Augmented Glutathione Absorption from Oral Mucosa and its Effect on Skin Pigmentation: A Clinical Review.

Treatment of dark skin with glutathione has become popular due to its depigmenting properties and low toxicity. Glutathione has been used topically, orally and parenterally in the management of dark skin. There are no clear published guidelines for management of skin pigmentation despite some clinical trials of shorter duration and small sample sizes. We examined published scientific and patient data to generate guidance for the clinician for managing hyperpigmentation using glutathione by orobuccal route. Various aspects of glutathione bioavailability were examined when administered by oral routes. Absorption of glutathione from the gastrointestinal tract is poor. Some trials have favored administering high oral doses to achieve therapeutic effect. General consensus remains against treatment of hyperpigmentation with glutathione by the oral route. Clinical and experimental evidence supporting significant glutathione absorption from orobuccal mucosa was examined. The latter is superior to the oral route since glutathione passes directly into systemic circulation resulting in a much higher rate of absorption compared to that achieved by oral intake. High blood levels thus achieved have therapeutic value. Treatment of hyperpigmentation with glutathione by the orobuccal route using hydroxypropyl cellulose (HPC) film was reviewed to formulate clinical guidance from published data. A future randomized, double-blind, placebo-controlled trial should study treatment of hyperpigmentation with glutathione using oral dispersible HPC film, with longer-term follow-up and larger sample size. This paper will hopefully offer broad guidance for the clinician on use of glutathione for hyperpigmentation management, until outcomes of larger, longer duration trials become available.

Comparative Study of UMA Jeunesse Classic® and UMA Jeunesse Ultra®.

INTRODUCTION: The emergence of hyaluronic acid dermal fillers with lidocaine has transformed the minimally invasive treatment of wrinkles, lines and folds of the face. Patients can be treated quickly, painlessly and without the need for large doses of lidocaine. Therefore, it is important to scientifically evaluate the merits of lidocaine-containing products over those without. METHODS: The two products, with (UJU) and without lidocaine (UJ), were randomly injected into nasolabial folds of 75 healthy volunteers with varying skin types in a split face study, age ranging 26-60 years. Only 73 subjects completed the follow-up. There were 68 females and 5 males with medium-to-deep nasolabial folds. All subjects were randomly injected with the two products on one or the other side of the face. Patients were followed up for 9 months. RESULTS: Both products achieved significant improvement in the wrinkle severity score. Overall results were slightly better with UJU due to ease of injection, lack of pain and avoidance of topical or parenteral anaesthetic. In all other respects, differences in clinical data were not statistically significant. UJU® was preferred by patients and injectors due to less pain during and after injection as compared to UJ® (P < 0.0001). The overall rate of early and late complications with the two products was similar. Duration of maintenance of aesthetic effect between products also showed similarity. Optimum aesthetic effect was maintained in most cases for over 9 months with both products but patients in the 30-50-year age group did better. The patient acceptability rate was much higher with UJU. CONCLUSION: Clinical data from this study suggest that performance and outcomes of treatment of medium-to-deep nasolabial folds with UJ and UJU are quite similar. However, treatment with UJU offers enhanced patient comfort and is preferred by patients and injectors. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Histologic and manometric studies on the esophagus following endoscopic sclerotherapy.

OBJECTIVE: The aim of this work was to study the histologic and manometric changes in the distal esophagus beyond 2 years following endoscopic sclerotherapy (EST) and/or surgical intervention, and to try to understand the etiological factors associated with these changes. PATIENTS AND INTERVENTIONS: Forty patients, with an average age of 61.5 years, were studied for 2-12 years following sclerotherapy and/or surgical intervention. The causes of liver disease were alcoholic cirrhosis (78.6%), primary biliary cirrhosis (14.3%), and chronic aggressive hepatitis (7.1%). A predominant number of cases (65%) had a mesocaval interposition shunt due to the failure of EST, 32.5% EST alone, and 2.5% esophageal devascularization. All patients had esophageal manometry following mucosal biopsies taken in duplicate endoscopically from three levels of the distal esophagus. RESULTS: In the EST and shunt groups, 88.5% had manometric abnormalities, esophagitis, and chronic inflammatory changes. In the EST group, all but two patients had manometric abnormalities and chronic inflammatory changes. Analysis of the patient groups on the basis of the number of EST sessions and the amount of sclerosant injected showed that both histologic changes and dysmotility were more profound in those treated over five times with EST. The differences were significant. CONCLUSION: It appears that EST causes persistent manometric abnormalities and chronic inflammatory changes in the distal esophagus, the severity of which seems to vary directly with the frequency of sclerotherapy and not amount of sclerosant injected.