Optimising the use of urea in dermatology

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Multiple reactive keratoacanthomas in a patient with hypertrophic lichen planus treated with cyclosporine: successful treatment with acitretin.

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Advances in the use of topical imiquimod to treat dermatologic disorders

Imiquimod (IQ) is an immune-response modifying agent, first approved by FDA for the topical treatment of external genital and perianal warts in 1997. It induces, through stimulation of Toll-like receptors (TLRs) localized on the surface of antigen-presenting cells, synthesis and release of several endogenous pro-inflammatory cytokines such as interferon-α (IFN-α), tumor necrosis factor-α (TNF-α) and interleukins (IL) 6 and 12, which in turn stimulate both the innate and acquired immune pathways, resulting in upregulation of natural antiviral and antitumor activity. IQ 5% cream has been used for the treatment of a wide variety of dermatologic conditions in which the immune system is thought to play a role in regression of the disease. In some disorders, such as genital and perianal warts, actinic keratoses, basal cell carcinomas, Bowen’s disease and molluscum contagiosum, relative safety and efficacy are supported by randomized controlled trials of IQ. However, it is common for patients to experience local skin reactions, which can range from mild to severe in intensity, but usually resolve 1–2 weeks after interrupting treatment. Additional randomized trials are encouraged to assess safety and efficacy of IQ in the treatment of an even wider range of cutaneous disorders

Erythema-directed digital photography for the enhanced evaluation of topical treatments for acne vulgaris.

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Clinical evidences of urea at low concentration

Urea is a hygroscopic molecule that, because of its moisturising properties, is topically used for the treatment of skin dryness at concentrations ranging from 2% to 12% in different formulations. Based on existing literature, low-concentration urea-containing products are effective in the treatment and/or prevention of xerosis in some skin disorders such as ichthyosis, atopic dermatitis and psoriasis, or unrelated to specific skin diseases. Generally, urea formulations at low concentration are well-tolerated and suited for the treatment of large skin areas, once or twice daily, even for a long period of time. At low concentrations stinging and burning sensation is rare and transient, whit no reported sensitisation despite its widespread use

Evaluación clínica de dos surfactantes en prematuros con enfermedad de membrana hialina: experiencia de 8 años

Introducción: el uso de surfactante exógeno en prematuros con dificultad respiratoria severa es una práctica generalizada y ampliamente reconocida por mejorar la oxigenación, disminuir las complicaciones relacionadas con el escape aéreo y la mortalidad.Objetivo: evaluar el impacto de dos diferentes surfactantes, uno sintético y otro natural, en la oxigenación durante las primeras 48 horas en prematuros con enfermedad de membrana hialina severa en ventilación mecánica.Material y método: estudio observacional analítico de cohorte retrospectivo. Se estudiaron 111 RN menores de 34 semanas con diagnóstico de enfermedad de membrana hialina tratados con surfactante en la unidad de cuidados intensivos neonatales desde el año 2001 hasta el 2008. Se compararon los índices de oxigenación del grupo que recibió SE sintético con el que recibió SE natural. Se utilizó la prueba t de student con un nivel de significancia de 0,05.Resultados: 40 neonatos recibieron surfactante sintético y 58 natural, la edad gestacional media fue 32 y 30 semanas respectivamente, con pesos al nacer entre 1550 y 1300 gm. Ambos grupos tuvieron igual grado de insuficiencia respiratoria antes de recibir la primera dosis de surfactante. La respuesta fue favorable en ambos grupos, pero el grupo tratado con surfactante natural tuvo una mejoría más rápida en la oxigenación (p <0,01), menor necesidad de repetición de dosis (p <0,01), menos tiempo de ventilación mecánica y menor mortalidad sin llegar estos a tener significancia estadística.Conclusión: el surfactante natural presenta un efecto más rápido que el sintético en la mejoría de laoxigenación en recién nacidos prematuros con dificultad respiratoria

History of urea as a dermatological agent in clinical practice.

Urea, also known as carbamide, is a polar, hygroscopic molecule produced by the human body that was first discovered in urine in 1773 by the French chemist Hilaire Rouelle and was artificially synthesised from inorganic precursors in 1828 by the German chemist Friedrich Wöhler. The importance of urea in dermatology is twofold: it primarily has a physiological key role for the maintenance of skin hydration, and it secondarily has been used for more than a century in different topical preparation and concentration in various skin conditions. One of the first uses of urea was the topical treatment of wounds because of its antibacterial and proteolytic properties. Since the second part of the 20th century, urea became one of the most common moisturisers and keratolytic agents, useful for the treatment of xerosis, atopic dermatitis, ichthyosis and psoriasis

Clinical evidences of urea at medium concentration.

Urea-based topical compounds at medium concentrations (15%-30%) represent useful dermatological agents for their humectant and keratolytic effects by enhancing stratum corneum hydration and by loosening epidermal keratin, respectively. The aim of this paper is to review the clinical evidences of the use of 15%-30% urea as single topical agent. Although limited evidence supports the use of these concentrations of urea in skin disorders characterised by xerosis and hyperkeratosis, in clinical practice they are largely used especially in xerosis of limited skin areas, in which the side effects are tolerable, or hyperkeratosis involving large or more sensitive (eg, face, genital region, etc) areas, in which higher concentration may be irritant. In addition, urea at medium concentrations is used in combination with other substances including topical antifungals as penetration enhancer

Double-ended Pseudocomedones in Hidradenitis Suppurativa: Clinical, Dermoscopic, and Histopatho­logical Correlation

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Smart E-Skin Cancer Care in Europe During and After the COVID-19 Pandemic: A Multidisciplinary Expert Consensus

Introduction: Melanoma is the deadliest of all the skin cancers and its incidence is increasing every year in Europe. Patients with melanoma often present late to the specialist and treatment is delayed for many reasons (delay in patient consultation, misdiagnosis by general practitioners, and/or limited access to dermatologists). Beyond this, there are significant inequalities in skin cancer between population groups within the same country and between countries across Europe. The emergence of the COVID-19 pandemic only aggravated these health deficiencies. Objectives: The aim was to create an expert opinion about the challenges in skin cancer management in Europe during the post COVID-19 acute pandemic and to identify and discuss the implementation of new technologies (including e-health and artificial intelligence defined as "Smart Skin Cancer Care") to overcome them. Methods: For this purpose, an ad-hoc questionnaire with items addressing topics of skin cancer care was developed, answered independently and discussed by a multidisciplinary European panel of experts comprising dermatologists, dermato-oncologists, patient advocacy representatives, digital health technology experts, and health technology assessment experts. Results: After all panel of experts discussions, a multidisciplinary expert opinion was created. Conclusions: As a conclusion, the access to dermatologists is difficult and will be aggravated in the near future. This fact, together with important differences in Skin Cancer Care in Europe, suggest the need of a new approach to skin health, prevention and disease management paradigm (focused on integration of new technologies) to minimize the impact of skin cancer and to ensure optimal quality and equity