Topical Therapy for Peristomal Pyoderma Gangrenosum

Background: Pyoderma gangrenosum (PG) is an uncommon condition. Literature on the management of peristomal PG (PPG) is sparse. In the absence of randomized controlled trials the reporting of case series is potentially helpful to the management of this uncommon disease. Objective: In this study we report our experience with topical corticosteroid therapy for 14 consecutive cases of PPG. Methods: A clinical diagnosis PPG was made by a trained dermatologist using the appropriate investigations where necessary. Results: The majority of the cases presented were managed with simple topical corticosteroids, occasionally in combination with a change of dressing. In 8/14 (57%) cases ulcer resolution was achieved within 3 months with topical treatment alone or topical treatment plus a change of dressing to a silicone-based product applied directly to the wound under the normal base plate of the stoma bag. Conclusion: Our experience suggests that a significant proportion of PPG can be managed by topical treatment alone. The simple topical treatment allows the patient to continue use of stoma care products while minimizing the potential for side effects.

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Platypnoea–orthodeoxia syndrome induced by short-term weight loss: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa498 ◽

2020 ◽

Author(s):

Yudai Tamura ◽

Tomohiro Sakamoto

Keyword(s):

Weight Loss ◽

Septal Defect ◽

Case Series ◽

Transoesophageal Echocardiography ◽

Sitting Position ◽

Short Time Period ◽

Time Period ◽

Uncommon Condition ◽

The Right ◽

Short Time

Abstract Background Platypnoea–orthodeoxia syndrome (POS) is an uncommon condition characterized by dyspnoea and arterial desaturation in the standing or sitting position that improves in the supine position. Case summary We report two cases of POS caused by an atrial septal defect (ASD) and a patent foramen ovale (PFO). Both cases reported a recent decrease in body weight of more than 10 kg in a short time period. Transoesophageal echocardiography (TOE) with agitated saline bubble study revealed and a large amount of contrast bubble through the ASD (Patient 1) or the PFO (Patient 2) from the right atrium to the left atrium in the sitting position. Both patients were diagnosed by the finding of positional dyspnoea and the results of TOE using agitated saline bubble contrast. Discussion Taken together, their presentations suggest that weight loss in a short time period could be a pathogenic factor for POS.

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Topical Treatment with 1% Sodium Cromoglycate in Pyoderma Gangrenosum

Dermatology ◽

10.1159/000246377 ◽

1996 ◽

Vol 192 (3) ◽

pp. 252-254 ◽

Cited By ~ 19

Author(s):

A. Tamir ◽

M. Landau ◽

S. Brenner

Keyword(s):

Sodium Cromoglycate ◽

Pyoderma Gangrenosum ◽

Topical Treatment

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Clinical outcomes and response of patients applying topical therapy for pyoderma gangrenosum: A prospective cohort study

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2016.06.016 ◽

2016 ◽

Vol 75 (5) ◽

pp. 940-949 ◽

Cited By ~ 30

Author(s):

Kim S. Thomas ◽

Anthony D. Ormerod ◽

Fiona E. Craig ◽

Nicola Greenlaw ◽

John Norrie ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Pyoderma Gangrenosum ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Topical Therapy

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Mixed non-specific vaginal infections: the experience with topical therapy

Russian Journal of Woman and Child Health ◽

10.32364/2618-8430-2020-3-4-221-227 ◽

2020 ◽

Vol 3 (4) ◽

pp. 221-227

Author(s):

I.O. Borovikov ◽

◽

I.I. Kutsenko ◽

V.P. Bulgakova ◽

E.R. Rubinina ◽

...

Keyword(s):

Cell Count ◽

Topical Treatment ◽

Vaginal Discharge ◽

Topical Therapy ◽

Treatment Compliance ◽

Cellular Composition ◽

Candida Spp ◽

Vaginal Infections ◽

And Child Health ◽

Lactobacillus Spp

Aim: to describe the experience with the topical treatment for mixed non-specific vaginal infections. Patients and Methods: this prospective study included 72 women (mean age 26.3±5.5 years) with mixed non-specific vaginal infections who received a vaginal capsule containing metronidazole and miconazole (at night for 10 days) followed by a probiotic containing L. casei rhamnosus Doderleini (intravaginally for 14 days). Vaginal microbiota was assessed by real-time PCR. The ratios of Lactobacillus spp. and anaerobic microbe concentrations and the total amount of opportunistic microflora were calculated. In addition, vaginal pH, Hay/Ison criteria, and the sensitivity of Candida spp. to antimycotics (NCCLS standards) were evaluated. When analyzing cellular composition, white blood cell count, epithelial cell count, total cell count, and cytological coefficient were measured. The efficacy was assessed 10 days and 1 month after the treatment. Results: the treatment resulted in the significant reduction in the clinical (both subjective and objective) symptoms of mixed non-specific vaginal infections, the improvement of vaginal discharge pH and the cellular composition of vaginal discharge and vaginal microbiocenosis. Microscopy with Hay/Ison criteria assessment demonstrated the normalization of Lactobacillus count and the reduction in the threshold of opportunistic microflora and Candida spp. Conclusions: our experience with the topical treatment for mixed non-specific vaginal infections using a drug containing metronidazole and miconazole has demonstrated high clinical (96%) and microbiological (97.4%) efficacy and safety as well as good treatment compliance. KEYWORDS: mixed non-specific vaginal infection, decontamination, metronidazole, miconazole, vaginal microbiocenosis, bacterial dysbiosis. FOR CITATION: Borovikov I.O., Kutsenko I.I., Bulgakova V.P. et al. Mixed non-specific vaginal infections: the experience with topical therapy. Russian Journal of Woman and Child Health. 2020;3(4):221–227. DOI: 10.32364/2618-8430-2020-3-4-221-227.

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Case series and review of Ayurvedic medication induced liver injury

BMC Complementary Medicine and Therapies ◽

10.1186/s12906-021-03251-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Christopher M. Karousatos ◽

Justin K. Lee ◽

David R. Braxton ◽

Tse-Ling Fong

Keyword(s):

Liver Injury ◽

Plant Extracts ◽

Significant Proportion ◽

Case Series ◽

The United States ◽

Tinospora Cordifolia ◽

Individual Plant ◽

Medicine Use ◽

Drug Induced ◽

Drug Induced Liver Injury

Abstract Background Complementary and alternative medicine use among Americans is prevalent. Originating in India, Ayurvedic medicine use in the United States has grown 57% since 2002. CAM accounts for a significant proportion of drug induced liver injury in India and China, but there have been only three reports of drug induced liver injury from Ayurvedic medications in the U.S. We report three cases of suspected Ayurvedic medication associated liver injury seen at a Southern California community hospital and review literature of Ayurvedic medication induced liver injury. Case presentations Three patients presented with acute hepatocellular injury and jaundice after taking Ayurvedic supplements for 90–120 days. First patient took Giloy Kwath consisting solely of Tinospora cordifolia. Second patient took Manjishthadi Kwatham and Aragwadhi Kwatham, which contained 52 and 10 individual plant extracts, respectively. Third patient took Kanchnar Guggulu, containing 10 individual plant extracts. Aminotransferase activities decreased 50% in < 30 days and all 3 patients made a full recovery. Roussel Uclaf Causality Assessment Method (RUCAM) scores were 7–8, indicating probable causality. These products all contained ingredients in other Ayurvedic and traditional Chinese medicines with previously reported associations with drug induced liver injury. Conclusions These patients highlight the risk of drug induced liver injury from Ayurvedic medications and the complexity of determining causality. There is a need for a platform like LiverTox.gov to catalog Ayurvedic ingredients causing liver damage.

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Network Meta-Analysis of Different Clinical Commonly Used Drugs for the Treatment of Hypertrophic Scar and Keloid

Frontiers in Medicine ◽

10.3389/fmed.2021.691628 ◽

2021 ◽

Vol 8 ◽

Author(s):

Sha Yang ◽

Yujia J. Luo ◽

Cong Luo

Keyword(s):

Clinical Trials ◽

Randomized Controlled Trials ◽

Topical Treatment ◽

Hypertrophic Scar ◽

Meta Analysis ◽

Treatment Strategies ◽

Controlled Trials ◽

Cochrane Central Register ◽

Randomized Controlled ◽

Silicone Gels

Background: There is no uniform treatment for pathological scars, including keloids and hypertrophic scars, in clinic currently. Previously, multiple randomized controlled trials have examined the clinical efficacy of different treatments. Nonetheless, the results are inconsistent, and many treatments have not been directly compared. This makes it difficult to conclude which approach is more favorable, in terms of efficacy and safety, for the treatment of pathological scarring. This study aimed at evaluating the efficacy of different injection and topical treatment strategies for hypertrophic scar and keloid.Methods: Relevant literature from PubMed, Medline, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CCRCT), and WHO International Clinical Trials Registry Platform (WHO-ICTRP) were searched, from database inception through November 2020. Randomized clinical trials evaluating different treatment strategies of pathological scars, including triamcinolone acetonide (TAC), verapamil (VER), 5-fluorouracil (5-FU), botulinum toxin A (BTA), bleomycin (BLM), and silicone gels were included in the study.Results: The network meta-analysis included a total of 2,009 patients from 29 studies. A network meta-analysis of injection and topical treatment strategies showed that the efficacy of TAC combined with BTA was best in the treatment of pathological scars. Combination therapies of TAC with 5-FU and TAC with BTA significantly improved the clinical efficiency. However, there was no statistically significant difference between other treatment strategies. The order of efficacy predicted by the surface under the cumulative ranking (SUCRA) curve was as follows: TAC+BTA (82.2%) > TAC+5-FU (69.8%) > BTA (67.3%) > 5-FU+silicone (59.4%) > TAC+silicone (58.3%) > 5-FU (49.8%) > BLM (42.0%) > TAC (26.7%) > VER (26.2%) > silicone (18.3%). There was no publication bias revealed based on the funnel diagram.Conclusion: This study recommends intralesional injection of TAC-BTA and TAC-5-FU combined therapies. But for patients who cannot tolerate the side effects, the use of silicone gels in combination with TAC is recommended. However, these conclusions need to be further confirmed by more randomized controlled trials.

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New perspectives on the treatment of hidradenitis suppurativa

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211055920 ◽

2021 ◽

Vol 12 ◽

pp. 204062232110559

Author(s):

Victoria Amat-Samaranch ◽

Eugènia Agut-Busquet ◽

Eva Vilarrasa ◽

Lluís Puig

Keyword(s):

Hidradenitis Suppurativa ◽

Topical Therapy ◽

Clinical Manifestations ◽

Light Therapy ◽

The Body ◽

Biologic Agent ◽

Inflammatory Skin Disease ◽

Randomized Controlled ◽

Modifying Factors ◽

Systemic Treatments

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by the presence of painful nodules, abscesses, chronically draining fistulas, and scarring in apocrine gland-bearing areas of the body. The exact pathogenesis of HS is not yet well understood, but there is a consensus in considering HS a multifactorial disease with a genetic predisposition, an inflammatory dysregulation, and an influence of environmental modifying factors. Therapeutic approach of HS is challenging due to the wide clinical manifestations of the disease and the complex pathogenesis. This review describes evidence for effectiveness of current and emerging HS therapies. Topical therapy, systemic treatments, biological agents, surgery, and light therapy have been used for HS with variable results. Adalimumab is the only US Food and Drug Administration (FDA) approved biologic agent for moderate-to-severe HS, but new therapeutic options are being studied, targeting different specific cytokines involved in HS pathogenesis. Comparing treatment outcomes between therapies is difficult due to the lack of randomized controlled trials. Treatment strategy should be selected in concordance to disease severity and requires combination of treatments in most cases.

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Thromboembolic complications of endovenous thermal ablation and foam sclerotherapy in the treatment of great saphenous vein insufficiency

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514529948 ◽

2014 ◽

Vol 30 (5) ◽

pp. 357-364 ◽

Cited By ~ 17

Author(s):

Meghan Dermody ◽

Marlin W Schul ◽

Thomas F O’Donnell

Keyword(s):

Venous Thromboembolism ◽

Randomized Controlled Trials ◽

Thermal Ablation ◽

Meta Analysis ◽

Case Series ◽

Controlled Trials ◽

Foam Sclerotherapy ◽

Bootstrap Analysis ◽

Randomized Controlled ◽

Endovenous Thermal Ablation

Objective Portions of these data were presented in a poster at the XVII World Meeting of the International Union of Phlebology, 8–13 September 2013, Boston, MA, USA. We assessed the incidence of venous thromboembolism following treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy using meta-analysis of published randomized controlled trials and case series. Methods Medline, Embase, Cochrane, and Clinical Trials Registry databases were searched from January 2000 through January 2013 for randomized controlled trials and large case series employing endovenous thermal ablation or foam sclerotherapy as a single modality for the treatment of great saphenous insufficiency, with concomitant postoperative duplex scanning. Pooled (stratified) incidence of venous thromboembolism with 95% confidence intervals was estimated using the DerSimonian–Laird procedure for random effects meta-analysis. A bootstrap analysis was performed to examine between-modality differences. Results Twelve randomized controlled trials and 19 case series investigating endovenous thermal ablation (radiofrequency ablation with VNUS/Covidien ClosureFAST™ catheter only, endovenous laser ablation, or both) were included. Data from 12 randomized controlled trials and 6 case series investigating nonproprietary foam preparations were analyzed. Estimated incidence of venous thromboembolism was low (mostly <1%) and similar across treatment modalities and study types. Conclusions Treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy is a common vascular intervention. The stratified incidence of venous thromboembolism appears to be low as reported in both randomized controlled trials and case series investigating these modalities. Although duplex scans were obtained postoperatively, a minority of studies specified protocols for venous thromboembolism detection.

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