OBJECTIVES: This study aimed to evaluate the efficacy and safety of cashew nut extract (DeBCC©) cream compared with a vehicle cream in the treatment of basal cell carcinomas (BCC), mainly by comparing each group's composite clearance rate, defined by the absence of histopathologic evidence of BCC at the target lesion site.

METHODS: A randomized double-blind vehicle-controlled trial was conducted on nineteen patients, who underwent eight weekly topical treatment application sessions of either vehicle or experimental drug. Six weeks post-treatment, they underwent surgical excision of their lesions. A dermatopathologist examined these specimens. Clinical and histopathologic clearances were evaluated.

RESULTS: The clinical clearance rate (67%) of DeBCC was significantly higher compared to vehicle (p=0.003), while the composite clearance rate (33%) was not (p>0.005). The pre-test probability of clinical clearance in concordance with histopathologic clearance (15.79%) suggests that clinical resolution of a BCC lesion may not equate to histopathologic clerance.

CONCLUSION: This study showed a modest clinical clerance rate but a low composite clerance rate for DeBCC cream. Further studies with bigger sample size that are limited to less aggressive BCC subtypes are needed to strongly establish the efficacy and safety of topical cashew nut extract for BCC treatment.

Human ; Anacardium ; Nuts ; Carcinoma, Basal Cell ; Administration, Topical ; Probability ; Aminoquinolines ; Skin Neoplasms

A 1-year-old female with maple syrup urine disease presenting with erythematous, partially eroded plaques on the trunk, anogenital area, and extremities experienced metabolic crisis. The skin lesions appeared at 11 months of age and was thought to result from amino acid imbalance secondary to erratic supplementation of specialized milk formula devoid of isoleucine, leucine, and valine. Serial urine monitoring showed persistent ketones and elevated serum leucine and valine. The patient was managed with emollients, intralipid 20%, and addition of isoleucine and valine supplements to counter the neurotoxic effect of leucine. After 8 days of proper feeding and continuous emollient application, the lesions improved and skin biopsy revealed superficial perivascular dermatitis. Although a decrease in erythema and desquamation was noted, the patient had persistent cerebral edema and continued to deteriorate.

Maple Syrup Urine Disease ; Isoleucine ; Leucine ; Valine ; Erythema