Effects of oral isotretinoin therapy on the nasal cavities / Efeitos nasais da terapia com isotretinoína oral

Abstract Introduction Isotretinoin (13 cis-retinoic acid) is the most effective treatment for acne vulgaris and is the only treatment option that can provide either remission or a permanent cure. Objective The aim of this study was to use both subjective and objective methods to assess the nasal complaints of patients with severe acne who received oral isotretinoin therapy. Methods Fifty-four subjects were enrolled in the study. All the subjects were assessed with subjective (NOSE and VAS questionnaires) and objective (rhinomanometry and saccharine) tests to determine the severity of their nasal complaints. Results The mean severity scores (min: 0; max: 100) for nasal dryness/crusting and epistaxis were 0.47 ± 1.48 (0-5); 0.35 ± 1.30 (0-5) at admission, 3.57 ± 4.45 (0-10); 2.26 ± 4.71 (0-20) at the first month, and 4.28 ± 6 (0-20); 2.26 ± 4.71 (0-20) at the third month of the treatment respectively. Total nasal resistance of 0.195 ± 0.079 (0.12-0.56) Pa/cm3/s at admission, 0.21 ± 0.084 (0.12-0.54) Pa/cm3/s at the first month, and 0.216 ± 0.081 (0.14-0.54) Pa/cm3/s at the third month. Conclusion Oral isotretinoin therapy can cause the complaint of nasal obstruction. In addition, nasal complaints, such as dryness/crusting and epistaxis, significantly increase in patients during the therapy schedule.

Resumo Introdução A isotretinoína (ácido-13 cis-retinóico) é o tratamento por via oral mais eficaz para acne vulgar e é a única opção de tratamento que pode produzir remissão ou cura permanente. Objetivo Usar métodos subjetivos e objetivos para avaliar as queixas nasais de pacientes com acne grave que receberam terapia com isotretinoína oral. Método Foram incluídos no estudo 54 indivíduos. Todos os indivíduos foram avaliados por meio de testes subjetivos (questionários NOSE e escala EVA) e objetivos (rinomanometria e teste de sacarina) para determinar a gravidade de suas queixas nasais. Resultados Os escores médios de gravidade (min: 0; max: 100) para ressecamento/crostas e epistaxe nasal foram de 0,47 ± 1,48 (0-5); 0,35 ± 1,30 (0-5) no início, 3,57 ± 4,45 (0-10); 2,26 ± 4,71 (0-20) no primeiro mês e 4,28 ± 6 (0-20); 2,26 ± 4,71 (0-20) no terceiro mês do tratamento, respectivamente. A resistência nasal total foi de 0,195 ± 0,079 (0,12 a 0,56) Pa/cm3/s no início, 0,21 ± 0,084 (0,12 a 0,54) Pa/cm3/s no primeiro mês e 0,216 ± 0,081 (0,14 a 0,54) Pa/cm3/s no terceiro mês. Conclusão A terapia com isotretinoína por via oral pode resultar em queixa de obstrução nasal. Além disso, queixas nasais, tais como ressecamento/formação de crostas e epistaxe, aumentam significativamente nos pacientes durante o esquema terapêutico.

Profile of wound healing process induced by allantoin / Perfil do processo de cicatrização induzido pela alantoína

PURPOSE: To evaluate and characterize the wound healing process profile induced by allantoin incorporated in soft lotion oil/water emulsion using the planimetric and histological methods. METHODS: Female Wistar rats (n=60) were randomly assigned to 3 experimental groups: (C) control group-without treatment; (E) group treated with soft lotion O/W emulsion excipients; (EA) group treated with soft lotion O/W emulsion containing allantoin 5 percent. The emulsions either containing or not allantoin were topically administered for 14 days and the wound area was evaluated by planimetry and by qualitative and quantitative histological analysis of open wound model. RESULTS: The data which were obtained and analyzed innovate by demonstrating, qualitatively and quantitatively, by histological analysis, the profile of healing process induced by allantoin. The results suggest that the wound healing mechanism induced by allantoin occurs via the regulation of inflammatory response and stimulus to fibroblastic proliferation and extracellular matrix synthesis. CONCLUSION: This work show, for the first time, the histological wound healing profile induced by allantoin in rats and demonstrated that it is able to ameliorate and fasten the reestablishment of the normal skin.

OBJETIVO: Avaliar e caracterizar o perfil cicatricial induzido pela alantoína incorporada em uma emulsão óleo/água, sob os aspectos planimétrico e histológico. MÉTODOS: Ratos Wistar fêmeas (n=60) foram agrupados aleatoriamente em três grupos experimentais grupo controle - sem tratamento (C); grupo tratado com emulsão pura (E); grupo tratado com emulsão contendo 5 por cento de alantoína (EA). As emulsões contendo ou não alantoína foram administradas topicamente durante 14 dias e a área da ferida foi avaliada por planimetria e por análise histológica qualitativa e quantitativa em modelo de ferida aberta. RESULTADOS: Na análise planimétrica não foi observado diferenças significativas entre os grupos experimentais. Os resultados da análise histológica sugerem que o mecanismo de cicatrização induzido pela alantoína ocorre via controle da resposta inflamatória e estímulos à proliferação fibroblástica e síntese de matrix extracelular de maneira mais intensa e rapidamente em relação aos grupos controles. CONCLUSÃO: Este trabalho mostra pela primeira vez o perfil histológico de cicatrização induzido pela alantoína em ratos, demonstrando ser capaz de melhorar e acelerar o processo de reconstituição da pele.

Experiencia clínica de un tratamiento a base de vitamina C glicosilada, ácido salicílico y zincadone ATM en hombres chilenos con piel mixta a grasa hasta acné inflamatorio leve / Action and tolerance of a formulation with glycosylated vitamin C, zincadone ATM and salicylic acid on Chilean male patients with greasy or mixed normal/greasy skin and/or mild inflammatory acne

Con el fin de evaluar la acción y tolerancia de una formulación a base de vitamina CG, Zincadone ATM y ácido salicílico se reclutaron 65 hombres con piel facial mixta, seborreica y/o con acné inflamatorio leve. Durante un período de 60 días se realizó un estudio clínico abierto y prospectivo en el cual se cuantificó clínicamente el número de lesiones no inflamatorias e inflamatorias, se evaluó el grado de dilatación de los poros a través de escala visual y con lente 30X, se cuantificó la presencia de sebo mediante sebumetría y el porcentaje de hidratación de la piel del rostro. Adicionalmente se utilizó el sistema VISIA para realizar un análisis de la dilatación de los poros, porfirinas cutáneas y textura de la piel. Se observó una mejoría significativa en cada uno de los parámetros medidos.

An open and prospective study was performed in order to evaluate the action and tolerance of a formulation with Glycosylated Vitamin C, Zincadone ATM and Salicylic Acid on 65 male patients with greasy or mixed normal/greasy skin and/or mild inflammatory acne during a period of sixty days. The degree of dilated pores was evaluated both visually and through a 30X lens. The number of inflammatory and non inflammatory lesions, sebumetry and moisture percentage were clinically quantified. Additionally, the VISIA system was utilized to evaluate dilated pores, cutaneous porphyrines and skin texture. There was a significant improvement in each one of the parameters studied.

Corticoides sistémicos: uso racional en dermatología / Systemic glucocorticoids: rational use in dermatology

Los glucocorticoides (GC) son potentes agentes inmunosupresores y antiinflamatorios ampliamente utilizados en el tratamiento de enfermedades dermatológicas. Las complicaciones asociadas a la terapia esteroidal sistémica aumentan con dosis mayores, tratamientos prolongados y administración fraccionada. Para maximizar la eficacia de la terapia esteroidal minimizando el riesgo de efectos adversos, es necesario conocer su farmacocinética y función a nivel de distintos órganos blanco. En esta revisión damos una visión general del mecanismo de acción de los GC y sus efectos adversos, junto con algunas recomendaciones prácticas para su uso clínico efectivo y seguro, disminuyendo el riesgo de desarrollar complicaciones.

(GC) are potent immunosuppressive and anti-inflammatory agents widely used in the treatment of many dermatologic diseases. Complications associated with systemic GC increase with higher doses, prolonged therapies, and divided administration. In order to maximize the effectiveness of steroidal therapy, minimizing the risk of adverse effects, it is necessary to know their pharmacokinetics and function on different target organs. In this review, we take general look at the mechanism of action and side effects of GC, along with some practical recommendations for their safe and effective use in order to decrease the risk of complications.

Uso de biológicos para el tratamiento de la psoriasis / Biologic therapies for psoriasis

La psoriasis es una enfermedad inflamatoria crónica, mediada por los linfocitos T, que afecta a 1 por ciento-3 por ciento de la población mundial. Afectando primordialmente la piel y las articulaciones (artritis psoriática), también está asociada con otras condiciones inflamatorias, como son la enfermedad intestinal inflamatoria y patología coronaria, entre otras. El tratamiento de la psoriasis viene dado según su extensión y severidad, variando desde modalidades locales (tópicas e intralesionales), fototerapia, hasta regímenes sistémicos. Estos últimos generalmente conllevan efectos secundarios cuando son utilizados a largo plazo. Hoy en día, gracias a los últimos avances científicos, se ha logrado profundizar el entendimiento de la patogénesis de la psoriasis, dando lugar a terapias específicamente dirigidas conocidas como “biológicos”. A continuación se discutirán los principales biológicos utilizados en el tratamiento de la psoriasis en placa moderada a severa: efalizumab, alefacept, etanercept, infliximab, adalimumab e inhibidores de la interleuquina (IL) 12/23.

Psoriasis is a chronic T cell-mediated inflammatory disease that mainly affects the skin and joints, and is present in 1 percent-3 percent of world population. It is also associated to other inflammatory conditions such as inflammatory intestinal disease and coronary pathologies, among others. Conventional treatments for moderate to severe psoriasis are associated to broad band immunosuppression and/or organ-toxicities which can be problematic when used in a long-term. Advances in the understanding of psoriasis pathogenesis have led to targeted therapy in the form of biologics. These agents have gained popularity as safe, effective and convenient alternatives for the treatment of chronic moderate to severe plaque psoriasis. This review focuses on the main biologics used in the treatment of moderate to severe plaque psoriasis: efalizumab, alefacept, etanercept, infliximab, adalimumab and interleukin inhibitors (IL) 12/23. Mechanisms of action, guidelines for usage, efficacy data, and safety concerns will be discussed for each biologic. In addition, the new Th17 biologics and their role in psoriasis pathogenesis will also be examined.

Calcineurin inhibitors in the treatment of allergic dermatitis

OBJETIVO: Revisar o papel dos inibidores da calcineurina no tratamento das dermatoses alérgicas, com ênfase nos mecanismos de ação, eficácia e efeitos adversos tópicos e sistêmicos. FONTES DOS DADOS: Artigos de língua inglesa publicados na MEDLINE, considerando as palavras chave: pimecrolimus, tacrolimo, calcineurin inhibitors. Foram selecionados os artigos originais que apresentaram estudos controlados e estudos abertos para avaliação da eficácia, tolerabilidade e eventos adversos. Também foram avaliados artigos de revisão e relatos e série de casos, sendo estes últimos considerados apenas para avaliação de efeitos adversos. Foram consultados os sites oficiais da Food and Drug Administration e dos fabricantes de inibidores da calcineurina. SíNTESE DOS DADOS: Os dados mostraram que inibidores de calcineurina são eficientes no tratamento da dermatite atópica leve a grave, levando a melhora dos sintomas, diminuição do número de crises e necessidade de corticoterapia tópica. Apresentam boa tolerabilidade e poucos efeitos adversos tópicos. Até o momento, não há evidências que sustentem a maior prevalência de neoplasias nos pacientes que utilizam esses medicamentos; entretanto, um adequado sistema de farmacovigilância está montado para avaliar esse aspecto. CONCLUSÕES: Os inibidores de calcineurina são uma nova classe de medicamentos para o tratamento das dermatoses alérgicas. São eficazes, tolerados e com poucos efeitos adversos. Devem ser sempre utilizados de acordo com as orientações preconizadas, e os pacientes devem ser sempre acompanhados pelo médico durante e após sua administração.

OBJECTIVE: To review the role of calcineurin inhibitors in the treatment of allergic dermatitis, focusing on mechanisms of action, efficacy and topical and systemic adverse effects. SOURCES: Articles written in English and published in MEDLINE using the following keywords: pimecrolimus, tacrolimus, calcineurin inhibitors. Original articles that presented controlled and open studies for assessing efficacy, tolerability and adverse effects were selected. Review articles and case series were also evaluated; the latter was only considered for assessing adverse effects. The official websites of the Food and Drug Administration and of manufacturers of calcineurin inhibitors were also used. SUMMARY OF THE FINDINGS: The data showed that calcineurin inhibitors are efficient in the treatment of mild to severe atopic dermatitis, leading to improvement in symptoms, reduction in number of attacks and need of topical corticotherapy. Calcineurin inhibitors have good tolerability and few topical adverse effects. To date, there has been no evidence to support higher prevalence of neoplasia in patients using these drugs; however, an adequate pharmacovigilance system has been set up to assess this aspect. CONCLUSIONS: Calcineurin inhibitors, which are a new drug class in the treatment of allergic dermatitis, are efficient, well tolerated and have few adverse effects. Calcineurin inhibitors should always be used according to recommended guidelines, and patients should always be followed by the physician during and after their administration.

Topical immunomodulators in dermatology.

Topical immunomodulators are agents that regulate the local immune response of the skin. They are now emerging as the therapy of choice for several immune-mediated dermatoses such as atopic dermatitis, contact allergic dermatitis, alopecia areata, psoriasis, vitiligo, connective tissue disorders such as morphea and lupus erythematosus, disorders of keratinization and several benign and malignant skin tumours, because of their comparable efficacy, ease of application and greater safety than their systemic counterparts. They can be used on a domiciliary basis for longer periods without aggressive monitoring. In this article, we have discussed the mechanism of action, common indications and side-effects of the commonly used topical immunomodulators, excluding topical steroids. Moreover, newer agents, which are still in the experimental stages, have also been described. A MEDLINE search was undertaken using the key words "topical immunomodulators, dermatology" and related articles were also searched. In addition, a manual search for many Indian articles, which are not indexed, was also carried out. Wherever possible, the full article was reviewed. If the full article could not be traced, the abstract was used.

Skin cleansing in neonates and infants--basics of cleansers.

OBJECTIVE: Using a proper cleanser for bathing neonatal and infant skin is of prime importance considering the anatomical differences with regard to adult skin. Choosing the right cleanser requires knowledge of the composition of a cleanser as well as the properties of the individual ingredients. METHODS: The article discusses the guidelines for cleansing the skin of neonates and infants. The characteristics of an ideal cleanser for pediatric skin have also been enumerated. RESULTS: In India, majority of cleansers recommended for babies do not mention their active ingredients. Their claims of "mildness" have not been substantiated with clinical studies. Cetaphil, a non-soap, lipid-free liquid cleanser, has been clinically proven to be non-irritating by the Chamber Scarification Test. Moreover, Cetaphil also has a pH of less than 7, which does not alter the physiological pH of skin. CONCLUSION: Hence, Cetaphil should definitely be considered while choosing a cleanser for neonates and infants.