Geert Cauwenbergh

Split face study on the cutaneous tensile effect of 2‐dimethylaminoethanol (deanol) gel

Background/aims: Beyond subjective assessments, the effect of skin tensors is difficult to assess. The present 2‐phase randomized double‐blind split face study was designed to compare the effect of a gel containing 3% 2‐dimethylaminoethanol (deanol, DMAE) with the same formulation without DMAE.

A Pilot Study on Seborrheic Dermatitis Using Pramiconazole as a Potent Oral Anti-Malassezia Agent

Background: Seborrheic dermatitis is considered to be a Malassezia-driven disease. Little objective information is available so far from biometrological quantitative assessments of this skin condition. Pramiconazole is a novel triazole with potent in vitro antifungal activity, especially against Malassezia spp. Objective: To study the sequential effects of pramiconazole on Malassezia, inflammation and epidermal changes. Method:This study was performed in 2 groups of subjects suffering from seborrheic dermatitis. The first group (n = 17) remained untreated and was used as control. Clinical, mycological and biometrological assessments were performed at inclusion and during the following 2 weeks. The second group of subjects (n = 10) received a single 200-mg oral dose of pramiconazole at inclusion. Clinical, mycological and biometrological evaluations were performed before and during 1 month following the single antifungal intake. For both parts of the study, several parameters were assessed including yeast density, desquamation, erythema, itching and sebum excretion. Results: In the control group, no significant changes were observed in any of the parameters during the observation period. The findings were markedly different in the pramiconazole-treated subjects. The yeast density was significantly improved on days 3, 7 and 28. Desquamation, erythema, itching, and the global clinical evaluation as assessed by the patients and investigators became significantly improved on days 7 and 28. A trend in decrease of scaliness was noted. No effect on sebum excretion was evidenced. In conclusion, a single 200-mg dose of pramiconazole exhibitsin vivo efficacy in controlling some important clinical aspects of seborrheic dermatitis. Following a reduction in the number of yeasts on day 3, a decrease in the severity of clinical signs and symptoms occurred from day 7 onwards. Sebum excretion appeared uninvolved in the clearing process of seborrheic dermatitis. Conclusion: A single 200-mg dose of pramiconazole appears to abate seborrheic dermatitis. The density in Malassezia present on lesional skin is first decreased, followed by clearing of the clinical signs.

Novelties in the multifaceted miconazole effects on skin disorders

Background: Miconazole nitrate is a time-honored antifungal of the imidazole class. Objective: To revisit the various aspects of action of the drug in a dermatologic setting. Method: Review of the current peer-reviewed publications. Results/conclusion: Miconazole essentially inhibits 14α-demethylase, an enzyme required for the biosynthesis of ergosterol, which is the main sterol constituent of fungal cell membranes. Hence, toxic methylated sterols accumulate. Synthesis of triglycerides and phospholipids is also affected. In addition, miconazole also exhibits other ancillary mechanisms of action that probably participate in the therapeutic efficacy of the drug. The oxidative and peroxidative enzyme activities are altered leading to an intracellular build up of a toxic concentration of hydrogen peroxide. This may contribute to the deterioration of subcellular organelles and to cell necrosis. Farnesol synthesis is stimulated in Candida spp. leading to the prevention of yeast-to-mycelium formation. Overall, miconazole is fungistatic through its effect on ergosterol biosynthesis, but it may also have a fungicidal effect against a number of fungal species due to its effect on hydrogen peroxide accumulation. In addition, miconazole is active against a series of Gram-positive bacteria and has been shown to help the repair of the skin barrier function and to help mitigate some inflammatory cell reactions (such as in acne). To conclude, miconazole exerts multi-pronged effects both against pathogenic fungi and on skin physiology.

Coping with mild inflammatory catamenial acne A clinical and bioinstrumental split-face assessment

Background: Acne is a multifactorial disease exhibiting distinct clinical presentations. Among them, the catamenial type is a matter of concern for young women. Some oral contraceptives may help without, however, clearing the skin condition.

Efficacy of a Single Oral Dose of 200 mg Pramiconazole in Vulvovaginal Yeast Infections: An Exploratory Phase IIa Trial

Pramiconazole (R126638) is a novel azole with potent antifungal activity against yeasts, dermatophytes and many other fungal species. The aim of this study was to evaluate the efficacy and tolerance of a single oral dose of 200 mg pramiconazole in acute and recurrent vulvovaginal yeast infections. Thirty-two patients (15 acute and 17 recurrent cases) were KOH microscopy- and culture-positive at inclusion. Clinical cure was 53% at one week and 66% at one month. Mycological eradication was obtained in 88% at one week, whereas at one month 75% of the patients were still culture-negative. Effects in both acute and recurrent cases appeared to be similar for mycological cure. The composite sign and symptom score (sum of scores for oedema, erythema, excoriation pruritus, burning and irritation) had a median value of 7.5 (range 2-17) at inclusion. At one week this value was reduced to 1.0 (range 0-8) and at one month a further reduction to 0 (range 0-11) was seen. p-values compared with baseline at both follow-up visits were <0.001. The drug was well tolerated and the reported adverse events were rare and minimal. In conclusion, the results of this trial indicate that pramiconazole possesses properties that warrant further clinical studies in a larger number of patients with acute and recurrent vulvo notvaginal yeast infection to confirm its efficacy and tolerability.

Effect of a single overnight topical application of miconazole nitrate paste on acne papules.

Background  The classical management of acne calls for prolonged oral and/or topical treatments; however, some patients request a rapid effect to make the papules disappear within a few hours or days.