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Alpha-Hydroxy acid

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101. Laser Tissue Resurfacing (Follow-up)

of retinoic acid, hydroquinone, alpha-hydroxy acids, and sunblock. Previous Next: Intraoperative Details Laser tissue interaction Carbon dioxide laser emits light at a wavelength of 10,600 nm, which is strongly absorbed by water (the primary chromophore for carbon dioxide light that is abundant in the skin). [ ] Although approximately 90% of the carbon dioxide laser energy is absorbed by the initial 20-30 µm of skin, traditional, continuous wave lasers leave a zone of thermal damage measuring 0.2-1 mm (...) in the course. [ ] Recovery is dependent on the depth of ablation. During the first week, patients experience variable degrees of oozing and crusting. Dressings should be applied until complete reepithelialization takes place; the patient can start applying a light water-based moisturizer for the next 2-3 weeks. Postprocedure skin reconditioning should begin early during the healing process. Hydroquinone and retinoic acid can be reintroduced 3-4 weeks postoperatively. Alpha-hydroxy acids should be avoided

2014 eMedicine.com

102. Ichthyosis Vulgaris, Hereditary and Acquired (Follow-up)

systemic condition. The main approach to treatment of both conditions includes hydration of the skin and application of an ointment to prevent evaporation. Hydration promotes desquamation by increasing hydrolytic enzyme activity and the susceptibility to mechanical forces. Pliability of the stratum corneum is also improved. Note the following: Topical retinoids are helpful for some patients. Alpha-hydroxy acids (eg, lactic, glycolic, or pyruvic acids) are effective for hydrating the skin. They work (...) by causing disaggregation of corneocytes in the lower levels of the newly forming stratum corneum. Lactic acid is available as a 12% ammonium lactate lotion, or it can be compounded by prescription in a concentration of 5-10% in a suitable vehicle. Twice-daily applications have shown to be superior to petrolatum-based creams for controlling of ichthyosis vulgaris. Removal of scales can be aided by keratolytics (eg, salicylic acid), which induce corneocyte disaggregation in the upper stratum corneum

2014 eMedicine.com

103. Skin Resurfacing, Laser: Erbium YAG

previous millennia that describe the topical application of substances such as soured milk, vegetable extracts, and mud packs. [ ] Modern agents include preparations of retinoic acid, ascorbic acid alpha-hydroxy acids, and antioxidants used in conjunction with sunscreens. These treatments are useful for restoring and maintaining the health of the epidermis, but they generally are not effective for deeper, long-lasting rejuvenation. A more penetrating removal of the outer layers of aged and sun-damaged (...) of the papillary dermis. Resurfacing can be used as an adjunct to facial surgery, or it can replace facial surgery when surgery is inappropriate or not desired by the patient. Removing the outer layers of skin to the level of the papillary dermis induces reepithelialization and new collagen formation, which can create a smoother, pinker, and more youthful appearance. Chemical removal of skin layers with peels (eg, trichloroacetic acid, phenol) and mechanical removal (ie, ) are effective modalities for facial

2014 eMedicine Surgery

104. Skin Resurfacing: Chemical Peels

slower and scarring more likely. Penetration into the reticular dermis entails a very high risk of scarring. The weaker agents (eg, alpha-hydroxy acids) change the pH sufficiently to cause a superficial shock to the cells and, depending on many variables, cell injury or death. When used with a moisturizer, the acid acts simply to cause cellular and intercellular swelling and plumping, leading to a transient increase in cell and matrix size and lessening of fine lines and rhytides. Sequential (...) volume. This process decreases solar elastosis and replaces and reorients the new dermal connective tissue. The result is an improved clinical appearance of the skin, with fewer rhytides and decreased pigmentary dyschromia, and a more youthful appearance. The images below depict a patient during and after a salicylic acid peel. Men also request chemical peeling. This 56-year-old man is in the process of a salicylic acid peel. Same patient as shown above following a successful chemical peeling

2014 eMedicine Surgery

105. Skin Resurfacing, Chemical Peels

slower and scarring more likely. Penetration into the reticular dermis entails a very high risk of scarring. The weaker agents (eg, alpha-hydroxy acids) change the pH sufficiently to cause a superficial shock to the cells and, depending on many variables, cell injury or death. When used with a moisturizer, the acid acts simply to cause cellular and intercellular swelling and plumping, leading to a transient increase in cell and matrix size and lessening of fine lines and rhytides. Sequential (...) volume. This process decreases solar elastosis and replaces and reorients the new dermal connective tissue. The result is an improved clinical appearance of the skin, with fewer rhytides and decreased pigmentary dyschromia, and a more youthful appearance. The images below depict a patient during and after a salicylic acid peel. Men also request chemical peeling. This 56-year-old man is in the process of a salicylic acid peel. Same patient as shown above following a successful chemical peeling

2014 eMedicine Surgery

106. Seborrheic Keratosis (Follow-up)

> Seborrheic Keratosis Treatment & Management Updated: Oct 30, 2018 Author: Arthur K Balin, MD, PhD, FACP; Chief Editor: William D James, MD Share Email Print Feedback Close Sections Sections Seborrheic Keratosis Treatment Medical Care Ammonium lactate and alpha hydroxy acids have been reported to reduce the height of seborrheic keratoses. [ , ] Superficial lesions can be treated by carefully applying pure trichloroacetic acid and repeating if the full thickness is not removed on the first treatment (...) , Russell TJ, Krochmal L. Evaluation of ammonium lactate in the treatment of seborrheic keratoses. J Am Acad Dermatol . 1990 Feb. 22(2 Pt 1):199-203. . Van Scott EJ, Yu RJ. Alpha hydroxy acids: procedures for use in clinical practice. Cutis . 1989 Mar. 43(3):222-8. . Herron MD, Bowen AR, Krueger GG. Seborrheic keratoses: a study comparing the standard cryosurgery with topical calcipotriene, topical tazarotene, and topical imiquimod. Int J Dermatol . 2004 Apr. 43(4):300-2. . Eskata (hydrogen peroxide

2014 eMedicine.com

107. Dermal Fillers (Follow-up)

Agent Contents Method of Action Indications Injection Duration Limits Sculptra Synthetic, biodegradable, biocompatible, immunologically inert polymer from the alpha-hydroxy-acid family; must be reconstituted with at least 3-5 mL of sterile water for injection; must stand for at least 2 hours to ensure hydration prior to treatment. Particles of poly-L-lactic acid stimulate formation of new collagen (collagen neosynthesis) in the skin, adding volume over time. Intended for restoration (...) not established. Table 8. Poly-L-Lactic Acid Agent Contents Method of Action Indications Injection Duration Limits Sculptra Synthetic, biodegradable, biocompatible, immunologically inert polymer from the alpha-hydroxy-acid family; must be reconstituted with at least 3-5 mL of sterile water for injection; must stand for at least 2 hours to ensure hydration prior to treatment. Particles of poly-L-lactic acid stimulate formation of new collagen (collagen neosynthesis) in the skin, adding volume over time

2014 eMedicine.com

108. Erythrokeratodermia Variabilis (Follow-up)

usually is very low. The use of topical agents in the management depends on the symptoms and focuses on hydration, lubrication, and keratolysis. Therapy may include the use of emollients and keratolytics, such as urea, alpha-hydroxy acids, propylene glycol, salicylic acid, and topical vitamin D analogs and retinoid preparations. Newer synthetic retinoids, such as short-contact topical tazarotene, combined with moisturizers seem promising. [ ] Masking the erythematous lesions of uncovered skin

2014 eMedicine.com

109. Corns (Follow-up)

relieves pain, especially with helomas. Lesions may be maintained in this state if the patient uses short soaks and pumice stone debridement at home. Debridement may be enhanced with the use of keratolytic agents, such as ureas, alpha-hydroxy acid (eg, glycolic, malic, or lactic acid), or beta-hydroxy acid (eg, salicylic acid). [ ] Garlic extracts have also been described as being helpful. [ ] Self-adhesive pads are most effective for reducing thick lesions, whereas lotions, creams, and medicaments (...) of ulceration and, consequently, the need for surgical intervention. [ ] The use of orthotics and conservative footwear with extra toe space are often beneficial. When all else fails, surgery may be performed. If abnormal dermatoglyphics or pinpoint bleeding is seen, wart therapy is initiated. If normal dermatoglyphics are noted, salicylic acid compounds and orthotics may be beneficial. Relief of symptoms may be achieved by thinning and cushioning of the involved lesions. Paring of the lesions immediately

2014 eMedicine.com

110. Botanical Dermatology (Follow-up)

is converted to tulipalin A, the allergen, by means of acidic hydrolysis. Tuliposide B, the alpha-hydroxy derivative of tuliposide A, and the hydrolytic product tulipalin B are commonly found in tulips; they are much weaker sensitizers than tulipalin A. Alstroemeriaceae The family Alstroemeriaceae includes the Peruvian lily. Florists often develop erythema, fissures, vesicles, hyperkeratosis, and exfoliation of the fingertips, which often affects their dominant hand. The allergen can pass through vinyl (eg (...) soldiers who were stationed in India during World War II had adverse reactions to their marked garments. Plant identification - Cross-reacting species from other families The Ginkgo tree ( Ginkgo biloba ) is widely grown in suburban areas in North America and Europe because of its beauty, size, and pollution resistance. Allergic reactions are mediated by anacardic acid, which is present in the seed pulp. The unique fan-shaped leaves, shown below, are easily recognizable. Mature gingko tree, Ginkgo

2014 eMedicine.com

111. Acne Keloidalis Nuchae (Follow-up)

or chlorhexidine can help prevent secondary infection. [ ] Tar shampoos may provide an effective alternative. In addition, mild keratolytic agents containing alpha-hydroxy acids or topical retinoids may help soften the coarse hairs. Patients should discontinue hair greases or pomades, which can interfere with hair growth. [ ] Early, mild papular disease may respond to potent or superpotent topical steroids with or without the use of topical retinoids. This latter combination seems to be somewhat more effective (...) sutures may be used to re-approximate the skin as they cause less of an inflammatory response than nylon sutures. Instruct patients to clean the postoperative area 3 times a day with a mild cleanser, followed by application of a topical antibiotic ointment. The sutures should be removed in 7-10 days, and the patient should then begin a twice-daily topical retinoic acid/corticosteroid regimen for 4-6 weeks. The preferred method of excision for larger linear lesions (1 cm or less in diameter

2014 eMedicine.com

112. Dermal Fillers (Diagnosis)

Agent Contents Method of Action Indications Injection Duration Limits Sculptra Synthetic, biodegradable, biocompatible, immunologically inert polymer from the alpha-hydroxy-acid family; must be reconstituted with at least 3-5 mL of sterile water for injection; must stand for at least 2 hours to ensure hydration prior to treatment. Particles of poly-L-lactic acid stimulate formation of new collagen (collagen neosynthesis) in the skin, adding volume over time. Intended for restoration (...) not established. Table 8. Poly-L-Lactic Acid Agent Contents Method of Action Indications Injection Duration Limits Sculptra Synthetic, biodegradable, biocompatible, immunologically inert polymer from the alpha-hydroxy-acid family; must be reconstituted with at least 3-5 mL of sterile water for injection; must stand for at least 2 hours to ensure hydration prior to treatment. Particles of poly-L-lactic acid stimulate formation of new collagen (collagen neosynthesis) in the skin, adding volume over time

2014 eMedicine.com

113. Botanical Dermatology (Diagnosis)

is converted to tulipalin A, the allergen, by means of acidic hydrolysis. Tuliposide B, the alpha-hydroxy derivative of tuliposide A, and the hydrolytic product tulipalin B are commonly found in tulips; they are much weaker sensitizers than tulipalin A. Alstroemeriaceae The family Alstroemeriaceae includes the Peruvian lily. Florists often develop erythema, fissures, vesicles, hyperkeratosis, and exfoliation of the fingertips, which often affects their dominant hand. The allergen can pass through vinyl (eg (...) soldiers who were stationed in India during World War II had adverse reactions to their marked garments. Plant identification - Cross-reacting species from other families The Ginkgo tree ( Ginkgo biloba ) is widely grown in suburban areas in North America and Europe because of its beauty, size, and pollution resistance. Allergic reactions are mediated by anacardic acid, which is present in the seed pulp. The unique fan-shaped leaves, shown below, are easily recognizable. Mature gingko tree, Ginkgo

2014 eMedicine.com

114. Atopic Dermatitis (Treatment)

-containing preparations are also on the market. [ ] Urea-containing products have been shown to soften and moisturize dry skin. Commonly available preparations include Aquacare cream or lotion and Ureacin Crème. Alpha-hydroxy and lactic acid preparations also are helpful as moisturizers. Name brands include Aqua Lacten Lotion, AmLactin Lotion, LactiCare Lotion, Lac-Hydrin Lotion, and Nutraderm 30. In addition, 12% ammonium lactate lotion has been shown to improve skin barrier function and even (...) to mitigate dermal or epidermal atrophy induced by corticosteroids. [ ] Because of the stinging sensation experienced by children with acute or fissured dermatoses, the 10% urea concentration is preferred over the higher concentrations, and care should also be used in the application of the alpha-hydroxy and lactic acid preparations. LactiCare-HC Lotion also contains hydrocortisone to further benefit acute flares of atopic dermatitis. For children with repeated cutaneous infections, adding 2 teaspoons

2014 eMedicine Pediatrics

115. Cerebrotendinous Xanthomatosis (Overview)

7-alpha-hydroxy-4-cholesten-3-one. [ ] Deposition of cholestanol and cholesterol in the CNS (the brain and spinal cord), muscle (including the heart), blood vessels, eye, and tendon results in a degenerative process that worsens over time unless treated. The mechanisms leading to brain involvement have been debated. [ , ] Patients with cerebrotendinous xanthomatosis appear to have a diffuse decrease in total brain volume, the decrease being predominantly in cortical grey matter rather than white (...) > Cerebrotendinous Xanthomatosis (CTX) Updated: Jul 07, 2017 Author: Robert D Steiner, MD; Chief Editor: Maria Descartes, MD Share Email Print Feedback Close Sections Sections Cerebrotendinous Xanthomatosis (CTX) Overview Background Cerebrotendinous xanthomatosis (CTX) is a rare genetic metabolic disorder of cholesterol and bile acid metabolism that results in systemic and neurologic abnormalities. Typically, the disease begins in infancy with chronic . Cataracts become evident in childhood or adolescence

2014 eMedicine Pediatrics

116. Atopic Dermatitis (Follow-up)

-containing preparations are also on the market. [ ] Urea-containing products have been shown to soften and moisturize dry skin. Commonly available preparations include Aquacare cream or lotion and Ureacin Crème. Alpha-hydroxy and lactic acid preparations also are helpful as moisturizers. Name brands include Aqua Lacten Lotion, AmLactin Lotion, LactiCare Lotion, Lac-Hydrin Lotion, and Nutraderm 30. In addition, 12% ammonium lactate lotion has been shown to improve skin barrier function and even (...) to mitigate dermal or epidermal atrophy induced by corticosteroids. [ ] Because of the stinging sensation experienced by children with acute or fissured dermatoses, the 10% urea concentration is preferred over the higher concentrations, and care should also be used in the application of the alpha-hydroxy and lactic acid preparations. LactiCare-HC Lotion also contains hydrocortisone to further benefit acute flares of atopic dermatitis. For children with repeated cutaneous infections, adding 2 teaspoons

2014 eMedicine Pediatrics

117. Tetrahydrobiopterin Deficiency (Diagnosis)

an unstable 4-alpha--peroxy-BH4. The mono-oxygenation of aromatic amino acids is thus concomitant with oxidation of BH4 to 4-alpha--hydroxy-BH4 (pterin-4-alpha-carbinolamine). Pterin-4-alpha-carbinolamine is subsequently dehydrated to quinonoid-dihydrobiopterin (q-dihydrobiopterin) and water by the specific and highly efficient pterin-4-alpha-carbinolamine dehydratase. The PCBD gene on chromosome band 10q22 encodes PCD. In the last step of BH4 recycling, q-dihydrobiopterin is reduced back to BH4 (...) biosynthesis (ie, aromatic amino acid synthesis). In addition to hydroxylating aromatic amino acids, BH4 serves as the cofactor for nitric oxide synthase and glyceryl-ether mono-oxygenase. [ ] Tetrahydrobiopterin reacts with molecular oxygen to form an active oxygen intermediate that can hydroxylate substrates. Although BH4 is absolutely essential for nitric oxide synthase activity, its exact biochemical function with different forms of the enzyme and its mechanism of action remain to be defined. Excess

2014 eMedicine Pediatrics

118. Tetrahydrobiopterin Deficiency (Overview)

an unstable 4-alpha--peroxy-BH4. The mono-oxygenation of aromatic amino acids is thus concomitant with oxidation of BH4 to 4-alpha--hydroxy-BH4 (pterin-4-alpha-carbinolamine). Pterin-4-alpha-carbinolamine is subsequently dehydrated to quinonoid-dihydrobiopterin (q-dihydrobiopterin) and water by the specific and highly efficient pterin-4-alpha-carbinolamine dehydratase. The PCBD gene on chromosome band 10q22 encodes PCD. In the last step of BH4 recycling, q-dihydrobiopterin is reduced back to BH4 (...) biosynthesis (ie, aromatic amino acid synthesis). In addition to hydroxylating aromatic amino acids, BH4 serves as the cofactor for nitric oxide synthase and glyceryl-ether mono-oxygenase. [ ] Tetrahydrobiopterin reacts with molecular oxygen to form an active oxygen intermediate that can hydroxylate substrates. Although BH4 is absolutely essential for nitric oxide synthase activity, its exact biochemical function with different forms of the enzyme and its mechanism of action remain to be defined. Excess

2014 eMedicine Pediatrics

119. Cerebrotendinous Xanthomatosis (Diagnosis)

7-alpha-hydroxy-4-cholesten-3-one. [ ] Deposition of cholestanol and cholesterol in the CNS (the brain and spinal cord), muscle (including the heart), blood vessels, eye, and tendon results in a degenerative process that worsens over time unless treated. The mechanisms leading to brain involvement have been debated. [ , ] Patients with cerebrotendinous xanthomatosis appear to have a diffuse decrease in total brain volume, the decrease being predominantly in cortical grey matter rather than white (...) > Cerebrotendinous Xanthomatosis (CTX) Updated: Jul 07, 2017 Author: Robert D Steiner, MD; Chief Editor: Maria Descartes, MD Share Email Print Feedback Close Sections Sections Cerebrotendinous Xanthomatosis (CTX) Overview Background Cerebrotendinous xanthomatosis (CTX) is a rare genetic metabolic disorder of cholesterol and bile acid metabolism that results in systemic and neurologic abnormalities. Typically, the disease begins in infancy with chronic . Cataracts become evident in childhood or adolescence

2014 eMedicine Pediatrics

120. Toxicity, Alcohols (Diagnosis)

to glycolic acid is somewhat rapid. In contrast, the conversion of glycolic acid to glyoxylic acid is slower and is the rate-limiting step in the metabolism of ethylene glycol. Glyoxylic acid is subsequently metabolized into several different products, including oxalic acid (oxalate), glycine, and alpha-hydroxy-beta-ketoadipate. The conversion to glycine requires pyridoxine as a cofactor, while the conversion to alpha-hydroxy-beta-ketoadipate requires thiamine as a cofactor. The oxalic acid combines (...) prolonged inhalation or skin absorption. [ , , , ] Methanol is rapidly absorbed from the gastric mucosa, and achieves a maximal concentration 30-90 minutes after ingestion. [ ] Methanol is primarily metabolized in the liver via alcohol dehydrogenase into formaldehyde. Formaldehyde is subsequently metabolized via aldehyde dehydrogenase into formic acid, which ultimately is metabolized to folic acid, folinic acid, carbon dioxide, and water. A small portion is excreted unchanged by the lungs. Formic acid

2014 eMedicine Emergency Medicine

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