Update on topical therapy (Proceedings)


Update on topical therapy (Proceedings)

Apr 01, 2009

I. Glycotechnology
a. Sugars are found on the surface of most cells including keratinocytes
i. They are important in
1. Cell to cell interactions
2. Immune signaling and fighting pathogenic microorganisms
b. Microorganisms attach to cells by means of glycoproteins called lectins; lectins recognize and bind to sugar moieties on the host cells.
i. Under normal circumstances this does not occur because of normal barrier function of the stratum corneum.
ii. If the barrier is disrupted, the bacteria can adhere.
iii. Exposing the bacteria to exogenous sugars blocks adhesion by sugars binding to the lectins.
iv. In vitro studies
1. A combination of 3 monosaccharides is able to decrease Pseudomonas adherence by 53%.
2. A polysaccharide decreases Staphylococcus intermedius adherence by 52%
3. A polysaccharide decreases Malassezia adherence by 42%.
c. Cytokines also interact with sugar moieties
i. Exogenous sugars may inhibit the binding of cytokines which then inhibits the release of more cytokines.
ii. In vitro study showed 75% decrease in tumor necrosis factor release.
d. Found in multiple Virbac products (Ketochlor®, Epi-soothe®, Hexadene®, and Keratolux® shampoos, Epi-Otic® Advanced)

II. T8 Keto Flush®
a. Contains tris-EDTA and 1% ketoconazole
b. Gentle antifungal with less acute contact irritation than other products
c. Non-drying
d. Not recommended for chronic maintenance due to the possibility of Malassezia resistance

III. Douxo Products® (Douxo seborrhea shampoo/spray/spot on, Douxo chlorhexidine shampoo)
a. Phytosphingosines
i. Sphingoid bases
1. Long-chained aliphatic amines
2. Defining structural unit of sphingolipids
ii. Commonly found in plant and skin associated ceramides
iii. Antimicrobial activity against
1. Staphylococcus aureus
2. Pseudomonas aeruginosa
3. Microsporum canis
4. Malassezia
b. Ceramide
i. Sphingolipid consisting of a sphingoid base linked to a fatty acid via an amide bond.
ii. Usually short lived key intermediate in the biosynthesis of more complex sphingolipids, except in the skin.
iii. Function in the skin
1. Make up 45-50% of the stratum corneum lipids.
2. Important in stratum corneum organization.
3. Essential for normal barrier function.
iv. Biological functions
1. Trigger apoptosis
2. Arrest cell growth and proliferation
c. Used for the treatment of
i. Idiopathic seborrhea
ii. Vitamin A responsive dermatosis
iii. Sebaceous adenitis
iv. Golden retriever ichthyosis
d. Douxo calm® shampoo/spray/gel
i. Ingredients
1. Phytosphingosine
2. Hinokitiol
a. Red cedar extract
3. Raspberry seed oil
a. Essential n-3 and n-6 fatty acids
ii. Useful for allergic dermatitis.