Stretch marks during pregnancy: a review of topical prevention

Striae gravidarum (SG), or stretch marks developing during pregnancy, affect up to 90% of women. While not medically dangerous, SG can be disfiguring, causing emotional and psychological distress. However, studies specifically addressing the prevention of SG, especially during pregnancy, are sparse. Furthermore, the molecular pathogenesis of SG is unclear and may differ from that of striae from other causes. Considering these factors, we review topical modalities that have been used specifically for preventing SG during pregnancy. We identify two major strategies (end points) addressed by these modalities, namely (i) preventing the de novo development of SG and (ii) reducing the severity of SG that have recently developed. We also identify risk factors for the development of SG and suggest that pregnant women with these risk factors are an appropriate target population for prevention. In reviewing the literature, we find that there is limited evidence that centella, and possibly massage with bitter almond oil, may prevent SG and/or reduce their severity. There is weak evidence that hyaluronic acid prevents SG. Tretinoin holds promise for reducing the severity of new‐onset SG, but its use is limited by its pregnancy category. Finally, cocoa butter and olive oil are not effective for preventing SG or reducing the severity of lesions. We conclude that reliable methods for preventing SG are scarce. Furthermore, available topical modalities generally lack strong evidence from rigorous, well‐designed, randomized controlled trials with ample numbers of subjects. Thus, further research is necessary to elucidate SG pathogenesis, which may lead to effective prevention modalities.     

Acute surgical complications: cause, prevention, and treatment

The acute complications that may result in failure of the surgical procedure are discussed. These include bleeding, hematoma, infection, dehiscence, and necrosis. The background of each is covered in detail and an attempt is made to show the interrelationships among them. The purpose of this communication is to aid in the recognition, treatment, and prevention of these acute surgical complications.     

Scalp psoriasis: a review of current topical treatment options

The scalp is the most common site of disease involvement at the onset and throughout the course of psoriasis. For many patients, psoriasis of the scalp is the most difficult aspect of their disease; yet, despite a wide range of therapy options and an extensive literature base, scalp psoriasis remains difficult to treat, highlighting a long-standing unmet need for the effective treatment of scalp psoriasis. A review of past and current medical literature reveals that a number of interesting therapeutic approaches have been used in the treatment of scalp psoriasis. The diverse and sometimes extreme therapeutic approaches, the marginal benefit of many topical agents, the paucity of controlled studies evaluating the efficacy of topical agents in the treatment of scalp psoriasis and the high level of patient dissatisfaction with currently available treatments for psoriasis all support the need for new, effective and well-tolerated treatment options for scalp psoriasis.     

Current topical and systemic approaches to treatment of rosacea

Rosacea is a common, often overlooked, chronic facial dermatosis characterized by intermittent periods of exacerbation and remission. Clinical subtypes and grading of the disease have been defined in the literature. On the basis of a genetic predisposition, there are several intrinsic and extrinsic factors possibly correlating with the phenotypic expression of the disease. Although rosacea cannot be cured, there are several recommended treatment strategies appropriate to control the corresponding symptoms/signs. In addition to adequate skin care, these include topical and systemic medications particularly suitable for the papulopustular subtype of rosacea with moderate to severe intensity. The most commonly used and most established therapeutic regimens are topical metronidazole and topical azelaic acid as well as oral doxycycline. Conventionally, 100–200 mg per day have been used. Today also a controlled release formulation is available, delivering 40 mg per day using non-antibiotic, anti-inflammatory activities of the drug. Anti-inflammatory dose doxycycline in particular allows for a safe and effective short- and long-term therapy of rosacea. Topical metronidazole and topical azelaic acid also appear to be safe and effective for short-term use. There are indications that a combined therapy of anti-inflammatory dose doxycycline and topical metronidazole could possibly have synergy effects. Further interesting therapy options for the short- and long-term therapy of rosacea could be low-dose minocycline and isotretinoin; however, too little data are available with regard to the effectiveness, safety, optimal dosage and appropriate length of treatment for these medications to draw final conclusions.

Conflicts of interest

None declared.     

Scar sarcoidosis: a case report and brief review

Scar sarcoidosis refers to lesions of cutaneous sarcoidosis that appear in preexisting scars. This condition may be caused by mechanical trauma such as skin cuts or venipuncture, scars caused by infection such as herpes zoster, and tattoos. We present a case of a 34-year-old man who developed scar sarcoidosis following minor trauma to the left calf. We review the epidemiology, clinical presentations, pathophysiology, and treatment options for scar sarcoidosis.     

Efficacy and safety of topical antifungals in the treatment of dermatomycosis: a systematic review

The analysis of comparative efficacy and safety of topical antifungals in the literature is restricted to the treatment of tinea pedis and onychomycosis. Therefore our objective was to evaluate and compare the efficacy and safety of topical antifungals used in the treatment of dermatomycosis, we performed a comprehensive search for randomized controlled trials (RCTs) in the following databases: Medline, Cochrane Central Register of Controlled Trials, EMBASE, Lilacs and International Pharmaceutical Abstracts, we identified studies that compared the use of topical antifungals with other antifungals or with placebo published up to July 2010 in English, Spanish or Portuguese. The quality of reporting was assessed according to the Jadad scale; only studies with a score of 3 or more were included. The outcomes evaluated were mycological cure at the end of treatment, sustained cure, occurrence of adverse events and tolerability, including withdrawals due to adverse events. A total of 104 RCTs satisfied the inclusion criteria, containing a total of 135 comparisons, with 55 out of 120 possible comparisons among the 16 drugs evaluated. Pooled data on efficacy showed that all the antifungals were better than placebo. There were no significant differences among antifungal classes. No differences were found in safety or tolerability in any direct comparison. Sensitivity analysis indicated the robustness of the findings. Our results indicate the clear superiority of topical antifungals over placebo but that there is no consistent difference among classes. Mixed treatment comparisons are necessary to rank antifungals, as direct comparisons among many of them are lacking.     

Sexually transmitted infections in women with disabilities: diagnosis, treatment, and prevention: a review

BACKGROUND AND OBJECTIVES: Women with disabilities can and do contract sexually transmitted diseases (STDs). However, because of access barriers, attitudinal misconceptions, and lack of awareness of their risk status, these infections may go under or undiagnosed. GOAL: To address issues regarding the treatment of women with disabilities and to suggest ways in which the patient and the provider can work together for a positive outcome. STUDY DESIGN: A literature review was performed using recent textbooks, publications, and medical journals to collect information regarding the health behaviors of women with disabilities and sexually transmitted disease symptom manifestations, which may differ in this population. The Physicians Desk Reference was consulted to assemble information on medical selection. RESULTS: The treatment of STDs in women with disabling conditions presents diagnostic and therapeutic challenges to clinicians, because symptoms may be confusing and may mimic manifestations of underlying disorders. Women with spinal cord injury may be at risk for the development of autonomic activation as a sign of STDs. CONCLUSION: To enhance compliance with medication regiments, the limitations of the patient should be considered. Furthermore, women with disabilities are at high risk for sexual abuse; therefore, the presence of an STD may be of special concern. Developing good communication with the patient will enable the clinician to work with her to sort out symptoms, design therapeutic regiments, and to help protect her from abuse.     

青蒿素、青蒿琥酯抗皮肤瘢痕的研究

目的 检测青蒿素和青蒿琥酯对兔耳增生性瘢痕模型瘢痕防治的效果.方法 用青蒿素和青蒿琥酯配制外用膏剂治疗兔耳腹侧增生性瘢痕模型,用药28 d后切取瘢痕HE染色、VG染色,检测瘢痕组织的增生指数、成纤维细胞数密度及胶原纤维面积密度.结果 青蒿素、青蒿琥酯配制的膏剂组均较对照组瘢痕平坦、柔软且成纤维细胞胞体变小,胶原纤维排列较稀疏、整齐.青蒿素组增生指数、成纤维细胞数密度、胶原纤维面积密度分别为(1.452±0.27)、(3638.245±463.0)细胞/mm2、(32.29±6.9)%;青蒿琥酯组增生指数、成纤维细胞数密度、胶原纤维面积密度分别为(1.445±0.24)、(3585.016±638.9)细胞/mm2、(34.74±8.27)%.两实验组检测指标均小于基质对照组及空白对照组,P＜0.01.青蒿素组与青蒿琥酯组相比较,P＞0.05,差异无统计学意义.结论 青蒿素、青篙琥酯膏可有效地抑制动物实验性皮肤瘢痕.     

Efficacy measurement of topical antihistamines: a review

More and more antihistamines are used in gels or ointments for local antipruritic therapy. Among other factors, the efficacy is dependent on the penetration properties of the respective agents and the optimal choice of vehicle substances. To avoid expensive treatment with unsatisfying success, a reliable efficacy measurement would be desirable prior to the admission of new topical antihistamine preparations. Therefore we reviewed the literature for common methods to assess the efficacy of local antihistamines in healthy volunteers. The principle is to apply the test substance to marked test areas and to challenge the skin after a certain time with a standardised amount of histamine, allergens or mast-cell-degranulating substances. For the test evaluation, the areas of wheal, flare and itch are measured and compared between antihistamine-treated and control fields. Challenge models and most of the described evaluation methods are suited for the preliminary efficacy measurement of antihistamines. However, to be able to compare the results, a standardised procedure used by all investigators would be desirable.     

Cutaneous T-cell lymphomas: a review with emphasis on new treatment approaches

Primary cutaneous T-cell lymphomas represent a wide variety of non-Hodgkin lymphomas that are characterized by a distinct clinical presentation. Advanced molecular and biological techniques have enhanced the recognition of cutaneous T-cell lymphomas. The most common subtypes of cutaneous T-cell lymphomas are the epidermotropic variants mycosis fungoides and Sézary syndrome. At present, a stage-adjusted therapy is the best concept available, since early aggressive treatment options did not improve the prognosis of patients with cutaneous T-cell lymphomas. Accurate diagnostic and clinical assessment as well as identification of prognostic factors provides a helpful basis for treatment strategies. Current medical literature on diagnosis, prognosis, and treatment is reviewed with emphasis on new biologic response-modifying treatment options.     

Systematic review of topical capsaicin in the treatment of pruritus

Objective To determine the efficacy of topical capsaicin in treating pruritus in any medical condition. Data sources Cochrane library, Medline, Embase, Cinahl and Amed, up to April 2008. No language restrictions. Study selection Randomized, controlled trials comparing topically applied capsaicin with placebo or other standard treatment in patients with pruritus, independently selected by two reviewers. Data extraction Independently extracted by two reviewers. Quality assessed using the Jadad scale. Data synthesis Six randomized controlled trials were identified for inclusion. Three were for hemodialysis‐related pruritus and provided insufficient data for the efficacy of topical capsaicin to be evaluated. A crossover study of capsaicin for treating idiopathic intractable pruritus ani reported a statistically significant difference in responder rates favoring capsaicin over placebo for itching scores but included insufficient data for the validity of this result to be assessed. A study on notalgia paresthetica reported a statistically significant difference in the first phase of a crossover study favoring capsaicin over placebo in a visual analogue scale for itch intensity but failed to report data for a second outcome measure. The final study on brachioradial pruritus used an inappropriate design and reported no significant reduction in itch between capsaicin and placebo. Conclusion At present, there is no convincing evidence for the use of capsaicin to treat pruritus in any medical condition. Further research is needed, and should attempt to address methodological issues identified through this review including unblinding and the suitability of crossover designs.     

The role of phototherapy in the surgical treatment of vitiligo: a systematic review

Vitiligo is frequently treated with the combination of phototherapy and melanocyte transplantation. However, the additional benefit of phototherapy is unclear. Moreover, the optimal type and regimen of phototherapy are unknown. The objective of this systematic review was to identify whether phototherapy improves the outcome of melanocyte transplantation in vitiligo. We searched and screened for eligible studies in the databases of MEDLINE, EMBASE and CENTRAL. We included all clinical studies investigating melanocyte transplantation combined with phototherapy. After screening and selection of abstracts and full‐texts, we found 39 eligible clinical studies with 1624 patients. The eligible studies investigated several phototherapy modalities, such as NBUVB (n = 9), PUVA (n = 19), UVA (n = 1), MEL (n = 4) and active sunlight exposure (n = 9). Four studies directly compared phototherapy versus no phototherapy and two studies confirmed the benefit of phototherapy for melanocyte transplantation. We found no significant differences in repigmentation in studies directly comparing phototherapy modalities. The overall quality of the studies was moderate to poor and high heterogeneity between studies was found. We found limited evidence that phototherapy improves the outcome of melanocyte transplantation in vitiligo. There is insufficient evidence to recommend a specific type or regimen of phototherapy. More studies should be performed investigating the additional benefit of different phototherapies and the preferred moment of phototherapy.     

Direct medical costs for surgical and medical treatment of condylomata acuminata

OBJECTIVE: To determine which treatment modalities for condylomata acuminata are associated with the lowest direct medical costs. DESIGN: Cost-effectiveness analysis. SETTING: Ambulatory private practice, primary or specialty care. PATIENTS OR OTHER PARTICIPANTS: Adults with no presenting complaints other than condylomata acuminata. INTERVENTIONS: Construction of a cost-effectiveness model. From a literature review, extraction of commonly accepted guidelines regarding duration and frequency as well as reports of efficacies of typical treatment regimens; from Medicare physician fee schedules, costs of physician visits and physician-administered treatments; from published data, average wholesale prices of medications. MAIN OUTCOME MEASURE: Estimated direct medical costs per complete clearance associated with different treatment options for condylomata acuminata. RESULTS: Mean direct medical costs per complete clearance are lowest for surgical excision ($285). Other low-cost modalities are loop electrosurgical excision procedure ($316), electrodesiccation ($347), carbon dioxide laser ($416), podofilox ($424), and pulsed-dye laser ($479). Higher-cost modalities are cryotherapy ($951), trichloroacetic acid ($986), imiquimod ($1255), podophyllum resin ($1632), and interferon alfa-2b ($6665). CONCLUSION: Surgical modalities, including excision, electrodesiccation, loop electrosurgical excision procedure, and laser, as well as podofilox are low-cost options for the treatment of condylomata acuminata.     

Primary prevention of keratinocyte carcinoma among outdoor workers,the general population and medical professionals: a systematic review updated for 2019

Worldwide 2–3 million cases of keratinocyte carcinoma (KC) are diagnosed annually. Sun‐related knowledge is essential for adequate protection against solar ultraviolet radiation (UVR), the main risk factor for KC. The goal was (i) to provide an updated overview of primary prevention against KC including skin cancer‐related knowledge, attitudes and sun protection behaviour (SPB) of outdoor workers, the general population and medical professionals as well as (ii) to evaluate the effectiveness and acceptability of sun protection programmes. We conducted a systematic review of articles indexed for MEDLINE on PubMed using selected MeSH terms and keywords related to the studied topic as well as an extensive hand search of publications between 1 January 2012 and 31 December 2018. We identified 51 relevant cross‐sectional studies and 22 interventional studies. Sun‐related knowledge and attitude showed substantial differences with some alarming results, including people who had not even heard about skin cancer before. Reported SPB varied enormously between the included studies, with none of the studies providing an overall sufficient SPB in their examined sun protection measures. However, sun protection programmes using new technologies seem to have great potential to increase sun‐related knowledge and SPB. In countries worldwide, particularly in those where KC is not yet a public health issue, UVR protection should be promoted by healthcare institutions and authorities, politicians, cancer foundations and dermatologists to increase awareness as well as SPB and to decrease the worldwide burden of KC.     

Laser and intense pulsed light therapy for the treatment of hypertrophic scars: a systematic review

Hypertrophic scars are difficult to improve and remain a therapeutic challenge. Several lasers and light sources have been evaluated in the past decades and have been shown to improve hypertrophic scars. However, a systematic review is not available. To assess current evidence of efficacy of all laser and intense pulsed light therapies used in the treatment of hypertrophic scars, we performed a systematic review searching electronic databases MEDLINE, EMBASE and CENTRAL. The quality of the controlled clinical trials was evaluated according to the Cochrane Collaboration’s tool for assessing risk of bias. Thirteen articles involving seven different lasers met the inclusion criteria. Most evidence was found for the pulsed dye laser (PDL) 585 nm (eight studies), followed by the PDL 595 nm (two studies), whereas limited evidence (one trial per laser) was available for the fractional nonablative laser 1540 nm, CO₂ laser 10 600 nm, low‐level laser therapy, Nd:YAG laser 532 nm and Erbium:YAG laser 2940 nm. Treatment recommendations should be formulated with caution as current evidence is insufficient for comparing the efficacy of different laser therapies. The PDL 585 nm showed a low efficacy for the treatment of hypertrophic scars. With moderate efficacy, the PDL 595 nm is promising, although more research is necessary. Little evidence was found for the efficacy of other lasers. Future research, with a low risk of bias, well‐defined scar characteristics, validated outcome measures, standardized measurement methods, follow‐up periods of at least 6 months and well‐defined laser settings, is needed.