Efficacy of a 3% kānuka oil cream for the treatment of moderate-to-severe eczema : a single blind randomised vehicle-controlled trial

Background: Māori, the indigenous people of New Zealand, have traditionally used the kānuka tree as part of their healing system, Rongoā Māori, and the oil from the kānuka tree has demonstratable anti-inflammatory and anti-bacterial properties. This trial investigated the efficacy and safety of a 3% kānuka oil (KO) cream compared to vehicle control (VC) for the topical treatment of eczema. The trial was conducted through a nationwide community pharmacy research network. Methods: This single-blind, parallel-group, randomised, vehicle-controlled trial was undertaken in 11 research trained community pharmacies across New Zealand. Eighty adult participants with self-reported moderate-to-severe eczema, assessed by Patient Orientated Eczema Measure (POEM) were randomised by blinded investigators to apply 3% KO cream or VC topically, twice daily, for six weeks. Randomisation was stratified by site and eczema severity, moderate versus severe. Primary outcome was difference in POEM scores at week six between groups by intention to treat. The study is registered on the Australian New Zealand Clinical Trial Registry (ANZCTR) reference number, ACTRN12618001754235. Findings: Eighty participants were recruited between 17 May 2019 and 10 May 2021 (41 KO group, 39 VC group). Mean POEM score (standard deviation) improved between baseline and week six for KO group, 18·4 (4·4) to 6·8 (5·5), and VC group, 18·7 (4·5) to 9·8 (6·5); mean difference between groups (95% confidence interval) was -3·1 (-6·0 to -0·2), p = 0·036. There were three adverse events reported in the KO group related to the intervention and two in the control group. Interpretation: The KO group had a significant improvement in POEM score compared to VC. Rates of adverse events and withdrawals were similar between groups with no serious adverse events reported. Treatment acceptability was high for both groups across all domains. Our results suggest that in adults with moderate-to-severe eczema, the addition of KO to a daily emollient regimen led to a reduction in POEM score compared to VC. KO may represent an effective, safe, and well tolerated treatment for moderate-to-severe eczema in adults

The role of intravascular factors in systemic sclerosis and the effect of various therapeutic agents

Systemic sclerosis is a disease characterised by reduced blood flow to the skin, the digits and to various organs in the body. The exact initiating factors remain unknown but it is now clear that damage to the vascular endothelium is of primary importance. This results in both morphological changes in blood vessels and functional changes in blood flow which then go on to produce the sclerosis which is the hallmark of the disease. Treatment with the vasodilator nifedipine significantly reduces the number and severity of Raynaud's episodes as well as helping to heal digital ulcers in these patients, although the drug has no demonstrable effect on digital blood flow. This suggests that the mode of action is mediated via a mechanism other than simple vasodilatation. A variety of intravascular factors, including red cell rheology, white cell activation, platelet activity and thrombolysis, have been implicated in this disease. This thesis examines the role of these factors in the pathogenesis of systemic sclerosis and whether they are amenable to treatment with calcium channel antagonists. The ability of red cells to deform is a critical determinant of the flow through the microvasculature. Using a filtration technique, it is clear that the deformability of red cells from patients with systemic sclerosis is diminished and that this can be significantly enhanced in vitro by calcium channel antagonists. It is likely that the reduced filterability is secondary to an increase in intracellular Ca2+, as red cells from patients with systemic sclerosis have increased influx of Ca2+ across their membranes which can be blocked ex vivo by nifedipine. This alteration in calcium flux is probably mediated via intracellular cAMP as forskolin, prostacyclin, and a phosphodiesterase inhibitor, all known modulators of cAMP activity, result in improved red cell filterability. Nifedipine does not however, affect red cell charge which is reduced in systemic sclerosis. In addition, nifedipine does not influence the production of hydrogen peroxide by polymorphonuclear leucocytes which is significantly increased in systemic sclerosis, as measured by whole blood and isolated polymorphonuclear leucocyte chemiluminescence. Calcium channel antagonists do, however, correct the abnormal activation of platelets and the disturbed thrombolysis demonstrated in patients with systemic sclerosis using the novel instrument, the haemostatometer. There is no doubt that the intravascular changes described above influence disease progression in patients with systemic sclerosis. Unfortunately it has not been possible to correlate these changes with disease activity but this reflects the lack of suitable criteria for quantifying `disease activity'.</p

Isotretinoin for acne vulgaris – an update on adverse effects and laboratory monitoring

A significant barrier to the usage of isotretinoin has been concerns regarding its adverse effect profile. The dose-dependent mucocutaneous side effects of isotretinoin are well recognized and easily managed, particularly if a lower dose is used. A possible association with depression has gained widespread media attention and is a source of concern for many patients and their carers, but data from prospective studies and recent meta-analyses have been reassuring. Furthermore, there has been much confusion amongst both patients and physicians regarding a possible association with inflammatory bowel disease, as well the ocular and rheumatological adverse effects of isotretinoin. We provide an update on the evidence surrounding the adverse effects of isotretinoin and discuss practical strategies to prevent and manage these adverse effects. We also discuss appropriate laboratory monitoring for patients taking isotretinoin

Allergic contact dermatitis from exposure to Grevillea robusta in New Zealand

ABSTRACT There are a number of reports in the literature of allergic contact dermatitis as a result of exposure to the sawdust and plant parts of Grevillea robusta. While this tree is prevalent in New Zealand, there seems to have been no previous published accounts of contact dermatitis, although anecdotal evidence indicates that such cases may be common. Two brief case reports are provided regarding severe phytodermatitis to G. robusta among professional arborists in New Zealand. As with other common plants capable of inducing allergic contact dermatitis, greater awareness among arborists, orchardists, forestry workers, gardeners, and health professionals will likely result in a reduction of cases

Global research profile on monkeypox-related literature (1962–2022): A bibliometric analysis

The recent monkeypox or mpox outbreak has been a global concern. The present study evaluated the global research outputs, research trends, and topics of published research on monkeypox using a bibliometric approach. The Scopus database was searched for terms associated with "monkeypox" or "monkey pox" up until 19 November 2022. Maps and bibliometric indicators of the retrieved documents were shown and analyzed. A total of 1,422 documents were obtained from Scopus. Other than monkeypox, the most commonly used terms included epidemic, disease outbreaks, smallpox vaccine, and orthopoxvirus. In total, 90.3% of the documents were published between 2002 and 2022. The United States, the United Kingdom, and India were the top three countries in terms of productivity. Most of the institutions were from the United States. The International Journal of Surgery, the Journal of Medical Virology, and the Travel Medicine and Infectious Disease are some of the top journals currently publishing research on monkeypox. Tecovirimat, coronavirus disease 2019 (COVID-19), homosexuality, and pandemic are emerging topics related to monkeypox

Global research profile on monkeypox-related literature (1962–2022): A bibliometric analysis

The recent monkeypox or mpox outbreak has been a global concern. The present study evaluated the global research outputs, research trends, and topics of published research on monkeypox using a bibliometric approach. The Scopus database was searched for terms associated with "monkeypox" or "monkey pox" up until 19 November 2022. Maps and bibliometric indicators of the retrieved documents were shown and analyzed. A total of 1,422 documents were obtained from Scopus. Other than monkeypox, the most commonly used terms included epidemic, disease outbreaks, smallpox vaccine, and orthopoxvirus. In total, 90.3% of the documents were published between 2002 and 2022. The United States, the United Kingdom, and India were the top three countries in terms of productivity. Most of the institutions were from the United States. The International Journal of Surgery, the Journal of Medical Virology, and the Travel Medicine and Infectious Disease are some of the top journals currently publishing research on monkeypox. Tecovirimat, coronavirus disease 2019 (COVID-19), homosexuality, and pandemic are emerging topics related to monkeypox

The Australasian Psoriasis Collaboration view on methotrexate for psoriasis in the Australasian setting

The Australasian Psoriasis Collaboration reviewed methotrexate (MTX) in the management of psoriasis in the Australian and New Zealand setting. The following comments are based on expert opinion and a literature review. Low-dose MTX (< 0.4 mg/kg per week) has a slow onset of action and has moderate to good efficacy, together with an acceptable safety profile. The mechanism of action is anti-inflammatory, rather than immunosuppressive. For pretreatment, consider testing full blood count (FBC), liver and renal function, non-fasting lipids, hepatitis serology, HbA1c and glucose. Body mass index and abdominal circumference should also be measured. Optional investigations in at-risk groups include an HIV test, a QuantiFERON-TB Gold test and a chest X-ray. In patients without complications, repeat the FBC at 2-4 weeks, then every 3-6 months and the liver/renal function test at 3 months and then every 6 months. There is little evidence that a MTX test dose is of value. Low-dose MTX rarely causes clinically significant hepatotoxicity in psoriasis. Most treatment-emergent liver toxicity is related to underlying metabolic syndrome and non-alcoholic fatty liver disease or non-alcoholic steatohepatitis. Alcohol itself is not contraindicated, but should be limited to < 20 mg/day. Although MTX is a potential teratogen post-conception, there is little evidence for this pre-conception. MTX does not affect the quality of sperm. There is no evidence that MTX reduces healing, so there is no specific need to stop MTX peri-surgery. MTX may be used in combination with cyclosporine, acitretin, prednisone and anti-tumour necrosis factor biologics