Dermatology : international journal for clinical and investigative dermatology
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In recent years, liposomes have been increasingly explored as novel drug delivery systems, and several liposome-based drug products have been approved in Europe, the USA and Japan. Depending on size, composition and surface characteristics, liposomes interact specifically with biological structures. Liposomal drug products provide a topical activity at the desired locus of action and are deemed more effective and less toxic than conventional drug formulations. ⋯ The other aim is a well-tolerated liposomal PVP-I hydrogel for improved antiseptic wound treatment with moisturizer. It has been reported that liposomes are enriched at the wound bottom for direct action against infection and support of wound healing. An animal study on the efficacy and tolerability of different formulations of a hydrogel with PVP-I liposomes in deep dermal burn wounds has indicated an outstanding quality of wound healing with smooth granulation tissue, less inflammation, less wound contraction and no hyperkeratotic reactivity, especially with the 3% PVP-I liposome formulation.
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To consider whether oral isotretinoin (Roaccutane/Accutane) represents good value compared with typical alternative treatments for moderate or severe acne. ⋯ The costs and benefits of alternative treatments for acne should be assessed over a period of at least 2 years, preferably longer. The higher initial cost of oral isotretinoin should not be a barrier to its use where the drug is clinically indicated.
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The introduction of oral 13-cis-retinoic acid (isotretinoin, Roaccutane/Accutane) has been a key step in he history of dermatological treatments; it was and still is more than 15 years later the only compound which cures acne while oral antibiotics and other therapies, at best, have less dramatic effects. That oral isotretinoin works so well is probably entirely linked to its effect of the sebaceous glands that dedifferentiate and stop producing sebum. Amongst oral retinoids, both natural (such an all-trans-retinoic acid and 9-cis-retinoic acid) and synthetic (such as etretinate, acitretin, arotinoids), only 13-cis-retinoic acid exerts such an effect on sebum production and therefore on acne. ⋯ Considering the broad experience gained with this drug until now, guidelines for adequate use are evolving. Accordingly, it appears appropriate to: (1) redefine the indications for treatment with oral isotretinoin; (2) reconsider cost-benefit; (3) update labeling recommendations regarding daily doses since a cumulative treatment dose appears to be accepted as a means of preventing relapse, and (4) continue to control the teratogenic risk. These questions were the 'raison d'être' of this symposium.
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Dermatology (Basel) · Jan 1997
Antiseptic efficacy of disinfecting solutions in suspension test in vitro against methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli in pressure sore wounds after spinal cord injury.
In pressure sore wounds after spinal cord injury, methicillin-resistant Staphylococcus aureus can be detected in 2% of the cases. The elimination of the germ is the aim of the treatment. Pressure sore wounds are an often found complication after spinal cord injury. ⋯ The results show a superior efficacy of the povidone-iodine preparations. Betadine, probably due to the higher concentration, is more efficacious than Braunol; chlorhexidine is sufficiently efficacious without the addition of albumin. These results still have to be confirmed by in vivo studies.
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A consensus meeting was held in Brussels in 1995 to review current oral isotretinoin (Roaccutane/Accutane) treatment policies among internationally renowned experts and to improve service to needy patients by proposing treatment guidelines based upon a review of 1,000 acne patients who received this therapy. The group agreed that acne conditions warranting oral isotretinoin treatment include severe acne and poorly responsive acne which improves less than 50% after 6 months of therapy with combined oral and topical antibiotics. Furthermore, acne which relapses, scars or induces consequential psychological distress should be treated with oral isotretinoin. ⋯ The same dosage guidelines were applied to repeated courses of oral isotretinoin therapy with no evidence of increased risk. Mucocutaneous side-effects were predictable; dose-dependent and systemic side-effects were rarely problematic. Acne patients gain immeasurable physical and emotional relief from isotretinoin treatment and society benefits from limiting bacterial resistance evolution and reducing health care costs.