Aims and Scope
Basal Cell Carcinoma Destruction by a Concentrate of Proteolytic Enzymes Enriched in Bromelain: A Preliminary ReportLior Rosenberg, Adam J Singer, Yaron Shoham
Basal Cell Carcinoma (BCC) is the most common skin cancer generally treated by a variety of surgical and non-surgical destructive therapies. A Concentrate of Proteolytic Enzymes Enriched in Bromelain (CPEEB) derived from the stems of pineapples is approved for use for debriding deep burns. Prior studies suggest that bromelain also has anti-tumor effects. We describe our preliminary off-label treatment experience using topical CPEEB for the destruction of six BCCs in three patients.
CPEEB was self-applied by three patients on six different Morphea, nodular, and superficially invasive BCCs. The CPEEB was applied as a thin layer prior to bedtime and left for a period of 9-12 hours. The wound was then covered with a petrolatum-based ointment for the next 24 hours. Application of the CPEEB was repeated up to 5 times over the course of 10 days, during which the patients were monitored daily and reevaluated by a board-certified plastic surgeon. If necessary, the CPEEB was reapplied up to five additional times over the next 10-day period. If necessary, any remaining lesion was surgically excised (MOHS surgery). The patients were then followed for up to 1 year.
Six BCCs located on the face, neck, and extremities were self-treated by three patients with 2-6 CPEEB applications. All of the BCCs were completely removed after the CPEEB application. CPEEB application was associated with local irritation and mild itching pain which resolved untreated within hours. In one patient, two of the lesion’s sites were surgically excised after 6 months with no tumor cells noted on histopathology. None of the BCCs recurred over the next 1 year.
Our preliminary findings are a proof-of-concept that a concentrate of proteolytic enzymes enriched in bromelain may be a safe and effective destructive treatment for basal cell carcinomas. Future studies on larger groups of BCC patients are necessary in order to elucidate the potential use of CPEEB for this indication.
June 04, 2021
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Fractional Carbon-Dioxide Laser Plus Topical Clotrimazole versus Oral Itraconazole plus Topical Clotrimazole for Onychomycosis: A Randomized, Controlled TrialTro V. Chau, Long P. Mai, Hao T. Nguyen, Suong M. Nay, Huyen T.N. Nguyen, Thang T. Nguyen
Treating onychomycosis is problematic for a variety of reasons. The very nature of the hard, protective nail plate itself makes it difficult for topical drugs to reach the fungal pathogens beneath it. Oral therapy is more effective than topical therapy, but it is expensive, requires monitoring for toxicity, and can result in multiple drug interactions.
To compare the efficacy and safety of fractional CO2 laser combined with topical clotrimazole to oral itraconazole plus topical clotrimazole in the treatment of onychomycosis.
A sample of 88 adults (between the ages of 18 and 78) was randomly divided into two groups. 45 patients received fractional CO2 laser therapy at an interval of 2 weeks and twice-daily application of clotrimazole 1% cream. 43 patients were treated by pulsed itraconazole (200 mg twice daily, 1 week on, 3 weeks off) and twice-daily application of clotrimazole 1% cream. The duration of the treatment was 3 months for fingernails and 4 months for toenails in both groups. The clinical effect was measured using the Scoring Clinical Index for Onychomycosis (SCIO index), KOH examination for the affected nails were performed, and liver function tests in the two groups were analyzed.
73% of patients treated with fractional ablative CO2 laser achieved a negative KOH examination compared with 79% of the itraconazole group (P>0.05). The SCIO reduction in the laser group was superior to that in the itraconazole group (P<0.001). Notably, a biochemical abnormality was not documented in patients who received laser treatment. In contrast, liver transaminases elevations without clinical symptoms were documented in two patients at the end of itraconazole therapy.
Fractional CO2 laser plus a topical antifungal drug might be more clinically effective in the treatment of onychomycosis than itraconazole, without any adverse reactions. It could be an alternative for clinicians in onychomycosis cases in which oral antifungal agents are contraindicated.
June 30, 2020
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