I think the ointment is sticky. Did the patients concern with this?

Could this ointment be used with standard medication? 

I think the ointment is sticky. Did the patients concern with this?

Could this ointment be used with standard medication? 

What are the anti-inflammatory ingredients in the ointment? and what is it's properties to help treat hand eczema. ?

From this study, when or which type of the patient should use this treatment?

From this study, when or which type of the patient should use this treatment?

Dear เปรมจิต จันทองจีน (VISITOR)

Thank you for your good and interesting question.

In this study, this healing ointment demonstrates good efficacy and safety in the treatment of mild-to-moderate chronic hand eczema after 28 days of twice-daily application. Hence, patients with mild-to-moderate disease severity should use this healing ointment.

Moreover, this healing ointment may be used as an emollient for providing skin moisturization and anti-inflammatory effect in patients with more disease severity. However, other treatment modalities such as high potency topical corticosteroid, systemic immunosuppressive drugs, or phototherapy may be required

Best regards

Nutthawut  Techalert, M.D. 

Presenter

Dear SUPARUJ LUEANGARUN (VISITOR)

Thank you for your good and interesting questions.

For the first question, What are the anti-inflammatory ingredients in the ointment? and what is it's properties to help treat hand eczema?

     This healing ointment contains anti-inflammatory ingredients including bisabolol and panthenol.

     Bisabolol is an extract from German chamomile. The previous studies demonstrated the efficacy of reducing skin inflammation in both in vitro and in vivo study. Mice studies showed that bisabolol can significantly inhibit the production of pro-inflammatory cytokines (TNF-α as well as IL-6) induced by 12-O-tetradecanoyl-phorbol-13-acetate (TPA) in macrophage cells. Moreover, bisabolol also showed a strong binding affinity to the active site of the pro-inflammatory proteins. These findings supported that bisabolol should be a novel agent for the reduction of skin inflammation.

     Panthenol is an alcoholic form of pantothenic acid (vitamin B5). A previous study showed that it provided an anti-inflammatory effect on skin erythema after UV exposure. Furthermore, panthenol has also been used in diaper dermatitis, leg ulcers, and anal fissures because it may modulate the expression of the responsible genes leading to an acceleration of wound healing

For the second question, Could this ointment be used with standard medication? 

     In patients with mild-to-moderate chronic hand eczema, standard medication usually consists of a strong potency topical corticosteroid and emollient. this healing ointment provides both anti-inflammatory and moisturization effect. Thus, it may substitute both topical corticosteroid and emollient. On the other hand, the use of this healing ointment with topical corticosteroids may theoretically provide more efficacy in disease control. However, there is no well-designed study for demonstrating the efficacy of these combinations. In conclusion, this healing ointment may be used as an emollient concomitant with the standard medication. 

Lastly, I think the ointment is sticky. Did the patients concern with this?

     This is one of my concerned issues too. Thus, I request all patients to fill in the questionnaire about the satisfaction and drawback of this ointment. Four (15.40%) of twenty-six patients reported stickiness and heaviness feelings from this healing ointment at the first follow-up visit. After the first follow-up visit, the patients can tolerate these feelings. Moreover, the patients tell that treatment with this healing ointment do not disturb their daily life.

Best regards

Nutthawut  Techalert, M.D.

Presenter

Which ingredients in the healing ointment are responsible for a significant improvement of trans-epidermal water loss ?

Which ingredients in the healing ointment are responsible for a significant improvement of HECSI ?

This healing ointment is quite interesting!

I would like to ask 2 questions.

1. Is it commercially available in Thailand or in the process of development?

2. In the COVID-19 era, I see a lot of patients and also healthcare providers develop hand dermatitis due to frequent handwashing. Could this ointment help in this condition?

Thanks

I like your rapid and comprehensive talk. 

Could you please explain how to measure trans-epidermal water loss (TEWL) and stratum corneum hydration (SCH) in this study? (i.e. which instrument, how many times to measure, environmental control)

 I see the result that this healing ointment provides a significant improvement in the visual analog scale for the intensity of itching. Which ingredients in this ointment help for the reduction of itching?

Dear SUPARUJ LUEANGARUN (VISITOR)

Thank you for your good and interesting questions.

For the first question, Which ingredients in the healing ointment are responsible for a significant improvement of trans-epidermal water loss?

     A significant improvement of trans-epidermal water may be explained by two main reasons.

     The first one is an improvement of skin moisture due to an effective moisturizing ingredient especially the group of occlusive. Occlusive moisturizing ingredients in this healing ointment are petrolatum,  mineral oil, and ceresin.

     Another reason is the restoration of natural skin barrier resulting in the reduction of water loss from skin to the environment. All moisturizing ingredients in this ointment play a role in this aspect. 

For the second question, Which ingredients in the healing ointment are responsible for a significant improvement of HECSI?

     There are three main reasons for the significant improvement of HECSI from this healing ointment. 

          1.) Improved skin moisture which facilitates natural barrier repair process

          2.) Direct reduction of skin inflammation by various pathways such as inflammatory cytokine modulation

          3.) Decrease itching by the involvement of nerve ending such as filling the defect gap on the nerve ending

Best regards

Nutthawut Techalert, M.D.

Presenter

Dear PATTHARAPHONG PLURKSATHAPORN (VISITOR)

Thank you for your good and interesting questions.

For the first question; Is it commercially available in Thailand or in the process of development?

This healing ointment is now commercially available in Thailand in the tradename of Aquaphor® Healing Ointment (AHO) (Beiersdorf Inc, Wilton, CT).

For the second question; In the COVID-19 era, I see a lot of patients and also healthcare providers develop hand dermatitis due to frequent handwashing. Could this ointment help in this condition?

Frequent hand washing results in hand dermatitis because it impairs skin barrier (also decrease skin moisture) and allows more exposure to allergen and irritant. According to the data from this study, this healing ointment provides a good efficacy for improving skin moisture and reduction of clinical severity (HECSI). Thus, this ointment should obviously help in the condition of hand dermatitis due to frequent handwashing. 

Best regards

Nutthawut Techalert, M.D.

Presenter

Dear YUTARAT SUWANCHATKUL (VISITOR)

Thank you for your good and interesting question.

Could you please explain how to measure trans-epidermal water loss (TEWL) and stratum corneum hydration (SCH) in this study? (i.e. which instrument, how many times to measure, environmental control)

     - Biophysical measurement composes of skin hydration measured by Corneometer® CM 825 (Courage + Khazaka electronic GmbH, Germany), and TEWL measured by Tewameter® TM 300 (Courage + Khazaka electronic GmbH, Germany).

     - To determine TEWL, the value will be reported as an average value from two times measurement at the corresponding area.

     - To determine the SCH, the value will be reported as an average value from three times measurement at the corresponding area with 30 seconds interval. 

     - For environmental control, all patients are allowed to be under same controlled environment including temperature at 20-22 degree Celsius and humidity 40-60% at least 20 minutes before measurement.

Best regards

Nutthawut Techalert, M.D.

Presenter

Dear PAPOB CHAIWATANODOM (VISITOR)

Thank you for your good and interesting question.

Which ingredients in this ointment help for the reduction of itching?

     The reduction of itching may be from two main reasons.

     The first one is the reduction of disease severity determined by an improvement of HECSI. All moisturizing ingredients play role in this aspect especially those with anti-inflammatory effects including panthenol and bisabolol.

     The second one is the ability to fill the defect gap in the nerve ending of the patients. It is mainly explained by emollient moisturizing ingredients. For this healing ointment, the emollient moisturizing ingredient is lanolin alcohol. Moreover, some previous studies showed that petrolatum can also diffuse in the intercellular lipid domain and act as an emollient moisturizing ingredient.

Best regards

Nutthawut Techalert, M.D.

Presenter

Thank you for your presentation. I have a question for you as:

Are your healing ointment ingredients compatible to each other. If yes then tell me which method of analysis was used by you.

I like the way you present your topic. It is very clear and interesting!

I also have a question. Is it possible to use this healing ointment in the patients with severe chronic hand eczema?

Thank you.

Dear DR. NRIPENDRA SINGH (PARTICIPANT)

Thank you for your good and interesting question.

For your question; Are your healing ointment ingredients compatible to each other. If yes then tell me which method of analysis was used by you.

     I am sorry to say that I do not sure that I understand your question correctly or not. In my opinion, your question is about the compatibility and stability of all ingredients in the same preparation. The healing ointment in this study is a commercially available product worldwide including Thailand under development and production by Beiersdorf Inc, Wilton. From my experiences, the healing ointment is always in the ointment base appearance. After topical application, this ointment will cover the skin homogeneously with mild greasiness appearance due to petrolatum-based ointment. No oily or crystal appearance was seen. However, no direct method of analysis for the compatibility of each ingredient had been conducted in this study. This study is mainly conducted as a clinical trial for evaluating the responses from the patients.

Best regards

Nutthawut Techalert, M.D.

Presenter

Dear POOM VISUTJINDAPORN (PARTICIPANT)

Thank you for your good and interesting question.

For your question; Is it possible to use this healing ointment in the patients with severe chronic hand eczema?

     This is a very interesting question. This study result showed a good efficacy of this healing ointment as monotherapy for mild-to-moderate chronic hand eczema. However, there is no data about the efficacy of this healing ointment in the treatment of patients with severe chronic hand eczema. In my opinion, severe chronic hand eczema needs personalized treatment depending on the morphology of skin diseases and also symptoms. Furthermore, systemic treatment such as systemic immunosuppressive agents is usually required. Thus, this healing ointment is quite rarely possible to be monotherapy for severe chronic hand eczema. However, the use of this healing ointment in combination with other standard treatments should theoretically increase the efficacy of the treatment of the standard treatment. Further study is required for demonstrating this benefit.

Best regards

Nutthawut Techalert, M.D.

Presenter 

Thank you for your presentation.

As your mention about the adverse effects of the conventional treatment of eczema. Why the doctor still use the conventional method? It should have something worth for this. Why did you pick this ointment?Which properties in this material make you choose it?.

Dear YARDNAPAR PARCHAROEN (VISITOR)

Thank you for your good and interesting question.

For your first question: As your mention about the adverse effects of the conventional treatment of eczema. Why the doctor still use the conventional method? It should have something worth for this.

     Conventional treatment for mild-to-moderate chronic hand eczema is a strong potency topical corticosteroid. It is considered as the first-line therapy due to dramatic response and also quite cheap price. However; long term use may be resulting in numerous adverse events.

For your second question: Why did you pick this ointment? Which properties in this material make you choose it?.

     Because active ingredients in this ointment play a vital role in the pathophysiology of the disease. Petrolatum is a very strong occlusive which significantly reduces trans-epidermal water loss facilitating natural skin barrier repair. Bisabolol and panthenol yield good anti-inflammatory effect. Lanolin alcohol acts as emollient. Panthenol is also a good humectant. Moreover, this ointment had been demonstrated to provide a semi-occlusive environment that facilitates the healing of the skin. Lastly, this ointment is a steroid-free moisturizer; thus, the adverse events from topical corticosteroids have never been reported. All these reasons make me choose this healing ointment for the treatment of mild-to-moderate chronic hand eczema.

Best regards

Nutthawut Techalert, M.D.

Presenter