ahmadabadi A, Nakhostin-Ansari A, Lankarani KB, Moghadami M, Mousavi SM, Hashemi SA, Gholami A, Shokripour M, Ebrahimi Z. The modulatory potential of herbal antioxidants against oxidative stress and heavy metal pollution: plants against environmental oxidative stress. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:61908-61918. [PMID: 34550520 DOI: 10.1007/s11356-021-16530-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/10/2021] [Indexed: 02/05/2023]
Abstract
Free radicals, principally reactive oxygen species (ROS), contribute to oxidative stress in human beings. Free radicals have different mechanisms of action and affect lipids, proteins, and DNA. Heavy metals including cadmium (Cd), lead (Pb), and arsenic are environmental pollutants that may induce oxidative stress and produce ROS, leading to harmful effects on different body systems such as the liver and brain. On the other side, antioxidants can have protective effects against oxidative stress and decrease their toxicity. Herbal antioxidants have potential antioxidative effects. These antioxidants positively affect neurodegenerative diseases, atherosclerotic diseases, lung fibrosis, kidney injuries, and liver toxicities induced by oxidative agents, including heavy metals. In this manuscript, we explained the mechanisms of oxidative stress, and also discussed heavy metals which contribute to human oxidative stress. We further discussed different herbal antioxidants, their mechanisms of action, and their clinical use for various diseases.
Collapse
Affiliation(s)
- Navid Omidifar
- Clinical Education Research Center, and Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Nili-Ahmadabadi
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amin Nakhostin-Ansari
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Health Institute, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Moghadami
- Health Policy Research Center, Health Institute, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Mojtaba Mousavi
- Department of Chemical Engineering, National Taiwan University of Science and Technology, Taipei City, Taiwan
| | - Seyyed Alireza Hashemi
- Nanomaterials and Polymer Nanocomposites Laboratory, School of Engineering, University of British Columbia, Kelowna, BC, V1V 1V7, Canada
| | - Ahmad Gholami
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansoureh Shokripour
- Depatment of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Ebrahimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
25
|
Shahidi-Dadras M, Gholizadeh N, Dadkhahfar S, Gheisari M, Heydarifakher P, Moslemi Haghighi S, Mozafari N. A comparative study of intralesional bleomycin versus cryotherapy in the treatment of condyloma accuminata. Int J STD AIDS 2021; 32:1347-1353. [PMID: 34546119 DOI: 10.1177/09564624211041467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bleomycin is an antineoplastic agent, which is used off label for various dermatologic conditions. There are numerous reports on the use of intralesional bleomycin (ILB) for the treatment of common warts. However, reports on the efficacy of bleomycin in the treatment of anogenital warts (AGWs) are still limited. The aim is to compare the efficacy/tolerability and recurrence rates of AGW treatment with ILB versus cryotherapy. In this prospective study, 50 patients with AGWs were assigned either to receive triple freeze-thaw cycle of cryotherapy or to receive 1.5 mg/mL ILB for a maximum of four sessions with 3-week intervals. Clinical efficacy was determined by the percentage of the patients with complete clearance. The patients with complete clearance were visited by passing 3 months from the last treatment session to evaluate any recurrence. Of 44 patients completing the study, 16 of 21 (76.19%) patients in the ILB group and 15 of 23 (65.22%) patients in the cryotherapy group showed complete resolution (p value = .425). Moreover, recurrence occurred after 3 months in 18.75% and 46.66% of the ILB and the cryotherapy groups' patients, respectively (p value = .096). The most common local adverse events in both treatment groups were pain, dyspigmentation, and ulceration/erosion, while the delayed ulceration and secondary infection were only observed in the bleomycin group. Intralesional bleomycin is as effective as cryotherapy in the treatment of AGWs, but it is more invasive and associated with post-treatment pain, the delayed ulceration, and cutaneous infection. Intralesional bleomycin is not accompanied with the major risk of necrosis or fibrosis, so the use of ILB in the anogenital area is likely to be safe.This clinical trial was registered in Iranian Registry of Clinical Trials site with code: IRCT20190519043631N1.
Collapse
Affiliation(s)
| | - Nasim Gholizadeh
- School of Medicine, 48486Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, 48486Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Gheisari
- Skin Research Center, 48486Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parsa Heydarifakher
- Skin Research Center, 48486Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Nikoo Mozafari
- Skin Research Center, 48486Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, 48486Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
26
|
Hendel K, Hansen ACN, Bik L, Bagger C, van Doorn MBA, Janfelt C, Olesen UH, Haedersdal M, Lerche CM. Bleomycin administered by laser-assisted drug delivery or intradermal needle-injection results in distinct biodistribution patterns in skin: in vivo investigations with mass spectrometry imaging. Drug Deliv 2021; 28:1141-1149. [PMID: 34121567 PMCID: PMC8205002 DOI: 10.1080/10717544.2021.1933649] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Bleomycin (BLM) is being repositioned in dermato-oncology for intralesional and intra-tumoural use. Although conventionally administered by local needle injections (NIs), ablative fractional lasers (AFLs) can facilitate topical BLM delivery. Adding local electroporation (EP) can augment intracellular uptake in the target tissue. Here, we characterize and compare BLM biodistribution patterns, cutaneous pharmacokinetic profiles, and tolerability in an in vivo pig model following fractional laser-assisted topical drug delivery and intradermal NI, with and without subsequent EP. In vivo pig skin was treated with AFL and topical BLM or NI with BLM, alone or with additional EP, and followed for 1, 2 and 4 h and eventually up to 9 d. BLM biodistribution was assessed by spatiotemporal mass spectrometry imaging. Cutaneous pharmacokinetics were assessed by mass spectrometry quantification and temporal imaging. Tolerability was evaluated by local skin reactions (LSRs) and skin integrity measurements. AFL and NI resulted in distinct BLM biodistributions: AFL resulted in a horizontal belt-shaped BLM distribution along the skin surface, and NI resulted in BLM radiating from the injection site. Cutaneous pharmacokinetic analyses and temporal imaging showed a substantial reduction in BLM concentration within the first few hours following administration. LSRs were tolerable overall, and all interventions permitted almost complete recovery of skin integrity within 9 d. In conclusion, AFL and NI result in distinct cutaneous biodistribution patterns and pharmacokinetic profiles for BLM applied to in vivo skin. Evaluation of LSRs showed that both methods were similarly tolerable, and each method has potential for individualized approaches in a clinical setting.
Collapse
Affiliation(s)
- Kristoffer Hendel
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anders C N Hansen
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Liora Bik
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charlotte Bagger
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christian Janfelt
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Uffe H Olesen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Catharina M Lerche
- Department of Dermatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
27
|
Nuccitelli R, LaTowsky BM, Lain E, Munavalli G, Loss L, Ross EV, Jauregui L, Knape WA. Safety and Efficacy of Nano-Pulse Stimulation Treatment of Non-Genital, Cutaneous Warts (Verrucae). Lasers Surg Med 2021; 53:1301-1306. [PMID: 34008877 PMCID: PMC9291480 DOI: 10.1002/lsm.23423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/18/2021] [Accepted: 05/09/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES This study describes the effects of nano-pulse stimulation (NPS) technology on the common verruca with the objectives of demonstrating efficacy and safety. NPS technology applies nanosecond pulses of non-thermal electrical energy to induce highly localized regulated cell death in the cellular structures of the targeted zone with negligible effects on surrounding non-cellular structures. Previous clinical studies applying NPS to common, benign skin lesions have demonstrated safety and efficacy in clearing seborrheic keratoses and sebaceous hyperplasia. STUDY DESIGN/MATERIALS AND METHODS Sixty-two subjects were enrolled at a total of five sites. One hundred and ninety-five study verrucae up to 10 mm wide were treated with NPS delivered by a console-based handheld applicator (CellFX® System; Pulse Biosciences) and follow-ups occurred every 30 days with the option to retreat at 30, 60, and 90 days. There were 62 untreated controls and 46% of the treated verrucae were recalcitrant. RESULTS Overall, 75.3% (70/93) of the common verrucae, 72.7% (8/11) of the flat verrucae, and 43.8% (14/32) of the plantar verrucae treated with NPS were completely clear by 60 days following the last treatment and did not recur within the 120-day observation period. The majority (54%) of verrucae cleared with a single NPS procedure. The most common treatment site reactions were erythema (50.5%) and eschar formation (23.4%) on Day 30 and on Day 120 mild erythema was present in 14% of the cases and hyperpigmentation in 18.5%. No serious adverse events were reported. A particle counter was used during 11 NPS procedures on verrucae and no significant plume generation was detected during these procedures. CONCLUSIONS NPS is a safe and effective procedure for removing non-genital, cutaneous verrucae. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.
Collapse
Affiliation(s)
| | - Brenda M LaTowsky
- Clear Dermatology and Aesthetics Center, 20201N. Scottsdale Healthcare Dr. #260, Scottsdale, Arizona, 85255
| | - Edward Lain
- Sanova Dermatology, 1601 E Pflugerville Pkwy,Bldg 1 Ste 1102, Pflugerville, Texas, 78660
| | - Girish Munavalli
- Dermatology, Laser & Vein Specialists, 1918 Randolph Rd., Charlotte, North Carolina, 28207
| | - Lesley Loss
- Dermatology Associates, 100 White Spruce Blvd, Rochester, New York, 14623
| | - E Victor Ross
- Scripps Clinic, 3811 Valley Centre Dr., San Diego, California, 92130
| | - Lauren Jauregui
- Pulse Biosciences, 3957 Point Eden Way, Hayward, California, 94545
| | - William A Knape
- Pulse Biosciences, 3957 Point Eden Way, Hayward, California, 94545
| |
Collapse
|
28
|
Management of Difficult-to-Treat Warts: Traditional and New Approaches. Am J Clin Dermatol 2021; 22:379-394. [PMID: 33432476 DOI: 10.1007/s40257-020-00582-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/24/2022]
Abstract
Warts are regularly treated by dermatologists, and while many respond readily to first-line treatments, others may represent a therapeutic challenge. Large, deep, numerous, and extensive warts; treatment-resistant lesions with higher risk for side effects, such as hypopigmentation; or patients unable to tolerate or comply with our treatment regimen, may need alternative treatment options. In this work we review the characteristics of select modalities that should be considered for difficult-to-treat warts. We discuss efficacy and tolerability data as well as practical features that can guide us to select the best treatment for every scenario. Novel approaches, still in an investigational phase, are also discussed to illustrate potential future directions of wart treatment.
Collapse
|
29
|
Ramezani S, Javadi I, Kokhdan EP, Omidifar N, Nikbakht J, Sadeghi H, Doustimotlagh AH, Danaei N, Abbasi R, Sadeghi H. Protective and therapeutic effects of ethanolic extract of Nasturtium officinale (watercress) and vitamin E against bleomycin-induced pulmonary fibrosis in rats. Res Pharm Sci 2020; 16:94-102. [PMID: 33953778 PMCID: PMC8074801 DOI: 10.4103/1735-5362.305192] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/15/2020] [Accepted: 12/13/2020] [Indexed: 12/11/2022] Open
Abstract
Background and purpose Pulmonary fibrosis is a chronic disease of the lungs caused by inflammation, species of reactive oxygen, and immune defects. Antioxidant properties of Nasturtium officinale has been reported in some studies. Therefore, the objective of the current study was to evaluate the effect of ethanolic extract of Nasturtium officinale (EENO) on bleomycin (BLM)-induced lung fibrosis in rats. Experimental approach Forty adult male Wistar rats (180-220 g) were randomly divided into 5 experimental groups. Normal control, BLM control received a single dose of BLM (6 IU/kg) intratracheally only on the first day, EENO + BLM group received EENO (500 mg/kg) one week before intratracheal BLM instillation and two weeks afterward, BLM + EENO group and BML + vitamin E group received EENO (500 mg/kg) and vitamin E (500 mg/kg) half-hour after BLM installation, respectively. The animals were sacrificed on day 22. Change in body weight, lung index, serum level of malondialdehyde (MDA) and nitric oxide (NO) metabolite, lung tissue hydroxyproline content and lung pathology were assessed. Findings/Results Pre- or post-treatment with EENO attenuated pulmonary fibrosis as evidenced by normalized lung index, improved histological changes and inhibited collagen deposition (hydroxyproline) in the animal lung. EENO also decreased MDA and NO metabolite release in comparison to the BLM control. vitamin E (500 mg/ kg) also significantly inhibited the BLM-induced lung toxicity. Conclusions and implications EENO can prevent BLM-induced lung fibrosis in rats via antioxidant activities. However, more studies are needed to elicit the exact mechanism of this effect.
Collapse
Affiliation(s)
- Sanaz Ramezani
- Department of Toxicology, Shahreza Branch, Islamic Azad University, Shahreza, I.R. Iran
| | - Iraj Javadi
- Department of Toxicology, Shahreza Branch, Islamic Azad University, Shahreza, I.R. Iran
| | - Esmaeel Panahi Kokhdan
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, I.R. Iran
| | - Navid Omidifar
- Clinical Education Research Center, Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, I.R. Iran
| | - Jafar Nikbakht
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, I.R. Iran
| | - Heibatollah Sadeghi
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, I.R. Iran
| | | | - Nazanin Danaei
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, I.R. Iran
| | - Reza Abbasi
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, I.R. Iran
| | - Hossein Sadeghi
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, I.R. Iran
| |
Collapse
|
30
|
Singal A, Grover C. Efficacy and Safety of Intralesional Bleomycin in the Management of Ungual Warts. Skin Appendage Disord 2020; 6:346-350. [PMID: 33313049 DOI: 10.1159/000510989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/15/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Ungual warts are common fibroepithelial tumours of the nail unit caused by human papillomavirus. Although various treatment modalities are available, their management is challenging due to high potential for recurrence and treatment-related nail dystrophy. OBJECTIVE This study evaluates the efficacy and safety of intralesional bleomycin injections in the treatment of ungual warts. METHODS Medical records of 80 patients with ungual warts, treated by us from 2015 to 2019, were analysed retrospectively with respect to the number of warts, site, morphology, and treatment outcome. Children <5 years of age, and pregnant and lactating women were excluded. All ungual warts were treated with intralesional injections of bleomycin 3 Units/mL, given at 3-4 weeks interval. RESULTS AND CONCLUSIONS A total of 250 periungual and subungual warts were treated in 80 patients. An average of 2.61 sessions per patient was required for complete resolution. Moderate pain was reported by 65 patients (81.2%), and transitory perilesional hyperpigmentation was observed in 155 lesions (62%). Severe pain and necrosis developed in 3 lesions (1.2%) that were reversible without any residual scarring and deformity. We conclude that intralesional bleomycin is an effective and safe therapeutic modality for ungual warts.
Collapse
Affiliation(s)
- Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and G.T.B. Hospital, University of Delhi, New Delhi, India
| | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences and G.T.B. Hospital, University of Delhi, New Delhi, India
| |
Collapse
|
31
|
Kaul S, Kaur I, Jakhar D, Edigin E, Caldito EG. The diverse methods of bleomycin delivery in cutaneous warts: A literature review. Dermatol Ther 2020; 34:e14401. [PMID: 33040473 DOI: 10.1111/dth.14401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 01/19/2023]
Abstract
Bleomycin is a useful treatment option for recalcitrant verrucae. Several different methods of bleomycin delivery have been described, including intralesional injection, intralesional injection combined with laser, microneedling, multiple puncture and adhesive tape. We reviewed the literature to evaluate the various methods of bleomycin administration to treat warts, including the different doses, instruments and procedures used. Intralesional injection (cure rate ranged from 67.8% to 99.23%) and topical bleomycin with multipuncture or microneedling methods (63.6% to 100%) were found to be effective in the treatment of warts. Overall, pain is significantly less with microneedling and multipuncture techniques compared with intralesional injection. Bleomycin injection combined with pulsed dye laser, electroporation, or by other methods, such as, microneedle patches or adhesive tape do not seem to be more beneficial than bleomycin administered by intralesional injection, multipuncture or microneedling techniques.
Collapse
Affiliation(s)
- Subuhi Kaul
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Ishmeet Kaur
- Department of Dermatology, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, New Delhi, India
| | - Deepak Jakhar
- Department of Dermatology, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, New Delhi, India
| | - Ehizogie Edigin
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Elena Gonzalez Caldito
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| |
Collapse
|
32
|
Intralesional bleomycin in cutaneous warts: Does combining with lasers or electroporation confer additional benefit? J Am Acad Dermatol 2020; 85:1287-1288. [PMID: 32926976 DOI: 10.1016/j.jaad.2020.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 01/17/2023]
|
33
|
Kaul S, Caldito EG, Jakhar D, Kaur I, Kwatra SG, Mehta S. Comparative efficacy and safety of intralesional bleomycin relative to topical bleomycin with microneedling in the treatment of warts: A systematic review. J Am Acad Dermatol 2020; 84:816-819. [PMID: 32553681 DOI: 10.1016/j.jaad.2020.06.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Subuhi Kaul
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois.
| | - Elena Gonzalez Caldito
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois
| | - Deepak Jakhar
- Department of Dermatology, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, New Delhi, India
| | - Ishmeet Kaur
- Department of Dermatology, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, New Delhi, India
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shilpa Mehta
- Division of Dermatology, John H. Stroger Hospital of Cook County, Chicago, Illinois
| |
Collapse
|
34
|
Kaul S, Jakhar D, Kaur I. Gray-white discoloration of wart surface: An endpoint for multipuncture-assisted delivery of bleomycin. J Am Acad Dermatol 2020; 84:e227-e228. [PMID: 32348826 DOI: 10.1016/j.jaad.2020.04.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Subuhi Kaul
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, Illinois.
| | - Deepak Jakhar
- Department of Dermatology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Ishmeet Kaur
- Department of Dermatology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| |
Collapse
|