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Biomedical subjects

L Guenther

Publications and source records attributed to L Guenther.

At least 19 recordsLinked to original sources
PubMed2002

Topical treatment of actinic keratoses with 3.0% diclofenac in 2.5% hyaluronan gel.

BACKGROUND: Actinic keratoses (AKs) are premalignant skin lesions, which, if left untreated, can develop into squamous cell carcinoma. Current treatments for AKs are destructive and are often associated with significant adverse events. The development of an effective and well-tolerated topical treatment for AK is desirable. OBJECTIVES: To evaluate the efficacy and safety of 3.0% diclofenac in 2.5% hyaluronan gel as a treatment for AK. METHODS: This was a multicentre, double-blind, placebo-controlled study in which 195 patients with at least five AKs in up to three designated treatment blocks were randomized to four treatment groups. Patients randomized into the active treatment groups A30 (n = 49) and A60 (n = 48) received topical treatment with 3.0% diclofenac in 2.5% hyaluronan gel 0.5 g twice daily for 30 or 60 days, respectively. Patients in the placebo (vehicle gel) groups V30 (n = 49) and V60 (n = 49) received topical treatment with 2.5% hyaluronan gel 0.5 g twice daily for 30 or 60 days, respectively. Treatment efficacy was assessed by target and cumulative lesion number scores (TLNS and CLNS, respectively) and lesion total thickness score (TTS). Investigator and patient global improvement indices (IGII and PGII) were also used to rate overall improvement. RESULTS: Compared with placebo, significantly more patients given active treatment for 60 days had TLNS = 0 (33% vs. 10%, P < 0.05; an improvement of 64% compared with 34% with placebo), CLNS = 0 (31% vs. 8%, P < 0.05; an improvement of 54% compared with 23% with placebo) and TTS = 0 (25% vs. 6%, P < 0.05; an improvement of 59% compared with 31% with placebo). The IGII and PGII scores were also significantly better when active treatment was compared with placebo (P < 0.05). Both treatments were generally well tolerated and the incidence of the most common adverse events was similar between groups. CONCLUSIONS: Treatment with 3.0% diclofenac in 2.5% hyaluronan gel was effective when used for 60 days and was well tolerated in patients with AK.

Adjuvants, Immunologic↗
PubMed2002

Efficacy and safety of a new combination of calcipotriol and betamethasone dipropionate (once or twice daily) compared to calcipotriol (twice daily) in the treatment of psoriasis vulgaris: a randomized, double-blind, vehicle-controlled clinical trial.

BACKGROUND: Calcipotriol and betamethasone dipropionate are both widely used, effective treatments for psoriasis. Vitamin D analogues and topical corticosteroids have different mechanisms of action in the treatment of psoriasis. A new vehicle has been developed in order to contain both calcipotriol (50 micro g g-1) and betamethasone dipropionate (0.5 mg g-1) in an ointment form. By using calcipotriol and a corticosteroid together, greater efficacy may be achieved than by using either compound alone. OBJECTIVES: The present study was conducted in order to compare the clinical efficacy and safety of the combined ointment formulation used once daily with the vehicle ointment used twice daily, calcipotriol ointment used twice daily and the combined formulation used twice daily in psoriasis vulgaris. METHODS: This was an international, multicentre, prospective, randomized, double-blind, vehicle-controlled, parallel group, 4-week study in patients with psoriasis vulgaris amenable to topical treatment. Patients were randomized to one of four treatment groups: combined formulation once daily, combined formulation twice daily, calcipotriol twice daily or vehicle twice daily. Efficacy and safety were assessed. RESULTS: There was no statistically significant difference in the mean percentage change in the Psoriasis Area and Severity Index (PASI) from baseline to end of treatment between the two combined formulation groups, but the difference in PASI reduction was significantly higher in the combined formulation groups (68.6% once daily, 73.8% twice daily) than in both the twice daily calcipotriol group (58.8%) and the vehicle group (26.6%). Safety data showed the frequency of adverse events to be less in the combined formulation groups than in both the calcipotriol group and the vehicle group. The proportion of patients with lesional/perilesional adverse reactions was less in the combined formulation groups and vehicle group than in the calcipotriol group (9.9% combined formulation once daily, 10.6% combined formulation twice daily, 19.8% calcipotriol, 12.5% vehicle). CONCLUSIONS: No statistically significant nor clinically relevant difference in efficacy was seen between the combined formulation used once daily and twice daily. When compared to vehicle ointment or calcipotriol ointment alone, the combined formulation was shown to be clearly more efficacious.

Adolescent↗
PubMed2001

Dermatological manifestations of Down's syndrome.

BACKGROUND: Down's syndrome (DS) is an extensively researched congenital condition characterized by mental retardation and distinct physical features. The cutaneous manifestations of DS are numerous, yet they seldom receive appropriate attention. OBJECTIVE: To review the dermatological conditions associated with DS. METHODS: A review of the medical literature. RESULTS: DS is associated with an increased incidence of numerous dermatological conditions, some of which may be related to an immunological deficiency. CONCLUSION: Along with the importance of understanding the physical and psychosocial aspects of DS, an appreciation of the dermatological manifestations of this condition is integral to comprehensive medical care.

Adolescent↗
PubMed2000

Tazarotene combination treatments in psoriasis.

In the hope of increasing efficacy and improving safety, several combination regimens involving tazarotene gel have been explored for the treatment of plaque psoriasis. A number of large-scale studies have shown that the adjunctive use of a mid-potency or high-potency steroid can enhance both the efficacy and tolerability of tazarotene treatment. A small pilot study also suggested improved efficacy when used in combination with calcipotriene. Likewise, the adjunctive use of tazarotene can enhance the efficacy and potentially the safety of treatment with steroids, broad-band and narrow-band UVB phototherapy, and psoralens plus UVA bath therapy.

Adrenal Cortex Hormones↗
PubMed1999

Impact of a sun awareness curriculum on medical students' knowledge, attitudes, and behaviour.

BACKGROUND: Physicians teach sun awareness to their patients, but frequently have no formal training in this area. A week-long dermatology curriculum during Sun Awareness Week that included skin cancer and sun awareness education to first-year medical students was introduced in May 1998 at the University of Western Ontario, London, Canada. OBJECTIVE: The purpose of this study was to determine the baseline knowledge, attitudes, and behaviour of the first-year medical students towards sun awareness before and after the new curriculum. METHOD: This study used a pre- and post-test design to determine the impact of the curriculum on the medical students' knowledge, attitudes, and intent to change behaviour. It also reports any influence of demographic variables on these parameters. RESULTS: The students demonstrated a substantial improvement in their knowledge of sun-related topics despite some baseline knowledge. Many students reported unhealthy behaviour prior to the curriculum, but demonstrated an intent to adopt more healthy behaviour after the curriculum. Minor differences in knowledge and behaviour due to demographic characteristics disappeared upon completion of the curriculum. CONCLUSIONS: An undergraduate medical curriculum with skin cancer and sun awareness education can improve the medical students' knowledge, attitudes, and behaviour towards sun awareness.

Adult↗
PubMed1999

Sun and the skin: evaluation of a sun awareness program for elementary school students.

BACKGROUND: Research suggests that childhood exposure to ultraviolet radiation is a significant risk factor for the development of melanoma and nonmelanoma skin cancers. Sun awareness education programs for children can positively influence children's sun protective practices to decrease the risk of skin cancer. OBJECTIVE: The purpose of this study was to evaluate a sun awareness education program, entitled "Sun and the Skin" that had recently been developed and implemented in London, Ontario. METHOD: The study uses a pre- and posttest design to evaluate both knowledge and behaviour of Grade 4 students participating in the program at baseline, immediately after, and 1 month after the program. RESULTS: The students demonstrated a significant increase in their sun-protective practices after participation in the "Sun and the Skin" program. There was a significant improvement in the students' level of knowledge after the program. Improvement in both behaviour and knowledge were maintained weeks after completion of the program. Minor differences in knowledge due to demographic characteristics were detected after the program. CONCLUSIONS: A sun awareness education program for Grade 4 students can improve both their knowledge and behaviour over time. This format should be used in conjunction with changes in school policy in order to make a significant longterm impact.

Child↗
PubMed1999

The role of Apligraf in the treatment of venous leg ulcers.

A cultured, allogeneic, bi-layered human skin equivalent has recently become available to help clinicians manage difficult-to-heal venous ulcers. This skin equivalent has an epidermis and dermis similar to human skin. Its living keratinocytes and fibroblasts are from cultured cell banks derived from human neonatal foreskin. Because the skin equivalent is made up of viable human cells, it cannot be terminally sterilized. Safety concerns, which have been addressed, include the risk of possible transmission of infection, immunogenicity, immunological graft rejection, and tumor formation. However, the maternal blood of the neonatal donor and the master cell banks are screened for infectious agents. Additionally, the human skin equivalent is produced under strict aseptic control, with sterility continuously monitored by the Good Manufacturing Processes. This paper reviews the characteristics of this human skin equivalent and provides practice guidelines.

Algorithms↗
PubMed1997

Skin drugs in pregnancy--which ones to use.

The safety of dermatologic drugs in pregnancy has not been established; however, many are probably safe. Drugs used in pregnancy must be absolutely indicated. Women who are pregnant or contemplating pregnancy should be clearly informed of the risks and benefits of medications they are prescribed.

Contraindications↗
PubMed1994

Melkersson-Rosenthal syndrome and Crohn's disease: one disease or two? Report of a case and discussion of the literature.

In 1985, a 19-year-old woman had clinical features suggesting anorectal Crohn's disease. Two years later, swelling of the vulva associated with perianal swelling developed. The clinical manifestations responded to oral prednisone until 1989, when she returned with a swelling of the upper lip, a polypoid lesion of the oral buccal mucosa, and swelling of the anus and vulva. The lip biopsy demonstrated granulomas. The illness failed to respond to systemic immunosuppressive therapy, wider consultation was made, and the diagnosis of the Melkersson-Rosenthal syndrome was made. Such an appearance of this rare condition is unusual. We describe her case and discuss the literature, raising the possibility that the Melkersson-Rosenthal syndrome and Crohn's disease are the same condition with different initial clinical appearances.

Adult↗
PubMed1990

Metastatic Crohn's disease. Case report and review of the literature.

Metastatic Crohn's disease is an unusual granulomatous inflammation of the skin that is noncontiguous to the gastrointestinal tract. Our review of the English-language literature shows that 23 cases of metastatic Crohn's disease have been published since its description in 1964. The skin lesions can be in the form of erythematous nodules, plaques, or ulcers, and the lower extremities are involved in half of the cases. We describe a 24-year-old woman with metastatic Crohn's disease. Ultrastructural examination revealed changes that were compatible with episodic endothelial cell injuries. Results of both direct and indirect immunofluorescence studies were negative. The possible role of T lymphocytes and macrophages in mediating this vascular damage is considered.

Adult↗
PubMed1981

A controlled comparison of amcinonide cream 0.1 percent and halcinonide cream 0.1 percent in the treatment of eczematous dermatitis.

A 2-week, double-blind clinical trial was conducted to compare the efficacy and cosmetic acceptability of amcinonide cream 0.1 percent and halcinonide cream 0.1 percent in the treatment of 29 patients with eczematous dermatitis. The dermatologic status of each patient was rated by improvement in clinical signs and symptoms, by the investigator's overall evaluation, and by two patient evaluations. Both medications produced statistically significant and equivalent improvement by Week 2. However, amcinonide was significantly favored in the efficacy evaluation of relief from burning pain at Week 2 and in patient acceptability evaluations in regard to the absence of burning, stinging, and itching on application. The role of propylene glycol in the formulation of the halcinonide cream as a contributing cause of irritation is noted.

Adolescent↗