Clinical and pathological analysis of 345 cases of vulvar lichen sclerosus and a preliminary study on the frequency of maintenance treatment / 中华妇产科杂志

Objective: To analyze and summarize the clinical and pathological characteristics, management, and efficacy of patients with vulvar lichen sclerosus (VLS) through a single center large sample study, and preliminarily to explore the frequency of maintenance treatment medication for VLS. Methods: The clinical data of VLS patients in Obstetrics and Gynecology Hospital of Fudan University from 2018 to 2021 were retrospectively collected. The clinicopathological characteristics (patients' age, course of disease, complicated disease history, family history, symptoms, signs and pathology), treatment and effects were retrospectively analyzed. The patients in the maintenance treatment stage were followed up regularly to explore the minimum frequency of individual medication to maintain the stability of the disease. Results: (1) General situation: a total of 345 patients with VLS were included in this study. The average age was (50.4±14.7) years (ranged from 8 to 84 years old), prevalence was highest in the 50-59 years group (30.1%, 104/345). Immune diseases occurred in 18.6% (33/177) of patients, 24.3% (43/177) of patients had allergic skin diseases, and 5.6% (10/177) of the patients' immediate family members had chronic vulvar pruritus or vulvar hypopigmentation. (2) Clinical features: the most common symptom was vulvar pruritus (96.1%, 196/204) among 204 patients with recorded symptoms. The most common sign was hypopigmentation of the vulva (96.3%, 206/214). The most common involved sites were labia minora (70.3%, 142/202), labia majora (67.8%, 137/202), and labial sulcus (59.4%, 120/202). The cumulative number of sites involved in 62 vulvar atrophy patients (2.7±1.1) was significantly higher than that in 152 non-atrophy patients (2.2±1.0; t=3.48, P=0.001). The course of vulvar atrophy was (9.3±8.5) years, which was significantly longer than that of non-atrophy patients [(6.6±5.6) years; t=2.04, P=0.046]. (3) Pathological features: among the 286 patients with electronic pathological sections, the most common pathological feature in the epidermis was epithelial nail process passivation (71.3%, 204/286). The common pathological features in the dermis were interstitial collagenization (84.6%, 242/286), and inflammatory cell infiltration (73.8%, 211/286). (4) Treatment: 177 patients received standardized treatment after diagnosis and were followed up regularly in our hospital. In the initial treatment stage, 26.0% (46/177) of the patients were treated with 0.05% clobetasol propionate cream, and 74.0% (131/177) of the patients were treated with 0.1% mometasone furoate ointment. The complete remission rates of the two methods were respectively 80.4% (37/46) and 74.0% (97/131), and there was no statistically significant difference (χ²=0.76, P=0.385). During maintenance treatment, 27.1% (48/177) of the patients took the medication twice a week, 35.0% (62/177) took the medication once a week, and 37.9% (67/177) took the medication once every 10 days. During follow-up after 6 months of maintenance treatment, there were no patients with recurrence of pruritus or progression of vulvar signs. Conclusions: The majority of VLS patients have itching, hypopigmentation, involvement of labia minora and labia majora, progressive atrophy, and inflammatory infiltration of dermis. Local treatments of mometasone furoate and clobetasol propionate have good initial therapeutic effects. The frequency exploration of individualized maintenance treatment could minimize the occurrence of adverse reactions when ensuring the stability of the patients' condition.

Effect of topical corticosteroids on nasal patency after acute positive airway pressure exposure / Efeito dos corticosteroides tópicos na patência nasal após exposição aguda à pressão positiva nas vias aéreas

Abstract Introduction Nasal congestion and obstruction are reported in the majority of continuous positive airway pressure users and are frequently cited as reasons for noncompliance. Baseline inflammation due to allergic rhinitis could increase or exacerbate the inflammatory effect of high airflow in the nasal cavity as the result of continuous positive airway pressure and lead to greater continuous positive airway pressure intolerance. In this setting, intranasal steroids would be expected to counteract the nasal inflammation caused by allergic rhinitis and/or continuous positive airway pressure. Objective The aim of the present study is to evaluate the effects of topical corticosteroid use on nasal patency after acute exposure to positive pressure. Methods Ten individuals with allergic rhinitis were exposed to 1 h of continuous airway pressure (15 cm H2O) in the nasal cavity, delivered by a continuous positive airway pressure device. Visual analog scale, nasal obstruction symptom evaluation scale, acoustic rhinometry and peak nasal inspiratory flow were performed before and after the intervention. After 4 weeks topical nasal steroid (budesonide) application, positive pressure exposure was repeated as well as the first assessments. Results Patients reported a statistically significant improvement both on the visual analog (p = 0.013) and obstruction symptom evaluation scales (p < 0.01). Furthermore, objective measurements were improved as well, with increased nasal cavity volume on acoustic rhinometry (p = 0.02) and increased peak nasal inspiratory flow (p = 0.012), after corticosteroid treatment. Conclusion In patients with allergic rhinitis, intranasal corticosteroid therapy improved objective and subjective parameters of nasal patency after acute exposure of the nasal cavity to positive pressure.

Resumo Introdução Congestão e obstrução nasais são relatadas na maioria dos usuários de pressão positiva contínua nas vias aéreas e são frequentemente mencionadas como razões para a falta de aderência. A inflamação basal devida à rinite alérgica pode aumentar ou agravar o efeito inflamatório do alto fluxo de ar na cavidade nasal como resultado da pressão positiva contínua nas vias aéreas e aumentar a intolerância à mesma. Nesse cenário, espera-se que os esteróides intranasais neutralizem a inflamação nasal causada pela rinite alérgica e/ou pela pressão positiva contínua nas vias aéreas. Objetivo Avaliar os efeitos do uso tópico de corticosteroides na patência nasal após exposição aguda à pressão positiva. Métodos Dez indivíduos com rinite alérgica foram expostos a uma hora de pressão contínua nas vias aéreas (15 cm H2O) na cavidade nasal, fornecida por um dispositivo de pressão positiva contínua nas vias aéreas. A escala visual analógica, a escala Nasal Obstruction Symptom Evaluation, rinometria acústica e pico de fluxo inspiratório nasal foram aplicados antes e após a intervenção. Após 4 semanas de aplicação tópica de esteroide nasal (budesonida), a exposição positiva à pressão foi repetida, bem como as primeiras avaliações. Resultados Os pacientes relataram uma melhoria estatisticamente significante tanto na escala visual analógica (p = 0,013) quanto na escala Nasal Obstruction Symptom Evaluation (p < 0,01). Além disso, as medidas objetivas também foram melhoradas, com aumento do volume da cavidade nasal na rinometria acústica (p = 0,02) e aumento do pico de fluxo inspiratório nasal (p = 0,012), após o tratamento com corticosteroide. Conclusão Em pacientes com rinite alérgica, a terapia com corticosteroide intranasal melhorou os parâmetros objetivos e subjetivos da patência nasal após exposição aguda da cavidade nasal à pressão positiva.

Individualized treatment for allergic rhinitis based on key nasal clinical manifestations combined with histamine and leukotriene D4 levels / Tratamento individualizado para a rinite alérgica baseado nas principais manifestações clínicas nasais e dos níveis de histamina e leucotrieno D4

Abstract Introduction The types of allergic rhinitis are roughly classified based on the causative antigens, disease types, predilection time, and symptom severity. Objective To examine the clinical typing and individualized treatment approach for allergic rhinitis and to determine the optimal treatment method for this disease using various drug combination therapies. Methods A total of 108 participants with allergic rhinitis were divided into three groups based on symptoms. Subsequently, each group was further categorized into four subgroups based on the medications received. The efficacy of the treatments was evaluated using the visual analog scale VAS scores of the total and individual nasal symptoms, decline index of the symptom score, histamine and leukotriene levels, and mRNA and protein expression levels of histamine 1 and cysteinyl leukotriene 1 receptors. Results Loratadine + mometasone furoate and loratadine + mometasone furoate + montelukast significantly improved the sneezing symptom and reduced the histamine levels compared with the other combination therapies (p < 0.05). Meanwhile, montelukast + mometasone furoate and montelukast + mometasone furoate + loratadine considerably improved the nasal obstruction symptom and decreased the leukotriene D4 levels compared with the other combination therapies (p < 0.05). Conclusion Clinical symptom evaluation combined with experimental detection of histamine and leukotriene levels can be an objective and accurate method to clinically classify the allergic rhinitis types. Furthermore, individualized treatment based on allergic rhinitis classification can result in a good treatment efficacy.

Resumo Introdução A rinite alérgica é basicamente classificada de acordo com os antígenos causadores, tipos de doença, peridiocidade e gravidade dos sintomas. Objetivo Avaliar os tipos clínicos e a abordagem terapêutica individualizada para cada tipo de rinite alérgica e determinar o método de tratamento ideal utilizando várias terapias de combinação de fármacos. Método Um total de 108 participantes com rinite alérgica foram divididos em três grupos com base nos sintomas. Posteriormente, cada grupo foi subsequentemente categorizado em quatro subgrupos com base nos medicamentos recebidos. A eficácia dos tratamentos foi avaliada utilizando os escores da escala visual analógica EVA dos sintomas nasais totais e individualmente, índice de declínio do escore de sintomas, níveis de histamina e leucotrienos e níveis de expressão de mRNA e proteína dos receptores de histamina 1 e cisteinil-leucotrieno 1. Resultados As associações entre loratadina + furoato de mometasona, assim como a de loratadina + furoato de mometasona + montelucaste melhoraram significativamente o sintoma de espirros e reduziram os níveis de histamina em comparação às outras terapias combinadas (p < 0,05). Por outro lado, a associação montelucaste + furoato de mometasona, assim como a associação montelucaste + furoato de mometasone + loratadina melhoraram consideravelmente o sintoma de obstrução nasal e diminuíram os níveis de leucotrieno D4 em comparação com as outras combinações (p < 0,05). Conclusão A avaliação clínica dos sintomas combinada com a detecção experimental dos níveis de histamina e leucotrieno pode ser um método objetivo e preciso para classificar clinicamente os tipos de rinite alérgica. Além disso, o tratamento individualizado baseado na classificação da rinite alérgica pode resultar no aumento da eficácia do tratamento.

Crusted (Norwegian) scabies in an infant: A case report

@#INTRODUCTION: Norwegian or crusted scabies is a rare and highly contagious form of skin parasitosis caused by Sarcoptes scabiei var. hominis. Individuals maffffinly affected are considered to be immunocompromised such as those on prolonged glucocorticosteroid therapy, with AIDS or organ transplant patients. This disease presents as a hyperkeratotic dermatosis with an acral distribution. CASE REPORT: This is a case of a 2-month-old healthy Filipino male, who was previously managed as a case of miliaria rubra and treated with clobetasol 0.05% – ketoconazole 2% cream for 1 week. The papules and plaques became widespread. Consult with a pediatrician revealed widespread scabies and for which patient was prescribed topical permethrin with no improvement. On examination, patient presented with multiple erythematous papules and plaques with crusts on the face, trunk, extremities, palms and soles. Thickened yellowish plaques were observed on the palms and soles. Both parents also presented with widespread papules most prominent on the flexural areas accompanied by nocturnal pruritus. On dermoscopy, numerous mites and burrows were seen in a “jet with contrail pattern.” Prominent yellowish scales were also noted. Patient was admitted due to fever and superimposed bacterial infection and was given IV oxacillin, paracetamol, 8% precipitated sulfur in a hypoallergenic lotion applied twice daily and sodium fusidate ointment. On the 4th hospital day, the patient was afebrile and the lesions were noted to decrease in both erythema and crusting. Follow-up dermoscopy revealed absence scales, burrows and mites. CONCLUSION: Prolonged, unsupervised use of topical corticosteroids in our case most likely induced an immunocompromised state thus predisposing the patient to develop Norwegian scabies. In countries were cases of Norwegian scabies have been unresponsive to permethrin and when ivermectin is not available, the use of precipitated sulfur may still be the best therapeutic and safest option for infants.

Prescription Profile and Clinical Outcomes in Patients with Allergic Rhinitis Treated with Oral Antihistamines or Nasal Corticosteroids

Abstract Introduction Oral antihistamines and intranasal corticosteroids have been shown to be effective and safe for the treatment of allergic rhinitis; however, the evidence suggests a level of superiority of corticosteroids, so they should be preferred over the former. Objective To know the prescription profile of two second generation antihistamines (cetirizine and levocetirizine) and two nasal corticosteroids (mometasone and furoateciclesonide) in a cohort of patients with allergic rhinitis, and to compare the clinical outcomes obtained. Methods A cohort study was carried including patients with allergic rhinitis treated with cetirizine, levocetirizine, mometasone furoate or ciclesonide. The improvement was evaluated with the total nasal symptoms score (TNSS). This scale yields results between 0 and 12. Zero indicates absence of symptoms. Results A total of 314 patients completed 12 weeks of follow-up. Seventy-five percent were treated with antihistamines, 20% with corticosteroids, and 5% with a combination of the above. The TNSS median for corticosteroid was 2.5 points; for antihistamines, its was 5 points, and for combination, it was 4 points. We found differences between corticosteroids and antihistamines. Conclusion The prescription percentage of second generation oral antihistamines is higher than that of intranasal corticosteroids. However, patients with allergic rhinitis treated with the second option obtained better control of symptoms.

Postoperative Management of Eosinophilic Chronic Rhinosinusitis with Nasal Polyps: Impact of High-Dose Corticosteroid Nasal Spray

Abstract Introduction Eosinophilic chronic rhinosinusitis (ECRS) is characterized by an eosinophilic inflammation driven by Th2-type cytokines. Glucocorticosteroids are the most common first-line treatment for ECRS with nasal polyps. Objective We have evaluated the long-term treatment with double-dose intranasal corticosteroids in refractory ECRS nasal polyps resistant to the conventional dose and assessed the risk of adverse systemic effects Methods Sixteen subjects were enrolled in this study. All subjects had ECRS after endoscopic sinus surgery that resulted in recurrentmild andmoderate nasal polyps and were undergoing a postoperative follow-up application of mometasone furoate at a dose of 2 sprays (100 μg) in each nostril once a day (200 μg). All the patients were prescribed mometasone furoate, administered at a dose of 2 sprays (100 μg) in each nostril twice a day (400 μg) for 6 months. Results The average scores of the symptoms during the regular dose of intranasal steroid treatment were 5.2 ± 2.2, but 6 months after the high-dose application, they had significantly decreased to 2.5 ± 1.4 (p < 0.05). The polyp size showed an average score of 1.38 during the regular dose which was significantly reduced to 0.43 (p < 0.01) by the double dose. Glycated hemoglobin (HbA1c) showed normal ranges in all the patients tested. The cortisol plasma concentration was also normal. Conclusion Doubling the dose of the nasal topical spray mometasone furoate might be recommended for the treatment of recurrent nasal polyps in the postoperative follow-up of intractable ECRS. (AU)

Dermatite de contato por corticoide em pacientes com dermatite atópica / Corticosteroid contact dermatitis in patients with atopic dermatitis

Objetivo: Avaliar a sensibilização a corticoides tópicos e substâncias do teste de contato padrão e cosméticos em pacientes com dermatite atópica (DA) no Serviço de Alergia e Imunologia do HSPE-SP. Método: Estudo retrospectivo com análise de prontuário de pacientes com DA, classificados de acordo com o SCORing Atopic Dermatitis (SCORAD) em leve, moderada e grave, que foram atendidos no ambulatório de Alergia e Imunologia do HSPE-SP, submetidos a teste de contato com baterias padrão, cosméticos, corticoides, incluindo furoato de mometasona. Resultados: Após análise estatística dos dados de 51 pacientes portadores de DA, foi identificada maior prevalência no gênero feminino (73%). Pacientes com DA moderada/grave apresentaram maior positividade (62%) para pelo menos uma substância. Foram mais propensos a positivar para teste de contato, pacientes maiores de 18 anos. As substâncias que foram mais positivas na bateria padrão foram: sulfato de níquel (33%), neomicina (10%), e bicromato de potássio e cloreto de cobalto (8% cada). O sulfato de níquel foi mais positivo no gênero feminino. Três (5,9%) pacientes apresentaram positividade para teste de contato com bateria de corticoides, sendo positivas substâncias betametasona 1%, budesonida 0,01% e butirato de hidrocortisona 1%, e todos eram portadores de DA leve. Foi identificada relação entre positividade para bateria de corticoides e sulfato de níquel. Conclusão: Os testes de contato foram mais positivos em adultos. Houve maior sensibilidade para o sulfato de níquel no gênero feminino. Sensibilidade importante à neomicina na DA moderada/grave. Pacientes com alergia de contato por corticoides podem apresentar alergia a sulfato de níquel. Esse trabalho chama atenção para a porcentagem importante de pacientes com DA acometidos por alergia de contato por corticoides, sendo esse tipo alergia um problema emergente e que tem sido cada vez mais relatado na última década; porém, ainda são escassos os estudos envolvendo esse assunto.

Objective: To evaluate sensitization to topical corticosteroids and standard patch testing substances in patients with atopic dermatitis (AD) at the HSPE-SP Allergy and Immunology Department. Methods: This retrospective study assessed medical records of patients with AD, whose severity was classified as mild, moderate or severe according to SCORing Atopic Dermatitis (SCORAD). They were seen at the HSPE-SP Allergy and Immunology outpatient clinic and underwent a patch test with the following series: standard, cosmetics, and corticosteroids, including mometasone furoate. Results: After statistical analysis of data from 51 patients with AD, a higher prevalence was identified in female participants (73%). Patients with moderate-to-severe AD had more positive results (62%) for at least one substance. Patients older than 18 years were more likely to be positive in the patch test. The substances that were most frequently positive in the standard series were nickel sulfate (33%), neomycin (10%) and potassium dichromate and cobalt chloride (8% each). Positive nickel sulfate was more common in female participants. Three (5.9%) patients were positive for corticosteroids (1% betamethasone, 0.01% budesonide and 1% hydrocortisone butyrate) and all had mild AD. A relationship between positivity for corticosteroid series and nickel sulfate was identified. Conclusion: Patch tests were more frequently positive in adults. There was higher sensitivity to nickel sulfate in female patients. There was important sensitivity to neomycin in patients with moderate-to-severe AD. Patients with corticosteroid contact allergy may present with allergy to nickel sulfate. This paper draws attention to the important percentage of patients with AD affected by corticosteroid contact allergy, which has become an emerging problem that has been increasingly reported in the past decade. However, there are still few studies addressing this topic.

Efecto de los corticoesteroides intranasales tópicos en los valores de eosinófilos en mucosa nasal en pacientes adultos con rinitis alérgica / Effect of topical intranasal corticosteroids on eosinophil values in nasal mucosa in adult patients with allergic rhinitis / Efeito dos corticosteróides intranasais tópicos nos valores de eosinófilos na mucosa nasal em pacientes adultos com rinite alérgica

INTRODUCCIÓN: La citología nasal es utilizada como método complementario diagnóstico de la rinitis y el hallazgo de eosinófilos; en la misma aumenta la sensibilidad para confirmar una alergia a casi el 80%. Los corticoesteroides intranasales tópicos se utilizan actualmente como primera línea de tratamiento de la rinitis porque reducen la inflamación de la mucosa que subyace a los signos y síntomas de la enfermedad. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo y analítico. Se incluyeron pacientes entre 16 a 65 años edad inclusive, que consultaron al Servicio de Otorrinolaringología y Alergia e Inmunología de la Clínica Universitaria Reina Fabiola entre agosto de 2016 y julio de 2017 con diagnóstico de rinitis alérgica. La información de las variables cuantitativas se sometió a una comprobación estadística realizada mediante el test de Wilcoxon apareado. Se consideró significativo un valor de p<0,05…

INTRODUCTION: Nasal cytology is used as a complementary diagnostic method of rhinitis and the finding of eosinophils in it increases the sensitivity to confirm an allergy to almost 80%. Topical intranasal corticosteroids are currently used as the first line of treatment for rhinitis because they reduce the inflammation of the mucosa that underlies the signs and symptoms of the disease. MATERIAL AND METHODS: Observational, retrospective and analytical study. Patients between the ages of 16 and 65 years were included, who consulted the Otorhinolaryngology and Allergy and Immunology Department of the Reina Fabiola University Clinic between August 2016 and July 2017 with a diagnosis of allergic rhinitis. The information of the quantitative variables was subjected to a statistical check carried out by means of the paired Wilcoxon test. A value of p...

Costo-efectividad de furoato de mometasona tópica nasal para el tratamiento de la rinosinusitis aguda en México / Cost-effectiveness of nasal topical mometasone furoate for the treatment of acute rhinosinusitis in Mexico

Resumen Introducción: La rinosinusitis aguda (RSA) es frecuente en primer nivel de atención y los pacientes pueden mejorar sin antibióticos.Objetivo: Análisis de costo efectividad de furoato de mometasona spray nasal (FMSN) comparado con amoxicilina en tratamiento de rinosinusitis aguda en México desde punto de vista del Sistema Nacional de Salud. Método: Análisis costo-efectividad comparando FMSN 200 mg dos veces al día y amoxicilina 500 mg tres veces al día. Resultados en términos de eficacia modelados como cambios en sistema de Calificación de Síntomas Mayores (MSS por siglas inglés). MSS consiste en cinco preguntas: rinorrea, goteo retro nasal, congestión, cefalea sinusal y dolor facial. Datos clínicos obtenidos de ensayo clínico aleatorizado. Costos expresados en pesos mexicanos 2016. Se realizó análisis de sensibilidad univariable y multivariables para algunos parámetros utilizados en el modelo. Resultados: Los costos proyectados fueron de $3,261 pesos con FMSN y $3,438 pesos con amoxicilina. FMSN fue asociado con ahorro de costos por paciente de $177 pesos comparado con amoxicilina en un periodo de dos semanas. La tasa incremental de costo-efectividad del FMSN lo ubica como dominante frente a amoxicilina. El análisis de sensibilidad confirma los ahorros globales de costos y la superioridad en términos de la eficacia. Conclusión: En pacientes con rinosinusitis aguda, no complicada, el tratamiento del, FMSN 200 mcg dos veces al día, produjo mejoras significativas de los síntomas en comparación con amoxicilina en pacientes sin infecciones bacterianas y es una alternativa costo efectiva para el Sistema Nacional de Salud Mexicano. Comentario editorial al finalizar el artículo.

Abstract Introduction: Acute rhinosinusitis (RSA) is a common cause of consultation on first level of attention and it can be solved without antibiotics use. Objective: Analysis of cost effectiveness of nasal spray mometasone furoate (NSMF) compared to amoxicillin in treatment of acute rhinosinusitis in Mexico from a National Mexican Health System perspective. Methods: Cost-effectiveness analysis comparing NSMF 200µg twice daily and amoxicillin 500mg three time daily. The effectiveness outcomes of the study were modeled as changes in the Major Symptom Score (MSS). MSS consists of five questions concerning rhinorrhea, post-nasal drip, nasal congestion, sinus headache, and facial pain. Clinical data were obtained from a randomized clinical trial. Cost were expressed in Mexican pesos 2016. Sensitivity analysis was conducted univariable and multivariable for some model parameters. Results: The projected costs were $3,261 pesos with NSMF and $3,438 pesos with amoxicillin. NSMF was associated with a cost savings per patient of $177 pesos versus amoxicillin over a 2 weeks period. The incremental cost-effectiveness ratio for NSMF dominated amoxicillin. The sensitivity analysis confirms overall cost savings and superiority in terms of effectiveness. Conclusion: In patients with non-complicated acute rhinosinusitis NSMF 200 µg twice daily produce significantly an improvement in symptoms compared to amoxicillin in patients without bacterial infections and is a cost-effective alternative for the National Health Mexican System. Editorial comment at the end of this article.

Individualized Treatment of Allergic Rhinitis According to Nasal Cytology

PURPOSE: Nasal cytology is important in the diagnosis and treatment of nasal inflammatory diseases. Treatment of allergic rhinitis (AR) according to nasal cytology has not been fully studied. We plan to explore the individualized treatment of AR according to nasal cytology. METHODS: Nasal cytology from 468 AR patients was examined for inflammatory cell quantity (grade 0–5) and the percentage of neutrophils and eosinophils. Results were subdivided into the following categories: AR(Eos), eosinophil ≥50% of the whole inflammatory cells; AR(Neu), neutrophils ≥90%; AR(Eos/Neu), 10%≤ eosinophil <50%; AR(Low), grade 0/1 inflammatory cell quantity. Nasal cytology-guided treatment was implemented: all AR(Eos) patients (n=22) and half of the AR(Neu) patients (AR[Neu1], n=22) were treated with mometasone furoate spray and oral loratadine. Another half of the AR(Neu) patients (AR[Neu2], n=22) were treated with oral clarithromycin. Visual analog scale (VAS), symptom scores, and nasal cytology were evaluated 2 weeks before and after treatment. RESULTS: There were 224/468 (47.86%) AR(Eos), 67/468 (14.32%) AR(Neu), 112/468 (23.93%) AR(Eos/Neu), and 65/468 (13.89%) AR(Low) of the AR patients studied. There were no significant differences in clinical characteristics among these subgroups, except that the nasal blockage score was higher in AR(Eos) patients than in AR(Neu) patients (1.99 vs. 1.50, P=0.02). Comparing AR(Eos) patients with AR(Neu1) patients 2 weeks after treatment, nasal symptoms and VAS were significantly lower in AR(Eos) patients, except for nasal blockage symptoms (P<0.05 of nasal itching and sneezing; P<0.01 for nasal secretion, total scores, and VAS). Comparing AR(Neu1) with AR(Neu2) patients, nasal symptoms, and VAS were significantly lower in AR(Neu2), except for nasal blockage and nasal itching symptoms (P<0.05 for nasal secretions, sneezing, total score, and VAS). CONCLUSIONS: Nasal cytology may have important value in subtyping AR and optimizing AR treatment. Treating neutrophils is very important in AR patients with locally predominant neutrophils.

Mometasone Furoate Suppresses PMA-Induced MUC-5AC and MUC-2 Production in Human Airway Epithelial Cells / 결핵및호흡기질환

BACKGROUND: Mucus hypersecretion from airway epithelium is a characteristic feature of airway inflammatory diseases. Tumor necrosis factor α (TNF-α) regulates mucin synthesis. Glucocorticoids including mometasone fuorate (MF) have been used to attenuate airway inflammation. However, effects of MF on mucin production have not been reported. METHODS: Effects of MF and budesonide (BUD) on the phorbol-12-myristate-13-acetate (PMA)–induction of mucin and TNF-α in human airway epithelial cells (NCI-H292) were investigated in the present study. Confluent NCI-H292 cells were pretreated with PMA (200 nM) for 2 hours. Subsequently, the cells were stimulated with MF (1–500 ng/mL) or BUD (21.5 ng/mL) for 8 hours. Dexamethasone (1 µg/mL) was used as the positive control. Real-time polymerase chain reaction was used to determine MUC2 and MUC5AC mRNA levels. The level of total mucin, MUC2, MUC5AC, and TNF-α in culture supernatants were measured using enzyme-linked immunosorbent assay. RESULTS: MF and BUD significantly suppressed MUC2 and MUC5AC gene expression in PMA-stimulated NCI-H292 cells. The inhibitory effects of the two steroid drugs were also observed in the production of total mucin, MUC2 and MUC5AC proteins, and TNF-α. CONCLUSION: Our findings demonstrated that MF and BUD attenuated mucin and TNF-α production in PMA-induced human airway epithelial cells.

Mometasone furoate in the treatment of mild, moderate, or severe persistent allergic rhinitis: a non-inferiority study (PUMA) / Furoato de mometasona no tratamento de rinite alérgica persistente leve, moderada ou grave: estudo de não inferioridade (PUMA)

ABSTRACT INTRODUCTION: Allergic rhinitis is considered the most prevalent respiratory disease in Brazil and worldwide, with great impact on quality of life, affecting social life, sleep, and also performance at school and at work. OBJECTIVE: To compare the efficacy and safety of two formulations containing mometasone furoate in the treatment of mild, moderate, or severe persistent allergic rhinitis after four weeks of treatment. METHODS: Phase III, randomized, non-inferiority, national, open study comparing mometasone furoate in two presentations (control drug and investigational drug). The primary endpoint was the percentage of patients with reduction of at least 0.55 in nasal index score (NIS) after four weeks of treatment. Secondary outcomes included total nasal index score score after four and 12 weeks of treatment; individual scores for symptoms of nasal obstruction, rhinorrhea, sneezing, and nasal pruritus; as well as score for pruritus, lacrimation, and ocular redness after four and 12 weeks of treatment. The study was registered at clinicaltrials.gov with the reference number NCT01372865. RESULTS: The efficacy primary analysis demonstrated non-inferiority of the investigational drug in relation to the control drug, since the upper limit of the confidence interval (CI) of 95% for the difference between the success rates after four weeks of treatment (12.6%) was below the non-inferiority margin provided during the determination of the sample size (13.7%). Adverse events were infrequent and with mild intensity in most cases. CONCLUSION: The efficacy and safety of investigational drug in the treatment of persistent allergic rhinitis were similar to the reference product, demonstrating its non-inferiority.

Resumo Introdução: A rinite alérgica é considerada a doença respiratória mais prevalente no Brasil e em todo o mundo, com grande impacto na qualidade de vida; além de, afetar a vida social, o sono e também o desempenho na escola e no trabalho. Objetivo: Comparar a eficácia e segurança de duas formulações contendo furoato de mometasona no tratamento da rinite alérgica persistente leve, moderada ou grave por um período de quatro semanas. Método: Trata-se de um estudo nacional aberto de fase III, randomizado, de não inferioridade de comparação do furoato de mometasona em duas apresentações (medicação de controle e fármaco sob investigação). O ponto final primário foi o percentual de pacientes com redução mínima de 0,55 no escore de índice nasal (EIN) após quatro semanas de tratamento. Os desfechos secundários foram: escore NIS total após 4 e 12 semanas de tratamento; escores individuais para sintomas de obstrução nasal, rinorréia, espirros e prurido nasal, bem como escores para prurido, lacrimejamento e hiperemia conjuntival após 4 e 12 semanas de tratamento. O estudo foi registrado em clinicaltrials.gov com o número de referência NCT01372865. Resultados: A análise de eficácia primária demonstrou não inferioridade do fármaco sob investigação em relação à medicação de controle, visto que o limite superior do intervalo de confiança (IC) de 95% para a diferença entre os percentuais de sucesso após quatro semanas de tratamento (12,6%) situava-se abaixo da margem de não inferioridade proporcionada durante a determinação do tamanho da amostra (13,7%). Eventos adversos foram pouco frequentes e de leve intensidade na maioria dos casos. Conclusão: A eficácia e a segurança de um fármaco experimental no tratamento da rinite alérgica persistente foram similares às do produto de referência, o que demonstrou sua não inferioridade.

The Effect of Mometasone Furoate Cream on Skin Barrier Function in Patients with Allergic Contact Dermatitis / 대한피부과학회지

BACKGROUND: It is unclear how the usage of topical steroid agents affects skin barrier function. OBJECTIVE: In order to follow up on previous research into this topic, we sought to investigate the effects of a 3-week application of topical mometasone cream on the alteration of skin barrier function. METHODS: Twenty-six patients who had been clinically diagnosed with allergic contact dermatitis were enrolled. Topical mometasone cream was applied to the skin lesions. Clinical symptoms, transepidermal water loss (TEWL), corneometer unit, and pH value were measured on the initial visit, 1 week after treatment, and 3 weeks after treatment, and their values were compared. RESULTS: Clinical symptoms showed improvement after topical mometasone cream was applied (p0.05). CONCLUSION: This study found that treatment with topical mometasone cream for 3 weeks has no effect on skin barrier function. We believe that this research will help determine the optimal duration and dosage of topical steroid agents used for treating allergic contact dermatitis.

Reacción a un tatuaje de henna negra tratado con furoato de mometasona y gel de silicona: Caso clínico / Reaction to a black henna tattoo treated with mometasone furoate and silicone gel: case report

Black henna tattoos have paraphenylenediamine (PPD), which contains a product of herbal origin, which due to its molecular characteristics is capable of inducing, in susceptible individuals, a type IV hypersensitivity reaction. It clinically manifests as a contact dermatitis that usually when it disappears, scarring and hypopigmentation are left in the injured area. Objective: To describe the case of a patient with hypersensitivity to henna tattoo and to present the most relevant phenomena associated with this condition. Case report: The case of a 6 year-old patient with a black henna tattoo on his right leg, who was diagnosed with contact dermatitis probably attributed to PPD, is presented. Mometasone furoate and topical silicone gel treatment was started with good response. Conclusion: Mometasone furoate and silicone gel are a good possible therapeutic option for treating contact dermatitis caused by PPD as the dermatosis was resolved without residual lesions.

Los tatuajes de henna negra son aquellos que contienen parafenilendiamina (PPD), que contienen un producto de origen herbal, que por sus características moleculares es capaz de inducir, en individuos susceptibles, una reacción de hipersensibilidad tipo IV. Se manifiesta clínicamente como una dermatitis de contacto, que generalmente al desaparecer, persiste de manera residual una cicatriz hipertrófica e hipopigmentación en la zona lesionada. Objetivo: Describir el caso de un paciente con hipersensibilidad al tatuaje de henna, y presentar los fenómenos más relevantes asociados a esta patología. Caso clínico: Paciente de 6 años de edad, que se realizó un tatuaje con henna negra en la pierna derecha, en quien se diagnosticó posteriormente una dermatitis de contacto atribuida probablemente a la PPD. Se comenzó tratamiento con furoato de mometasona y gel de silicona con buena respuesta por vía tópica. Conclusión: El furoato de mometasona y gel de silicona son una posible opción terapéutica de utilidad para tratar la dermatitis de contacto causada por el PPD, debido a que la dermatosis se resolvió sin lesiones residuales.

Efectividad y seguridad del corticosteroide nasal mometasona comparado con beclometasona, budesonida, ciclesonida y fluticasona para el tratamiento de pólipos nasales en adultos y niños / Effectiveness and safety of nasal corticosteroid mometasone compared to beclomethasone, budesonide, ciclesonide and fluticasone for the treatment of nasal polyps in adults and children

Introducción: los pólipos nasales son una manifestación de la inflamación crónica de la mucosa nasal y senos paranasales. Generalmente surgen desde la mucosa que rodea al meato medio y muchas veces causan bloqueo nasal y restricción al flujo de aire a través de las fosas nasales. Su prevalencia ha sido reportada entre un 0.5% y un 4% en la población general. El principal objetivo del tratamiento de la poliposis nasal es aliviar los síntomas nasales debido a la eliminación o reducción en el tamaño del pólipo. Debido a sus propiedades antiinflamatorias, los corticoesteroides son el pilar del tratamiento de la poliposis nasal. Objetivo: esta evaluación de tecnología tiene como objetivo examinar los beneficios y riesgos del uso del corticosteroide tópico nasal Mometasona en comparación con otros corticoesteroides nasales para el tratamiento de poliposis nasal. Metodología: se realizó una búsqueda sistemática y exhaustiva de literatura. Todo el proceso se acogió a los estándares de calidad internacional utilizados por la Colaboración Cochrane. Resultados: de las búsquedas, se obtuvieron 166 referencias, de las que, luego de tamización de título y resumen, se obtuvieron 5 para evaluar en texto completo, y de las cuáles se excluyeron 3, para incluir dos en éste reporte. Las razones por las cuales fueron excluidas las anteriores referencias se describen a continuación: 1) versión anterior de una de las RSL incluidas en los resultados del reporte, 2) la población no respondía a los criterios de inclusión, y 3) un reporte era un resumen de conferencia. Conclusiones: no se encontró evidencia directa, ni indirecta, que permitiera conocer las diferencias entre mometasona y el resto de los CEN. En general, los corticoesteroides nasales son mejores que el placebo en efectividad sobre casi todos los desenlaces clínicos importantes y críticos. En general todos los CEN presentaron más efectos adversos que el placebo, aunque todos fueron leves. No se encontró evidencia de diferencias en cuanto a eventos adversos entre los CEN entre sí.(AU)

Efectividad y seguridad del corticosteroide nasal mometasona como tratamiento de rinosinusitis crónica sin pólipos / Effectiveness and safety of nasal corticosteroid mometasone as a treatment of chronic rhinosinusitis without polyps

Introducción: la rinosinusitis crónica (RSC) es definida como una inflamación de la mucosa nasal y senos paranasales durante al menos 12 semanas o superior, afecta a todas las edades, pero es más prevalente en la edad adulta. Debido a que la rinosinusitis crónica idiopática es una enfermedad inflamatoria crónica, el manejo médico debe estar dirigido a controlar la inflamación y el manejo de las exacerbaciones. El uso diario de corticosteroides tópicos nasales es la piedra angular en el tratamiento de la rinosinusitis crónica idiopática. Objetivo: examinar la efectividad y seguridad del corticosteroide tópico nasal Mometasona como tratamiento de síntomas relacionado con rinosinusitis crónica idiopática en pacientes niños y adultos. Metodología: se realizó una búsqueda sistemática y exhaustiva de literatura, de revisiones sitemáticas de literatura de alta calidad en los últimos 5 años. Todo el proceso se acogió a los estándares de calidad internacional utilizados por la Colaboración Cochrane. Resultados: de las búsquedas, se obtuvieron 531 referencias, de las que, luego de tamización de título y resumen, se obtuvieron 6 para evaluar en texto completo, y de las cuáles se excluyeron 4, para incluir dos en el análisis de este reporte. Conclusiones: los CEN son más efectivos que el placebo para controlar los síntomas nasales y, adicionalmente, se relacionan con mayor proporción de pacientes con cirugía de senos paranasales que responden al tratamiento. En el caso de pacientes sin cirugía de senos paranasales, no hubo diferencias entre los CEN y el placebo, ni tampoco se encontraron diferencias entre ellos en mejorar la calidad de vida, ni diferencias en la mejoría evaluada con cambios endoscópicos. No hay evidencia de diferencias entre ellos mismos (beclometasona, fluticasona y mometasona), en cuanto a efectividad. No hay evidencia para determinar que beclometasona, fluticasona, mometasona y ciclesonida, son diferentes en cuanto a eventos adversos.

Efectividad y seguridad del corticosteroide en suspensión para inhalación nasal mometasona como tratamiento de rinitis alérgica para pacientes niños y adultos / Effectiveness and safety of corticosteroid suspension for nasal inhalation mometasone as a treatment of allergic rhinitis for children and adults

Introducción: la rinitis alérgica (RA) es un trastorno sintomático de la nariz inducido por la inflamación mediada por IgE de la mucosa nasal después de la exposición a un alérgeno. Los síntomas más comunes son la rinorrea, la obstrucción nasal, el prurito nasal y los estornudos. En Colombia la prevalencia se ha estimado entre 12 y 32 % para el asma y la rinitis alérgica, respectivamente, variabilidad que se ha relacionado con las diversas herramientas de medición utilizadas. Actualmente, los corticosteroide en suspensión para inhalación nasal son los fármacos más efectivos para el tratamiento de la rinitis alérgica y no alérgica. Objetivo: el objetivo de esta evaluación es determinar efectividad y seguridad del corticosteroide en suspensión para inhalación nasal mometasona en monoterapia, comparada con otros corticosteroide en suspensión para inhalación nasales tales como beclometasona, budesonida, biclesonida o fluticasona en el tratamiento de síntomas relacionado con rinitis alérgica. Metodología: se llevó a cabo una búsqueda sistemática y exhaustiva de literatura con el fin de identificar evidencia científica relevante en relación con la pregunta de investigación, en las siguientes fuentes: Se consultaron las siguientes fuentes: MEDLINE, incluyendo los repositorios In-Process & Other Non-Indexed Citations y Daily Update (plataforma Ovid); EMBASE (plataforma Ovid), y Cochrane Database of Systematic Reviews - CDSR (plataforma Wiley). En adición a la anterior, y de acuerdo a la evidencia encontrada, se llevó a cabo una segunda búsqueda sistemática para Ensayos Clínicos con Asignación Aleatoria, en los últimos 7 años.Resultados: se obtuvieron 1191 referencias, de las que, luego de tamización de título y resumen, se obtuvieron 5 para evaluar en texto completo, y de las cuáles todas excluyeron. Solamente se encontró una RSL que evaluaba mometasona vs CEN o Placebo (13) y aunque 3 de los estudios primarios tenían brazos adicionales a placebo en donde se comparaban mometasona con otros CEN, las medidas los resultados de los desenlaces reportados no permitían ser metaanalizadas. En esta revisión sistemática la búsqueda de la literatura fue realizada hasta 2007. Se realizó una nueva búsqueda de estudios primarios, limitada a los años 2007-2014, y para ECA. De esta segunda búsqueda se obtuvieron, luego de la tamización, 2 ECA. Estos dos artículos se combinaron con tres estudios que provenían de la RSL, en un metanálisis de novo comparando mometasona vs fluticasona. Conclusiones: en términos de efectividad, mometasona en comparación con fluticasona no resultó superior en efectividad en cuanto a mejoría en el puntaje total de síntomas nasales y calidad de vida. No hubo diferencia entre mometasona y fluticasona con respecto a la presencia de efectos adversos.(AU)

Onset feature and efficacy of early interventional treatment of Artemisia pollinosis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical feature and treatment methods of Artemisia pollinosis.</p><p><b>METHODS</b>Skin prick test results of 14 426 cases from Beijing Tongren hospital and pollen concentration of Beijing observatory from 2007 to 2011 were analyzed to identify the clinical feature of Artemisia pollinosis patients and its correlation with the pollen concentration. Patients were given leukotriene receptor antagonists (Montelukast) for 2 weeks, followed by 4 weeks of mometasone furoate nasal spray (EIT group: n = 21), or only 4 weeks of mometasone furoate nasal spray (POT group: n = 16). The nasal symptom score was compared between 2 groups.SPSS 16.0 software was used to analyze the data.</p><p><b>RESULTS</b>Artemisia pollinosis accounted for 30.8% (4 442/14 426) of all SPT positive allergic rhinitis patients, and most Artemisia SPT positive results were strong positive(3 793/4 442, 85.4%); onset age peak of Artemisia pollinosis patients was at the age of 19 to 30, onset time concentrated in August to September, was consistent with the peak period of Artemisia pollen concentration; EIT treatment using leukotriene receptor antagonists two weeks before pollen season significantly improved sneeze, sniveling and rhinocnesmus symptoms (t value was 3.28, 3.92, 3.09, respectively, all P < 0.01) compared with post-onset treatment (POT). But nasal obstruction and cough symptoms had no significant difference between two groups (t value was 0.85, 1.52, respectively, all P > 0.05).</p><p><b>CONCLUSION</b>Artemisia pollen is the main pollen allergen in Beijing, EIT treatment was effective to pollinosis.</p>

Discussion on the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>A total of 386 children with OSAHS were enrolled from June 2008 to April 2011.Ninety children with adenoid and tonsil ≤ degree III (group A) were randomly divided into A1 subgroup and A2 subgroup, while 22 of 296 (group B) children aged less than 3 years old with degree IV adenoid and(or) tonsil were divided into B1 subgroup, and the other 274 of 296 children with degree IV adenoid and (or) tonsil were divided into B1 subgroup, B2 subgroup and B3 subgroup. The adenoid, tonsil size examination and nasal endoscopic examination scores were performed before treatment, 3 months and 6 months after treatment. Drug therapy included oral antibiotics, mometasone furoate as a nasal spray, leukotriene receptor antagonist (LTRAs), mucoactive medications. Conservative treatment meant drug therapy plus negative pressure of sputum aspiration.Surgical treatment meant coblation adenotonsillectomy. A1 subgroup received drug therapy for 3 months; A2 and B1 subgroup received conservative treatment for 3 months; B2 subgroup received coblation adenotonsillectomy after 3 days conservative treatment and postoperative drug therapy for 2 weeks; B3 subgroup received coblation adenotonsillectomy after 2 weeks conservative treatment and postoperative drug therapy for 3 months.</p><p><b>RESULTS</b>The adenoid and tonsil size of A2 subgroup decreased at 3 months after treatment (Wald χ² were 10.584 and 8.366, respectively, P < 0.05), no significant re-increase was found at 6 months, and no decrease was found in the A1 subgroup (P > 0.05). The nasal endoscopic examination scores decreased in both A1 and A2 subgroup at 3 months after the treatment (F = 403.420, P < 0.05), but it was found re-increase in A1 subgroup at the 6 months (P < 0.05), no significant re-increase was found in the A2 subgroup. The polysomnography (PSG) monitor of A2 subgroup was 100.0% normal at 3 months after treatment, while the A1 subgroup was only 43.2% (χ² = 36.189, P < 0.05). B2 and B3 subgroups cured after coblation adenotonsillectomy, but no decrease of the adenoid and tonsil size was found in B1 subgroup (P > 0.05). The nasal endoscopic examination scores of B1, B2 and B3 subgroups showed significant decrease after the treatment, but re-increase was found in both B1 and B2 subgroups at the 6 months (F = 1 614.244, P < 0.05), no significant re-increase was found in the B3 subgroup. The PSG monitor of B3 subgroup was 100.0% normal at 3 months after treatment, B2 subgroup 73.4%, and B1 subgroup only 57.4% (χ² = 90.846, P < 0.05).</p><p><b>CONCLUSIONS</b>The treatment method of children with OSAHS should be selected according to the age, condition of disease, and size of the adenoid and tonsil. Adenoid and tonsil ≤ degree III should select conservative treatment; while for degree IV adenoid and (or) tonsil, surgical treatment should be primary choice. Conservative treatment can reduce the risk of perioperative and adequate postoperative drug therapy can help prevent recurrence after surgery.</p>