ABSTRACT
Topical corticosteroids are first-line treatments for atopic dermatitis (AD) and their efficacy is well-established in randomized controlled clinical trials. When corticosteroids fail in clinical practice, it often is attributed to nonresponse. However, poor adherence also should be considered. With the advent of electronic monitoring systems, objective data on adherence can be obtained. The purpose of this study was to determine both self-reported and actual adherence to clocortolone pivalate cream 0.1% in the treatment of AD in a pediatric population. Six participants completed the 4-week study. Self-reported adherence was significantly higher than objectively measured adherence (P = .01). In general, adherence was best during the first week of treatment and tapered off thereafter. Clocortolone pivalate cream 0.1% was generally effective, with rapid improvement over the first week of treatment, even when adherence was limited. This study was limited by the small sample size and the failure of 2 participants to complete the study. Patients overestimate their adherence behavior. While some patients are adherent to treatment, others rapidly discontinue their use of medication over time. Midpotency topical corticosteroids such as clocortolone pivalate cream 0.1% are highly effective treatments for AD. Poor adherence should be considered when AD is not responding to topical corticosteroid treatment.
Subject(s)
Dermatitis, Atopic/drug therapy , Drug Monitoring/methods , Fluocortolone/analogs & derivatives , Immunosuppressive Agents/administration & dosage , Patient Compliance/statistics & numerical data , Self Administration/statistics & numerical data , Administration, Cutaneous , Adolescent , Caregivers/psychology , Child , Dermatitis, Atopic/pathology , Drug Administration Schedule , Drug Monitoring/instrumentation , Electronics, Medical/instrumentation , Fluocortolone/administration & dosage , Humans , Patient Compliance/psychology , Severity of Illness Index , Skin/pathology , Treatment OutcomeABSTRACT
Migrant farmworkers experience a high incidence of skin disease. This report provides information on the case history of cutaneous larva migrans in a Latino migrant farmworker. Treatment options are reviewed, and information for prevention is discussed.
Subject(s)
Agricultural Workers' Diseases/diagnosis , Foot Dermatoses/diagnosis , Larva Migrans/diagnosis , Transients and Migrants , Adult , Agricultural Workers' Diseases/pathology , Diagnosis, Differential , Foot Dermatoses/pathology , Humans , Larva Migrans/pathology , MaleABSTRACT
BACKGROUND: Rosacea is an extremely common chronic dermatosis affecting an estimated 14 million Americans. Rosacea is most commonly managed with topical metronidazole, sometimes in combination with oral antibiotics. PURPOSE: To review published studies about topical metronidazole therapy for rosacea, both as a monotherapy and in conjunction with oral antibiotics. METHODS: Medline searches were conducted for clinical trials using metronidazole, tetracycline, and doxycycline for rosacea. RESULTS: Topical metronidazole has been well studied as a rosacea therapy. Twice-daily dosing of metronidazole 1.0% cream is as effective as 250 mg tetracycline twice daily. Metronidazole 1.0% gel used once daily is as effective as azelaic acid 15% gel dosed twice daily. When dosed at subantimicrobial levels, doxycycline 20 mg taken twice daily is effective in decreasing inflammatory lesions and erythema associated with rosacea. Metronidazole 0.75% lotion is more effective when used in combination with doxycycline 20 mg dosed twice daily. DISCUSSION: Metronidazole in 0.75% strength lotion, cream, and gel and 1.0% metronidazole cream and gel are all efficacious in treating rosacea. Combination treatment with oral antibiotics at both antimicrobial and subantimicrobial doses is an efficacious means of treating rosacea. Maintenance treatment with topical metronidazole decreases relapses and allows for longer intervals between flares.