transdermal

Randomized placebo-controlled trial of a flavonoid-rich plant extract-based cream in the treatment of rosacea.: J Eur Acad Dermatol Venereol. 2005 Sep;19(5):564-8  Authors:  Rigopoulos D, Kalogeromitros D, Gregoriou S, Pacouret JM, Koch C, Fisher N, Bachmann K, Brown M, Schwarz E, Camel E, Katsambas A       

BACKGROUND: Biological research suggests that vascular changes may play a major role in rosacea pathogenesis. Chrysanthellum indicum is a plant-based extract containing a unique combination of phenylpropenoic acids, flavonoids and saponosids, and has a well-documented effect on vascular wall permeability and increase of the mechanical resistance of capillaries. OBJECTIVE: To determine the efficacy and safety of a cream containing 1%C. indicum extract with vitamin P properties in the treatment of rosacea. METHODS: This study included 246 patients diagnosed clinically as having moderate rosacea. Patients were randomly allocated to C. indicum extract-based cream (n = 125) and placebo (n = 121) groups. Patients were advised to apply the products on their face twice a day for a 12-week period. The patients were examined at the end of each 4-week period. Severity of erythema (graded by reference to six photographs), surface of erythema and rosacea overall severity scores were recorded at each visit on days 0, 28, 56 and 84. Investigators carried out a final efficacy assessment at the end of week 12. Volunteers' final overall efficacy assessment was recorded in a self-administered questionnaire. Adverse events were identified through examination, interview and collection of comments in patients' questionnaires. RESULTS: Treatment with the C. indicum extract-based cream resulted in significant improvement (P < 0.05) in severity of erythema, overall rosacea severity compared to baseline and placebo, and investigator and patient overall efficacy assessment scores (P = 0.046 and P = 0.001, respectively) compared with placebo scores. Adverse reactions were mild, and did not differ between the C. indicum extract-based cream and the placebo groups. CONCLUSION: Chrysanthellum indicum extract-based cream is an effective and well-tolerated topical agent for the treatment of moderate rosacea. The mode of action of the active ingredient suggests that additional efficacy might be expected from combination with other topical treatments.

Toxic Epidermal Necrolysis: Analysis of Clinical Course and SCORTEN-based Comparison of Mortality Rate and Treatment Modalities in Korean Patients.: Acta Derm Venereol. 2005;85(6):497-502 Authors: Kim KJ, Lee DP, Suh HS, Lee MW, Choi JH, Moon KC, Koh JK

Toxic epidermal necrolysis (TEN) is a rare, life-threatening, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition, we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13-year period (1990-2003) at the Asan Medical Center was performed. The mean involved body surface area was 49+/-17%. All except three cases were associated with medications, most commonly antibiotics, followed by non-steroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8+/-5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5%, 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR) = 0.425; 95% CI, 0.011-2.368), whereas corticosteroid therapy showed no such difference (SMR = 1.004; 95% CI, 0.369-2.187).

[Local tolerability of two preparations with eucalyptus oil and pine-needle oil]: MMW Fortschr Med. 2005 Oct 6;147 Suppl 3:109-12 Authors: Willms RU, Funk P, Walther C

The objective of this open-label, single-centre study was to assess the tolerability of two locally applicable eucalyptus oil and pine-needle oil preparations using patch testing as an accepted and standardised method. METHOD: Two eucalyptus oil and pine-needle oil preparations were applied to the forearm of 46 subjects with healthy skin using standardised patches. The patches were removed after 48 hours and skin reactions were assessed immediately and after 24 and 48 hours. The major objective was the reaction of the patch test. RESULT: Neither preparation caused any positive skin reaction in any of the subjects. CONCLUSION: Skin tolerability to the two eucalyptus oil and pine-needle oil preparations is very good with regard to their active ingredients and other excipients.

[Local tolerability of two preparations with eucalyptus oil and pine-needle oil]: MMW Fortschr Med. 2005 Oct 6;147 Suppl 3:109-12 Authors: Willms RU, Funk P, Walther C

The objective of this open-label, single-centre study was to assess the tolerability of two locally applicable eucalyptus oil and pine-needle oil preparations using patch testing as an accepted and standardised method. METHOD: Two eucalyptus oil and pine-needle oil preparations were applied to the forearm of 46 subjects with healthy skin using standardised patches. The patches were removed after 48 hours and skin reactions were assessed immediately and after 24 and 48 hours. The major objective was the reaction of the patch test. RESULT: Neither preparation caused any positive skin reaction in any of the subjects. CONCLUSION: Skin tolerability to the two eucalyptus oil and pine-needle oil preparations is very good with regard to their active ingredients and other excipients.

Inhibition of collagenase by naturally-occurring flavonoids.: Arch Pharm Res. 2005 Oct;28(10):1152-5 Authors: Sin BY, Kim HP

We examined the inhibitory activities of various flavonoids, including the flavanones, flavones/isoflavones and flavonols, on collagenase from Clostridium histolyticum to establish their therapeutic potential against skin inflammation and photoaging. In general, the flavonols were stronger inhibitors than the flavones/isoflavones, and this indicated the importance of the C-3 hydroxyl substitution. Quercetin was the most active flavonoid among those tested, and it showed an IC50 of 286 microM. These novel results suggest that certain flavonoids, particularly the flavonols, may prevent collagen breakdown by inhibiting collagenase in inflamed skin as well as photoaged skin.

A report on three recent clinical trials using Mahonia aquifolium 10% topical cream and a review of the worldwide clinical experience with Mahonia aquifolium for the treatment of plaque psoriasis.: Am J Ther. 2005 Sep-Oct;12(5):398-406 Authors: Gulliver WP, Donsky HJ

This monograph summarizes 3 recent clinical trials and the worldwide clinical experience with Mahonia aquifolium in patients with psoriasis. Study 1 was an open-label study to evaluate the safety of Mahonia aquifolium in 39 patients treated for 12 weeks. Assessments made were modified PASI, global assessment, psoriasis history questionnaire, Dermatology Life Quality Index, and Psoriasis Disability Index. The results indicate statistically significant improvement in PASI score and Dermatology Life Quality Index after 4 weeks of treatment. This response continued 1 month after the end of treatment. Study 2 was a clinical trial of 32 patients with mild to moderate bilateral psoriasis treated up to 6 months. One side of the body received Mahonia and the other standard psoriatic treatment (eg, Dovonex cream). The primary outcomes were patient ratings of the Mahonia-treated side alone and the comparison between treatments received on each side of their body. Eighty-four percent of patients rated the Mahonia-treated psoriasis as good to excellent response. When compared with standard treatment, 63% of patients rated Mahonia aquifolium equal to or better than the standard psoriatic treatment. Study 3 was an observational study of 33 patients with mild to moderate bilateral psoriasis treated for 1 month. The results indicate improvement in psoriasis after 1 week of treatment. The side treated with Mahonia did as well or better than the side treated with the vehicle cream. Results from these 3 open-label clinical trials are in agreement with published data that include placebo-controlled studies. Taken together, these clinical studies conducted by several investigators in several countries indicate that Mahonia aquifolium is a safe and effective treatment of patients with mild to moderate psoriasis.