Neomycin 0.35% / Triamcinolone 0.1% ear drops

BackgroundTopical steroids are used widely to manage excessive inflammation and hypergranulation in burns; however, their use is controversial, and current evidence is largely anecdotal. Topical KENACOMB is a steroid preparation consisting of triamcinolone acetonide, neomycin, gramicidin, and nystatin, and it is standard of care at the Royal Brisbane and Women's Hospital burns unit. To our knowledge, there is no published literature that reports the use of KENACOMB to treat wound-associated inflammation and hypergranulation.ObjectiveTo synthesise current evidence surrounding the efficacy and safety of topical steroid use in treating inflammation and hypergranulation in burns patients. We also describe the use of topical KENACOMB in our burns unit.MethodsA systematic review of PubMed, Cochrane, and EMBASE databases was performed. Articles published in English that reported the use of topical steroids for granulation tissue or inflammation in burn wounds or skin graft donor sites were included.ResultsWe identified 350 articles, of which six met inclusion criteria. Four studies presented primary patient data, and two studies reported the results of surveys of burns unit professionals. A total of 54 patients were included across all studies, and no control group was reported in any study. Studies reported rapid improvements in healing, with 86.6%-100% of wounds showing complete reepithelialisation following treatment. Reported adverse outcomes included skin thinning, atrophy of granulation tissue, systemic side effects, and local wound infection.ConclusionsThis review highlights the paucity of conclusive evidence on the outcomes of topical steroids in treating inflammation and hypergranulation in burns and donor sites. While KENACOMB has shown efficacy in treating these wound types in our local experience, there is limited research available on the product. There is a clear need for quality research on the use of topical steroids in burns patients to better inform its ongoing clinical use.

Abstract licence: CC BY-NC-ND

BackgroundWe would assess the efficacy of intravitreal injection of triamcinolone acetonide IVTA combined with standard phacoemulsification on the central subfield macular thickness (CSMT), the progression of diabetic retinopathy (DR), and the corrected distant visual acuity (CDVA) in type 2 diabetic patients.MethodsIn this prospective single-blinded randomized clinical trial we recruited patients with type 2 diabetes who were eligible for cataract surgery. The patients were randomly assigned to two groups. The case group received an intravitreal IVTA at the end of phacoemulsification, and the control group had routine surgery. CSMT, progression of DR, CDVA, IOP, and adverse events including endophthalmitis were compared between the groups preoperatively and at 1, 3, and 6 months postoperatively.ResultsAmong a total of 66 patients that were treated within the study period, 50 patients were included in the final analysis. The case group comprised 21 eyes, and the control group included 29 eyes. Regression models and corrected ANOVA test for repeated measures showed a significant reduction in CSMT at 3 and 6 months postoperatively, which was most significant when the preoperative CSMT was ≥300 μm, with a cut-off value of 347.3 μm in the case group (p  0.05). No endophthalmitis was recorded.ConclusionsDiabetic patients benefit significantly from cataract surgery. This study supports IVTA injection at the end of phacoemulsification in diabetic patients. Triamcinolone is an affordable (which is of particular importance in low-income countries as per our setting), and relatively safe "phaco-enhancer".Trial registrationNCT05413330. Initial release 10/06/2022. Unique Protocol ID: UDMS-Opthal-01-2022.

Abstract licence: CC BY

Knuckle pads (KPs) are benign hyperkeratotic fibrous thickening skin disorder characterized by nodules or plaques located on the extensor surface of the joints. However, there are no specific treatments for KPs so far. Here, we reported a case of KPs successfully treated with 2% crisaborole ointment combined with triamcinolone acetonide and neomycin plaster. This combined therapy might be a new therapeutic option for KPs.

Abstract licence: CC BY-NC 3.0

IntroductionOral mucosal wounds present significant clinical challenges due to their susceptibility to infection, inflammation, and delayed healing. The limitation of standard anti-inflammatory drugs (both steroidal and non-steroidal) highlights the urgent need for plant-derived alternative therapies. Granola potato (Solanum tuberosum L.) from Pangalengan, West Java, Indonesia, has shown promise due to its bioactive compounds. However, its potential for wound healing and anti-inflammatory effects, specifically for oral mucosal wounds, remains largely unexplored.PurposeTo evaluate the wound healing and anti-inflammatory activity of Granola potato peel ethanol extract (GPPEE) on the oral mucosa of Wistar rats based on histopathological analysis.Materials and methodsForty-eight Wistar rats were wounded on the palatal mucosa using a 4 mm punch biopsy and subsequently divided into four groups: placebo gel, 0.1% triamcinolone acetonide ointment (TCA), 4% GPPEE gel, and 6% GPPEE gel. The rats were euthanized on days 0, 1, 3, 7, and 14. Histopathological parameters assessed included fibroblast proliferation, collagen deposition, angiogenesis, and the presence of inflammatory cells.ResultsPhytochemical screening revealed the presence of phenolic compounds, flavonoids, tannins, and alkaloids in the Granola potato peel ethanol extract (GPPEE). Significant differences in the number of inflammatory cells were observed on days 1, 3, 7, and 14 (p0.05).ConclusionThe application of 4% and 6% GPPEE gel demonstrated superior wound healing efficacy compared to 0.1% TCA and exhibited comparable anti-inflammatory activity to 0.1% TCA.

Abstract licence: CC BY-NC

Purpose. We report a case of bacterial keratitis secondary to an undescribed Bergeyella sp. Bergeyella spp. are not easily cultured, and many reports have identified unculturable isolates through broad-range bacterial polymerase chain reaction (PCR). Observations. A healthy 29-year-old male was attempting to repair an acrylic cannabis water pipe when it shattered and a fragment hit him in the left eye. Two weeks later, he presented with foreign body sensation, scleral injection, and photophobia that were refractory to prolonged corticosteroid therapy. Following a subconjunctival triamcinolone injection, the patient developed a hypopyon and multifocal, midstromal, epithelized corneal infiltrates. Broad-range PCR of the aqueous fluid detected deoxyribonucleic acid closely matching the Bergeyella genus. Empiric treatment directed toward gram-negative bacteria led to the clinical resolution of the inflammation. Conclusions and Importance. This is the first reported case of ocular inflammation secondary to a Bergeyella spp.. As broad-range PCR testing becomes more accessible, we anticipate that additional PCR-positive and culture-negative scenarios will occur.

Abstract licence: CC BY

PurposeRefractory periorbital dermatitis has a chronic course with exacerbations leading to discomfort and cosmetic issues, yet characterization of treatment options is limited.AimsThe objective was to present comprehensive demographic data and medical management of a series of patients with refractory periorbital dermatitis.Settings and designRetrospective review identified patients treated at a single institution from January 2010 to August 2020.MethodsDescriptive analyses were performed. Demographic data and treatment history were reviewed and data including medication, use, date of use and discontinued use, reason for discontinuation (if applicable), refractory status, formulation, concentration, and dose frequency were extracted.Statistical analysis usedDescriptive analyses.ResultsForty-five patients were included. The average age at first diagnosis was 60.3 years (sd 14.9). 82.2% were women and 84.4% identified as Caucasian. Triamcinolone cream was most frequently used followed by tobramycin-dexamethasone, tacrolimus, and neomycin-polymyxin-dexamethasone. Less than 30% of patients on triamcinolone were refractory. 13.3% of patients used topical hydrocortisone, with over 80% of these patients experiencing refractory episodes of persistent irritation and erythema. Most patients were refractory during initial use or the first recurrence of periorbital dermatitis flare.ConclusionsBy better characterizing the diverse treatment regimens in a unique subset of refractory patients, we hope to better inform potential courses of medical management for periorbital dermatitis.

Abstract licence: CC BY-NC-SA

This report aims to describe a case of tumor-like lymphoplasmacytic conjunctivitis in a 7-year-old spayed-female Pomeranian. On complete ophthalmic examination, a mass with papillary projections was noted on the bulbar surface of the right third eyelid. Debulking of the mass was performed while preserving as much of the third eyelid as possible. On the histopathological examination, the mass was diagnosed as lymphoplasmacytic conjunctivitis with mild epithelial hyperplasia. Although a slight regrowth of the mass was noted 3 weeks after surgery, intralesional injection of triamcinolone acetonide led to its disappearance. There was no further recurrence after 5 months.

Abstract licence: CC BY-NC-SA

Neurodermatitis and chronic eczema are characterized by severe itching and can lead to complications such as skin infections and folliculitis. Current treatment primarily involves glucocorticoid analogs which may be associated with side effects and lack of effective delivery strategies. The suspended ointment developed in this study aims to address these issues, offering improved therapeutic outcomes. The present study aimed to investigate the relationship between formulation/process variables versus the content uniformity and viscosity of neomycin sulfate and triamcinolone acetonide ointments and to explore the feasibility of using an in vitro approach to assess product sameness. Monofactor analysis was used to evaluate the impact of formulation and process variables. The new formulation was evaluated in terms of the prescription process, quality, stability, in vitro drug release behavior, and distribution of skin. The optimal prescription composition was 0.54% neomycin sulfate, 0.10% triamcinolone acetonide, 5.08% substrate A and 94.28% liquid paraffin. Quality and stability assessments confirmed that the formulation met the required standards for appearance and composition. Mathematical modeling of the drug release profile indicated that the release kinetics evaluated using the vertical diffusion cell method, closely aligned with first-order kinetics. Raman spectroscopy confirmed the successful penetration of triamcinolone acetonide into the skin, triamcinolone acetonide works primarily in the skin. Furthermore, skin irritation tests demonstrated that the formulation caused no detectable irritation. These results demonstrate that it can be a promising drug in treating neurodermatitis and chronic eczema.

Abstract licence: CC BY-NC-ND 4.0