Oral Versus Topical Diclofenac Sodium in the Treatment of Osteoarthritis

Osteoarthritis (OA) is one of the most common causes of joint pain in the United States and non-steroidal anti-inflammatories (NSAIDs), such as Diclofenac sodium, which is currently available in two main routes of administration; oral and topical distribution have been established as one of the standard treatments for OA. Generally, oral NSAIDs are well tolerated; however our narrative review suggests that the topical solution had a better tolerability property than oral Diclofenac sodium, especially due to side effects of gastrointestinal bleeding with the utilization of the oral format. In addition, the topical route may be considered a reasonable selection by clinicians for management of musculoskeletal pain in those patients with a history of potential risk and adverse side effects. Most studies reviewed comparing oral versus topical solution of Diclofenac sodium revealed comparable efficacy, with minimal side effects utilizing the topical route. The key point of this narrative review is to help clinicians that currently must decide between very inexpensive diclofenac oral presentations and expensive topical presentations especially in the elderly population and the pros and cons of such decision-making process.     

Topical therapies for localized psoriasis

Psoriasis is a chronic inflammatory condition of the skin with pronounced physical and psychosocial implications. This common condition affects 1% to 2% of the US population and is encountered frequently by nondermatologists and dermatologists. Fortunately, most patients have limited psoriasis, involving less than 5 % of their body surface area. Although no cure is available, several topical therapies can minimize the disease in such patients. This article reviews the topical medications currently available for the treatment of psoriasis and provides an approach to patients with localized disease.     

皮肤T细胞淋巴瘤局部用药和物理治疗的研究进展

皮肤T细胞淋巴瘤(cutaneous T cell lymphoma，CTCL)大多属于惰性淋巴瘤，病情进展缓慢，患者确诊时多处于疾病早期。局部用药和物理治疗在CTCL治疗中占重要地位，包括局部外用皮质类固醇激素、免疫抑制剂、维A酸，放疗及光疗等。近年来，有研究对CTCL传统局部用药和物理治疗方法的有效性和安全性进行了重新评估。同时，新型CTCL局部用药和物理治疗策略也不断涌现，如局部外用他扎罗汀、瑞喹莫特，紫外线A联合新型光敏剂的光化学疗法和光动力治疗等。本文对CTCL局部用药和物理治疗的研究进展作一综述。     

Hypertension as a complication of topical testosterone therapy.

OBJECTIVE: To report a patent developing hypertension following the use of testosterone gel. CASE SUMMARY: A 65-year-old white man who was placed on topical testosterone therapy to increase libido developed hypertension and increased hematocrit simultaneously. After discontinuation of the testosterone, the hematocrit returned to mid-normal reference range and blood pressure returned to normal; he had been normotensive prior to topical testosterone use. DISCUSSION: The popularity of hormone replacement for women for the maintenance of appearance and lifestyle and the prevention of complications such as osteoporosis has been established over several decades, and the complications and risks and benefits of this therapy have been well described. More recently, and particularly with the availability of topical preparations of testosterone, hormone replacement for men is becoming popular with both older male patients and their physicians. We describe a case of hypertension as a complication of the application of topical testosterone and link this adverse effect to the known anabolic effects of testosterone. CONCLUSIONS: Clinicians should be cautious in prescribing topical preparations of testosterone for the proper administration by the patient and alert to the development of hypertension in this population at increased risk for cardiovascular events due to their age.     

New capabilities for diagnosis of iron-deficiency anemia by computer morphometry of reticulocytes

With the advent of new cytological techniques, such as computer morphometry, the problems in the study of the structure of reticulocytes that characterize insignificant changes in the parameters of erythroid population functioning in the bone marrow in response to altered hemoglobin synthesis in patients with iron-deficiency anemia (IDA) become topical. The changes in peripheral blood reticulocytes in IDA determine those in red blood cells and may be a reliable differential diagnostic tool to identify IDA.     

Topical matrix-based siRNA silences local gene expression in a murine wound model

The ability to affect gene expression via topical therapy has profound therapeutic implications for conditions characterized by open wounds including cutaneous neoplasms, thermal injury, skin disorders and dysfunctional wound healing. Specifically targeting local gene expression avoids systemic toxicity and simplifies treatment. We have developed a new method of topical matrix-based short interfering RNA application to precisely and effectively silence local gene expression in nondelimited wounds.     

Topical treatments for pain

Topical analgesics exert their analgesic benefit locally and without significant systemic absorption. The mechanism of the topical analgesic is unique to the specific medication. Key differences between topical and transdermal analgesics are discussed in this article. A new term, targeted peripheral analgesics, has been suggested to replace the term topical analgesics, but is not in widespread use. Topical analgesics have been studied in an increasing number of painful clinical conditions; the results of many of these studies are summarized in this review. Recent data suggest that at least one topical analgesic, although applied peripherally, may result in central nervous system alterations of pain processing.     

The effectiveness of topical and oral tetracycline for acne.

A group of 135 college students with acne was evaluated in a 12-week, double-blind study comparing placebo, oral tetracycline 0.5 gm daily, and a new topical tetracycline preparation. The topical tetracycline preparation containing n-decyl methyl sulfoxide to enhance penetration, produced statistically significant improvement of acne as compared to placebo after 7, 10, and 12 weeks of treatment. Oral tetracycline, 0.5 gm daily, was statistically significantly more effective for acne than placebo after 4, 7, 10, and 12 weeks of therapy. The placebo group also had marked improvement which may have been related to sun exposure. Emotional stress produced by final examinations had no apparent effect on the patients given placebo, oral, or topical tetracycline. Side effects of the topical tetracycline included a slight yellowish discoloration of the skin in 25% of the subjects and transient stinging or tingling sensation after application in 36%.     

Efinaconazole (Jublia) for the treatment of onychomycosis

Efinaconazole 10% nail solution (Jublia^®) is a new topical triazole antifungal designed for the topical treatment of distal and lateral subungual onychomycosis. It inhibits ergosterol biosynthesis enzyme sterol 14α-demethylase. Efinaconazole has lower minimum inhibitory concentrations than terbinafine, ciclopirox, itraconazole and amorolfine in Trichophyton rubrum, Trichophyton mentagrophytes and Candida albicans. The solution based formula has low surface tension and keratin binding properties that increase penetrance through the nail plate. Safety studies have shown that this formulation is not associated with atopic dermatitis or contact sensitivity. Duplicate Phase III clinical trials in adults with mild to moderate distal and lateral subungual onychomycosis indicate that efinaconazole 10% solution is an effective therapy with a pooled complete cure rate of 17% and a pooled mycological cure rate of 54%. Efinaconazole 10% nail solution is a safe and effective new topical therapy for onychomycosis, which will fill a pressing need for more effective topical therapy in this disease.     

Scabies, lice, and fungal infections

Scabies and pediculosis capitis are frequent and often unrecognized causes of multiple streptococcal and staphylococcal pyodermas. Permethrin 1 per cent creme rinse (NIX) for head lice, and permethrin 5 per cent topical cream for scabies are new, highly effective, safe, and cosmetically elegant treatments which have shown superiority over older remedies. In populations in which pediculosis and scabies have resisted traditional lindane therapy, patients promptly responded to these permethrin products. Scabies in nursing homes is a persistent and expanding problem which demands a high level of diagnostic suspicion and an integrated approach to management. For fungal infections, several new broad-spectrum oral and topical agents have been introduced. Their successful use is enhanced by appropriate diagnostic tests which can be performed in the office setting. Recommendations and references are given to assist the physician in diagnosis and choice of therapy.     

Using mixed methods in disability and rehabilitation research.

This paper will discuss the theoretical design considerations and the practical integration of quantitative and qualitative methods in disability and rehabilitation research, which have gained recent popularity among researchers of various disciplines. Whereas quantitative experimental and survey approaches allow researchers to draw generalizable conclusions that apply to a particular population as a whole, qualitative methods capture the depth of respondents' experiences in their own words. Qualitative methods may be used to explore new topical areas prior to implementing a population-based survey, or they may follow quantitative approaches to explain findings in greater detail. We will discuss research findings from two recent studies of rehabilitation industry professionals and people with physical disabilities to exemplify the utility of mixed-method designs in disability and rehabilitation research. The article will conclude with recommendations for rehabilitation nursing researchers to apply both qualitative and quantitative methods in their research practice.     

Critical review of topical management of oral hairy leukoplakia

Oral hairy leukoplakia (OHL) is a disease associated with Epstein-Barr virus and human immunodeficiency virus infections. OHL is usually an asymptomatic lesion, but in some cases treatment is recommended to reestablish the normal characteristics of the tongue, to eliminate pathogenic microorganisms, to improve patient comfort and for cosmetic reasons. Proposed treatments for this condition include surgery, systemic antiviral treatment and topical management. Topical treatment is an inexpensive and safe therapy that is easy to apply, noninvasive, free of systemic adverse effects and effective over a long period of time. The aim of this study was to present a review of the literature for topical therapy for OHL. Gentian violet, retinoids, podophyllin, acyclovir and podophyllin associated with topical antiviral drugs were used to treat OHL. Reports with this focus are limited, and since 2010, no new studies have been published that discuss the efficacy of topical treatments for OHL. Podophyllin with acyclovir cream was found to be effective, causing regression of lesions with no recurrences. Additional searches are necessary to provide clinical evidence of topical management effectiveness.     

Topical medications: a focus on antifungals and topical steroids

Because skin disease is accessible, it can be treated with locally applied medication, which offers great advantages--exposure to a drug is limited to the affected skin and systemic effects of potentially toxic drugs are minimized. Ointments, creams, antifungals, and antibiotics all have their place in treating various skin diseases. Topical steroids, the largest group of topical medications, are effective but present the potential for side effects. This article discusses current and new topical medications that can be used to treat a range of skin diseases.     

The cyanoacrylate topical skin adhesives

Each year there are over 7 million lacerations requiring wound closure in the emergency department. Traditionally, most lacerations have been closed with sutures. Topical cyanoacrylate skin adhesives offer many advantages over traditional wound closure devices. Recently, the Food and Drug Administration (FDA) has reclassified the topical skin adhesives. As a result, new topical skin adhesives are expected to enter the market in the near future. This article will review the structure and function of cyanoacrylates as well as their advantages, indications, and usage.     

Pharmacologic management of osteoarthritis-related pain in older adults: a review shows that many drug therapies provide small-to-modest pain relief

OVERVIEW: Because pain is a common and debilitating symptom of osteoarthritis in older adults, the authors reviewed data on the efficacy and safety of commonly used oral, topical, and intraarticular drug therapies in this population. A search of several databases found that most studies have focused on knee osteoarthritis and reported only short-term outcomes. Also, treatment efficacy was found to vary by drug class; the smallest effect was observed with acetaminophen and the largest with opioids and viscosupplements.Acetaminophen and topical agents had the best safety profiles, whereas oral nonsteroidal antiinflammatory drugs and opioids had the worst. Little data were available on patients ages 75 years old and older and on patients from diverse racial and ethnic groups. Most drug therapies gave mild-to-moderate pain relief; their long-term safety and efficacy and their effects in diverse populations (particularly older adults) remain undetermined.     

Chronic plaque psoriasis

Chronic plaque psoriasis, the most common form of psoriasis, is a papulosquamous disease defined by erythematous plaques with a silvery scale. The diagnosis usually is clinical, but occasionally a biopsy is necessary. Psoriasis affects 0.6 to 4.8 percent of the U.S. population, and about 30 percent of affected patients have a first-degree relative with the disease. Psoriasis is a T-cell-mediated autoimmune disease, but certain medications and infections are well-known risk factors. Management of psoriasis includes education about chronicity, realistic expectations, and use of medication. Steroids and vitamin D derivatives (e.g., calcipotriene) are the mainstays of topical therapy. Topical steroids and calcipotriene together may work better than either agent alone. Patients with psoriasis involving more than 20 percent of their skin or those not responding to topical therapy are candidates for light therapy; traditional systemic therapy; or systemic treatment with immunomodulatory drugs such as alefacept, efalizumab, and etanercept.     

Antiglaucoma medications: a review of safety and tolerability issues related to their use

BACKGROUND: Much experience has been gained with the use of older classes of antiglaucoma agents--topical beta-adrenergic-receptor antagonists, nonselective adrenergic-receptor agonists, oral carbonic anhydrase inhibitors, and cholinergic agents. In the past decade, new drugs and classes of drugs used to treat glaucoma have become available, including topical carbonic anhydrase inhibitors, prostaglandin analogues, and alpha2-adrenergic-receptor agonists. Extensive community-based use of antiglaucoma medications has led to an increased understanding of the acute and long-term safety and tolerability issues associated with their use. OBJECTIVE: This paper reviews the side effects associated with the various classes of topical antiglaucoma drugs, with a particular focus on long-term safety issues.     

Norfloxacin and silver-norfloxacin as topical antimicrobial agents: results of in vitro susceptibility testing against bacteria and Candida sp isolated from burn patients

Because of its broad spectrum of antibacterial action, Norfloxacin, a new quinoline carboxylic acid compound, was formulated in a topical cream base and tested for activity against a variety of bacteria and yeasts isolated from burn patients. An in vitro agar well diffusion topical susceptibility test was used. The silver salt of Norfloxacin also was tested. For comparative purposes, commonly used topical antibacterial and antifungal preparations were examined as well. No bacterial isolate tested was resistant to the action of Norfloxacin or that of silver-Norfloxacin. Furthermore, all Candida organisms assayed were susceptible to silver-Norfloxacin. All other topical agents tested had some strains of bacteria or yeast, or both, that were resistant to their action. Therefore, Norfloxacin and, particularly, silver-Norfloxacin, warrant further development as topical anti-infective agents for use in treating burn patients.     

Topical anesthesia for laceration repair: tetracaine versus TAC (tetracaine, adrenaline, and cocaine)

Topical anesthetics have always had a place in anesthetizing mucous membranes. The earliest writing in Greek medical literature makes reference to the use of these topical anesthetizing agents. Previous studies utilized a mixture of tetracaine, Adrenaline, and cocaine in the pediatric population with increased patient compliance. In contrast, another study cites the increased risk of infection in cases where topical anesthetics in combination with potent vasoconstrictors are used. To examine the efficacy and safety of a tetracaine and a tetracaine, Adrenalin, and cocaine mixture (TAC), a randomized, double-blind study was undertaken. A total of 68 patients participated in the study, with 36 receiving TAC and 32 receiving tetracaine. The results indicate that the most efficacious use of TAC is on facial lacerations, regardless of length or depth. Of the 46 participants available for follow-up, one patient in the tetracaine group reported a wound infection. A recommendation of increased use of TAC on facial lacerations, in both the adult and pediatric populations, is made based on the results of this study.     

Ctriporin, a new anti-methicillin-resistant Staphylococcus aureus peptide from the venom of the scorpion Chaerilus tricostatus

Antibiotic-resistant microbes, such as methicillin-resistant Staphylococcus aureus, seriously threaten human health. The outbreak of "superbugs" in recent years emphasizes once again the need for the development of new antimicrobial agents or resources. Antimicrobial peptides have an evident bactericidal effect against multidrug-resistant pathogens. In the present study, a new antimicrobial peptide, ctriporin, was cloned and characterized from the venom of the scorpion Chaerilus tricostatus, an animal which has not yet been explored for toxic peptide resources. The MICs of ctriporin against Staphylococcus aureus, Bacillus thuringiensis, Bacillus subtilis, Micrococcus luteus, and Candida albicans are 5 to 20 μg/ml. Meanwhile, it MIC against clinical antibiotic-resistant bacterial strains is 10 μg/ml. Furthermore, the potential for ctriporin to be used as a topical antibiotic for treating staphylococcal skin infections was investigated. External use of the peptide ctriporin dramatically decreased the bacterial counts and cured skin infections in mice. In addition, ctriporin demonstrates antimicrobial efficacy via the bactericidal mechanism of rapid cell lysis. Together, these results suggest the potential of developing ctriporin as a new topical antibiotic.