The Itch that freckles? Development of lentigines in areas of resolved chronic atopic dermatitis.

We report two pediatric patients with a history of chronic lichenified atopic dermatitis (AD) who subsequently developed eruptive lentigines at sites of resolved AD. The occurrence of this phenomenon in eczematous dermatoses in the absence of topical calcineurin inhibitor (TCI) use is rarely reported in the literature.

Clinical efficacy of mucopolysaccharide polysulfate ointment combined with desonide ointment in treatment of infantile eczema.

To observe and analyze the clinical efficacy of mucopolysaccharide polysulfate (MPS) ointment combined with desonide ointment in treatment of infantile eczema. A total of 180 infants who had been treated for eczema at our hospital were enrolled. The patients were divided into control group accepting desonide ointment only and research group accepting mucopolysaccharide polysulfate ointment and desonide ointment. The therapeutic efficacies of two groups were compared. Results: By comparing the total therapeutic efficacy, results showed that the total efficacy of the research group was 96.67%, while that value of the control group was 82.22%, making the total efficacy of the research group significantly higher (p<0.05). And the improvement of the Eczema Area and Severity Index (EASI) score in the research group after drug administration was significantly better than that of the control group (p<0.05). Moreover, there was a greater decrease in the recurrence rate of the research group than that of the control group (p<0.05). Combined application of mucopolysaccharide polysulfate ointment and desonide ointment can achieve better therapeutic effect in treatment of infantile eczema.

Comparison of Topical, Systemic, and Combined Therapy with Steroids on Idiopathic Granulomatous Mastitis: A Prospective Randomized Study.

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a benign disorder of the breast, for which the optimal treatment modality remains missing. METHODS: A total of 124 patients with a histopathologically proven diagnosis of IGM were enrolled in a prospective, randomized parallel arm study. Patients were treated with topical steroids in Group T (n: 42), systemic steroids (0.8 mg/kg/day peroral) in Group S (n: 42), and combined steroids (0.4 mg/kg/day peroral + topical) in Group C (n: 40). Compliance with the therapy, response to the therapy, the duration of therapy, side effects and the recurrence rates were compared. RESULTS: Sixteen patients did not comply with the treatment, and the highest ratio of compliance with therapy was seen in Group T (p < 0.05). Complete clinical regression (CCR) was observed in 90 (83.3%) patients. Response to the treatment (RT) was evaluated radiologically and observed in 89.8% of the patients. There was no statistically significant difference between groups regarding CCR, RT and the recurrence rate. The longest duration of therapy was observed in Group T (22 ± 9.1-week), whereas the shortest was observed in Group S (11.7 ± 5.5-week) (p < 0.001). The systemic side effects were significantly lower in Group T in comparison with Groups S and C (2.4% vs. 38.2% and 30.3%, respectively) (p < 0.001). CONCLUSIONS: The efficiency of the treatment was similar for all groups, both clinically and radiologically. Although the duration of therapy was longer in Group T, the lack of systemic side effects increased the compliance of the patients with the therapy. Therefore, topical steroids would be among first-line treatment options of IGM.

Rash on eyebrows and periumbilical region.

Patch testing data indicate that the 5 most prevalent contact allergens out of more than 3700 that are known are: nickel (14.3% of patients tested), fragrance mix (14%), the topical antibiotic neomycin (11.6%), balsam of Peru (used in some perfumes, toiletries, and pharmaceutical items) (10.4%), and the mercury-based vaccine preservative thimerosal (10.4%).

Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review.

BACKGROUND: Facial seborrheic dermatitis (SD), a chronic inflammatory skin condition, can impact quality of life, and relapses can be frequent. Three broad categories of agents are used to treat SD: antifungal agents, keratolytics, and corticosteroids. Topical therapies are the first line of defense in treating this condition. OBJECTIVE: Our objective was to critically review the published literature on topical treatments for facial SD. METHODS: We searched PubMed, Scopus, Clinicaltrials.gov, MEDLINE, Embase, and Cochrane library databases for original clinical studies evaluating topical treatments for SD. We then conducted both a critical analysis of the selected studies by grading the evidence and a qualitative comparison of results among and within studies. RESULTS: A total of 32 studies were eligible for inclusion, encompassing 18 topical treatments for facial SD. Pimecrolimus, the focus of seven of the 32 eligible studies, was the most commonly studied topical treatment. CONCLUSION: Promiseb®, desonide, mometasone furoate, and pimecrolimus were found to be effective topical treatments for facial SD, as they had the lowest recurrence rate, highest clearance rate, and the lowest severity scores (e.g., erythema, scaling, and pruritus), respectively. Ciclopirox olamine, ketoconazole, lithium (gluconate and succinate), and tacrolimus are also strongly recommended (level A recommendations) topical treatments for facial SD, as they are consistently effective across high-quality trials (randomized controlled trials).

The effect of desonide hydrogel on pruritis associated with atopic dermatitis.

Itch is a common and troubling symptom of atopic dermatitis. It is not mediated by histamine, and standard anti-itch therapies, therefore, have limited benefit for most AD patients. Instead, anti-inflammatory agents are used to reduce inflammation and therefore improve associated itch. Studies confirm that long-term use of corticosteroids can lead to a reduction in pruritus. A pilot study was designed to assess the effects of one week of twice-daily application of desonide hydrogel 0.05% for the treatment of atopic dermatitis. Active treatment was associated with significant improvements in IGA scores at day 3 and day 7 (mean score 0.55, 75.83% improvement from Baseline; P <.0001) and pruritus VAS scores at day 3 and day 7 (mean 6.35-point, 86.61% reduction in VAS scores; P <.0001). Treatment with the convenient, hydrating hydrogel formulation is effective and associated with an improvement in subjects' quality of life.

Efficacy and limitations of pulse cyclophosphamide therapy in polymyositis and dermatomyositis.

OBJECTIVES: To assess the therapeutic response of intravenous (IV) pulse cyclophosphamide therapy in polymyositis and dermatomyositis. METHODS: Data of 9 patients (M:F = 2:7) who received IV pulse cyclophosphamide therapy were retrospectively analyzed. RESULTS: The mean symptom duration was 11.33 ± 10.6 months (range, 2-34 months). The cohort comprised (1) primary idiopathic polymyositis (n = 1), (2) primary idiopathic dermatomyositis (n = 1), (3) childhood type associated with vasculitis (n = 1), and (4) associated with collagen vascular disease (n = 6). All patients improved and became clinically asymptomatic after a mean period of 12.33 ± 6.5 months (range, 4-24 months); 5 remained asymptomatic at the end of a median follow-up period of 22 months. All patients received concomitant steroid therapy, and in 6, steroids could be tapered after the initiation of IV pulse cyclophosphamide therapy. CONCLUSIONS: In this cohort of polymyositis/dermatomyositis, treatment with IV pulse cyclophosphamide was associated with improvement; the therapeutic response was sustained in majority of the patients.

Re-emergence of papulonodular napkin dermatitis with use of reusable diapers: report of 5 cases.

The use of reusable diapers, often made of cotton and bamboo material, is becoming more widespread in France--with the "eco" fashion, as they are considered more natural, ecologic and economic. We report 5 cases of papulonodular lesions in convex skin areas associated with the use of these diapers in infants. One case was typical Sevestre and Jacquet erosive dermatitis. The 4 others presented skin-coloured umbilicated papules or nodules with slight or no erythema and could be considered early-stage Sevestre and Jacquet erosive dermatitis, granuloma gluteale (1 case) or pseudo-verrucous papules. These 3 diagnoses probably belong to the same disease spectrum, proposed as "irritant napkin papulonodules". Napkin lesions occurred subsequent to 1) in all cases, use of reusable diapers, which are probably less absorbent than disposable diapers; 2) in 2 cases, insufficient food, which was responsible for lack of weight gain and delayed healing; and 3) in 1 case, diarrhea, which worsened the moisture. We alert physicians to possible papulonodular napkin dermatitis in infants wearing reusable diapers.

Effects of TLC-Ag dressings on skin inflammation.

The TLC-Ag dressings, a combination of technology lipido-colloid and silver salts, are used to promote healing in wounds with risks or signs of local infection, thanks to the antimicrobial properties of the silver salts. Nanocrystalline silver dressings containing nanocrystalline silver, also used to improve wound healing, present both antimicrobial and anti-inflammatory effects. The aim of this study was to investigate the anti-inflammatory effects of TLC-Ag dressings in a model of chronic skin inflammation induced by repeated application of 12-O-tetradecanoylphorbol-13-acetate to the skin of hairless mice, in comparison with TLC dressing, Silcryst nanocrystalline dressing, desonide cream 0.05%, a corticoid cream used as positive control, and gauze. Daily treatments of the mice began 7 days after the start of induction of chronic skin inflammation and lasted for 7 days. A macroscopic score was performed daily during the treatment period until the mice killing on day 15 and skin samples were taken for histopathological analysis. TLC-Ag reduced significantly the macroscopic score of chronic skin inflammation from day 10 in comparison with gauze and TLC dressing, similarly to Silcryst nanocrystalline dressing and desonide cream, which presented the best anti-inflammatory effects. No significant differences were observed between TLC dressing and gauze. TLC-Ag reduced significantly the microscopic score of chronic skin inflammation in comparison with TLC dressing and gauze, similarly to Silcryst nanocrystalline dressing but significantly less than desonide cream. These results demonstrate that TLC-Ag dressings present significant anti-inflammatory effects on chronic skin inflammation. They can improve wound healing, due to both the antimicrobial and anti-inflammatory properties.

Fiddler's neck: Chin rest-associated irritant contact dermatitis and allergic contact dermatitis in a violin player.

Fiddler's neck refers to an irritant contact dermatitis on the submandibular neck of violin and viola players and an allergic contact dermatitis to nickel from the bracket attaching the violin to the chin rest on the violinist's supraclavicular neck. A 26-year-old woman developed submandibular and supraclavicular left neck lesions corresponding to the locations of the chin rest and bracket that was attached to her violin that held it against her neck when she played. Substitution of a composite chin rest, which did not contain nickel, and the short-term application of a low potency topical corticosteroid cream, resulted in complete resolution of the allergic contact dermatitis supraclavicular neck lesion. The irritant contact dermatitis submandibular neck lesion persisted. In conclusion, violin players are predisposed to developing irritant contact dermatitis or allergic contact dermatitis from the chin rest. We respectfully suggest that the submandibular neck lesions from contact with the chin rest be referred to as 'fiddler's neck - type 1,' whereas the supraclavicular neck lesions resulting from contact of the bracket holding the chin rest in place be called 'fiddler's neck - type 2.' A composite chin rest should be considered in patients with a preceding history of allergic contact dermatitis to nickel.

Golimumab-exacerbated subacute cutaneous lupus erythematosus.

BACKGROUND: Subacute cutaneous lupus erythematosus (SCLE) is characterized by annular, nonscarring, photodistributed, or papulosquamous lesions. The disease may be idiopathic, drug induced, or drug exacerbated. OBSERVATIONS: A 66-year-old woman with a history of hypertension, parkinsonism, rheumatoid arthritis, anxiety and depression, and symptoms of Sjögren syndrome was seen with a 1-month history of an eruption on her upper extremities and upper trunk. The eruption had begun 2 to 3 weeks after subcutaneous injection of golimumab for rheumatoid arthritis. She had developed SCLE 2 years previously due to furosemide use and 10 years previously due to hydrochlorothiazide use. Physical examination revealed scaly, annular, erythematous plaques photodistributed on the arms, legs, and upper trunk. A punch biopsy specimen demonstrated vacuolar interface dermatitis and lymphohistiocytic perivascular inflammation. Serological abnormalities included a positive antinuclear antibody, an elevated anti-La/SS-B antibody level, and an elevated anti-Ro/SS-A antibody level. She was diagnosed as having SCLE and was initially treated with desonide lotion, photoprotection, prednisone (40 mg/d) tapered over 6 weeks, and hydroxychloroquine sulfate (200 mg twice daily). Because of persistent disease, methotrexate sodium (12.5 mg/wk) was subsequently added to the regimen, and her eruption cleared completely. CONCLUSIONS: Golimumab should be added to the list of medications capable of inducing or exacerbating SCLE. Our patient demonstrated variable times to the resolution of SCLE, possibly attributable in part to the different half-lives of the agents administered.

The importance of vehicle properties to patients with atopic dermatitis.

The properties of vehicle formulations may influence drug delivery, efficacy, and tolerance profiles of topical medications. Patient preferences vary and the importance of certain aesthetic attributes depend on the disease state, the site of application, and the length and extent of treatment, among other factors. Formulations that offer aesthetic advantages over traditional vehicles may improve patients' willingness to apply therapy as directed and therefore may affect the outcome of treatment. A participant preference study was conducted to determine if an aqueous gel (hydrogel) formulation of desonide would appeal to patients with atopic dermatitis (AD). Before treatment adult participants with AD completed a questionnaire to assess their AD history and prior topical treatments and to rate the importance of topical vehicle attributes. Each participant then applied desonide hydrogel 0.05% to affected areas twice daily for 4 weeks. At the end of the treatment, participants were queried on the attributes of desonide hydrogel and how it compared with other vehicles previously used. Twenty-two participants with mild to moderate AD completed the study; 100% (22/22) of participants found desonide hydrogel to be easy to apply/use/spread, easy to use on hair-bearing skin, comfortable to use under makeup and/or cosmetics, suitable for use on multiple body areas, and stain free. Most participants reported that the product was soothing (82% [18/22]), did not dry the skin (96% [21/22]), disappeared quickly (82% [18/22]), was comfortable to wear under clothes (91% [20/22]), and was not greasy or shiny on skin (96% [21/22]).

Self-reported participant experience with desonide hydrogel in the treatment of mild to moderate atopic dermatitis.

The objective of this study was to evaluate patients' real-world experiences with desonide hydrogel for the treatment of mild to moderate atopic dermatitis (AD). Physicians who participated in this patient-experience program identified eligible participants (age range, < 3 months to 91 years) for treatment with desonide hydrogel 0.05%. The medication was prescribed by each participant's physician according to his/her practice guidelines and was provided to the participant at no charge. Patients (or their parents/guardians) voluntarily participated by providing consent and completing 2 surveys: one at baseline (pretreatment) and the other approximately 3 weeks after initiation of desonide hydrogel treatment (posttreatment). The pretreatment survey included questions about prior topical medication use for AD and satisfaction with prior treatments. The second survey assessed compliance with desonide hydrogel, satisfaction with treatment, characteristics of desonide hydrogel, intent to continue treatment, and willingness to recommend desonide hydrogel to others. A total of 1185 participants completed both the pretreatment and posttreatment surveys. Participant satisfaction with desonide hydrogel was 95% greater than satisfaction with prior topical medications for AD (P < .01). Adherence to treatment with desonide hydrogel was more than 80% based on reports from participants. Eighty-nine percent of participants reported that they would continue to use the medication for their condition if needed and 85% would recommend desonide hydrogel to others. Prescribing physicians received individual summaries of survey responses reported by each of his/her participating patients, which provided valuable feedback regarding participants' perceptions of treatment. Participants reported favorable experiences after treatment with desonide hydrogel compared with prior topical therapies. Desonide is widely prescribed for the treatment of AD.

Moisturizing advantages of desonide hydrogel in treating atopic dermatitis.

The stratum corneum typically is compromised in patients with atopic dermatitis (AD). Beneficial AD treatments should provide moisture to the skin as well as restore impaired barrier function. Traditional treatments involve ointments or creams. A clinical study was conducted to determine if desonide in a hydrogel vehicle (HGV) could improve the moisture content and barrier function of the stratum corneum in adults with mild to moderate AD. Participants applied desonide hydrogel 0.05% twice daily for 4 weeks to areas of both lesional and nonlesional skin. Corneometry and transepidermal water loss (TEWL) were measured at baseline and weeks 1, 2, and 4. Statistically significant improvements in corneometry and TEWL measurements on lesional skin were observed at all study visits compared with baseline (all P < or = .002 and P < or = .04, respectively).