Skin permeation enhancement of nicotinamide through using fluidization and deformability of positively charged ethosomal vesicles: A new approach for treatment of atopic eczema

Ethosome-Based Transdermal Drug Delivery: Its Structural Components, Preparation Techniques, and Therapeutic Applications Across Metabolic, Chronic, and Oncological Conditions

Transdermal drug delivery systems (TDDSs) provide a non-invasive alternative to oral and parenteral routes, delivering drugs into the bloodstream while avoiding gastrointestinal degradation and first-pass metabolism. Despite benefits like enhanced bioavailability and patient compliance, the stratum corneum limits drug permeation. Ethosomes overcome the stratum corneum barrier with superior flexibility and permeability compared to liposomes. Ethanol disrupts the skin's lipid bilayer, enabling deep penetration and efficient drug delivery. Ethosomes offer high entrapment efficiency and stability, delivering both hydrophilic and lipophilic drugs. However, challenges like stability optimization and clinical translation persist. This review examines the structural components, preparation methods, and therapeutic applications of ethosomes in metabolic and chronic diseases, including diabetes, cardiovascular diseases, neurodegenerative disorders, arthritis, and cancers. Moreover, it highlights the potential of ethosomes to revolutionize TDDSs for managing chronic and metabolic diseases, providing a foundation for further research and clinical development.

Understanding the role of ethosomes in rheumatoid arthritis: innovative solutions to challenges in transdermal delivery of synthetic drugs and phytoconstituents

Rheumatoid Arthritis (RA), an autoimmune disease, is a chronic inflammatory disorder affecting the joints leading to severe damage and cartilage destruction. Current therapies for RA such as DMARDs, NSAIDs, glucocorticoids and phytoconstituents often face challenges related to solubility and transdermal permeability. Considering the barriers posed by the stratum corneum in transdermal drug delivery, ethosomes have shown promising results in overcoming these hurdles. The presence of ethanol in ethosomes imparts flexibility and disrupts the skin's lipid bilayer, allowing for transdermal penetration. Researchers have explored the potential of ethosomal drug delivery systems loaded with various synthetic drugs and phytoconstituents for the management of RA. Despite promising preclinical findings, these systems have yet to transition from the bench to the bedside, and there is a lack of comprehensive review papers highlighting the potential of ethosomes in RA treatment. Considering the commercial challenges in scaling up such nano systems, this review aims to analyse the current state of the art and advancements in ethosomal formulations loaded with synthetic agents and phytoconstituents. Further, it explores the impact of excipients and processing parameters, on the preparation of ethosomes and their efficacy in overcoming skin barriers, to enhance the permeability of therapeutic agents.

Harnessing phytoconstituents in ethosomes: A new frontier in skin disorder management

The rising incidence of skin disorders has necessitated the exploration of innovative therapeutic modalities that harness the beneficial properties of natural compounds. Phytoconstituents, renowned for their diverse pharmacological attributes, present considerable promise in the management of various dermatological conditions. This review delineates the integration of phytoconstituents into ethosomal formulations, which are advanced lipid-based carriers specifically designed to enhance transdermal delivery. We discuss the advantages conferred by ethosomes, including their capacity to improve the stability and bioavailability of phytochemicals, facilitate deeper skin penetration, and provide controlled release profiles. Recent advancements in the formulation of ethosomes encapsulating a variety of phytoconstituents are highlighted, with a focus on their physicochemical properties, therapeutic efficacy, and safety profiles. Furthermore, the review examines the mechanisms by which ethosomes enhance the delivery of bioactive compounds to targeted skin layers, particularly in the context of treating conditions such as acne, eczema, and psoriasis. Challenges associated with formulation stability and scalability are also addressed, along with potential future research directions in this domain. By synthesizing current knowledge and identifying existing gaps, this article aims to provide a comprehensive overview of phytoconstituent-based ethosomes as a promising strategy for the development of effective and safe topical therapies for skin disorders. Ultimately, this review underscores the potential of these innovative formulations to improve patient outcomes and contribute significantly to the advancement of dermatological treatment options.

Unraveling Atopic Dermatitis: Insights into Pathophysiology, Therapeutic Advances, and Future Perspectives

Atopic dermatitis (AD) is an inflammatory skin condition that frequently develops before the onset of allergic rhinitis or asthma. More than 10% of children are affected by this serious skin condition, which is painful for the sufferers. Recent research has connected the environment, genetics, the skin barrier, drugs, psychological factors, and the immune system to the onset and severity of AD. The causes and consequences of AD and its cellular and molecular origins are reviewed in this paper. The exploration of interleukins and their influence on the immunological pathway in AD has been facilitated by using relevant biomarkers in clinical trials. This approach enables the identification of novel therapeutic modalities, fostering the potential for targeted translational research within the realm of personalized medicine. This review focuses on AD's pathophysiology and the ever-changing therapeutic landscape. Beyond the plethora of biologic medications in various stages of approval or development, a range of non-biologic targeted therapies, specifically small molecules, have emerged. These include Janus kinase (JAK) inhibitors like Baricitinib, Upadacitinib, and Abrocitinib, thus expanding the spectrum of therapeutic options. This review also addresses the latest clinical efficacy data and elucidates the scientific rationale behind each targeted treatment for atopic dermatitis.

Biomaterial-based delivery platforms for transdermal immunotherapy

Nowadays, immunotherapy is one of the most essential treatments for various diseases and a broad spectrum of disorders are assumed to be treated by altering the function of the immune system. For this reason, immunotherapy has attracted a great deal of attention and numerous studies on different approaches for immunotherapies have been investigated, using multiple biomaterials and carriers, from nanoparticles (NPs) to microneedles (MNs). In this review, the immunotherapy strategies, biomaterials, devices, and diseases supposed to be treated by immunotherapeutic strategies are reviewed. Several transdermal therapeutic methods, including semisolids, skin patches, chemical, and physical skin penetration enhancers, are discussed. MNs are the most frequent devices implemented in transdermal immunotherapy of cancers (e.g., melanoma, squamous cell carcinoma, cervical, and breast cancer), infectious (e.g., COVID-19), allergic and autoimmune disorders (e.g., Duchenne's muscular dystrophy and Pollinosis). The biomaterials used in transdermal immunotherapy vary in shape, size, and sensitivity to external stimuli (e.g., magnetic field, photo, redox, pH, thermal, and even multi-stimuli-responsive) were reported. Correspondingly, vesicle-based NPs, including niosomes, transferosomes, ethosomes, microemulsions, transfersomes, and exosomes, are also discussed. In addition, transdermal immunotherapy using vaccines has been reviewed for Ebola, Neisseria gonorrhoeae, Hepatitis B virus, Influenza virus, respiratory syncytial virus, Hand-foot-and-mouth disease, and Tetanus.

Development, Optimization, and In Vitro/In Vivo Evaluation of Azelaic Acid Transethosomal Gel for Antidermatophyte Activity

Treatment of dermatophytosis is quite challenging. This work aims to investigate the antidermatophyte action of Azelaic acid (AzA) and evaluate its efficacy upon entrapment into transethosomes (TEs) and incorporation into a gel to enhance its application. Optimization of formulation variables of TEs was carried out after preparation using the thin film hydration technique. The antidermatophyte activity of AzA-TEs was first evaluated in vitro. In addition, two guinea pig infection models with Trichophyton (T.) mentagrophytes and Microsporum (M.) canis were established for the in vivo assessment. The optimized formula showed a mean particle size of 219.8 ± 4.7 nm and a zeta potential of -36.5 ± 0.73 mV, while the entrapment efficiency value was 81.9 ± 1.4%. Moreover, the ex vivo permeation study showed enhanced skin penetration for the AzA-TEs (3056 µg/cm²) compared to the free AzA (590 µg/cm²) after 48 h. AzA-TEs induced a greater inhibition in vitro on the tested dermatophyte species than free AzA (MIC₉₀ was 0.01% vs. 0.32% for T. rubrum and 0.032% for T. mentagrophytes and M. canis vs. 0.56%). The mycological cure rate was improved in all treated groups, specially for our optimized AzA-TEs formula in the T. mentagrophytes model, in which it reached 83% in this treated group, while it was 66.76% in the itraconazole and free AzA treated groups. Significant (p < 0.05) lower scores of erythema, scales, and alopecia were observed in the treated groups in comparison with the untreated control and plain groups. In essence, the TEs could be a promising carrier for AzA delivery into deeper skin layers with enhanced antidermatophyte activity.

Formulation and Characterization of Metformin-Loaded Ethosomes for Topical Application to Experimentally Induced Skin Cancer in Mice

To achieve the best treatment of skin cancer, drug penetration inside the deepest layers of the skin is an important scientific interest. We designed an ethosome formulation that serves as a carrier for metformin and measured the in vitro skin permeation. We also aimed to measure the antitumor activity of the optimal ethosomal preparation when applied topically to chemically induced skin cancer in mice. We utilized a statistical Box-Behnken experimental design and applied three variables at three levels: lecithin concentration, cholesterol concentration and a mixture of ethanol and isopropyl alcohol concentrations. All formulations were prepared to calculate the entrapment efficiency %, zeta potential, size of the vesicles and drug release % after 1, 2, 4, 8 and 24 h. The size of the vesicles for the formulations was between 124 ± 14.2 nm and 560 ± 127 nm, while the entrapment efficiency was between 97.8 ± 0.23% and 99.4 ± 0.24%, and the drug release % after 8 h was between 38 ± 0.82% and 66 ± 0.52%. All formulations were introduced into the Box-Behnken software, which selected three formulations; then, one was assigned as an optimal formula. The in vivo antitumor activity of metformin-loaded ethosomal gel on skin cancer was greater than the antitumor activity of the gel preparation containing free metformin. Lower lecithin, high ethanol and isopropyl alcohol and moderate cholesterol contents improved the permeation rate. Overall, we can conclude that metformin-loaded ethosomes are a promising remedy for treating skin cancers, and more studies are warranted to approve this activity in other animal models of skin cancers.

A Comprehensive Review of Therapeutic Approaches Available for the Treatment of Dermatitis

BACKGROUND

Dermatitis or eczema is a prevalent skin disorder worldwide and is also very common as a pediatric inflammatory skin disorder. Its succession gets worse with the multiple comorbidities which exhibit mechanisms that are poorly understood. Its management further becomes a challenge due to the limited effective treatment options available. However, the Novel Drug Delivery Systems (NDDS) along with new targeting strategies can easily bypass the issues associated with dermatitis management. If we compare the active constituents against phytoconstituents effective against dermatitis then phytoconstituents can be perceived to be more safe and gentle.

OBJECTIVE

Administration of NDDS of plant extract or actives displays improved absorption behavior, which helps them to permeate through lipid-rich biological membrane leading to increased bioavailability. The newer efficient discoveries related to eczema can face various exploitations. This can be intervened by the subjection of patent rights, which not only safeguard the novel works of individual(s) but also give them the opportunity to share details of their inventions with people globally.

CONCLUSION

The present review focuses on the available research about the use of nanoformulations in the topical delivery. It further elaborates the use of different animal models as the basis to characterize the different features of dermatitis. The review also highlights the recent nanoformulations which have the ability to amplify the delivery of active agents through their incorporation in transfersomes, ethosomes, niosomes or phytosomes, etc.

Emerging topical drug delivery approaches for the treatment of Atopic dermatitis

BACKGROUND

Atopic dermatitis is a chronic, relapsing skin inflammation disease that generally affects 20% of children and 1-3% of adults. It is characterized by pruritus, inflammatory skin lesions, and skin barrier defect. The pillar treatment is topical therapies that have shown great adherence and incredible results in alleviating symptoms of atopic dermatitis. Topical corticosteroids and calcineurin inhibitors have shown improvement in the symptoms of atopic dermatitis but have certain side effects. There is need to develop new therapies or novel drug delivery approaches which can overcome drawbacks of the conventional formulation and increase the therapeutic efficacy.

AIM

The scope of this review is to describe the new topical therapies including phosphodiesterase inhibitors, Janus kinase inhibitors, and nano-formulations such as nanoemulsion, polymeric and lipid nanoparticles, vesicular system, and micelles.

METHODS

The article reviews and discusses the published literature of the topical drug delivery approaches for treatment of Atopic dermatitis.

RESULTS

The reported literature highlighted the benefits of novel topical formulations exhibiting targeted drug delivery, better penetration, enhanced therapeutic efficacy, and overcome systemic side effects.

CONCLUSION

Literature indicated that the new therapies and novel drug delivery approaches found to be the therapeutically more effective in increasing the efficacy of drugs and reducing the side effects in comparison with the conventional treatments for Atopic dermatitis. This has provided a way to modify and develop more such formulations for dermal delivery.

Kinetics of the Release of Nicotinamide Absorbed on Partially Neutralized Poly(acrylic-co-methacrylic acid) Xerogel under the Conditions of Simultaneous Microwave Heating and Cooling

The kinetics of release of nicotinamide (NIAM) that was absorbed on partially neutralized poly(acrylic-co-methacrylic) (PAM) xerogel/hydrogel, under the conditions of simultaneous microwave heating and cooling (SMHC) were examined. The kinetics curves of NIAM release into an aqueous solution at temperatures of 308-323 K were recorded. By applying the model-fitting method (MFM), it was found that the kinetics of NIAM release can be modeled by a kinetic model of a first-order chemical reaction. The values of the release rate constants (k_M) at different temperatures were calculated, and their values were found to be within the range 8.4 10^-3 s ^-1-15.7 10^-3 s^-1. It has been established that the Arrhenius equation was valid even in the conditions of SMHC. The values of the kinetic parameters (activation energy (Ea) and pre-exponential factor (A) of the NIAM release process adsorbed on PAM xerogel/hydrogel were calculated as follows: Ea = 25.6 kJ/mol and ln (A/s^-1) = 5.21. It has been proven that the higher value of the rate constant at SMHC in relation to CH is not a consequence of the overheating of the reaction system or the appearance of "hot-points". The values of change of the enthalpy of activation (ΔH*) and the change of entropy of activation (ΔS*) were calculated as follows: ΔH* = +23.82 kJ/mol and ΔS* = -201.4 J/mol K. The calculated higher values of the kinetic parameters and thermodynamic parameters of activation are explained by the formation of a specific activated complex under SMHC, whose structure and degree of order are different than in the one formed under CH.

Tailoring of Retinyl Palmitate-Based Ethosomal Hydrogel as a Novel Nanoplatform for Acne Vulgaris Management: Fabrication, Optimization, and Clinical Evaluation Employing a Split-Face Comparative Study

AIM

Retinyl palmitate (RP), the most stable vitamin A derivative, is used to treat photoaging and other skin disorders. The need to minimize the adverse effects of topical drug administration has led to an enhanced interest in loading RP on ethosomes for topical drug delivery. The aim of the current study was to prepare and compare the performance of RP decorated ethosomal hydrogel with tretinoin cream in the treatment of acne vulgaris as an approach to improve drug efficacy and decrease its side effects.

METHODS

RP-loaded ethosomes were prepared using the injection sonication technique. A Box-Behnken design using Design Expert® software was used for the optimization of formulation variables. Particle size, zeta potential (ZP), entrapment efficiency percent (EE%), % drug release, and permeation over 24 h of different formulations were determined. The optimal formulation was incorporated into a hydrogel. Finally, the efficacy and tolerability of the optimized RP ethosomal hydrogel were clinically evaluated for acne treatment using a split-face comparative clinical study.

RESULTS

The optimized ethosomal RP showed particle size of 195.8±5.45 nm, ZP of -62.1±2.85 mV, EE% of 92.63±4.33%, drug release % of 96.63±6.81%, and drug permeation % of 85.98 ±4.79%. Both the optimized RP ethosomal hydrogel and tretinoin effectively reduced all types of acne lesions (inflammatory, non-inflammatory, and total lesions). However, RP resulted in significantly lower non-inflammatory and total acne lesion count than the marketed tretinoin formulation. Besides, RP-loaded ethosomes showed significantly improved tolerability compared to marketed tretinoin with no or minimal skin irritation symptoms.

CONCLUSION

RP ethosomal hydrogel is considerably effective in controlling acne vulgaris with excellent skin tolerability. Therefore, it represents an interesting alternative to conventional marketed tretinoin formulation for topical acne treatment.

Coenzyme Q10 phospholipidic vesicular formulations for treatment of androgenic alopecia: ex vivo permeation and clinical appraisal

INTRODUCTION

Coenzyme Q10 (CoQ10) is an antioxidant molecule with anti-aging activity on human hair, and because of its pharmaceutical limitations such as large molecular weight, high lipophilicity and poor water solubility, its therapeutic effectiveness has been hampered. Therefore, different vesicular nanocarriers were developed in the current work, for enhancement of the skin penetration of CoQ10 for treatment of androgenic alopecia.

AREAS COVERED

In order to overcome the poor skin penetration of CoQ10, it was formulated in liposomes, transfersomes, ethosomes, cerosomes and transethosomes using the thin-film hydration method. Results revealed that transethosomes were the carrier of choice for CoQ10, in which it displayed a particle size of 146 nm, zeta potential -55 mV and entrapment efficiency of 97.63%. Transethosomes also achieved the highest deposition percentage for CoQ10, exceeding 95% in the different skin layers. Upon clinical examination in patients suffering from androgenic alopecia, CoQ10 transethosomes displayed better clinical response than the administration of CoQ10 solution, which was further confirmed by dermoscopic examination.

EXPERT OPINION

Findings of this study further prove that loading antioxidants such as CoQ10 in nanocarriers maximizes their therapeutic efficiency, and opens many opportunities for their application in treatment of several other topical diseases.

Physical Enhancement? Nanocarrier? Current Progress in Transdermal Drug Delivery

A transdermal drug delivery system (TDDS) is a method that provides drug adsorption via the skin. TDDS could replace conventional oral administration and blood administration because it is easily accessible. However, it is still difficult to design efficient TDDS due to the high barrier property of skin covered with stratum corneum, which inhibits the permeation of drug molecules. Thus far, TDDS methods by applying physical stimuli such as microneedles and chemical stimuli such as surfactants have been actively developed. However, it has been hard to avoid inflammation at the administration site because these methods partially destroy the skin tissue. On the other hand, TDDS with nanocarriers minimizing damage to the skin tissues has emerged together with the development of nanotechnology in recent years. This review focuses on current trends in TDDS.

Combined Cutaneous Therapy Using Biocompatible Metal-Organic Frameworks

Combined therapies emerge as an interesting tool to overcome limitations of traditional pharmacological treatments (efficiency, side effects). Among other materials, metal-organic frameworks (MOFs) offer versatilities for the accommodation of multiple and complementary active pharmaceutical ingredients (APIs): accessible large porosity, availability of functionalization sites, and biocompatibility. Here, we propose topical patches based on water-stable and biosafe Fe carboxylate MOFs (MIL-100 and MIL-127), the biopolymer polyvinyl alcohol (PVA) and two co-encapsulated drugs used in skin disorders (azelaic acid (AzA) as antibiotic, and nicotinamide (Nic) as anti-inflammatory), in order to develop an advanced cutaneous combined therapy. Exceptional MOF drug contents were reached (total amount 77.4 and 48.1 wt.% for MIL-100 and MIL-127, respectively), while an almost complete release of both drugs was achieved after 24 h, adapted to cutaneous delivery. The prepared cutaneous PVA-MOF formulations are safe and maintain the high drug-loading capacity (total drug content of 38.8 and 24.2 wt.% for MIL-100 and MIL-127, respectively), while allowing a controlled delivery of their cargoes, permeating through the skin to the active target sites. The total amount of drug retained or diffused through the skin is within the range (Nic), or even better (AzA) than commercial formulations. The presented results make these drug combined formulations promising candidates for new cutaneous devices for skin treatment.

Nanocarriers for treatment of dermatological diseases: Principle, perspective and practices

Skin diseases are the fourth leading non-fatal skin conditions that act as a burden and affect the world economy globally. This condition affects the quality of a patient's life and has a pronounced impact on both their physical and mental state. Treatment of these skin conditions with conventional approaches shows a lack of efficacy, long treatment duration, recurrence of conditions, systemic side effects, etc., due to improper drug delivery. However, these pitfalls can be overcome with the applications of nanomedicine-based approaches that provide efficient site-specific drug delivery at the target site. These nanomedicine-based strategies are evolved as potential treatment opportunities in the form of nanocarriers such as polymeric and lipidic nanocarriers, nanoemulsions along with emerging others viz. carbon nanotubes for dermatological treatment. The current review focuses on challenges faced by the existing conventional treatments along with the topical therapeutic perspective of nanocarriers in treating various skin diseases. A total of 213 articles have been reviewed and the application of different nanocarriers in treating various skin diseases has been explained in detail through case studies of previously published research works. The toxicity related aspects of nanocarriers are also discussed.