salicylates and Pruritus

Tinea infections are fungal infections of the skin caused by dermatophytes. It is estimated that 10% to 20% of the world population is affected by fungal skin infections. Sites of infection vary according to geographical location, the organism involved, and environmental and cultural differences. Both tinea corporis, also referred to as 'ringworm' and tinea cruris or 'jock itch' are conditions frequently seen by primary care doctors and dermatologists. The diagnosis can be made on clinical appearance and can be confirmed by microscopy or culture. A wide range of topical antifungal drugs are used to treat these superficial dermatomycoses, but it is unclear which are the most effective.. To assess the effects of topical antifungal treatments in tinea cruris and tinea corporis.. We searched the following databases up to 13th August 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 7), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched five trials registers, and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials. We handsearched the journal Mycoses from 1957 to 1990.. Randomised controlled trials in people with proven dermatophyte infection of the body (tinea corporis) or groin (tinea cruris).. Two review authors independently carried out study selection, data extraction, assessment of risk of bias, and analyses.. Of the 364 records identified, 129 studies with 18,086 participants met the inclusion criteria. Half of the studies were judged at high risk of bias with the remainder judged at unclear risk. A wide range of different comparisons were evaluated across the 129 studies, 92 in total, with azoles accounting for the majority of the interventions. Treatment duration varied from one week to two months, but in most studies this was two to four weeks. The length of follow-up varied from one week to six months. Sixty-three studies contained no usable or retrievable data mainly due to the lack of separate data for different tinea infections. Mycological and clinical cure were assessed in the majority of studies, along with adverse effects. Less than half of the studies assessed disease relapse, and hardly any of them assessed duration until clinical cure, or participant-judged cure. The quality of the body of evidence was rated as low to very low for the different outcomes.Data for several outcomes for two individual treatments were pooled. Across five studies, significantly higher clinical cure rates were seen in participants treated with terbinafine compared to placebo (risk ratio (RR) 4.51, 95% confidence interval (CI) 3.10 to 6.56, number needed to treat (NNT) 3, 95% CI 2 to 4). The quality of evidence for this outcome was rated as low. Data for mycological cure for terbinafine could not be pooled due to substantial heterogeneity.Mycological cure rates favoured naftifine 1% compared to placebo across three studies (RR 2.38, 95% CI 1.80 to 3.14, NNT 3, 95% CI 2 to 4) with the quality of evidence rated as low. In one study, naftifine 1% was more effective than placebo in achieving clinical cure (RR 2.42, 95% CI 1.41 to 4.16, NNT 3, 95% CI 2 to 5) with the quality of evidence rated as low.Across two studies, mycological cure rates favoured clotrimazole 1% compared to placebo (RR 2.87, 95% CI 2.28 to 3.62, NNT 2, 95% CI 2 to 3).Data for several outcomes were pooled for three comparisons between different classes of treatment. There was no difference in mycological cure between azoles and benzylamines (RR 1.01, 95% CI 0.94 to 1.07). The quality of the evidence was rated as low for this comparison. Substantial heterogeneity precluded the pooling of data for mycological and clinical cure when comparing azoles and allylamines. Azoles were slightly less effective in achieving clinical cure compared to azole and steroid combination creams immediately at the end of treatme. The pooled data suggest that the individual treatments terbinafine and naftifine are effective. Adverse effects were generally mild and reported infrequently. A substantial number of the studies were more than 20 years old and of unclear or high risk of bias; there is however, some evidence that other topical antifungal treatments also provide similar clinical and mycological cure rates, particularly azoles although most were evaluated in single studies.There is insufficient evidence to determine if Whitfield's ointment, a widely used agent is effective.Although combinations of topical steroids and antifungals are not currently recommended in any clinical guidelines, relevant studies included in this review reported higher clinical cure rates with similar mycological cure rates at the end of treatment, but the quality of evidence for these outcomes was rated very low due to imprecision, indirectness and risk of bias. There was insufficient evidence to confidently assess relapse rates in the individual or combination treatments.Although there was little difference between different classes of treatment in achieving cure, some interventions may be more appealing as they require fewer applications and a shorter duration of treatment. Further, high quality, adequately powered trials focusing on patient-centred outcomes, such as patient satisfaction with treatment should be considered.

Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Allylamine; Antifungal Agents; Azoles; Benzoates; Drug Combinations; Female; Humans; Male; Naphthalenes; Pruritus; Randomized Controlled Trials as Topic; Salicylates; Terbinafine; Tinea

Itch is an important, but underestimated symptom in psoriasis. Many therapies are available for pruritus; however, few are effective for psoriatic itch. Antipruritic therapies that are potentially effective in psoriasis include coal tar products, topical corticosteroids, topical salicylates, menthol and pramoxine, capsaicin, phototherapy, vitamin D analogs, topical immunomodulators, methotrexate, oral mirtazapine, and biologics. Using these therapies can benefit psoriasis patients in the outpatient clinical setting.

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Antipruritics; Capsaicin; Coal Tar; Emollients; Histamine H1 Antagonists; Humans; Immunologic Factors; Immunosuppressive Agents; Keratolytic Agents; Methotrexate; Mianserin; Mirtazapine; Morpholines; Phototherapy; Pruritus; Psoriasis; Quality of Life; Salicylates; Skin Care; Vitamin D

The nonsteroidal anti-inflammatory drugs are one of the most commonly prescribed classes of drugs used in medical practice. This review discusses the diverse cutaneous reactions associated with nonsteroidal anti-inflammatory drugs. Adverse cutaneous reactions occur most frequently with benoxaprofen, piroxicam, sulindac, meclofenamate sodium, zomepirac sodium, and phenylbutazone. The most serious adverse cutaneous reactions, Stevens-Johnson syndrome and toxic epidermal necrolysis, appear to be most often associated with sulindac and phenylbutazone. Tolmetin and zomepirac sodium, two structurally similar pyrrole derivatives, have been associated with a disproportionate number of cases of anaphylactoid reactions. Among the currently marketed nonsteroidal anti-inflammatory drugs, piroxicam appears to have the highest rate of phototoxic reactions. This phototoxic eruption is most often vesiculobullous.

Topics: Acetates; Anti-Inflammatory Agents; Aspirin; Drug Eruptions; Humans; Ibuprofen; Indomethacin; ortho-Aminobenzoates; Piroxicam; Propionates; Pruritus; Pyrazoles; Pyrazolones; Salicylates; Skin; Skin Diseases; Stevens-Johnson Syndrome; Thiazines

Topics: Asthma; Asthma, Exercise-Induced; Bronchitis; Cough; Diagnosis, Differential; Heart Failure; Humans; Occupational Diseases; Peak Expiratory Flow Rate; Pruritus; Pulmonary Embolism; Radiography, Thoracic; Respiratory Sounds; Salicylates

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Antimalarials; Azathioprine; Cushing Syndrome; Cyclophosphamide; Drug Eruptions; Gold; Humans; Lichen Planus; Nail Diseases; Pemphigus; Penicillamine; Pigmentation Disorders; Pruritus; Purpura; Salicylates; Skin Neoplasms; Urticaria

Lipohydroxyacid is a lipophilic derivative of salicylic acid with comedolytic properties.. To compare lipohydroxyacid and salicylic acid peels in subjects with comedonal acne.. In this split face, randomized study, 20 subjects with comedonal acne received lipohydroxyacid peels on one side of the face, while the other side was treated with salicylic acid peels. A total of six peels at 2-week intervals were performed. Efficacy was evaluated by counting noninflammatory and inflammatory lesions and by performing a global change in acne assessment. Safety was assessed by evaluating adverse events, global tolerance, and the presence of erythema, scaling, and dryness.. There was a statistically significant decrease of 55.6% and 48.5% from baseline to Day 98 in the mean number of noninflammatory lesions for the sides treated with lipohydroxyacid and salicylic acid peels, respectively (P < 0.001). There was no significant difference in the degree of reduction in noninflammatory lesions between the two peels. There was no significant reduction in the number of inflammatory lesions. Both peels were generally very well tolerated.. This study suggests that lipohydroxyacid peels can be beneficial to subjects with comedonal acne.

Topics: Acne Vulgaris; Administration, Topical; Adult; Chemexfoliation; Erythema; Face; Female; Humans; Keratolytic Agents; Male; Pruritus; Salicylates; Salicylic Acid; Treatment Outcome

Contact sensitization is frequent among patients with frontal fibrosing alopecia (FFA) (52%-76%).. To evaluate the frequency of sensitization/photosensitization in an FFA population.. A population of FFA patients were patch tested (Spanish Contact Dermatitis Research Group [GEIDAC] baseline; cosmetic and fragrance series), and photopatch tested (sunscreen series).. Thirty-six patients (mean age: 64.6 years; 35/36: women) were studied. A history of dermatitis was recorded in 69.4% (frequently involving the face). Overall, 80.5% patients showed positive patch-test reactions. The most frequently positive allergens were nickel sulfate (25%), benzyl salicylate (22%), gallates (16.6%), propolis (16.6%), and limonene hydroperoxides (13.8%). Benzyl salicylate was likely relevant to the dermatitis (labeled on personal care products and most patients reporting clinical improvement with allergen avoidance). Patch tests with sunscreens showed positive reactions to 11 materials (five patients). Photopatch tests were positive in one case.. We speculate a possible relationship between sensitization to benzyl salicylate and FFA. Hypothetically, the most likely explanation is that sensitization to benzyl salicylate involving FFA patients is a consequence of increased exposure to it. It is unclear whether allergen avoidance may impact the prognosis of alopecia. However, it seems to significantly improve the patients´ quality of life by lessening dermatitis and pruritus.

Topics: Adult; Aged; Aged, 80 and over; Allergens; Alopecia; Cosmetics; Dermatitis, Allergic Contact; Dermatitis, Photoallergic; Female; Humans; Male; Middle Aged; Odorants; Pruritus; Quality of Life; Retrospective Studies; Salicylates; Spain; Sunscreening Agents

Topics: Chronic Disease; Cosmetics; Dermatitis, Allergic Contact; Edema; Erythema; Eyelid Diseases; Facial Dermatoses; Female; Humans; Middle Aged; Pruritus; Salicylates

There is a strong need for antipruritic substances for treating itch in clinical dermatology. In one recent human study, topically applied acetylsalicylic acid has been described to rapidly decrease histamine-induced itch. We have established a model for periferally elicited pruritus by injecting serotonin into the rostral back area (neck) in rats. Using this model, we aimed to investigate the antipruritic potential of four different salicylic compounds, which all possess different skin penetration characteristics. Eighteen rats were studied for 6 weeks. Prior to serotonin injections (2 mg/ml, 50 micro l), 10 micro l of test substances was applied to a circular area 18 mm in diameter. The four substances were salicylic acid, butyl salicylate, diethylamine salicylate and salicylamide, all solubilized in dimethyl isosorbide to a concentration of 5% w/w. Diethylamine salicylate and salicylamide were previously shown to be slowly absorbed through rat skin in contrast to salicylic acid and butyl salicylate. After serotonin injections, scratching was monitored by video recording for 1.5 h. Compared with the vehicle, a lower number of scratch sequences were seen when diethylamine salicylate (P < 0.001) and salicylamide (P = 0.005) had been applied. The numbers of scratch sequences were lower with diethylamine salicylate and salicylamide than with the vehicle throughout the 1.5-h study period. We conclude that topical application of diethylamine salicylate and salicylamide could suppress serotonin-induced scratching in rats. The antipruritic effect seems to be related to the slow drug release of the two substances. The results may be clinically relevant as serotonin induces itch in humans.

Topics: Administration, Topical; Animals; Antipruritics; Female; Pruritus; Rats; Rats, Mutant Strains; Salicylamides; Salicylates; Salicylic Acid; Serotonin

Generalized pruritus in the elderly is a common and distressing problem; often there is no evidence of skin disease other than xerosis.. The aim of the study was to determine whether any abnormality could be detected in the structure and function of the skin of patients with generalized pruritus.. The skin of 13 elderly patients with generalized pruritus, without skin disease or any underlying cause, was contrasted with that of age- and sex-matched normal control subjects.. The patients had clinically drier skin (mean visual analogue scale score 2.9 [standard deviation +/- 2.2], controls 0.52 [+/- 0.59], p = 0.002). The severity of the pruritus was related to the degree of xerosis (r = 0.66). The patients had decreased skin surface conductance (10.7 mumho [+/- 3.4], controls 16 mumho [+/- 5.3], p = 0.017), and increased intracorneal cohesion (240.5 g [+/- 88], controls 162.7 g [+/- 39.8], p = 0.001). The patients also had statistically significantly diminished parameters of skin surface contour.. The findings of increased intracorneal cohesion and altered skin surface contour parameters suggest that elderly patients with generalized pruritus may have an acquired abnormality of keratinization.

Topics: Aged; Aged, 80 and over; Baths; Benzocaine; Circadian Rhythm; Cornea; Drug Combinations; Electric Conductivity; Epidermis; Erythema; Female; Humans; Ichthyosis; Male; Middle Aged; Niacin; Pruritus; Salicylates; Skin; Skin Diseases; Time Factors; Vasodilator Agents

Topics: Female; Genital Diseases, Female; Genitalia, Female; Humans; Pelvic Inflammatory Disease; Pruritus; Salicylates; Vaginitis