Novel transdermal device for delivery of triamcinolone for nail psoriasis treatment

INTRODUCTION@#Nail psoriasis treatment is challenging due to difficult drug delivery and systemic therapy toxicities. Self-dissolvable microneedle patches embedded with corticosteroids offers a potentially rapid, minimally invasive drug delivery platform with good efficacy and minimal adverse side effects.@*METHODS@#We conducted a 4-month prospective randomised controlled trial. Subjects with psoriatic nails were randomised to receive microneedle device delivered topical steroids on one hand and control treatment (topical Daivobet gel) on the other. Two independent dermatologists blinded to the treatment assignment scored their Nail Psoriasis Severity Index (NAPSI) during visits at baseline, 2 and 4 months. All treatment was discontinued after 2 months. Average NAPSI score on each hand was analysed.@*RESULTS@#A total of 25 participants were recruited, aged 22 to 73 years. Majority were Chinese (72%), followed by Indian and Malay. There was equal randomisation of treatment to the left and right nail. While there was a rapid significant improvement in average NAPSI score for the control arm at 2 months, the treatment arm had a greater, more sustained improvement of the NAPSI score at 4 months. The average NAPSI score improved for both treatment and control group at 4 months compared to baseline. However, only the NAPSI value improvement in the controls at 2 months compared to baseline was statistically significant (P=0.0039). No severe adverse effects were reported.@*CONCLUSION@#To the best of our knowledge, this is the first prospective randomised control trial comparing microneedle technology against conventional topical steroids in nail psoriasis treatment. Our findings demonstrate microneedle technology is as efficacious as topical therapy.

Use of silicon for skin and hair care: an approach of chemical forms available and efficacy

Abstract Silicon is the second most abundant element on Earth, and the third most abundant trace element in human body. It is present in water, plant and animal sources. On the skin, it is suggested that silicon is important for optimal collagen synthesis and activation of hydroxylating enzymes, improving skin strength and elasticity. Regarding hair benefits, it was suggested that a higher silicon content in the hair results in a lower rate of hair loss and increased brightness. For these beneficial effects, there is growing interest in scientific studies evaluating the efficacy and safety of using dietary supplements containing silicon. Its use aims at increasing blood levels of this element and improving the skin and its annexes appearance. There are different forms of silicon supplements available and the most important consideration to be made in order to select the best option is related to safety and bioavailability. Silicon supplements are widely used, though there is wide variation in silicon bioavailability, ranging from values below 1% up to values close to 50%, depending on the chemical form. Therefore, the aim of this study was to evaluate the scientific literature related to the different chemical forms of silicon supplements available and the limitations and recent progress in this field. According to reported studies, among the different chemical forms available, the orthosilicic acid (OSA) presents the higher bioavailability, whereas the others forms have absorption inversely proportional to the degree of polymerization. However, clinical studies evaluating safety and efficacy are still lacking.

Phaeohyphomycosis of the ungual apparatus - Case report

Phaeohyphomycosis is a disease caused by dematiaceous fungi with a worldwide geographic distribution and broad spectrum. It is most commonly found in adult individuals of both genders and all races. We report the case of a 57-year-old woman with phaeohyphomycosis in the ungual apparatus.

Nail psoriasis: a review of the literature

Nails are considered epidermal appendages, and as such, are commonly affected in patients with psoriasis, 80% of whom are likely to develop nail psoriasis as a result of their condition. Two patterns of nail disorders have been shown to be caused by psoriasis. Nail matrix involvement can result in features such as leukonychia, pitting (punctures or cupuliform depressions), red spots in the lunula and crumbling. Nail bed involvement, on the other hand, can cause onycholysis, salmon or oil-drop patches, subungual hyperkeratosis and splinter hemorrhages. Nail disease causes aesthetic and functional impairment, and is indicative of more severe forms of psoriasis as well as of joint involvement. The treatment for nail psoriasis involves behavioral interventions, topical medications, or systemic therapy in case of extensive skin or joint involvement. This article presents a review of the main features of nail psoriasis, its clinical presentation, diagnostic and assessment methods, clinical repercussions, and of its available treatment options.

Comparison of nail lacquer clobetasol efficacy at 0,05%, 1% and 8% in nail psoriasis treatment: prospective, controlled and randomized pilot study / Comparação da eficácia do clobetasol em esmalte 0,05%, 1% e 8% no tratamento da psoríase ungueal: estudo piloto, prospectivo, controlado e randomizado

BACKGROUND: Nail psoriasis may affect up to 90% of patients with psoriasis in the course of the disease throughout their lives and it is often a therapeutic challenge to dermatologists. Topical treatments described in the literature have demonstrated variable efficacy, and unsatisfactory results have been associated to inefficient penetration of the active ingredient into the nail plate and proximal nail fold. Recently the use of clobetasol on nail lacquer vehicle has been suggested, with satisfactory results and no side effects. OBJECTIVE: To determine the efficacy and safety of clobetasol in nail lacquer vehicle in three concentrations (0.05%, 1% and 8%) in patients with nail psoriasis. METHODS: Prospective, controlled, randomized pilot study in fifteen patients with nail bed and/or nail matrix psoriasis in both hands, subdivided into three groups: A(0.05% clobetasol nail lacquer), B(1% clobetasol nail lacquer) and C(8% clobetasol nail lacquer). All groups used clobetasol nail lacquer on the left hand and base coat nail lacquer as control on the right, twice a week for 16 weeks. Clinical evaluation was done by photographic records and the NAPSI score of both treated and control hands, as well as modified NAPSI score of the most affected nail of the treated hand. RESULTS: Group C showed a statistically relevant clinical response compared to the other groups, reflected in the improvement of clinical parameters, of treated hand NAPSI score, when compared to the control hand, and modified NAPSI score of the most affected nail in the treated hand. CONCLUSION: The 8% clobetasol nail lacquer was effective and safe, and it can be considered a good option of topical therapy in the treatment of nail psoriasis.

FUNDAMENTOS: A psoríase ungueal, de difícil manejo terapêutico, pode afetar até 90% dos portadores de psoríase no transcurso da doença, ao longo de suas vidas. Os tratamentos tópicos descritos na literatura têm eficácia variável, muitas vezes com resultados insatisfatórios causados pela ineficiência da penetração da substância ativa através da placa ungueal e dobra proximal. Recentemente tem sido proposto o uso do clobetasol em veículo esmalte, demonstrando resultados satisfatórios e ausência de efeitos colaterais. OBJETIVO: Determinar a eficácia e segurança do clobetasol em veículo esmalte em três concentrações (0,05%, 1% e 8%) nos pacientes com psoríase ungueal. MÉTODOS: Estudo piloto, prospectivo, controlado e randomizado com quinze pacientes portadores de psoríase ungueal em ambas as mãos. Os pacientes foram subdivididos em três grupos: A (esmalte clobetasol 0,05%), B (esmalte de clobetasol 1%) e C (esmalte de clobetasol 8%). Os pacientes usaram esmalte de clobetasol na mão esquerda e esmalte base (sem medicação - controle) na direita, aplicandoos duas vezes por semana, por 16 semanas. Fez-se a avaliação clínica por registros fotográficos e pelos MÉTODOS: NAPSI da mão tratada e controle e NAPSI modificado da unha mais acometida da mão tratada. RESULTADOS: O grupo C apresentou de forma estatisticamente significativa a resposta clínica mais relevante, refletida na melhora dos parâmetros clínicos, do NAPSI da mão tratada comparado ao da mão controle e do NAPSI modificado da unha mais acometida da mão tratada. CONCLUSÕES: Neste estudo piloto, o esmalte de clobetasol a 8% foi eficaz e seguro, mostrando-se uma boa opção de terapêutica tópica no tratamento da psoríase ungueal.

NAPSI utilization as an evaluation method of nail psoriasis in patients using acitretin / Utilização do NAPSI como instrumento de avaliação na psoríase ungueal em pacientes com uso da acitretina

BACKGROUND: assessment instruments of nail psoriasis have been published in literature as means to standardize the previous subjective assessments of authors. OBJECTIVES: Using Nail Psoriasis Severity Index for evaluation in patients with plaque psoriasis during treatment with acitretin. METHODS: Thirty volunteers with plaque psoriasis were selected for the study. Twenty patients (8 women and 12 men) completed the study. The initial dose of acitretin was 0.3 mg/kg/day for 30 days and was later raised to 0.5 mg/kg/day. Nail Psoriasis Severity Index was collected in the first evaluation, after 2 and 4 months. Nails of both hands were evaluated. RESULTS: nail lesions were present in all patients at first evaluation. The initial Nail Psoriasis Severity Index median was 20 and the final score 20.5 (2.5% of worsening at the end of the study). No statistically significant difference between the three evaluations was found (X2 = 0.8084, GL = 2, p = 0.6657). Seven patients worsened in the final score. Three patients improved 50% of the initial Nail Psoriasis Severity Index and only one had an improvement of 75%. Linear correlation showed a weak association between the improvement percentage in PASI and Nail Psoriasis Severity Index (r = 0.105, F = 2.12, p = 0.162). CONCLUSION: The method was easy and of rapid execution while potentially bringing information about changes in nail plate and matrix during treatment. The Nail Psoriasis Severity Index does not quantify the existing lesions and might not have the sensitivity to detect small changes.

FUNDAMENTOS: instrumentos de avaliação da psoríase ungueal têm sido publicados na literatura como meio de padronizar as avaliações antigamente subjetivas dos autores. OBJETIVOS: utilizar índice de Gravidade da Psoríase Ungueal ou Nail Psoriasis Severity Index para avaliação em pacientes portadores de psoríase em placas durante o tratamento com acitretina. MÉTODOS: trinta voluntários portadores de psoríase em placas foram selecionados para o estudo. Vinte deles ( 8 mulheres e 12 homens) completaram o estudo. A dose inicial da acitretina foi de 0,3mg/kg/dia por 30 dias sendo elevado posteriormente para 0,5mg/kg/dia. Utilizou-se a avaliação do Nail Psoriasis Severity Index na primeira avaliação, após 2 e 4 meses avaliando-se as unhas de ambas as mãos. RESULTADOS: lesões de unhas estavam presentes em todos os pacientes na primeira avaliação. A mediana inicial do Nail Psoriasis Severity Index foi de 20 e o escore final 20,5 (2,5% de piora ao final do estudo), sem diferença estatística significativa entre as três (X2=08084, GL=2, p=0,6657). Sete pacientes pioraram no escore final. Três pacientes obtiveram melhora de 50% do Nail Psoriasis Severity Index inicial em relação ao final e apenas 1 obteve melhora de 75 . A correlação linear simples mostrou fraca associação entre a porcentagem de melhora do PASI e do Nail Psoriasis Severity Index (r=0,105, F=2,12, p=0,l62). CONCLUSÕES: o método se mostrou de fácil e de rápida execução, podendo trazer informações sobre as alterações de lâmina e matriz de um modo global. O Nail Psoriasis Severity Index não quantifica as lesões existentes isoladamente, podendo não ter a sensibilidade de detectar pequenas alterações.

Síndrome da unha amarela: tríade clássica e pleurodese com iodopolvidine para tratamento do derrame pleural recorrente / Yellow nail syndrome: triad classic and iodopolvidone pelurodesis for recurrent pleural effusions

É descrito manifestação clinica clássica da síndrome da unha amarela em paciente de 52 anos. Os sintomas iniciaram-se há 23 anos com edema linfático em membros inferiores, que ocorreram posterior a repetidas infecções nas pernas por erisipela. Dois anos mais tarde, apresentou unhas das mãos e pés espessas e amarelas que não melhoraram com antifúngico. Há três anos iniciou derrame pleural recorrente à direita, tratado em definitivo no início de 2004 com pleurodese com iodopolvidine (PVPI). As últimas publicações sobre tratamento de derrame pleural recorrente utilizam o iodopolvidine, entretanto, não há relato em pacientes portadores de síndrome da unha amarela.

A classic clinical picture of yellow nail syndrome is described in a patient 52 years old. His symptom beginning for 23 years with lymphatic edema in inferior member, occurred later to frequently infection in his leg for erysipelas. Two years later present nail gross and yellow in his hands and feet that don't get better with antifungals. For 3 years initiate the recurrent pleural effusion to right that was treaty in definitive in begin of 2004 with a pleurodesis make with iodopolvidone (PVPI). The last publication about treatment of recurrent pleural effusion utilized iodopolvidone, however don't have related in patient that have the yellow nail syndrome.

Psoriasis ungueal: experiencia con el tratamiento combinado de clobetasol al 8 por ciento en laca ungueal y calcipotriol / Combined clobetasol and calcipotriol treatment for nail psoriasis

La psoriasis ungueal es un problema común en los pacientes psoriáticos, con una incidencia de vida de 90%. A pesar de su alta incidencia y del gran impacto que produce en la calidad de vida, ha sido poco estudiada y el tratamiento óptimo aún no está bien dilucidado. Los corticoides tópicos y los análogos de la vitamina D son las terapias más usadas, pero no existe un esquema estándar para su uso. La combinación de estos agentes se ha estudiado en los últimos años para pacientes con afectación de la matriz y del lecho ungueal, mostrando muy buenos resultados. El caso que presentamos demuestra la sinergia entre estos agentes.

Nail psoriasis is a common problem among psoriatic patients, with a lifetime incidence of 90%. Despite its high incidence and severe impact on the quality of life, it has not been fully studied and the optimal treatment is still unclear. Topical glucocorticosteroids and vitamin D analogues are the most used therapies, but there is no standard therapeutic regimen for their use. The combination of both of these agents has been studied during the last years for the treatment of patients with matrix and bed nail compromise, showing very good results. The case that we present shows the synergy between these agents.

Evaluation of a simplified protocol of steroid injections for nail psoriasis

To evaluate the efficacy of a modified regimen of intralesional steroid injection therapy for the treatment of nail psoriasis and to assess the side effects of this regimen. Quasi-experimental study. Dermatology department of Military Hospital Rawalpindi from Feb 1999 to Jan 2001. Patients having psoriatic nail dystrophy, reporting in skin department of Military Hospital Rawalpindi were registered. The features accounted for were pitting, onycholysis, subungual hyperkeratosis, ridging, thickening and color change. Injection of Triamcinolone acetenoid [10mg/ml] was given into the nail bed and matrix following ring block anesthesia. A second injection was given after 02 months if warranted by poor response. The follow up period ranged upto 06 months. Eighty three digits were injected in 35 subjects. Pitting was the commonest presenting feature seen in 71 [85.5%] digits and improved in 51 [71.8%] digits. Onycholysis was seen in 37 [44.6%] digits and improved in 25 [67.6%] digits. Subungual hyperkeratosis was seen in 57 [68.7%] digits and improved in all cases. Other features like longitudinal ridging, thickening and yellow oil drop like discoloration also improved considerably. The side effects of this regimen were minimal. This regimen has been found to be effective and safe for the treatment of psoriatic nail dystrophy

Chronic mucocutaneous candidiasis: a case report.

Chronic mucocutaneous candidiasis is a immuno deficiency disorder primarily due to T cell dysfunction characterized by persistent candidal infection of mucous membrane, skin, scalp and nails. Chronic mucous membrane candidiasis has an onset in infancy or childhood; the primary affected site is the oral cavity; however, lesions may occur on trunk, hands, feet and scalp. This paper describes a 12-year-old girl with candidial infection of the oral mucosa and extra oral involvement of fingers, nails, toes and intertragus area.

Callosidades dolorosas constitucionales: tratamiento con etritinato / Constitutional painful callosities: treatment with etretinate

Se describe un caso de queratodermia palmoplantar circunscripta, bilateral, con paquioniquia e hiperhidrosis, en una paciente de sexo femenino, de 32 años de edad, sin antecedentes heredofamiliares de la afección. Se la trató con etretinato durante 3 meses , obteniéndose la remisión de las lesiones y su sintomalogía hasta la actualidad. Proponemos, de acuerdo a la revisión realizada, la clasificación de los cuadros de callosidades dolorosas en constitucionales o hereditarias. Nuestro caso constituye la segunda observación en la bibliografía de callosidades dolorosas constitucionales (CDC).

Tioconazol en solución al 28 por ciento: estudios clínicos en el tratamiento de los hongos localizados en las uñas (onicomicosis) / Ticonazole 28 porcent solution: clinics studies in the treatment of the fungies localizations in the nails (onicomicosis)

El estudio realizado en 20 pacientes, con una cuidadosa observación clínica y el debido control Micológico con KOH y cultivo, nos indica que el tratamiento tópico de las Onicomicosis con Tioconazol solución al 28 por ciento es efectivo. Ninguno de los pacientes presentó intolerancia al preparado, ni efectos indeseables a nivel local ni mucho menos sistémicos por absorción. El tratamiento bien aplicado durante seis meses es efectivo en más del 70 por ciento de los casos y que en un 20 por ciento se apreciaron signos clínicos evidentes de la eficacia terapeútica pero que las localizaciones de las lesiones a nivel de las uñas (proximal o laterales) retrasan la restitución morfológica de las uñas; sin embargo, el estudio micológico directo con KOH y cultivo confirman la curación parasitaria. En los casos que no hubo curación clínica ni micológica el tratamiento no fue aplicado correctamente, hecho que el dermatólogo debe conocer, con el fin de utilizar técnicas mixtas como es la separación quirúrgica de la uña y aplicación correcta de Tioconazol solución al 28 por ciento.

Tioconazol en solución al 28 por ciento en el tratamiento de las onicomicosis / Tioconazol in solution at 28 porcent at the treatment of the onicomicosi

1. Si ha sido interés primordial descartar mediante el legrado uterino, la degeneración maligna en la leiomiamatosis u otra patología maligna concomitante, podemos concluir, de acuerdo a los resultados histológicos obtenidos por ese procedimiento, que no se justifica como norma de rutina efectuar el legrado uterino previo a la histrectomía. 2. La biopsia de endometrio, para efectos de información respecto al patrón hormonal, debe de cumplir un requisito elemental que no es otro que efectuarse en la segunda fase del ciclo. Si bien es cierto que en la mayoría de los casos si se tomó en cuenta esta recomendación, lamentablemente en un porcentaje nada despreciable se omitío esta norma, pero debe aclarase que en algunos casos la sintomatología obligó a efetar el procedimiento sintomar en cuenta el día del ciclo. 3. En el 17 por ciento de los casos no se obtuvo información, por tratarse de material insuficiente. 4. En cuanto a la poca o nula utilidad terapúetica, es francamente llamativo que en el 96 por ciento de los casos se mantuvieran las mismas condiciones y sólo en el 2 por ciento hubo mejoría temporal. Debemos tener en cuenta que en el 57 por ciento la histerectomía se realizó en un tiempo corto, explicable por persistencia de la sintomatología y por que se había descartado la malignidad.