A comparative study on the effect of alcohol-based hand sanitizers in spray and gel formulation on the skin: A prospective, randomised, crossover trial

BACKGROUND

Many formulations of Alcohol-based hand rubs (ABHRs), such as liquid, gel, and spray have been developed and used for preventing infections. This study aimed to compare skin irritation from using ABHRs in gel and spray formulations.

METHOD

This was a prospective, randomised, crossover trial conducted to investigate the effect of skin irritation caused by ABHRs in gel compared to spray formulation after 21 days of using each formulation. Clinical outcomes were assessed using subjective Larson's skin assessment score and Frosch and Kligman observer skin assessment score, as well as bioengineering measures: transepidermal water loss (TEWL) and skin capacitance on days 3, 7, 14, and 21.

RESULTS

Among 38 participants, both formulations showed no significant change in clinical scores and skin capacitance during the study. However, TEWL increased significantly from baseline on day 3 (p = 0.029) for the spray formulation and on day 21 (p = 0.019) for the gel formulation, with no statistically significant difference between the formulations (p = 0.46).

CONCLUSION

Our research supports the safety of gel and spray ABHRs for regular use, with the only potential issue being mild skin irritation. For those with sensitive skin, the gel formulation is preferable.

The efficacy of a transdermal hydrogel patch containing betamethasone dipropionate for treatment of chronic hand eczema: A single-blind, randomized and controlled trial

BACKGROUND

Topical corticosteroids under occlusion have been used to enhance the treatment of eczema. However, no study has investigated the efficacy of a steroid-containing transdermal patch for the treatment of chronic hand eczema.

METHODS

We conducted a randomized, controlled, assessor-blinded trial to determine the efficacy of a transdermal patch containing betamethasone dipropionate compared to topical betamethasone dipropionate ointment in the treatment of mild to moderate chronic hand eczema. The patients were included and assigned to receive either the transdermal patch once daily at night or the ointment twice daily for a period of 8 weeks. The outcomes were assessed using the Hand Eczema Severity Index (HECSI), Physical Global Assessment (PGA) score, self-reported compliance, level of patient satisfaction, quality of life, and side effects.

RESULTS

Fifty-six patients completed this study. At 8 weeks, there was a significant reduction in the HECSI scores in both the transdermal patch and topical ointment groups compared to those measured at baseline (14.61 to 1.86, p < 0.001; 18.46 to 3.43, p < 0.001, respectively) without a statistically significant difference between the two groups. Similarly, the two groups did not show any significant difference in the PGA scores, quality of life and side effects. However, the transdermal patch group reported better compliance and a higher level of patient satisfaction than the topical ointment group.

CONCLUSION

The transdermal corticosteroid patch has proven to be a safe and effective treatment, comparable to topical corticosteroids, after 8 weeks of use. Its sustained-release properties, along with once-daily use, can improve patient satisfaction and promote greater adherence to the treatment.

TRIAL REGISTRATION

This study was registered with the Thai Clinical Trials Registry (www.

CLINICALTRIALS

in.th) under registration number TCTR20220413003.

Efficacy of anti-sebum moisturizing cream containing 2% l-carnitine and 5% epigallocatechin gallate in seborrhea: A randomized clinical trial

BACKGROUND

Seborrhea leads to facial greasiness and unpleasant feeling. People with seborrhea also have trouble with selecting moisturizers. l-Carnitine and epigallocatechin gallate (EGCG) are reported anti-sebum properties. However, neither efficacy comparison nor the combination effect of the two topical anti-sebum agents was studied. Moisturizing cream with these agents is supposed to provide skin with an optimal water-oil balance.

AIMS

To compare the efficacy of moisturizer containing 2% l-carnitine or 5% EGCG alone on sebum controlling, and the synergistic effect of these two agents.

METHODS

Three study creams were formulated by adding three kinds of anti-sebum agents which were 2% l-carnitine, 5% EGCG, and 2% l-carnitine plus 5% EGCG in moisturizing cream base of dimethicone and glycerin. A randomized clinical trial was conducted. Ninety subjects, divided into three groups, applied the cream for 4 weeks. Sebum level, skin capacitance, and transepidermal water loss (TEWL) were evaluated at Weeks 0, 1, 2, and 4. Life qualities and subjective outcomes were assessed before and after treatment.

RESULTS

The mean sebum reduction from baseline was statistically significant in all treatment groups (p < 0.01). The median time to oil control was longer in l-carnitine group. The combine group had significantly greater anti-sebum efficacy than l-carnitine group (p = 0.009). All three groups had significant improvement of other objective parameters and subjective outcomes.

CONCLUSIONS

The anti-sebum moisturizing cream exhibited beneficial effect on the sebum reduction with improve skin hydration in people with seborrhea and made users satisfied. The EGCG group and the combine group show the greater anti-sebum effect than the l-carnitine group.

Efficacy and Safety of Detachable Microneedle Patch Containing Triamcinolone Acetonide in the Treatment of Inflammatory Acne

Background

Detachable microneedles (DMNs) are dissolvable microneedles that detach from the base during administration. The use of DMNs-containing steroids for acne has never been investigated.

Methods

Thirty-five patients with facial inflammatory acne were evaluated for acne treatment efficacy and safety of DMNs and DMNs containing triamcinolone acetonide (TA) via a 28-day randomized, double-blind, controlled trial. Four inflammatory acne lesions were selected from each participant and randomly treated with a single application of 700 µm DMNs containing 262.02 ± 15.62 µg TA (700DMNTA), 1000 µm DMNs containing 160.00 ± 34.92 µg TA (1000DMNTA), 700 µm DMN without TA (700DMN), and a control. Efficacy was measured by assessing physical grading, diameter, volume, erythema index, and melanin index. Safety was evaluated by assessing reports of adverse effects from patients and physicians.

Results

All three treatment groups achieved resolution of inflammatory acne significantly faster than the control group, with median times for resolution of 4.6, 5.25, 6.7, and 8.1 days in the 1000DMNTA, 700DMNTA, 700DMN, and control, respectively. When compared to the control group, the diameters and post-acne erythema of inflammatory acne were significantly reduced in the treatment groups. The 1000DMNTA decreased acne size and erythema more than other treatments. DMNTA also tended to decrease acne size and erythema more than DMN with no TA, but there was no statistically significant difference. All participants preferred DMN over conventional intralesional steroid injection due to less pain and self-application. No adverse effect was observed.

Conclusion

DMNTA is a safe, effective alternative treatment for inflammatory acne and significantly reduces post-acne erythema.

Comparison of the onset, depth, and duration of cutaneous anesthesia between topical 10% lidocaine and EMLA creams: A randomized, intraindividual, comparative trial

BACKGROUND

The eutectic mixture of local anesthetics (EMLA) is an effective cutaneous anesthetic, although its application is time consuming and poses a risk of methemoglobinemia. Currently, the efficacy of topical 10% lidocaine cream is unclear.

OBJECTIVE

To compare the onset, anesthesia depth, and duration of topical 10% lidocaine and EMLA cream.

METHODS

The randomized, split-body, comparative trial performed on 40 participants who received a topical 10% lidocaine cream or EMLA on forearms for 15-150 min. Pain was stimulated using a 21-gauge needle insertion and evaluated with the Verbal Pain Score. Adverse effects were recorded.

RESULTS

EMLA conferred significantly better efficacy than 10% lidocaine (p < 0.001). For acceptable pain at 4-mm depth, the minimal application times were 40.88 and 45.38 min of EMLA and 10% lidocaine creams, respectively. With 60/120-min application, the maximal needle-insertion depths with acceptable pain were 6.61/9.47 mm (EMLA) and 6.01/8.94 mm (10% lidocaine). EMLA's anesthetic effect showed an early increase after removal which was sustained for 60-90 min. Both creams caused adverse effects, with EMLA showing higher proportions, although the differences were statistically insignificant.

CONCLUSION

The efficacy of EMLA was superior to 10% lidocaine cream, especially regarding anesthesia onset and duration.

A pilot study of combined oral minocycline and narrowband UVB phototherapy in vitiligo: A randomized, double-blind, placebo-controlled trial

Narrowband ultraviolet B (NBUVB) phototherapy is an effective therapeutic option for generalized vitiligo. Previous reports showed the potential benefit of minocycline to stop disease progression in vitiligo. Meanwhile, minocycline has antioxidative, anti-inflammatory, and immunomodulating properties. There is no clinical study combining oral minocycline and NBUVB for treating generalized vitiligo. This study aims to compare the efficacy and safety of the combination treatment of NBUVB plus oral minocycline with NBUVB alone in generalized vitiligo. A randomized, double-blinded, placebo-controlled pilot study was conducted. Patients were randomly treated with either combined oral minocycline 100 mg per day plus NBUVB phototherapy or placebo plus NBUVB. All patients recieved NBUVB two times per week, for 12 weeks. The outcomes were assessed using Vitiligo Area Scoring Index score (VASI) percent change, quartile grading scale (QGS) of repigmentation, and Vitiligo Disease Activity Index (VIDA) score. Fourteen generalized vitiligo patients were included, and seven cases were assigned in each group. At week 12, the mean VASI score was decreased by 28.87% (24.15) in the minocycline group compared to 27.26% (7.98) in placebo group (p = 0.886). No significant difference was observed between both treatment modalities in QGS of repigmentation and mean VIDA score change. Two of the seven patients (29%) receiving minocycline developed hyperpigmentation, dark-brown and muddy brown discoloration, which was only confined to some vitiliginous patches. In conclusion, combination therapy with oral minocycline does not enhance the efficacy of NBUVB in generalized vitiligo. Due to the high incidence of drug-induced skin hyperpigmentation, minocycline plus NBUVB should be avoided.

The efficacy of probiotic-derived lotion from Lactobacillus paracasei MSMC 39-1 in mild to moderate acne vulgaris, randomized controlled trial

BACKGROUND

Probiotics provide benefits for reducing acne. Previous studies showed an anti-inflammatory effect of Lactobacillus paracasei. However, the clinical evidence of topical probiotic lotion and acne treatment is still lacking.

OBJECTIVE

To evaluate the efficacy and safety of probiotic-derived lotion compared to 2.5 % benzoyl peroxide in the treatment of mild to moderate acne vulgaris.

METHODS

Topical probiotic-derived lotion was formulated from cell-free supernatant of L. paracasei MSMC 39-1. In vivo study showed the ability of the supernatant to inhibit both antibiotic-resistance and susceptibility strains of C. acnes and inhibit tumor necrosis factor-α. The patients with mild to moderate acne vulgaris on the face were randomized to receive topical probiotic-derived lotion or 2.5 % benzoyl peroxide. Acne lesion counts, erythema index, and side effects were assessed after 2 and 4 weeks of treatment.

RESULTS

One hundred and four acne vulgaris patients were enrolled. After four weeks of treatment, the inflammatory acne lesion counts and erythema index significantly decreased compared to baseline in both the probiotic lotion group and 2.5 % benzoyl peroxide group (p < 0.001 in both groups) without statistically significant difference between the two groups (p > 0.05). However, the comedones were not affected in both groups. Four patients (7.69%) treated with probiotic-derived lotion and 14 patients (26.92%) treated with 2.5% benzoyl peroxide reported treatment-associated side effects.

CONCLUSION

Probiotic-derived lotion is safe and effective for treating mild to moderate acne vulgaris, a comparable outcome with 2.5% benzoyl peroxide. It could be an alternative treatment of acne with more minor side effects.

Minimum Contact Time of 1.25%, 2.5%, 5%, and 10% Benzoyl Peroxide for a Bactericidal Effect Against Cutibacterium acnes

Purpose

Benzoyl peroxide (BPO) is an effective acne treatment and has been used as a cleanser and short contact therapy. However, data on the minimum contact time of BPO needed to kill Cutibacterium acnes are lacking. Thus, the aim of this study was to determine the minimum contact time of commonly used BPO concentrations for bactericidal effects on C. acnes.

Materials and Methods

An in vitro experimental study of clinically isolated C. acnes was performed to determine the minimal inhibitory concentration (MIC) of BPO using the broth microdilution method. Subsequently, the minimum contact times of various concentrations of BPO were evaluated, and their bactericidal effects were assessed by the plate count method.

Results

The median MIC of BPO was 9375 µg/mL, which did not significantly differ between antibiotic-resistant and nonresistant C. acnes. The minimum contact time of BPO with C. acnes was significantly different among the BPO concentrations. For bactericidal activity against all isolates, 1.25%, 2.5%, 5%, and 10% BPO required 60 min, 15 min, 30 sec, and 30 sec, respectively.

Conclusion

BPO demonstrated bactericidal activity against both antibiotic-resistant and antibiotic-susceptible C. acnes. The in vitro contact time needed to kill C. acnes was almost immediate with 5% or more BPO, but ≤ 2.5% BPO required longer contact times for bactericidal effects.

Association Between Diet and Acne Severity: A Cross-sectional Study in Thai Adolescents and Adults

The association between diet and acne is of growing concern. Every country has its own food culture; however, only a few studies have surveyed the influence of Asian cuisine on acne. This study investigated the association between acne severity and diet/lifestyle factors in 2,467 Thai adolescents and adults. Data were collected via a validated semi-quantitative food frequency questionnaire. In Thai adolescents and adults, the prevalence of mild acne was 52%, moderate acne 22%, and severe acne 8%. No acne was found in 18% of participants. The dietary factors associated with increased severity of acne were consumption of chocolate >100 g/week (adjusted odds ratio (aOR) 1.29; 95% CI 1.07–1.56), oily and fried food >3 times/week (aOR 1.84; 95% CI 1.07–3.16) and white rice (aOR 1.80; 95% CI 1.24–2.63). Conversely, the factors associated with decreased severity of acne were consumption of sugar-free milk-free tea (aOR 0.61; 95% CI 0.43–0.87) and vegetables (aOR 0.74; 95% CI 0.62–0.89).

Comparison of Normal Saline Injection with Pneumatic Injector to Subcision for the Treatment of Atrophic Acne Scars

BACKGROUND: Acne scarring is a concerning consequence of acne with a prevalence of 11 to 14 percent after acne resolution. Needle subcision is usually used by clinicians to treat acne scars due to its safety and simplicity. Recently, normal saline injection with a pneumatic injector has shown compatible outcomes in treating acne scars. OBJECTIVE: This study compared the effectiveness of acne scar treatment with a pneumatic injector and that of hypodermic needle subcision. METHODS: Twenty patients with moderate to severe atrophic acne scars were voluntarily enrolled. All consecutive patients were randomly selected and treated with normal saline injection by using a pneumatic injector on one side of the face during three sessions, separated by a four-week interval. The other side of the face was treated with needle subcision at the end of the first week of the protocol. Subjective assessments were performed by self-evaluation and two blinded dermatologists. For objective assessment, the depth and volume of acne scars were estimated by an ultraviolet A light video camera and Vernier calipers at baseline and four, eight, and 12 weeks. Pain score and adverse reactions were also noted at each visit. RESULTS: Eighteen patients with Fitzpatrick Skin Type III or IV completed the study. Differences in the resolution in diameter and the volume of boxcar and rolling acne scars over 12 weeks of follow-up between the pneumatic injection and needle subcision groups were statistically significantly improved relative to at baseline; however, there was no statistically significant difference in the efficacy between the two modalities. Satisfaction with each modality was not statistically different. No serious adverse effects occurred. Minor reactions such as minor hematoma and subcutaneous emphysema resolved within two weeks. CONCLUSIONS: The efficacy of normal saline injection with a pneumatic injector is not statistically different from that of needle subcision in treating boxcar and rolling acne scars; however, less side effects were recorded. Given this advantage, the use of pneumatic injectors should be considered for treating acne scars.

A cream containing linoleic acid, 5% dexpanthenol and ceramide in the treatment of atopic dermatitis

BACKGROUND

Nowadays, moisturizers contain non-steroidal anti-inflammatory agents that help for treatment of atopic dermatitis (AD). Defensil® (black currant seed oil, sunflower oil, and balloon vine), a new anti-inflammatory, obtained from plant extracts, remain had a few studies for AD.

OBJECTIVE

To compare the effectiveness of moisturizer containing 3% Defensil®, 5% dexpanthenol and ceramide (LDC) with 5% urea cream in childhood AD treatment.

METHODS

Thirty-eight patients with diagnosis of atopic dermatitis by UK working party's criteria were recruited in randomized, controlled, double-blinded 4-week study. The patients were received with twice-daily application of LDC cream on one side of the body and 5% urea cream on the opposite side. The clinical severity was assessed by modified scoring of atopic dermatitis (SCORAD). Median time to remission was analyzed by survival analysis.

RESULTS

Thirty-seven out of 38 patients accomplished the protocol. The clinical SCORAD significantly improved from baseline in both groups (p < 0.001) after 2 and 4 weeks. Furthermore, the LDC group significantly reduced severity of disease better than the 5% urea group (P = 0.043). The mean difference SCORAD scores were -13.83 (±1.83) and -13.04 (±3.22) respectively. Stratum corneum hydration (SCH) was enhanced from baseline in both groups (p < 0.001) but no statistically significant difference between both groups. Median time to remission had no statistically significant difference (P = 0.697).

CONCLUSIONS

The effectiveness of LDC cream is better than 5% urea cream for improving clinical atopic dermatitis. It was suggested that moisturizer containing LDC could be used for the treatment of mild-to-moderate childhood atopic dermatitis.

Efficacy and safety of a novel water-soluble herbal patch for acne vulgaris treatment: A randomized, assessor-blinds controlled, intra-individual split-face comparative study

Acne vulgaris is a chronic inflammatory skin disease. Antibiotics, particularly clindamycin and erythromycin, are used for the treatment of acne vulgaris. However, emerging antibiotic-resistant strains have been an important problem. This study aims to evaluate the efficiency and safety of a novel water-soluble herbal acne patch (WHAP) compared with the hydrocolloid acne patch (HAP) in mild to moderate inflammatory acne patients. The randomized, assessor-blind controlled, intra-individual split-face study was performed on 49 acne patients. The clinical outcomes were evaluated on day 2, 4, 7, 9, and 11 of treatment. It was shown that the median time to resolution of the inflammatory acne treated with WHAP was shorter than HAP with a statistically significant difference (WHAP was 4 days, whereas HAP was 6 days) (P value <.001). Moreover, WHAP had a more significant decrease in the rate of inflammatory diameter, erythema scores (by clinical and colorimetry), and a more increase in the rate of lightness scores (by colorimetry) than HAP (P value <.05). No adverse effects were reported in both groups. It is safe to use WHAP as an alternative treatment for inflammatory acne.

Comparison between the use of intense pulsed light and Q-switched neodymium-doped yttrium aluminum garnet laser for the treatment of axillary hyperpigmentation

BACKGROUND

Axillary hyperpigmentation (AH) is a condition in which axillary skin is darker than the adjacent areas. To date, there is no standard treatment for AH. The Q-switched neodymium-doped yttrium aluminum garnet 1064-nm(QS) laser and intense pulsed light (IPL) are two effective modalities for the treatment of pigmentary disorders; however, the efficacy and safety levels of both treatments for AH have not yet been compared in a controlled study.

AIMS

To evaluate and compare the efficacy and safety of the QS laser and IPL in the treatment of AH.

METHODS

A randomized, split-side study was conducted on 22 subjects; all subjects received a total of five split-side treatments every 2 weeks. The efficacy was determined using the melanin index (MI), color chart level using the Pantone SkinTone™ Guide, improvement grading scale (IGS), and patient satisfaction scores at weeks 2, 4, 6, 8, and 10.

RESULTS

The results showed that there was no significant difference in MI, color chart level, IGS, and patient satisfaction scores between the two treatments. Both treatments significantly improved AH after three sessions. However, the pain score was lower for IPL treatment. The adverse effects were transient and were found after IPL treatment in one participant (4.45%) who developed hyperpigmentation and another participant (4.45%) who developed erythema.

CONCLUSIONS

Intense pulsed light therapy is safe and effective for the treatment of AH, with no significant difference in the outcome compared with QS laser treatment.

A comparison of the efficacy of silicone gel containing onion extract and aloe vera to silicone gel sheets to prevent postoperative hypertrophic scars and keloids

Background

Hypertrophic scars and keloids are postsurgery problems. Some studies showed that onion extract and aloe vera might be beneficial for postoperative scars. However, few of the randomized clinical trials were investigated.

Aims

To compare the efficacy of silicone gel containing onion extract and aloe vera (SGOA) to silicone gel sheets (SGS) to prevent postoperative hypertrophic scars and keloids.

Methods

The prospective randomized assessor‐blind controlled trial was conducted with 40 patients who had undergone surgery. The patients were divided into two groups: one treated with SGOA, the other with SGS. The patients were evaluated after 1, 2, and 3 months. The objective assessment was to determine the incidences of scarring, erythema, and melanin values using Mexameter, and pliability through Cutometer. The subjective assessment consisted of the patient and observer scar assessment scale (POSAS) and patient satisfaction.

Results

After the 12‐week follow‐up, there was no statistically significant difference in the scarring incidence rate of both groups. There were no statistical differences in the POSAS score, erythema, and melanin value between both groups. Using objective assessment, pliability in the SGOA group was statistically significantly higher compared to the SGS group. Pain and itchiness significantly decreased in both groups. No adverse effects were reported in either group.

Conclusion

Silicone gel containing onion extract and aloe vera is effective as SGS for postoperative scar prevention.

The comparative study of efficacy between 1064-nm long-pulsed Nd:YAG laser and 595-nm pulsed dye laser for the treatment of acne vulgaris

BACKGROUND

The popularity of laser therapy in acne treatment has been increasing recently due to its safety, effectiveness, and convenience. Both 595-nm pulsed dye laser (PDL) and 1064-nm long-pulsed neodymium:yttrium-aluminum-garnet laser (Nd:YAG) have been successful in treating inflammatory acne lesions. However, clinical data from controlled comparative studies are still lacking.

AIMS

To compare the clinical efficacy of 1064-nm Nd:YAG with 595-nm PDL for the treatment of acne vulgaris.

METHODS

Thirty-four participants with mild to moderate facial acne were enrolled and then randomized to receive three, 2-week interval treatments with 1064-nm Nd:YAG on one side of the face and 595-nm PDL on the other side. Clinical assessments including acne lesion counts, acne erythema grading, and erythema index were performed at baseline, 2nd, 4th, and 8th week. Participants' satisfaction, preference, and adverse effects were recorded.

RESULTS

As compared with baseline, the significant reduction of mean inflammatory acne lesion counts, acne erythema grading, and erythema index was demonstrated on 595-nm PDL-treated sides and 1064-nm Nd:YAG-treated sides. However, there were no significant differences between both sides. The participants were satisfied with both laser treatments, but the participants preferred 1064-nm Nd:YAG over 595-nm PDL treatment. The adverse effects were less on 1064 nm Nd: YAG-treated sides.

CONCLUSIONS

1064-nm Nd:YAG and 595-nm PDL treatments are equally effective in reducing inflammatory acne lesions and acne erythema in mild to moderate facial acne vulgaris.

Efficacy and tolerability of 20% aluminum sesquichlorohydrate vs 20% aluminum chloride for the treatment of axillary hyperhidrosis: A randomized controlled trial

This study evaluated the efficacy and tolerability of topical aluminum sesquichlorohydrate (AS) when compared to aluminum chloride (AC) as a treatment for primary axillary hyperhidrosis (PAH). Twenty subjects were included in this randomized, controlled, split-side 8-week study. All participants applied 20% AS and 20% AC lotions in their axillae (one treatment per axilla) every night for 2 weeks; next, the application was reduced to three times a week for 4 weeks. The assessment was performed using the sweating intensity visual scale (SIVS), hyperhidrosis disease severity score (HDSS), patient satisfaction score, and the appearance of adverse effects on weeks 0, 1, 2, 4, 6, and 8. Both AS as well as AC application showed positive results, significantly differing from the baseline, as assessed using SIVS, HDSS, and patient satisfaction score at every follow-up visit; however, no significant difference was observed between the AS and AC groups at any follow-up visit. The mean time of response was 1.14 weeks for both treatments. A side effect was observed in one subject (5%), who reported itching on the AC axilla. The therapeutic effects persisted even after reducing the frequency of application and lasted for at least 2 weeks after cessation of use. In conclusion, topical 20% AS demonstrated similar efficacy to topical 20% AC in the treatment of PAH, with a high safety profile.

Nitrogen plasma skin regeneration for the treatment of mild-to-moderate periorbital wrinkles: A prospective, randomized, controlled evaluator-blinded trial

BACKGROUND

Nitrogen plasma skin regeneration is a novel device that produces heat to the skin, resulting in the production of new collagen. Because of lower energy with safer skin damage and lesser adverse effects who have high Fitzpatrick's skin type especially Thais, this technique is very interesting for clinical application for skin esthetic treatment. However, this treatment has yet been empirically studied as the treatment for mild-to-moderate periorbital wrinkles.

OBJECTIVES

This study aimed to evaluate clinical efficacy of nitrogen plasma for the treatment of mild-to-moderate periorbital wrinkles.

METHODS

Eighteen volunteers were enrolled. Each volunteer was randomized to receive nitrogen plasma treatment on one side of periorbital wrinkles with three sessions at a three-week interval and compared with contralateral side without treatment. Photographic examination, skin wrinkle (SEw) score, melanin index, patients' satisfaction score, side effect, and pain score were reported.

RESULTS

At over fourteen weeks, all volunteers completed the study. Treatment with nitrogen plasma group had significantly better improvement for periorbital wrinkles score by Lemperle scale, skin wrinkle (SEw) score by Visioscan® VC 98, and the melanin index by Mexameter® than the control groups (P = 0.004, P < 0.001, P < 0.001, respectively). This study also showed significantly greater satisfaction score to favor the nitrogen plasma treatment group than the control group (P < 0.001). The short-term adverse effects included erythema, scaling, temporary hyperpigmentation, pruritus, and dryness.

CONCLUSION

Nitrogen plasma skin regeneration is effective and safe for the treatment of mild-to-moderate periorbital wrinkles and darkening.

The Comparative Study of Topical Therapy on Striae Alba between a Herbal Extract Cream and 0.1% Tretinoin Cream in Adolescence

BACKGROUND

Striae are commonly developed in adolescence as a result of active growth spurt. Although they create little physical health issue, they are cosmetic concerns to the patients. Effective striae treatment can help improve their mental health and personality.

OBJECTIVE

To compare the effects of a herbal extract cream and 0.1% tretinoin cream in the treatment of striae alba.

MATERIAL AND METHOD

Forty eight participants aged between 10 - 19 years old, with striae alba at their thighs were randomized into two groups. Each group was separately treated with 0.1% tretinoin and herbal extract for 16 weeks. The width, length and surface roughness of the lesions were assessed including histological evaluation and participants’ satisfaction.

RESULTS

Thirty nine participants completed the study after 16 weeks. Compared to initial lesions, the striae width was reduced by 9.01% (p = 0.002) in tretinoin group and 13.09% (p<0.001) in herbal extract group. The length was reduced by 9.54% in tretinoin group (p<0.001) and 8.73% in herbal extract group (p<0.001). The surface roughness assessed by Visioscan VC98 was reduced by 13.70% in tretinoin group (p = 0.036) and 17.24% in herbal extract group (p<0.001). From H&E staining, the mean difference of epidermal thickness was 4.79±7.15 microns in tretinoin group and 14.22±16.98 microns in herbal extract group. The mean difference of collagen amount was 13.75±6.02 units in tretinoin group and 6.60±4.92 units in herbal extract group. From Masson trichrome staining, the mean difference of collagen amount was 6.75±3.50 units in tretinoin group and 12.20±7.73 units in herbal extract group. From Verhoff van Gieson staining, the mean difference of elastin amount was 2.25±3.30 units in tretinoin group and 5.40±4.16 units in herbal extract group. There was no statistical significant difference between two groups in histological evaluation. The herbal extract caused irritant contact dermatitis only 4.55% in contrast to 72.73% from the tretinoin group. Most participants from both groups had moderate to high satisfaction according to the efficacy of their treatments.

CONCLUSION

The herbal extract cream is as effective as 0.1% tretinoin cream in the treatment of striae alba. As tretinoin can cause skin irritation, the herbal extract can be a better alternative treatment.

Comparative Trial of Silver Nanoparticle Gel and 1% Clindamycin Gel when Use in Combination with 2.5% Benzoyl Peroxide in Patients with Moderate Acne Vulgaris

BACKGROUND

Treatments of acne vulgaris commonly use antimicrobials and comedolytic agents. Considering bacterial resistance to topical antibiotics, the alternative treatment such as silver manufactured into nanoparticle receives an attention. Silver nanoparticle has an antibacterial effect against Propionibacterium acnes and anti-inflammation. Clinical study of silver nanoparticle gel for the treatment of acne vulgaris is limited.

OBJECTIVE

To compare the efficacy and safety between silver nanoparticle gel and 1% clindamycin gel both combine with 2.5% benzoyl peroxide for the treatment of moderate severity of acne vulgaris.

MATERIAL AND METHOD

This was an experimental, double-blinded, randomized-controlled study. Sixty-four moderately severe acne patients were enrolled. They were randomized to receive either silver nanoparticle gel with 2.5% benzoyl peroxide or clindamycin gel with 2.5% benzoyl peroxide (32 patients each). The clinical outcomes were evaluated for inflammatory and non-inflammatory acne count, acne redness, the patients’ satisfaction and patients’ Dermatology Life Quality Index (DLQI) at the baseline, 2, 4, 6 and 8-week visit.

RESULTS

After 8 weeks of follow-up period, the average mean percent change from the baseline of non-inflammatory and inflammatory acne counts were gradually declined in both silver nanoparticle and clindamycin group. At the study endpoint (8-week visit), average mean percent change from the baseline of inflammatory acne count was slightly better reduction in silver nanoparticle group (79.7%) than clindamycin group (72.6%) with no significant difference (p = 0.18). The average mean percent change from the baseline of non-inflammatory acne count reduction was also no difference from silver nanoparticle and clindamycin group (61.1% and 66.8% respectively, p = 0.22). For clinical erythema score and Mexameter erythema index to evaluate acne redness were no statistical difference between the 2 groups. Moreover, the patients’ satisfaction to study medication and their quality of life of patients (DLQI score) were reported with better improvement from the baseline in both groups but there was no statistical significant difference. Except for average mean, patients’ satisfaction to acne severity at 6-week visit showed that silver nanoparticle group had better satisfaction score than clindamycin group (4.6±0.6 vs. 4.2±0.6) with statistical significance (p = 0.01). Common adverse effects were skin dryness (28.1%) and skin irritation (4.7%) which might be caused by 2.5% benzoyl peroxide. There was no adverse effect for silver nanoparticle gel from the present study.

CONCLUSION

Silver nanoparticle gel is effective with good safety profile for the treatment of acne vulgaris. The present study demonstrated that there were no clinical significant differences between silver nanoparticle gel and clindamycin gel for the treatment of moderate severity of acne vulgaris when use in combination with 2.5% benzoyl peroxide. The clinical application as alternative treatment for acne is advised.

The Effects of Oral Vitamin D Supplement on Atopic Dermatitis: A Clinical Trial with Staphylococcus aureus Colonization Determination

BACKGROUND

An increase in Staphylococcus aureus skin colonization in atopic dermatitis patients resulted from the reduction of cathelicidin production in these patients. Recently, an in vivo study demonstrated that vitamin D could stimulate cathelicidin production. Oral supplements of vitamin D might be beneficial in atopic dermatitis.

OBJECTIVE

To determine the effects of oral vitamin D supplements on clinical impact including Staphylococcus aureus skin colonization evaluation in atopic dermatitis patients.

MATERIAL AND METHOD

Twenty-four atopic dermatitis patients were included in this double-blind, placebo-controlled study. They were randomly assigned into 2 groups for oral 2,000 IUs/day of vitamin D, supplement and placebo. The lesional swab culture for S. aureus was done at week 0, 2 and 4. Clinical outcomes were assessed by SCORAD score, mexameter for erythema index and konometer for conductance were done at week 0, 2 and 4. Serum vitamin D levels were also determined at week 0 and 4.

RESULTS

Twenty patients completed the protocol. S. aureus skin colonization, SCORAD score and erythema index were significantly reduced from baseline to week 4for vitamin D treated group comparing with placebo (p = 0.022, 0.028 and 0.014, respectively). There was an inverse correlation between serum vitamin D levels with S. aureus skin colonization and SCORAD score (r = -1.0, p < 0.001).

CONCLUSION

Oral vitamin D supplement could reduce skin colonization of S. aureus and demonstrated the clinical improvement of patients with atopic dermatitis.

New innovation of moisturizers containing non-steroidal anti-inflammatory agents for atopic dermatitis

Atopic dermatitis is a chronic, relapsing and extremely pruritic eczematous disease which commonly affects children. The standard management consists of a combination of anti-inflammatory drugs in adjunctive with skin care management particular moisturizer application. A concern for the side effects associated with long term use of corticosteroids has also been considered. There has been an emerging interest in moisturizer containing non-steroidal anti-inflammatory agents such as herbal extracts, vitamins, mineral and lipids. The in vitro and the in vivo studies of each agent were reviewed. The clinical study on the efficacy of moisturizers containing these agents were also demonstrated including the author’s studies and clinical experience. These moisturizers might be considered as an alternative treatment in acute flare of mild to moderate atopic dermatitis.

Comparative trial of moisturizer containing spent grain wax, Butyrospermum parkii extract, Argania spinosa kernel oil vs. 1% hydrocortisone cream in the treatment of childhood atopic dermatitis

OBJECTIVE

To compare an efficacy of a moisturizer containing spent grain wax, Butyrospermum parkii extract, Argania spinosa kernel oil (S) with 1% hydrocortisone cream (HC) for the treatment of mild to moderate atopic dermatitis.

MATERIAL AND METHOD

Twenty-nine patients, age between 2 and 15 years old with mild to moderate atopic dermatitis were enrolled The body was randomly divided to left and right side. One side was applied with S cream and the other side was applied with HC cream twice daily for four weeks. Observation of recurrence rate after remission was recorded. Clinical outcomes were analyzed by using the scoring ofAtopic Dermatitis (SCORAD) score. Statistical analysis was done by using descriptive statistics, pair t-test, one-way repeated ANOVA, and McNemar's test.

RESULTS

It was demonstrated that both agents had improvement of SCORAD score after two weeks, with statistically significant difference (p< 0. 001). At fourth week, both agents had improvement of SCORAD score without being statistically significant different (p>0.05). Although the S cream side had higher remission rate than the HC cream side, there was no statistically significant difference (p> 0. 05).

CONCLUSION

S cream was as effective as HC cream in the treatment and maintenance period of mild to moderate childhood atopic dermatitis.

The study on effects and safety of Spongilla lacustris in 3% hydrogen peroxide solution on rat skin

OBJECTIVE

To study the effects and safety of Spongilla lacustris (SL) in 3% hydrogen peroxide (H2O) on rat skin.

MATERIAL AND METHOD

An experimental study was conducted on 3 groups of Wistar-Furth adult rats. The first group was applied with SL in H2O2 the second group with SL in 0.9% normal saline (NSS) and the control group with NSS. These agents were applied on and wiped off the rat skin weekly for four weeks, then the skin biopsies were done. The number of SL spicule and the depth of spicule penetration were examined by scanning electron microscope and by polarized light microscope respectively. Skin histopathology was determined by hematoxylin-eosin staining. The gross skin changes were observed.

RESULTS

Under electron microscopic examination, SL was demonstrated as spicule which was sharp-edged, rod-shaped and smooth surface with approximate 150-300 microns in length and 10-20 microns in diameter. Spicule retention was found in the rat skin lasted until day 3 but was undetectable on day 7. The spicules could be detected deep into stratum basalis. Comparing among three groups, the thickness of epidermis in the second group was decreased with statistically significant difference (p = 0.044) by the end of week 7. The dermal thickness of all groups was increased by age. No any gross skin alteration of all groups was observed.

CONCLUSION

The authors hypothesized that the spicule causes puncture that enhances H2O2 penetration into the skin. This solution was safe in the short-term usage. However, the long-term safety regarding granulomatous formation is still questionable.

Comparative trial of 5% dexpanthenol in water-in-oil formulation with 1% hydrocortisone ointment in the treatment of childhood atopic dermatitis: a pilot study

BACKGROUND

Atopic dermatitis (AD) is a common chronic relapsing disease particularly affecting children. The emollient used for protection of skin barrier function is the standard treatment for patients with AD. Currently, there is a growing interest in the use of nonsteroidal anti-inflammatory agents such as dexpanthenol (vitamin B5) as an alternative treatment.

OBJECTIVE

To compare the effectiveness of 5% dexpanthenol (DT) ointment with 1% hydrocortisone (HC) ointment in childhood AD therapy.

METHOD

Patients were treated topically with 5% DT ointment on the right side of the body and 1% HC ointment on the other side twice daily for 4 weeks. The clinical responses were evaluated by SCORAD (Scoring Atopic Dermatitis index) with statistical analysis using paired t-test.

RESULT

Of the 30 children enrolled, 26 completed the protocol; mean age was 7.19 years. The average baseline SCORAD score of the DT-treated side and the HC-treated side was 30.95 and 30.54, respectively. There was no statistically significant difference in SCORAD score reduction between the 2 agents. The edematous score of the HC-treated side exhibited faster resolution than that of the DT-treated side, with a statistically significant difference at week 1 and without a statistically significant difference at weeks 2 to 4. The lichenification response rate of HC treatment was more rapid than that of DT treatment; however, there was no statistical group difference. No adverse events were observed with either agent.

CONCLUSION

The effectiveness of 5% DT ointment is equal to that of 1% HC ointment. DT ointment may be used as alternative treatment in mild to moderate childhood AD therapy.

Topical antifungal agents for seborrheic dermatitis: systematic review and meta-analysis

OBJECTIVE

Assess the efficacy of topical antifungal agents for seborrheic dermatitis treatment.

MATERIAL AND METHOD

A systematic review and meta-analysis of all relevant randomized vehicle-controlled trials of topical antifungal agents for seborrheic dermatitis treatment were searched. The quality of the enrolled studies was measured by criteria from Cochrane Collaboration, followed by data extraction. Two reviewers independently assessed the present study articles. When there was a disagreement between the two reviewers, a consensus was made by the third reviewer. Pooled relative risk (PRR) statistical analysis was used to determine the efficacy of treatment.

RESULTS

One thousand ninety five studies were reviewed and nine studies were included. Four reports studied the efficacy of ketoconazole, two of metronidazole, two of ciclopirox, and one of bifonazole. Ketoconazole was more effective than vehicle [PRR is 5.78 (95% CI, 2.17-15.40)], as was metronidazole [PRR is 1.83 (95% CI: 1.05-3.17)] ciclopirox [PRR is 3.00 (95% CI, 1.86-4.84)], and bifonazole [PRR is 1.86 (95% CI: 0.96-3.59)].

CONCLUSION

The meta-analysis in the present study showed that the topical antifungal agents that demonstrated strong and moderate evidence of the efficacy for seborrheic dermatitis treatment were ketoconazole and ciclopirox, respectively. They could be used as an alternative treatment for seborrheic dermatitis.

Comparative trial of moisturizer containing licochalcone A vs. hydrocortisone lotion in the treatment of childhood atopic dermatitis: a pilot study

BACKGROUND

Although moisturizer usage has been considered a mainstay of treatment for atopic dermatitis (AD) patients, few clinical studies have been investigated. Recently, moisturizers containing non-steroidal anti-inflammatory agents, such as licochalcone A (LA) and vitamin B(12) are of emerging interest.

OBJECTIVE

To compare the effectiveness of moisturizer containing LA with hydrocortisone (HC) lotion in treatment of childhood AD. Methods  The randomized, controlled, investigator-blinded 6-week study was conducted. Patients were administered with twice-daily application of LA lotion on one side of the body and HC lotion on the opposite side. The clinical outcome was assessed by the scoring of atopic dermatitis (SCORAD) index. The relapse rate was comparatively analysed by survival analysis.

RESULTS

From 30 patients enrolled, 26 patients completed the protocol. The mean age of the children was 5.8 years. The average baseline SCORAD score is about 28 on both sides. The response rates of both agents were equal to 73.33%. There is no statistical significant group difference in reduction of SCORAD score. Although we observed more rapid resolution of oedema and erythema in areas treated with HC lotion, both agents exhibited no significant difference. The relapse rate of HC group was higher than in LA group; however, there was no significant difference. No side-effect was observed from both agents.

CONCLUSION

The effectiveness of LA lotion is equal to that of HC lotion. It was suggested that moisturizer containing LA could be used both for treatment of acute and maintenance phase in mild-to-moderate childhood AD.

An oral nutraceutical containing antioxidants, minerals and glycosaminoglycans improves skin roughness and fine wrinkles

Various nutraceuticals (dietary supplements) are claimed to have cutaneous antiageing properties, however, there are a limited number of research studies supporting these claims. The objective of this research was to study the effectiveness of an oral nutraceutical containing antioxidants, minerals and glycosaminoglycans on cutaneous ageing. In this double-blind, placebo-controlled trial, 60 women aged 35-60 years were randomized to receive oral dietary supplement (n = 30) or placebo (n = 30), once daily for 12 weeks. The depth of skin roughness and fine wrinkles were measured using surface evaluation of skin parameters for living skin (Visioscan) at baseline, and at the 4, 8 and 12 weeks of treatment. Surface evaluation using a replica film (Visiometer) at baseline and at the 12th week of treatment was also carried out. Statistical differences in objective skin improvement were assessed by the independent t-test. The volunteers' satisfaction was tested using the chi-squared test. The baseline depth of skin roughness and fine wrinkles in the treatment group and the placebo group were 100.5 and 100 mum, respectively. At the end of the study, the depth of skin roughness and fine wrinkles in the treatment group showed a 21.2% improvement, whereas improvement in the control group was 1.7%. This difference was statistically significant (P < 0.001). With regard to the volunteers' satisfaction, there was no statistically significant decrease in the homogenization of skin colour, however, a statistically significant reduction in pore size and depth of skin roughness and fine wrinkles were observed (P < 0.05). No side effects were noted throughout the study. The oral dietary supplement containing antioxidants, minerals and glycosaminoglycans improved skin roughness and fine wrinkles but did not affect skin colour change in female volunteers.