Congenital adrenal hyperplasia: experience at intersex clinic, AIIMS.

During 1981-88, 63 cases of female pseudohermaphroditism (FPH) were seen at the Intersex clinic at AIIMS, of whom 34 (54%) were diagnosed as due to congenital adrenal hyperplasia (CAH). Though ambiguity was present at birth in most cases, only one child was brought immediately after birth, while 14 presented after one year. Family history of affected siblings and fetal wastage was present in 10. Salt wasting symptoms were present in 13 (38.2%), evidence of early virilization in 10 (29.4%) and generalised hyperpigmentation in 7 (20.6%). Clitoromegaly was present in 30 children with labial fusion in 10 and scrotalisation of labia in 6. The urogenital opening was single in 25 (73.5%). Buccal smear was positive for sex chromatin in 19. Chromosomal pattern showed 46 XX in 33. Dyselectrolytemia was present in 16 children. Bone age was advanced in all. Adrenal hyperplasia could be documented in 3 on CT scan. All the girls were put on hydrocortisone or prednisolone, and fluodrocortisone was given only to children with salt wasting CAH. Children with CAH are being brought to medical attention much too late and investigative and therapeutic facilities are grossly inadequate. There is a need to educate primary care physicians for early case detection and provide minimum diagnostic and therapeutic facilities in regional centres.

Liquen escleroso de la vulva: experiencia de los últimos 12 años / Lichen sclerosus of the vulva: experience of the latest 12 years

Se presenta la experiencia del consultorio de Patología Vulvar del Hospital Clínico de la Universidad de Chile, sobre liquen escleroso de la vulva, la que abarca desde 1976 a 1987. Durante este lapso se diagnosticaron 34 casos nuevos de esta enfermedad, evaluándose los resultados del tratamiento con propionato de testosterona y fluocortolona a lo largo de un seguimiento promedio de 3,2 años. Once de las treinta y cuatro pacientes, se controlaron por medio de biopsias vulvares. Comprobándose en dos casos mejoría histológica de las lesiones. No se observó tendencia a la malignización en ninguna de las pacientes estudiadas

Adverse Effect of Topical Steroids / 대한피부과학회지

Since Epsteins report in 1963, which identified topical corticosteroid therapy as a possible cause of striae formation, many adverse effects resulting from topical steroids therapy has heen observed in dermatological practice. In this study, 365 cases of side-effects with topical steroids in Department of Dermatology, Chonnarn University Hospital from 1972 to 1981 were analyzed, and the results obtained can be summerized as follows; 1. During this pericd, themean average percent of side effects with topical steroids was 0.85 of the yearly total patients and 12 different kinds of side-effects were found to be present in this study. 2. The annual rate of increase of side-effects with topical steroids (2.4%) was higher than that of yearly total patients (0.5%) and the annual frequency of the 12 side-effects was shown in Table 1. 3. The frequency of the 12 side-effects by age group was shown in Table 2. 4. The frequency of the 12 side-effects by season, sex and region was shown in Table 8. 5. The frequency of the 12 side-effects by lesion site was shown in Table 5. 6. T.he mean period of application with topical steroids was 4. 18 months and applied topical steroids were betamethasone-17-valerate(30.4%), fluocortolone (22.7%), hetamethasone dipropionate(12.9%), fluocmolone acetonide (9.0%) and prednisolone(8.8%) respectively. 7. The most frequent topical steroids and period of application causing each side-effects were as follows: betamethaaone-17-valerate for 1 month resulting in Steroid acne, betamethasone-17-valerate for 2 months resulting in Telangiectasia rubeosis et steroidica, triamcinolone acetonide for 1 month resulting in Perioral dermatitis and betarnethasone-17-valerate for 11 months resulting in Atropic striae.

A Study on the Effect of Topical Nonsteroidal Anti - inflammatory Drugs And Cortisosteroids on Ultraviolet Light - Induced Erythema / 대한피부과학회지

lt is generally beIieved that several chemical mediators such as histamine, kinine, prustaglandin E and lysosomal enzyme are related to the pathogenesis of sunburn, but the exact mechenism of erythema is unknown. Recently, prostaglandins appear to be important mediators of ultraviolet erythema (UV-erythema) and several investigators has reported that the nonsteroidal antiinflammatory druga and corticosteroids supressed UV-erythema by inhibition of prostaglandin synthesis. This study was undertaken to evaluate the effect of topical nonsteroidaI antiinflammatary drugs and corticosteroids on UV-erythema induced by a artificial sunlamp. Nonsteroidal anti-inflammatory drugs (5% Bufexamac cream, 5% Ibuprofen cream, 5% Indomethacin cream) and corticosteroids(0.05% Fluocinonide cream, 0.5% Fluocortolone oint., 1%, Hydrocortisone cream) were applied immediately after 3~4 minimal erythema dose(MED) irradiation on back skin of 40 healthy volunteers and the delayed UV-erythema response was evaluated at 2, 4, 6, 8, 12, 24, 48 and 72 hours after irradiation, respectively. The resulta were as follows; 1) Minimal erythema dose(MED) was noted 4min. (62.5%), 3min. (25.0%), 5min. (22.5%). The averaged MED was 3. 63min. 2, MED has to be increased on site, applied nonsteroid and steroid agents topically, comparing with control site. 3) Blanching effect was detected in all cases of nonsteroid and steroid agents applicated topically, but in control site. 4) Average score in blanching effect was highest in 5% Indomethacin cream among nonsteroid agents(average score-2. 47) and 1% Hydrocortisone cream (average scoro -2. 63) among steroid agents.

A Case of Lymphocytoma Cutis Treated with CD2 Slush / 대한피부과학회지

A case of lymphocytoma cutis, the circumscribed form in 9 year-old girl is reported. This is seldom conclusive without histological examinatien for a wide variety of conditions has to be considered. The circumscribed form usually responds rapidly to radiotherapy, although recurrence is possible and good results from the use of procaine penicillin especially in the disseminated form. In this case, I experienced good results from CO, slush and topical application of 0.25 % fluocortolone 3 times a day without recurrence in 3 months after treatment.

Clinical experience with Fluocinonide cream / 대한피부과학회지

Lidex(Fluacinonide) 0.05% in FAPG base is a new fluorinated topical corticosteroid. 30 patients with different steroid responsive dermatoaes were treated with 0. 05% Lidex. The diagnosis included atopic dermatitis, contact dermatitis, neurodermatitis, seborheic dermatitis, nummular eczema, psoriasis vulgaris, chronic eczema and pustulosis pahmaris et plantaris. In the majority of cases Lidex cream produced excellent to good result(70%) after unoccluded application 3 times daily for 10 days. Two patients complained burning or itching sensation after the initial application of Lidex. 0.05% Lidex was compared with 0. 25% Desoxymethasone cream and 0. 25% Fluocortolone cream and was found slightly more effective in Lidex.

A Study on the Steroid Acne / 대한피부과학회지

Dermatologic treatment was greatly advanced when topical corticasteroids were introduced for the management of many inflammatory and pruritic dermatoses. Their use reduced or diminished mnst of the undiserable side effects which accompanied the systemic administration of these compounds. The good effects of topical application of hydrocortisone had been demonstration in the treatment of variaus dermatoses eg., atopic dermatitis, seborrheic dermatitis, contact dermatitis etc. The halogenated derivatives followed and led to the trend to most of analogs now in use. Especially, fluocinolone acetonide cream greatly enhanced its therapeutic effectiveness in psoriasis, chronic discoid lupus erythematosus, pustular bacterid, granuloma and neurodermatitis circumscripta. But many side effects of topical corticosteroids such as steroid acne. Stria were developed and also fluorinated topical corticosteroids resulted in telangiectasia, purpura, atrophy in skin. Weber reported that strong topical corticosteroids eg.. Betamethasone valerate and fluocinolone acetonide were resulted in rosacealikc dermatitis and it was steadily increased. These adverse side effcts of topical corticosteroids, especially steroid acne, were indisputable argument in dermatologic field, for the view that this topical corticosterodis is used for cosmetics and treatment of acne vulgaris in our country. Since the strong corticosteroid tnpical preparation, the peculiar form acne, so called steroid acne, was steadily increased in our clinic. Behrman and goodman reported that acneform eruption induced by hormone was not associated with oiliness and there were but few comedone. Sullivan and Zeligman reported that the the acneform eruption due to adrenal corticaa 1 hormone was uniform in size, small papule and few pustule, usualIy erythematous base. There were also differential histologic feature. The most important difference is the normal apperance of sebaceous glands in acneform eruption due to corticosteroids contrast with hyperplasia in acne vulgaris. Abscess formation was more frequent and more extensive in acne vulgaris. Sutton Jr and Van Scott & MacCardle described that histologically, the major component in lesion of steroid acne was excessive keratinization of follicle. Castor and Baker demonstrated that topical application of corticosteroids resulted in decrease of sebaceous gIands, decrease of mitosis and increased cornification in epidermis. The present study investigated clinical case of the steroid acne, which are induced by topical application and systemic administration of corticosteroids and experimentally induced the steroid acne with the topical application of corticosteroid. And also clinical cases and experimentally induced steroid acne were compared with acne vulgaris. Material and method Subjects are 13 Patients of steroid acne induced by strong topical corticosteroid eg., fluocinolone acetonide, fluocortolone, dexamethaone, betamethasone valerate and 4 patients of steroid acne induced by systemic administration of corticosteroid eg., prednisolone and also 10 patients of acne vulgaris. Biopsy was performed from 13 patients of topical steroid acne, 3 patients of steroid acne induced by systemic administration of steroid and one patient of acne vulgaris. In order to induce steroid acne, experimentally, strong topical corticosteroid such as beta methasone valerate, fluocinolone acetonide and fluocortolone were applied on back. Comment and conclusion In Clinical feature, the steroid acne by topical application and systemic administration of corticosteroid and experimentally induced steroid acne had unique clinicall features, that showed absence of comedone and uniform sized follicular papule on deep seated erythematous scaly base. The topical steroid acne was distributed the region where were applied. But the eruption of the steroid acne induced by systemic administration of corticosteroids was distributed to face, neck, and scalp. Above findings are quite different form acne vulgaris. Histopathologically, the steroid acne induced by topical application and systemic administration of corticosterojds showed hypoplasia of sebaceous glands and excessive follicular keratinization. Occlusion of pilosebaceous opening by keratotic plug in severe case by long term application showed atrophy of epidermis and sparsity of sebaceous glands with hypokeratosis and parakeratosis. In experimentally induced steroid acne, it was definitely specific features which were absolutely identcall with above cinical steroid acne.