Article

Clay Jojoba Oil Facial Mask for Lesioned Skin and Mild Acne - Results of a Prospective, Observational Pilot Study

Authors:
  • Charité Universitätsmedizin Berlin and Immanuel Krankenhaus
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Abstract

External application of clay facial masks is a cosmetic procedure generally used to reduce skin lesions and to improve overall skin condition. Collecting pilot data about self-treatment with clay jojoba oil masks on participants with acne-prone, lesioned skin and acne. Open, prospective, observational pilot study: Participants received written information, instructions, and questionnaires without direct contact with the study physician. For 6 weeks, they applied the masks 2-3 times per week. The primary outcome is the difference of skin lesions: baseline vs. after 6 weeks. 194 participants (192 female, 2 male, mean age (± SE) (32.3 ± 0.7 years) returned questionnaires and diaries. 133 of these participants returned complete and precise lesion counts (per-protocol (PP) collective). A 54% mean reduction in total lesion count was observed after 6 weeks of treatment with clay facial mask. Both inflammatory and non-inflammatory skin lesions were reduced significantly after treatment compared to baseline: Median counts (MC) of pustules per affected participant were reduced from 7.0 ± 0.9 to 3.0 ± 0.5 (mean individual reduction (MIR) = 49.4%), the MC of the papules from 3.5 ± 2.2 to 1.0 ± 0.4 (MIR = 57.3%), the MC of cysts from 2.0 ± 0.8 to 0.5 ± 0.4 (MIR = 68.6%) and the MC of comedones from 26.5 ± 6.3 to 16.0 ± 4.0 (MIR = 39.1%). DLQI-average score decreased from 5.0 ± 4.5 (mean ± SE) before to 2.1 ± 2.8 after treatment. The present study gives preliminary evidence that healing clay jojoba oil facial masks can be effective treatment for lesioned skin and mild acne vulgaris.

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... These changes contribute to the overall softness of the skin and make it possible to accommodate stretching and movement without cracks and tears, perceived as scaliness, developing on the surface. That surface suppleness changes rapidly in response to the application of water or known emollients [6,8,10,11,44]. Jojoba oil in single-phase and emulsion systems shows an excellent lubricity without the oily, greasy feel of other lipids, especially lanolin and petrolatum [45]. It can also contribute to superior transpirational water control in the skin, thus reducing evaporation without blocking the passage of gases and water vapor. ...
... A mixture of jojoba oil and hydrogenated jojoba wax was not mutagenic both with and without activation in the Ames assay [8,10,44,89]. Taguchi measured the safety of Jobacohol, which was produced by sodium reduction and molecular distillation. No acute toxicity was found in mice, and eye irritation was quite low. ...
Article
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Jojoba is a widely used medicinal plant that is cultivated worldwide. Its seeds and oil have a long history of use in folklore to treat various ailments, such as skin and scalp disorders, superficial wounds, sore throat, obesity, and cancer; for improvement of liver functions, enhancement of immunity, and promotion of hair growth. Extensive studies on Jojoba oil showed a wide range of pharmacological applications, including antioxidant, anti-acne and antipsoriasis, anti-inflammatory, antifungal, antipyretic, analgesic, antimicrobial, and anti-hyperglycemia activities. In addition, Jojoba oil is widely used in the pharmaceutical industry, especially in cosmetics for topical, transdermal, and parenteral preparations. Jojoba oil also holds value in the industry as an anti-rodent, insecticides, lubricant, surfactant, and a source for the production of bioenergy. Jojoba oil is considered among the top-ranked oils due to its wax, which constitutes about 98% (mainly wax esters, few free fatty acids, alcohols, and hydrocarbons). In addition, sterols and vitamins with few triglyceride esters, flavonoids, phenolic and cyanogenic compounds are also present. The present review represents an updated literature survey about the chemical composition of jojoba oil, its physical properties, pharmacological activities, pharmaceutical and industrial applications, and toxicity.
... Numerous studies have demonstrated its clinical benefits and its effects on inflammatory mediators. Interleukins, the immune system, respiratory factors, collagen production boost [1,2]. In addition, it is beneficial to reduce excess oil, absorbs unwanted toxins and impurities in the skin [3]. ...
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This research is a study on the development of innovative clay mask mixed with the Acanthus ebracteatus Vahl extract product. The purposes of this research are as follows. Firstly, the research is to develop a clay mask product mixed with natural extracts from the Acanthus ebracteatus Vahl. Secondly, it is aimed to study on the antioxidant activity, anti-inflammatory effect, antimicrobial effect and total Phenolic contents of the Acanthus ebracteatus Vahl extracts. Thirdly, it is tostudy stability of the product. Finally, the research is to study on the calculation of suitable product formulations for clay products mixed with Acanthus ebracteatus Vahl extracts. By starting from the selection of raw materials, the extracts are prepared to determine the total phenolic content. Later, 2,2-diphenyl-1-picrylhydrazyl (DPPH) Assay method is conducted for antioxidant activity test, followed by anti-inflammatory effect test (Nitric oxide production inhibitory activity test, inhibition of LPS-induced TNF-α secretion test and Anti-inflammatory activity test (COX-2). Afterwards, a suitable formulation is developed. The test for the safety and physical properties of the product is then carried out followed by the skin irritation test in a group of 10 volunteers in order to ensure that the clay mask product containing Acanthus ebracteatus Vahl extracts is effective and safe. From the results of the product stability study, the findings indicated that the clay mask product containing Acanthus ebracteatus Vahl extracts did not show any phase separation. The irritation test in 10 volunteers after 12 hours of using the product showed no sign of allergic reaction, itching or irritation. Toxicity test results found no cytotoxicity. The anti-inflammatory effect test was found to have potent anti-inflammatory properties, when tested in the RAW 264.7 macrophage cell. This study is only for the development of an innovative product of skin clay mask mixed with the Acanthus ebracteatus Vahl extracts.
... For the wound healing process, the ingredients of NS-21 also include vitamin E [10], honey [16] and Zn-Cu [15]. Plant oils may play a role in promoting skin barrier homeostasis as well as antioxidative and anti-inflammatory properties to help wound healing [21], such as grape seed oil [13,14], soybean oil [12,36], avocado oil [19], jojoba oil [20,37,38] and rose hip oil [21,22]. The results from the abovementioned studies as well as the current study suggest that NS-21 may be a potential candidate for skin moisture maintenance during RT or CCRT. ...
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Background: To evaluate the practicality of NS-21 cream with regard to its skin-related toxicity in patients with head and neck cancer (HNC) who are undergoing concurrent chemoradiation therapy (CCRT) or radiotherapy (RT). Methods: Between July 2015 and November 2017, 30 HNC patients who underwent RT or CCRT were randomly allocated to receive either NS-21 or control treatment on their irradiated skin three times per day, starting at the initiation of RT or CCRT and ending 2 weeks after the completion of RT or until the appearance of grade 3 acute radiation dermatitis (ARD). Dermatitis was recorded weekly according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Skin humidity was monitored by a digital moisture meter. The generalized estimating equation (GEE) and logit link function method were used for statistical analysis. Results: No serious adverse events were observed in either group. Itching dermatitis occurred on the right lower neck in one patient of the NS-21 group during the 3rd week of CCRT, but the severity was mild. The median skin moisture value at the time of the final treatment was significantly different between the study and control groups (30.6 vs. 27.3, p = 0.013). Additionally, there was an inverse relationship between skin moisture and ARD grade (B = -0.04, p = 0.005). The incidence of ARD at the time of the last treatment was not significantly different between the study and control groups (6.7% vs 26.7%, p = 0.165). The risk of grade 3 ARD for skin that had received an irradiation dose of 47-70 Gy was higher than that of skin that had received an irradiation dose ≤46 Gy (OR = 31.06, 95% CI =5.95-162.21, p < 0.001). Nevertheless, the risk of ARD was not significantly different between the groups (OR = 0.38, 95% CI = 0.08-1.74, p = 0.212). Conclusions: NS-21 was well tolerated and effective for the maintenance of skin moisture; however, there was no statistically significant reduction in the risk of ARD in HNC patients undergoing RT or CCRT when compared with HNC patients in the control group. Trial registration: The study was approved by the Institutional Review Board of Far Eastern Memorial Hospital ( FEMH-IRB , 104048-F), Registered 1st June 2015.
... It has been shown to be effective in enhancing the absorption of topical drugs [132][133][134]. The high content of wax esters makes jojoba oil a good repair option for dermatoses with altered skin barriers, such as seborrheic dermatitis, eczematous dermatitis, AD, and acne [98]. Jojoba oil also has a proven anti-inflammatory effect, with potential uses in a variety of skin conditions including skin infections, skin aging, and WH [99,132]. ...
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Plant oils have been utilized for a variety of purposes throughout history, with their integration into foods, cosmetics, and pharmaceutical products. They are now being increasingly recognized for their effects on both skin diseases and the restoration of cutaneous homeostasis. This article briefly reviews the available data on biological influences of topical skin applications of some plant oils (olive oil, olive pomace oil, sunflower seed oil, coconut oil, safflower seed oil, argan oil, soybean oil, peanut oil, sesame oil, avocado oil, borage oil, jojoba oil, oat oil, pomegranate seed oil, almond oil, bitter apricot oil, rose hip oil, German chamomile oil, and shea butter). Thus, it focuses on the therapeutic benefits of these plant oils according to their anti-inflammatory and antioxidant effects on the skin, promotion of wound healing and repair of skin barrier.
... Studies have suggested that JJO helps during the wound healing process [8,31,48] and has some anti-microbial benefit [49], lending itself to acne product formulations [50]. Other studies have shown beneficial effect in the management of scalp psoriatic plaques [51]. ...
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Renewed consumer and industry interest in natural ingredients has led to a large growth of natural cosmetics. This has put pressure on formulation skills and product claims when it comes to using natural compounds. Taking a strategic and comprehensive approach in viewing natural ingredients, including natural oils, as ‘active’ ingredients rather than just providing for so-called ‘natural’ claims, aids both innovation and development. Given the ever-increasing consumer demand for natural ingredients, and more importantly the demand for effective natural ingredients including plant oils, it is important for the cosmetic industry to re-evaluate them in this context. The objectives of this review are to provide an update of three popular cosmetic plant oils - Sweet Almond, Evening Primrose, and Jojoba - in terms of their cosmetic applications as ‘active’ ingredients. This review highlights the activity of these oils, in the management of dry skin, ageing skin, juvenile skin, atopic dermatitis, scalp conditions, and their wider potential. Attention is given to formulation considerations where the content of these oils impacts product oxidation, skin penetration and stratum corneum homeostasis. Benefits of these oils have been well documented both pre-clinically and clinically. Historically, they have been used for hundreds if not thousands of years for their management and treatment of various skin and other ailments. Given the discrepancies in some clinical data presented for a variety of dermatoses, the importance of the choice of oil and how to formulate with them within the context of the epidermal barrier function, skin penetration, and toxicity, cannot be underestimated. Care should be taken in terms of the quality and stability of theses oils, as well as ensuring best formulation type, if the reported activities of these oils are to be achieved with consistency. Despite discrepancies in the literature and questionable study designs, it is clear, that Sweet Almond, Evening Primrose and Jojoba oils, do have skin care benefits for both adult and juvenile applications. They are effective ingredients for skin care preparations to strengthen stratum corneum integrity, recovery, and lipid ratio. Nevertheless, further experimental data are required concerning the impact on stratum corneum physiology and structure.
... Attempts have been made to use alternative methods of treatment for acne. Some of this work appears to indicate that plants such as Camellia sinensis (green/black tea) show 5α-hydroxidase and anti-inflammatory activity [14], jojoba oil may reduce inflammatory-and non-inflammatory-lesion counts [15], and tea tree (Melaleuca alternifolia) oil significantly reduces total lesion counts and acne severity index as compared to placebo [16]. ...
Article
Background: Acne vulgaris is a self-limiting disorder of the pilosebaceous unit. The aesthetic aspect of the disorder may provoke depression and diminish the quality of life. A number of agents are used for acne treatment, e.g., retinoids, antibiotics, benzoic acid, azelaic acid, and hormones. These agents have side-effects, sometimes severe ones. Case reports: Presented are 2 cases of severe acne treated with individualized homeopathic medicines. Both patients were treated using the classical method of homeopathy, i.e., a single medicine based on the patient's individual characteristics was prescribed. The cases were documented photographically at onset and during the course of treatment. Both patients went into remission following treatment, and long-term follow-up suggested that the therapy remained efficacious long after cessation of treatment. No significant side effects were noted. Conclusions: Homeopathic medicines may be useful as stand-alone treatment of patients with severe acne vulgaris. A case series suggested a remission rate of more than 80% using individualized homeopathic treatment. The treatment remained efficacious long after cessation and is not accompanied by significant side-effects. It is to be hoped that this presentation will stimulate research interest into homeopathic medicines as stand-alone or adjunct treatments of acne.
... Apart from that, the addition of jojoba oil was found to enhance the viscosity and stability of lubricants at a high temperature, which is suitable to be utilized as a cosmetic ingredient (Alvarez & Rodríguez, 2000). Also, a pilot study from Meier et al. (2012) with the application of jojoba oil in clay facial mask preparation was found as a preliminary evidence of jojoba oil in the treatment of lesioned skin, mild acne vulgaris, and improvement of overall skin condition. Floratech, a company that produces and markets botanical-derived ingredients for personal care and cosmetic industry has patented a lipid complex (L22 ® ) produced from jojoba oil/macadamia seed oil esters, squalene, phytosteryl macadamiate, phytosterols, and tocopherol. ...
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The photoprotective skincare products are in high demand to meet the consumer market with concern on skin health. Seed oils are commonly used as ingredients in many cosmetic products due to their natural antioxidants and now being increasingly recognized for their effects on skin health and photoprotection. This article briefly reviews the application of seed oils in sunscreen development focusing on the antioxidants that contribute to photoprotection, thus preventing UV‐induced erythema and photoaging. The addition of seed oils that contain specific natural bioactive compounds was discussed in the review. Besides that, seed oils acting in molecular pathways that benefit photoprotection were also summarized. Seed oils (pomegranate seed oil, castor oil, cocoa butter, jojoba oil, rosehip oil, grapeseed oil, kenaf seed oil, and pumpkin seed oil) utilization have high potential to act as natural UV filters and at the same time help in skin repairing. The seed oils contributed beneficial properties to the sunscreen formulation due to their synergistic effect with antioxidants, antiaging properties, anti‐inflammatory effect, and potential hormetic effect. The finding of specific bioactive compound from seed oils provides a better understanding of the contribution of seed oils in sunscreen formulation.
... This was an open, prospective, observational pilot study and lacked vehicle control as well as blinding. Both inflammatory and non-inflammatory skin lesions were reduced significantly after treatment compared to baseline [22]. Da Silva et al. showed the effectiveness of Copaiba essential oil versus vehicle in reducing facial acne lesions. ...
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Purpose of Review To review the current literature regarding complementary and alternative treatment options for acne vulgaris. Recent Findings Acne vulgaris is an increasingly prevalent disease worldwide. While conventional methods of treatment are still primarily used to treat acne, complementary and alternative methods of treatment are becoming utilized in conjunction or in place of prescription medications. Summary Studies have shown comparable benefit of Complementary and Alternative Medicine (CAM) therapies to conventional treatment. Oral green tea extract was a moderately effective treatment of inflammatory acne without significant side effects. Nicotinamide oral and topical preparations demonstrated efficacy in the treatment of moderate inflammatory acne without significant side effects. Oral zinc gluconate was not as effective as oral minocycline in the treatment of inflammatory acne. CAM therapy has relatively few reported side effects for acne vulgaris, and is mildly effective in treatment of inflammatory and comedonal acne. More studies are needed for further comparison of CAM modalities with each other as well as with conventional treatment.
... Clay has effectively proven itself in both cosmetology and dermatology [4][5][6][7][8][9][10][11]. Clays have cleansing, moisturizing, soothing, regenerative, anti-inflammatory, sedative, anti-septic and detoxifying effects; they rejuvenate, tone and nourish the skin [9,10,[12][13][14][15][16][17]. Clays can eliminate excess grease and toxins from skin, and hence are said to be effective for dermatological diseases such as furunculosis and management of ulcers [12]. ...
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Clay has a great biomedical application potential, however there are just a few instrumental studies and the impact of lake clay on the skin has not yet been studied. The DermaLab skin analysis system (Cortex Technology) was used for hydration, elasticity, transepidermal water loss (TEWL) and pH measurements after lake clay facial applications. Research included short-term tests (measurements 20 and 60 min after clay application) and long-term tests (application every 4th day for 3 weeks with measurements 20–24 h post-application). Control measurements and application tests to exclude contact allergy were made beforehand. No volunteer (n = 30) had positive allergic reaction. The matched-pairs design was applied: the right and left parts of forehead were used for the test and control groups. The Wilcoxon signed-rank test (significance level p = 0.001) was applied for statistical analysis. There were statistically significant pH changes demonstrated during the short-term measurements. The long-term measurements provided data that clay significantly improves skin hydration and elasticity.
... Simmondsia chinensis seed oil (jojoba) Simmondsia chinensis seed oil contains up to 50% wax esters, while natural human sebum consists of approximately 26% wax esters, which makes it a good option to altered-skin barrier conditions, presenting positive effects on acne [67], wound healing [68], psoriasis and rosacea [69]. ...
... Oil obtained from jojoba seeds is 50% colourless and odourless which is being used in several cosmetics. The oil is composed of straight chain monoesters of C-20 and C-22 acids and alcohols and two double bonds [48][49][50] and helps in the treatment of acne and psoriasis [51]. ...
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Acne is the most common skin condition with substantial cutaneous and psychological disease burden characterized by different areas of scaly red skin, papules, blackheads and whiteheads, nodules and pimples. The pathogenesis and existing treatments for acne is difficult. The severity of acne varies greatly among the individuals and genetic background plays a vital role in its development. Propionibacterium acnes (P. acne) have been recognized as pus-forming bacteria which triggers the inflammation in acne. The present study was conducted to evaluate antimicrobial activities of Indian medicinal plants against the etiologic agents of acne vulgaris. Pathogenic factors include increased sebum production, hyper cornification of pilosebaceous ducts, abnormal bacterial function, and production of inflammation. The therapy includes yearlong administration of synthetic medicines, which can cause severe side effects. Hence, the less toxic and safe substances are needed for the treatment. Herbal or herbal based medicines are safe alternatives in which extracts of natural origin are used as medicines. The aim of herbal therapy is to provide safe, efficient and economical medicines so that the people can utilize them. In present review input of herbs in the treatment of acne is summarized. Different databases were searched for retrieving all the medicinal plants with anti-acne activity.
... Simmondsia chinensis carrier oil is also indicated for the improvement of acne, psoriasis, and inflammation [90, 166,209]. The clay facial mask has been shown to decrease inflammation and significantly improve acne [151]. This liquid wax has not only been reported as a non-toxic substance in animal studies, but has been found to display moderate absorption where it effectively permeates into the outer layer of the subcutaneous level of the skin and increases water content, lending to its ability to exert a moisturising effect [157,239,268]. ...
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... For the wound healing process, the ingredients of NS-21 also include vitamin E [10], honey [16] and Zn-Cu [15]. Plant oils may play a role in promoting skin barrier homeostasis as well as antioxidative and anti-inflammatory properties to help wound healing [21], such as grape seed oil [13,14], soybean oil [12,36], avocado oil [19], jojoba oil [20,37,38] and rose hip oil [21,22]. The results from the abovementioned studies as well as the current study suggest that NS-21 may be a potential candidate for skin moisture maintenance during RT or CCRT. ...
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The complicated and multifactorial nature of acne pathophysiology provides a multitude of opportunities for vitamins and minerals to disrupt the inflammatory cascade. In their traditional roles as dietary necessities, vitamins and minerals participate in keratinocyte proliferation and maturation, modulation of lipid production in human sebocytes, and inhibition of pro-inflammatory cytokines, matrix metalloproteinases, and antimicrobial peptides, as well as act as antioxidants. Not surprisingly, then, there is considerable in vitro and preclinical data predicting their efficacy in acne. Although conclusive clinical evidence is currently lacking for many of them, more vigorous trials are being conducted with increasingly convincing in vivo data. At this time, data for vitamin A analogs, zinc, and niacinamide is most compelling. It may well be that combination therapy will be more efficacious than monotherapy. Fortunately, due to their large safety margin, we can afford to be generous with our recommendations while awaiting more definitive results.
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A very important issue in the practice of cosmetologists is the selection of an appropriate cosmetic mask at the end of each care treatment. Due to their effects, cosmetic masks can contain various active substances in different concentrations that are tailored to the needs of a given skin type. The aim of the study was to investigate what are the guidelines of cosmetologists while choosing cosmetic masks in a beauty salon and home care.
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Major components of two tea-tree oil samples were identified using thin layer and gas-liquid chromatography (TLC and GLC). Using a TLC-bioautographic technique, the tea-tree oils, terpinen-4-ol, alpha-terpineol and alpha-pinene were found to be active against Staphylococcus aureus, Staph. epidermidis and Propionibacterium acnes whereas cineole was inactive against these organisms. The MIC values of the three active compounds increased in the order alpha-terpineol < terpinen-4-ol < alpha-pinene for all three micro-organisms. MIC values of the tea-tree oils and terpinen-4-ol were lower for P. acnes than for the two staphylococci. This study supports the use of tea-tree oil in the treatment of acne, and demonstrates that terpinen-4-ol is not the sole active constituent of the oil.
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A simple practical questionnaire technique for routine clinical use, the Dermatology Life Quality Index (DLQI) is described. One hundred and twenty patients with different skin diseases were asked about the impact of their disease and its treatment on their lives; a questionnaire, the DLQI, was developed based on their answers. The DLQI was then completed by 200 consecutive new patients attending a dermatology clinic. This study confirmed that atopic eczema, psoriasis and generalized pruritus have a greater impact on quality of life than acne, basal cell carcinomas and viral warts. The DLQI was also completed by 100 healthy volunteers; their mean score was very low (1.6%, s.d. 3.5) compared with the mean score for the dermatology patients (24.2%, s.d. 20.9). The reliability of the DLQI was examined in 53 patients using a 1 week test-retest method and reliability was found to be high (gamma s = 0.99).
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Androgens are an essential prerequisite for the development of acne. The present study was undertaken to characterize the androgen status of women with late onset and persistent acne only and, using the dexamethasone (dex) suppression test, to identify the source(s) of the androgen excess. We measured serum levels of total testosterone (T), free testosterone (FT), androstenedione (δ 4A), dihydrotestosterone (DHT), dehydroepiandrosterone sulphate (DHEA-S) and sex hormone binding globulin (SHBG) in 34 healthy control subjects, in 34 women with mild acne and in 29 women with moderate or severe acne. Serum FT, DHT and DHEA-S levels in patients of both acne groups were significantly higher than those in the control subjects. The other hormone levels showed no significant differences between patients and control subjects, and there were no significant differences between the two acne groups in any of the androgen levels. In order to evaluate the ovarian and adrenal contributions to serum androgens in the acne patients, the serum levels of δ 4A, T, DHT and DHEA-S were measured prior to and following 2 weeks of dex therapy. Following the dex test, the DHT and T of adrenal origin were significantly higher in the acne patients than in the control subjects. These results suggest that, in acne patients, hyperandrogenaemia is likely to develop as a result of adrenal androgen excess. In addition, since abnormally high androgen levels are frequently seen in late onset and persistent acne, it seems that this condition is likely to be a sign of hyperandrogenism.
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Recent experiments in our laboratory have suggested that certain montmorillonite clays, when exchanged with the cationic surfactant cetylpyridinium (CP), may be useful in removing bacteria from aqueous solution. During an initial study, screening various CP-exchanged products for potential antibacterial activity, three CP-exchanged clays - CP*AAM (acid-activated montmorillonite), CP*STx-1 (Ca(++)-montmorillonite), and CP*SWy-2 (Na(+)-montmorillonite), proved to be the most effective. Binding studies were performed using 1mg each of CP-exchanged AAM, STx-1, and SWy-2 with a standardized Salmonella enteritidis solution containing approximately 40,000 colony forming units (CFU)/ml. The modified clays reduced bacterial numbers 98.1, 97.6, and 95.2%, respectively. In contrast, the parent clays only produced reductions of 39.8, 16.9, and 16.6%, respectively. Attempts were made to desorb CP from the modified clays by washing in sterile physiological saline for 24h. The resulting wash solutions failed to produce any significant reduction in bacterial colony counts; while, the washed clays retained their full antimicrobial activity. These findings suggested that the antibacterial effect of the clays is localized on the clay surface and is not due to CP dissociating from the clay. Electron microscopy revealed that the bacteria adhered to the surface of the CP-exchanged clays, but not the parent clays. Results from timed binding studies showed that the antibacterial effect was stable over the period observed. Rates of binding were positively influenced by increasing temperature, not affected by changes in pH, and negatively influenced by the presence of organic contaminants. The mechanism by which bacterial counts are reduced may involve the enhanced hydrophobicity and affinity of the CP-exchanged clay for Salmonella and the antibacterial activity of CP.
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Systemic treatment is required in patients with moderate-to-severe acne, especially when acne scars start to occur. Antibiotics with anti-inflammatory properties, such as tetracyclines (oxytetracycline, tetracycline chloride, doxycycline, minocycline and limecycline) and macrolide antibiotics (erythromycin and azithromycin) are the agents of choice for papulopustular acne, even though the emerging resistant bacterial strains are minimizing their effect, especially regarding erythromycin. Systemic antibiotics should be administered during a period of 8-12 weeks. In severe papulopustular and in nodulocystic/conglobate acne, oral isotretinoin is the treatment of choice. Hormonal treatment represents an alternative regimen in female acne, whereas it is mandatory in resistant, severe pubertal or post-adolescent forms of the disease. Compounds with anti-androgenic properties include estrogens combined with progestins, such as ethinyl estradiol with cyproterone acetate, chlormadinone acetate, desogestrel, drospirenone, levonogestrel, norethindrone acetate, norgestimate, and other anti-androgens directly blocking the androgen receptor (flutamide) or inhibiting androgen activity at various levels, corticosteroids, spironolactone, cimetidine, and ketoconazole. After 3 months of treatment control of seborrhea and acne can be obtained. Low-dose corticosteroids (prednisone, prednisolone, or dexamethasone) are indicated in patients with adrenal hyperandrogenism or acne fulminans. New developments and future trends represent low-dose long-term isotretinoin regimens, new isotretinoin formulations (micronized isotretinoin), isotretinoin metabolites, combination treatments to reduce toxicity, insulin-sensitizing agents, 5alpha-reductase type 1 inhibitors, antisense oligonucleotide molecules, and, especially, new anti-inflammatory agents, such as lipoxygenase inhibitors.
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The objective of this study was to conduct a laser-Doppler flowmetry investigation of skin microcirculation changes induced by mud pack therapy. The magnitude of the changes, potential remote effects, and potential influence of mud pack thickness were studied. Twenty female spa therapy patients aged 28-67 years (median, 51 years) participated in the study. The reason for spa therapy was lower limb venous insufficiency in 14 patients and osteoarthritis in six patients, none of whom had involvement of the shoulders. Mud pack treatment was associated with a significant elevation in skin temperature, by 1.8 +/- 0.2 and 1.0 +/- 0.2 degrees C with the 30- and 15-mm packs, respectively (P < 0.001 for both comparisons; nonsignificant difference between the two packs). Skin blood flow increased significantly, by 619 +/- 82 and 410 +/- 124 mV with the 30- and 15-mm packs, respectively (P < 0.0001 for both comparisons; nonsignificant difference between the two packs). The vasomotion score increased markedly on the treated side, by 16.7 +/- 2.8 and 13.0 +/- 1.6 with the 30- and 15-mm packs, respectively (P < 0.005 for both comparisons; no significant difference between the two packs). Furthermore, low-frequency vasomotion waves of a type not described previously were recorded. The microcirculatory changes lasted longer than did the temperature increase. No significant changes were noted in the other shoulder or in central body temperature. The patients were volunteers receiving spa therapy and free of diabetes mellitus, vasoactive drug treatment, and inflammatory shoulder disease. Two mud packs, 15 and 30 mm in thickness, respectively, were applied at an interval of 48 h, at the same time of day in a given patient, and at a distance from other spa treatments. The packs were centered on the deltopectoral groove. The side and order of application of the two packs were determined at random. Superficial skin blood flow was measured by laser-Doppler flowmetry (Perimed PF4001, wavelength 82 nm) and recorded by the Perisoft computer program with a 3-s time constant downstream from a broadband filter (12 MHz). These results suggest that the vascular changes induced by mud pack therapy are not fully explained by vasodilation in response to local temperature elevation. Further studies are in order to identify the other mechanisms involved.
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Jojoba [Simmondsia chinensis (Link 1822) Schneider 1907] is an arid perennial shrub grown in several American and African countries. Jojoba seeds, which are rich in liquid wax, were used in folk medicine for diverse ailments. In the current study, the potential anti-inflammatory activity of jojoba liquid wax (JLW) was evaluated in a number of experimental models. Results showed that JLW caused reduction of carrageenin-induced rat paw oedema in addition to diminishing prostaglandin E2 (PGE2) level in the inflammatory exudates. In a test for anti-inflammatory potential utilizing the chick's embryo chroioallantoic membrane (CAM), JLW also caused significant lowering of granulation tissue formation. Topical application of JLW reduced ear oedema induced by croton oil in rats. In the same animal model, JLW also reduced neutrophil infiltration, as indicated by decreased myeloperoxidase (MPO) activity. In addition, JLW ameliorated histopathological changes affected by croton oil application. In the lipopolysaccharide (LPS)-induced inflammation in air pouch in rats, JLW reduced nitric oxide (NO) level and tumor necrosis factor-alpha (TNF-alpha) release. In conclusion, this study demonstrates the effectiveness of JLW in combating inflammation in several experimental models. Further investigations are needed to identify the active constituents responsible for the anti-inflammatory property of JLW.
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Beidellitic montmorillonite is a purified clay containing a double aluminium and magnesium silicate. To assess the efficacy and the safety of beidellitic montmorillonite (3 g, t.d. for 8 weeks) in patients with irritable bowel syndrome (IBS). A multicentre, double-blind, placebo-controlled, randomized study with parallel groups, was performed in IBS patients selected according to ROME I criteria. Patients were included after a 1-week washout period to confirm that abdominal pain and/or discomfort was rated at least 2 on a 0-4 graded Likert scale. Patients were then randomized and stratified according to their predominant bowel habit profile into three groups. The use of rescue medication was allowed: polyethylene glycol 4000 (10-20 g/day) as a laxative agent in case of stool absence for three consecutive days, phloroglucinol (80 to a maximum of 320 mg/day) as a spasmolytic agent for no more than 8 days. The main end-point was the improvement of abdominal pain and/or discomfort by at least 1 point on the Likert scale. A total of 524 patients constituted the overall intent-to-treat population (ITT), 263 were assessed in the beidellitic montmorillonite group, i.e. 93 diarrhoea-predominant IBS (D-IBS), 83 constipation-predominant IBS (C-IBS), 87 alternating constipation/diarrhoea-IBS (A-IBS); 261 in the placebo group, i.e. 81 D-IBS, 92 C-IBS and 88 A-IBS. Initial analysis in the ITT population demonstrated a higher rate of success with beidellitic montmorillonite (51.7%) when compared with the placebo group (45.2%); however, the difference was not statistically significant. Improvement was significant in C-IBS both in ITT (beidellitic montmorillonite group = 49.4%, placebo group = 31.5%, P < 0.016) and per protocol populations (59.4% vs. 37.8%) (P < 0.01). The time to improvement of abdominal pain and/or discomfort (log Rank test) was also significantly in favour of beidellitic montmorillonite, (P < 0.04). The average number of stools per day was not different from baseline, either in all patients or in C-IBS patients. Spasmolytic and laxative agent intakes were not different between the two groups. Subjective evaluation by patients of treatment efficacy and visual analogue scale test of treatment efficacy by investigators were significantly better in the beidellitic montmorillonite group (P < 0.05). Tolerance of beidellitic montmorillonite was considered optimal without any significant adverse event. Although pain or discomfort was not significantly improved in the entire IBS population treated with beidellitic montmorillonite in comparison with placebo, this study demonstrates that beidellitic montmorillonite is efficient for C-IBS patients (P < 0.016). This effect of beidellitic montmorillonite on pain cannot be explained by changes in bowel habits. The efficacy of this well-tolerated therapy warrants further confirmatory therapeutic trials in C-IBS patients.
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Acne vulgaris is a common skin disease that affects 70 to 96% of individuals. Topical benzoyl peroxide has been used successfully for acne treatment; however, it may be accompanied by drying and or flaking skin. The addition of a 10% urea to the product excipient is theorized to moisturize the skin due to its humectant properties, aid in the efficacy of benzoyl peroxide due to its keratolytic properties, and effectively combat Propionibacterium acnes due to its antibacterial properties. To assess the efficacy and tolerability of the treatment of acne vulgaris with multiple strengths of benzoyl peroxide in a 10% urea vehicle gel or cream and cleanser. Methods: A multicenter, non-randomized, open-label study in which 1,089 patients with acne vulgaris were enrolled at 133 participating physician office sites. Qualifying and consenting patients were prescribed either 4.5% or 8.5% benzoyl peroxide in a 10% urea vehicle cream or gel and cleanser. Additional medications were permitted during the study with the exception of those containing benzoyl peroxide. The physician assessed lesion counts, both inflammatory and non-inflammatory, at baseline and Week 4. Dryness and erythema were rated by the physician on a scale from 0 (none) to 8 (severe or deep) at baseline and Week 4. Nine hundred sixty-three patients completed the study. The following significant treatment arms were analyzed: patients treated with 4.5%/8.5% benzoyl peroxide in a 10% urea vehicle product only, patients treated with 4.5%/8.5% benzoyl peroxide in a 10% urea vehicle products along with oral doxycycline, and patients treated with 4.5%/8.5% benzoyl peroxide in a 10% urea vehicle products along with oral minocycline. A 44% (n=567) mean reduction in total lesion count was observed after 4 weeks of treatment with 4.5%/8.5% benzoyl peroxide in a 10% urea vehicle products only. Dual therapy using oral doxycycline (n=17) proved to be even more effective with a significant mean reduction in lesion count of 52% after only 4 weeks of treatment. Dual therapy using oral minocycline (n=21) yielded a significant mean reduction in lesion count of 34% after 14 weeks of treatment. The overall tolerability of the treatment illustrated the utility of urea as a moisturizing agent. Benzoyl peroxide in a 10% urea vehicle gel or cream and cleanser, used once daily for 4 weeks was found to be both effective and well tolerated for the treatment of symptoms related to acne vulgaris.
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Acne is traditionally regarded as a skin disorder of the teenage years. However, recent epidemiologic studies have shown that a significant number of female patients aged >25 years experience acne. One recent community-based UK study estimated the prevalence of facial acne in adult women aged between 26 and 44 years to be 14%. It is not clear whether there is a true increase in acne in this age group or whether these patients are less tolerant of their acne and/or better informed of available therapies and so seek advice. The reasons for persistent acne are not fully understood. External factors such as use of certain cosmetics, ingestion of drugs, and endocrine abnormalities should all be considered when managing these patients. Post-adolescent acne in females can be divided into ‘persistent acne’, which represents a continuation of acne from adolescence into adult life, and ‘late-onset’ acne, which describes significant acne occurring sometimes for the first time after the age of 25 years. The clinical picture of each of these forms of acne in adult females can differ slightly from conventional adolescent disease. The course of each form is more indolent. Because of these variations, the approach to investigation and management of these cases may have subtle differences when compared with that for teenage disease. Acne treatment should aim to reduce sebum, comedogenesis, propionibacteria population, and inflammation. Treatment selection will depend on the acne grade and site as well as the patient‘s preference and ability to comply with therapy. Maintenance therapy plays an important role in managing this group of patients. As the response to treatment is inevitably slow, patients must be encouraged to adhere to the chosen treatment regimen. This article reviews the literature on persistent acne in women in terms of clinical presentation and possible etiologic factors, and outlines principles of therapy related to managing these cases.
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The aim of this study was to reveal the efficacy of mud pack treatment in patients with knee osteoarthritis and to find the contribution of chemical factors to the build up of these effects. Sixty patients were randomly assigned to directly applied mud pack (study) group or to nylon-covered mud pack (control) group. Thirty patients in the study group had mud application 15 times to both knees: heated mud, up to 43 degrees C, was applied to skin directly for 30 minutes. Thirty patients in the control group had the same treatment as the study group except heated mud was applied over an impermeable nylon pack. Primary outcome measures of the study were the Western Ontario and McMaster Universities (WOMAC) index, pain intensity on a visual analog scale (VAS), patient's assessment of disease severity index, physician's assessment of disease severity index, and analgesic consumption. The patients were evaluated before and after (end of 15th application) the intervention and followed up for 24 weeks at 4-week intervals. The results were assessed on an intent-to-treat basis. As compared to the baseline, significant decreases were observed in WOMAC, pain intensity, disease severity index scores, and analgesic consumption in both groups after the intervention. Observed improvements in the study group were found to be superior to the control during the whole postintervention follow-up, except for analgesic consumption in the third week. A significant number of patients in the study group showed minimal clinically important improvement as compared to the control group. Mud pack treatment significantly improved the pain and functional status of patients with knee osteoarthritis, whether applied directly or coated with nylon. Direct application was found to be superior, which implies chemical properties of the mud contribute to the build up of therapeutic effect.