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Background The popularity of social media appears to be increasing the acceptance of cosmetic treatments, prompting more consumers to seek cosmetic treatments. As the estimated prevalence of acne vulgaris among adult women may be as high as 54%, acne is commonly observed among patients presenting for cosmetic treatments. Concomitant treatment of acne in the aesthetic patient population will improve overall clinical outcomes. Aims The goal of this work was to deliver a high‐quality ethical and evidence‐based educational program to physicians and adjunctive health care providers to advance patient care. Methods This paper is based on a webcam presentation with roundtable discussion by several notable experts in their field. Results A range of topical medications, injectable products, chemical peels, and energy‐based devices are available for treating acne vulgaris. In most instances, these are compatible with rejuvenation procedures in the aesthetic patient. Conclusion The growth of social media is raising awareness of aesthetic procedures and appears to be increasing the number of patients seeking aesthetic treatment. Educating patients about the importance of treating acne vulgaris can improve overall treatment outcomes. In most instances, the presence of acne is not a barrier to aesthetic care.

Scoping reviews address the nature of the literature per se rather than inferring evidence-based treatment guidelines. Scoping reviews of the published literature are intended to describe the aggregated nature of the evidence surrounding some agent or intervention, in contrast to systematic reviews that seek when possible to guide clinical practice. We conducted a scoping review to identify reports of potential clinical utility of off-label topical analgesics and adjuvants when FDA-approved treatments have proven inadequate. We performed a comprehensive search of three databases (PubMed, Web of Science and Embase) for articles dating from 1947 to the present. Mindful that FDA-approved and WHO-recommended analgesic medications often prove inadequate for individual patients in extremis with palliative, hospice or cancer pain, we used broad, structured inclusion criteria to retrieve articles. We retrieved 12,100 articles; after screening, we had 39 reports addressing 19 different topical agents out of the 32 chemical entities. Our scoping review disclosed evidence about agents that might not have met inclusion criteria for clinical practice guidelines. Although generally considered lower quality evidence, case reports or series present suggestions for diverse topical medications to manage pain in challenging circumstances when high-quality evidence for agents and routes of administration is lacking. Patients with the greatest need for evidence to identify and guide lesser-used agents during aggressive pain management are the most difficult to enroll and follow in standardized, controlled and/or blinded clinical trials. This scoping review identifies medications, dosages, and routes of topical agents reported to be effective in these often-challenging circumstances. Until larger and higher quality studies are completed, we must rely on the best available evidence even if of lower quality.

Nano-emulgel is an emerging drug delivery system intended to enhance the therapeutic profile of lipophilic drugs. Lipophilic formulations have a variety of limitations, which includes poor solubility, unpredictable absorption, and low oral bioavailability. Nano-emulgel, an amalgamated preparation of different systems aims to deal with these limitations. The novel system prepared by the incorporation of nano-emulsion into gel improves stability and enables drug delivery for both immediate and controlled release. The focus on nano-emulgel has also increased due to its ability to achieve targeted delivery, ease of application, absence of gastrointestinal degradation or the first pass metabolism, and safety profile. This review focuses on the formulation components of nano-emulgel for topical drug delivery, pharmacokinetics and safety profiles.

Patients with end stage renal failure consider the pain caused by recurrent fistula cannulations as the most intense stress they experience from their treatment and the biggest concern in their lives. One of the fundamental objectives of the nursing procedures is to relieve this pain. Therefore, this study aimed to determine the impact of two topical medications, namely Piroxicam and EMLA cream, on the pain caused by fistula cannulation among hemodialysis patients. This was a clinical trial conducted on 75 patients referring to the dialysis unit of the Shohadaye Ashayer Hospital of Khorramabad, West of Iran, in 2013. The patients were randomly divided into three groups: group A (Piroxicam), group B (EMLA cream), and group C (placebo). The data collection instrument was a questionnaire consisting of three parts: demographic information, the visual analog scale (VAS) for pain assessment, and a checklist for the likely side effects of the medications. The severity of pain during fistula cannulation was assessed in the three groups in two stages (before and after the intervention). To analyze the data, the Kruscal-Wallis and the Mann-Whitney statistical tests and SPSS 19 were used. The median for pain relief was obviously higher in the EMLA cream group than in either the Piroxicam or the placebo group and this difference was statistically significant (p<0.001). Comparing the Piroxicam and the placebo showed that the pain reduction median was much higher in the Piroxicam group than the placebo group, but the difference was not significant. The results of this study showed that the EMLA cream is more effective than the Piroxicam gel in the reduction of pain caused by fistula cannulation among hemodialysis patients. Therefore, based on the results of the present study, it can be suggested that the EMLA cream, as a simple treatment method which can be applied by the patient himself/herself, be used to relieve pain during fistula cannulation of hemodialysis patients.

Carbonic anhydrase inhibitors (CAIs) have been used for many decades in the treatment of glaucoma. Systemic CAIs were an early treatment option to lower intraocular pressure by reducing aqueous humour production; however, frequent side effects including polyuria and paresthesia contributed to the eventual development of topical CAIs. As topical drug development evolved over time, prostaglandin analogues and beta-blockers have become the gold standard of glaucoma therapies. Although prescribed less often than other classes of topical glaucoma therapies, topical CAIs continue to be used in combination therapies with beta-blockers and alpha agonists. Topical CAIs have also been demonstrated to alter biomarkers of ocular haemodynamics, which have relevance in glaucoma. The purpose of this review is to review and summarise the current state of topical CAI prescribing trends, known efficacy and suggested mechanisms and potential influence on ocular haemodynamics for the future of glaucoma management.

The topical route is the most appropriate route for the targeted delivery of drugs to skin tissues for the treatment of local skin diseases; however, the stratum corneum (SC), the foremost layer of the skin, acts as a major barrier. Numerous passive and active drug delivery techniques have been exploited to overcome this barrier; however, these modalities are associated with several detrimental effects which restrict their clinical applicability. Alternatively, nanotechnology-aided interventions have been extensively investigated for the topical administration of a wide range of therapeutics. In this review, we have mainly focused on the biopharmaceutical significance of polymeric nanoparticles (PNPs) (made from natural polymers) for the treatment of various topical skin diseases such as psoriasis, atopic dermatitis (AD), skin infection, skin cancer, acute-to-chronic wounds, and acne. The encapsulation of drug(s) into the inner core or adsorption onto the shell of PNPs has shown a marked improvement in their physicochemical properties, avoiding premature degradation and controlling the release kinetics, permeation through the SC, and retention in the skin layers. Furthermore, functionalization techniques such as PEGylation, conjugation with targeting ligand, and pH/thermo-responsiveness have shown further success in optimizing the therapeutic efficacy of PNPs for the treatment of skin diseases. Despite enormous progress in the development of PNPs, their clinical translation is still lacking, which could be a potential future perspective for researchers working in this field.

Background: Lidocaine, classified as an amide-type agent, and tetracaine, designated as an ester-type agent, are frequently co-formulated for dermatologic procedures. Despite the extensive literature on the pharmacokinetics (PK) of these substances, there is a paucity of head-to-head comparisons of intravenous (IV) and topical administration in the same preclinical model. Absolute bioavailability (F%) is imperative for optimizing formulation design and safety. Methods: A single-dose, single-sequence, three-period pilot study was performed in male Göttingen mini-pigs. The first period of the study involved the intravenous bolus administration of lidocaine HCl and tetracaine HCl, with a dosage of 1 mg/kg for each agent. In Period 2, the topical application of Pliaglis (a combination of 7% lidocaine and 7% tetracaine, with a concentration of 10 g/100 cm2 and a duration of 60 min) was utilized. In Period 3, the pharmacokinetic profile of Z4T4L4 (a formulation comprising 4% lidocaine HCl and 4% tetracaine HCl) was assessed under the same experimental conditions. Blood samples were collected up to 24 h after the administration of the drug; skin biopsies were obtained 90 min after the application of the test substance. Plasma and skin concentrations were measured by means of validated liquid chromatography–tandem mass spectrometry (LC–MS/MS). PK parameters were derived using a noncompartmental analysis approach, while F% was calculated through AUC comparison with IV dosing. Results: Subsequent to intravenous administration, the mean elimination half-lives of lidocaine and tetracaine were determined to be 1.62 h and 1.85 h, respectively. Pliaglis demonstrated higher skin concentrations of lidocaine (358 μg/g) and tetracaine (465 μg/g) compared to Z4T4L4 (33.6 μg/g and 46.1 μg/g, respectively). Despite lower skin levels, Z4T4L4 produced higher F% (lidocaine: 1.98% vs. 1.41%; tetracaine: 3.34% vs. 1.26%). The time to maximum plasma concentration (Tmax) for lidocaine was found to be 2–4 h (Pliaglis) and 2–8 h (Z4T4L4), while for tetracaine, it was 1–8 h (Pliaglis) and 2–8 h (Z4T4L4). Conclusions: In this preliminary study, which included three subjects, Z4T4L4 exhibited a numerical tendency towards increased systemic bioavailability in comparison with Pliaglis. This observation was noted despite the fact that Z4T4L4 resulted in markedly lower skin concentrations. Due to the exploratory nature of the pilot study (n = 3), observed differences are reported as numerical trends. The data suggest that Z4T4L4 may enhance systemic absorption while reducing skin retention, highlighting a potential formulation-dependent dissociation between local concentration and systemic bioavailability. These preliminary findings provide in vivo evidence of a divergence between eutectic-based tissue retention and enhancer-driven systemic flux. This highlights that formulation design fundamentally dictates the safety profile of local anesthetics, necessitating a balance between local efficacy and systemic safety.

Practice Pointers Patients with seasonal allergic conjunctivitis and perennial allergic conjunctivitis often report itching, tearing, swollen eyelids, and redness mediated by the release of histamine from mast cells, resulting in conjunctival inflammation.1,2 Itching is the most common symptom, occurring in more than 75% of patients. Trials comparing the antihistamines azelastine (nine studies) and levocabastine (not available in the United States; five studies) vs. placebo all favored the antihistamines. Because of heterogeneity between studies, meta-analysis was possible only for four studies with 204 patients that compared the effect of olopatadine (Patanol) with ketotifen (Zaditor) on itching and tearing at 14 days. Topical Treatments for Allergic Conjunctivitis Drug class Dosing schedule Cost* Antihistamines Bepotastine (Bepreve) Twice per day NA ($180) Emedastine (Emadine) Four times per day NA ($120) Epinastine (Elestat) Twice per day $38 ($220) Mast cell stabilizers Lodoxamide (Alomide) Four times per day NA ($150) Nedocromil (Alocril) Twice per day NA ($190) Pemirolast (Alamast) Four times per day NA ($115) Other formulations Azelastine† Up to four times per day $40 Ketotifen (Zaditor)† Twice per day NA ($15) Olopatadine (Patanol) Twice per day $50 ($250) NA = not available. *-Estimated retail cost for one month of therapy based on information obtained at http://www.goodrx.com (accessed April 13, 2016).

PurposeTo investigate the 2-year efficacy of atropine, orthokeratology (ortho-k) and combined treatment on myopia. To explore the factors influencing the efficacy.MethodsAn age-stratified randomised controlled trial. Children (n=164) aged 8–12 years with spherical equivalent refraction of −1.00 to −6.00 D were stratified into two age subgroups and randomly assigned to receive placebo drops+spectacles (control), 0.01% atropine+spectacles (atropine), ortho-k+placebo (ortho-k) or combined treatment. Axial length was measured at baseline and visits at 6, 12, 18 and 24 months. The primary analysis was done following the criteria of intention to treat, which included all randomised subjects.ResultsAll interventions can significantly reduce axial elongation at all visits (all p<0.05). Overall, the 2-year axial elongation was significantly reduced in combined treatment than in monotherapies (all p<0.05). After stratification by age, in the subgroup aged 8–10, the difference between combined treatment and ortho-k became insignificant (p=0.106), while in the subgroup aged 10–12, the difference between combined treatment and atropine became insignificant (p=0.121). A significant age-dependent effect existed in the ortho-k group versus the control group (p for interaction=0.013), and a significant age-dependent effect existed in the ortho-k group versus the atropine group (p for interaction=0.035), which indicated that ortho-k can achieve better efficacy in younger children.ConclusionsAtropine combined with ortho-k treatment can improve the efficacy of myopia control compared with monotherapy in children aged 8–12. Younger children might benefit more from ortho-k.Trial registration numberChiCTR1800015541.