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We present the case of a 56 years old female, who referred to our clinic for the presence of 0.5–1 cm, asymptomatic, pale-white plaques, sharply delimited, and multiple milk-white macules, located on the dorsal hands. The lesions developed over a period of 12 months, gradually enlarging. The patient revealed she had multiple summer sun exposures and reported severe erythema and oedema on the presented lesions. The physical examination revealed no pathologic findings. The patient had no personal history of malignancy but suffered from arterial hypertension, dyslipidaemia receiving chronic treatment with antihypertensives and statin therapy. The topical treatment with high potency steroids was unsuccessful. We initiated topical therapy with piperine extract. The results were observed after 3 weeks of daily applications. The pattern of repigmentation consisted in pigmentation islands (Figs. 22.1a, b and 22.2a, b, c).

Although vitiligo is one of the most frequently occurring depigmentary disorder, its pathophysiology is still not fully clarified, resulting in the incapacity to find a targeted cure. Most of the treatment options available at the time have an anti-inflammatory or immunosuppressive effect, influencing the immune factor in vitiligo but without having a direct effect on melanocyte differentiation, migration or proliferation. This study shows that Piper nigrum (PN) extract and its main alkaloid, piperine, promote melanocyte proliferation in vivo, being consistent with previous study. A PN fruit extract and pure piperine were integrated in two different ointments and tested on human subjects affected by vitiligo. A number of 9 areas were treated: 3 using the extract, 3 using pure piperine, 1 using travoprost solution, and 2 using an association of travoprost (prostaglandin F2α analogue) solution and our products. Pigmentation was achieved in all the treated areas. The extract caused faster and more remarkable results than the pure piperine. The association of the travoprost solution speed up the process and changed the pigmentation pattern, especially when associated with the PN extract. Our early studies suggest that PN extract may represent, in the future, a new treatment option for vitiligo, especially considering the mild side effects of the tested products and the reduced amount of time needed for repigmentation. However, more studies are needed to validate this experimental data.

Background Clopidogrel is used in at-risk infants to prevent thrombotic complications. There is no commercially available liquid preparation and existing formulations have not been evaluated for the chiral stability of clopidogrel. Aim To determine the stability of clopidogrel 1 mg/mL liquid formulations using chiral chromatography. Method Clopidogrel 1 mg/mL suspension was formulated using Plavix (clopidogrel) tablets and Ora-Plus:Ora-Sweet 1:1, and stored at room temperature and under refrigeration. Samples were also prepared using a variety of co-solvents and stored at room temperature. Samples were taken for up to 49 days and assayed for S-clopidogrel, R-clopidogrel and S-acid using high-performance chiral liquid chromatography. Percentage of S-clopidogrel remaining (at least 90% of nominal content) and percentage of degradation product formation were used to estimate shelf-life. Results Only the refrigerated Ora-Plus:Ora-Sweet mixture did not have degradation products that exceeded USP limits for clopidogrel impurities for at least 30 days. The estimated shelf-lives of the Ora-Plus:Ora-Sweet mixtures at room temperature (25 °C) and under refrigeration (4 °C) were 19 and 37.5 days, respectively. There was no improvement in stability when mixtures were prepared using a variety of co-solvents. Conclusion Clopidogrel 1 mg/mL suspension made with Ora-Plus:Ora-Sweet and stored in amber glass bottles was stable for 1 month under refrigeration and 2 weeks at room temperature.