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Background: Bullous pemphigoid is the most common subepidermal autoimmune blistering disease. Till now, the reported prognostic factors in bullous pemphigoid vary considerably. Aims: The purpose of this study was to determine the overall survival rate and prognostic factors in bullous pemphigoid. Methods: We conducted a retrospective cohort study on newly diagnosed bullous pemphigoid patients between July 2001 and November 2019 in a referral unit for autoimmune blistering skin diseases in Romania. Results: One hundred forty-eight patients were included in the study. The Kaplan–Meier overall survival rates at 1, 3, 5 and 10 years were respectively 74.2% (95% confidence interval, 67.5–81.6%), 53.4% (45.7–62.2%), 43.6% (35.9–53%) and 31.3% (23.5–41.7%). The median follow-up among survivors was 48 months (interquartile range: 11–150). Ninety (60.8%) patients died during the follow-up period; of them, 38 (42.2%) had active disease at the time of death. Advanced age, neurological diseases, valvular heart disease, malignancies, use of statins, skin infections and extensive cutaneous involvement were linked to poorer outcomes, while the use of topical corticosteroids was associated with increased overall survival. Limitations: This study lacks a control cohort to validate the obtained results. It was conducted in a retrospective manner in a single centre. In addition, indirect immunofluorescence microscopy was not performed in all patients. Conclusion: Beyond ageing and neurological comorbidities, the prognosis of bullous pemphigoid patients was significantly influenced by the presence of skin infections, valvular heart disease, use of statins and extensive cutaneous involvement. Topical corticosteroid treatment was associated with increased survival in these patients
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A dermatite atópica (DA) é uma doença cutânea inflamatória, crônica, comum, complexa e de etiologia multifatorial, que se manifesta clinicamente com prurido muitas vezes incapacitante, lesões recorrentes do tipo eczema, xerose e que pode evoluir para liquenificação. Embora o conhecimento sobre a sua fisiopatologia venham crescendo nos últimos anos, ainda as formas graves são frequentes e representam um desafio para o clínico. Para o presente guia realizou-se revisão não sistemática da literatura relacionada à DA grave refratária aos tratamentos habituais com o objetivo de elaborar um documento prático e que auxilie na compreensão dos mecanismos envolvidos na DA, assim como dos possíveis fatores de risco associados à sua apresentação. A integridade da barreira cutânea é um dos pontos fundamentais para a manutenção da homeostase da pele. Além dos cuidados gerais: evitação dos agentes desencadeantes e/ou irritantes, o uso de hidratantes, suporte emocional, entre outros, o uso de agentes anti-inflamatórios/imunossupressores de uso tópico e/ou sistêmico também foi revisado. A aquisição de novos agentes, os imunobiológicos e as pequenas moléculas, melhorou a terapêutica para os pacientes com formas graves de DA, sobretudo as refratárias aos tratamentos convencionais.
Atopic dermatitis is a chronic, common, and complex inflammatory skin disease with a multifactorial etiology. It manifests clinically with often disabling pruritus, recurrent eczema-like lesions, and xerosis, and can progress to lichenification. Although understanding of the disease's pathophysiology has been growing in recent years, severe forms are still frequent and represent a challenge for clinicians. A non-systematic review of the literature on severe atopic dermatitis refractory to conventional treatment was conducted to develop the present guide, whose purpose is to help clarify the mechanisms involved in the disease and possible risk factors. The integrity of the skin barrier is fundamental for maintaining skin homeostasis. In addition to general care, patients should avoid triggering and/or irritating agents and moisturizers and seek emotional support, etc.; the use of topical and/or systemic anti-inflammatory/immunosuppressive agents was also reviewed. New agents, immunobiologicals, and small molecules have led to a broader range of therapies for patients with severe forms of the disease, especially cases refractory to conventional treatment.
Subject(s)
Humans , Societies, Medical , Immunoglobulin E , Cyclosporine , Adrenal Cortex Hormones , Calcineurin Inhibitors , Antibodies, MonoclonalABSTRACT
The most widely prescribed drugs for the treatment of a variety of dermatoses are Topical corticosteroids (TC). These medications are approved for the treatment of inflammatory and pruritic manifestations of dermatologic disorders due to their powerful symptom-relieving impact. Clobetasol propionate (CP) is the most popular (TC) used to relieve itching, redness, and oedema caused by a variety of skin disorders. Anti-inflammatory, anti-pruritic, and vasoconstrictive characteristics are all present in it. CP works by binding to cytoplasmic glucocorticoid receptors and activating glucocorticoid receptor-mediated gene expression, resulting in the production of anti-inflammatory proteins while suppressing the production of inflammatory mediators. The formulation is free from known contact allergens, such as propylene glycol, short-chain alcohols, and sorbitol-based emulsifiers, and has demonstrated hypoallergenic effects. The efficacy, safety, and clinical experience of utilizing CP 0.025% cream for the treatment of various dermatologic disorders are discussed in this case series
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Background: Topical corticosteroid (TCS) abuse is rampant and results in steroid addiction labeled as topical steroid-dependent or damaged face (TSDF). Indian market is replete with triple combination creams containing TCS sold as over-the-counter products at low cost, luring people to use them without prescription. The resultant damage if detected late is irreversible and difficult to treat. Dermoscopy can help in the early identification of features of TSDF at a preclinical stage resulting in better prognosis. However, the literature on the same is limited. Aims: This study is undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS. Methods: One hundred and thirty-two patients aged 18 years or above, with clinical symptoms and signs suggestive of TSDF and with history of application of TCS on the face for a period of more than one month, were enrolled in the study. Their demographic details, clinical features, and dermoscopy findings were recorded using a predesigned structured format. Comparison of dermoscopic findings with clinical examination, gender, potency of TCS, and duration of TCS use was done using Chi-square test, Fisher’s exact test, and one-tailed Z-test. Results: Mean age of the patients was 31.7 ± 8.1 years. Male to female ratio was 2:9. Sixty-nine (52.3%) patients abused TCS for more than one year. Clinical findings noted in the patients were erythema (81.1%), hyperpigmentation (80.3%), and hypertrichosis (68.2%). The most common dermoscopy findings seen were brown globules (96.2%), red diffuse areas (92.4%), vessels (87.1%), white structureless areas (86.4%), and hypertrichosis (80.3%). Red diffuse areas, vessels, brown globules, white structureless areas, and white hair were observed in a statistically higher proportion of cases dermoscopically. Y-shaped vessels and brown globules were seen in significantly higher number of patients, using TCS for more than three months and in those continuing it beyond six months, polygonal vessels were predominant. Limitations: Lack of histopathological correlation is the limitation of our study. Furthermore, brown globules seen in 96.2% patients of TSDF on dermoscopy may have been over-estimated and not always signify TSDF; instead, it could represent melasma for which patient applied TCS. Conclusion: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.
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Los corticoides se utilizan en el tratamiento de muchas enfermedades dermatológicas, debido a sus efectos antiinflamatorios, inmunosupresores y antiproliferativos. Su uso indiscriminado puede ocasionar serios efectos adversos locales y sistémicos, fundamentalmente, en niños y frente a ciertos factores predisponentes. Si bien los corticoides tópicos son seguros y efectivos, se debe prestar principal atención a factores como la edad del paciente, el estado de la barrera cutánea, la localización, la potencia y el vehículo del corticoide antes de su prescripción, para disminuir la posibilidad de efectos adversos. Se presenta a una paciente de 5 meses de edad, la cual concurrió a la consulta por un hemangioma ulcerado en el glúteo izquierdo asociado a un síndrome de Cushing, debido a la aplicación local de un corticoide tópico durante más de 3 meses para tratar dicha lesión.
Corticosteroids are used in the treatment of many dermatological diseases due to their anti-inflammatory, immunosuppressive and antiproliferative effects. Its indiscriminate use can cause serious local and systemic adverse effects, mainly in children and in the presence of certain predisposing factors. While topical corticosteroids are safe and effective, it is important to pay attention to factors such as patient's age, skin barrier, clinical characteristic and localization of the lesion, potency and vehicle of the corticosteroid before its prescription to reduce the possibility of adverse effects. We present the case of a 5-month-old patient who presented an ulcerated hemangioma in the left buttock. Due to the local application of a topical corticosteroid on the hemangioma for more than 3 months, she developed Cushing's syndrome.
Subject(s)
Humans , Female , Infant , Adrenal Cortex Hormones , Cushing Syndrome , Long Term Adverse EffectsABSTRACT
Background: Topical corticosteroids (TC) have a reputation as anti-acne, anti-blemish effects and popularly used as fairness creams. In India, there has been a rise in misuse of TC in last10 years. The present study was conducted to analyse the magnitude of adverse effects of topical corticosteroids abuse in dermatology outpatient department of a tertiary care hospital.Methods: A retrospective observational study was conducted on patients after categorizing them as a TC misuser by dermatologists. The socio-demographic data, chief complaints, details of drugs misuse and adverse drug reaction outcome was collected.Results: A total of 1240 patients was screened, out of which 80 patients misused TC without dermatologist prescription for their skin disease. TC was mainly misused by teenagers (43.8%). Misuse of topical corticosteroids was more common among females (76.3%). Betamethasone valerate (72.5%) was most common TC misused. Most common source of advice of TC misuse was friends (37.5%). Most common purpose of TC misuse was acne (55%) followed by cosmetic purposes (21.3%). The most common morphological varieties of adverse drug reactions were burning and itching sensation (53%) followed by increase severity of acne (44%).Conclusions: TC misuse was more common in teenage females. Most common adverse effect reported is burning and itch sensation followed by increase severity of acne. The study data indicates a significance of problem and requirement of urgent measures to control TC misuse.
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Corticosteroids are known to cause many ocular and systemic side effects when administered by oral or parenteral routes. Corticosteroid induced systemic toxicity secondary to topical steroid eye drops is rare. A 6-week-old, male infant was brought to our tertiary eye care center with bilateral congenital cataracts. The child underwent phacoaspiration with primary posterior capsulotomy without intraocular lens implantation in both eyes at an interval of 6 weeks. Child was initiated on topical betamethsone 0.1% eight times a day, tobramycin 0.3% six times a day, homatropine 2% twice a day, and carboxymethylcellulose 0.5% four times a day. Two and four weeks later he underwent surgical membranectomy in the right and left eye respectively followed by frequent use of topical steroids, initially given 1 hourly and then tapered weekly in the follow-up period. The patient showed increase in intraocular pressure and gain in body weight along with development of cushingoid habitus nearly 6 to 8 weeks after starting topical steroids. These side effects started weaning off following the reduction in dose of topical steroids, suggesting the role of the corticosteroid-related systemic side effects. This case highlights the serious systemic side effects secondary to increased frequency and duration of topical corticosteroid use in infancy. Hence, dosage of topical steroids should be adjusted in its therapeutic range to prevent their ocular and systemic side effects. Therefore, close monitoring is advocated for children using topical corticosteroids to prevent serious ocular and systemic side effects.
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Objective To analyze clinical effects of Mupirocin ointment combined with topical glucocorticoid drugs in treating eczema/atopic dermatitis. Methods 100 patients with eczema / atopic dermatitis patients treated in our hospital from March 2015 to August 2016 were selected and randomly divided into the control group and the experimental group, 50 patients in each group. The control group were treated with glucocorticoid therapy, the experimental group were treated with topical corticosteroids combined with Mupirocin ointment drug. Compared the clinical effect between two groups. Results After treatment, 7 cases relapsed in the experimental group and 17 relapsed in the control group.The recurrence rate of the control group(34.0%)was significantly higher than that of the experimental group (14.0%),there was significantly statistical difference(P<0.05). There were no obvious adverse reactions in two groups. In the experimental group, 8 cases were ineffective, and the total effective number was 42 cases. In the control group, 20 cases were ineffective, and the total effective number was 30 cases. The effective rate of the control group (60.0%) was significantly lower than that of the experimental group(84.0%), there was significantly statistical difference (P<0.05). Conclusion Mupirocin ointment combined with topical glucocorticoid drugs was good clinical effect and low adverse reactions.
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Objective To analyze clinical effects of Mupirocin ointment combined with topical glucocorticoid drugs in treating eczema/atopic dermatitis. Methods 100 patients with eczema / atopic dermatitis patients treated in our hospital from March 2015 to August 2016 were selected and randomly divided into the control group and the experimental group, 50 patients in each group. The control group were treated with glucocorticoid therapy, the experimental group were treated with topical corticosteroids combined with Mupirocin ointment drug. Compared the clinical effect between two groups. Results After treatment, 7 cases relapsed in the experimental group and 17 relapsed in the control group.The recurrence rate of the control group(34.0%)was significantly higher than that of the experimental group (14.0%),there was significantly statistical difference(P<0.05). There were no obvious adverse reactions in two groups. In the experimental group, 8 cases were ineffective, and the total effective number was 42 cases. In the control group, 20 cases were ineffective, and the total effective number was 30 cases. The effective rate of the control group (60.0%) was significantly lower than that of the experimental group(84.0%), there was significantly statistical difference (P<0.05). Conclusion Mupirocin ointment combined with topical glucocorticoid drugs was good clinical effect and low adverse reactions.
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Since their introduction, topical corticosteroids have become indispensable in the treatment of various dermatoses. Hydrocortisone was the fi rst compound. Modifi cations in the basic structure generated in vivo activity and thus different topically active compounds were discovered. Apart from the Stoughton vasoconstrictor assay, various other methods are used for potency assessment of topical corticosteroids. Topical corticosteroides are classifi ed based upon potency and action of these molecules. Mechanism of action at the cellular level and indications of topical corticosteroid use have been discussed. Various adverse effects often occur as an extension of their activity combined with inappropriate usage. Tachyphylaxis and contact allergy are potential problems in clinical practice. Newer compounds with improved risk-benefit ratio are available.
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Topical corticosteroids and sunscreens are extensively used formulations, both as over-the-counter products and as prescription medicines. Topical corticosteroids are increasingly being recognized as causes of allergic contact dermatitis. Because of their anti-inflammatory property, contact allergy to these agents may be difficult to suspect and prove. With corticosteroid allergy, there are special issues in patch testing that need to be considered: Screening tests need to be done with budesonide and tixocortol pivalate, and delayed readings are essential to pick up all positive cases. Preventive advice needs to be tailored according to the structural and chemical peculiarities of a particular molecule. Sunscreen allergy is a significant part of cosmetic allergy; especially in cases of photoallergic reactions. Each passing decade is bringing forth new allergens in this class. In many countries, benzophenones have recently been replaced by octocrylene as the leading causes of contact dermatitis to sunscreens. This article provides a broad overview of corticosteroid and sunscreen allergy so that the readers are aware of these important emerging classes of allergens.
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Atopic eczema, also known as atopic dermatitis, is a frequent, highly pruritic, chronic skin disease, which is typically running in flares. The traditional treatment mainly consists of the reactive application of topical anti-inflammatory agents such as topical corticosteroids and topical calcineurin inhibitors. The short term benefit of this approach is well known, but long term remission between flares is difficult to achieve. Therefore, innovative long-term treatment strategies targeting flare prevention and skin barrier stabilization are needed. We and others have shown that normal looking, non-lesional skin of atopic dermatitis patients is immunobiologially not normal but characterized by an invisible inflammation and barrier defect. This has led to the novel concept of proactive therapy, which is defined as long-term, low-dose intermittent application of anti-inflammatory therapy to the previously affected skin, together with an ongoing emollient treatment of unaffected skin. This review article describes the most important long-term treatment options for atopic dermatitis, which includes emollient therapy, the novel concept of proactive treatment, the different ultraviolet light modalities and a selection of systemic immunosuppressive drugs and biologics. Current trial data, licensed indications, off-label use and relevant side effects of the different treatment modalities are summarized.
Subject(s)
Humans , Adrenal Cortex Hormones , Anti-Inflammatory Agents , Calcineurin , Dermatitis, Atopic , Emollients , Inflammation , Off-Label Use , Running , Skin , Skin Diseases , Ultraviolet RaysABSTRACT
BACKGROUND: Topical corticosteroids are not uncommonly abused in patients with facial dermatoses. Although it is well known that uncontrolled use of topical corticosteroids cause steroid-induced rosacea, its clinical manifestation is not studied yet in Korean patients. OBJECTIVE: The purpose of this epidemiological study was to investigate a usage history of topical corticosteroid and clinical manifestation of steroid-induced rosacea. METHODS: Among the 424 rosacea patients who visited the dermatologic clinics of Pusan National University Hospital between January 2006 and May 2011, a face-to-face structured questionnaire was given to 66 rosacea patients with a history of topical corticosteroid use on the face for more than 1 month before onset of rosacea symptoms. Investigated factors include sex, age, history about use of topical corticosteroids and clinical manifestations. RESULTS: Of the 66 patients, 41 were female and 25 were male with the mean age of 52.1+/-14.6 (range 16~76) year. Celestone-G(R) (n=14) was the most commonly used product in the 34 patients who remembered the brand name of topical corticosteroids, which they had used. Forty-three patients used topical corticosteroids for treatment of facial skin lesions without diagnosis. Eighteen patients purchased topical corticosteroids without doctor's prescription. The mean duration and frequency of topical corticosteroid use was 3.8 years and 1.3 times per day, respectively. Constant erythema (n=31) was the most common symptom and it started to occur 2 months after use of topical corticosteroid. CONCLUSION: High-potency topical corticosteroids are frequently used for patients with facial dermatoses without correct diagnosis and without doctor's prescription. Besides, abuse of topical corticosteroids cause rosacea symptoms, such as constant erythema. To prevent the occurrence of steroid-induced rosacea, there should be a great social concern for abuse and misuse of topical corticosteroid in patients with facial dermatosis.
Subject(s)
Female , Humans , Male , Adrenal Cortex Hormones , Androsterone , Epidemiologic Studies , Erythema , Facial Dermatoses , Prescriptions , Rosacea , Skin , Surveys and QuestionnairesABSTRACT
Objective To investigate the efficacy and safety of long-term intermittent treatment with topical corticosteroids in localized chronic eczema.Methods A total of 129 patients with localized chronic eczema were treated with triamcinolone acetonide and econazole nitrate cream (Pevisone (R)).Those who achieved a clinical cure within 4-week treatment were recruited into the following long-term study and classifled into 2 groups to be intermittently treated with triamcinolone acetonide and econazole nitrate cream or a moisturizing cream for 8 weeks.The cream was applied topically twice a day for 2 days every week.Patients were followed up on week 4 and 8 after the beginning of treatment and on week 12 after the discontinuation of treatment.The severity of eczema in patients was rated according to SCORAD (SCORing atopic dermatitis) score.Results The SCORAD score was significantly lower in patients treated with triamcinolone acetonide and econazole nitrate cream than in those with moisturizing cream on week 8 in the treatment and week 12 after the discontinuation (t=3.076,2.367,both P<0.05).A statistical decrease was also observed in the recurrence rate of eczema in patients treated with triamcinolone acetonide and econazole nitrate cream compared with moisturizing cream.treated patients at the 3 follow-up time points (x2=4.426,7.683,8.199,all P<0.05).The incidence of adverse events was 3.1% during the treatment with triamcinolone acetonide and econazole nitrate cream.No severe adverse reactions were observed.Conclusion Long-term intermittent treatment with topical corticosteroids is effective for the prevention of exacerbation and postponement of recurrence,of eczema.
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Prolonged exogenous corticosteroid aclministration may cause Cushingi syndrome. Howeve7 the development of Cushing's syndrome from topical corlico,sleroid therapy is rare. A 7%-year- old boy has sufferedfrom psoriasis vulgaris since the age of nvo. He was treated by a dermatologist with a mixlure of 3'% salicylic acid, 50% liquor carbonis delergens, 10 grams of 0.1% mometasonefuroate ointment, ancl 5 grams combination cream consisting of 0.1% gentamycin sulphate and 0.0250 Àfiuocinolone acetonide. The parents continued the treatment without the doctorb supervision. They applied it lo all over the patient's body three times dailyfor 3% years. The patient showed milcl hypertension, moonface, btffilo hump, obesity, multiple striae, and suppression of hypothalamus-pituitary-adrenal axis. The bone minerttl density and bone age examinations revealed normal results. Children are more prone to develop systemic side fficts of topical medicalion beccntse o/'their higher ratio of btal body surface area to body weight. Corticosteroid must be used with great care, especially in children. It is very important to inform the parents abott polential side effects of corticosteroid.
Subject(s)
Cushing Syndrome , Adrenal Cortex HormonesABSTRACT
Atopic dermatitis is estimated to affect 15-20% of the childhood population and there id considerable evidence that the prevalence is increasing. But it is frequently under diagnosed and inappropriately treated yet. Atopic dermatitis can have a large social;. emotional and financial effect on the child and their family. Atopic dermatitis also commonly predated the development of asthma and allergic rhinitis. Therefore early diagnosis and proper treatment are the key for control the atopic dermatitis itself and modify the future repiratory allergies. This review will cover the new diagnostic criteria and treatment briefly.
Subject(s)
Child , Humans , Asthma , Dermatitis, Atopic , Early Diagnosis , Hypersensitivity , Prevalence , RhinitisABSTRACT
The ability of topical corticosteroids to induce an increase in intraocular pressure(IOP) limits the usefullness in ocular disease. To evaluate of the effects of different types of corticosteroids on the IOP, we applied two kinds of corticosteroics to 103 outpatients without intraocular disease. Subjects were randomly divided into two groups. The first group consisted of 67 patients were treated with 0.12% prednisolone. The second group consisted of 36 patients were treated with 0.1% fluorometholone. In the first group, following six weeks of topical application, patients demonstrated significant increase in the IOP (p0.05). In the first group, 72 of 134 eyes(54%) demonstrated increase in the rop. In the second group, 34 of 72 eyes (47%) demonstrated increase in the IOP. The IOP response failed to correlate significantly with sex, age, baseline IOP, refractive error and cup/disc ratio in two different corticosteroids (p>0.05). These findings do emphasize the need to measure the IOP of all patients who undergoing topical steroids application for an extended period.