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

OBJECTIVE: The study aimed to assess the efficacy and safety of Senna alata (akapulko) plant extracts compared with topical antifungals in the treatment of superficial fungal skin infections.

METHODS: A systematic review and meta-analysis of randomized controlled trials that studied patients with diagnosed cutaneous tinea or dermatophytosis (excluding hair and nail), tinea versicolor, or cutaneous candidiasis, via microscopy or culture, and compared the efficacy and safety of S. alata (akapulko) extract versus topical antifungals. Two authors independently screened titles and abstracts of merged search results from electronic databases (The Cochrane Skin Group Specialized Register, CENTRAL, MEDLINE, EMBASE (January 1990 to December 2011), Health Research and Development Information Network (HERDIN), and reference lists of articles), assessed eligibility, assessed the risk of bias using the domains in the Cochrane Risk Bias tool and collected data using a pretested Data extraction form (DEF). Meta-analyses were performed when feasible.

RESULTS: We included seven RCTs in the review. There is low certainty of evidence that S. alata 50% lotion is as efficacious as sodium thiosulfate 25% lotion (RR 0.91, 95% CI, 0.79 to 1.04; 4 RCTs, n=216; p=0.15; I2=52%) and high quality evidence that S. alata cream is as efficacious as ketoconazole (RR 0.95, 95% CI, 0.82 to 1.09; 1 RCT, n=40; p=0.44) and terbinafine cream (RR 0.93, 95% CI, 0.86 to 1.01; 1 RCT, n=150; p=0.09) in mycologic cure. For adverse effects, there is very low certainty of evidence of increased harm with S. alata 50% lotion compared to sodium thiosulfate 25% lotion (RR 1.26, 95% CI, 0.46, 3.44; 2 RCTs, n=120; p=0.65; I2=19%). Adverse effects were few and mild.

CONCLUSION: S. Alata 50% lotion may be as efficacious as sodium thiosulfate 25% lotion and is as efficacious as ketoconazole 2% and terbinafine 1% creams. There is insufficient evidence to compare the safety of S. alata 50% lotion with sodium thiosulfate 25% lotion.

Tinea Versicolor