Background: Although the benefits of emollient therapy are widely accepted in atopic dermatitis, there is a relative lack of clinical evidence supporting their efficacy in these conditions. The aim ...of this study was to evaluate the efficacy, the tolerance and the effects on children's quality of life of a new moisturizer milk (Exomega milk®) in childhood atopic dermatitis. Methods: This controlled, randomized, multi-centric study had two parallel groups, involving children aged 6 months to 12 years, with mild and moderate atopic dermatitis (Scorad<35). The treated group applied the moisturizer milk twice a day for 2 months, in association with a cleansing bar. The non-treated group had only the cleansing bar. The use of strong and moderate topical corticoids was allowed and quantified. The following parameters were evaluated: Scorad, tolerance and the children's quality of life index. Results: A total of 76 children (mean age 4 years) were included: 37 in the treated group, 39 in the non-treated group. After 2 months, the decrease of the Scorad index in the treated group was not statistically significant (p = 0.051) but detailed evaluation showed a significant improvement of xerosis (p = 0.01) and pruritus (p = 0.01) in the treated group compared with the non-treated group. Clinical improvement in the treated group after 2 months of treatment was correlated to a significant improvement of the children's quality of life index (p = 0.0011). Tolerance was good to excellent in 97% of cases. Conclusion: The milk emollient studied was found to provide an interesting auxiliary treatment in childhood atopic dermatitis since it gave positive results, in particular on xerosis and pruritus, as well as an improvement of the quality of life of the children.
Full text
Available for:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objective. Clinical interest of silver in the management of chronic wounds is not fully established. The main objective of this clinical study was to assess the ability of a new silver releasing ...lipido-colloid contact layer to promote the healing process of venous leg ulcers (VLU) presenting inflammatory signs suggesting a heavy bacteria colonization and then a delayed healing, in comparison to the same wound dressing not impregnated with silver salts.
This was an open-labeled, randomized, controlled trial. VLU presenting at least 3 out of 5 clinical signs suggesting heavy bacterial colonization were recruited. Patients were treated with contact layer silver dressing (CLS, Restore® Contact Layer, Silver* (Hollister Wound Care, Libertyville, Ill) or contact layer dressing (CL Restore® Contact Layer**, Hollister Wound Care, Libertyville, Ill) for 4 weeks, then all treated ulcers were treated with CL for the 4 additional weeks. Wound evaluation and area measurements were conducted weekly during the first 4 weeks and then at week 6 and 8. Main efficacy criterion was absolute wound area decrease (AD) at week 4 and week 8.
Patients (N = 102) were randomized and treated. Ulcers were present for nearly 11 months on average; 65% were recurrent and mean area was 20.0 ± 17.8 cm2. Almost 80% of the treated VLU were stagnating/aggravating with their previous treatment. By week 4, mean surface area decreased by 6.5 ± 13.4 cm2 (median: 4.2 cm2) and 1.3 ± 9.0 cm2 (median: 1.1 cm2) in CLS and CL groups, respectively (P = 0.023). At week 8, median decrease was 5.9 cm2 versus 0.8 cm2 (P = 0.002) with a wound percentage decrease of 47.9% and 5.6% (P = 0.036). Median closure rate was 0.145 versus 0.044 cm2/day (P = 0.009) at week 4 and remained higher in the CLS group up to week 8 even after switching to CL dressing in these patients (P = 0.001). Odds ratio (multinomial logistic regression) of the chance to reach a ≥ 40% wound area reduction was 2.7 (95% CI: 1.1 to 6.7; P = 0.038) for silver treated ulcers. Dressing tolerance was good in both groups.
A 4-week treatment with silver releasing lipido-colloid contact layer promotes a sustained increase of closure rate of venous leg ulcers presenting inflammatory signs suggesting a high bacterial load. Also marketed as *Urgotul® Silver and **Urgotul®, Laboratoires Urgo, (France)..
The last years are marked by the emergence of new molecules for the treatment of metastatic cutaneous melanoma with a significant benefit on the survival. Besides, some techniques are in development ...for the loco-regional treatment of the metastatic sites, bringing new therapeutic perspectives. However, their respective use and place in the therapeutic strategy are debated by healthcare professionals.
The French National Cancer Institute leads a national clinical practice guidelines project since 2008. It realized a review of these modalities of treatment and developed recommendations.
The clinical practice guidelines development process is based on systematic literature review and critical appraisal by a multidisciplinary expert workgroup. The recommendations are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines are reviewed by independent practitioners in cancer care delivery.
This article presents recommendations for loco-regional treatments of the pulmonary, bone, cutaneous, hepatic and digestive metastatic sites for patients with pauci-metastatic cutaneous melanoma.
OBJECTIVE To study the efficacy of bagged larvae on wound debridement compared with conventional treatment. DESIGN Randomized, multicenter, controlled, prospective phase 3 trial with blinded ...assessment of outcome measures by a single observer. SETTING Two hospital referral centers in Caen and Lyon, France. PATIENTS Random sampling of 119 patients with a nonhealing, sloughy wound 40 cm2 or smaller, less than 2 cm deep, and an ankle brachial index of 0.8 or higher. INTERVENTION During a 2-week hospital stay, patients received either maggot debridement therapy (MDT) or conventional treatment. At discharge, conventional dressings were applied and a follow-up visit occurred at day 30. MAIN OUTCOME MEASURE Percentage of slough in wounds at day 15. RESULTS There was a significant difference between groups at day 8 (54.5% in the MDT group and 66.5% in the control group) (P = .04). The mean percentage of slough at day 15 was 55.4% in the MDT group and 53.8% in the control group (P = .78). CONCLUSIONS Although MDT shows no significant benefit at day 15 compared with conventional treatment, debridement by MDT is significantly faster and occurs during the first week of treatment. Because there is no benefit in continuing the treatment after 1 week, another type of dressing should be used after 2 or 3 applications of MDT. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01211236
We report an exceptional case of cutaneous necrosis due to the coexistence of 4 thrombophilic factors, inherited and acquired. We would like to draw attention to these unrecognized associations.
A ...72-year-old woman was admitted with a 5 month history of necrotic nonhealing, painful ulcer of both legs and recently a purple toe. She had a history of 3 deep venous thromboses of the leg complicated by pulmonary embolism. A skin biopsy of the ulcer and purple toe showed only thrombosis in the dermal vessel. Laboratory findings showed a circulating lupus anticoagulant, positive anticardiolipin antibodies, antinuclear antibodies (1/320 dilution) and an anti Sm. Moreover, activated protein C resistance associated with factor V Leiden mutation and hyperhomocysteinemia was found; protein S was transiently low. With iloprost, oral anticoagulant, vitamin B12 and folic acid, the evolution was good, with healing of ulcer.
cutaneous necrosis can reveal hypercoagulable states, sometimes complex. We find 4 thrombophilic factors in our case, i.e. antiphospholipid antibodies, factor V Leiden, protein S deficiency and hyperhomocysteinemia. This is exceptional but highlights the role of several constitutional and acquired thrombophilic factors in the genesis of thrombosis. Extended protein C pathway disturbances could explain the mechanism that leads to cutaneous necrosis, in this patient, with an antiphospholipid syndrome. This case shows that it is necessary in some circumstances to make a complete hemostatic laboratory search to detect several thrombophilic factors. If they are present they can justify an oral anticoagulant treatment and a familial screening.
PDF
