Phase III Study of Silver Leaf Nylon Dressing vs Standard Care for Reduction of Inframammary Moist Desquamation in Patients Undergoing Adjuvant Whole Breast Radiation Therapy

AimsThe primary objective of this study was to assess silver leaf nylon dressings as a prophylactic measure in reducing inframammary fold radiation induced dermatitis in women receiving adjuvant whole breast radiotherapy compared with standard skin care. A secondary objective was to assess if the dressing influenced breast skin–related pain, itching and burning resulting from whole breast radiotherapy.Material and methodsA prospective randomized trial compared silver leaf nylon dressing worn continuously from the sixth fraction of whole breast radiotherapy until 14 days after therapy completion to standard skin care in patients deemed to be at risk of inframammary radiation induced dermatitis by virtue of a large breast volume or a significant inframammary skin fold in the treatment position. Stratification before randomization was for anthracycline chemotherapy and fractionation scheme. Digital photos of the inframammary region were taken at one week before, the last day of whole breast radiotherapy, and one week after treatment completion. Three observers blinded to treatment arm assessed the images for the presence of moist desquamation and the Radiation Therapy Oncology Group (RTOG) skin toxicity score. Patients completed questionnaires comprising visual analogue scales for pain, itching and burning sensation, and questions regarding which topical skin cream was being used, at the before-mentioned times as well as at baseline and two weeks after completing whole breast radiotherapy.ResultsA total of 196 patients completed the study. Moist desquamation occurred in 38% of patients. No difference in incidence or maximum size of moist desquamation or RTOG skin toxicity scores was seen between the treatment arms. However, on the last day of radiation treatment and one week after completion of treatment, patient reports of itching decreased in the experimental arm. At one week before whole breast radiotherapy completion, patients using Glaxal Base cream reported worse burning, those using aloe vera reported worse pain and burning, whereas patients who had not used a moisturizing cream reported less pain.ConclusionSilver leaf nylon dressing use did not demonstrate a decrease in the incidence of inframammary moist desquamation, but did decrease itching in the last week of radiation and one week after treatment completion.     

Retrospective study of radiotherapy-induced skin reactions in breast cancer patients: Reduced incidence of moist desquamation with a hydroactive colloid gel versus dexpanthenol

PurposeDermatitis is a very frequent and distressing side effect of radiation therapy that may necessitate a treatment interruption when evolving towards more severe forms such as moist desquamation (MD). The aim of this study was to compare the efficacy of two topical agents, a dexpanthenol cream vs a hydroactive colloid gel combining absorbing and moisturising properties, in preventing MD in breast cancer patients.MethodsThis retrospective study compared two successive groups of breast cancer patients undergoing radiotherapy after breast-sparing surgery between 2008 and 2012. A group of 267 patients applied a 5% dexpanthenol cream on the irradiated zone throughout the course of their radiotherapy. Another group of 216 patients applied first the dexpanthenol cream then replaced it by the hydroactive colloid gel after 11–14 days of radiotherapy. Radiation treatment (total dose, technique, and equipment) was the same for the two groups. The clinical outcomes were the occurrence and time to onset of moist desquamation.Key resultsThe overall incidence of MD was significantly lower in patients who applied the hydroactive colloid gel (16%) than in those who applied the dexpanthenol cream (32%, odds-ratio = 0.35). Also, MD occurred significantly later with the hydroactive colloid gel than with the dexpanthenol cream (hazard ratio = 0.39).ConclusionsCompared with the dexpanthenol cream, the hydroactive colloid gel significantly reduced the risk of developing MD in patients undergoing radiotherapy for breast cancer. These promising results warrant further research on the efficacy of hydroactive colloid gels in managing radiation dermatitis.     

The effect of topical non-steroidal anti-inflammatory cream on the incidence and severity of cutaneous burns following external DC cardioversion

INTRODUCTION: Cutaneous burns are a common cause of morbidity following direct current (DC) cardioversion. We designed a study to determine whether the application of non-steroidal anti-inflammatory cream prior to cardioversion reduces their incidence and severity. MATERIALS AND METHODS: Two hours before elective DC cardioversion, we randomised 55 patients to receive ibuprofen 5% cream or placebo cream over sternal and apical pad sites, with patients acting as their own controls. Two hours after cardioversion an independent blinded observer measured skin temperature, erythema index, and minimum sensory and pain detection thresholds at sternal and apical pad sites. Visual analogue pain score (VAS) for each site was recorded at 2 h and 24 h post-cardioversion. RESULTS: There was a statistically significant difference between pain measured by VAS, skin temperature and pain detection threshold measured at pad sites with pre-applied ibuprofen 5% cream and those with pre-applied aqueous cream, after elective DC cardioversion. CONCLUSION: Prophylactic application of topical ibuprofen 5% cream 2h prior to elective DC cardioversion reduces pain and inflammation. Consideration should be given to use of prophylactic application of topical ibuprofen as routine treatment for elective DC cardioversion.     

芦荟治疗急慢性创伤疗效的系统评价

目的系统评价芦荟及芦荟产品（如外用敷料及凝胶等）对急性创伤（如撕裂伤、手术切口及烧伤等）和慢性创伤（如感染性伤口及动静脉溃疡等）的疗效。方法计算机检索TheCochraneLibrary、PubMed、EMbase、CBM、CNKI和VIP,检索时限均为从建库至2012年4月,收集芦荟或其派生产品治疗急慢性创伤的随机对照试验（RCT）。由2名研究者独立进行文献筛选、数据提取及偏倚风险评估后,采用RevMan5．0软件进行Meta分析。结果最终纳入15个RCT,共计773例患者,纳入研究的质量均较低。8个RCT评价芦荟用于治疗急性创伤（烧伤、痔切除术及皮肤活检）,所有文献均未涉及是否有感染发生这一指标。Meta分析结果显示：与磺胺嘧啶银乳膏相比,芦荟产品能提高烧伤患者的伤口愈合数[RR=I．28,95％CI（1．03,1．60）,P=0．03];与抗生素霜相比,芦荟产品能缩短烧伤患者的平均伤口愈合时间[MD=-12．90,95％CI（-13．29,-12．51）,P〈0．00001）];与传统治疗相比,芦荟凝胶增加了皮肤急性外科创伤伤口愈合患者数[RR=16．33,95％CI（3．46,77．15）,P=0．0004],能提高压疮患者伤口愈合数[RR=1．73,95％CI（1．21,2．49）,P=0．003]。结论应用芦荟外用制剂或敷料对急慢性创伤均有积极意义,但此结论至今仍缺少高质量研究证据予以支持。     

The effect of prophylactic topical steroid cream on the incidence and severity of cutaneous burns following external DC cardioversion

INTRODUCTION: Cutaneous burns are a common cause of morbidity following direct current (DC) cardioversion. We designed a prospective double-blinded controlled study to determine whether the application of steroid cream prior to cardioversion reduces their incidence and severity. MATERIALS AND METHODS: Two hours before elective DC cardioversion, we applied betamethasone 0.1% cream or placebo cream over sternal and apical pad sites in 56 patients, with patients acting as their own controls. Two hours after cardioversion, a separate blinded observer measured the visual analogue pain score (VAS), sensory and pain detection thresholds, skin temperature and erythema index at sternal and apical pad sites. RESULTS: The study had an 80% power to detect a 50% difference in VAS at 2 h, accepting an alpha error of 0.05. There was no difference between pain at 2 or 24 h, skin temperature, erythema index, sensory and pain detection thresholds at pad sites treated with steroid cream or control. CONCLUSION: Topical betamethasone 0.1% cream applied 2 h before elective DC cardioversion is no more effective than placebo at reducing the pain and inflammation from cardioversion burns.     

Outpatient burns: prevention and care

Most burn injuries can be managed on an outpatient basis by primary care physicians. Prevention efforts can significantly lower the incidence of burns, especially in children. Burns should be managed in the same manner as any other trauma, including a primary and secondary survey. Superficial burns can be treated with topical application of lotions, honey, aloe vera, or antibiotic ointment. Partial-thickness burns should be treated with a topical antimicrobial agent or an absorptive occlusive dressing to help reduce pain, promote healing,and prevent wound desiccation. Topical silver sulfadiazine is the standard treatment; however, newer occlusive dressings can provide faster healing and are often more cost-effective. Physicians must reevaluate patients frequently after a burn injury and be aware of the indications for referral to a burn specialist.     

芦荟联合维生素E预防放射性皮肤损伤的效果观察

目的 探讨芦荟、维生素E联合外用对放疗时患者皮肤的保护效果.方法 将应用直线加速器首次接受放疗的138例恶性肿瘤患者随机分为预防组(n=70)及对照组(n=68),预防组于每次放疗前将新鲜芦荟汁均匀涂在患者照射野皮肤,待自然干燥后再行放疗,每次放疗结束用冷开水清洁照射野皮肤,涂适量维生素E.出现皮肤损伤后可增加局部用药(芦荟,维生素E)次数;对照组照射野皮肤不采用保护措施,出现皮肤损伤后局部涂氟哌酸或用金因肽外喷.对两组患者照射野皮肤按RTOG急性放射损伤分级标准每日进行评价至疗程结束.结果 预防组放射性皮肤损伤发生率明显低于对照组,损伤程度明显轻于对照组,损伤发生时间比对照组明显推迟,差异均有统计学意义.结论 芦荟与维生素E联合局部给药,对恶性肿瘤放射性皮肤损伤有较好的预防和控制效果.     

Outpatient burns: prevention and care

Most burn injuries can be managed on an outpatient basis by primary care physicians. Prevention efforts can significantly lower the incidence of burns, especially in children. Burns should be managed in the same manner as any other trauma, including a primary and secondary survey. Superficial burns can be treated with topical application of lotions, honey, aloe vera, or antibiotic ointment. Partial-thickness burns should be treated with a topical antimicrobial agent or an absorptive occlusive dressing to help reduce pain, promote healing, and prevent wound desiccation. Topical silver sulfadiazine is the standard treatment; however, newer occlusive dressings can provide faster healing and are often more cost-effective. Physicians must reevaluate patients frequently after a burn injury and be aware of the indications for referral to a burn specialist.     

Clinical trials in dermatology. Evaluation of the tolerability and efficacy of a topical anti-acne]

Acne is a frequent dermatologic disease of the teenagers. Methodology of antiacne preparations clinical trials has evolved recently, leading to better comprehension of acne treatment on acne lesions. The main rules for good clinical evaluation of acne treatments are: an objective counting of each individual lesions on a defined area (face, back), a global acne assessment, a therapy duration from 1 to 3 months or more, a skin safety evaluation for erythema, desquamation, dryness, itching, burning and oiliness with a 0 to 3 scoring system.     

Effects of tazarotene 0.1 % cream in the treatment of facial acne vulgaris: pooled results from two multicenter, double-blind, randomized, vehicle-controlled, parallel-group trials

BACKGROUND: Topical retinoids are one of the most effective classes of topical drugs used to treat acne vulgaris.The effects of the gel formulation of the topical retinoid tazarotene have been widely reported, but few data on the cream formulation are available. OBJECTIVE: The primary aim of the 2 studies reported in this article was to determine the effects of tazarotene 0.1 % cream in patients with facial acne vulgaris. METHODS: Two randomized, double-blind, parallel-group studies were performed. The first was conducted at 14 investigational sites across the United States, and the second took place at 15 sites, with 5 of these providing blood samples for analysis of tazarotenic acid. In both studies, patients aged > or =12 years with facial acne vulgaris were randomized to receive tazarotene or vehicle cream QD for 12 weeks. Lesion counts (noninflammatory, inflammatory, and total) and overall clinical and global assessments were made at weeks 0 (baseline), 4, 8, and 12. Adverse events (AEs) were monitored throughout the study In one of the studies, therapeutic drug monitoring was performed at weeks 4 and 8 in members of the study population who gave consent for blood withdrawal. RESULTS: Eight hundred forty-seven patients were enrolled in the 2 studies (430 males, 417 females; mean age,19 years; age range, 11-52 years [1 patient was entered into the study at age 11 years, in violation of the protocol]). At 12 weeks, the median percentage changes from baseline in all 3 lesion counts were significantly lower with tazarotene than with vehicle (all, P < 0.001), as were the overall clinical and global responses (both, P < 0.001). Treatment-related AEs whose incidence was higher with tazarotene than with vehicle included desquamation, dry skin, erythema, a burning sensation on the skin, and skin irritation (all, P < 0.001) and pruritus (P < 0.01); most (83%-98%) were mild or moderate. Systemic exposure to tazarotenic acid was limited (mean, <0.1 ng/mL) and did not increase with time. CONCLUSIONS: In these 2 studies in adolescent and adult patients with facial acne vulgaris, tazarotene 0.1%cream QD for 12 weeks was effective and well tolerated. Systemic exposure to tazarotenic acid was limited.     

The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline

Goals of work

To develop a practice guideline report on the questions: What are the optimal methods to prevent acute skin reactions (occurring within the first 6 months of irradiation) related to radiation therapy? What are the optimal methods to manage acute skin reactions related to radiation therapy?

Materials and methods

Cancer Care Ontario’s Supportive Care Guidelines Group (SCGG) conducted a systematic review of literature on this topic. Evidence-based recommendations were formulated to guide clinical decision making, and a formal external review process was conducted to validate the relevance of these opinions for Ontario practitioners.

Main results

Twenty-eight trials meeting the inclusion criteria were identified. Of the twenty-three trials that evaluated preventative methods, washing was the only practice which significantly prevented skin reaction. Some evidence suggested topical steroid creams and calendula ointment might be effective. None of the five trials evaluating skin reaction management detected a positive effect using steroid cream, sucralfate cream, or dressings.

Conclusions

Skin washing, including gentle washing with water alone with or without mild soap, should be permitted in patients receiving radiation therapy to prevent acute skin reaction. There is insufficient evidence to support or refute specific topical or oral agents for the prevention or management of acute skin reaction. In the expert opinion from the SCGG, the use of a plain, non-scented, lanolin-free hydrophilic cream may be helpful in preventing radiation skin reactions. In addition, a low dose (i.e., 1%) corticosteroid cream may be beneficial in the reduction of itching and irritation.     

Efficacy of a new cream formulation of mupirocin: comparison with oral and topical agents in experimental skin infections

A new cream formulation of mupirocin developed to improve patient compliance was compared with systemic and topical antibiotics commonly used to treat primary and secondary skin infections. A mouse surgical wound model infected with Staphylococcus aureus or Streptococcus pyogenes was used. Topical treatment was applied at 4 and 10 h postinfection or oral treatment at a clinically relevant dose was administered 4, 8, and 12 h postinfection; treatments were continued three times daily for a further 3 days. Mupirocin cream was significantly more effective than (P < 0.01; two of eight studies) or not significantly different from (six of eight studies) mupirocin ointment in reducing bacterial numbers. Mupirocin cream was similar in efficacy to oral flucloxacillin but significantly more effective (P < 0.001) than oral erythromycin. It was also similar in efficacy to cephalexin against S. pyogenes but superior against S. aureus (P < 0.01). Mupirocin cream had a similar efficacy to fusidic acid cream against S. aureus but was significantly superior against S. pyogenes (P < 0.01). A hamster impetigo model infected with S. aureus was also used. Topical or oral treatment was administered at 24 and 30 h postinfection (also 36 h postinfection for oral therapy) and then three times daily for a further 2 days. On day 5, mupirocin cream was significantly more effective than mupirocin ointment in one study (P < 0.01) and of similar efficacy in the other two studies. Mupirocin cream was not significantly different from fusidic acid cream or neomycin-bacitracin cream, but it was significantly superior (P < 0.01) to oral erythromycin and cephalexin. Mupirocin cream was as effective as, or superior to, oral and other topical agents commonly used for skin infections.     

Ultrasound with Topical Anesthetic Rapidly Decreases Pain of Intravenous Cannulation

Objectives: Physicians and nurses in the emergency department rarely use topical anesthesia when starting intravenous (IV) lines because of time constraints and lack of data on patients' perception of the pain associated with this procedure. Ultrasound pretreatment of skin increases permeation rates of hydrophobic topical medications, including topical lidocaine. The objective of this study was to demonstrate that ultrasound treatment followed by brief application of topical anesthetic decreases the patients' perception of the pain of IV cannulation. Methods: This was a randomized, controlled, prospective trial performed in a university hospital emergency department. Eighty-seven consecutive English-speaking, subcritically injured or ill adult patients able to give consent who were receiving an IV line as part of their care were enrolled. The intervention was a brief ultrasound treatment using the SonoPrep (Sontra Medical Corp., Franklin, MA) therapeutic ultrasound device (frequency, 53–56 kHz) followed by 5 minutes of 4% liposomal lidocaine cream and standard-care IV cannulation, or standard care alone. Participants rated their pain on a visual analog scale. Researchers assessed the site after IV insertion and 20–36 hours later. The primary outcome was participants' subjective pain score, and the secondary outcome was site skin irritation. Results: The ultrasound group reported significantly less pain (p<0.001), with 80% of treated participants reporting pain scores ≤3 versus only 37% of controls (p <0.001). Conclusions: The SonoPrep ultrasound device applied to skin for 15 seconds followed by 5 minutes of 4% liposomal lidocaine cream significantly reduced patients' perception of the pain of an IV start when compared with standard care. There were no adverse side effects noted in any participant during the 36 hours of the follow-up period.     

Cutaneous Tape Stripping to Accelerate the Anesthetic Effects of EMLA Cream: A Randomized, Controlled Trial

Abstract. Most medications are not absorbed topically due to the stratum corneum barrier. While effective as a topical anesthetic, EMLA cream is absorbed slowly, delaying its effects for up to one hour, thereby limiting its usefulness.
Objective: To determine whether removal of the cornified layer of the skin by tape stripping (TS) would allow more rapid onset of anesthesia after topical application of EMLA cream prior to IV catheterization (IVC).
Methods: This was a prospective, randomized, controlled trial comparing the levels of pain of IVC 15 minutes after topical application of EMLA cream in patients who had TS vs patients who did not. The setting was a suburban university-affiliated ED. A convenience sample of 68 alert adult patients requiring IVC were enrolled. The primary outcomes measured were pain of IVC and pain of TS using a previously validated 100-mm visual analog scale as well as the IVC success rate.
Results: The pain of IVC was less for TS vs control patients [29.7 mm (95% CI = 20.4 to 39.0 mm) vs 15.9 mm (95% CI = 9.1 to 22.6 mm), p = 0.017]. The mean pain of TS was 4.8 ± 7.4 mm. The IVC success rate for TS vs control patients was 91% vs 74% (p = 0.056). There were no adverse events after TS.
Conclusions: Removal of the cornified layer of the skin resulted in a more rapid anesthetic effect of EMLA cream as evidenced by lower IVC pain scores after TS. The effectiveness of TS for enhanced absorption of other medications should be investigated.     

Efficacy of a topical formulation of henna (Lawsonia inermis L.) in contact dermatitis in patients using prosthesis: A double-blind randomized placebo-controlled clinical trial

BackgroundContact dermatitis is a common complication in prosthetic limb users. There are no effective, available and cheap treatments for skin problems of these patients. In traditional Iranian medicine, henna (Lawsonia inermis L.) is a plant that has anti-inflammatory, antimicrobial and skin-enhancing properties, all of which are beneficial for people with artificial limbs. The aim of this study was to assess the efficacy of a topical henna preparation in management of contact dermatitis in patients using lower limb prosthetics.MethodsThe current randomized, double-blind, placebo-controlled clinical trial was conducted on ninety-five participants with lower extremity amputation using limb prosthetics, aged 12–70 years who complained of contact dermatitis. They were randomly assigned to receive either two weeks of topical henna preparation every night as the intervention group, or topical placebo as the control group. Participants were instructed to spread henna preparation on the surfaces of the amputated limb that were in contact with the prosthesis. Severity of contact dermatitis symptoms was set as the primary outcome measure. Edema, papules and erythema were evaluated by a physician using standard color atlas. Secondary outcomes included symptoms such as burning, itching, pain, thickness and skin sweating evaluated by a self-administered questionnaire.ResultsA significant improvement was observed in the symptoms of contact dermatitis including skin edema, itching, sweating, skin thinning and pain (p-value<0.05) in the henna group compared to the placebo group. Skin burning decreased more in the henna group compared to the placebo group, but this was not statistically significant (p-value = 0.052). Moreover, skin redness significantly increased in the henna group (p-value = 0.001).ConclusionTopical formulation of henna might be a complementary choice for improving contact dermatitis in patients using lower limb prosthetics.     

Comparison of topically applied 5-ethyl-2''-deoxyuridine and acyclovir in the treatment of cutaneous herpes simplex virus infection in guinea pigs.

Three percent 5-ethyl-2'-deoxyuridine (EdU) in an aqueous cream base was compared with 5% acyclovir (ACV) in polyethylene glycol ointment and 3% EdU in 95% dimethyl sulfoxide (DMSO) for efficacy in the topical treatment of an experimental dorsal cutaneous herpes simplex virus type 1 infection in guinea pigs. Topical ACV treatment reduced the mean lesion number by 15%, the lesion area by 32%, and the lesion virus titer by 60% when compared with measurements at contralateral sites treated with the vehicle alone. Application of 3% EdU cream was more beneficial, effecting reductions of 29, 44, and 68% in the same measurements. EdU in DMSO was even more effective, reducing the lesion measurements by 39, 60, and 90%, respectively. The penetration of EdU and ACV through guinea pig skin was compared in single-chamber diffusion cells. In the aqueous cream, EdU readily penetrated excised skin and exhibited rates of flux 10-fold greater than those shown by ACV in ointment formulation (0.56 versus 0.05 microgram/cm2 per h; P = 0.05). The flux of EdU in DMSO was 3.39 micrograms/cm2 per h, six times higher than the flux in the cream vehicle. EdU was more effective than ACV in this experimental animal model, most likely due to better percutaneous drug delivery of EdU from the cream and DMSO vehicles.     

Evidence-based skin care management in radiation therapy

OBJECTIVES: To review published studies evaluating interventions for the prevention and management of radiation skin reactions/dermatitis. DATA SOURCES: Research studies, review articles, and clinical practice guidelines. CONCLUSION: There is insufficient evidence in the literature to recommend specific topical or oral agents in the prevention or management of skin reactions. Recent limited evidence suggests that the use of calendula cream may reduce the incidence of grade 2 and 3 reactions in women with breast cancer. Additionally, early studies evaluating the use of barrier films or creams may improve moist desquamation. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to increase their awareness of the evidence or lack of evidence when recommending interventions to their patients. Further research is required to evaluate interventions in the prevention and management of radiation dermatitis.     

Effect of a blend of comfrey root extract (Symphytum officinale L.) and tannic acid creams in the treatment of osteoarthritis of the knee: randomized, placebo-controlled, double-blind, multiclinical trials

Objective

The purpose of this study was to determine the effect of 2 concentrations of topical, comfrey-based botanical creams containing a blend of tannic acid and eucalyptus to a eucalyptus reference cream on pain, stiffness, and physical functioning in those with primary osteoarthritis of the knee.

Methods

Forty-three male and female subjects (45-83 years old) with diagnosed primary osteoarthritis of the knee who met the inclusion criteria were entered into the study. The subjects were randomly assigned to 1 of 3 treatment groups: 10% or 20% comfrey root extract (Symphytum officinale L.) or a placebo cream. Outcomes of pain, stiffness, and functioning were done on the Western Ontario and MacMaster Universities Osteoarthritis Index. Participants applied the cream 3× a day for 6 weeks and were evaluated every 2 weeks during the treatment.

Results

Repeated-measures analyses of variance yielded significant differences in all of the Western Ontario and MacMaster Universities Osteoarthritis Index categories (pain P < .01, stiffness P < .01, daily function P < .01), confirming that the 10% and 20% comfrey-based creams were superior to the reference cream. The active groups each had 2 participants who had temporary and minor adverse reactions of skin rash and itching, which were rapidly resolved by modifying applications.

Conclusion

Both active topical comfrey formulations were effective in relieving pain and stiffness and in improving physical functioning and were superior to placebo in those with primary osteoarthritis of the knee without serious adverse effects.     

单用功效性护肤品治疗轻中度面部玫瑰痤疮及脂溢性皮炎的多中心临床研究

[目的]探讨单用功效性护肤品治疗轻中度面部玫瑰痤疮及脂溢性皮炎的临床疗效.[方法]在全国范围内17家医院皮肤科门诊招募1个月以上病史的轻中度面部玫瑰痤疮或脂溢性皮炎患者,给予面部单用功效性护肤品2周,每周复诊1次,对其临床症状(干燥、瘙痒、灼热)和体征(脱屑、红斑)进行评分,并检测其皮肤屏障指标.[结果]共324名受试...     

The effect of topical wheatgrass cream on chronic plantar fasciitis: a randomized, double-blind, placebo-controlled trial

OBJECTIVES: To investigate the efficacy of a topical wheatgrass cream for improving pain and function in patients with chronic plantar fasciitis. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Eighty participants with chronic plantar fasciitis were randomly assigned to a treatment group (wheatgrass cream) or a control group (placebo cream). All participants applied a cream twice daily for 6 weeks. Follow up was conducted at 6 and 12 weeks. MAIN OUTCOME MEASURES: Visual Analogue Scale (VAS) for daily first-step pain and the Foot Health Status Questionnaire (FHSQ) for overall foot function. Secondary measures of foot posture, calf muscle strength and range of ankle dorsiflexion were also assessed. RESULTS: No significant differences were found between groups with respect to main outcomes of first-step pain or foot function at any time. Both groups improved significantly from baseline to 6 weeks, and these improvements were maintained at 12 weeks. CONCLUSIONS: The topical application of wheatgrass cream is no more effective than a placebo cream for the treatment of chronic plantar fasciitis.