Application Of Corticosteroids Research Articles

Application of Corticosteroids in Dentistry: A Review

ABSTRACT Corticosteroids are crucial in dentistry for their anti-inflammatory and immunosuppressive properties, aiding in managing conditions such as oral lichen planus, recurrent aphthous stomatitis, and post-operative inflammation. By inhibiting pro-inflammatory mediators and immune cell activity, they offer significant symptomatic relief and promote healing. However, potential systemic and local side effects necessitate cautious application. This article explores the use of corticosteroids in routine dental practice.

Investigation of the Effect of Local and Systemic Preoperative Dexamethasone Application on Bone Tissue Healing in Mandibular Bone Defects.

The aim of this study was to investigate the effect of locally and systemically delivered single-dose corticosteroid injections on bone tissue. A total of 84 Wistar albino rats were divided into 2 groups as local and systemic injection groups, and 2 groups as control and experiment among themselves. Before the procedure, dexamethasone was given to the experimental group and physiological saline was given to the control group. A defect was created in the jawbone. It was sacrificed on the third, seventh, and 40th days. The mandible bones of the sacrificed rats were removed and the healing of the bone tissue was examined histopathologically. No significant difference was observed in the tissue sections of the subjects sacrificed after 40 days. However, the increase in fibroblastic connective tissue and the number of osteoblasts were less in the experimental local groups that were sacrificed after 7 days compared with the control groups (P=0.040 and 0.041). Again, it was determined that there was a statistically significant decrease in the experimental local group compared with the experimental systemic group (P=0.040 and 0.004). It can be said that single-dose corticosteroid applications cause a delay in bone healing in the early period.

Topical corticosteroids in the treatment of acute sunburn: a systematic review

Background: Acute sunburn is a prevalent dermatological issue, particularly affecting individuals with fair skin types I-III. It is characterized by erythema, edema, and discomfort due to ultraviolet (UV) radiation exposure. Topical corticosteroids are commonly used for their anti-inflammatory properties, but their efficacy in sunburn treatment is debated due to limited high-quality evidence from randomized controlled trials (RCTs). This study aims to assess the efficacy of topical corticosteroids in relieving symptoms and inflammation of sunburn. Methods: A systematic review was conducted by searching PubMed, Web of Science, ProQuest, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) for studies published up to April 30, 2024. Keywords included combinations of terms related to corticosteroids, topical application, and sunburn. Studies were selected based on PRISMA 2020 guidelines, focusing on adult patients treated with topical corticosteroids compared to placebo. Data extraction and quality assessment were independently performed by two researchers using the Cochrane Collaboration’s Risk of Bias tool. Results: The review included six RCTs with a total of 339 participants, aged 18-68 years, conducted in Europe and the USA. Various topical corticosteroids were studied, including methylprednisolone aceponate, hydrocortisone 17-butyrate, and hydrocortisone-21-acetate. Treatment durations ranged from single applications to twice daily for seven days. The results demonstrated that prolonged treatment with topical corticosteroids significantly reduced sunburn symptoms such as erythema and pain. When applied for seven days, treated areas showed lower sunburn reaction scores and reduced inflammation compared to untreated areas. Early application of corticosteroids, particularly within 6 hours post-exposure, was more effective than later applications. Histological analyses supported these findings, showing improvements in epidermal thickness and reduced dermal inflammation in treated areas. Conclusion: Topical corticosteroids can effectively alleviate acute sunburn symptoms and aid skin recovery by targeting inflammatory pathways. Their efficacy is enhanced with prolonged and early application. Further research is needed to optimize treatment protocols and assess long-term effects to fully realize the therapeutic potential of corticosteroid therapy in managing acute sunburn.

Steroid-induced dermatoses: a challenge for modern dermatology

The aim of this work is to determine the variability and significance of motivating and provoking factors associated with the uncontrolled use of topical glucocorticosteroids, psychological features of this condition. Materials and methods. 50 patients with exacerbation of inflammatory dermatoses after long-term topical application of drugs with glucocorticosteroids as an active substance were examined. The key diagnostic measures were a clinical examination, an anamnesis collection with clarification of the activity class of the used agent, duration and potential reason for its systematic or periodic use. Assessment of the psycho-emotional state in relation to self-perception of one’s own body was carried out using the dermatological version of the dysmorphic disorder questionnaire – BDDQ-DV. Results. The main pathology for which patients of both sexes used this group of drugs were rosacea, perioral dermatitis, and seborrheic dermatitis. Taking into account anamnestic data, the mean duration of application of topical corticosteroids in creams, ointments or lotions was 10.25 ± 3.50 months for women and 8.3 ± 1.6 months for the male cohort. Most patients received information about the need to use a topical steroid from acquaintances / friends and pharmacists. The most frequent pharmacological agent was betamethasone dipropionate. Analyzing the psychopathological aspect of the studied group, dysmorphic manifestations are prevalent and the most well argued. 32 individuals (64 %) from the cohort met the criteria for concern about the body or its parts. Conclusions. Regional clinical features of steroid-induced dermatoses, which are mostly represented by chronic inflammatory conditions located in aesthetically significant areas, have been determined. 64 % of patients with steroid-induced dermatoses develop a psychopathological profile. An important aspect remains the necessity to raise the awareness of medical, pharmaceutical workers, and the public about the need and correct use of topical corticosteroids.

Gross and Histopathological Study of Postscabietic Nodules

Background: Nodular postscabietic scabies refer to the persistent intermittent signs of scabies that are seen in active and post-treatment period that might last for months. The spectrum of clinico-morphological ranges that can be observed with sarcoptic nodules is broad, and most of the entity's criteria can be elicited histopathologically and pathologically. The management of such nodules may be a challenge. They are commonly treated through local application of corticosteroids or injection of corticosteroids to nodules but the response to treatment is less than clent and relapses are very frequent. The objective of this study was to illuminate which of these features prevail and which ones fade in scarred sites which undergo postscabietic nodule development. The time span between August 2021 to May 2022 was allowed to collect samples from patients with (1-60) years old and full of scabies burrows who visit teaching hospitals and private dermatology clinics in Kut, Wasit Province, Iraq. Treat groups were split into 30 females, and 20 males; with persistent itchy nodular lesions of scabies demonstrated clinically and histopathologically. Everity grade scabies was evaluated by the number of lesions and rated it as severity of itching. Long-term treatment with topical glucocorticoids for 14 days in every age. Tissue from the blisters of patient was obtained after medication. The specimens were washed, fixed and cut to 4-5 µm and stained with H&E. The staining allowed us to observe the fragments of tissues under light microscope with different magnification power. We have observed excessive males and the prevalence of SCABies were more in a young adult group in comparison with other age groups. It was found that lesions with wiry projections tended to persist for two weeks to 52 weeks and the number of nodules had varied from one to fourteen lesions. Examination of Histopathological slide showing acanthosis in 80, histolymphocytic infiltration in 76, and eosinophilia in 100 of total cases in the whole period. After the scabitic nodule loop, the body experiences a hypersensitivity reaction. From the three hundred cases examined microscopically, most (80%) of them were found to be characterized by acanthotic epidermis and diffuse dense dermal lymphocytic infiltration. Neutrophilic reaction, epithelioid-granulomatous inflammation and eosinophilia have been diagnosed in 76 % sight upon while 100 % of other nodules have shown eosinophilia.

Pruritic urticarial papules and plaques of pregnancy: An unusual case report from a tertiary care hospital of the Eastern part of India

Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a rare dermatitis of unknown etiology first diagnosed in 1979. It occurs most commonly in the 3rd trimester of pregnancy. Postpartum presentation is extremely rare. Treatment modalities mostly involve the relief of symptoms. We are going to report here one case of a 24-year-old primigravid female who presented in the 9th month of the gestational period with generalized pruritic eruptions in a tertiary care hospital in the Eastern part of India. These eruptions were erythematous, hyperpigmented, and papular, which began within the striae distensae of the abdomen and progressively spread on the skin of upper and lower limbs, trunk, and buttocks. After the delivery of a full-term male child, there was an aggravation of the symptoms such as itching and disturbed sleep. There was also increased spread of the lesions over the skins of the mentioned areas, which persisted for 6 weeks of the postpartum period. The lesions and associated symptoms gradually subsided with topical application of corticosteroids and hydroquinone along with oral antihistaminic for prolonged periods. Our objective behind reporting this case is to make clinicians aware of PUPPP as a differential diagnosis of peripartum and postpartum pruritic eruptions for prolonged periods.

Clinical Characteristics and Pathogen Spectrum of Male Genital Fungal Infections in Nanchang Area, South China

The cutaneous fungal infections in male genitalia are relatively rare, and often present with various atypical clinical symptoms. It was mainly reported in a small number of case reports, while data with large number of patients were rarely reported. In this study, we reported 79 male patients with cutaneous fungal infections on scrotum or penis. The fungal infections were confirmed by microscopic examination directly and fungus culture. Clinical characteristics and predisposing factors were also collected. Of these 79 patients, 72 has lesions on scrotum, 5 on penis and 2 on both scrotum and penis. Trichophyton (T.) rubrum is the most common pathogen, found in 50 (67.6%) patients, which presented diverse clinical manifestation such as majorly erythematous, dry diffused scaly lesions without a clear border, slightly powdery and scutular scalings. Candida (C.) albicans is the secondly common pathogen, found in 21 (28.4%) patients, which also presented diverse lesions such as erythematous with dry whitish scaly lesions and erythematous erosion. The predisposing factors mainly included concomitant fungal infections on sites other than genitalia, especially inguinal region (tinea cruris), application of corticosteroid and high moisture. In conclusion, cutaneous fungal infections in male genitalia could be caused by different fungi, showed atypical or mild clinical appearances in most cases and might be a fungus reservoir, emphasizing the necessity to timely perform the fungi examinations and corresponding therapy.

Dexamethasone protects against asthma via regulating Hif-1α-glycolysis-lactate axis and protein lactylation

PurposeAsthma can not be eradicated till now and its control primarily relies on the application of corticosteroids. Recently, glycolytic reprogramming has been reportedly contributed to asthma, this study aimed to reveal whether the effect of corticosteroids on asthma control is related to their regulation of glycolysis and glycolysis-dependent protein lactylation. MethodsOvalbumin (OVA) aeroallergen was used to challenge mice and stimulate human macrophage cell line THP-1 following dexamethasone (DEX) treatment. Airway hyperresponsiveness, airway inflammation, the expressions of key glycolytic enzymes and pyroptosis markers, the level of lactic acid, real-time glycolysis and oxidative phosphorylation (OXPHOS), and protein lactylation were analyzed. ResultsDEX significantly attenuated OVA-induced eosinophilic airway inflammation, including airway hyperresponsiveness, leukocyte infiltration, goblet cell hyperplasia, Th2 cytokines production and pyroptosis markers expression. Meanwhile, OVA-induced Hif-1α-glycolysis axis was substantially downregulated by DEX, which resulted in low level of lactic acid. Besides, key glycolytic enzymes in the lungs of asthmatic mice were notably co-localized with F4/80-positive macrophages, indicating metabolic shift to glycolysis in lung macrophages during asthma. This was confirmed in OVA-stimulated THP-1 cells that DEX treatment resulted in reductions in pyroptosis, glycolysis and lactic acid level. Finally, protein lactylation was found significantly increased in the lungs of asthmatic mice and OVA-stimulated THP-1 cells, which were both inhibited by DEX. ConclusionOur present study revealed that the effect of DEX on asthma control was associated with its suppressing of Hif-1α-glycolysis-lactateaxis and subsequent protein lactylation, which may open new avenues for the therapy of eosinophilic asthma.

Does Epidural Corticosteroid Application During Spinal Surgery Reduce Postoperative Pain?: An Adjunct to Multimodal Analgesia.

A prospective, randomized, placebo-controlled, double-blinded study. To examine the effect of intraoperative epidural administration of Depo-Medrol on postoperative back pain and radiculitis symptoms in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF). Postoperative pain is commonly experienced by patients undergoing spinal fusion surgery. Adequate management of intense pain is necessary to encourage early ambulation, increase patient satisfaction, and limit opioid consumption. Intraoperative steroid application has been shown to improve postoperative pain in patients undergoing lumbar decompression surgeries. There have been no studies examining the effect of epidural steroids on both back pain and radicular pain in patients undergoing TLIF. In all, 151 patients underwent TLIF surgery using rh-BMP2 with 3 surgeons at a single institution. Of those, 116 remained in the study and were included in the final analysis. Based on a 1:1 randomization, a collagen sponge saturated with either Saline (1cc) or Depo-Medrol (40mg/1cc) was placed at the annulotomy site on the TLIF level. Follow-up occurred on postoperative days 1, 2, 3, 7, and postoperative months 1, 2, and 3. Lumbar radiculopathy was measured by a modified symptom- and laterality-specific Visual Analog Scale (VAS) regarding the severity of back pain and common radiculopathy symptoms. The patients who received Depo-Medrol, compared with those who received saline, experienced significantly less back pain on postoperative days 1, 2, 3, and 7 (P<0.05). There was no significant difference in back pain beyond day 7. Radiculopathy-related symptoms such as leg pain, numbness, tingling, stiffness, and weakness tended to be reduced in the steroid group at most time points. This study provides Level 1 evidence that intraoperative application of Depo-Medrol during a TLIF surgery with rh-BMP2 significantly reduces back pain for the first week after TLIF surgery. The use of epidural Depo-Medrol may be a useful adjunct to multimodal analgesia for pain relief in the postoperative period.

Multi-centers experience using therapeutic plasma exchange for corticosteroid/tocilizumab-refractory cytokine release syndrome following CAR-T therapy

The chimeric antigen receptor T (CAR-T) cell therapy significantly enhances the prognosis of various hematologic malignancies; however, the systemic expansion of CAR-T cells also gives rise to severe cytokine release syndrome (CRS), and immune effector cell-associated neurotoxicity syndrome (ICANS). Despite the successful application of corticosteroids and tocilizumab in alleviating severe CRS in most patients, there are still individuals who experience life-threatening CRS without responding to the aforementioned therapies. In our retrospective cohort, we conducted an analysis of clinical and laboratory parameters, including inflammatory cytokines, in 17 patients from three centers who underwent therapeutic plasma exchange (TPE) for refractory CRS with or without ICANS following CAR-T products treatment. Our findings demonstrate a significant improvement in both clinical symptoms and laboratory parameters subsequent to TPE treatment. The rapid decrease in temperature and levels of inflammatory indexes indicates the remarkable scavenging efficacy of TPE against cytokine storm following CAR-T therapy. In conclusion, TPE may serve as a valuable and safe adjunct to corticosteroids and tocilizumab in the management of severe CRS resulting from CAR-T cell infusion. We eagerly await further prospective studies to validate this finding.

Role of corticosteroids in the treatment of critically ill sepsis patients: a meta-analysis review.

It was to systematically evaluate the effect of corticosteroids on 28d all-cause mortality (ACM), in-hospital death rate, and ICU death rate in critically ill sepsis patients. PubMed, Embase, and Medline databases were used to screen the published literatures on the therapeutic effect of corticosteroids in the treatment of critically ill sepsis patients. After evaluating the quality of the included literatures, RevMan 5.3 software was used for meta-analysis. 4524 literatures regarding the application of corticosteroids to treat critically ill sepsis patients were preliminarily searched. After screening was carried out, 9 literatures were finally included. 2,850 patients were treated with corticosteroids and 2867 patients were treated with placebo. The meta-analysis of the effect of corticosteroids versus placebo on 28dACM showed [OR = 0.87, 95% CI 0.78-0.98, Z = 2.22, P = 0.03], P < 0.05; the meta-analysis of the outcome of corticosteroids versus placebo on ICU death rate showed [OR = 0.77, 95% CI 0.63-0.94, Z = 2.60, P = 0.009], P < 0.05; and the meta-analysis of the effect of corticosteroids versus placebo on in-hospital death rate showed [OR = 0.80, 95% CI 0.66-0.96, Z = 2.34, P = 0.002], P < 0.05. In summary, corticosteroids can reduce the death rate of critically ill sepsis patients to a certain extent and have good clinical application value.

Characterization of isolated and integrated clinical and dermoscopic features of topical steroid-dependent/damaged face: A study from central India

ABSTRACT Background: Topical steroid-dependent/damaged face (TSDF) is defined as semi-permanent or permanent damage to the skin of the face due to unsupervised or prolonged application of topical corticosteroids to the face. Dermoscopy is widely practiced as a non-invasive, effective technique to analyze the immediate or delayed features of TSDF. Objectives: The objective was to evaluate the clinical profile along with dermoscopic features of clinically diagnosed cases of TSDF. Materials and Methods: The study was conducted on seventy-five patients attending the Department of Dermatology, Venereology, and Leprosy between April 2021 and September 2022 with clinical symptoms and signs suggestive of TSDF. Thorough history taking, clinical evaluation, and dermoscopic examination were performed, and data was recorded in a structured proforma with a sixteen-point questionnaire. Results: Sixty-eight percent of the patients were females, yielding a female-to-male ratio of 2.1:1. The most frequently affected age group was 26–35 years (48%), with a mean age of 31.8 years. The most common topical steroid employed was beclomethasone dipropionate 0.25% (33.33%), followed by clobetasol propionate 0.05% (29.33%). The most common clinical findings observed were erythema with hyperpigmentation (74.66%), followed by erythema with telangiectasia (34.66%). The most often observed dermoscopic findings were red, diffuse areas with vessels (61.33%), red, diffuse areas with an exaggerated pigment network (52%), and clustered vellus hairs with white vellus hair (44%). Conclusion: Topical corticosteroids are commonly abused drugs seen in modern clinical practice, resulting in a plethora of symptoms and creating a paramount dermatological concern. Dermoscopy plays a cardinal evaluating role in the early discernment and establishment of TSDF besides determining the gravity of damage. Key words: Topical steroid-dependent/damaged face (TSDF), Topical corticosteroids, Dermoscopy

Alternative Approach in Colorectal Anastomotic Stricture: Bougie Dilatation

Dear Editor, Anostomotic stricture (AS) is seen in 2-30% of patients after colorectal surgery. Various factors such as tissue ischaemia, anastomotic leakage and radiotherapy have been suggested in its pathogenesis [1,2]. Endoscopic methods (balloon dilatation, bougie dilatation, stents, endoscopic electroincision), digital dilatation, surgical methods (stapler stricturoplasty, transanal circular stapler resection, transabdominal redo-anastomosis) and corticosteroids are used in AS [3,4]. Surgery is generally preferred in complete/near complete AS [1]. Stents; the benefit of stents in AS after oncological surgery has not been shown [3]. However, Philip BC Pangg et al. treated near-total AS non-operatively with the colonic/rectal endoscopic ultrasound (EUS) anastomosis technique and a hot lumen metallic stent [5]. We applied 3-stage bougie dilation to the patient with near complete anastomotic stricture. A 59-year-old female patient who underwent laparoscopic anterior resection due to sigmoid colon tumor was followed up with complaints of abdominal swelling, intermittent abdominal pain and difficulty in defecation. One month later, when colonoscopy was performed, near complete anastomotic stricture was observed. Bougie dilatation was performed with maloney flexible bougie dilators under wire guidance. Bougie dilatation was performed 3 times with fifteen days intervals. After the first (33, 36 and 42 F) and the second bougie dilatation (36, 42 F), the upper segment of the anastomotic stricture was reached by gastroscopy. After dilatation with a bougie (42, 45 F) for the third time, the colonoscope was easily passed through the anastomosis line to the upper segment. Six months later, colonoscopy was performed and the proximal part of the anastomosis was easily passed without the use of bougie dilators. Balloon dilatation is the first method used in AS. However, several repetitions are necessary for the success of the procedure. In addition, the risk of perforation increases when the stricture diameter is &lt;5 mm and length &gt;1 cm. The chances of success in AS are lower compared to bougie dilatation. Endoscopic electroincision is recommended in failure of balloon dilatation. Digital dilatation: used in distal anorectal anostamotic strictures. Corticosteroid application: very large studies are not available. Bougie dilatation in AS provides tactile feedback, allowing the amount of resistance to the passage of the dilator to be estimated and perforation to be avoided. Bougie dilatation method is simple, inexpensive and low risk of complications. Especially Maloney flexible silicone bougie minimise the risk of complications. Bougie dilatators can remain intact for many years and can be reused. But balloon dilatators are not reused. Surgical methods are used in 3-4% (complete/near complete AS) in the failure of endoscopic methods. But mortality risk is high [1,4-6]. Therefore, the alternative method of Philip BC Pang et al. can be applied [5]. However, due to limited endoscopic ultrasonography (EUS) centers, gradual dilatation can be performed with flexible bougie dilators in case of anastomosis stricture. Yours Sincerely

The relationship between corneal calcareous degeneration and various ophthalmic diseases in dogs: A retrospective study

AbstractObjectiveTo investigate ocular factors that influence the development of corneal calcareous degeneration (CCD) in dogs.Animals and ProceduresThe medical records of 96 eyes of dogs with CCD and 288 eyes without CCD were retrospectively reviewed. Dogs with evidence of causative systemic illness associated with CCD were excluded from the study. Logistic regression analysis was used to identify the ocular factors associated with the development of CCD. To identify the effect of phosphate‐containing eyedrops on CCD, the application periods of phosphate‐containing antiglaucoma eyedrops were compared between the glaucomatous eyes in the CCD and non‐CCD groups.ResultsIncreased age, brachycephalic breed, keratoconjunctivitis sicca, advanced cataract, history of phacoemulsification, and topical corticosteroid application were significantly associated with CCD development. Glaucoma was significantly overrepresented in the non‐CCD group, and the application period of phosphate‐containing antiglaucoma eyedrops was significantly longer in eyes with CCD than in those without CCD.ConclusionsOphthalmic diseases requiring long‐term management of ocular inflammation and long‐term application of phosphate‐containing eyedrops may contribute to the development of CCD. Glaucoma is overrepresented in dogs without CCD, which is thought to be due to the differences in predisposed age and breeds between dogs with glaucoma and CCD.

Standard doses of Triamcinolone do not affect fibroblast cell migration of abdominoplasty patients in-vitro1.

Recent studies have demonstrated that local application of corticosteroids reduces wound exudation following abdominoplasty and other reconstructive surgical procedures. On the other hand, corticosteroids might provoke wound healing disturbances due to their immunosuppressive effects. The main objective of this study was to gain further information about the impact of the corticosteroid triamcinolone on cell migration in abdominoplasty patients. An in-vitro scratch assay wound healing model was applied to observe cell migration of fibroblasts cultured with nutrient medium containing human seroma aspirate±triamcinolone. There were no significant differences regarding cell migration when fibroblasts were incubated with triamcinolone + seroma containing culture medium compared to seroma containing culture medium without triamcinolone. The performed in-vitro study suggests that triamcinolone does not decelerate fibroblast cell migration which is considered as a surrogate of wound healing.

Chronic Necrotizing Pulmonary Aspergillosis After SARS-CoV-2 Infection – A Case Report

Abstract Aspergillosis is a fungal infection, caused by the mould Aspergillus, most commonly Aspergillus fumigatus species. Chronic pulmonary aspergillosis after SARS Cov-2 infection is a rare presentation that is commonly misdiagnosed. The prolonged corticosteroid and antibiotic application and the pro-inflammatory state in COVID-19 patients predisposes to Aspergillus infection and its chronification. Surgery plays a pivotal role in cases with unclear diagnosis, ineffective medical therapy or when complications develop. We present a case of a 73-year-old woman with chronic pulmonary aspergillosis, developed after COVID-19 pneumonia. A right lateral muscle-sparing thoracotomy, right upper lobectomy and atypical resection of the 9th and 10th segments were performed.

The Effect of Intracochlear and Intratympanic Dexamethasone on Cochlear Implant Impedance.

This study investigated the impact of different local corticosteroid applications on impedance measurements in patients with cochlear implants. The study was designed as a controlled, randomized, and prospective study in which 34 consecutive patients who had undergone cochlear implant surgery were divided into three groups. The first group received intracochlear dexamethasone, in the second group the middle ear cavity was filled with dexamethasone, and the third group did not receive dexamethasone. Intraoperative, postoperative 1st week, 1st month, 3rd month, 6th-month neural response telemetry, and impedances were measured. The measurements were compared by electrode groups representing the different regions of cochlea like basal (1-7), middle (8-13), and apical (14-22) regions. The intergroup analysis showed no statistically significant differences in impedance measurements of the basal, middle, and apical regions (p>0.05). However, the impedances were lower in the two dexamethasone groups, especially in the basal and middle parts. Sixth month impedances were also lower in the dexamethasone groups. There was apparent stability in the impedance of the basal region with the intracochlear application during the first week. Local dexamethasone applications had a potentially positive impact on the impedance of the basal and middle regions. Patients had lower impedances than the control group during follow-up and at the endpoint. The increase in the apical region may indicate that dexamethasone was not reaching the apical zone in local applications.

Study of clinicodermoscopic features of topical steroid damaged face patients

Background: Topical steroid dependent or damaged face is an alarming upcoming entity rampant in India due to over-the-counter availability of topical corticosteroids containing products. The present study aimed to study the clinical and dermoscopic changes in patients with topical steroid damaged face and to correlate them with potency and duration of application of the TCS. Methods: 80 patients visiting the dermatology OPD &amp; IPD at SAIMS Hospital &amp; PG Institute, Indore, with the chief complains of redness, itching, red raised lesions, burning, swelling, photosensitivity, pigmentation; with a history of application of topical corticosteroids of any potency on face for continuous 7 days or intermittent for 15 or more days were enrolled for the study. Results: Mean age of the patients was 31.5±8.13 years. Male to female ratio was 1:9. Twelve (15.2%) patients abused TCS for more than one year. Presenting complains of the patients were redness (82.5%), itching (66.3%), hypertrichosis (47.5%), pigmentation (66.3%), burning (38.8%) and acne (28.8%). The most common dermoscopy findings i.e., unpatterned brown pigmentation (86.3%), polygonal vessels (73.8%), fine scales (52.5%), hypertrichosis (53.8%), follicular plugs (32.5%), micropustules (15%) and ivory patches (11.3%) were observed in a statistically higher proportion of cases dermoscopically Conclusions: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

Interpretation of the key updates in the 2022 European guideline on the management of neonatal respiratory distress syndrome

With the deepening of clinical research, the management of neonatal respiratory distress syndrome (RDS) needs to be optimized and improved. This article aims to introduce the 2022 European guideline on the management of neonatal RDS, focusing on its key updates. The guide has optimized the management of risk prediction for preterm birth, maternal referral, application of prenatal corticosteroids, application of lung protective ventilation strategies, and general care for infants with RDS. The guideline is mainly applicable to the management of RDS in neonates with gestational age greater than 24 weeks.

Sweet’s Syndrome: A Rare Case Report

Sweet’s Syndrome, also known as acute febrile neutrophilic dermatosis is a rare disease of unknown etiology, but has been associated with autoimmune processes, malignancies, infections, GI disorders and drug reactions. It is more prevalent in women than men, except in case of malignancy associated origin. Clinical features of this disorder include acute onset of painful plaques on skin, neutrophilic leukocytosis, fever, dermal infiltrations by neutrophils. Usually, sweet’s syndrome is presented in three main clinical settings which includes: the classical (idiopathic), malignancy-associated, and drug induced. Classical Sweet’s Syndrome (CSS) is usually seen in women between the age of 30 to 50 years. It is frequently preceded by an upper respiratory illness and could be linked to pregnancy, inflammatory bowel disease, and both. Recurrence of the dermatosis is usually seen in one third of the patients experiencing classical sweet’s syndrome. Malignancy associated Sweet’s Syndrome (MASS) is usually present in patients with confirmed cancer and manifested as a paraneoplastic syndrome. Also occurs in those whose solid tumor or hematologic dyscrasia associated with sweet’s syndrome was previously undetected. Drug induced Sweet’s Syndrome (DISS) occurs in patients being treated with granulocyte-colony stimulating factor. Various other drugs including antibiotics like Minocycline, Trimethoprim Sulfamethoxazole, nitrofurantoin, antiepileptics like Carbamazepine, Diazepam, NSAIDS, Diuretics and Retinoids can also cause DISS. Diagnosis of sweet syndrome is usually done by two major criteria (histopathology and acute cutaneous lesion), and four minor criteria’s (infection, malignancy, medications, fever, and extra cutaneous manifestations like leukocytosis and corticosteroid response. Systemic corticosteroids are the golden standard of treatment for Sweet’s Syndrome. Systemic corticosteroids (0.5mg to 1mg/kg/day) for 4-6 weeks improves the systemic symptoms and reduce the skin lesions. For treating localized lesions, topical application of high potency corticosteroids or intralesional corticosteroids are effective. Other first line agents including potassium iodide and colchicine are also used. Second line agents include Indomethacin, Cyclosporine, Dapsone and Clofazimine. Keywords: Sweet’s Syndrome, Corticosteroids, Malignancy, Leukocytosis