Biomedical subjects

Nicholas J Lowe

Publications and source records attributed to Nicholas J Lowe.

27 records · Page 2Linked to original sources

PubMed2003

Photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: results of a prospective randomized multicenter trial.

BACKGROUND: Photodynamic therapy (PDT) is a promising new treatment modality for actinic keratoses. Methyl aminolevulinate (MAL) (Metvix, PhotoCure, Oslo, Norway) leads to selective accumulation of photoactive porphyrins in premalignant skin lesions and makes the lesions susceptible to phototoxic effects on illumination with red light. OBJECTIVE: This multicenter, randomized, double-blind study compared complete response rates, cosmetic outcome, and patient satisfaction for PDT with cream containing 160 mg/g MAL or placebo cream in the treatment of actinic keratoses. METHODS: After application of the cream under occlusion for 3 hours, the lesions were illuminated by noncoherent red light (570-670 nm, light dose 75 J/cm(2)). Treatment was repeated after 1 week and response was assessed 3 months later. A total of 80 patients were randomized into the study, 42 in the active and 38 in the placebo group. RESULTS: Complete lesion response rate was higher after MAL PDT than placebo, 89% versus 38% per protocol analysis (P =.001). An excellent or good cosmetic outcome was reported in more than 90% of patients treated with MAL. CONCLUSION: In this small study, PDT using topical MAL was a safe and effective treatment for actinic keratoses with excellent cosmetic outcome. It is a promising treatment that could benefit from further study.

Administration, Topical↗

PubMed2002

Efficacy of 0.1% tazarotene cream for the treatment of photodamage: a 12-month multicenter, randomized trial.

OBJECTIVE: To determine the efficacy and safety of 0.1% tazarotene cream for the treatment of photodamage. DESIGN: A 24-week multicenter, double-blind, randomized, vehicle-controlled intervention study followed by a 28-week open-label extension. SETTING: Ambulatory patients in private and institutional practice. PATIENTS: Of 563 patients with facial photodamage, 91% and 86% completed the double-blind and open-label phases, respectively. In the double-blind phase, 20 of 283 tazarotene-treated patients and 1 of 280 vehicle-treated patients discontinued treatment owing to adverse events. INTERVENTION: Once-daily application of 0.1% tazarotene cream or nonmedicated vehicle cream to the face for 24 weeks. Then, all continuing patients received treatment with 0.1% tazarotene cream for another 28 weeks. MAIN OUTCOME MEASURES: Primarily, fine wrinkling and mottled hyperpigmentation. Also, lentigines, elastosis, pore size, irregular depigmentation, tactile roughness, coarse wrinkling, telangiectasia, actinic keratoses, overall integrated assessment of photodamage, global response to treatment, patients' overall assessment of photodamage, and plasma levels of tazarotenic acid. RESULTS: Compared with the vehicle, at week 24 tazarotene resulted in a significantly greater incidence of patients achieving treatment success (>or=50% global improvement) and at least a 1-grade improvement in fine wrinkling, mottled hyperpigmentation, lentigines, elastosis, pore size, irregular depigmentation, tactile roughness, coarse wrinkling, and the overall integrated assessment of photodamage (P<.01). Additional clinical improvement occurred with continued tazarotene treatment and had not plateaued by week 52. Plasma tazarotenic acid concentrations did not exceed 0.71 ng/mL. CONCLUSIONS: Once-daily applications of 0.1% tazarotene cream significantly reduced multiple signs of photodamage. Plasma levels of tazarotenic acid remained below those of endogenous retinoids.

Administration, Topical↗

PubMed2002

Efficacy and safety of botulinum toxin type a in the treatment of palmar hyperhidrosis: a double-blind, randomized, placebo-controlled study.

BACKGROUND: Recent studies demonstrate that botulinum toxin type A (BTX-A) decreases palmar hyperhidrosis. OBJECTIVE: To evaluate the efficacy and safety of BTX-A for palmar hyperhidrosis. METHODS: Patients (n = 19) received injections of placebo (normal saline) in one hand and BTX-A in the other. Assessments included gravimetric measurement of sweat production and physician's and patient's rating of severity. Safety evaluations included measuring grip strength. Preliminary 28-day results are reported. RESULTS: The mean percentage decrease in gravimetric measurement at day 28 was significantly greater with BTX-A versus placebo. One hundred percent of 17 patients rated the treatment as successful, while only 12% (2/17) rated placebo injection successful. Grip and hand strength were unchanged with either treatment. Only 21% (4/19) reported mild adverse events. CONCLUSION: BTX-A injections produce significant improvements in palmar hyperhidrosis without a concomitant decrease in grip or dexterity, or the occurrence of serious adverse events.

Adolescent↗

PubMed2002

A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines.

BACKGROUND: Botulinum toxin type A (BTX-A) is widely used for facial esthetics but is incompletely studied. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of BTX-A treatment of glabellar lines. METHODS: Patients with moderate to severe glabellar lines at maximum frown received intramuscular injections of 20 U BTX-A (BOTOX, Allergan, Inc, Irvine, Calif) or placebo into 5 glabellar sites. Patients were followed up for 120 days after injection. Outcome measures were physician rating of glabellar line severity at maximum frown and rest, patient assessment of improvement, and vital sign and adverse event monitoring. RESULTS: Two hundred sixty-four patients were enrolled (BTX-A: 203, placebo: 61). There was a significantly greater reduction in glabellar line severity with BTX-A than with placebo (all measures, every follow-up visit; P <.022). The effect was maintained for many patients through day 120. There was a low occurrence (5.4%) of mostly mild blepharoptosis in the BTX-A group. CONCLUSION: BTX-A injections are safe and effective in reducing the severity of glabellar lines.

Adolescent↗

PubMed2002

Bilateral, double-blind, randomized comparison of 3 doses of botulinum toxin type A and placebo in patients with crow's feet.

BACKGROUND: Optimum dosing for botulinum toxin type A (BTX-A) in crow's feet remains to be defined. OBJECTIVE: Our purpose was to compare the efficacy and safety of 3 doses of BTX-A and placebo in patients with crow's feet. METHODS: Patients were treated with 6, 12, or 18 units of BTX-A in orbicularis oculi muscle on one side and placebo contralaterally (double-blind design). At 16 weeks after injection, patients were treated with 12 or 18 units of BTX-A bilaterally (open-label design). Trained observers and patients rated the wrinkles on a scale of 0 (none) to 3 (severe) at maximum contraction and repose and at baseline and 4-week intervals over a 16-week period after injection. RESULTS: All doses of BTX-A were significantly superior to placebo with no clear dose-response relationship. Benefits of the second injection lasted longer than the first. Few and mild adverse events were seen. CONCLUSION: BTX-A is a safe and effective treatment for crow's feet. Benefits are more sustained with repeat treatment.

Aged↗

PubMed2002

Botulinum toxins types A and B for brow furrows: preliminary experiences with type B toxin dosing.

BACKGROUND: Facial lines resulting from hyperactivity can be misleading manifestations of negative emotions, fatigue and stress. They may also contribute to a perception of facial aging. A well established treatment is botulinum toxin type A (BTX-A). Recently, botulinum toxin type B (BTX-B) has become available for the treatment of cervical dystonia. There has been little comparison on the efficacy of the two different types of botulinum toxins, nor is there information on appropriate dosing of BTX-B for facial muscles. OBJECTIVES: The purpose of this pilot study was to observe the effects of BTX-B in comparison to BTX-A, on patients with brow furrows assessing initial efficacy and duration of effect. METHODS: Patients were injected with BTX-B in two different dose conversions against BTX-A to the corrugator-procerus complex. Some patients received a conversion of 50 units of BTX-B (total of 1000 units) to one unit of BTX-A while others received a conversion of 100 units of BTX-B (total of 2000 units) to one unit of BTX-A. The patients treated with BTX-A received a total of 20 units. These patients were clinically assessed prior to treatment and 3 days, 1 week, 4 weeks, 12 weeks and 16 weeks after treatment. RESULTS: Both types of botulinum toxin were effective at improving glabellar frown lines. The onset of actions occurred slightly sooner (2-3 days) with BTX-B than with BTX-A (3-7 days). Duration of effect with BTX-A was at least 16 weeks. With 1000 units of BTX-B, dose duration was 6-8 weeks and with 2000 units of BTX-B, duration was 10-12 weeks. SUMMARY: Both types of botulinum toxin are effective at correcting deep glabellar furrows. At least with the doses used, BTX-B has a quicker onset of action and BTX-A has longer benefit for glabellar wrinkles. These data strongly suggest that further dose ranging studies of BTX-B are necessary and indicated in controlled double blind studies in a larger patient population.

Adult↗

PubMedDate not supplied

Use of topical metronidazole in moderate to severe rosacea.

Rosacea is a chronic condition requiring long-term therapy for control and maintenance. Numerous controlled studies have shown that metronidazole 0.75% in combination with oral antibiotics significantly reduces the number of papules and pustules and erythema severity scores in patients with severe disease. Topical metronidazole 0.75% also maintains long-term remissions after oral tetracycline has been discontinued. Although original studies involving topical metronidazole 0.75% used a twice-daily regimen, subsequent work has shown that this formulation used once daily is as effective as 1% metronidazole.

Administration, Cutaneous↗

PubMedDate not supplied

Botulinum toxin types A and B: comparison of efficacy, duration, and dose-ranging studies for the treatment of facial rhytides and hyperhidrosis.

One of the most common etiologic forces for the persistence of facial rhytides is the repetitive contraction of the intrinsic muscles that are necessary for facial expression. These include the forehead lines, crow's feet, glabellar rhytides, and wrinkles in the lower face. Although filling agents such as collagen and laser procedures can help reduce the appearance of these lines, they do not address the underlying forces that cause these wrinkles to persist. Botulinum toxin type-A and type-B are neurotoxins that address these issues and result in the relaxation of the intrinsic facial muscles and subsequent resolution of these dynamic facial rhytides. This article will compare the efficacy, duration, dose ranging studies, and safety in the treatment of facial rhytides with both types of toxins. In addition, the treatment of hyperhidrosis with type-A and type-B botulinum toxin will also be discussed.

Botulinum Toxins↗

PubMedDate not supplied

Cosmetic uses of botulinum toxins for lower aspects of the face and neck.

The ability of botulinum toxin A (BTX-A) to improve the appearance of facial lines was first reported among patients who had been receiving injections for facial dystonias or surgical procedures. Since that time, there has been very extensive use of this treatment for relaxation of a wide variety of facial muscles and also for platysmal lines of the neck. Considerable experience over the last decade or longer confirms the safety and efficacy of BTX-A in the treatment of upper facial lines. BTX-A has been used also lower facial indications, but published papers are mainly uncontrolled observations on patients. Unlike the placebo-controlled studies on the upper face, there is a lack of controlled studies for lower face and neck BTX-A treatment. This article will summarize the use of BTX-A for the lower face and its role as combination treatment. Examples of combinations that may be used with BTX-A resurfacing, nonablative skin rejuvenation and skin fillers. Although little used at present, Botulinum Toxin B will be briefly discussed.

Botulinum Toxins, Type A↗