A comparative study of tar and betamethasone valerate in chronic plaque psoriasis: a study in Thailand.

OBJECTIVE: Evaluate and compare the efficacy, safety, and tolerability of coal tar (10% LCD, liquor carbonis detergens), with betamethasone valerate in the therapy of large plaque-type psoriasis. MATERIAL AND METHOD: Patients with stable, mild to moderate plaque psoriasis at the Department of Medicine, Lerdsin General Hospital, Bangkok, Thailand were randomized for treatment with either coal tar (10% LCD) cream or betamethasone valerate cream (0.1%). All patients entered a 2 week wash-out period followed by the creams being applied twice daily until completion at 6 weeks. The patient severity of psoriasis was assessed using the modified Psoriasis Area and Severity Index (PASI) score at baseline and after 2, 4, and 6 weeks of treatment. RESULT: At the end of the trial, the mean reduction of the PASI score from baseline was 38.39% with the coal tar group and 69.36% with the betamethasone valerate group. The mean percentage of the PASI score reduction was statistically significant in both groups but the betamethasone valerate group was significantly superior to the coal tar group. Both drugs' adverse effects were limited to mild irritation localized to the skin without systemic side effects. The Betamethasone valerate cream was safe, effective, and well-tolerated while the coal tar cream was described as messy, malodorous, and with a tendency to staining clothes. CONCLUSION: The investigator's overall assessment of the treatment response at completion of the trial demonstrated that the betamethasone valerate group achieved significantly greater clearance and marked improvement compared with the coal tar group.

Esteroides tópicos como tratamiento consevador de la fimosis / Topic steroids as conservative treatment of phimosis

Introducción: la fimosis se define como la incapacidad para retraer el prepucio a una edad a la cual normalmente debería retraerse. En los últimos años se ha comenzado a utilizar la aplicación tópica de esteroides como una alternativa al tratamiento quirúrgico de la fimosis. Objetivo: describir la respuesta terapéutica de la fimosis a la aplicación tópica de betametasona. Material y métodos: se evaluó la respuesta terapéutica la aplicación tópica de valerato de betametasona al 0,1 por ciento dos veces por día durante 30 días en una cohorte de niños de 3 a 14 años de edad con fimosis, asistidos en el Centro de Salud Materno-Infantil Maciel, entre junio de 2001 y marzo de 2002. Resultados: se incluyeron 28 niños. La media de la edad fue de 5,6 años. Se observó curación en 17, mejoría en ocho y falla terapéutica en tres. Los tres pacientes con la terapéutica presentaban fimosis tipo l. Conclusiones: ésta constituye la primera descripción nacional de una experiencia de tratamiento médico de la fimosis en el niño mediante la aplicación de esteroides tópicos. El tratamiento con betametasona tópica constituye una alternativa terapéutica de bajo costo y segura, recomendable especialmente en casos no severos.

Clinico-Epidemiologic study on the Abuse, Misuse, and Adverse Effects of Topical Dermatologic Drugs / 대한피부과학회지

BACKGROUND: The abuse, misuse, and adverse effects to topical drugs have been widespread in Korea due to lack of awareness of seriousness of drug abuse and misuse, and improper designation of prescription and non-prescription drugs. OBJECTIVE: This study was conducted to bring Korean people to an awareness of the abuse, misuse, and adverse effects of topical drugs, and to stress the importance of proper designation of non-prescription drugs. METHODS: A multicenter, prospective, clinico-epidemiologic evaluation was made from patients with adverse effects to topical drugs who visited 31 dermatologic departments in university hospitals or private clinics nationwide from march, 2002 to December, 2002. RESULTS: The diagnostic incidence of adverse effects from topical drugs are abuse and misuse (40%), dermatophytosis incognito (29%), bacterial infection (14%), contact dermatitis (9%), acne (2.5%), skin atrophy (1.4%), telangiectasia (1%). Erghty three percent of adverse effects are caused by topical corticosteroids, and betamethasone valerate, prednicarbate and triamcinolone acetonide are commonly used topical corticosteroids that induce adverse effects frequently. The most common way to obtain topical drugs is purchase directly from pharmacist without prescriptions. CONCLUSION: From this study, we confirmed that adverse effects to topical corticosteroids are very common even after the enforcement of designation of prescription drugs and non-prescription drugs. The proper designation of prescripton drugs should be reevaluated and based on the safety of patients to protect people from adverse effects of topical drugs.

Estudo comparativo in vitro entre a associaçäo de valerato de betametasona, sulfato de gentamicina, tolnaftato e clioquinol versus outros compostos nas cepas bacterianas e fúngicas mais freqüêntes nos meios comunitário e hospitalar / In vitrto comparative study between the association of betamethasone valerato, gentamicin sulfate, tolnaftate and clioquinol versus other medications on frequent bacterials and fungicals samples from communitary and hospitalar environment

A freqüência das infecçöes associadas fúngico-bacterianas cutâneas é um achado muito freqüênte na prática clínica diária. Devido a isso, o encontro de um produto eficiente para resolver essas dermatoses, economicamente viável e com uma comodidade de aplicaçäo é um desafio para os médicos no mundo inteiro. No corrente estudo, verificamos que a eficácia "in vitro" da associaçäo de valerato de betametasona, sulfato de gentamicina, tolnaftato e clioquinol em 20 cepas de Candida spp., Trichophytun spp., Streptococcus pyogenes, Staphylococcus aureus, Acinetobacter sp.,Escherichia coli, Pseudomonas aeruginosa e Pseudomonas aeruginosa resistente variou de 95 a 100 porcento, sendo maior e mais abrangente do que outros produtos antimicrobianos usados freqüêntemente em nosso mercado. Podemos considerar essa associaçäo uma alternativa eficaz no tratamento de infecçöes cutâneas com associaçäo de bactérias e fungos.(au)

Therapeutic Effect of Topical Application of Linoleic Acid and Lincomycin in Combination with Betamethasone Valerate in Melasma Patients

Melasma is an acquired symmetric hypermelanosis characterized by irregular lightto gray-brown macules and patches on sun-exposed areas. Many therapeutic agents are available but are unsatisfactory. Recently, it has been demonstrated that lincomycin (LM) and linoleic acid (LA) can inhibit melanogenesis in vitro. Our purpose was to investigate the clinical efficacy of topical application of LM and LA in combination with betamethasone valerate (BV) in melasma patients. Fortyseven Korean female adults with clinically diagnosed melasma were enrolled in a 6-week, double-blind, randomized clinical trial. Patients were treated with one application of the vehicle (group A), 2% LM mixed with 0.05% BV (group B), or 2% LM mixed with 0.05% BV and 2% LA (group C) on the face every night. Determination of efficacy was based on the Melasma Area and Severity Index (MASI) score and objective assessment (no effect, mild, moderate, or excellent) at intervals of 2 weeks until the end of the study at 6 weeks. After 6 weeks, in comparison with the pre-treatment MASI score, the average MASI score of group C decreased to 68.9%, compared with 98% in group A (p<0.05) and 85.4% in group B. There was no statistically significant difference between group A and group B. Seven patients (43.7%) in group C revealed more than moderate improvement in objective assessment, compared with none in group A and two patients (12.5%) in group B. There were no significant side effects. Topical application of linoleic acid is considered to be effective in the treatment of melasma patients.

Beauty creams causing acneiform eruptions

Adolescent and post adolescent females presented to Dermatology Out patients with white comedones and inflamed papules, situated mainly on cheeks and forehead. Most of these patients related the onset of these lesions after continuous use of a beauty cream to improve complexion. Twenty four patients presenting to the Outpatients Department of Dermatology at Abbassi Shaheed Hospital and Burhani Community Hospital, were collected. Subjects were questioned about their acneiform eruption. Each patient was examined and beauty products and 17 betamethasone valerate cream were shown to them for correct identification. All patients related the lesions after continuous application of the beauty cream obtained after mixing 5gm tube of betamethasone valerate cream with one tube each of two famous beauty products. The average daily application lasted for about three months. The predominant lesions were white comedones and inflamed papules [100%]; macular erythema and telangiectasia were seen in [16%.] The cheeks and forehead were universally involved in all patients and the chin was involved in four [16%]. The majority belonged to middle and low-income families. Conclusions: Since time immemorial, females have used beauty products to improve their complexion. The recent amateur addition of 17- betamethasone valerate to commercial beauty creams has led to more acneiform eruptions

Avaliaçäo comparativa da eficácia e tolerabilidade do furoato de mometasona a 0,1 porcento, da hidrocortisona a 1 porcento e do valerato de betametasona a 0,1 porcento, formulaçäo creme, no tratamento de dermatoses córtico-sensíveis em crianças e adultos / Efficacy and tolerabillity evaluation for mometasone furoato cream 0.1 percent, hydrocortisone cream 1 percent and betamethasone valerate 0.1 percent, in cortico-sensitive dermatosis treatment of children and adults

FUNDAMENTOS- O uso de cremes de corticóides em dematoses córtico-sensíveis constitui uma das principais medidas treapêuticas. A necessidade de usar estes produtos várias vezes ao dia constitui uma das causas da näo adesäo dos pacientes ao tratamento. OBJETIVOS - Comparar a eficácia e a tolerabilidade do furoato de mometasona creme a 0,1 porcento, aplicado uma vez ao dia, com a hidrocortisona creme a 1 porcento e o velerato de betametasona creme a 0,1 porcento, estes dois últimos aplicados duas vezes ao dia. MÉTODOS - Foram estudados 101 pacientes, com idade entre 2 e 18 anos, portadores de dermatoses córtico-sensíveis, em ensaio clínico multicêntrico, duplo-cego, aleatório, prospectivo e comparativo. A duraçäo do tratamento foi de 21 dias. RESULTADOS - Houve maior eficácia clínica, estatisticamente significativa, da mimetasona e da betametasona em comparaçäo a hidrocortisona. Näo houve diferença estatística entre a eficácia da mometasona e a da betametasona. Quanto a tolerabilidade, näo houve diferença estatística entre os três grupos. CONCLUSÄO - Os três tratamentos foram seguros, eficazes e produziram melhora estatisticamente significativa. O fuorato de memetasona tem a vantagem de ser aplicado uma vez ao dia.

Estudo comparativo entre o acetonido de triancinolona e o valerato de betametasona, ambos associados e antibióticos e antimicóticos no tratamento de dermatites sensíveis à corticoterapia / Comparative study between the triamcinolone acethenide and the betamethasone valerate, associated with antibiotics and antimicotics in the treatment of dermatites sensible to corticotherapy

Foram estudados cento e vinte pacientes portadores de dermatites variadas, dos quais 60 (Grupo A) foram submetidos à terapêutica tópica com creme ou pomada de Acetonido de Triancinolona, e 60 (Grupo B) com creme ou pomada de Valerato de Betametasona. O estudo empregou o método duplo-cego, randomizado, comparativo em paralelo. Ambas as medicaçöes foram utilizadas em 3 aplicaçöes diárias por um período de 7 a 28 dias. A maioria das afecçöes (53 casos em 60 no Grupo A e 56 casos em 60 no Grupo B) foram classificadas como de intensidade leve e moderada, todavia predominaram as dermatites crônicas de longa duraçäo (66,6% no Grupo A e 55% no Grupo B). Dos cento e vinte pacientes estudados, 67 já haviam recebido anteriormente tratamento com um ou mais medicamentos, com resultado, na maioria das vezes, insatisfatório. A eficácia de ambos os produtos foi avaliada subjetiva e objetivamente por meio de controles semanais até o máximo de 4 semanas. Ao final do estudo 59 pacientes do Grupo A (Triancinolona) e 58 pacientes do Grupo B (Betametasona) obtiveram resultados terapêuticos classificados como excelente e bom, näo sendo detectadas diferenças significativas entre os dois grupos; entretanto, observou-se uma remissäo mais rápida e significativa do quadro clínico na altura da 3ª semana (81,67% de resultado excelentes e bons com a Triancinolona contra apenas 23,34% dos casos tratados com a Betametasona no mesmo período). Näo foram observados efeitos adversos ou reaçöes de hipersensibilidade em nenhum dos pacientes de ambos os grupos estudados

Daily Topical Sequential Triple Therapy of Tretinoin, Betamethasone Valerate and Hydroquinone on Melasma / 대한피부과학회지

Daily topical sequential triple therapy(tretinoin, betamethasone valerate and hydroquinone), as proposed by Kligman et al and Gano et al, has been performed on 29 Korean female patients with melasma. After 4 weeks treatment with 2% hydroquinone cream, only three of eight patients (37. 5%) showed good to excellent results. However, after 4 weeks treatment with 4% hydroquinone cream, twelve of twentyone patients (57. 1%) showed good to excellent results and its therapeutic effects appeared more rapidly than the former group. Overall, after 4 weeks treatment. 96.6% of the total group showed fair to excellent results of which 57. 7% had a good to excellent rating. The fair-com- plexioned Koreans had a better response than dark-complexioned.

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.