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Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The purpose of this study was to explore the psychological characteristics of patients who suffer from psychophysiological skin disorders. The research was an effort to obtain an understanding of their personality development within the conceptual framework of Ego Psychology. The investigation was designed to examine complex combinations of variables which permit specific traits to be evaluated relative to each other without losing the uniqueness of the individual. [TRUNCATED] / 2031-01-01

Consumers of topical formulations apply a wide spectrum of preparations, both cosmetic and dermatological, to their healthy or diseased skin. These formulations range in physicochemical nature from solid through semisolid to liquid. Pharmaceutical foams are pressurized dosage forms containing one or more active ingredients that, upon valve actuation, emit a fine dispersion of liquid and/or solid materials in a gaseous medium. Foam formulations are generally easier to apply, are less dense, and spread more easily than other topical dosage forms. Foams may be formulated in various ways to provide emollient or drying functions to the skin, depending on the formulation constituents. Therefore, this delivery technology should be a useful addition to the spectrum of formulations available for topical use; however, as yet, only a few are commercially available. Probably the most convincing argument for the use of foams is ease of use by the patient, and consumer acceptance. Most foam dosage forms used in dermatology to date have incorporated corticosteroids, although some products have also been used to deliver antiseptics, antifungal agents, anti-inflammatory agents, local anesthetic agents, skin emollients, and protectants. Although there is no clinical evidence that foam formulations are currently superior to other conventional delivery vehicles, these formulations have a clear application advantage and with continued developments in the science of supersaturation technology, it seems certain that foam delivery systems will retain their place in the dermatological and cosmetic armamentarium.

Background: Metronidazole (MTZ) is an anti-oxidant and anti-inflammatory agent with beneficial therapeutic properties. The hydrophilic nature of the molecule limits its penetration across the skin. Existing commercial formulations have limitations of inadequate drug concentration present at the target site, which requires frequent administration and poor patient compliance. Objective: The aim of the current study was to develop and evaluate water in oil microemulsion of Metronidazole with higher skin retention for the treatment of inflammatory skin disorders. Methods: Pseudo ternary phase diagrams were used in order to select the appropriate ratio of sur-factant and co-surfactant and identify the microemulsion area. The selected formulation consisted of Capmul MCM as oil, Tween 20 and Span 20 as surfactant and co-surfactant, respectively, and water. The formulation was characterized and evaluated for stability, Ex vivo permeation studies and in vivo anti-inflammatory effect (carrageenan induced rat paw edema, air pouch model), anti-p-soriatic activity (mouse-tail test). Results: The particle size analyses revealed the average diameter and polydispersity index of the selected formulation to be 16 nm and 0.373, respectively. The results of ex vivo permeation studies showed statistically higher mean cumulative amount of MTZ retained in rat skin from microemul-sion, i.e., 21.90 ± 1.92 µg/cm2, which was 6.65 times higher as compared to Marketed gel (Metro-gyl gel®) with 3.29 ± 0.11 µg/cm2 (p<0.05). The results of in vivo studies suggested the microemul-sion based formulation of MTZ to be similar in efficacy to Metrogyl gel®. Conclusion: Research suggests the efficacy of the developed MTZ loaded microemulsion in the treatment of chronic skin inflammatory disorders.

Objective. To determine whether using standardized patients dressed in moulage improves pharmacy students' ability to assess skin disorders compared to using picture-based paper cases. To determine pharmacy student preferences when learning assessment of skin disorders through these two educational methods. Methods. Faculty members investigated student assessments of drug-induced skin disorders and contact dermatitis by using picture-based paper cases compared with using standardized patients dressed in moulage in a patient assessment course. Faculty members measured student knowledge via multiple-choice questions before laboratory, immediately after laboratory, and during a final examination 3 weeks later. Student preferences were measured immediately after laboratory via survey instrument in this randomized, non-blinded, crossover design educational study. Results. No significant differences in knowledge scores related to skin disorders were found after laboratory or 3 weeks later when comparing the two educational methods. However, survey results suggested student preferences for using standardized patients dressed in moulage for drug-induced skin disorders. No significant differences were found for contact dermatitis cases. Conclusion. Using standardized patients dressed in moulage did not improve pharmacy students' ability to assess skin disorders compared to using picture-based paper cases. Pharmacy students preferred standardized patients dressed in moulage only when learning assessment of drug-induced skin disorders.

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This dissertation focuses on an understudied population of people with severe and chronic skin disorders concerning their lived realities in mainstream and specialized settings. Little is known about the life experiences of this population that, because of the rarity of these largely inherited disorders, is demographically scattered throughout North America. Through descriptive narratives from an individual perspective, the aim of this research is to educate others as to how people with severe and chronic skin disorders shape their identities, often as disabled, and experience daily life. Research participants include forty-four men and women, ranging in age from eighteen to seventy-plus years, who attended at least one of four week-long camp programs for children with severe and chronic skin disorders in the summer of 2009 at varied locations in the United States. Ethnographic research methods include participant-observation, face-to-face and telephone interviews to glean life narratives, and questionnaires for demographic and statistical analysis. Interview data are assigned to four categories: 1) Those with skin disorders who did not attend a childhood camp designed specifically for children with skin disorders, 2) those who did attend a skin disorders camp as a child and are now staff at such camps, 3) medical personnel who are camp staff, and 4) adult camp staff attendees who are not medical professionals nor any diagnoses of severe or chronic skin disorders. Through the ethnographic process themes evolved, including the effects of socially constructed markers of race, gender, age, and extent of disability, that further impact individuals' experiences of life in both the camp and mainstream settings. All persons with skin disorders interviewed report negative effects from stigmatization to a varying degree in mainstream society, while four report adverse experiences in the camp setting. All participants with skin disorders interviewed report that camp programs for children with skin disorders have positively impacted their lives in both mainstream and camp settings. Additionally, all medical personnel interviewed report positive, life-changing experiences and a new understanding of how people with skin disorders experience daily life. This dissertation also addresses the role that the social institution of biomedicine plays in the creation of camps for children with severe and chronic skin disorders, as well as how the relationships of biomedical practitioners and adults with skin disorders at camp change the perceptions of each other. Ultimately, it is the overt goal that this dissertation educates all readers with respect to how people with skin disorders are often labeled as being disabled and suffer consequences of stigmatization related to disability, as well as increase awareness of how mainstream society affects the identities of this particular population. / Anthropology

[pt] A pele tem uma importância fundamental na nossa constituição psíquica. Através dos primeiros contatos de pele com a mãe ou ambiente maternante o bebê começa a formar as mais primitivas impressões acerca do corpo que lhe pertence e do mundo que o rodeia. Este estudo pretende mostrar que as afecções de pele refletem um desejo de retorno ou permanência no estado de indiferenciação com a mãe. Deste modo, parte-se do princípio que distorções no elo mãe-filho desde cedo não permitem ao mesmo vivenciar com naturalidade seu trajeto rumo à independência, nos termos de Winnicott, ou em direção à individuação, de acordo com Mahler. A falta de um ambiente bom o bastante dificulta a aquisição de uma experiência subjetiva de corpo. Por outro lado, abordam- se também os pressupostos da Escola de Psicossomática de Paris, segundo a qual, os processos que levam à vulnerabilidade psicossomática também estariam relacionados à falhas na estruturação desta ligação, resultando na insuficiência e/ ou desorganização das funções psíquicas. Portanto, com este objetivo pretende-se mostrar que as afecções de pele refletem uma falha nos processos de delimitação das fronteiras do corpo pela falta ou inadequação do investimento materno nos primeiros anos de vida, dificultando a experiência de unidade e coesão de seus processos internos e externos. Na parte final, procede-se à discussão de um caso clínico à luz das teorias anteriormente mencionadas. / [en] The skin is of basic importance to our psychic constitution. Through the first skin contacts with the mother or mothering environment the baby starts to form the most primitive impressions concerning the body that belongs to him/her as well as the world that surrounds it. This study intends to show that skin disorders reflect the desire of a return or permanence in the state of indiferenciation with the mother. In this way, based on distortions in the early mother-baby link, the child is not allowed to naturally live his passage towards independence, as per Winnicott, or towards individuation, according to Mahler. The lack of a good enough environment makes the acquisition of a subjective body experience difficult. On the other hand, principles of the school of psychoanalytic psychosomatics of Paris were used, according to which processes that lead to the psychosomatic vulnerability would also be related to imperfections in structuring this relationship, which would result in an insufficient and/or a disorganization of the psychic functions. Therefore with this objective in mind, it was intended to show that skin disorders reflect a failure in the process of delimitation of the body limits due to the lack or inadequate maternal investments in the first years of life, hindering an experience of oneness and cohesion of internal and external processes. In the final part of the dissertation a clinical case is discussed according to the theoretical background covered in this work.

Cannabidiol, a non-psychoactive constituent of cannabis, has garnered much attention after United States Food and Drug Administration approved Epidiolex® for oral use. Although therapeutic effect of cannabidiol after systemic absorption has been investigated extensively, its therapeutic potential in treating skin disorders after local delivery still needs further exploration. Our study has investigated the effect of cannabidiol concentration, chemical enhancers, and essential oils on percutaneous absorption of cannabidiol. In vitro permeation tests were conducted on human skin. The 24 h study results suggest no significant difference in amount of drug absorbed into skin, between 5% (242.41 ± 12.17 µg/cm) and 10% (232.79 ± 20.82 cm) cannabidiol solutions. However, 1% delivered (23.02 ± 4.74 µg/cm) significantly lower amount of drug into skin than 5% and 10%. Transcutol and isopropyl myristate did not enhance delivery of cannabidiol. However, oleic acid was found to be useful as chemical enhancer. Oleic acid (43.07 ± 10.11 µg/cm) had significantly higher cannabidiol delivery into skin than the group without oleic acid (10.98 ± 3.40 µg/cm) after a 4 h in vitro permeation study. Essential oils at concentrations tested had lower total cannabidiol delivery when compared to control. This study's findings will help guide future research on the pharmacological effect of percutaneously delivered cannabidiol on inflammatory skin disorders.