Chlorhexidine Scrub, ZnO Nanoparticles Socks and the Combination for Treatment of Pitted Keratolysis (PK_treatment)

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ClinicalTrials.gov Identifier: NCT04332796

Recruitment Status : Not yet recruiting

First Posted : April 3, 2020

Last Update Posted : February 25, 2021

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Sponsor:

Information provided by (Responsible Party):

Mahidol University

Study Description

Brief Summary:

This study aimed to study the efficacy of chlorhexidine scrub, zinc oxide nanoparticles (ZnO-NPs) socks and the combination of chlorhexidine scrub and ZnO-NPs socks in treatment of pitted keratolysis.

Condition or disease	Intervention/treatment	Phase
Foot Dermatoses	Drug: Chorhexidine scrub Device: ZnO-NPs socks Combination Product: Combination of chorhexidine scrub and ZnO-NPs socks	Phase 4

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Detailed Description:

Introduction Pitted keratolysis is a common skin disease, caused by various gram-positive bacteria including Corynebacterium species, Kytococcus sedentarius, Dermophilus congolensis and Actinomyces species. These bacteria create small tunnels in the stratum corneum, causing pitted lesions at plantar areas. This condition is frequent accompanied by feet malodor and is commonly found in young male adults, especially in soldiers, miners and athletes. The reported prevalence of pitted keratolysis among naval cadets in Thailand was 38.7%. Predisposing factors related to pitted keratolysis are pedal hyperhidrosis and prolonged feet occlusion. Although this condition is generally not painful, our previous study in 2018 revealed adversely affects patients' quality of life.

Regarding treatment modalities of pitted keratolysis, various medications and life-style modification have been recommended. Previous studies revealed efficacy of topical choices, including benzoyl peroxide gel, clindamycin-benzoyl peroxide gel, glycopyrrolate cream, erythromycin gel, clindamycin solution, chlorhexidine scrub and mupirocin ointment. Oral antibiotics and botulinum toxin injection were also beneficial in pitted keratolysis. As to life-style modification, wearing cotton socks and opened footwear, and proper hygiene, have also been suggested.

Zinc oxide (ZnO) has been demonstrated to exhibit antimicrobial activities against many microorganisms, such as Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa and fungal infections including dermatophytosis. It has been proposed that the mechanism is the generation of reactive oxygen species, such as hydrogen peroxide, on microorganism cell surfaces, thereby causing membrane dysfunction. The antimicrobial activities have been observed to vary with changes in the physical and chemical properties of ZnO, for instance, its particle size, porosity and specific surface area.

Nanobiotechnology , which is the integration of biotechnology and nanotechnology, is currently being used in drug delivery systems. The bactericidal efficacy of ZnO nanoparticles (ZnO-NPs) has been shown to improves with a decrease in their particle size. ZnO has also been shown to be is safe and compatible with human skin, which makes it a suitable additive for textiles. Research by Choopong and Sarayut established that ZnO-NP-coated socks exhibited antimicrobial activities against gram-positive (S. aureus) and gram-negative (Klebsiella pneumoniae) bacteria.

Objective This study aimed to study the efficacy of chlorhexidine scrub, zinc oxide nanoparticles (ZnO-NPs) socks and the combination of chlorhexidine scrub and ZnO-NPs socks in treatment of pitted keratolysis.

Material and Methods First-year naval rating cadets, who had pitted keratolysis were invited to enroll in this study. The cadets who previously received any topical treatment including topical antibiotic, antiperspirant or aluminum chloride within 6 months prior to the study were excluded. Consent was informed and obtained from all participants. Participants were assessed for behavioral risk factors and level of foot odor measured by a self-assessed visual analogue scale (VAS), using questionnaires. Clinically examination of feet was done in all subjects by treatment-blinded dermatologists. Subjects were randomly assigned either chlorhexidine scrub, ZnO-NPs socks and the combination of chlorhexidine scrub and ZnO-NPs socks for 2 weeks. During the study, using of other topical treatment such as topical antibiotics, antiperspirant or aluminum chloride was not allowed. Participants who received chlorhexidine scrub were advised to wash their both soles with chlorhexidine scrub two times per day in the morning and evening. Participants who received ZnO-NPs socks were asked to wear these socks everyday and at least 8 hours per day. All were able to regularly participate in physical military training during the study. Two weeks after the treatment, clinical examinations by dermatologists and the cadets' self-assessment questionnaires, including feet odor by using VAS, treatment satisfaction and adverse effects, were used to evaluate the effectiveness. Pitted lesions improvement at plantar areas, evaluated by dermatologists, was divided into no improvement, slight improvement (decrease of pitted lesions at feet for 1 level) and much improvement (decrease of pitted lesions at feet for at least 2 level). Data were analyzed using SPSS version 18 (SPSS, Inc., Chicago, IL, USA).

Duration of study: 6 months Study design: Randomized control trial

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	72 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Double (Investigator, Outcomes Assessor)
Masking Description:	Single blind controlled trial between participants, drug preparing team, doctors, investigators, and outcome assessors.
Primary Purpose:	Treatment
Official Title:	A Study of Efficacy of Chlorhexidine Scrub, ZnO Nanoparticles Socks and the Combination of Chlorhexidine Scrub and ZnO Nanoparticles Socks for Treatment of Pitted Keratolysis
Estimated Study Start Date :	September 5, 2021
Estimated Primary Completion Date :	June 1, 2022
Estimated Study Completion Date :	October 1, 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Foot Health

Drug Information available for: Chlorhexidine

U.S. FDA Resources

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Chorhexidine scrub Chorhexidine scrub was given to patients for 2 weeks	Drug: Chorhexidine scrub Chorhexidine scrub was given to patients for 2 weeks
Active Comparator: ZnO-NPs socks ZnO-NPs socks to patients for 2 weeks	Device: ZnO-NPs socks ZnO-NPs socks was given to patients for 2 weeks
Active Comparator: Combination of chorhexidine scrub and ZnO-NPs socks Chorhexidine scrub and ZnO-NPs socks to patients for 2 weeks	Combination Product: Combination of chorhexidine scrub and ZnO-NPs socks Combination of chorhexidine scrub and ZnO-NPs socks was given to patients for 2 weeks

Outcome Measures

Primary Outcome Measures :

The number of patients who had improvement of pitted lesion after treatment [ Time Frame: 2 weeks ]
Effectiveness was evaluated

Secondary Outcome Measures :

The percentage of patients developed any side effect such as erythema, burning [ Time Frame: 2 weeks ]
Side effects was assessed

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:	18 Years and older (Adult, Older Adult)
Sexes Eligible for Study:	Male
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

First-year naval rating cadets, who had pitted keratolysis

Exclusion Criteria:

The cadets who previously received any topical treatment including topical antibiotic, antiperspirant or aluminum chloride within 6 months prior to the study.

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04332796

Contacts

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Contact: Charussri Leeyaphan, MD	+6624194333	charussrilee@gmail.com
Contact: Sumanas Bunyaratavej, MD	+6624194333	consultskin@yahoo.com

Locations

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Thailand
Department of Dermatology Siriraj Hospital
Bangkok, Thailand, 10700

Sponsors and Collaborators

Mahidol University

More Information

Publications of Results:

de Almeida HL Jr, Siqueira RN, Meireles Rda S, Rampon G, de Castro LA, Silva RM. Pitted keratolysis. An Bras Dermatol. 2016 Jan-Feb;91(1):106-8. doi: 10.1590/abd1806-4841.20164096.

Makhecha M, Dass S, Singh T, Gandhi R, Yadav T, Rathod D. Pitted keratolysis - a study of various clinical manifestations. Int J Dermatol. 2017 Nov;56(11):1154-1160. doi: 10.1111/ijd.13744. Epub 2017 Sep 18.

van der Snoek EM, Ekkelenkamp MB, Suykerbuyk JC. Pitted keratolysis; physicians' treatment and their perceptions in Dutch army personnel. J Eur Acad Dermatol Venereol. 2013 Sep;27(9):1120-6. doi: 10.1111/j.1468-3083.2012.04674.x. Epub 2012 Aug 7.

Leeyaphan C, Bunyaratavej S, Taychakhoonavudh S, Kulthanachairojana N, Pattanaprichakul P, Chanyachailert P, Ongsri P, Arunkajohnsak S, Limphoka P, Kulthanan K. Cost-effectiveness analysis and safety of erythromycin 4% gel and 4% chlorhexidine scrub for pitted keratolysis treatment. J Dermatolog Treat. 2019 Sep;30(6):627-629. doi: 10.1080/09546634.2018.1543846. Epub 2018 Dec 11.

Vlahovic TC, Dunn SP, Kemp K. The use of a clindamycin 1%-benzoyl peroxide 5% topical gel in the treatment of pitted keratolysis: a novel therapy. Adv Skin Wound Care. 2009 Dec;22(12):564-6. doi: 10.1097/01.ASW.0000363468.18117.fe.

Bunyaratavej S, Leeyaphan C, Chanyachailert P, Pattanaprichakul P, Ongsri P, Kulthanan K. Clinical manifestations, risk factors and quality of life in patients with pitted keratolysis: a cross-sectional study in cadets. Br J Dermatol. 2018 Nov;179(5):1220-1221. doi: 10.1111/bjd.16923. Epub 2018 Sep 14.

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Responsible Party:	Mahidol University
ClinicalTrials.gov Identifier:	NCT04332796
Other Study ID Numbers:	PK_treatment
First Posted:	April 3, 2020 Key Record Dates
Last Update Posted:	February 25, 2021
Last Verified:	February 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD:	Undecided

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Studies a U.S. FDA-regulated Drug Product:	No
Studies a U.S. FDA-regulated Device Product:	No

Keywords provided by Mahidol University:


Pitted keratolysis Foot Odor Chlorhexidine solution Zinc oxide nanoparticles

Additional relevant MeSH terms:

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Skin Diseases Foot Dermatoses Foot Diseases Benzalkonium Compounds	Benzethonium Anti-Infective Agents, Local Anti-Infective Agents

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