Five-day study to judge the short-term effect of a benzoyl peroxide 3% gel on acne lesions.

INTRODUCTION: Acne is a common, chronic skin disease that has both physical and psychological consequences. Over-the-counter products are a treatment option frequently chosen by dermatologists and acne sufferers for reasons of cost or convenience. There are reports that such products can effect rapid resolution in certain lesion parameters. AIMS: To evaluate the short-term effect of a benzoyl peroxide 3% gel on acne lesions. METHODS: A 5-day, double-blind, randomized clinical trial was conducted among subjects with mild-to-moderate acne. Subjects applied the benzoyl peroxide 3% gel, a salicylic acid 2% gel, or a vehicle gel under supervision once daily for 4 days. Target lesion parameters of swelling, diameter, and erythema were evaluated at various times after the first and subsequent applications. RESULTS: Although target lesion parameters showed overall improvement from baseline, the effects of the active treatment gels were not significantly different from those of the vehicle gel at any evaluation. The assessed parameters showed marked variability in target lesion behavior at the subject level over the course of the study. CONCLUSIONS: The results of this study illustrate the unpredictability of individual acne lesion's responses to therapy and the challenge associated with using these responses to judge short-term treatment efficacy. While rapid acne resolution is desired by patients and consumers, setting realistic expectations for treatment response is critical to encourage compliance and avoid disappointment.

Protocol to predict the dry skin benefit from the unique in-shower body lotion product form.

A controlled exposure method was developed to predict dry skin improvement from a new in-shower body lotion product form. An in-shower body lotion is used in the shower after cleansing, and methods for cleansers and leave-on lotions are not applicable. Protocol parameters were chosen on the basis of consumer habits and practices studies and randomized clinical testing. The resulting protocol is consumer-relevant, and reliably and reproducibly predicts dry skin improvement from the in-shower body lotion product form.

Facilitating facial retinization through barrier improvement.

The utility of topical tretinoin as a treatment for improving the appearance of photodamaged skin is limited by irritation that occurs during the early phases of facial retinization. The observed side effects are consistent with stratum corneum barrier compromise. This paired double-blinded study was conducted to determine if preconditioning the skin with a barrier-enhancing cosmetic facial moisturizer before beginning tretinoin therapy and continuing moisturizer application during therapy would mitigate these side effects. Women with facial photodamage were recruited and randomly assigned to apply one cosmetic moisturizer to one side of the face and the other cosmetic moisturizer to the other side of the face twice daily for 10 weeks. One moisturizer contained a mixture of vitamins (niacinamide, panthenol, and tocopheryl acetate) to enhance stratum corneum barrier function, and the other moisturizer contained similar moisturizing ingredients but no vitamins. Daily full-face treatment with tretinoin cream 0.025% commenced 2 weeks into the study. Subjects' facial skin condition was monitored via investigator assessments, instrumental measurements, and subject self-assessments. The results show that improving stratum corneum barrier function before beginning topical tretinoin therapy and continuing use of a barrier-enhancing cosmetic moisturizer during therapy facilitates the early phase of facial retinization and augments the treatment response.

Niacinamide-containing facial moisturizer improves skin barrier and benefits subjects with rosacea.

A growing body of literature suggests that some moisturizers can improve stratum corneum barrier function, as well as ameliorate dry skin. The clinical signs and symptoms of rosacea, which include increased facial skin dryness and sensitivity, suggest a possible role for such moisturizers as an adjuvant in the management of this condition. This randomized, investigator-blind, controlled observational study (N = 50) was designed to assess whether a niacinamide-containing facial moisturizer would improve the stratum corneum barrier and thus provide a clinical benefit to subjects with rosacea. Subjects with rosacea applied the test moisturizer to their face and to one forearm twice daily for 4 weeks. The other forearm remained untreated as a control. Barrier function on the forearms was assessed instrumentally and using a dimethyl sulfoxide (DMSO) chemical probe. Stratum corneum hydration also was measured instrumentally. The dermatologist investigator evaluated each subject's rosacea condition over the course of the study, and subjects self-assessed their facial skin condition at study end. Instruments provided objective measures of stratum corneum barrier function and hydration on the face.

Efficacy of organic acids in hand cleansers for prevention of rhinovirus infections.

Direct hand-to-hand contact is an important mechanism of transmission of rhinovirus infection. The rhinoviruses are inactivated at a low pH. A survey of organic acids in vitro revealed that these compounds have antirhinoviral activity that persists for at least 3 h after application to the skin. In additional studies of salicylic acid (SA) and pyroglutamic acid (PGA), the hands of volunteers were contaminated with rhinovirus at defined times after application of the acid, and then volunteers attempted to inoculate the nasal mucosa with one hand and quantitative viral cultures were done on the other hand. In one study, 3.5% SA or 1% SA with 3.5% PGA was compared with controls 15 min after application to assess the efficacy of the inactivation of virus and prevention of infection. Virus was recovered from the hands of 28 out of 31 (90%) of the volunteers in the control group compared to 4 out of 27 (15%) and 0 out of 27 in the groups administered 3.5 and 1% SA, respectively (P < 0.05). Rhinovirus infection occurred in 10 out of 31 (32%) of the controls and 2 out of 27 (7%) of volunteers in both treatment groups (P < 0.05 compared with control). In a second study, the efficacy of 4% PGA was evaluated 15 min, 1 h, and 3 h after application. Significantly fewer volunteers had positive hand cultures at all time points compared with the control group, but the proportion that developed rhinovirus infection was not significantly reduced. These results suggest the feasibility of the prevention of rhinovirus transmission by hand treatments that are virucidal on contact and have activity that persists after application.

The effect of two skin cleansing systems on moderate xerotic eczema.

BACKGROUND: Moderate xerotic eczema, characterized by stratum corneum desquamation, erythema, and pruritus is a common condition that can be induced or worsened by skin cleansing. Traditional dermatologic therapy includes the use of emollients, medium or high potency topical corticosteroids, and a change in bathing habits. OBJECTIVE: To investigate the effect of two cleansing systems: a synthetic detergent bar soap applied with a cotton washcloth and a petrolatum-delivering body wash applied with a polyethylene puff as part of a topical treatment approach to moderate xerotic eczema. METHOD: Sixty patients with moderate xerotic eczema were enrolled in a 4-week investigator-blinded study. Half were randomly treated with a strong topical corticosteroid cream (0.05% fluocinonide) and a traditional cleansing system consisting of a synthetic detergent bar soap applied with a washcloth. The remaining patients were treated with a weaker, medium strength topical corticosteroid cream (0.1% triamcinolone acetonide) and a novel cleansing system consisting of a petrolatum-delivering body wash applied with a polyethylene puff. Dermatologist investigator evaluations and patient self-assessments were conducted at baseline, 2 weeks, and 4 weeks. RESULTS: Patients using the novel petrolatum-delivering body wash and polyethylene puff cleansing system and the lower potency corticosteroid cream demonstrated significantly greater clinical improvement than those patients using the traditional cleansing system of a synthetic detergent beauty bar and washcloth system and the higher potency corticosteroid cream after both 2 and 4 weeks of treatment. CONCLUSION: The cleansing system of a petrolatum-delivering body wash delivered by a polyethylene puff may be useful as a cleanser for patients with moderate xerotic eczema.

Fluorescence spectral imaging of dihydroxyacetone on skin in vivo.

Dihydroxyacetone (DHA) has been proposed as a potential alternative to dansyl chloride for use as a fluorescence marker on skin to assess stratum corneum turnover time in vivo. However, the fluorescence from DHA on skin has not been adequately studied. To address this void, a noninvasive, noncontact spectral imaging system is used to characterize the fluorescence spectrum of DHA on skin in vivo and to determine the optimal wavelengths over which to collect the DHA signal that minimizes the contributions from skin autofluorescence. The DHA-skin fluorescence signal dominates the 580-680 nm region of the visible spectrum when excited with ultraviolet radiation in the 320-400 nm wavelength region (UVA). An explanation of the time-dependent spectral features is proposed in terms of DHA polymerization and binding to skin.