Multicenter study for efficacy and safety evaluation of a fixeddose combination gel with adapalen 01% and benzoyl peroxide 2 5% (Epiduo® for the treatment of acne vulgaris in Brazilian population

Abstract: BACKGROUND: The current options for the treatment of acne vulgaris present many mechanisms of action. For several times, dermatologists try topical agents combinations, looking for better results. OBJECTIVES: To evaluate the efficacy, tolerability and safety of a topical, fixed-dose combination of adapalene 0.1% and benzoyl peroxide 2.5% gel for the treatment of acne vulgaris in the Brazilian population. METHODS: This is a multicenter, open-label and interventionist study. Patients applied 1.0 g of the fixed-dose combination of adapalene 0.1% and benzoyl peroxide 2.5% gel on the face, once daily at bedtime, during 12 weeks. Lesions were counted in all of the appointments, and the degree of acne severity, overall improvement, tolerability and safety were evaluated in each visit. RESULTS: From 79 recruited patients, 73 concluded the study. There was significant, fast and progressive reduction of non-inflammatory, inflammatory and total number of lesions. At the end of the study, 75.3% of patients had a reduction of >50% in non-inflammatory lesions, 69.9% in inflammatory lesions and 78.1% in total number of lesions. Of the 73 patients, 71.2% had good to excellent response and 87.6% had satisfactory to good response. In the first week of treatment, erythema, burning, scaling and dryness of the skin were frequent complaints, but, from second week on, these signals and symptoms have reduced. CONCLUSION: The fixed-dose combination of adapalene 0.1% and benzoyl peroxide 2.5% gel is effective, safe, well tolerated and apparently improves patient compliance with the treatment.

Mycobacterium chelonae cutaneous infection in a patient with mixed connective tissue disease

Around 50 mycobacteria species cause human disease. Immunosuppressive states predispose to non-tuberculous mycobaterium infection, such as Mycobacterium chelonae: AFB, non-tuberculous, fast growth of low virulence and uncommon as a human pathogen. It may compromise the skin and soft tissues, lungs, lymph nodes and there is also a disseminated presentation. The diagnosis involves AFB identification and culture on Agar and Lowenstein-Jensen medium base. A 41-year-old female with MCTD (LES predominance) is reported, presenting painless nodules in the right forearm. She denied local trauma. Immunosuppressed with prednisone and cyclophosphamide for 24 months. Lesion biopsy has demonstrated positive bacilloscopy (Ziehl-Neelsen stain) and M.chelonae in culture (Lowenstein-Jensen medium base), therefore clarithromycin treatment has been started (best therapy choice in the literature).

Estudo das mudanças quali e quantitativas da participação de ácidos graxos no sebo de pacientes com acne inflamatória, graus II ou III, em uso sistêmico de limeciclina e/ou suplementação oral à base de ácidos linoleico, gamalinolênico / Study of qualitative and quantitative changes of fatty acids in the sebum of patients with inflammatory acne, grade II or III, under systemic use of lymecycline and/or oral supplementation based on linoleic, gamma-linolenic, and oleic acids using gas

Introdução: Acne é uma dermatose que apresenta o padrão do sebo alterado, tanto quali, quanto quantitativamente. Objetivos: Estudar as possíveis alterações quali e quantitativas dos ácidos graxos encontrados no sebo de portadores de acne vulgar graus II ou III mediante ao uso diário de limeciclina e/ou suplemento oral a base de ácidos linoleico, gamalinolênico e oleico. Métodos: Quarenta e cinco sujeitos de pesquisa masculinos, de 12 a 40 anos de idade, portadores de acne vulgar graus II ou III, submeteram-se a 90 dias de uso de: Grupo A, 300mg/dia de limeciclina; Grupo B, 540mg de ácidos gamalinolênico, 1.200mg linoleico e 510mg oleico/dia; Grupo C: Grupos A+B. A cada 30 dias, eles tinham amostra de sebo da fronte coletada para análise cromatográfica dos ácidos graxos nele presentes. Resultados: Quarenta sujeitos de pesquisa (88,9 por cento) concluíram o estudo, os quais ingeriram todas as doses dos produtos, sem apresentarem eventos adversos em qualquer dos Grupos. O número de comedões, pústulas e cistos reduziu com o tempo (p<0,001, para todos), nos três Grupos. Com relação ao número total de lesões, houve uma maior quantidade de lesões em pacientes do Grupo B, quando comparados aos do Grupo A (p=0,033) e aos do Grupo C (p=0,030). Sete ácidos graxos apresentaram mudanças de seu padrão durante o estudo. De um modo geral, as mudanças que se tornaram mais evidentes foram: 1) a concentração de esqualeno no SB não reduziu em qualquer Grupo de estudo; 2) C12:0, C14:0 e C16:1 tiveram suas respectivas concentrações aumentadas nos três Grupos com o tempo de terapêuticas; 3) há indicativo de aumento de C18:1n9c+C18:1n9t na associação das duas classes terapêuticas estudadas; 4) limeciclina e/ou ingestão de ácido linoleico não aumentaram a participação do ácido linoleico no sebo; 5) ácido -linolênico teve sua concentração aumentada e, depois diminuída com o uso de LM e/ou com sua própria suplementação oral...

Introduction: Acne is a dermatosis that presents an altered sebum pattern, quantitatively and qualitatively. Objectives: To study the possible quantitative and qualitative changes of fatty acids found in the sebum of patients with acne vulgaris grade II or III, through the daily use of lymecycline and/or oral supplementation based on linoleic, gamma-linolenic, and oleic acids. Methods: Fortyfive male research subjects, ages 12 to 40, presenting acne vulgaris grade II or III, were submitted to a 90-day use of: Group 1, 300mg of lymecycline per day; Group 2, 540mg of gamma-linolenic acid, 1,200mg of linoleic acid, and e 510mg of oleic acid per day; Group 3: Groups A+B. Every 30 days, a sample of the sebum of their forehead was collected for chromatographic analysis of the fatty acids contained therein. Results: Forty research subjects (88.9 percent ) concluded the study. They ingested all dosages of the products, without presenting side effects in any of the Groups. The number of comedones, pustules, and cysts reduced with time (p<0.001, for all), in all the 3 Groups. With respect to the total number of lesions, Group B´s patients presented a larger quantity of lesions, as compared to those of Group A (p=0.033) and Group C (p=0.030). Seven fatty acids presented pattern changes during the study. In general, the changes that became more evident were: 1) the squalene concentration in the sebum did not diminish in any Group under study; 2) C12:0, C14:0, and C16:1 had their respective concentrations increased in the 3 Groups over the time of the treatments; 3) there is an indication for increasing of C18:1n9t+C18:1n9c when both of therapies are associated; 4) lymecycline and/or the ingestion of linoleic acid did not increase the participation of linoleic acid in the sebum; and 5) gama-linolenic acid had its concentration increased during the first 60-day and diminished during the last 30-day therapies period using lymecycline and/or with its own oral supplementation...

Estudo in vivo de atividade anti-radicalar por quantificação de peróxidos cutâneos / In vivo antiradicalar activity by skin peroxidies quantification

FUNDAMENTOS: O organismo humano possui eficientes mecanismos de defesa contra os radicais livres. A relação causal observada entre estresse oxidativo e diversos processos degenerativos despertou o interesse para a exploração de diversos antioxidantes. OBJETIVOS: Este trabalho propõe um método in vivo para comprovação da eficácia de um novo complexo de alta atividade anti-radicalar (acetato de tocoferila, licopeno e mistura de ácidos clorogênicos rica em ácido caféico). MÉTODOS: Neste ensaio, não invasivo e placebo controlado, a medida da taxa de peróxido cutâneo realizou-se em diferentes áreas - três após a incidência da radiação UV, duas tratadas, uma não tratada, e uma não tratada e não irradiada. A presença do peróxido foi detectada pela aplicação de sonda fluorescente em adesivo específico, que retirou uma amostra do estrato córneo dos sítios supracitados. O cálculo da proteção anti-radicalar dá-se em função das unidades fluorimétricas obtidas. RESULTADOS: Tomando-se como base áreas controles não irradiadas, as áreas irradiadas e tratadas com o complexo estudado apresentaram concentrações 116 por cento menores (p=0,02 por cento) de peróxidos cutâneos, com significância estatística em relação às áreas apenas irradiadas. Já as áreas irradiadas e tratadas com o placebo apresentaram concentrações apenas 49 por cento menores (p=0,501), o que não é estatisticamente significativo em comparação às áreas irradiadas. CONCLUSÃO: Os resultados obtidos indicam que o complexo estudado possui significativa capacidade protetora da pele contra a ação de radicais livres formados a partir da exposição solar.

BACKGROUND: Our organism has important defense mechanisms against free radicals. The causal relationship observed among the oxidative stress and degenerative problems in humans, are getting attention for the exploration of antioxidant agents. OBJECTIVES: This study proposes an in vivo methodology for proving the efficacy of a new high-activity antioxidant complex (tocopheryl acetate, licopene and a pool of chlorogenic acids rich in cafeic acid). METHODS: In this non-invasive and placebo controlled assay, the measure of the peroxide rates was performed in different areas, three after UV radiation, two treated, one non-treated, and an other non-treated and non-irradiated. The peroxide presence was detected through a fluorescent probe on samples stripped form the sites above mentioned. The free-radical scavenger activity is calculated through the fluorimetry results. RESULTS: Based on non-irradiated areas dataÆs, the irradiated and complex-treated areas presented skin-peroxide concentration 116 percent lower, statistically significant (p=0,02 percent) compared to the non-treated irradiated areas. Although, placebo-treated irradiated areas presented skin-peroxide concentration 49 percent lower, a non-statistically significant rate (p=0,501 percent) compared to the irradiated areas. CONCLUSION: The results indicate that studied-complex, have significant skin-protective action against the free-radicals, usually formed after sun exposure.

Avaliação imunológica na endocardite infecciosa / Immunologic evaluation in infective endocarditis

OBJECTIVE: To analyze the immune response in peripheral blood of patients with infective endocarditis. METHODS: We studied 10 patients with infective endocarditis, age range from 20 to 50 years-old, males and females, and 20 healthy subjects in the same age range. The diagnosis of the disease was based on the clinical picture, echocardiogram, and hemoculture based upon samples drawn and tested before the treatment started. The were no history of atopy or malnutrition, no autoimmune disease, and they were not using any immunosuppressant or antibiotic medication. RESULTS: The patients with endocarditis had significantly higher T and B lymphocyte, CD4+ and CD8+ cell counts, IgM and IgG serum levels, and C4 component of the complement than the control group; no significant difference concerning serum IgA and neutrophil oxidative metabolism; a significant decrease in C3, chemotaxis, and monocyte phagocytosis;cryoglobulins were detected in 66.6 percent of patients and they were formed by IgG, IgM, IgA, C3, and C4. CONCLUSION: The patients with infective endocarditis were immunocompetent in most sectors of immune response and, at a certain moment, an autoimmune component may be present