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PubMed1989

Effective topical dermatologic therapy.

Experienced dermatologists regularly use a great variety of topical dermatologic mixtures. Extemporaneously prepared medications are of great value in the treatment of those problems that fail to respond to the usually therapeutic commercially available products. These mixtures are also desirable in treating individuals in whom corticosteroid preparations were initially beneficial but were of less value with continued application. This article presents an accumulation of a quarter century of practical extemporaneously compounded dermatologic preparations.

Administration, Topical↗
PubMed1981

[Laser in dermatology: biological effects; indications (author's transl)].

The various laser-systems can be classified according to: 1) the wavelength or range of wavelengths of the beam and 2) the method of delivery of the laser output: continuous or pulsed. -- Principal continuous-wave lasers are: -- the argon-ion laser, which produces multiple transitions ranging from 448 to 544 nm, -- the neodymium yttrium aluminium garnet (Y. A. G.) operating in the near infrared at a wavelength of 1,060 nm, -- and the carbon-dioxide laser with its output occurring in the far infrared, at 10,600 nm. Continuous-wave lasers induce essentially thermal effects which are used to coagulate or volatilize various superficial skin lesions. But when high power density is required, the relative benefit of lasers as compared with other conventional thermal devices (such as high-frequency electrocoagulator) is not obvious. On the other hand, the argon laser is capable of selectivity damaging pigmented cutaneous lesions with satisfactory healing of the laser wound and sparing of the overlying skin. This selective absorption is useful in the treatment of some vascular lesions such as port-wine stain or melanotic lesions or tattoos, and gives a good results. The specific color absorption is not so pronounced with the Nd-YAG laser and is absent with the carbon dioxide laser, chiefly used as an "optical scalpel". Photochemical effects produced by other continuous-wave lasers such as U.V. lasers, seem to be of interest in photobiology research and in destruction of tumors after the addition of a colorant. -- Pulsed laser systems produce not only thermal but also "non-linear" reactions, which are not well-known. The classical ruby laser is still appropriate in the treatment of some skin lesions.

Humans↗
PubMed1998

Selective serotonin reuptake inhibitors in the treatment of affective disorders--III. Tolerability, safety and pharmacoeconomics.

The clinical use of tricyclic antidepressants (TCAs) is often complicated by toxicity and safety problems due to their effects on multiple mechanisms of action, many of which are unnecessary for therapeutic effect. The development of the selective serotonin reuptake inhibitors (SSRIs), with their selective mode of action, has resulted in a class of antidepressant drugs possessing an improved side-effect profile, while retaining good clinical efficacy. Their introduction into clinical practice has led to enhanced patient compliance with antidepressant therapy and the ability to maintain treatment over longer periods of time at an adequate therapeutic dose. Although, as a result of their selective action, side-effects associated with SSRI therapy are minimised, distinct variations between individual SSRIs in terms of their tolerability profiles have been observed. The wealth of clinical data now available has revealed differences in their potential to cause psychiatric and neurological side-effects, dermatological reactions, anticholinergic side-effects, changes in body weight, sexual dysfunction, cognitive impairment, discontinuation reactions and drug-drug interactions. Patients who suffer from concomitant depression and physical illness may experience different tolerability profiles, in addition to the greater likelihood that they will be receiving concomitant medications with the potential for pharmacokinetic drug-drug interactions with coadministered SSRI therapy. In addition, the safety margin of SSRIs in overdose may vary within the group. Knowledge of the differences that exist among the SSRIs in respect of tolerability and safety will aid physicians in the selection of the most beneficial treatment strategy for their patients. A successful clinical outcome leads to a reduced economic burden for the patient, their family and the healthcare services. Thus, pharmacoeconomic considerations are also important in choosing antidepressant therapy. The SSRIs, despite relatively higher prescription costs, have been demonstrated to be a more cost-effective option than the TCAs. Furthermore, there is evidence that the emerging clinical differences between SSRIs may translate into significantly different economic outcomes within the group.

Antidepressive Agents, Second-Generation↗
PubMed1995

Soft tissue augmentation. A review.

BACKGROUND: Soft tissue augmentation is one of the most sought after cosmetic procedures around the world. It has been performed for centuries, but only in this decade or so have materials become available that allow effective therapy. OBJECTIVE: This review article discusses the use of materials for soft tissue augmentation as to where they fit into the overall scheme of treating the aging face, as well as the benefits and side effects of each, and how to maximize the use of these various materials. RESULTS: The materials reviewed with regard to both efficacy and safety of those currently on the market as well as those currently in research. CONCLUSION: With the understanding of the role of soft tissue augmentation in the overall treatment of the aging face as well as risk factors and ways to minimize the side effects, dermatologic surgeons can reach the goal of effectively treating patients with these materials.

Biocompatible Materials↗
PubMed1984

Dermatological problems with synthetic resins and plastics in glues. Part I.

In order to understand the medical implications of using adhesives a few remarks are made concerning forces which may be active in bonding two materials. Knowledge about the exact chemical composition of adhesives is essential for understanding possible untoward dermatological effects which are to be expected if the transition from a viscous to a solid state is based on chemical reactions between chemically active constituents. A number of examples are given about cited or suspected dermatologically untoward effects in using various types of glues and dental composite restorative resins.

Adhesives↗
PubMed2006

[Health economics studies in dermatology].

Because of reduced resources for health care, provision of modern effective dermatologic care for patients with German public health insurances has become more and more difficult. This survey is designed to aid in the assessment of published health economic studies as well as encourage participation in health economic evaluations. These studies should analyze and optimize the allocation of the available resources. Four main approaches can be used to calculate the incidental expenses; they differ in their methods of evaluation and assessment of health services. They all offer methods to calculate the anticipated costs and consequences. The methods include cost minimization analysis (CMA), cost effectiveness analysis (CEA), cost utility analysis (CUA) or cost benefit analysis (CBA). Many subgroups also exist. Important criteria for the evaluation of health economic trials and hints for the publication of the results are provided on the basis of the recommendations for health economic evaluations.

Clinical Trials as Topic↗
PubMed1994

Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy.

OBJECTIVES: This meta-analysis was performed to determine whether corticosteroid therapy induces the development of peptic ulcer and other putative complications of steroid therapy. DESIGN: A retrospective investigation in which we analysed all the randomized, double-blind, controlled trials (RDBCT) in which steroids had been administered that we were able to identify. The number of episodes of peptic ulcer, dermatological effects, sepsis, diabetes, hypertension, osteoporosis, psychosis and tuberculosis reported in both the placebo and steroid groups were compared. SETTING: The international medical literature was analysed for any RDBCT in which any steroid or ACTH had been administered in any dosage for any duration, and any putative complication of steroid therapy was reported. SUBJECTS: Of 1857 articles, 93 satisfied our requirements and were analysed by the meta-analytic techniques of Peto, DerSimonian and Laird. A total of 6602 patients were included. MAIN OUTCOME MEASURES: The relative frequencies of each of these eight 'complications' were compared in the placebo and steroid groups using conventional statistics and meta-analysis. The relative frequencies of 'annualized' subgroups of patients who received treatment for 1 to 7 days, 1 week to 1 month, 1 to 3 months and more than 3 months, were similarly analysed. RESULTS: Nine of 3267 patients in the placebo group (0.3%) and 13 of 3335 patients in the steroid group (0.4%) were reported to develop peptic ulcer (P > 0.05). The dermatological cosmetic effects of steroid therapy were observed more frequently in the steroid group (P < 0.001), as was diabetes (P < 0.001), hypertension (P < 0.01) and psychosis (P < 0.001). Sepsis, osteoporosis and tuberculosis all occurred more frequently in the steroid than in the placebo group, but the differences are not statistically significant. CONCLUSIONS: Peptic ulcer is a rare complication of corticosteroid therapy that should not be considered a contraindication when steroid therapy is indicated.

Adrenal Cortex Hormones↗
PubMed1989

[Dermatologic manifestation of undesirable effects of drugs (excluding cytostatic drugs)].

Medications, consumed more and more frequently as a result of self-medication or prescribed under medical supervision, have multiple side effects, including dermatological ones. In fact, the latter represent the primary cause of drug intolerance. However, the diagnosis is not always made easily and is based upon standardized norms defined by pharmacology control centers. Fixed pigmented eruptions are the only erythema solely of drug-induced origin. Failure to recognize a drug-induced dermatological manifestation can be fatal if the drug is taken again, as in the case of toxic epidermal necrolysis.

Autoimmune Diseases↗
PubMed2006

Safety of traditional arab herbal medicine.

Herbal remedies are widely used for the treatment and prevention of various diseases and often contain highly active pharmacological compounds. Many medicinal herbs and pharmaceutical drugs are therapeutic at one dose and toxic at another. Toxicity related to traditional medicines is becoming more widely recognized as these remedies become popular in the Mediterranean region as well as worldwide. Most reports concerning the toxic effects of herbal medicines are associated with hepatotoxicity although reports of other toxic effects including kidney, nervous system, blood, cardiovascular and dermatologic effects, mutagenicity and carcinogenicity have also been published in the medical literature. This article presents a systematic review on safety of traditional Arab medicine and the contribution of Arab scholars to toxicology. Use of modern cell biological, biochemical, in vitro and in vivo techniques for the evaluation of medicinal plants safety is also discussed.

Journal Article↗
PubMed1979

Comparisons of tolerability findings in international clinical trials.

This report summarizes tolerability results from over 30 000 patients treated with diclofenac in clinical trials in rheumatic and other indications in 21 countries. Comparative trials indicates that 75-150 mg daily of diclofenac is better tolerated than similar doses of indomethacin and 1.5-5 g daily of aspirin, and at least as well tolerated as 600-1200 mg of ibuprofen and 500 mg daily of naproxen. In general practice populations unwanted effects can be expected in about 18% of patients and will result in discontinuation in about 4%. Gastrointestinal disturbances were the most frequent unwanted effects with diclofenac, occurring in about 8% of patients. Mild CNS effects also occurred infrequently in about 1.5% and dermatological effects in about 1%; cardiovascular effects also occurred in about 1%. As over 80% of unwanted effects and all of the discontinuations for intolerability occurred in the first six months, the tolerability of diclofenac does not decrease with time.

Arthritis, Rheumatoid↗
PubMed1982

[Hematologic and dermatologic side-effects of antibiotic therapy].

The report details possible haematological and dermatological side effects due to co-trimoxazole: agranulocytosis and epidermiolysis bullosa (Lyell) respectively developed after short-term therapy with co-trimoxazole in two women treated for tonsillitis and acute relapse of chronic obstructive bronchitis respectively. The clinical findings, therapeutical management and clinical outcome of both patients are described. Reviewing the literature the relevance of co-trimoxazole induced side effects is discussed.

Aged↗
PubMed1998

Lack of nephrotoxicity and renal cell proliferation following subchronic dermal application of a hydroquinone cream.

Hydroquinone (HQ) is used in over-the-counter formulations of skin-lightening creams sold in the United States and European Union. HQ was introduced into these formulations to provide a safe and effective alternative to mercury and other less effective ingredients. Recent studies involving subchronic oral exposure of male F344 rats to HQ have shown nephrotoxicity and renal tubule cell proliferation (English et al., 1994), while chronic exposures of male F344 rats were reported to cause renal cell adenomas (NTP, 1989). Previous subchronic dermal toxicity studies (CTFA, 1986; NTP, 1989) with HQ failed to detect nephrotoxicity; however, these studies were not specifically designed to assess renal structure and function. More sensitive endpoints were used in the present subchronic study to address concerns over potential toxicity from repeated dermal exposure to HQ. Male and female F344 rats were given topical applications with 0, 2.0, 3.5, or 5.0% HQ in an oil-in-water emulsion cream for 13 wk (5 days/wk). Body weights, feed consumption and water consumption were monitored, and animals were observed for clinical signs of toxicity and dermal irritation. Blood taken at termination was analysed for haematological and clinical chemistry effects. Erythema, which abated when exposure stopped, was the only dermatological effect seen at the HQ-cream application sites. Cell proliferation in the kidneys was evaluated after 3, 6 and 13 wk of treatment using bromodeoxyuridine (BrdU) labelling, but no changes indicative of sustained cell proliferation were seen. The renal histopathological lesions noted after oral exposure to HQ were not present after dermal exposure. Thus, topical exposure to HQ does not result in the renal toxicity observed in previous studies with F344 rats given HQ orally.

Administration, Cutaneous↗