TOPICAL TREATMENTS TO REDUCE SEVERITY OF RADIATION DERMATITIS IN BREAST CANCER PATIENTS-A SYSTEMATIC REVIEW
Breast cancer (BC) patients are likely to undergo radiotherapy (RT) treatment which may lead to the development of the skin toxicity, radiodermatitis (RD). The purpose of this systematic review is to evaluate the effectiveness of topical interventions in reducing the severity of RD in females BC patients. Appropriate clinical studies were independently identified through a bibliographic search in PubMed and clinicaltrials.gov. Nine randomised, controlled clinical trials (RCTs) which stated a clear inclusion and exclusion criteria, were included in this review. The studies included in this review were conducted in the last 10 years and researched the effectiveness of only topical therapies on female BC patients. The severity of RD starting at baseline 0 to endpoint was measured using the Radiation Therapy Oncology Group (RTOG) scale, and results show most patients experienced a RTOG score change of 0-1 or 0-2. A significant relationship between results obtained from 0-1 and 0-2 was shown (p < 0.00001). Results suggest Radioskin 1&2 cream is the most effective topical treatment for RD as 95% of patients experienced a RTOG score change of 0-1 compared to 5% experiencing 0-2. However, controlled treatments like general care and Aqua Cream seem to be the least effective, as 1.9% of patients administrating general care experienced a RTOG score change of 0-1 compared to 41.9% experiencing 0-2.
Background: Sunscreen companies recommend replacing your chemical sunscreen every year. Consumer inquiries about product integrity under excessive exposure to heat prompted the FDA to add a requirement statement to sunscreen products indicating a need to protect stored sunscreen from excessive heat and direct sun. If heat exposure indeed affects chemical sunscreen stability, then in some areas, replacement may be warranted earlier than a year. Methods: We examined real-life scenarios related to the storage of sunscreen containers inside vehicles sitting in natural sunlight to provide information about the stability of sunscreen active ingredients under real-life storage conditions. The active ingredients avobenzone, oxybenzone, homosalate, octinoxate, octisalate, and octocrylene in samples of sunscreens were examined after heat exposure over six months using liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. The calculated levels of each active ingredient were then compared between the non-heat exposed samples and the heat exposed samples using a paired t-test to look for decreases in active chemicals from heat exposure. Results: No important differences were seen for heat exposure in this study of 378 hours of temperatures above 37.8 °C, with an additional 292 hours of exposure to temperatures of 32.2-37.7 °C, and 3454 hours at 26.7-32.2 °C. Conclusions: This suggests such heat exposure does not result in degradation of the active ingredients of sunscreens with sun protection factors (SPF) of 30 and 50. This is important for individuals attempting to prevent sunburns and skin cancer.
We report in the light of a literature review the results of 28 patients treated for Necrotizing Fasciitis (NF) at the extremities between 2012 and 2017 with a view to a prospective study with longer following up and a greater number of patients.
COMPARISON OF THE EFFICACY OF SUBCISION WITH FRACTIONAL CARBON DIOXIDE LASER VERSUS SUBCISION WITH MICRONEEDLING FRACTIONAL RADIOFREQUENCY IN THE TREATMENT OF ATROPHIC POST ACNE SCARS
Background: Many interventions have been used to treat post-acne scars, with various degrees of efficacy and adverse reactions. Multimodal approach can achieve better results for improving the physical appearance that even if minor may result in significant distress and reduced quality of life. Objective: To compare the efficacy of subcision with fractional carbon dioxide (CO2) laser and subcision with microneedling fractional radiofrequency (RF) in treating post-acne scars and to study their adverse effects. Methods: In this prospective, interventional clinical study, a total of 64 patients with post-acne scars were enrolled. The patients were randomly allocated into two groups of 32 patients each, in which group A was treated with subcision plus fractional carbon dioxide laser (CO2) and group B was treated with subcision plus microneedling fractional radiofrequency (RF) every 6 weeks for a total of four sittings. An objective score was calculated for each patient using the Goodman and Baron scale to evaluate the outcome every visit during treatment and then 3 months after completion of therapy. Results: In group A, the percentage reduction in the mean objective scores was found to be 64%. In group B, the percentage reduction in mean objective scores was found to be 42%. Most of the changes were seen in the boxcar and rolling types of scars. Conclusions: Subcision and fractional CO2 laser were considered superior over subcision with microneedling fractional (RF) technique for the treatment of post-acne scars. Boxcar and rolling types of scars showed a high response to treatment than icepick scars
Aim: The reported case involved a complicated diagnostic path, not only because of the usual difficulties specific to chronic urticaria but, also because the trigger was a T-cell large granular lymphocytic leukemia (T-LGLL), a rare type of leukemia with an indolent course whose etiology is still not well known. This leukemia is also known for its propensity to cause autoimmune diseases. The aim of this study was to identify whether the muscle damage was caused by dermatomyositis or by T-LGLL. Methods: After elevated muscle enzyme levels had been discovered magnetic resonance imaging (MRI) revealed muscle damage. Consequently, a muscle biopsy was performed in a targeted manner. In addition to muscle biopsy, transmission electron microscopy and anti-CN1A antibody testing were performed. Results: MRI of the lower limbs and pelvic girdle indicated moderate fibroadipose substitution in many muscles, moderate edema in others. No involvement of the shoulder girdle and upper limbs. Histological examination of the muscle fibers showed an “inflammatory myopathy with isolated phagocytotic fibers.” Inclusion-body myositis, which is known to be associated with chronic T-LGLL was excluded. On the same biopsy transmission electron microscopy confirmed inflammatory myopathy and anti-CN1A antibodies were positive. DNA extracted from the muscle of the micro-rearrangement for the y-chain of the TCR identified on the DNA extracted from peripheral blood was positive. Conclusions: Conclusions: Chronic urticaria was an indication of immunoproliferative disease. Myositis was the pathology due to T-LGLL, and dermatomyositis was excluded.
EFFECTIVENESS OF HORMONE BASED THERAPIES (SPIRONOLACTONE AND COMBINED ORAL CONTRACEPTIVES IN THE MANAGEMENT OF ACNE VULGARIS IN WOMEN: A SYSTEMATIC REVIEW AND META-ANALYSIS
Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous follicular unit that often occurs. Acne is a skin disorder that is not life-threatening but is mostly complained of because it is aesthetically disruptive, which can cause significant psychological problems for sufferers. The management of acne vulgaris in female patients has its challenges. There are many histories of failed therapy using conventional therapy, such as with antibiotics or isotretinoin, and female patients have a predisposition to the condition of androgen excess. Also, the increasing awareness about limiting the use of antibiotics to prevent resistance in dermatological cases, including acne vulgaris, encourages other treatment options in the female patient population, one of which is hormone-based therapy. A systematic review and meta-analysis were performed of randomized clinical trials assessing the effects of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives) in the management of Acne Vulgaris in Women. Methods: Medline Pubmed, Scopus, Cochrane Library, the reference list, conference proceedings, researchers in the field of eligible studies were searched. Ten studies (n=1906 sub-jects) were included in qualitative analysis, of which two studies (n=1842 subjects) were included in the meta-analysis. The age of the participant was greater than 14 years old. Intervention using combined oral contraceptives (n=8) or oral spironolactone (n=2). Duration of intervention (minimum six months for COC and three months for SL) and out-comes of mean difference number of acne vulgaris lesions before and after treatment. Results: Pooling of data using random-effects model found a significant difference in the mean difference in the number of lesions after treatment in the group receiving hormone-based therapy (spironolactone and combined oral contraceptives) and those receiving control therapy (p = 0.005). The overall mean difference was -0.890 ± 0.316. A negative value indicating the number of lesions after hormone-based therapy (spironolactone and combined oral…
THE EFFECTIVENESS OF PULSED DYE LASER IN MANAGEMENT OF ACNE VULGARIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Background: Acne vulgaris is one of the most prevalent skin diseases, affecting up to 85% of teenagers and young adults. Multiple treatment options including topical, systemic or physical therapies. However, the effects of conventional therapies are limited due to antibi-otic resistance and adverse effects such as irritation and teratogenicity of isotretinoin. Light-based therapy is an alternative and/or adjuvant therapy in patients who cannot tolerate or unresponsive to conventional therapies that may provide fewer side effects, patient com-fort, fast onset of action, and with equal or greater effectiveness. We aimed to assess the effectiveness of using Pulsed Dye Laser as a treatment option for acne vulgaris. A systemat-ic Review and Meta-analysis was peformed of randomized clinical trials assessing the ef-fectiveness of Pulsed Dye Laser in management of acne vulgaris. Methods: Medline Pubmed, Scopus, Cochrane library, the reference list, conference pro-ceedings, researchers in field of eligible studies were searched. Eight studies (n=275 sub-jects) were included in qualitative analysis of which six studies (n=190 subjects) were in-cluded in meta-analysis. The mean age of the participant was 21,94 years old. Intervention using application of Pulsed dye laser as monotherapy or combination in acne vulgaris pa-tients with follow-up at least 12 weeks. and the outcomes is a decrease mean of acne vul-garis lesions counts after received pulsed dye laser therapy. Results: Pooling of data using random effects model showed that the group that received PDL therapy alone or in combination had a lower number of acne lesions than the control group with the mean difference was -0.593 (95% CI = -1.290 to 0.104), the z value was -1.668 with p = 0.095. This shows that the number of lesions in the group that received sin-gle or combined PDL therapy was lower than the control group. However the difference is insignificant. Conclusion. From the results of…
THE EFFECTIVITY OF PH 4 EMULSION ON SKIN BARRIER FUNCTION IN THE ELDERLY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Background: The pH of the skin surface is elevated in the elderly therefore it may cause impaired barrier function manifest as various cutaneous abnormalities, including xerosis, pruritus, dermatitis, and skin infections. Consequently, skin care products for the elderly should contain moisturizing ingredients which are formulated to normalize the skin surface pH. Application of pH 4 emulsion is potentially beneficial to improve barrier function in the elderly and promoting skin health. We aimed to determine the difference of effectiveness of pH 4 emulsion compared to identical non pH 4 emulsion on decreasing TEWL in the elderly. A systematic review and meta-analysis was performed of randomized clinical trials assessing the effects of pH 4 emulsion on skin barrier function in the elderly. Methods: Medline Pubmed, Scopus, ProQuest, Cochrane library, ClinicalTrials.gov, the reference list, conference proceedings, researchers in the field of eligible studies were searched. Four studies (n=98 subjects) were included in qualitative analysis of which two studies (n=45 subjects) were included in the meta-analysis. The mean age of the participants was 71.1 years old. Interventions use the application of pH 4 water in oil emulsion (n=2) and pH 4 oil in water emulsion (n=2). Duration of intervention (24 hours-7 weeks) and outcomes of interest varied among included studies. Results: Pooling of data using random-effects model found lower TEWL score in the pH 4 emulsion than in non pH 4 emulsion, with no significant difference (overall effect mean difference -0.068, 95% confidence interval -0.485 – 0.348, p = 0.11, I2=60.1, two RCTs). In addition to that, the qualitative analysis found that the application of pH 4 emulsion increased stratum corneum hydration, decreased skin surface roughness and scaliness, decreased DASI, and improved ICLL length and lamellar organization. Conclusion: The meta-analysis result of the mean differences of TEWL scores lowering effect between pH 4 emulsion…
The 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act terminated the Sunscreen Innovation Act (SIA) that the Food & Drug Administration (FDA) uses to determine sunscreen actives as safe and effective for human use. The Act also nullified a recent FDA proposal that reclassified 14 organic sunscreen actives as either not safe for human use or requires more data before being used in humans. Most sunscreen actives were approved in 1978; since that time the FDA has determined that over the last 20 years several changes have occurred leading to a substantial increase in sunscreen usage and exposure that increases the potential health risks associated with their use. Based on the scientific literature for the actives reviewed, it is clear that the SIA is needed to assure that sunscreen and other over-the-counter drugs are safe and efficacious for human use prior to entering the marketplace.
ASSESSMENT OF EFFICACY AND TOLERABILITY OF FRACTIONAL CO2 LASER IN THE TREATMENT OF AXILLARY HYPERPIGMENTATION
Background: Axillary hyperpigmentation is a common and troublesome complaint especially among dark-skinned women. It is believed to be a form of post-inflammatory hyperpigmentation and so far, there is no universally accepted treatment for the disorder. Objective: The aim of this study is to assess the efficacy of fractional CO2 laser in the treatment of axillary hyperpigmentation Patients and methods: Thirty Egyptian females with axillary hyperpigmentation were recruited. The severity of the condition was estimated by both self-assessment and expert dermatologist before treatment. Four sessions of fractional CO2 laser were done. Both the efficacy and complications were assessed by the patient and the dermatologist six month after the last session. Results: There was a statistically significant difference of percentage of improvement of pigmentation before compared to one month after treatment as detected by self-assessment (p value= 0.002) and the observer’s assessment (p value= 0.001). Conclusion: Fractional CO2 laser, in properly chosen parameters, is an effective method for the treatment of axillary hyperpigmentation.