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PubMed2000

Ischemic wound healing and possible treatments.

The present review describes the major steps in wound healing, the factors that clinically cause ischemia including the changes found in diabetes mellitus and the possible interventions and treatments of ischemic wounds. The number of randomized, double-blind, controlled clinical trials is scarce, especially on the healing of chronic ischemic soft tissue wounds. Experimental and clinical studies to date have demonstrated that hyperbaric oxygen may be an effective treatment of chronic hypoxic wounds and that certain growth factors (e.g., recombinant platelet-derived growth factor-BB) are likely to enhance the healing of such wounds. Other treatments are discussed, among them vasoactive drugs (e.g., pentoxifylline), occlusive dressings and surgical treatment, including delayed primary closure of acute ischemic wounds.

Journal Article↗
PubMed2001

Continuous UVB irradiation to modify the biophysical properties and protein conformation of rat skin.

In order to determine the continuous irradiation effects of UVB on the skin of live Sprague Dawley (SD) rats, the changes in biophysical properties and protein conformation of the skin were studied. The continuous UVB irradiation affecting the water content, skin color and protein structure of the rat skin was investigated by using a skin surface hygrometer, a Chroma meter and an attenuated total reflection (ATR)/Fourier transform infrared (FT-IR) spectroscopy. Test areas on the dorsal skin were continuously irradiated with 600 +/- 10 microW/cm2 UVB for 56 h. Part of the dorsal skin was covered with a bandage as a non-irradiated control. The results indicated that the water content of the irradiated skin decreased with UVB irradiation, but the non-irradiated control skin exhibited a higher level of water content. The decrease in the skin's water-binding capacity from cracks induced by continuous UVB irradiation, and the occlusive dressing of the non-irradiated skin to prevent water loss and form full hydration might be responsible for the results. The decrease of L* value and the increase in a*, b* and delta E values in the skin color parameters with UVB irradiation indicates an incremental darkening of the skin and a marked increase in erythema. However, there was no significant change in skin color for the non-irradiated control skin. A slight modification of the protein secondary structure in the skin after continuous UVB irradiation was also evidenced by transforming the alpha-helix structure into a beta-sheet structure after long-term continuous UVB irradiation. Continuous UVB irradiation of SD rat skin may decrease the skin's water-binding capacity, cause darkening, increase erythema and modify the protein secondary structure of the skin.

Animals↗
PubMed1988

Clinical pharmacology and pharmacokinetic properties of topically applied corticosteroids. A review.

The development of topical corticosteroids since the 1950s has opened new doors for dermatologists previously faced with treating intractable dermatoses, so that the pharmacology of topically applied corticosteroids is now reasonably well described. Manipulation of the steroid molecule has produced compounds with greater lipophilicity, fewer mineralocorticoid properties and high potency. Potency is determined through various techniques, notably the vasoconstrictor assay as well as the mitotic index suppression method and atrophogenic potential assay. The mechanism of activity of corticosteroids is thought to result, at least in part, from binding of the drug to steroid receptors, with resultant effects on the synthesis of proteins responsible for specific effects. Corticosteroids are proposed to alter the inflammatory response, and thus provide therapeutic benefits, via actions on mediator release and function, inflammatory cell function and release of lysosomal enzymes. Disadvantages of corticosteroid activity include the possibility of adrenal suppression, epidermal and dermal thinning, and local effects such as purpura, striae, and steroid-induced rosacea and perioral dermatitis. The cutaneous pharmacokinetics, particularly of absorption of topical corticosteroids, must be examined in parallel with their pharmacodynamic effects to gain a more complete understanding of activity. Many factors can affect percutaneous steroid absorption: drug lipophilicity and solubility, drug concentration, anatomical site, age of the patient, presence of skin disease and use of occlusive dressings will each influence the degree to which topically applied corticosteroids achieve their intended therapeutic results. Cutaneous metabolism is a poorly understood process at present, but one which is acknowledged to have some impact on the biotransformation of corticosteroids applied topically. Thus, although some gaps still persist in present knowledge of the pharmacology and pharmacokinetics of this important class of drugs, there can be no denying the contribution of topical corticosteroids to the therapy of dermatoses.

Administration, Topical↗
PubMed2005

Pretibial myxedema: pathophysiology and treatment options.

Pretibial myxedema or localized myxedema or thyroid dermopathy is an autoimmune manifestation of Graves' disease. It also occasionally occurs in Hashimoto's thyroiditis. Lesions of thyroid dermopathy are usually asymptomatic and have only cosmetic importance. Advanced forms of dermopathy are associated with elephantiasis or thyroid acropachy. Almost all cases of thyroid dermopathy are associated with relatively severe ophthalmopathy. Usually ophthalmopathy appears first and dermopathy much later. All patients with localized myxedema have high serum concentrations of thyroid-stimulating hormone receptor antibodies, indicating the severity of the autoimmune condition. Occurrence of thyroid dermopathy in areas other than pretibial skin indicates a systemic process. Similar to Graves' ophthalmopathy, thyroid-stimulating hormone receptors in the connective tissue may be the antigen responsible for the immune process. Both humoral and cellular immune mechanisms are involved in the stimulation of fibroblasts and the production of large amounts of glycosaminoglycans. Localization in the pretibial area relates to mechanical factors and dependent position. Diagnosis of thyroid dermopathy is based on signs and typical pretibial skin lesions in association with a history of Graves' hyperthyroidism and ophthalmopathy. In some cases, skin biopsy is needed for confirmation. The lesions are usually mild and are overshadowed by more symptomatic ophthalmopathy. Most cases of thyroid dermopathy do not require any therapy. In mildly severe symptomatic cases and when there is cosmetic concern, topical corticosteroids applied under occlusive dressing are beneficial. In more severe cases, systemic immunomodulation may be necessary; however, conclusive evidence for long-term efficacy of these modalities is lacking. When significant edema and elephantiasis are present, local compressive therapy may have added benefit. In mild cases that do not require treatment, 50% of patients achieve complete remission after several years. Severe cases that receive topical corticosteroids or other therapies do not have a better outcome than untreated milder cases. Current treatment modalities for thyroid dermopathy and acropachy are at best palliative. Better and safer means of immunomodulation are needed.

Adult↗
PubMedDate not supplied

[Allergy skin testing after topical anesthesia].

Immediate skin test reactions are the hallmark of atopic diseases. EMLA (eutectic mixture of local anesthetics) is a local anesthetic that reduces the pain and apprehension for skin testing. We studied EMLA effects on the skin prick test with allergen and histamine. Reactions were evaluated by means of wheal and flare crossed diameters, speed of reaction and local temperature changes. One hour occlusion dressing with EMLA significantly delayed the beginning of reaction with antigen (129%) and histamine (101%). It decreased wheal diameter (33% and 15%) as well as local temperature variation (55% and 80%) respectively with antigen and histamine. Local anesthesia with EMLA probably interferes with histamine action and reduces the immediate skin test reaction. Therefore, it should not be used to reduce the pain of allergy skin testing.

English Abstract↗
PubMed1980

A lidocaine-prilocaine cream for superficial skin surgery and painful lesions.

A eutectic mixture of lidocaine and prilocaine in a water emulsion cream base produces effective superficial dermal analgesia when applied under occlusive dressing for 60 minutes. On the genitals, lips and oral mucosa, the application time can be reduced. The cream was found to be an effective alternative to conventional infiltration anesthesia for dermabrasion and superficial surgical procedures. It is especially useful in children for the removal of molluscum contagiosum and prior to venepuncture. The preparation is also an effective pain reliever when used on certain ulcerations.

Administration, Topical↗
PubMed1998

Preoperative and postoperative skin care with laser resurfacing.

Laser resurfacing has become a commonly used technique for the treatment of a variety of skin conditions including facial actinic damage, rhytides, and acne scarring. Although the procedure has the ability to deliver consistently good results with an excellent safety profile, complications do occur even in the best of hands. Independent of the type of laser used or the surgical technique, the risk of complications and the final outcome can be greatly influenced by the care of the skin before and after the procedure. This article will focus on the preoperative assessment of the patient, the concept of preconditioning the skin, and postoperative wound management after laser resurfacing. Various occlusive dressing products will be discussed, as well as their role in wound healing. A pre- and posttreatment skin care regimen will be provided to use as a guide in the management of patients undergoing laser resurfacing.

Dermatologic Surgical Procedures↗
PubMed1983

Studies on the percutaneous absorption of paeonol in experimental animals by a radioactive tracer technique.

Studies on in vivo percutaneous absorption of paeonol (2-hydroxy-4-methoxyacetophenone: I) in rabbits, guinea pigs, and rats were carried out by a radioactive tracer technique. Hydrophilic ointment (specific activity: 376 Bq (0.01016 microCi)/mg) containing I[carbonyl-14C] was applied for 24 h by occlusive dressing treatment on the shaven back of experimental animals. Then, the 14C-activity in urine, which is the dominant excretion route, was determined for 8 days. Percentage excreted within 24 h after application to rabbits, guinea pigs, and rats were 42.8%, 46.5% and 52.0%, respectively. Urinary metabolites were identified as 2,5-dihydroxy-4-methoxyacetophenone, resacetophenone, and substrate I in all the case.

Acetophenones↗
PubMed1999

Successful methods of treating leg ulcers. The tried and true, plus the novel and new.

The cause of a leg ulcer should be determined before a course of treatment is undertaken, and this often can be accomplished through history taking, physical examination, and use of simple noninvasive testing. Most leg ulcers are caused by venous disease, arterial insufficiency, neuropathy, or a combination of these factors. Complete management should address the patient's general health as well as specific findings, and treatment of any underlying cause is paramount. In venous ulcers, compression is the cornerstone of treatment, and a variety of effective stockings and other compression devices are available. Arterial ulcers usually require reestablishment of an adequate vascular supply, often through surgery. Neuropathic ulcers need thorough debridement to allow good granulation and epithelialization. Five types of occlusive dressings are available that achieve debridement less painfully but also more slowly than the surgical approach. Several adjunctive methods are now available that facilitate successful therapy in these ulcers, which have often been considered nonhealing wounds.

Bandages↗
PubMedDate not supplied

Comparative potency of formulations of mometasone furoate in terms of inhibition of 'PIRHR' in the forearm skin of normal human subjects measured with laser doppler velocimetry.

BACKGROUND AND AIMS: Topical glucocorticoid formulations are widely used for effective treatment and control of a variety of dermatoses. Mometasone furoate is a newer corticoid that has high potency but low systemic toxicity. Pharmaceutical factors are known to significantly influence potency and systemic absorption of topically applied glucocorticoids. We studied the potency of "Elocon", a topical formulation of mometasone furoate, compared with two other branded formulations of the same corticoid. METHODS: Corticoid potency was measured by employing a pharmacodynamic parameter of an inhibitory effect of the corticoid on post-ischemic-reactive-hyperemic-response (PIRHR) in human forearm skin under occlusive dressing. The PIRHR was expressed in terms of % increase in the skin blood flow (SBF) as measured with laser doppler velocimetry (LDV). RESULTS: All three active branded formulations of mometasone furoate produced significant inhibition of PIRHR. The AUC(0-2 min) of PIRHR was ( Mean +/- SEM ), Control = 213.52 +/- 11.80, Placebo = 209.77 +/- 19.31, Formulation A = 119.83 +/- 13.71, Formulation C = 53.67 +/- 4.85 and Formulation D = 111.46 +/- 22.87. Formulation "C" exhibited significantly higher topical anti-inflammatory potency than formulations "A" or "D". CONCLUSIONS: Thus, branded formulations of the same glucocorticoid, mometasone furoate significantly differed in their topical anti-inflammatory potency. "Elocon" was significantly more potent than the two other branded formulations studied.

Administration, Topical↗
PubMedDate not supplied

Cushing'S syndrome attributable to topical use of lotrisone.

OBJECTIVE: To emphasize the potentially devastating consequences of topical application of corticosteroids. METHODS: A case report is presented of a previously healthy 38-year-old woman in whom florid Cushing's syndrome developed after prolonged use of Lotrisone. RESULTS: Four years of continuous topical administration of Lotrisone, a combination antifungal-corticosteroid product, led to the development of Cushing's syndrome. The cream had been applied to less than 10% of the total body surface area without use of occlusive dressings, and the patient had no evidence of liver dysfunction or systemic skin disorder. Laboratory studies revealed an unmeasurable corticotropin level, suppressed or unmeasurable cortisol levels, and suppressed or low-normal 24-hour urine collection values for 17-hydroxy-steroids, 17-ketosteroids, and urinary free cortisol, all of which confirm suppression of the hypothalamic-pituitary-adrenal axis. CONCLUSION: (1) Betamethasone dipropionate can lead to the development of Cushing's syndrome, even in the absence of enhancing factors. (2) Combination medications can lead to the unintentional use of component agents. (3) Availability of potent corticosteroids as over-the-counter medications allows for inappropriate duration of therapy and inadequate medical supervision.

Journal Article↗
PubMed1995

Pressure ulcers in the nursing home.

OBJECTIVE: To review the literature on the causes, epidemiology, prevention, and treatment of pressure ulcers in nursing homes and to summarize this information for clinicians caring for nursing home residents. DATA SOURCES: A MEDLINE search of English-language articles published between 1980 and October 1994 using the terms decubitus ulcer and elderly. References from identified articles were also examined. STUDY SELECTION: Articles were excluded if the title indicated that patients were not nursing home residents (unless data from nursing homes were limited or unavailable), that patients were not elderly, or that the ulcers were related to peripheral vascular disease or neuropathy. DATA EXTRACTION: Selected studies either contained original data or were meta-analyses. Prevalence studies were required to have an identifiable denominator; risk factor and incidence studies were required to have an identifiable cohort and a specified duration of follow-up. Preference was given to risk factors identified through multivariate analyses. Studies of preventive and therapeutic interventions were required to have an identifiable control group; preference was given to randomized controlled trials. DATA SYNTHESIS: Seventeen percent to 35% of patients have pressure ulcers at the time of admission to a nursing home, and the prevalence of pressure ulcers among nursing home residents ranges from 7% to 23%. Among high-risk patients, the incidence of pressure ulcers is estimated to be 14/1000 patient-days. Residents at higher risk for developing ulcers are those who have limited ability to reposition themselves, cannot sense the need to reposition, have fecal incontinence, or cannot feed themselves. Occlusive dressings are as effective and less costly than traditional wet-to-dry saline dressings for treating earlier stages of pressure ulcers. There is no consensus on the use of specialized beds in the nursing home for promoting the healing of advanced-stage ulcers or for reducing the incidence of ulcers in high-risk patients. Specific interventions should not detract from careful, total assessment and management of the patient. CONCLUSIONS: Pressure ulcers in the nursing home are common problems associated with significant morbidity and mortality. Because resident characteristics can identify residents likely to develop ulcers, preventive measures can be implemented early. Therapy for advanced stages of pressure ulcers is expensive and prolonged. Involvement of the physician with the multidisciplinary nursing home team is essential for prevention and therapy.

Aged↗
PubMed2006

Does amethocaine gel influence blood results obtained from capillary sampling?

UNLABELLED: In many children routine blood samples are obtained by capillary sampling, a technique that appears to cause high levels of pain and distress in the child. Topical anaesthesia might alleviate the pain associated with capillary blood sampling but would it affect the blood sample? AIM: a preliminary study to determine whether topical local anaesthetic would affect the values of commonly performed biochemical tests METHOD: 22 healthy adult volunteers were recruited; each volunteer acted as his or her own control. Ametop was applied to a socially clean digit and covered with an occlusive dressing. After 30 minutes the dressing was taken off and excess gel was removed using a cotton wool ball. Two capillary samples were obtained from each volunteer, one from the Ametop treated digit and one from a digit on the opposing hand. The samples were analysed for sodium, potassium, glucose, urea, alkaline phosphatase (ALP), aspartate aminotransferase (AST), alinine aminotransferase (ALT) and bilirubin using a Vitros Chemistry analyser. Statistical analysis was performed on the blood results using Student's paired t-test. RESULTS: Sodium and potassium levels were significantly higher in the samples from digits with Ametop applied, and alkaline phosphatase was significantly lower. CONCLUSION: The use of amethocaine gel (Ametop) appears to affect the results of both sodium and potassium in capillary blood samples and therefore it cannot be recommended as a suitable agent for topical anaesthesia prior to this procedure.

Administration, Cutaneous↗
PubMedDate not supplied

[Corticotherapy and mucocutaneous pathology].

The tremendous advances in treatment brought about by corticotherapy applied to cutaneo-mucosal pathology should not be allowed to obscure the fact that its action is merely palliative, that it should only be proceeded with after careful diagnosis and that it may trigger undesirable side-effects. General corticotherapy is definitely indicated in certain serious dermatoses (e.g. pemphigus vulgaris) in large doses at the beginning of the course of treatment which often has to be kept up indefinitely; it is in these patients that the most serious accidents occur. It is also indicated in other dermatoses (e.g. lichen planus) in smaller doses and in separate courses, generally triggering incidents and accidents of a less serious nature which to a certain extent seem to be attenuated by taking the drug on alternate days. It is counter-indicated in one particular condition: psoriasis. Corticotherapy by intra- and sub-lesional local injection is most useful in the treatment of certain localised skin lesions (e.g. cheloids) and of the oral mucosa (e.g. erosive lichen planus). Either a few drops are injected or a larger quantity in a suspension of microcrystals. Complications have sometimes been observed in the skin (leukoderma, dermoepidermatrophia and, particularly, amaurosis), but never so far after sub-mucosal injections. Local corticotherapy by external application, very widely used in the form of ointments, creams and lotions for numerous cutaneous conditions may cause various more or less serious local side-effects, the systemic effects with depression of the hypophyso-adrenal axis, only seem to occur to any extent with occlusive dressings. It can also be used in the treatment of some conditions of the oral mucosa (e.g. some forms of lichen planus, benign mucous membrane pemphigoid) by means of either a corticosteroid incorporated into a special excipient which adheres to the mucous membrane or in tablets of 17-betamethasone valerate which gradually break up in the saliva. With the usual posology of 10 tablets of 0.1 mg per day, even over several months, there are no systemic effects, 17-betamethasone valerate (unlike phosphate) having an action which is primarily topic and being practically unabsorbed as has been shown by assessment of plasmatic cortisol.

Administration, Topical↗
PubMedDate not supplied

Vitamin A acid in lichen planus.

Since 1971, Vitamin A acid (VAA) has been used for topical treatment of lichen planus (L.p.) at the 2nd Department of Dermatology in Vienna. During this period, 43 patients have been treated in the following way: for a period up to 3 weeks, a 0.05% or 0.1% VAA cream or solution was applied twice daily to the affected skin or mucosa. In the first days of this therapy, a characteristic local reaction of the L.p. lesions could be observed; first an edematous swelling appeared, followed by scaling and regression of efflorescences. Finally, an inflammatory skin reaction also developed. At this juncture, VAA was abandoned and the treatment was continued with steroid-containing ointments. Occlusive dressings were used only in cases of hypertrophic L.p. The same therapy was performed in L.p. of mucous membranes. By this method it was possible to achieve good therapeutical results in all treated cases. However, the frequency of recurrences of L.p. could not be diminished.

Administration, Topical↗
PubMed2000

Acute toxicity, primary irritancy, and genetic toxicity studies with 3-(methylthio)propionaldehyde.

Basic acute toxicity, primary irritancy, and genetic toxicity studies were conducted with 3-(methylthio)propionaldehyde (3-MTP). The acute rat peroral LD50 (with 95% confidence limits) for 3-MTP as a 25% (v/v) dilution in corn oil was 1.00 (0.59-1.70) ml/kg (males) and 1.68 (0.95-2.99) ml/kg (females); most deaths occurred 1.5 to 4 h postdosing. By 24-h occluded contact with undiluted 3-MTP, the rabbit acute percutaneous LD50 was 0.71 (0.43-1.15) ml/kg (males) and 0.79 (0.49-1.30) ml/kg (females): times to death ranged from 2 h to 2 d after the start of dosing. Exposure of rats to a statically generated saturated atmosphere killed all 5 males with a 40 min exposure and all 5 females with a 24 min exposure. In contrast, a 4-h exposure of rats to a dynamically generated saturated vapor atmosphere of 3-MTP did not produce any mortalities or signs of toxicity. A 4-hr occluded contact with 0.5 ml undiluted 3-MTP caused moderate to severe erythema and severe edema resolving by 7 to 17 d. Five/6 animals had necrosis apparent on removal of the occlusive dressing and persisting 10 to 17 d. On the rabbit eye, 0.1 ml undiluted 3-MTP produced moderate to severe corneal injury with iritis and moderate conjunctival inflammation which persisted 21 d in 3/6 animals; 0.01 ml caused moderate diffuse corneal injury and moderate conjunctival inflammation with healing by 7 d. 3-MTP did not produce mutagenic activity either in the absence or presence of metabolic activation with a Salmonella typhimurium reverse mutation assay using strains TA98, TA100, TA1535, TA1537 and TA1538. In a mouse lymphoma cell (L5178Y/tk +/-) assay, 3-MTP produced concentration-related increases in mutant colonies, both in the absence and presence of metabolic activation. Increases were mainly in the sigma (chromosomal damaging) colonies. In a mouse bone marrow micronucleus study, with vapor exposures to 37.4, 88.5 and 155.6 ppm for 1 h/d for 2 consecutive d, there were exposure concentration-related increases in micronucleated erythrocytes which were statically significant for male mice.

Administration, Cutaneous↗
PubMedDate not supplied

Physiology of wound healing.

Wound healing is a complicated process that recruits at least 4 distinct cell types. Though the process is continuous, it is commonly referred to as occurring in "phases." The main phases of wound healing include coagulation, which begins immediately after injury; inflammation, which initiates shortly thereafter; a migratory and proliferative process, which begins within days and includes the major processes of healing; and a remodeling process, which may last for up to a year and is responsible for scar tissue formation and development of new skin. Wound healing is affected by several factors. These include local factors (growth factors, edema and ischemia, low oxygen tension, and infection), regional factors (arterial insufficiency, venous insufficiency, and neuropathy), systemic factors (inadequate perfusion and metabolic disease), and other miscellaneous factors, such as nutritional state, preexisting illnesses, exposure to radiation therapy, and smoking. In general, chronic wounds may be managed by preventing or medically treating infections through debridement and occlusive dressings. For wounds that are unresponsive to such interventions, the use of skin replacements is becoming a viable option. In this regard, a product such as Graftskin (APLIGRAF, Organogenesis Inc, Canton, MA, and Novartis Pharmaceuticals Corporation, East Hanover, NJ), a bilayered living skin construct with allogeneic dermis and epidermis, is a positive development.

Blood Coagulation↗
PubMed1975

Perils and pitfalls of open tibial fractures.

The status of the fibula is an index of the severity of injury. Open tibial fracture with associated fractured fibula is more likely to develop complications. Antibiotics should be started promptly. Judicious debridement is essential but bone fragments should be left whenever possible. When there is any question about contamination, the wound is best left open. Rigid occlusive dressings promote epithelial ingrowth. Fracture distraction and plate fixation are associated with a high incidence of complications.

Adult↗