Atopic dermatitis and role of Relizema: a multi-country user experience

Atopic dermatitis (AD) is characterized by itching or pruritus, erythematous lesions, pruritus, and a skin barrier defect. Repeated scratching can trigger the itch-scratch cycle. Itching is associated with an adverse impact on quality of life. The first-line treatment of AD includes the use of topical corticosteroids for atopic dermatitis. However, parents of children with atopic dermatitis are often reluctant to accept the use of topical corticosteroids due to their concern of adverse effects flare-up. Relizema™ cream is a prescription emollient device (PED) multi-ingredients moisturizer formulation that has been indicated for the treatment of signs and symptoms of dermatitis. It is approved as medical device (MD) class IIa in Europe and it is registered as a topical medical device in countries of Asia Pacific. A consensus meeting of 9 dermatologists from multiple countries in Asia Pacific region treating atopic dermatitis was conducted. The dermatologists presented their cases of atopic dermatitis. PED was reported by patients to offer good relief of symptoms and improve skin softness unlike other moisturizers. In fact, a few patients reported relief with Relizema™ cream after using other moisturizers which were not demonstrating clinical effectiveness. Patients reported they noticed a softness in their skin after the application of the PED. PED was effective even in patients with lichenified skin. The formulation which is enriched with antioxidants helped relieve eczema. Due to its steroid-free formulation, the PED can be continued as a part of long-term maintenance treatment to maintain healthy skin conditions, prolong remission, and prevent recurrence

Chronic Paronychia and Onychomadesis in Pemphigus Vegetans: An Unusual Presentation in a Rare Autoimmune Disease

Pemphigus vegetans is a rare variant of deep acantholytic pemphigus which usually presents with vesiculobullous rash and vegetative plaques on the folds. We report a case of pemphigus vegetans patient who presented with rashes on tips of fingers and toes resembling paronychia and onychomadesis that misled the diagnosis for months. The final diagnosis of Hallopeau-type pemphigus vegetans was made based on histopathology and direct immunofluorescence studies. Interestingly, not only the clinical presentation was atypical, but blood tests for anti-desmoglein 1 and 3 antibodies by ELISA technique were also negative. Thus, the rare unusual manifestation of pemphigus vegetans in this patient may associate with different autoantibodies to desmosomal proteins compared with those of classic pemphigus patients

Intralesional Botulinum Toxin A Injection for Recalcitrant Alopecial Totalis and Alopecia Universalis: A Randomized, Double-Blind, Placebo-Controlled Trial

Background: Alopecia totalis (AT) and alopecia universalis (AU) have a high rate of recurrence and are very difficult to treat. To date, no consensus has been reach among clinicians regarding the best way to treat these conditions. It was recently proposed that botulinum toxin type A (BT) injection in alopecia areata may inhibit unmyelinated C fibers from releasing substance P and calcitonin-gene-related protein (CGRP), which showed a favorable clinical response in cephalalgic alopecia areata. Objective: To investigate the efficacy of botulinum toxin type A (BT) in the treatment of recalcitrant AT and AU. Methods: Twenty patients with either recalcitrant AT or AU were enrolled in this study. One half of the scalp was injected with BT 50 units 2.5 ml intradermally (dilution 20 units/ml) and the other half of the scalp was injected with normal saline 2.5 ml. Clinical assessments were performed using Severity of Alopecia Tool (SALT) score, scalp mapping, and photography. Patients were followed up monthly for 4 months after treatment to evaluate terminal hair regrowth. Results: Based on patient results at the 4-month follow-up, no clinical improvement in either recalcitrant alopecia totalis or alopecia universalis was observed. Conclusion: Although BT has been demonstrated to improve the clinical features of cephalalgia alopecia areata, BT was not shown to improve the clinical features of recalcitrant AT or AU in this study. In order to understand and explain the differences in these two clinical outcomes using BT in alopecia, further investigation is needed

Pilot Study of the Efficacy and Safety of Nail Gel Containing Artemisia abrotanum Extract and Glycerin in the Treatment of Nail Plate Surface Abnormality

Background: Nail gels are utilized for the treatment of nails for nail plate surface abnormalities. However, the objective measurement of nail gel treatment is limited. Objective: This study investigated the efficacy and safety of a nail gel containing glycerin and Artemisia abrotanum extract in treating nail plate surface abnormalities. Material and Methods: All nails were evaluated with a Visiometer® system and by transonychial water loss (TOWL) at baseline, and at the 2nd and 8th weeks of treatment. Results: In total, 19 patients with a mean age of 50.6 years old were enrolled and 50 nails were studied. Sixty percent of the patients showed significant clinical improvement, as determined by the total agreement between two treatment-blinded dermatologists. Regarding the Visiometer®, a significant reduction in the SER value (roughness) of the nail plates was found at the 2nd week, while at the 8th week, the surface and volume values had significantly decreased from baseline and also from the values at the 2nd week. There was a significant improvement in the Rku (smoothness) value at the 8th week compared to baseline. The mean TOWL at the 2nd and 8th weeks were statistically decreased from baseline. No side effects were detected. Conclusions: This nail gel containing Artemisia abrotanum extract provided benefits in restoring hydration and improving the nail barrier in patients with nail surface abnormalities

A Double-Blinded, Randomized, Vehicle-Controlled Study of the Efficacy of Moisturizer Containing Licochalcone A, Decanediol, L-Carnitine, and Salicylic Acid for Prevention of Acne Relapse in Asian Population

Many topical agents are available for treating the acute phase of acne; however, few agents have been proven beneficial during the maintenance phase. Objective. To evaluate the efficacy and safety of moisturizer containing licochalcone A, 1,2-decanediol, L-carnitine, and salicylic acid during the maintenance phase of mild to moderate acne in Thai patients. Methods. One hundred and ten patients with mild to moderate acne vulgaris were initially treated with a fixed combination of adapalene 0.1%/benzoyl peroxide 2.5% gel once daily for 8 weeks. Fifty patients who achieved at least 50% reduction in lesion counts or at least a 2-grade improvement in the Investigator’s Global Assessment (IGA) grade from baseline were enrolled in the maintenance phase, which was an investigator-masked, left-right comparison, randomized, controlled, intraindividual study. Moisturizers with and without the active study ingredients were applied twice a day to each side of the face, respectively, for 12 weeks. Assessments included acne lesion counts, acne severity by IGA scoring, skin bioengineering measurements, and skin tolerability as assessed by both patient and physician. Results. The treatment group had a significant reduction in the mean counts of noninflammatory, inflammatory, and total lesions compared to the vehicle group at week 12 and also between baseline and week 12. There was no significant difference in the mean scores for skin dryness, stinging/burning, or pruritus at any time point between groups. Conclusions. Moisturizer containing licochalcone A, 1,2-decanediol, L-carnitine, and salicylic acid reduced acne lesions and prevented the development of new lesions during the maintenance phase. This trial is registered with ClinicalTrials.gov registration no. NCT04002024

Acquired Cutis Laxa Type I: Laxity Treatment Efficacy by Non-Ablative Radiofrequency Monitoring by Cutometer

Objective: To demonstrate the treatment efficicacy of tripolar radiofrequency (RF) in a Thai middle-aged female with generalized acquired CL. Case presentation: The patient was treated by tripolar RF device at face and forehead at weeks 0, 2, and 3. The gross elasticity of the skin was measured pre and post treatment by cutometer and physician assessment. After two treatment sessions, the skin elasticity at the treatment area evaluated both by physician assessment and cutometer did not reveal significant improvement. The patient was lost to follow up after the third treatment session. Conclusion: Tripolar RF did not improve skin elasticity at week 3. Future studies are required to determine the physiological effect of RF in CL, appropriate tripolar RF parameters, timing, as well as developing the suitable method of measurement of the skin elasticity in CL

Comparison of the efficacy and safety of 0.1% tacrolimus ointment and 0.1% mometasone furoate cream for adult vitiligo: A single-blinded pilot study

Topical tacrolimus has demonstrated efficacy in vitiligo. This study compared the efficacy and safety of 0.1% tacrolimus ointment with 0.1% mometasone furoate cream in adult vitiligo. We enrolled patients with symmetrical, nonacral vitiligo, and the patients on each side were randomized to receive either 0.1% tacrolimus ointment or 0.1% mometasone furoate cream, applied twice daily for 6 months. Repigmentation outcome at 6 months was compared with baseline. Of 18 cases, 22% and 33% in tacrolimus and mometasone groups, respectively, displayed more than 50% repigmentation (p > 0.05). Telangiectasia was presented in one-third of cases on the mometasone-treated side. Both treatments were effective in vitiligo; however, 0.1% tacrolimus ointment has fewer adverse effects

Evaluation of Hair Follicle Counts of Occipital Scalp Biopsies from Male Hair Transplant Patients in Thailand

Objective: To evaluate the average hair follicle count from the occipital scalp of Thai males with AGA who were candidates for hair transplantation. Materials & Methods: A cross-sectional study of 47 male with AGA undergoing hair transplantation surgery was conducted.  The 4-mm punch biopsies from the occipital scalp were evaluated for hair count parameters. The results were compared to prior studies. Results: The average counts of total hair follicles and the density of hair follicle per square millimeter were 18.6±1.2, and 1.5±0.1, respectively. The terminal-to-vellus ratio was 11.1, and the percent ratio of anagen-to-telogen ratio was 91.9:8.1. The hair count number is significantly lower than other ethnicities including Thais in general population (P < 0.001), but greater than the Thai males with AGA in the previous study. (P < 0.001). Conclusion: Our study showed a lower average hair density as compared to the other normal Asian population.  The total hair count in the occipital area from this study is less when compared to the previous studies conducted in Thai normal controls but higher than those with more advanced AGA. This result supported the evidence of hormonal effect involving the occipital scalp of male AGA.