SummaryEmollients can perform an important role in the treatment of a number of dermatological conditions. Currently, the use of emollient therapy in the UK is supported only by limited guidelines and a best-practice statement, although guidelines do exist for specific conditions such as childhood eczema. To address this need, a group of clinical professionals covering acute community-care settings and medicines management met to review current data and practice. Their aim was to support other professionals in their approach to the use of emollient therapies in dry-skin conditions.
BackgroundThe Clinical Practice Research Datalink (CPRD) was used to evaluate the overall costs to the National Health Service, including healthcare utilisation, of prescribing emollients in UK primary care for dry skin and atopic eczema (DS&E).MethodsPrimary care patients in the UK were identified using the CPRD and their records were interrogated for the 2 years following first diagnosis of DS&E. Data from patients with (n = 45,218) and without emollient prescriptions (n = 9780) were evaluated. Multivariate regression models were used to compare healthcare utilisation and cost in the two matched groups (age, sex, diagnosis). Two sub-analyses of the Emollient group were performed between matched groups receiving (1) a colloidal oatmeal emollient (Aveeno-First) versus non-colloidal oatmeal emollients (Aveeno-Never) and (2) Aveeno prescribed first-line (Aveeno-First) versus prescribed Aveeno later (Aveeno-Subsequently). Logistic regression models calculated the odds of prescription with either potent / very potent topical corticosteroids (TCS) or skin-related antimicrobials.ResultsCosts per patient were £125.80 in Emollient (n = 7846) versus £128.13 in Non-Emollient (n = 7846) matched groups (p = 0.08). The Emollient group had fewer visits/patient (2.44 vs. 2.66; p < 0.0001) and lower mean per-visit costs (£104.15 vs. £113.25; p < 0.0001), compared with the Non-Emollient group. Non-Emollient patients had 18% greater odds of being prescribed TCS and 13% greater odds of being prescribed an antimicrobial than Emollient patients. In the Aveeno-First (n = 1943) versus Aveeno-Never (n = 1943) sub-analysis, costs per patient were lower in the Aveeno-First compared with the Aveeno-Never groups (£133.46 vs. £141.11; p = 0.0069). The Aveeno-Never group had ≥21% greater odds of being prescribed TCS or antimicrobial than the Aveeno-First group. In the Aveeno-First (n = 1357) versus Aveeno-Subsequently (n = 1357) sub-analysis, total costs were lower in the Aveeno-First group (£140.35 vs. £206.43; p < 0.001). Patients in the Aveeno-Subsequently group had 91% greater odds of being prescribed TCS and 75% greater odds of being prescribed an antimicrobial than the Aveeno-First group.ConclusionsAcknowledging limitations from unknown disease severity in the CRPD, the prescription of emollients to treat DS&E was associated with fewer primary care visits, reduced healthcare utilisation and reduced cost. Prescribing emollients, especially those containing colloidal oatmeal, was associated with fewer TCS and antimicrobial prescriptions.Trial registrationThe study is registered at http://isrctn.com/ISRCTN91126037.Electronic supplementary materialThe online version of this article (10.1186/s12895-018-0076-y) contains supplementary material, which is available to authorized users.
During a routine appointment a 48 year old woman tells you that she feels tired all the time. She has changed jobs recently and her daughter has recently returned to university.
BackgroundTopical azelaic acid (AA) is indicated for acne and rosacea, but there is some evidence for its use for other dermatological conditions.AimsTo assess the effectiveness and safety of topical AA for acne vulgaris, rosacea, hyperpigmentation/melasma, and skin aging.MethodsRCTs of at least 6 weeks' treatment duration were eligible for inclusion. Databases including MEDLINE, Embase, CINAHL, and ClinicalTrials.gov were searched up to December 2022. Two reviewers were involved in all stages of the systematic review process.ResultsForty‐three RCTs met the inclusion criteria. Meta‐analyses within 20 rosacea studies demonstrated that erythema severity, inflammatory lesion counts, overall improvement, and treatment success (achieving skin clarity) were significantly improved with AA compared with vehicle after 12 weeks. AA was more effective than metronidazole 0.75% for improved erythema severity, overall improvement, and inflammatory lesion counts. Sixteen acne studies suggest that AA is more effective than vehicle for improving global assessments and reducing acne severity. AA 20% also significantly reduced more lesions than erythromycin gel. Within seven melasma studies, AA 20% was significantly better than vehicle for both severity and global improvement. AA 20% demonstrated significantly better results compared with hydroquinone 2% for global improvement. Very few significant differences between AA and comparators were observed for commonly reported adverse events. No eligible RCTs were found that evaluated skin aging.ConclusionsAA is more effective than vehicle for rosacea, acne and melasma. Comparisons between AA and other treatments were often equivalent. Where there is equivalence, AA may be a good option for some clinical situations. RCT evidence is needed to evaluate the effectiveness of AA on skin aging.
The purpose of this study is to describe the actual perioperative usage of orodental antiseptics and more specifically that of pharma gel. Methods: An observational, prospective, longitudinal study was conducted in implant surgery in Bulgaria. Patients having benefited from the placement of one or several implants were included in the study. Data collected at inclusion consisted in periodontal disease history and context, description of the surgery, prescription of treatments. During the follow-up visit, operative wound was assessed as well as treatments, plaque and gingival index and satisfaction of the dentist. Results: A total of 275 patients were included. The sex ratio was 1:1 and the mean age was 47 ±13.2 years. Two-stage surgery was performed on 61.1% patients, and 56.4% had a single implant. Before surgery, antibiotics and antiseptics mouthwash were the most prescribed. During the preparation of the operative site, 83.5% of patients were treated by mouthwash antiseptic. In post-operative, apart from antibiotics largely prescribed (84.1%), antiseptics gel was prescribed associated or not to mouthwash, for 99% of patients. At the follow up visit (between 7 and 21 days after surgery), the mean plaque index was 0.79±0.66 and the mean of gingival index was 0.61±0.59. Dentists were very satisfied with the oral antiseptic gel utilisation (9.3±1.4). ConClusions: Results show a very wide use of the oral antiseptic gel in Bulgaria during post-operative treatment period. This practice leads to an excellent clinical outcomes with very low scores of plaque index and gingival index. Therefore, we need further investigations and analysis to summarize the recommendations of the use of the oral antiseptic gel like a good practice reference.
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