# Patent

## Title
Nonsteroidal immunomodulating kit and composition and uses thereof

## Abstract

Compositions and therapeutic kits including an aerosol container containing a foamable composition that includes a nonsteroidal immunomodulating agent are described. The foamable composition includes a liquid hydrophobic carrier; a surface-active agent; polymeric additive; water; and a propellant.

## Background
CROSS REFERENCE TO RELATED APPLICATIONS
This application is a continuation-in-part application of co-pending International Patent Application No. IB03/005527 designating the United States and filed on Oct. 24, 2003, which claims the benefit of priority under 35 U.S.C. §119(e) to U.S. Patent Application Ser. No. 60/429,546, filed on Nov. 29, 2002, both entitled “Cosmetic and Pharmaceutical Foam,” and which also claims the benefit of priority under 35 USC§119(a) to Israeli Patent Appl. No. 152486, filed Oct. 25, 2002, all of which are hereby incorporated in their entirety by reference.
This application is a continuation-in-part application of co-pending U.S. patent application Ser. No. 10/911,367, filed on Aug. 4, 2004, which claims the benefit of priority under 35 U.S.C. §119(e) to U.S. Patent Application Ser. No. 60/492,385, filed on Aug. 4, 2003, both entitled “Foam Carrier Containing Amphiphilic Copolymer Gelling Agent” and both hereby incorporated in their entirety by reference.


BACKGROUND OF THE INVENTION
Nonsteroidal immunomodulating agents have been used to relieve inflammation and mild to moderate pain; they are also used for fever and inflammation. Such drugs are usually administered systemically and most often by oral administration. The most common side effect occurring during therapy with certain immunomodulating agents are gastro-intestinal disturbances.
Certain nonsteroidal immunomodulating agents are also available in topical dosage form. Compositions containing nonsteroidal immunomodulating agents for topical treatment of dermatologic and gynecological disorders are available in cream, lotion gel and ointment forms. While semi-solid compositions, such as creams, lotions, gels and ointments are commonly used by consumers, new forms are desirable, in order to achieve better control of the application, while maintaining or bestowing the skin beneficial properties of such products. Thus, the development of new compositions, having breakable foam consistency when released from a container and liquid properties when applied onto the skin is advantageous.
Foams and, in particular, foam emulsions are complicated systems which do not form under all circumstances. Slight shifts in foam emulsion composition, such as by the addition of active ingredients, may destabilize the foam.
There have been a few attempts to create foams including anti-inflammatory agents. U.S. Pat. No. 6,126,920 discloses treatment of various skin diseases, and in particular, scalp psoriasis, using a foamable pharmaceutical composition containing a corticosteroid active substance, an aliphatic alcohol, water, a fatty alcohol, a surface-active agent, a propellant and a buffering agent. The foamable composition contains 40-90% composition of an aliphatic alcohol. Alcohols, and in particular the methyl, ethyl and isopropyl alcohols which are preferred in U.S. Pat. No. 6,126,920, are defatting and irritating agents and may cause skin to become dry and cracked. EP 0535327 B1 discloses a pharmaceutical composition containing (a) 4-biphenylacetic acid (Felbinac); and (b) a carrier which comprises water, ethanol, an aerosol propellant and an ethoxylated stearyl alcohol surfactant. The carrier is adapted to create a quick-break foam. EP 0 270 316 (A3) Patent describes topical compositions including 1-substituted imidazole and non-steroidal anti-inflammatory drugs for treatment of acne. U.S. Pat. No. 6,358,541 teaches preparations for the treatment of androgenetic alopecia comprise saw palmetto berry extract containing phytosterols and one or more low irritability constituents that enhance penetration of the extract into hair follicular pores, e.g., adapalene, tretinoin, retinaldehyde, tazarotene, salicylic acid, azelaic acid, and glycolic acid, wherein the preparation further contains a topical vehicle selected from the group consisting of liquid, gel, foam, styling mousse, styling hair tonic and styling hair spray. U.S. Pat. No. 5,171,577 relates to a process for the preparation of cosmetics or pharmaceutical foam by foaming with the aid of a propellant, the cosmetic or pharmaceutical product includes a dispersion of a water-immiscible phase dispersed in an aqueous medium stabilized with niosomes including one or more layers of a nonionic lipid compound encapsulating an aqueous phase. In certain embodiments, the product may contain at least one product selected from the group consisting of a vitamin, a hormone, an enzyme, a vaccine, an anti-inflammatory agent, an antibiotic, a bactericide, an antifungal agent, an agent to prevent hair loss, an agent to promote hair growth and additional active agents. U.S. Pat. No. 4,981,677 teaches a skin conditioning composition for application to the skin including an oil-in-water emulsion and a propellant including at least 10 percent by weight of petrolatum, at least 50 weight percent of water, an emulsifier having a hydrophilic-lipophilic Balance value of 6 to 10 and a starch or modified starch ester. U.S. Pat. No. 5,002,680 describes a mild skin-cleansing aerosol mousse-forming emulsion including a mild nonsoap anionic or amphoteric surfactant; a polymeric skin feel aid, a moisturizer (preferably glycerin); water; and a propellant. WO 00/15193 teaches a pharmaceutical foam composition including (a) an active ingredient; (b) an occlusive agent; (c) an aqueous solvent; and (d) an organic cosolvent; wherein the active ingredient is insoluble in water and insoluble in both water and the occlusive agent; and wherein there is enough occlusive agent to form an occlusive layer on the skin.
SUMMARY OF THE INVENTION
present invention provides a therapeutic kit for providing a safe and effective dosage of a nonsteroidal immunomodulating agent, including an aerosol packaging assembly including: a container accommodating a pressurized product, and an outlet capable of releasing the pressurized product as a foam, wherein the pressurized product includes a foamable composition including: a nonsteroidal immunomodulating agent, at least one organic carrier selected from the group consisting of a hydrophobic organic carrier, a polar solvent, an emollient and mixtures thereof, at a concentration of about 2% to about 50% by weight, a surface-active agent, about 0.01% to about 5% by weight of at least one polymeric additive selected from the group consisting of a bio-adhesive agent, a gelling agent, a film forming agent and a phase change agent, water, and liquefied or compressed gas propellant at a concentration of about 3% to about 25% by weight of the total composition.
According to further embodiments of the present invention the foamable composition is an emulsion.
According to still further embodiments of the present invention the foamable composition is selected from the group consisting of an oil-in-water emulsion and a water in oil emulsion.
According to still further embodiments of the present invention the foamable composition is substantially alcohol-free.
Preferably, the composition of the present invention further comprises a therapeutically active foam adjuvant is selected from the group consisting of a fatty alcohol having 15 or more carbons in their carbon chain, a fatty acid having 16 or more carbons in their carbon chain, a fatty alcohols, derived from beeswax and including a mixture of alcohols, a majority of which has at least 20 carbon atoms in their carbon chain, a fatty alcohol having at least one double bond, a fatty acid having at least one double bond, a branched fatty alcohol, a branched fatty acid, a fatty acid substituted with a hydroxyl group, cetyl alcohol, stearyl alcohol, arachidyl alcohol, behenyl alcohol, 1-triacontanol, hexadecanoic acid, stearic acid, arachidic acid, behenic acid, octacosanoic acid, 12-hydroxy stearic acid and mixtures thereof. The concentration of the therapeutically active foam adjuvant is in the range of about 0.1% to about 5% by weight.
According to further embodiments of the present invention the foamable composition further includes a second therapeutic agent selected from the group consisting of an anti-infective, an antibiotic, an antibacterial agent, an antifungal agent, an antiviral agent, an antiparasitic agent, an steroidal antiinflammatory agent, an immunosuppressive agent, an immunomodulator, an immunoregulating agent, a hormonal agent, vitamin A, a vitamin A derivative, vitamin B, a vitamin B derivative, vitamin C, a vitamin C derivative, vitamin D, a vitamin D derivative, vitamin E, a vitamin E derivative, vitamin F, a vitamin F derivative, vitamin K, a vitamin K derivative, a wound healing agent, a disinfectant, an anesthetic, an antiallergic agent, an alpha hydroxyl acid, lactic acid, glycolic acid, a beta-hydroxy acid, a protein, a peptide, a neuropeptide, a allergen, an immunogenic substance, a haptene, an oxidizing agent, an antioxidant, a dicarboxylic acid, azelaic acid, sebacic acid, adipic acid, fumaric acid, a NSAID, an antiproliferative agent, an anticancer agent, a photodynamic therapy agent, benzoyl chloride, calcium hypochlorite, magnesium hypochlorite, an anti-wrinkle agent, a radical scavenger, a metal, silver, a metal oxide, titanium dioxide, zinc oxide, zirconium oxide, iron oxide, silicone oxide, talc, carbon, an anti wrinkle agent, a skin whitening agent, a skin protective agent, a masking agent, an anti-wart agent, a refatting agent, a lubricating agent and mixtures thereof.
According to a second embodiment of the present invention there is provided a therapeutic foamable composition including: a nonsteroidal immunomodulating agent, a therapeutically active oil agent, a surface-active agent, a therapeutically active foam adjuvant, selected from the group consisting of a fatty alcohol, a fatty acid, a hydroxyl fatty acid, and mixtures thereof, about 0.01% to about 5% by weight of at least one polymeric additive selected from the group consisting of a bioadhesive agent, a gelling agent, a film forming agent and a phase change agent, water, and liquefied or compressed gas propellant at a concentration of about 3% to about 25% by weight of the total composition.
According to further embodiments of the present invention the foamable composition further includes a second therapeutic agent.
According to further embodiments of the present invention the composition does not contain petrolatum.
According to the present invention there is provided a method of producing a therapeutic kit, including a nonsteroidal immunomodulating agent, including: providing a foamable therapeutic composition including: a nonsteroidal immunomodulating agent at a therapeutically effective concentration, at least one organic carrier selected from a hydrophobic organic carrier, a polar solvent, an emollient and mixtures thereof, at a concentration of about 2% to about 50% by weight, a surface-active agent, about 0.01% to about 5% by weight of a polymeric additive selected from a bioadhesive agent, a gelling agent, a film forming agent and a phase change agent, and water, introducing the foamable composition in an aerosol packaging assembly, consisting of a container, suitable for containing a pressurized product and a valve, capable of extruding a foam, and introducing to the aerosol packaging assembly a liquefied or compressed gas propellant at a concentration of about 3% to about 25% by weight of the total composition.
According to the present invention there is also provided a method of treating, alleviating or preventing a disorders of the skin, a body cavity or mucosal surface, wherein the disorder involves inflammation as one of its etiological factors, including: administering topically to a subject having the disorder, a foamed composition including: a nonsteroidal immunomodulating agent, at least one organic carrier selected from a hydrophobic organic carrier, a polar solvent, an emollient and mixtures thereof, at a concentration of about 2% to about 50% by weight, about 0.1% to about 5% by weight of a surface-active agent, about 0.01% to about 5% by weight of a polymeric additive selected from a bioadhesive agent, a gelling agent, a film forming agent and a phase change agent, and water, wherein the nonsteroidal immunomodulating agent is administered in a therapeutically effective amount.
According to still further embodiments of the methods according to the present invention the disorder is selected from the group consisting of a dermatose, a dermatitis, a vaginal disorder, a vulvar disorder, an anal disorder, a disorder of a body cavity, an ear disorder, a disorder of the nose, a disorder of the respiratory system, a bacterial infection, fungal infection, viral infection, dermatosis, dermatitis, parasitic infections, disorders of hair follicles and sebaceous glands, scaling papular diseases, benign tumors, malignant tumors, reactions to sunlight, bullous diseases, pigmentation disorders, disorders of cornification, pressure sores, disorders of sweating, inflammatory reactions, xerosis, ichthyosis, allergy, burn, wound, cut, chlamydia infection, gonorrhea infection, hepatitis B, herpes, HIV/AIDS, human papillomavirus (HPV), genital warts, bacterial vaginosis, candidiasis, chancroid, granuloma Inguinale, lymphogranloma venereum, mucopurulent cervicitis (MPC), molluscum contagiosum, nongonococcal urethritis (NGU), trichomoniasis, vulvar disorders, vulvodynia, vulvar pain, yeast infection, vulvar dystrophy, vulvar intraepithelial neoplasia (VIN), contact dermatitis, osteoarthritis, joint pain, hormonal disorder, pelvic inflammation, endometritis, salpingitis, oophoritis, genital cancer, cancer of the cervix, cancer of the vulva, cancer of the vagina, vaginal dryness, dyspareunia, anal and rectal disease, anal abscess/fistula, anal cancer, anal fissure, anal warts, Crohn's disease, hemorrhoids, anal itch, pruritus ani, fecal incontinence, constipation, polyps of the colon and rectum, and wherein the disorder is responsive to treatment with the nonsteroidal immunomodulating agent.



BRIEF DESCRIPTION OF THE DRAWING
The invention is described with reference to the FIGURE which is presented for the purpose of illustration and are not intended to be limiting of the invention.
The FIGURE is a schematic illustration of an aerosol valve suitable for use in the aerosol packaging assembly according to in one or more embodiments of the invention.



DETAILED DESCRIPTION OF THE INVENTION
The present invention provides a therapeutic kit including a nonsteroidal immunomodulating agent (also termed herein “nonsteroidal anti-inflammatory agent” and “NSAID”). The kit includes an aerosol packaging assembly having a container accommodating a pressurized product and an outlet capable of releasing the pressurized product as a foam.
Aerosol Packaging Assembly
The aerosol packaging assembly typically includes a container suitable for accommodating a pressurized product and an outlet capable of releasing a foam. The outlet is typically a valve. The FIGURE illustrates a typical aerosol valve 100. The valve is made up of the valve cup 110 typically constructed from tinplated steel, or aluminum, an outer gasket 120, which is the seal between the valve cup and the aerosol can (not shown), a valve housing 130, which contains the valve stem 132, spring 134 and inner gasket 136, and a dip tube 140, which allows the liquid to enter valve. The valve stem is the tap through which the product flows. The inner gasket 136 covers the aperture 150 (hole) in the valve stem. The valve spring 134 is usually made of stainless steel.
The valve stem is fitted with small apertures 150 (also termed “orifices” and “holes”), through which the product flows. Valves may contain one, two, three, four or more apertures, depending on the nature of the product to be dispensed. In the closed position, the aperture(s) is covered by the inner gasket. When the actuator is depressed it pushes the valve stem through the inner gasket, and the aperture(s) is uncovered, allowing liquid to pass through the valve and into the actuator.
The valve can have a stem with 1 to 4 apertures, or 1 to 2 apertures. Each aperture can have a diameter of about 0.2 mm to about 1 mm, or a diameter of about 0.3 mm to about 0.8 mm. The total aperture area, i.e., the sum of areas of all apertures in a given stem, is between about 0.01 mm2 and 1 mm2 or the total aperture area is between about 0.04 mm2 and 0.5 mm2.
Pharmaceutical Composition
All % values are provided on a weight (w/w) basis.
According to one or more embodiments of the present invention, the foamable therapeutic composition for administration to the skin, a body surface, a body cavity or mucosal surface, e.g., the mucosa of the nose, mouth, eye, ear, respiratory system, vagina or rectum (severally and interchangeably termed herein “target site”) includes:

    
    
        (1) a nonsteroidal immunomodulating agent, wherein the amount of the nonsteroidal immunomodulating agent is effective in the treatment of a disorder of the target site;
        (2) at least one organic carrier selected from a hydrophobic organic carrier, a polar solvent, an emollient and mixtures thereof, at a concentration of about 2% to about 5%, or about 5% to about 10%; or about 10% to about 20%; or about 20% to about 50% by weight;
        (3) about 0.1% to about 5% by weight of a surface-active agent;
        (4) about 0.01% to about 5% by weight of at least one polymeric agent selected from a bioadhesive agent, a gelling agent, a film forming agent and a phase change agent; and
        (5) a liquefied or compressed gas propellant at a concentration of about 3% to about 25% by weight of the total composition.
    
    


Water and optional ingredients are added to complete the total mass to 100%. Upon release from an aerosol container, the foamable composition forms an expanded foam suitable for topical administration.
According to one or more embodiments, the foamable composition is substantially alcohol-free, i.e., free of short chain alcohols. Short chain alcohols, having up to 5 carbon atoms in their carbon chain skeleton and one hydroxyl group, such as ethanol, propanol, isopropanol, butanol, iso-butanol, t-butanol and pentanol, are considered less desirable solvents or polar solvents due to their skin-irritating effect. Thus, the composition is substantially alcohol-free and includes less than about 5% final concentration of lower alcohols, preferably less than about 2%, more preferably less than about 1%.
In one or more embodiments, at least a portion of the NSAID is suspended in the composition, yet, in other embodiments, the NSAID is dissolved in the composition.
In one or more embodiments, the foam composition is formulated as an oil-in-water emulsion or oil-in-water microemulsion.
In one or more embodiments, the concentration of surface-active agent about 0.1% to about 5%, or from about 0.2% to about 2%.
Inflammation is defined as “redness, swelling, and fever in a local area of the body, often with pain and disturbed function, in reaction to an infection or to a physical or chemical injury” (Random House Webster's Dictionary). Typical symptoms of disorders of the skin, body surfaces, body cavities and mucosal surfaces (e.g., the mucosa of the nose, mouth, eye, ear, respiratory system, vagina or rectum) that involve inflammation, as at least one of their etiological factors, include redness (rash, erythema), tissue thickening and/or swelling (oedema), itch (pruritus), blistering and exudate. Inflammatory disorders can by short term or long term (chronic). Inflammation typically involves overproduction of pro-inflammatory cytokines, such as TNF-alpha, TNF-beta, interleukin-1, interleukin-4, interleukin-6, interleukin-10, interleukin-12, IFN-gamma from T cells, or increased release of cytokines and pro-inflammatory mediators from mast cells.
In the context of the present invention, a nonsteroidal immunomodulating agent (also termed herein “nonsteroidal anti-inflammatory agent” and “NSAID”) is a pharmaceutically active compound, other than a corticosteroid, which affects the immune system in a fashion that results in a reduction, inhibition, prevention, amelioration or prevention of an inflammatory process and/or the symptoms of inflammation and or the production pro-inflammatory cytokines and other pro-inflammatory mediators, thereby treating or preventing a disease that involves inflammation.
In one or more embodiments, the NSAID is an inhibitor of the cyclooxygenase (COX) enzyme. Two forms of cyclooxygenase are known today: the constitutive cyclooxygenase (COX-1); and the inducible cyclooxygenase (COX-2), which is proinflammatory. Thus, in one or more embodiments of the present invention, the NSAID is selected from the group consisting of a COX-1 inhibitor, a COX-2 inhibitor or a non-selective NSAID, which simultaneously inhibits both COX-1 and COX-2.
In one or more embodiments, the NSAID is salicylic acid a salicylic acid derivatives. Exemplary salicylic acid derivative include, in a non limiting fashion, aspirin, sodium salicylate, choline magnesium trislicylate, salsalate, diflunisal, salicylsalicylic acid, sulfasalazine, olsalazine, esters of salicylic acid with a carboxylic acid, esters of salicylic acid with a dicarboxylic acid, esters of salicylic acid with a fatty acid, esters of salicylic acid with a hydroxyl fatty acid, esters of salicylic acid with an essential fatty acid, esters of salicylic acid with a polycarboxylic acid, and any compound wherein salicylic acid is linked to an organic moiety through a covalent bond.
In one or more embodiments, the NSAID is encapsulated in particles, microparticles, nanoparticles, microcapsules, microsphres, nanocapsules, nanospheres, liposomes, niosomes, polymer matrix, nanocrystals or microsponges.
In one or more embodiments, the NSAID is para-aminophenol (e.g., acetaminophen) and salts and derivatives thereof.
In one or more embodiments, the NSAID is an indole or an indole-acetic acid derivative (e.g., indomethacin, sulindac, etodolac) and salts and derivatives thereof.
In one or more embodiments, the NSAID is an aryl acetic acids (e.g., tolmetin, diclofenac, ketorolac) and salts and derivatives thereof.
In one or more embodiments, the NSAID is an arylpropionic acid and salts and derivatives thereof. Exemplary arylpropionic acid derivative include, in a non limiting fashion, are ibuprofen, naproxen, flubiprofen, ketoprofen, fenoprofen, oxaprozin.
In one or more embodiments, the NSAID is anthranilic acids or an anthranilic acid derivative, also termed “fenamates” (e.g., mefenamic acid, meclofenamic acid) and salts and derivatives thereof.
In one or more embodiments, the NSAID is selected from the group of enolic acids, enolic acid salts, enolic acid esters, amides, anhydrides and salts and derivatives thereof. Non-limiting examples of enolic acid derivatives include oxicams (piroxicam, tenoxicam) and pyrazolidinediones (phenylbutazone, oxyphenthratrazone)
Yet, in additional embodiments, the NSAID is an alkanone (e.g., nabumetone).
Selective COX-2 Inhibitors include, in an exemplary manner diaryl-substituted furanones (e.g., Rofecoxib); diaryl-substituted pyrazoles (e.g., Celecoxib); indole acetic acids (e.g., Etodolac); and sulfonanilides (e.g., Nimesulide) and salts and derivatives thereof.
Certain imidazole drugs (e.g., ketoconazole) also possess anti-inflammatory properties, (See: J Am Acad. Dermatol. 1991 August; 25(2 Pt 1):257-61).
Another group of nonsteroidal immunomodulating agents includes agents, which inhibit pro-inflammatory cytokines, such as TNF-alpha, TNF-beta, interleukin-1, interleukin-4, interleukin-6, interleukin-10, interleukin-12 and IFN-gamma from T cells, which are especially important in the induction of inflammation or inhibit the release of cytokines and pro-inflammatory mediators from mast cells.
Agents that are used to affect the untoward influence of pro-inflammatory cytokines are chemically or biologically-originated materials that suppress the pro-inflammatory effect of a pro-inflammatory cytokine via various mechanisms, including, but not limited to (a) inhibiting the formation of a pro-inflammatory cytokine; (b) suppressing the interaction of a pro-inflammatory cytokine with its receptors; or (c) neutralization the proinflammatory cytokine by direct or indirect interaction.
Examples of chemical anti TNF-α agents are known pharmaceutical materials, such as pentoxifylline, propentofylline, torbafylline (and other related xanthines), amiloride, chloroquine, thalidomide and structural analogs thereof. Examples for biological anti-TNF-α agents are anti-TNF-α antibodies and soluble TNF-α receptors. Additional compounds are those that impair the signal transduction cascade from the receptor to other functional organs of the living cell. Such active agents, as well additional compounds, which are capable of inhibiting the production or otherwise suppressing the pro-inflammatory effects of TNF-α can be used in the composition of the present invention.
Immunosuppressant agents, immunoregulating agents and immunomodulators constitute an additional class of nonsteroidal anti-inflammatory agents, which are used according to the present invention. Such agents are chemically or biologically-derived agents that modify the immune response or the functioning of the immune system (as by the stimulation of antibody formation or the inhibition of white blood cell activity). Immunosuppressant agents and immunomodulators include, among other options, cyclic peptides, such as cyclosporine, tacrolimus, tresperimus, pimecrolimus, sirolimus (rapamycin), verolimus, laflunimus, laquinimod and imiquimod. In one or more embodiments, the non steroidal immunomodulating agent is a calcineurin Inhibitor.
In one or more embodiments, the NSAID is a nitric oxide inhibitor. Nitric oxide (NO) is a potent secondary messenger that is both highly reactive and highly diffusible. It is generated physiologically by a family of enzymes, referred to as NO synthases (NOS). Overproduction of NO plays a key role in the pathology of a wide range of disorders including disorders that involve inflammation, and NOS inhibitors have been suggested as anti-inflammatory agents. Agents that neutralize NO (also called “NO scavengers”) are considered as potential anti-inflammatory agents as well.
Also useful are compounds that inhibit or slow down the migration of leucocytes (white blood cell), e.g., macrophages, neutrophils, and monocytes towards an afflicted skin surface or mucosal membrane, which is known to accelerate the inflammatory process.
Among other inhibitors of leucocyte chemoaxis, dicarboxylic acids, having between about 6 and about 14 carbon atoms in their carbon atom skeleton are particularly useful in the treatment of disorders of the skin and mucosal membranes that involve inflammation. Suitable dicarboxylic acid moieties include, but are not limited to, adipic acid, pimelic acid, suberic acid, azelaic acid, sebacic acid, 1,11-undecanedioic acid, 1,12-dodecanedioic acid, 1,13-tridecanedioic acid and 1,14-tetradecanedioic acid. Thus, in one or more embodiments of the present invention, dicarboxylic acids, having between about 6 and about 14 carbon atoms in their carbon atom skeleton, as well as their salts and derivatives (e.g., esters, amides, mercapto-derivatives, anhydraides), are useful immunomodulators in the treatment of disorders of the skin and mucosal membranes that involve inflammation. Azelaic acid and its salts and derivatives are preferred.
Certain preferred dicarboxylic acid derivatives include a dicarboxylic acid wherein at least one ester moiety of the compound comprises a keratolytic agent, selected from the group consisting of alpha-hydroxy acids and derivatives thereof, beta-hydroxy acids and derivatives thereof, hydroxybenzoic acid and their ester, anhydride and amine derivatives, alkylhydroxybenzoate, dihydroxy benzene and their ester, anhydride and amide derivatives, cresols and their ester, anhydride and amide derivatives. Keratolytic agents also include alcohol derivatives of Vitamin A (retinoic acid), e.g., retinol and derivatives thereof, as provided in U.S. Pat. No. 6,180,669. Additional preferred dicarboxylic acid derivatives comprise at least one ester of a active alcohol moiety, selected from the groups of steroid hormones, corticosteroids, vitamin E and vitamin D, as provided in U.S. patent application 20040191196.
Mixtures of these non-steroidal immunomodulators may also be employed according to the present invention.
Solubility of the nonsteroidal immunmodulating agent is an important factor in the development of a stable foamable composition according to the present invention. Thus, in one or more embodiments, the nonsteroidal immunmodulating agent is soluble in the aqueous phase of the emulsion; in other embodiments, wherein the agent possesses hydrophobic characteristics the agent is soluble in the oil phase of the emulsion. Yet, in additional embodiments, the nonsteroidal immunmodulating agent is difficult to solubilize in either the aqueous phase of the water phase and thus, it is suspended in the emulsion, which contains suspension-stabilizing agents, i.e., the polymeric agents that are listed herein. Thus, in certain embodiments of the present invention, the composition and properties of the aqueous phase of the emulsion (e.g., pH, electrolyte concentration and chelating agents) and/or the composition of the oil phase of the emulsion are adjusted to attain a desirable solubility profile of the active agent.
The NSAID is included in the composition of the present invention in a concentration that provides a desirable ratio between the efficacy and safety. Typically, NSAIDs are included in the composition in a concentration between about 0.05% and about 24%. However, in some embodiments, the concentration of between about 0.05% and about 2%, in other embodiment between about 2% and about 5%, and in additional embodiments between about 5% and about 12% or between about 12% and about 24%.
In one or more embodiments, the NSAID is a COX-1 inhibitor, at a concentration between about 0.05% and about 6%.
In one or more embodiments, the NSAID is a COX-2 inhibitor, at a concentration between about 0.05% and about 6%.
In one or more embodiments, the NSAID is diclofenac, at a concentration between about 0.05% and about 4%.
In one or more embodiments, the NSAID is piroxicam, at a concentration between about 0.05% and about 4%.
In one or more embodiments, the NSAID is selected from the group consisting of cyclosporine, tacrolimus, tresperimus, pimecrolimus, sirolimus (rapamycin), verolimus, laflunimus, laquinimod and imiquimod, at a concentration between about 0.05% and about 4%.
In one or more embodiments, the NSAID is a calcineurin Inhibitor, at a concentration between about 0.05% and about 4%.
In one or more embodiments, the NSAID is selected from the group consisting of dicarboxylic acids, having between about 6 and about 14 carbon atoms in their carbon atom skeleton, as well as their salts and derivatives thereof at a concentration between about 1% and about 24%.
In one or more embodiments, the NSAID is a dicarboxylic acid, salts and derivatives thereof at a concentration between about 1% and about 24%.
In one or more embodiments, the NSAID is azelaic acid, salts and derivatives thereof at a concentration between about 1% and about 24%.
In one or more embodiments, the NSAID is an inhibitor of a pro-inflammatory cytokine, at a concentration between about 0.01% and about 10%.
Several disorders of the skin, a body cavity or mucosal surface (e.g., the mucosa of the nose, mouth, eye, ear, vagina or rectum), involve a combination of inflammation and other etiological factors. For example, psoriasis involves inflammation, excessive cell proliferation and inadequate cell differentiation. Atopic dermatitis involves inflammation and skin dryness. Bacterial, fungal and viral infections involve pathogen colonization at the affected site and inflammation. Hence, in many cases, the inclusion of an additional therapeutic agent in the foamable pharmaceutical composition of the present invention, contributes to the clinical activity of the NSAID. Thus, in one or more embodiments, the foamable composition further includes at least one additional therapeutic agent, in a therapeutically effective concentration.
In one or more embodiments, the at least one additional therapeutic agent is selected from the group consisting of an anti-infective, an antibiotic, an antibacterial agent, an antifungal agent, an antiviral agent, an antiparasitic agent, an steroidal antiinflammatory agent, a nonsterolidal anti-inflammatory agent, an immunosuppressive agent, an immunomodulator, an immunoregulating agent, a hormonal agent, vitamin A, a vitamin A derivative, vitamin B, a vitamin B derivative, vitamin C, a vitamin C derivative, vitamin D, a vitamin D derivative, vitamin E, a vitamin E derivative, vitamin F, a vitamin F derivative, vitamin K, a vitamin K derivative, a wound healing agent, a disinfectant, an anesthetic, an antiallergic agent, an alpha hydroxyl acid, lactic acid, glycolic acid, a beta-hydroxy acid, a protein, a peptide, a neuropeptide, a allergen, an immunogenic substance, a haptene, an oxidizing agent, an antioxidant, a dicarboxylic acid, azelaic acid, sebacic acid, adipic acid, fumaric acid, a retinoid, an antiproliferative agent, an anticancer agent, a photodynamic therapy agent, an anti-wrinkle agent, a radical scavenger, a metal oxide (e.g., titanium dioxide, zinc oxide, zirconium oxide, iron oxide), silicone oxide, an anti wrinkle agent, a skin whitening agent, a skin protective agent, a masking agent, an anti-wart agent, a refatting agent, a lubricating agent and mixtures thereof.
In certain cases, the disorder to be treated involves unaesthetic lesions that need to be masked. For example, rosacea involves papules and pustules, which can be treated with the NSAID, as well as erythema, telangiectasia and redness, which do not respond to treatment with an NSAID. Thus, in one or more embodiments, the additional active agent is a masking agent, i.e., a pigment. Non limiting examples of suitable pigments include brown, yellow or red iron oxide or hydroxides, chromium oxides or hydroxides, titanium oxides or hydroxides, zinc oxide, FD&C Blue No. 1 aluminum lake, FD&C Blue No. 2 aluminum lake and FD&C Yellow No. 6 aluminum lake.
The foamable composition of the present invention can be an emulsion, or microemulsion, including an aqueous phase and an organic carrier phase. The organic carrier is selected from a hydrophobic organic carrier (also termed herein “hydrophobic solvent”), an emollient, a polar solvent, and a mixture thereof.
A “hydrophobic organic carrier” as used herein refers to a material having solubility in distilled water at ambient temperature of less than about 1 gm per 100 mL, more preferable less than about 0.5 gm per 100 mL, and most preferably less than about 0.1 gm per 100 mL. It is liquid at ambient temperature. The identification of a hydrophobic organic carrier or “hydrophobic solvent”, as used herein, is not intended to characterize the solubilization capabilities of the solvent for any specific active agent or any other component of the foamable composition. Rather, such information is provided to aid in the identification of materials suitable for use as a hydrophobic carrier in the foamable compositions described herein.
In one or more embodiments, the hydrophobic organic carrier is an oil, such as mineral oil. Mineral oil (Chemical Abstracts Service Registry number 8012-95-1) is a mixture of aliphatic, naphthalenic, and aromatic liquid hydrocarbons that derive from petroleum. It is typically liquid; its viscosity is in the range of between about 35 CST and about 100 CST (at 40° C.), and its pour point (the lowest temperature at which an oil can be handled without excessive amounts of wax crystals forming so preventing flow) is below 0° C. The term hydrophobic organic carrier does not include thick or semi-solid materials, such as white petrolatum, also termed “Vaseline”, which, in certain compositions is disadvantageous due to its waxy nature and semi-solid texture.
According to one or more embodiments, hydrophobic solvents are liquid oils originating from vegetable, marine or animal sources. Suitable liquid oil includes saturated, unsaturated or polyunsaturated oils. By way of example, the unsaturated oil may be olive oil, corn oil, soybean oil, canola oil, cottonseed oil, coconut oil, sesame oil, sunflower oil, borage seed oil, syzigium aromaticum oil, hempseed oil, herring oil, cod-liver oil, salmon oil, flaxseed oil, wheat germ oil, evening primrose oils or mixtures thereof, in any proportion.
Suitable hydrophobic solvents also include polyunsaturated oils containing poly-unsaturated fatty acids. In one or more embodiments, the unsaturated fatty acids are selected from the group of omega-3 and omega-6 fatty acids. Examples of such polyunsaturated fatty acids are linoleic and linolenic acid, gamma-linoleic acid (GLA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Such unsaturated fatty acids are known for their skin-conditioning effect, which contribute to the therapeutic benefit of the present foamable composition. Thus, the hydrophobic solvent can include at least 6% of an oil selected from omega-3 oil, omega-6 oil, and mixtures thereof. In the context of the present invention, oils that possess therapeutically-beneficial properties are termed “therapeutically active oil”.
Another class of hydrophobic solvents is the essential oils, which are also considered therapeutically active oil, which contain active biologically occurring molecules and, upon topical application, exert a therapeutic effect, which is conceivably synergistic to the beneficial effect of the NSAID in the composition.
Another class of therapeutically active oils includes liquid hydrophobic plant-derived oils, which are known to possess therapeutic benefits when applied topically.
Silicone oils also may be used and are desirable due to their known skin protective and occlusive properties. Suitable silicone oils include non-volatile silicones, such as polyalkyl siloxanes, polyaryl siloxanes, polyalkylaryl siloxanes and polyether siloxane copolymers, polydimethylsiloxanes (dimethicones) and poly(dimethylsiloxane)-(diphenyl-siloxane) copolymers. These are chosen from cyclic or linear polydimethylsiloxanes containing from about 3 to about 9, preferably from about 4 to about 5, silicon atoms. Volatile silicones such as cyclomethicones can also be used. Silicone oils are also considered therapeutically active oil, due to their barrier retaining and protective properties.
In one or more embodiments, the hydrophobic carrier includes at least 2% by weight silicone oil or at least 5% by weight.
The solvent may be a mixture of two or more of the above hydrophobic solvents in any proportion.
A further class of solvents includes “emollients” that have a softening or soothing effect, especially when applied to body areas, such as the skin and mucosal surfaces. Emollients are not necessarily hydrophobic. Examples of suitable emollients include hexyleneglycol, propylene glycol, isostearic acid derivatives, isopropyl palmitate, isopropyl isostearate, diisopropyl adipate, diisopropyl dimerate, maleated soybean oil, octyl palmitate, cetyl lactate, cetyl ricinoleate, tocopheryl acetate, acetylated lanolin alcohol, cetyl acetate, phenyl trimethicone, glyceryl oleate, tocopheryl linoleate, wheat germ glycerides, arachidyl propionate, myristyl lactate, decyl oleate, propylene glycol ricinoleate, isopropyl lanolate, pentaerythrityl tetrastearate, neopentylglycol dicaprylate/dicaprate, isononyl isononanoate, isotridecyl isononanoate, myristyl myristate, triisocetyl citrate, octyl dodecanol, sucrose esters of fatty acids, octyl hydroxystearate and mixtures thereof.
According to one or more embodiments of the present invention, the hydrophobic organic carrier includes a mixture of a hydrophobic solvent and an emollient. According to one or more embodiments, the foamable composition is a mixture of mineral oil and an emollient in a ratio between 2:8 and 8:2 on a weight basis.
A “polar solvent” is an organic solvent, typically soluble in both water and oil. Examples of polar solvents include polyols, such as glycerol (glycerin), propylene glycol, hexylene glycol, diethylene glycol, propylene glycol n-alkanols, terpenes, di-terpenes, tri-terpenes, terpen-ols, limonene, terpene-ol, 1-menthol, dioxolane, ethylene glycol, other glycols, sulfoxides, such as dimethylsulfoxide (DMSO), dimethylformanide, methyl dodecyl sulfoxide, dimethylacetamide, monooleate of ethoxylated glycerides (with 8 to 10 ethylene oxide units), azone (1-dodecylazacycloheptan-2-one), 2-(n-nonyl)-1,3-dioxolane, esters, such as isopropyl myristate/palmitate, ethyl acetate, butyl acetate, methyl proprionate, capric/caprylic triglycerides, octylmyristate, dodecyl-myristate; myristyl alcohol, lauryl alcohol, lauric acid, lauryl lactate ketones; amides, such as acetamide oleates such as triolein; various alkanoic acids such as caprylic acid; lactam compounds, such as azone; alkanols, such as dialkylamino acetates, and admixtures thereof.
According to one or more embodiments, the polar solvent is a polyethylene glycol (PEG) or PEG derivative that is liquid at ambient temperature, including PEG200 (MW (molecular weight) about 190-210 kD), PEG300 (MW about 285-315 kD), PEG400 (MW about 380-420 kD), PEG600 (MW about 570-630 kD) and higher MW PEGs such as PEG 4000, PEG 6000 and PEG 10000 and mixtures thereof.
The polymeric agent serves to stabilize the foam composition and to control drug residence in the target organ. Exemplary polymeric agents, are classified below in a non-limiting manner. In certain cases, a given polymer can belong to more than one of the classes provided below.
In one or more embodiments, the composition of the present invention includes at least one gelling agent. A gelling agent controls the residence of a therapeutic composition in the target site of treatment by increasing the viscosity of the composition, thereby limiting the rate of its clearance from the site. Many gelling agents are known in the art to possess mucoadhesive properties.
The gelling agent can be a natural gelling agent, a synthetic gelling agent and an inorganic gelling agent. Exemplary gelling agents that can be used in accordance with one or more embodiments of the present invention include, for example, naturally-occurring polymeric materials, such as locust bean gum, sodium alginate, sodium caseinate, egg albumin, gelatin agar, carrageenin gum, sodium alginate, xanthan gum, quince seed extract, tragacanth gum, guar gum, starch, chemically modified starches and the like, semi-synthetic polymeric materials such as cellulose ethers (e.g. hydroxyethyl cellulose, methyl cellulose, carboxymethyl cellulose, hydroxy propylmethyl cellulose), guar gum, hydroxypropyl guar gum, soluble starch, cationic celluloses, cationic guars, and the like, and synthetic polymeric materials, such as carboxyvinyl polymers, polyvinylpyrrolidone, polyvinyl alcohol, polyacrylic acid polymers, polymethacrylic acid polymers, polyvinyl acetate polymers, polyvinyl chloride polymers, polyvinylidene chloride polymers and the like. Mixtures of the above compounds are contemplated.
Further exemplary gelling agents include the acrylic acid/ethyl acrylate copolymers and the carboxyvinyl polymers sold, for example, by the B. F. Goodrich Company under the trademark of Carbopol® resins. These resins consist essentially of a colloidal water-soluble polyalkenyl polyether crosslinked polymer of acrylic acid crosslinked with from 0.75% to 2% of a crosslinking agent such as polyallyl sucrose or polyallyl pentaerythritol. Examples include Carbopol® 934, Carbopol® 940, Carbopol® 950, Carbopol® 980, Carbopol® 951 and Carbopol®) 981. Carbopole 934 is a water-soluble polymer of acrylic acid crosslinked with about 1% of a polyallyl ether of sucrose having an average of about 5.8 allyl groups for each sucrose molecule.
In one or more embodiment, the composition of the present invention includes at least one polymeric agent, which is a water-soluble cellulose ether. Preferably, the water-soluble cellulose ether is selected from the group consisting of methylcellulose, hydroxypropyl cellulose, hydroxypropyl methylcellulose (Methocel), hydroxyethyl cellulose, methylhydroxyethylcellulose, methylhydroxypropylcellulose, hydroxyethylcarboxymethylcellulose, carboxymethylcellulose and carboxymethylhydroxyethylcellulose. More preferably, the water-soluble cellulose ether is selected from the group consisting of methylcellulose, hydroxypropyl cellulose and hydroxypropyl methylcellulose (Methocel). In one or more embodiments, the composition includes a combination of a water-soluble cellulose ether; and a naturally-occurring polymeric materials, selected from the group including xanthan gum, guar gum, carrageenan gum, locust bean gum and tragacanth gum.
Yet, in other embodiments, the gelling agent includes inorganic gelling agents, such as silicone dioxide (fumed silica).
Mucoadhesive/bioadhesion has been defined as the attachment of synthetic or biological macromolecules to a biological tissue. Mucoadhesive agents are a class of polymeric biomaterials that exhibit the basic characteristic of a hydrogel, i.e. swell by absorbing water and interacting by means of adhesion with the mucous that covers epithelia. Compositions of the present invention may contain a mucoadhesive macromolecule or polymer in an amount sufficient to confer bioadhesive properties. The bioadhesive macromolecule enhances the delivery of biologically active agents on or through the target surface. The mucoadhesive macromolecule may be selected from acidic synthetic polymers, preferably having at least one acidic group per four repeating or monomeric subunit moieties, such as poly(acrylic)- and/or poly(methacrylic) acid (e.g., Carbopol®, Carbomer®), poly(methylvinyl ether/maleic anhydride) copolymer, and their mixtures and copolymers; acidic synthetically modified natural polymers, such as carboxymethylcellulose (CMC); neutral synthetically modified natural polymers, such as (hydroxypropyl)methylcellulose; basic amine-bearing polymers such as chitosan; acidic polymers obtainable from natural sources, such as alginic acid, hyaluronic acid, pectin, gum tragacanth, and karaya gum; and neutral synthetic polymers, such as polyvinyl alcohol or their mixtures. An additional group of mucoadhesive polymers includes natural and chemically modified cyclodextrin, especially hydroxypropyl-β-cyclodextrin. Such polymers may be present as free acids, bases, or salts, usually in a final concentration of about 0.01% to about 0.5% by weight.
A suitable bioadhesive macromolecule is the family of acrylic acid polymers and copolymers, (e.g., Carbopol®). These polymers contain the general structure —[CH2—CH(COOH)—]n. Hyaluronic acid and other biologically-derived polymers may be used.
Exemplary bioadhesive or mucoadhesive macromolecules have a molecular weight of at least 50 kDa, or at least 300 kDa, or at least 1,000 kDa. Favored polymeric ionizable macromolecules have not less than 2 mole percent acidic groups (e.g., COOH, SO3H) or basic groups (NH2, NRH, NR2), relative to the number of monomeric units. The acidic or basic groups can constitute at least 5 mole percent, or at least 10 mole percent, or at least 25, at least 50 more percent, or even up to 100 mole percent relative to the number of monomeric units of the macromolecule.
Yet, another group of mucoadhesive agent includes inorganic gelling agents such as silicon dioxide (fumed silica), including but not limited to, AEROSIL 200 (DEGUSSA).
Many mucoadhesive agents are known in the art to also possess gelling properties.
The foam composition may contain a film forming component. The film forming component may include at least one water-insoluble alkyl cellulose or hydroxyalkyl cellulose. Exemplary alkyl cellulose or hydroxyalkyl cellulose polymers include ethyl cellulose, propyl cellulose, butyl cellulose, cellulose acetate, hydroxypropyl cellulose, hydroxybutyl cellulose, and ethylhydroxyethyl cellulose, alone or in combination. In addition, a plasticizer or a cross linking agent may be used to modify the polymer's characteristics. For example, esters such as dibutyl or diethyl phthalate, amides such as diethyidiphenyl urea, vegetable oils, fatty acids and alcohols such as oleic and myristyl acid may be used in combination with the cellulose derivative.
In one or more embodiments, the composition of the present invention includes a phase change polymer, which alters the composition behavior from fluid-like prior to administration to solid-like upon contact with the target mucosal surface. Such phase change results from external stimuli, such as changes in temperature or pH and exposure to specific ions (e.g., Ca2+).
Non-limiting examples of phase change polymers include poly(N-isopropylamide) and Poloxamer 407®.
The polymeric agent is present in an amount in the range of about 0.01% to about 5.0% by weight of the foam composition. In one or more embodiments, it is typically less than about 1 wt % of the foamable composition.
Surface-active agents (also termed “surfactants”) include any agent linking oil and water in the composition, in the form of emulsion. A surfactant's hydrophilic/lipophilic balance (HLB) describes the emulsifier's affinity toward water or oil. The HLB scale ranges from 1 (totally lipophilic) to 20 (totally hydrophilic), with 10 representing an equal balance of both characteristics. Lipophilic emulsifiers form water-in-oil (w/o) emulsions; hydrophilic surfactants form oil-in-water (o/w) emulsions. The HLB of a blend of two emulsifiers equals the weight fraction of emulsifier A times its HLB value plus the weight fraction of emulsifier B times its HLB value (weighted average).
According to one or more embodiments of the present invention, the surface-active agent has a hydrophilic lipophilic balance (HLB) between about 9 and about 14, which is the required HLB (the HLB required to stabilize an O/W emulsion of a given oil) of most oils and hydrophobic solvents. Thus, in one or more embodiments, the composition contains a single surface active agent having an HLB value between about 9 and 14, and in one or more embodiments, the composition contains more than one surface active agent and the weighted average of their HLB values is between about 9 and about 14. Yet, in other embodiments, when a water in oil emulsion is desirable, the composition contains one or more surface active agents, having an HLB value between about 2 and about 9.
The surface-active agent is selected from anionic, cationic, nonionic, zwitterionic, amphoteric and ampholytic surfactants, as well as mixtures of these surfactants. Such surfactants are well known to those skilled in the therapeutic and cosmetic formulation art. Nonlimiting examples of possible surfactants include polysorbates, such as polyoxyethylene (20) sorbitan monostearate (Tween 60) and poly(oxyethylene) (20) sorbitan monooleate (Tween 80); poly(oxyethylene) (POE) fatty acid esters, such as Myrj 45, Myrj 49, Myrj 52 and Myrj 59; poly(oxyethylene) alkylyl ethers, such as poly(oxyethylene) cetyl ether, poly(oxyethylene) palmityl ether, polyethylene oxide hexadecyl ether, polyethylene glycol cetyl ether, brij 38, brij 52, brij 56 and brij W1; sucrose esters, partial esters of sorbitol and its anhydrides, such as sorbitan monolaurate and sorbitan monolaurate; mono or diglycerides, isoceteth-20, sodium methyl cocoyl taurate, sodium methyl oleoyl taurate, sodium lauryl sulfate, triethanolamine lauryl sulfate and betaines.
In one or more embodiments of the present invention, the surface-active agent includes at least one non-ionic surfactant. Ionic surfactants are known to be irritants. Therefore, non-ionic surfactants are preferred in applications including sensitive tissue such as found in most mucosal tissues, especially when they are infected or inflamed. We have surprisingly found that non-ionic surfactants alone provide foams of excellent quality, i.e. a score of “E” according to the grading scale discussed herein below.
In one or more embodiments, the surface active agent includes a mixture of at least one non-ionic surfactant and at least one ionic surfactant in a ratio in the range of about 100:1 to 6:1. In one or more embodiments, the non-ionic to ionic surfactant ratio is greater than about 6:1, or greater than about 8:1; or greater than about 14:1, or greater than about 16:1, or greater than about 20:1.
In one or more embodiments of the present invention, a combination of a non-ionic surfactant and an ionic surfactant (such as sodium lauryl sulphate and cocamidopropylbetaine) is employed, at a ratio of between 1:1 and 20:1, or at a ratio of 4:1 to 10:1. The resultant foam has a low specific gravity, e.g., less than 0.1 g/ml.
It has been surprisingly discovered that the stability of the composition is especially pronounced when a combination of at least one non-ionic surfactant having HLB of less than 9 and at least one non-ionic surfactant having HLB of equal or more than 9 is employed. The ratio between the at least one non-ionic surfactant having HLB of less than 9 and the at least one non-ionic surfactant having HLB of equal or more than 9, is between 1:8 and 8:1, or at a ratio of 4:1 to 1:4. The resultant HLB of such a blend of at least two emulsifiers is between about 9 and about 14.
Thus, in an exemplary embodiment, a combination of at least one non-ionic surfactant having HLB of less than 9 and at least one non-ionic surfactant having HLB of equal or more than 9 is employed, at a ratio of between 1:8 and 8:1, or at a ratio of 4:1 to 1:4, wherein the HLB of the combination of emulsifiers is between about 9 and about 14.
In one or more embodiments of the present invention, the surface-active agent includes mono-, di- and tri-esters of sucrose with fatty acids (sucrose esters), prepared from sucrose and esters of fatty acids or by extraction from sucro-glycerides. Suitable sucrose esters include those having high monoester content, which have higher HLB values.
The total surface active agent is in the range of about 0.1 to about 5% of the foamable composition, and is typically less than about 2% or less than about 1%.
Preferably, a therapeutically effective foam adjuvant is included in the foamable compositions of the present invention to increase the foaming capacity of surfactants and/or to stabilize the foam. In one or more embodiments of the present invention, the foam adjuvant agent includes fatty alcohols having 15 or more carbons in their carbon chain, such as cetyl alcohol and stearyl alcohol (or mixtures thereof). Other examples of fatty alcohols are arachidyl alcohol (C20), behenyl alcohol (C22), 1-triacontanol (C30), as well as alcohols with longer carbon chains (up to C50). Fatty alcohols, derived from beeswax and including a mixture of alcohols, a majority of which has at least 20 carbon atoms in their carbon chain, are especially well suited as foam adjuvant agents. The amount of the fatty alcohol required to support the foam system is inversely related to the length of its carbon chains. Foam adjuvants, as defined herein are also useful in facilitating improved spreadability and absorption of the composition.
In one or more embodiments of the present invention, the foam adjuvant agent includes fatty acids having 16 or more carbons in their carbon chain, such as hexadecanoic acid (Cl6) stearic acid (Cl8), arachidic acid (C20), behenic acid (C22), octacosanoic acid (C28), as well as fatty acids with longer carbon chains (up to C50), or mixtures thereof. As for fatty alcohols, the amount of fatty acids required to support the foam system is inversely related to the length of its carbon chain.
In one or more embodiments, a combination of a fatty acid and a fatty ester is employed.
Optionally, the carbon atom chain of the fatty alcohol or the fatty acid may have at least one double bond. A further class of foam adjuvant agent includes a branched fatty alcohol or fatty acid. The carbon chain of the fatty acid or fatty alcohol also can be substituted with a hydroxyl group, such as 12-hydroxy stearic acid.
An important property of the fatty alcohols and fatty acids used in context of the composition of the present invention is related to their therapeutic properties per se. Long chain saturated and mono unsaturated fatty alcohols, e.g., stearyl alcohol, erucyl alcohol, arachidyl alcohol and behenyl alcohol (docosanol) have been reported to possess antiviral, antiinfective, antiproliferative and antiinflammatory properties (see, for example, U.S. Pat. No. 4,874,794). Longer chain fatty alcohols, e.g., tetracosanol, hexacosanol, heptacosanol, octacosanol, triacontanol, etc., are also known for their metabolism modifying properties and tissue energizing properties. Long chain fatty acids have also been reported to possess anti-infective characteristics.
Thus, in preferred embodiments of the present invention, a combined and enhanced therapeutic effect is attained by including both a nonsteroidal immunomodulating agent and a therapeutically effective foam adjuvant in the same composition, thus providing a simultaneous anti-inflammatory and antiinfective effect from both components. Furthermore, in a further preferred embodiment, the composition concurrently comprises a nonsteroidal immunomodulating agent, a therapeutically effective foam adjuvant and a therapeutically active oil, as detailed above. Such combination provides an even more enhanced therapeutic benefit. Thus, the foamable carrier, containing the foam adjuvant provides an extra therapeutic benefit in comparison with currently used vehicles, which are inert and non-active.
The foam adjuvant according to preferred embodiments of the present invention includes a mixture of fatty alcohols, fatty acids and hydroxy fatty acids and derivatives thereof in any proportion, providing that the total amount is 0.1% to 5% (w/w) of the carrier mass. More preferably, the total amount is 0.4%-2.5% (w/w) of the carrier mass.
The therapeutic foam of the present invention may further optionally include a variety of formulation excipients, which are added in order to fine-tune the consistency of the formulation, protect the formulation components from degradation and oxidation and modify their consistency. Such excipients may be selected, for example, from stabilizing agents, antioxidants, humectants, preservatives, colorant and odorant agents and other formulation components, used in the art of formulation.
Aerosol propellants are used to generate and administer the foamable composition as a foam. The total composition including propellant, foamable compositions and optional ingredients is referred to as the foamable carrier. The propellant makes up about 3% to about 25 wt % of the foamable carrier. Examples of suitable propellants include volatile hydrocarbons such as butane, propane, isobutane or mixtures thereof, and fluorocarbon gases.
Composition and Foam Physical Characteristics
A pharmaceutical or cosmetic composition manufactured using the foam carrier according to one or more embodiments of the present invention is very easy to use. When applied onto the afflicted body surface of mammals, i.e., humans or animals, it is in a foam state, allowing free application without spillage. Upon further application of a mechanical force, e.g., by rubbing the composition onto the body surface, it freely spreads on the surface and is rapidly absorbed.
The foam composition of the present invention creates a stable emulsion having an acceptable shelf-life of at least one year, or at least two years at ambient temperature. A feature of a product for cosmetic or medical use is long term stability. Propellants, which are a mixture of low molecular weight hydrocarbons, tend to impair the stability of emulsions. It has been observed, however, that emulsion foam compositions according to the present invention are surprisingly stable. Following accelerated stability studies, they demonstrate desirable texture; they form fine bubble structures that do not break immediately upon contact with a surface, spread easily on the treated area and absorb quickly.
The composition should also be free flowing, to allow it to flow through the aperture of the container, e.g., and aerosol container, and create an acceptable foam. Compositions containing semi-solid hydrophobic solvents, e.g., white petrolatum, as the main ingredients of the oil phase of the emulsion, exhibit high viscosity and poor flowability and are inappropriate candidates for a foamable composition.
Foam quality can be graded as follows:

    
    
        Grade E (excellent): very rich and creamy in appearance, does not show any bubble structure or shows a very fine (small) bubble structure; does not rapidly become dull; upon spreading on the skin, the foam retains the creaminess property and does not appear watery.
        Grade G (good): rich and creamy in appearance, very small bubble size, “dulls” more rapidly than an excellent foam, retains creaminess upon spreading on the skin, and does not become watery.
        Grade FG (fairly good): a moderate amount of creaminess noticeable, bubble structure is noticeable; upon spreading on the skin the product dulls rapidly and becomes somewhat lower in apparent viscosity.
        Grade F (fair): very little creaminess noticeable, larger bubble structure than a “fairly good” foam, upon spreading on the skin it becomes thin in appearance and watery.
        Grade P (poor): no creaminess noticeable, large bubble structure, and when spread on the skin it becomes very thin and watery in appearance.
        Grade VP (very poor): dry foam, large very dull bubbles, difficult to spread on the skin.
    
    


Topically administratable foams are typically of quality grade E or G, when released from the aerosol container. Smaller bubbles are indicative of more stable foam, which does not collapse spontaneously immediately upon discharge from the container. The finer foam structure looks and feels smoother, thus increasing its usability and appeal.
As further aspect of the foam is breakability. The breakable foam is thermally stable, yet breaks under sheer force. Sheer-force breakability of the foam is clearly advantageous over thermally-induced breakability. Thermally sensitive foams immediately collapse upon exposure to skin temperature and, therefore, cannot be applied on the hand and afterwards delivered to the afflicted area.
Another property of the foam is specific gravity, as measured upon release from the aerosol can. Typically, foams have specific gravity of less than 0.1 g/mL or less than 0.05 g/mL.
Fields of Pharmaceutical Applications
By including an appropriate nonsteroidal immunomodulating agent and optional active agents in the compositions of the present invention, the composition are useful in treating a patient having any one of a variety of dermatological disorders, which include inflammation as one or their etiological factors (also termed “dermatoses”), such as classified in a non-limiting exemplary manner according to the following groups:

    
    
        Dermatitis including contact dermatitis, atopic dermatitis, seborrheic dermatitis, nummular dermatitis, chronic dermatitis of the hands and feet, generalized exfoliative dermatitis, stasis dermatitis; lichen simplex chronicus; diaper rash;
        Bacterial infections including cellulitis, acute lymphangitis, lymphadenitis, erysipelas, cutaneous abscesses, necrotizing subcutaneous infections, staphylococcal scalded skin syndrome, folliculitis, furuncles, hidradenitis suppurativa, carbuncles, paronychial infections, erythrasma;
        Fungal Infections including dermatophyte infections, yeast Infections; parasitic Infections including scabies, pediculosis, creeping eruption;
        Viral Infections;
        Disorders of hair follicles and sebaceous glands including acne, rosacea, perioral dermatitis, hypertrichosis (hirsutism), alopecia, including male pattern baldness, alopecia areata, alopecia universalis and alopecia totalis; pseudofolliculitis barbae, keratinous cyst;
        Scaling papular diseases including psoriasis, pityriasis rosea, lichen planus, pityriasis rubra pilaris;
        Benign tumors including moles, dysplastic nevi, skin tags, lipomas, angiomas, pyogenic granuloma, seborrheic keratoses, dermatofibroma, keratoacanthoma, keloid;
        Malignant tumors including basal cell carcinoma, squamous cell carcinoma, malignant melanoma, paget's disease of the nipples, kaposi's sarcoma;
        Reactions to sunlight including sunburn, chronic effects of sunlight, photosensitivity;
        Bullous diseases including pemphigus, bullous pemphigoid, dermatitis herpetiformis, linear immunoglobulin A disease;
        Pigmentation disorders including hypopigmentation such as vitiligo, albinism and postinflammatory hypopigmentation and hyperpigmentation such as melasma (chloasma), drug-induced hyperpigmentation, postinflammatory hyperpigmentation;
        Disorders of cornification including ichthyosis, keratosis pilaris, calluses and corns, actinic keratosis;
        Pressure sores;
        Disorders of sweating; and
        Inflammatory reactions including drug eruptions, toxic epidermal necrolysis; erythema multiforme, erythema nodosum, granuloma annulare.
    
    


According to one or more embodiments of the present invention, the compositions are also useful in the therapy of non-dermatological disorders by providing transdermal delivery of an active nonsteroidal immunomodulating agent that is effective against non-dermatological disorders.
The same advantage is expected when the composition is topically applied to a body cavity or mucosal surface (e.g., the mucosa of the nose, mouth, eye, ear, vagina or rectum) to treat conditions such as chlamydia infection, gonorrhea infection, hepatitis B, herpes, HIV/AIDS, human papillomavirus (HPV), genital warts, bacterial vaginosis, candidiasis, chancroid, granuloma Inguinale, lymphogranuloma venereum, mucopurulent cervicitis (MPC), molluscum contagiosum, nongonococcal urethritis (NGU), trichomoniasis, vulvar disorders, vulvodynia, vulvar pain, yeast infection, vulvar dystrophy, vulvar intraepithelial neoplasia (VIN), contact dermatitis, pelvic inflammation, endometritis, salpingitis, oophoritis, genital cancer, cancer of the cervix, cancer of the vulva, cancer of the vagina, vaginal dryness, dyspareunia, anal and rectal disease, anal abscess/fistula, anal cancer, anal fissure, anal warts, Crohn's disease, hemorrhoids, anal itch, pruritus ani, fecal incontinence, constipation, polyps of the colon and rectum.
The following examples exemplify the therapeutic kits and pharmacological compositions and methods described herein. The examples are for the purposes of illustration only and are not intended to be limiting of the invention.
Example 1—Oil in Water Foamable Compositions ( ̃12% oil) Including Dicarboxylic Acids and Derivatives Thereof













Composition No:












AZ-1
DA-2
DA-3
DA-4








Ingredient
%














Azelaic acid
15.00





Dimethyl azelate

10.00


Di(ethyl salicylate) azelate 


10.00


(TU-2100)


Sebacic acid



10.00


Mineral oil
5.60
5.60
5.60
5.60


Isopropyl palmitate
5.60
5.60
5.60
5.60


Sorbitan stearate (Span 60)
2.00
2.00
2.00
2.00


PPG15-stearyl ether
1.00
1.00
1.00
1.00


Stearic acid
0.85
0.85
0.85
0.85


Glyceryl monostearate
0.45
0.45
0.45
0.45


Xanthan gum
0.26
0.26
0.26
0.26


Methocel K100M
0.26
0.26
0
0


Preservative
0.25
0.25
0.25
0.25


Propellant
10.00
10.00
10.00
10.00


Water
To 100
To 100
To 100
To 100









Example 2—Oil in Water Foamable Compositions ( ̃30% oil) Including Dicarboxylic Acids and Derivatives Thereof













Composition No:












AZ-2
DA-5
DA-6
DA-7








Ingredient
%














Azelaic acid
15.00





Dimethyl azelate

5.00


Di(ethyl salicylate) azelate


10.00


(TU-2100)


Sebacic acid



10.00


MCT oil
30.00
30.00
30.00
30.00


Glyceryl monostearate
0.50
0.50
0.50
0.50


Stearyl alcohol
1.00
1.00
1.00
1.00


Xanthan gum
0.30
0.30
0.30
0.30


Methocel K100M
0.30
0.30
0.30
0.30


Polysorbate 80
1.00
1.00
1.00
1.00


PEG-40 stearate
3.00
3.00
3.00
3.00


Cocamidopropyl betaine
0.50
0.50
0.50
0.50


Preservative
0.25
0.25
0.25
0.25


Propellant
16.00
16.00
16.00
16.00


Water
To 100
To 100
To 100
To 100









Example 3—COX Inhibitor Oil in Water Foamable Compositions













Composition No:













CX-1
CX-2
CX-3
CX-4
CX-5








Ingredient
%















Ethyl salicylate
4.00






Diclofenac

1.00
3.00


Salicylic acid



2.00
5.00


Mineral oil
5.60
5.60
5.60
5.60
5.60


Capric caprylic
5.60
5.60
5.60
5.60
5.60


triglyceride


PEG-40 stearate
2.80
2.80
2.80
2.80
2.80


Propylene glycol
—
2.00
—
—
—


Polysorbate 80
0.90
0.90
0.90
0.90
0.90


Stearic acid
0.90
0.90
0.90
0.90
0.90


Glyceryl monostearate
0.45
0.45
0.45
0.45
0.45


Xanthan gum
0.28
0.28
0.28
0.28
0.28


Methocel K100M
0.28
0.28
0.28
—
—


Preservative
0.25
0.25
0.25
0.25
0.25


Propellant
8.00
8.00
8.00
8.00
8.00


Water
To 100
To 100
To 100
To 100
To 100









Example 4—Ketoconazole Oil in Water Compositions













Composition Code:














KF-1
KF-2
KF-3
KF-4
KF-5
KF-6








Ingredient
%
















Ketoconazole
0.01
0.10
0.20
0.30
0.50
1.00


Water
72.82
71.83
71.73
72.53
72.33
71.83


Mineral oil
14.10
15.00
15.00
14.10
14.10
14.10


Span 60
2.00
2.00
2.00
2.00
2.00
2.00


PPG15-
1.00
1.00
1.00
1.00
1.00
1.00


stearyl ether


Stearic acid
0.85
0.85
0.85
0.85
0.85
0.85


Glyceryl
0.45
0.45
0.45
0.45
0.45
0.45


monostearate


Xanthan gum
0.26
0.26
0.26
0.26
0.26
0.26


Methocel
0.26
0.26
0.26
0.26
0.26
0.26


K100M


Phenochem
0.25
0.25
0.25
0.25
0.25
0.25


Propellant
8.00
8.00
8.00
8.00
8.00
8.00


Water
100
100
100
100
100
100







Composition Properties













Emulsion color
White
White
White
White
White
White


Foam Density
0.06
0.23
0.33
0.12
0.16
0.16









Example 5—Water in Oil Diclofenac Sodium Compositions













Composition Code:












DC3
DC4
DC5
D3IC3








Ingredient
%














Diclofenac sodium (active agent)
1.00
1.00
1.00
3.00


Transcutol P (Penetration
8.00


enhancer)


Propylene glycol (Penetration

3.00


enhancer)


Mineral oil
5.60
5.60
5.60
5.60


Isopropyl myristate
5.60
5.60
5.60
5.60


Glyceryl monostearate



0.45


Stearyl alcohol
0.85
0.85
0.85
0.85


Xanthan gum
0.25
0.25
0.25
0.26


Hydroxypropyl methylcellulose
0.25
0.25
0.25


Polysorbate 80
0.85
0.85
0.85


Polysorbate 60



0.90


PEG-40 stearate
2.50
2.50
2.50
2.60


Polyoxyethylene (2) Stearyl Ether



3.00


Polyoxyethylene (21) Stearyl Ether



2.00


Cocoamidopropylbethaine
0.40
0.40
0.40


Preservative
0.30
0.30
0.30


Propellant
8.00
8.00
8.00
8.00


Purified water
To 100
To 100
To 100
To 100







Composition Properties











Foam Quality
E
E
E
E


Density
0.028
0.033
0.030
0.043









Example 6—Stability of Composition D3IC3
Following the preparation of Composition D3IC3, it was tested for physical stability, ane the results were as follows:














End of


Test
Baseline
Program







4 Freeze-Thaw cycles (−10°/+40°) -
Excellent
Excellent


Foam Quality


4 Freeze-Thaw cycles (−10°/+40°) -
0.043
0.045


Density


Centrifugation (10,000 rpm, 10 min)
No separation
No separation


3 months at 25° C. - Foam Quality
Excellent
Excellent


3 months at 25° C. - Phase separation
None
None


3 months at 25° C. - Density
0.043
0.040


3 months at 25° C. - Color
White
White


3 months at 25° C. - Odor
Very faint typical
Very faint




typical


3 months at 40° C. - Foam Quality
Excellent
Excellent


3 months at 40° C. - Phase separation
None
None


3 months at 40° C. - Density
0.043
0.038


3 months at 40° C. - Color
White
White


3 months at 40° C. - Odor
Very faint typical
Very faint




typical









These results indicate that the foamable formulation of the present invention is physically stable.

Example 7—Water in Oil Nonsteroidal Immunomodulating Compositions













Composition Code:














WO-1
WO-2
WO-3
WO-4
WO-5
WO-6








Ingredient
%
















Etodolac (active agent)
1.00







Tacrolimus (active agent)

2.00


Ketoconazole (active agent)


2.00


Salicylic acid (active agent)



5.00


Azelaic acid (active agent)




15.00


Thalidomide (active agent)





4.00


Clindamycin (additional active



2.00
2.00


agent)


Mineral oil
12.00
12.00
12.00
12.00
12.00
10.00


Isopropyl myristate
12.00
12.00
12.00
12.00
12.00
10.00


Dimeticone V100
3.00
3.00
3.00
3.00
3.00


Glyceryl monostearate
0.50
0.50
0.50
0.50
0.50
0.50


Zinc oxide
10.00
15.00
15.00
20.00
25.00


Titanium Dioxide





20.00


Alpha-Bisabolol
0.20
0.20
0.20
0.20
0.20


MYRJ 52
3.00
3.00
3.00
3.00
3.00
3.00


Microcrystalline cellulose +
2.00
1.00
2.00
2.00
2.00
2.00


carboxymethyl cellulose)


TWEEN 80
1.00
1.00
1.00
1.00
1.00
1.00


Cocoamidopropylbethaine
0.50
0.50
0.50
0.50
0.50
0.50


D-Panthenol 50P
10.00
10.00
10.00
10.00
10.00


Preservative
0.30
0.30
0.30
0.30
0.30
0.30


Purified water
To 100
To 100
To 100
To 100
To 100
To 100









Example 8—Comparative Study, to Assess the Organoleptic Properties of Foamable Composition According to the Present Invention, vs. Foams According to PCT/AU99/00735
Usability of a pharmaceutical composition and its ease of use is a primary determinant in high treatment compliance and, subsequently, favorable therapeutic results. The present study was performed in order to assess the organoleptic properties of foamable compositions according to the present invention, vs. foams according to PCT/AU99/00735 ('735).
The vehicles of Composition AZ-1 (oil in water emulsion;  ̃12% oil) according the Examples 1 hereinabove were compared with Composition No. 1 according to the example of PCT/AU99/00735 (oil in water emulsion; 10% oil), in a consumer test panel of six subjects. The panelists were asked to assess the following parameters: appearance, physical disintegration, fluidity, ease of spreading (spreadability), absorbency, residual feeling and oily feeling. As presented in the following table, the majority of panelists determined that the AZ-1 foam was better than Composition No. 1 according to the example of the '735 patent.















AZ-1 Better than
‘735 Better than
AZ-1 Equals



‘735
AZ-1
‘735



















Appearance
5
0
0


Physical
5
0
0


disintegration


Fluidity
5
0
0


Easy to spread
2
0
3


Absorbency
3
0
2


Residual feeling
5
0
0


Oily feeling
5
0
0









The multiple advantageous features of compositions AZ-1 are presumably attained due to (1) the presence of a foam adjuvant in AZ-1, which contributes to facile spreading and absorbency; and (2) absence of petrolatum in AZ-1, which avoids the residual and oily feeling, typical to petrolatum-containing products.

## Claims

1. A therapeutic kit comprising an aerosol packaging assembly comprising:
a) a container accommodating a pressurized product; and
b) an outlet capable of releasing the pressurized product as a foam; wherein the pressurized product comprises:
(A) a foamable emulsion composition comprising:
i. a nonsteroidal immunomodulating agent;
ii. at least one liquid hydrophobic carrier at a concentration of about 20% to about 50% by weight;
iii. about 0.1% to about 5% by weight of surface active agent;
iv. about 0.01% to about 5% by weight of at least one polymeric agent selected from the group consisting of a bioadhesive agent, a gelling agent, a film forming agent and a phase change agent; and
v. water; and
(B) a liquefied or compressed gas propellant at a concentration of about 3% to about 25% by weight;
wherein the pressurized product includes less than 5% or about 5% by weight of ethanol, propanol, isopropanol, butanol, iso-butanol, t-butanol, and pentanol, or mixtures of two or more thereof;
wherein the surface active agent comprises a non-ionic surface active agent and optionally an ionic surface active agent at a maximum amount of less than about 0.72% by weight;
wherein if ionic surfactant is present the ratio of non-ionic to ionic surface active agent is about 6:1 or greater than 6:1;
wherein the nonsteroidal immunomodulating agent is substantially or completely dissolved in the oil phase of the emulsion; and
wherein the pressurized product is released from the container as an expanded, breakable foam that collapses upon application of shear force.

2. A therapeutic foamable composition comprising:
(a) an emulsion composition comprising:
i. a nonsteroidal immunomodulating agent;
ii. about 20% to about 50% by weight of a therapeutically active oil;
iii. about 0.1% to about 5% by weight of surface active agent;
iv. about 0.01% to about 5% by weight of at least one polymeric agent selected from the group consisting of a bioadhesive agent, a gelling agent, a film forming agent and a phase change agent; and
v. water; and
(b) a liquefied or compressed gas propellant at a concentration of about 3% to about 25% by weight;
wherein the foamable composition includes less than 5% or about 5% by weight of ethanol, propanol, isopropanol, butanol, iso-butanol, t-butanol and pentanol or mixtures thereof;
wherein the surface active agent comprises non-ionic surface active agent and optionally ionic surface active agent at a maximum amount of less than about 0.72% by weight;
wherein if ionic surfactant is present the ratio of non-ionic to ionic surface active agent is about 6:1 or greater than 6:1;
wherein the nonsteroidal immunomodulating agent is substantially or completely dissolved in the oil phase of the emulsion; and
wherein upon release from a pressurized canister the foamable composition forms an expanded, breakable foam that collapses upon application of shear force.

3. The kit of claim 1, wherein the polymeric agent is a gelling agent and wherein the propellant is selected from the group consisting of a hydrocarbon, a fluorocarbon, and mixtures thereof.

4. The kit of claim 2, wherein the polymeric agent is a gelling agent and wherein the propellant is selected from the group consisting of a hydrocarbon, a fluorocarbon, or mixtures thereof.

5. The kit of claim 3, wherein the foamable composition is selected from the group consisting of an oil-in-water emulsion and a water-in-oil emulsion.

6. The kit of claim 5, wherein the outlet comprises a valve.

7. The kit of claim 6, wherein the valve comprises a stem with 1 to 4 apertures formed in the stem.

8. The kit of claim 7, wherein each aperture formed in the stem has a diameter selected from the group consisting of (i) about 0.2 mm to about 1 mm; and (ii) about 0.3 mm to about 0.8 mm.

9. The kit of claim 7, wherein the sum of areas of all apertures in the stem is selected from the group consisting of (i) between about 0.01 mm2 and 1 mm2; and (ii) between about 0.04 mm2 and 0.5 mm2.

10. The kit of claim 5, further comprising about 0.1% to about 5% by weight of a therapeutically active foam adjuvant selected from the group consisting of a fatty alcohol having 15 or more carbons in its carbon chain; a fatty acid having 16 or more carbons in its carbon chain; fatty alcohols, derived from beeswax and including a mixture of alcohols, a majority of which has at least 20 carbon atoms in their carbon chain; a fatty alcohol having at least one double bond; a fatty acid having at least one double bond; a branched fatty alcohol; a branched fatty acid; a fatty acid substituted with a hydroxyl group; cetyl alcohol; stearyl alcohol; arachidyl alcohol; behenyl alcohol; 1-triacontanol; hexadecanoic acid; stearic acid; arachidic acid; behenic acid; octacosanoic acid; 12-hydroxy stearic acid; and mixtures of two or more thereof.

11. The kit of claim 10, wherein the pressurized product includes less than 2% or about 2% by weight of ethanol, propanol, isopropanol, butanol, iso-butanol, t-butanol and pentanol, or mixtures of two or more thereof.

12. The kit of claim 4, wherein the nonsteroidal immunomodulating agent is selected from the group consisting of:
i. an indole, an indende acetic acid, a heteraryl acetic acid, an arylpropionic acid, an anthranilic acids, a fenamate, an enolic acid, a pyrazolidinedione, and an alkanone; and salts thereof;
ii. salicylic acid, aspirin, sodium salicylate, choline magnesium trisalicylate, salsalate, diflunisal, salicylsalicylic acid, sulfasalazine, olsalazine, esters of salicylic acid with a carboxylic acid, esters of salicylic acid with a dicarboxylic acid, esters of salicylic acid with a fatty acid, esters of salicylic acid with a hydroxyl fatty acid, esters of salicylic acid with an essential fatty acid, esters of salicylic acid with a polycarboxylic acid, para-aminophenol, indole, indomethacin, sulindac, etodolac, tolmetin, diclofenac, ketorolac, ibuprofen, naproxen, flubiprofen, ketoprofen, fenoprofen, oxaprozin, mefenamic acid, meclofenamic acid, oxicams, piroxicam, tenoxicam, pyrazolidinediones, phenylbutazone, oxyphenthratrazone, nabumetone, diaryl-substituted furanones, Rofecoxib, diaryl-substituted pyrazoles, Celecoxib, indole acetic acids, Etodolac, sulfonanilides, Nimesulide, and salts and analogs thereof;
iii. an imidazole or triazole compound;
iv. ketoconazole;
v. a xanthine, pentoxifylline, propentofylline, torbafylline, amiloride, chloroquine, thalidomide, and salts and analogs thereof;
vi. a cyclic peptide, cyclosporine, tacrolimus, tresperimus, pimecrolimus, sirolimus, verolimus, laflunimus, laquinimod, and imiquimod;
vii. a dicarboxylic acid having between about 6 and about 14 carbon atoms in its carbon atom skeleton, and salts thereof;
viii. adipic acid, pimelic acid, suberic acid, azelaic acid, sebacic acid, 1,11-undecanedioic acid, 1,12-dodecanedioic acid, 1,13-tridecanedioic acid, and 1,14-tetradecanedioic acid;
ix. azelaic acid; and
x. a dicarboxylic acid covalently linked with at least one moiety selected from the group consisting of alpha-hydroxy acid, beta-hydroxy acid, hydroxybenzoic acid, alkylhydroxybenzoate, dihydroxy benzene, cresol, alcohol derivatives of Vitamin A, retinoic acid, retinal, steroid hormones, corticosteroids, vitamin E, and vitamin D, and analogs thereof.

13. The kit of claim 10, wherein the concentration range of the nonsteroidal immunomodulating agent is selected from the group consisting of (i) between about 0.05% and about 2% by weight; (ii) between about 2% and about 5% by weight; (iii) between about 5% and about 12% by weight; and (iv) between about 12% and about 24% by weight.

14. The kit of claim 5, wherein the foamable composition further comprises at least one additional therapeutic agent selected from the group consisting of an anti-infective, an antibiotic, an antibacterial agent, an antifungal agent, an antiviral agent, an antiparasitic agent, a steroidal antiinflammatory agent, an immunosuppressive agent, an immunomodulator, an immunoregulating agent, a hormonal agent, a vitamin A, a vitamin B, a vitamin C, a vitamin D, a vitamin E, a vitamin F, a vitamin K, a wound healing agent, a disinfectant, an anesthetic, an antiallergic agent, an alpha hydroxyl acid, lactic acid, glycolic acid, a beta-hydroxy acid, a protein, a peptide, a neuropeptide, a allergen, an immunogenic substance, a haptene, an oxidizing agent, an antioxidant, a dicarboxylic acid, azelaic acid, sebacic acid, adipic acid, fumaric acid, a retinoid, an antiproliferative agent, an anticancer agent, a photodynamic therapy agent, benzoyl chloride, calcium hypochlorite, magnesium hypochlorite, an anti-wrinkle agent, a radical scavenger, a metal, silver, a metal oxide, titanium dioxide, zinc oxide, zirconium oxide, iron oxide, silicone oxide, talc, carbon, an anti wrinkle agent, a skin whitening agent, a skin protective agent, a masking agent, an anti-wart agent, a refatting agent, a lubricating agent, and mixtures of two or more thereof.

15. The kit of claim 3, wherein the concentration of the surface active agent is between about 0.2% and about 2% by weight.

16. The kit of claim 11, wherein the surface active agent includes a mixture of at least one non-ionic surfactant and at least one ionic surfactant in a ratio in the range of about 100:1 to 6:1.

17. The kit of claim 3, wherein the surface active agent is non-ionic.

18. The kit of claim 5, wherein the emulsion is a water-in-oil emulsion.

19. The kit of claim 5, wherein the emulsion is an oil-in-water emulsion.

20. The kit of claim 5, wherein the surface active agent comprises a combination of at least one non-ionic surfactant having a hydrophilic/lipophilic balance (HLB) of less than 9 and at least one non-ionic surfactant having HLB of equal or more than 9, wherein the ratio between the at least one non-ionic surfactant having HLB of less than 9 and the at least one non-ionic surfactant having HLB of equal or more than 9, is between 1:8 and 8:1.

21. The kit of claim 10, wherein the polymeric agent is selected from the group consisting of a water-soluble cellulose ether and a naturally-occurring polymeric material.

22. The kit of claim 10, wherein the polymeric agent is selected from the group consisting of methylcellulose, hydroxypropyl cellulose, hydroxypropyl methylcellulose, hydroxyethyl cellulose, methylhydroxyethylcellulose, methylhydroxypropylcellulose, hydroxyethylcarboxymethylcellulose, carboxymethylcellulose, carboxymethylhydroxyethylcellulose, xanthan gum, guar gum, carrageenin gum, locust bean gum, tragacanth gum, and mixtures of any two or more thereof.

23. The foamable composition of claim 4, further comprising about 0.1% to about 5% by weight of a therapeutically active foam adjuvant selected from the group consisting of a fatty alcohol having 15 or more carbons in their carbon chain; a fatty acid having 16 or more carbons in their carbon chain; fatty alcohols, derived from beeswax and including a mixture of alcohols, a majority of which has at least 20 carbon atoms in their carbon chain; a fatty alcohol having at least one double bond; a fatty acid having at least one double bond; a branched fatty alcohol; a branched fatty acid; a fatty acid substituted with a hydroxyl group; cetyl alcohol; stearyl alcohol; arachidyl alcohol; behenyl alcohol; 1-triacontanol; hexadecanoic acid; stearic acid; arachidic acid; behenic acid; octacosanoic acid; 12-hydroxy stearic acid; and mixtures of two or more thereof.

24. The foamable composition of claim 23, wherein the foamable composition further comprises at least one additional therapeutic agent.

25. The foamable composition of claim 24, wherein the additional therapeutic agent is selected from the group consisting of an anti-infective, an antibiotic, an antibacterial agent, an antifungal agent, an antiviral agent, an antiparasitic agent, an steroidal antiinflammatory agent, an immunosuppressive agent, an immunomodulator, an immunoregulating agent, a hormonal agent, a vitamin A, a vitamin B, a vitamin C, a vitamin D, a vitamin E, a vitamin F, a vitamin K, a wound healing agent, a disinfectant, an anesthetic, an antiallergic agent, an alpha hydroxyl acid, lactic acid, glycolic acid, a beta-hydroxy acid, a protein, a peptide, a neuropeptide, a allergen, an immunogenic substance, a haptene, an oxidizing agent, an antioxidant, a dicarboxylic acid, azelaic acid, sebacic acid, adipic acid, fumaric acid, a retinoid, an antiproliferative agent, an anticancer agent, a photodynamic therapy agent, benzoyl chloride, calcium hypochlorite, magnesium hypochlorite, an anti-wrinkle agent, a radical scavenger, a metal, silver, a metal oxide, titanium dioxide, zinc oxide, zirconium oxide, iron oxide, silicone oxide, talc, carbon, an anti wrinkle agent, a skin whitening agent, a skin protective agent, a masking agent, an anti-wart agent, a refatting agent, a lubricating agent, and mixtures of two or more thereof.

26. The kit of claim 10, further comprising at least one organic carrier selected from the group consisting of a polar solvent, an emollient, and mixtures of two or more thereof.

27. The kit of claim 26, wherein the polar solvent comprises propylene glycol.

28. The kit of claim 26, wherein the polar solvent comprises a polyethylene glycol.

29. The kit of claim 10, wherein the foamable composition comprises the ionic surface active agent and the ratio of non-ionic to ionic surface active agent is about 8:1 or greater than 8:1.

30. The kit of claim 11, wherein the foamable composition comprises an ionic surface active agent and the ratio of non-ionic to ionic surface active agent is greater than 16:1.

31. The kit of claim 5, wherein the ratio of non-ionic to ionic surface active agent is about 14:1 or greater than 14:1.

32. The foamable composition of claim 2, wherein the foamable composition comprises the ionic surface active agent and the ratio of non-ionic to ionic surface active agent is about 16:1 or greater than about 16:1.

33. The foamable composition of claim 24, wherein foamable composition comprises the ionic surface active agent and the ratio of non-ionic to ionic surface active agent is about 20:1 or greater than about 20:1.

34. The foamable composition of claim 4, wherein the therapeutically active oil is selected from the group consisting of a polyunsaturated oil, a polyunsaturated fatty acid, an omega-3 fatty acid, an omega-6 fatty acid, linoleic acid, linolenic acid, gamma-linoleic acid (GLA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), an essential oil containing an active biologically occurring molecule, a liquid hydrophobic plant-derived oil possessing therapeutic benefits, and mixtures of any two or more thereof.

35. The kit of claim 3, wherein the nonsteroidal immunomodulating agent is selected from the group consisting of salsalate, salicylsalicylic acid, sulindac, fenoprofen, oxaprozin, meclofenamic acid sirolimus, everolimus, and mixtures of any two or more thereof.

36. The kit of claim 4, wherein the nonsteroidal immunomodulating agent is selected from the group consisting of an indende acetic acid, a heteraryl acetic acid, an arylpropionic acid, an anthranilic acids, olsalazine, tolmetin, oxyphenthratrazone, Rofecoxib, indole acetic acid, nimesulide, a xanthine, pentoxifylline, propentofylline, torbafylline, amiloride, chloroquine, tresperimus, pimecrolimus, laflunimus, laquinimod, and mixtures of any two or more thereof.