Hadar Lev-Tov

Microneedle-assisted incubation during aminolaevulinic acid photodynamic therapy of actinic keratoses: a randomized controlled evaluator-blind trial

Photodynamic therapy (PDT) is a common method of treating actinic keratoses (AKs) that compares favorably to other treatment methods.(1,2) However, treatment is limited by prolonged incubation times required for the medication to penetrate the stratum corneum.(3) Microneedles (MNs) are micrometer scale needles that are capable of puncturing the stratum corneum with minimal pain.(4,5) They have been utilized for various applications, including enhanced drug delivery.6 Few studies have evaluated MNs in conjunction with PDT for AKs.(7) We sought to assess the utility of short solid MN arrays that penetrate to the epidermis in shortening the incubation time for aminolevulinic acid (ALA) in PDT for AKs. This article is protected by copyright. All rights reserved.

Use of the hCONSORT criteria as a reporting standard for herbal interventions for common dermatoses: a systematic review

The use of complementary and alternative medicine (CAM) is increasing in Western countries, including in the area of dermatology. However, Western healthcare providers have not integrated CAM into regular practice owing to a lack of reliable data supporting its use. To encourage high‐quality research related to the use of CAM and specifically herbal interventions, the CONsolidated Standards Of Reporting Trials (CONSORT) extension criteria on reporting herbal interventions (hCONSORT) were published in 2006.

How Microneedles Can Change Cutaneous Drug Delivery—Small Needles Make a Big Difference

The year was 1971, and Intel had unveiled its first microchip. That same year, the US patent office registered an application from Martin S. Gerstel and Virgil A. Place for the drug delivery device that we know today as a microneedle array.1 Amazingly, although the sketch submitted by the inventors described a device very much like what we recognize today as a microneedle array, the technology to produce such small needles did not exist at that time. The vision became a reality when microfabrication technology made manufacturing of microscopic needles possible. Microneedles are miniature needles that typically range in length from 70 μm to a few millimeters.2 Microneedles pierce the skin, and, based on length and site of application, can penetrate through the stratum corneum to reach the papillary or reticular dermis. In the context of drug delivery, microneedles can be classified as solid, hollow, dissolving, or swelling (Figure). Hollow microneedles deliver agents via their core, while solid microneedles create temporary conduits in the skin. Solid microneedles can also be coated with the drug of interest, while dissolving microneedles slowly dissolve to release active drug into the skin. Swelling microneedles absorb interstitial fluid on introduction into the skin to allow release of preloaded active drug at higher doses.3 In addition to drug delivery, microneedles can be used to sample skin constituents and can also be used as a method to injure the dermis. The epidermis functions as an effective barrier and the stratum corneum is the main layer involved in maintaining barrier function. Thus, temporarily penetrating epidermis, especially the stratum corneum, is advantageous for drug delivery. In a study in this issue of the JAMA Dermatology, Petukhova et al4 use epidermal length microneedles to enhance the penetration of aminolevulinic acid (ALA) as part of photodynamic therapy (PDT) for treatment of actinic keratoses (AKs). The effectiveness of PDT as field therapy option for AKs has been well documented.5 However, treatment is limited by poor or variable transepidermal absorption owing to the hydrophilic nature of ALA.6 Strategies to improve transepidermal absorption of the chromophore, such as the synthesis of the more lipophilic methyl aminolevulinate, do not seem to impart significant clinical advantage.7 To overcome the problem of transepidermal delivery, patients wait for hours at a time between ALA application and the light treatment. These prolonged incubation times limit usefulness. The investigators4 hypothesized that microneedles would enhance penetration and decrease incubation period without compromising safety and efficacy. They treated patients with AKs on the forehead with PDT. Each patient was randomized to receive 10 or 20 minutes of incubation (significantly shorter times than common practice in the United States, which vary from a minimum of 1 hour up to 4 hours or more). In addition, they randomly assigned patients to receive pretreatment with solid, 200-μm–long microneedles to either side of the forehead while the contralateral forehead received sham microneedle treatment. They then measured the rate of AK resolution at 1 month. They found that patients who received microneedles pretreatment followed by 20 minutes of ALA Related article Figure. Drug Delivery via Microneedles

Dose, duration, and cost: opportunities to improve use of long-term oral antibiotics for people with rosacea

Abstract Background: Systemic antibiotics are often used to treat rosacea and tetracyclines are the most common antibiotic prescribed; however, there is ambiguity among clinical guideline suggestions. Importantly, there is an increasing call to all clinicians to curtail antibiotic use. Objective: To investigate the utilization and cost of long-term oral antibiotic use for the treatment of rosacea, including ocular rosacea. Methods: This was a retrospective cohort study of MarketScan® Commercial Claims and Encounters database, from January 1, 2005 through December 31, 2014. Claim data were used to determine the duration and costs of antibiotic treatment among adults with rosacea. Results: The sample included 72,411 patients. The mean (SD) duration of long-term antibiotic treatment was 87.68 (145.99) days and for patients with ocular rosacea was slightly longer, 108.34 (176.74) days [p < .0001]. The majority of antibiotic courses were shorter than 3 months (80.04%) for the entire sample and the subset with ocular rosacea (53.64% [p = .007]). Limitations: Patient adherence is uncertain and database lacks information on rosacea severity and clinical outcomes. Conclusions: The majority of oral antibiotic course durations follow guidelines. Costs of antibiotic therapy were lower for shorter courses and those utilizing generic medications; the cost-effectiveness of these modifications has not been investigated.

Complementary and Alternative Medicine Therapies for Psoriasis: A Systematic Review.

Importance Up to 51% of patients with psoriasis report the use of complementary and alternative medicine (CAM) in their treatment regimen, although it is unclear which CAM therapies are effective for treatment of psoriasis. Objective This review compiles the evidence on the efficacy of the most studied CAM modalities for treatment of patients with plaque psoriasis and discusses those therapies with the most robust available evidence. Evidence Review PubMed, Embase, and ClinicalTrials.gov searches (1950-2017) were used to identify all documented CAM psoriasis interventions in the literature. The criteria were further refined to focus on those treatments identified in the first step that had the highest level of evidence for plaque psoriasis with more than 1 randomized clinical trial supporting their use. This excluded therapies lacking randomized clinical trial (RCT) data or showing consistent inefficacy. Findings Primary CAM therapy searches identified 457 articles, of which 107 articles were retrieved for closer examination. Of those articles, 54 were excluded because the CAM therapy did not have more than 1 RCT on the subject or showed consistent lack of efficacy. An additional 7 articles were found using references of the included studies, resulting in a total of 44 RCTs (17 double-blind, 13 single-blind, and 14 nonblind), 10 uncontrolled trials, 2 open-label nonrandomized controlled trials, 1 prospective controlled trial, and 3 meta-analyses. Compared with placebo, application of topical indigo naturalis, studied in 5 RCTs with 215 participants, showed significant improvements in the treatment of psoriasis. Treatment with curcumin, examined in 3 RCTs (with a total of 118 participants), 1 nonrandomized controlled study, and 1 uncontrolled study, conferred statistically and clinically significant improvements in psoriasis plaques. Fish oil treatment was evaluated in 20 studies (12 RCTs, 1 open-label nonrandomized controlled trial, and 7 uncontrolled studies); most of the RCTs showed no significant improvement in psoriasis, whereas most of the uncontrolled studies showed benefit when fish oil was used daily. Meditation and guided imagery therapies were studied in 3 single-blind RCTs (with a total of 112 patients) and showed modest efficacy in treatment of psoriasis. One meta-analysis of 13 RCTs examined the association of acupuncture with improvement in psoriasis and showed significant improvement with acupuncture compared with placebo. Conclusions and Relevance The CAM therapies with the most robust evidence of efficacy for treatment of psoriasis are indigo naturalis, curcumin, dietary modification, fish oil, meditation, and acupuncture. This review will aid practitioners in advising patients seeking unconventional approaches for treatment of psoriasis.

Topical valsartan increases the healing pressure on wounds

Topical valsartan may help heal wounds in people with diabetes. Topical valsartan may help heal wounds in people with diabetes.

Dive deep, stay focused!

Noninvasive ultra-broadband optoacoustic mesoscopy skin imaging technology may provide objective assessment of skin disease. Noninvasive ultra-broadband optoacoustic mesoscopy skin imaging technology may provide objective assessment of skin disease.

Small spice for big wounds: Can curcumin close the gap?

Nanoformulation of curcumin may be the key to unlocking its wound healing potential. Nanoformulation of curcumin may be the key to unlocking its wound healing potential.

Wounds getting the royal treatment

Insect defensin-1 improves wound healing by inducing production of matrix metalloproteinase-9. Insect defensin-1 improves wound healing by inducing production of matrix metalloproteinase-9.

Defining targets to defeat hidradenitis suppurativa

Immunological data implicates IL-17 pathway in the pathogenesis of hidradenitis suppurativa. Immunological data implicates IL-17 pathway in the pathogenesis of hidradenitis suppurativa.