Efficacy and safety of 0.1% kinetin cream in the treatment of photoaging skin.

Background: Kinetin is a plant‑derived compound, which is reported to possess antiaging properties. It has been used in a topical cream to manage facial photo‑damage and aging. Although studies elsewhere have shown its benefits, not many studies of the effects of kinetin in Asian skin are available. Objectives: To assess the efficacy and tolerability of 0.1% kinetin cream in the treatment of facial photo‑aging. Methods: The study was designed to be open‑label and single‑blinded, without a control group. One hundred Thai female and male subjects with mild, moderate or severe facial photo‑damage were enrolled. They were asked to apply 0.1% kinetin cream twice daily for 12 weeks and follow up at 4, 8, and 12 weeks. Subjective patient self‑assessment and physician assessment of facial skin photo‑damage were accompanied by digital photographic analysis using the VISIA® (Canfield Scientific Inc, Fairfield, NJ) imaging system. Results: At baseline, most patients reported moderate skin changes related to photo‑damage, skin texture, skin color and wrinkles. After 12 weeks, physician and patient assessments showed slight but statistically significant improvements in overall skin condition, skin texture, color, and wrinkles. Findings were similar with the digital photographic system analysis, especially in relation to skin color. Facial ultraviolet spots and redness also showed statistically significant improvements after 12 weeks. The treatment was generally well tolerated. Limitations: The study was designed to be pragmatic and hence no randomization was carried out; there were also no intrapatient or interpatient control observations, and no comparison arm. Conclusion: Kinetin (0.1%) cream was found to slightly improve cutaneous facial photo‑damage after 12 weeks of use in a group of Thai patients.

Validation of the diagnostic criteria for atopic dermatitis in the adult Thai population.

Atopic dermatitis is a chronic inflammatory skin disorder, for which it is difficult to obtain epidemiologic findings. In a previous study, we suggested the following diagnostic criteria for atopic dermatitis in the adult Thai population: visible flexural dermatitis, a history of flexural dermatitis, a rash of more than six months duration and visible dry skin. However these criteria were not validated against physicians' diagnoses. In the present study, we validated these diagnostic criteria for atopic dermatitis in the Thai population in a clinical setting. A case-controlled study was performed on a total of 259 patients; 33 subjects with active atopic dermatitis, 26 with inactive atopic dermatitis, 100 controls presenting with an inflammatory skin disorder other than atopic dermatitis and 100 controls without any skin disease. Each patient was examined according to the above criteria. Sensitivity, specificity, relative value, positive predictive value, and negative predictive value were calculated for each individual criterion and for composite criteria. Our data confirmed that in order to achieve satisfactory sensitivity and specificity for diagnosing atopic dermatitis in Thai people older than 13 years, a patient must have a history of flexural dermatitis plus two or more of the other mentioned criteria.

Histopathologic aid to diagnosis of sarcoidosis: report of 8 cases.

Sarcoidosis is a multisystemic disease of unknown etiology. The disease is common in blacks and is very rare in Thailand. It presents as one of the most variable manifestations usually affecting the lungs and intrathoracic lymph nodes. Other organs such as liver, spleen, joints and eyes including skin are also involved The common cutaneous lesions are maculopapular, erythematous plaque, subcutaneous nodule, scar and lupus pernio. No reliable indicator is useful for diagnosis except the histopathologic change which is the only way for approaching this disease. Sarcoidosis is the disease of exclusion. Various infections producing granulomas should be excluded histologically. The ultimate diagnosis requires clinical correlation, laboratory investigations, chest X-ray as well as available tissue culture. Herein, the authors reported eight cases of sarcoidosis by retrospective study primarily diagnosed by histopathological findings at Siriraj Hospital from January, 1997 to December, 2004 with many different clinical presentations. Despite the diverse clinical pictures, interestingly, the presented patients almost had the same histopathologic findings as small, uniform, discrete naked granulomas usually without necrosis. These findings act as a hallmark for diagnosis of this disease.

Unit cost analysis of dermasurgery unit’s services.

Objective: The purpose of this study was to determine the cost and unit cost of Dermasurgery Unit’s services through the perspective of a healthcare provider. Methods: This was a retrospective study, based on the database of the Department of Dermatology and the Department of Finance, Faculty of Medicine Siriraj Hospital, including labor cost, material cost, capital cost and number of patients from documents of Dermasurgery Unit and SAP system during April 1 – September 30, 2005. Unit cost calculation was based on the official method of Cost Controlling Unit, Department of Finance, Faculty of Medicine Siriraj Hospital. Results: The results demonstrated that the total direct cost of the Dermasurgery Unit was 1,302,798 baht. It composed of the labor cost of 690,752 baht, the material cost of 142,299 baht and the capital cost of 469,747 baht. Indirect cost of Dermasurgery Unit derived from 20% of the total direct cost was 260,560 baht. Finally, the full cost calculated by a summation of the total direct cost and the indirect cost was 1,563,359 baht. Unit cost of carbon dioxide (CO2) laser, Q-switched Nd:YAG laser, pulsed dye laser, skin biopsy, electrocautery and cryosurgery were 1,413.11 baht, 1,272.52 baht, 2,795.35 baht, 485.89 baht, 326.92 baht and 119.53 baht, respectively. The other treatments such as chemical peeling, intramuscular injection, intralesional corticosteroids injection, comedone extraction, wound dressing, trichloracetic acid application, suture removal, excision, iontophoresis and paring had the same unit cost of 115.15 baht. Conclusion: The study enabled us to know the unit cost of Dermasurgery Unit’s services which may be used as primary information for pricing strategy and resources allocation by the administrative board of the Department of Dermatology.

Transepidermal water loss, hydration, pH and elasticity of skin in atopic dermatitis and normal Thai subjects.

In order to obtain objective data on skin functions in patients with atopic dermatitis (AD), we studied, by means of measurement of transepidermal water loss (TEWL), skin surface hydration, pH, and elasticity of dry and normal skin at the dorsum and volar aspects of the forearms in patients with atopic dermatitis compared with normal subjects. Transepidermal water loss (TEWL), skin surface hydration, pH, and elasticity function were measured using Tewameter TM 210, Corneometer CM 820, Skin-pH-meter pH 900, and Cutometer SEM 575, respectively. Forty-one subjects, twenty-five atopic dermatitis patients with dry skin, sixteen atopic dermatitis patients without dry skin, and twenty normal subjects, were recruited in the study. Considering all skin sites together, no significant differences were found between the mean values of TEWL in the same sites, the dorsum and volar forearms, of subjects in each group of patients (p = 0.717, and p = 0.981, respectively). Statistically, there were significant differences between the mean values of skin surface hydration at the dorsum and volar forearms (p = 0.019 and p = 0.019, respectively) and skin pH at the dorsum and volar forearms (p = 0.036 and p = 0.043, respectively). Regarding the elasticity function of the dorsum, immediate recovery and biological elasticity were significant differences in each group of the patients (p = 0.048 and p = 0.019, respectively), meanwhile, the elasticity function of the volar forearms, immediate recovery, elasticity index, elastic recovery index, viscoelastic ratio and relative elastic recovery were significant differences (p = 0.014, p = 0.029, p < 0.001, p < 0.001 and p < 0.001, respectively). Therefore, further well-controlled studies, investigating the skin morphology of patients with atopic dermatitis, should be pursued to provide more targeted therapies and establish an optimal standard of care for all patients with atopic dermatitis.