Application Of Steroid Ointment Research Articles

Efficacy and anti-inflammatory properties of low-molecular-weight fucoidan in patients with atopic dermatitis: a randomized double-blinded placebo-controlled trial

ABSTRACT Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease. Fucoidans are reportedly effective in treating AD; however, their clinical efficacy requires further exploration. This study aimed to investigate the clinical efficacy of low-molecular-weight fucoidan (LMF) supplementation in patients with AD and reveal the underlying mechanism of its effects; this is a randomized, double-blind, placebo-controlled trial. Participants were randomly assigned to a study or control group to receive conventional AD therapy with oral supplementation of either LMF or placebo for 12 weeks. Symptom severity was measured by the SCORing Atopic Dermatitis (SCORAD) index. Each participant used a diary to record daily medication use. Blood samples were collected at three time points for assessing AD-related cytokines, immunoglobulin E (IgE), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, the percentage of eosinophils, and biochemical profiles of hepatic and renal functions. The study group showed significant symptom relief, whereas the control group showed no significant improvements. The frequency of steroid ointment application significantly decreased, and the frequency of oral antihistamine use decreased in the study group, whereas no significant changes were observed in the control group. The AD-related immune parameters serum IgE, eosinophils, CD8+ T cells, interferon-γ (IFN-γ), ESR, and CRP significantly decreased in the study group but not the control group. There were no severe adverse events in either group. This study is the first to demonstrate the effectiveness and safety of LMF as a supplemental therapy for patients with AD via its anti-inflammatory activity.

P36-7 Importance of checking tinea infections before tyrosine kinase inhibitor treatment

Tyrosine kinase inhibitors (TKIs) are used to treat unresectable carcinoma can have adverse effects such as hand-foot skin reactions (HFSR) with symptoms on the palms and soles such as peeling, erythema, and pain. In this study, we report two cases in which suspected HFSR symptoms were caused by tinea infections. As nurses provide self-care support to patients starting TKI treatment, this report will help support patients' effective self-care. This study was approved by the Ethical Committee of the Graduate School of Nursing, Chiba University, Japan. A male patient aged 70 years had erythema on both soles by day 9 after starting the TKIs lenvatinib. By day 20, he had peeling and annular erythematous on the dorsal surface of both ankles, and his dose of lenvatinib was therefore reduced. His symptoms worsened and improved repeatedly, and when ulceration between toes was observed, he was referred to a dermatologist who diagnosed a tinea infection. A second male patient, aged 78 years, had ulcers from his left ankle joint to the dorsum by day 8 of treatment with the TKIs regorafenib, and he missed his treatment due to suspicion of side effects caused by the TKIs. When his symptoms worsened without treatment, he consulted a dermatologist and was diagnosed with a tinea infection. Although the application of steroid ointment is recommended when HFSR occurs, it is important to differentiate between HFSR and tinea infections because steroids can make tinea infections worse. HFSR and tinea infections have much in common, such as peeling and the tendency to develop in feet, and it can be difficult to differentiate them by visual examination and questioning alone. The nurses should observe the patients' feet before TKIs treatment and recommend consultation with a dermatologist if tinea infections are suspected.

Efficacy and Safety of Socheongryong-Tang Among Atopic Dermatitis Patients With Respiratory Disorders: A Double-Blinded, Randomized, Placebo-Controlled Clinical Trial.

Atopic dermatitis is a chronic inflammatory skin disease that affects the growth and development of children. The prevalence of atopic dermatitis has been continually increasing, and this has also been accompanied by rising socioeconomic costs. Interest has been growing in alternative medicine as a means of alleviating the burden of atopic dermatitis. This was a single-center, double-blinded, randomized, placebo-controlled investigator-led clinical trial including 60 atopic dermatitis patients. The participants were classified into an experimental group (30 persons) and a control group (30 persons), who were administered, respectively, socheongryong-tang or a placebo for 4 weeks. After 4 weeks of treatment, the participants visited the trial center again and assess their efficacy and safety. The researchers performed statistical comparisons of the changes in the SCORAD Index, amount and frequency of ointment use, and height and weight to assess the efficacy. To assess the safety, diagnostic tests and vital sign checks were performed at each visit, and the presence or absence of adverse events was observed. As a result, the frequency and the amount of steroid ointment application in both groups increased, but the experimental group showed less tendency (p = 0.081). Results of analyzing the children in the experimental group in relation to growth showed a significantly greater height growth than the control group (p < 0.05). In addition, all study participants did not show any remarkable abnormal signs in the safety evaluation. In conclusion, compared to the control group, the experimental group, who took socheongryong-tang showed a tendency to be less dependent on steroid ointment and statistically significant increase in height.

Washing with water alone versus soap in maintaining remission of eczema.

There is no consensus on the use of soap in skin care for atopic dermatitis in Japan. Thus, this study aimed to evaluate the efficacy of soap to maintain eczema remission in atopic dermatitis patients during the fall-winter period in Japan. This assessor-blinded, pragmatic randomized, non-inferiority study enrolled atopic dermatitis patients whose eczema was controlled by regular steroid ointment application less thanor equal to2days / week (tacrolimus ointment was permitted). For 8±3weeks, participants washed their upper and lower limbs on one side with soap (soap side) and on the other side with water alone (water side). The primary outcome was an Eczema Area and Severity Index score at week 8±3. Twenty-nine participants were analyzed. The Eczema Area and Severity Index scores at week 8±3 of the water and soap sides were 0.0 (0.0-0.4) and 0.0 (0.0-0.4), respectively (P=0.18). The difference between both sides was -0.02 (-0.11-0.08), and the limits of the 95% confidence interval did not reach the prespecified non-inferiority margin. The average Patient-Oriented Eczema Measure score was 1.27±1.7 and 1.32±1.8 for the water and soap sides, respectively (P=0.92). The total number of additional steroid ointment applications was four (0-20) times and six (0-23) times, respectively (P=0.98). Participants were categorized according to self-assessments of the usefulness of soap, with 2, 24, and 3 participants in the water-effective, invariant, and soap-effective groups, respectively. For children with controlled atopic dermatitis, washing with water alone was not inferior to washing with soap for maintaining remission of eczema during the fall-winter period in Japan.

Risk factors for early onset elevated intraocular pressure after pterygium surgery

PurposeIn this study, we aimed to identify the risk factors for early postoperative elevation of intraocular pressure (IOP) after pterygium surgery.Patients and methodsAll patients in this retrospective cohort study were evaluated for inclusion from a single tertiary care center at Boston Medical Center. Their pre- and postoperative IOP measurements (day 1, week 1, month 1, month 3, and when clinically necessary) were compared. Patients with postoperative IOP measurement of >22 mmHg or with an increase in IOP by ≥10 mmHg compared with the preoperative measurement value were grouped as “Ocular Hypertension” group; otherwise, patients were grouped in the “No Ocular Hypertension” group. Age, sex, race, baseline IOP, cup-to-disc (C/D) ratio, history of glaucoma, and frequency of use of postoperative steroid drops in all patients were compared. Chi square test was performed to compare the categorical variables, whereas Student’s t-test was performed to compare continuous variables. We performed a multivariate logistic regression analysis of categorical data with a significance level of p < 0.05.ResultsIn total, 240 patient charts were reviewed for inclusion in this study. Twenty-six patients required pterygium surgery on both eyes; for these patients, the eye with higher IOP was analyzed. Two patients were discontinued from this study because of elevated IOP in the contralateral, nonsurgical eye. Fortyeight out of 212 eyes (22.64%) developed postsurgical elevation of IOP within the first 3 months of operation. No significant differences were found between age, sex, baseline IOP, C/D ratio, history of glaucoma diagnoses, and frequency of use of postoperative steroid drops. However, Hispanic/Latino race (p = 0.036) and lack of application of steroid ointment (p = 0.001) were found to be the significant risk factors for the development of “Ocular Hypertension” in multivariate analysis.ConclusionEarly elevation of IOP is a risk of pterygium surgery. One nonmodifiable risk factor, Hispanic/Latino race, and one modifiable risk factor, lack of application of steroid ointments, were identified as potential causes of early postoperative IOP elevation.

504O - Effects of steroid ointment application on chemotherapy-induced phlebitis: A randomized, double-blind, placebo-controlled clinical trial

504O - Effects of steroid ointment application on chemotherapy-induced phlebitis: A randomized, double-blind, placebo-controlled clinical trial

A Case of Exfoliation of Oral Mucosal Epithelium in a Patient with Anti-Desmoglein 1 Antibody-Positive and Anti-Desmoglein 3 Equivocal Antibody

Pemphigus is an autoimmune bullous disease observed with lesions in the skin and mucosa. Pemphigus is classified by antibodies against desmogleins, which is cadherin type intercellular adhesion factors involved in adhesion between epidermal cells. In this case, because erosion of the oral mucosa was the primary symptom, a relationship with membrane-dominant pemphigus vulgaris was strongly suspected. And in terms of histopathology, findings not conflicted with pemphigus vulgaris were observed, but given all these different findings, the results did not correspond with bullous pemphigoid in clinical findings, and with pemphigus foliaceus and pemphigus vulgaris in various testing results, leading us to believe this represented a very rare case. We started oral health care, and when application of steroid ointment to the entire surface of the mucosa was continued, symptoms disappeared within approximately 2 months. In this case, relapse has not yet occurred and periodic follow-up was continued.

The Case Study of Lactobacillus mixture culture fluid on Atopic dermatitis

Objectives: Recently lactic acid formulation was known as the adjuvant therapy on atopic dermatitis(AD) symptoms because of little side effects. In this study, it was studied that Lactobacillus mixed culture appliment was effective on not on AD symptoms. Methods: The case-photos 30-40 times of AD symptoms from case were observed with literatures. The case-photos were acquired with environmental AD dermatitis experience program which is conducted in SUNCHANG RESERCH INSTITUTE OF HEALTH AND LONGEVITY from 2014.01 to 2014.08. Experience applicants were limited the oral administration and chemical external administration. Results: Lactobacillus mixed culture appliment was effective because of the mitigation or disappearance of AD primary symptoms like pruritus, erythema, edema, effusion, dry skin, scaly, scab etc. AD symptom degree was dependent on lactobacillus mixed culture appliment times, and classified as Reaction Period (RAP), Reduction Period (RDP), Efection Period (EP), Reproduction Period (RPP) on a single mixed culture appliment time. And AD symptoms which were appeared in RPP were classified as Rebound Period (RBP), Effection Period (EP), Subclinical Period (SCP). Conclusions: Lactobacillus mixed culture appliment is considered to be useful for AD symptoms and is estimated to be effective by different mechanism with oral administration or steroid ointment application. Lactobacillus mixed culture appliment is expected to induce a synergistic effects on AD symptom reliefs with the other oral administration.

Relocation pharyngoplasty

Relocation pharyngoplasty

A New Uniform Protocol of Combined Corticosteroid Injections and Ointment Application Reduces Recurrence Rates After Surgical Keloid/Hypertrophic Scar Excision

Published reports indicate that corticosteroid injections can prevent recurrence after keloid excision, but the side effects of repetitive intralesional steroid injections may preclude treatment maintenance. Additionally, few of these studies employed a standardized treatment protocol. To analyze the results of a new uniform treatment protocol combining corticosteroid injections and ointment application designed to reduce recurrence rates after excisional surgery in individuals with keloids or hypertrophic scars. As a standard procedure, the first corticosteroid injection took place after removal of the sutures and then once every 2 weeks after that until it had been done five times. In addition, all postsurgical wounds received self-administered steroid ointment application twice daily for 6 months after suture removal. Postoperative follow-up in this series ranged from 24 to 57 months (median 32 months, mean 32.5 months). Recurrence occurred in three of the 21 keloid cases (14.3%) and one of the six hypertrophic scar cases (16.7%). We evaluated a new standardized adjuvant corticosteroid therapy to prevent recurrence after surgical keloid or hypertrophic scar excision. Using this method, we achieved low recurrence rates.

Tinea Faciei by Microsporum gypseum Mimicking Allergic Reaction following Cosmetic Tattooing of the Eyebrows

A 63-year-old healthy female patient presented with well defined itchy erythematous lesions on the area of her eyebrows. Her eyebrows had been tattooed two months before her visit to us. The lesions had previously been treated by application of steroid ointment and anti-histamine and steroid tablets by mouth without success. We suspected the lesions to be contact dermatitis caused by some metal element contained in the dye used for tattooing. Treatment was continued for two weeks, but the lesions spread to her cheeks and forehead. No fungal element was found from the lesions by direct microscopy at this stage. The patch-testing to 20 metal substances on her skin showed no allergic reaction. After one more week of treatment, we reexamined the scale taken from the lesions by direct microscopy, and fungal elements were found at that time. Microsporum (M.) gypseum was isolated from the scale taken from the lesions. The lesions cleared after treatment of 11 weeks' oral intake of itraconazole 100mg daily. It was found that the patient was accustomed to sleep with her dog, a Chihuahua. On examination by a veterinarian, no skin lesions were found on the dog. We speculate that the paws of the dog might have carried soil contaminated by M. gypseum, a geophilic fungus, to the area of her eyebrows which had minor trauma after being tattooed.

Treatment of Pretibial Myxedema (PTM) with Topical Steroid Ointment Application with Sealing Cover (Steroid Occlusive Dressing Technique: Steroid ODT) in Graves' Patients

Localized pretibial myxedema (PTM) is a sign of Graves' disease. A 53-year-old man with Graves' disease was admitted with the development of PTM following radioisotope (131)I treatment for Graves' hyperthyroidism. TSH receptor antibody (TRAb) titer was also increased after (131)I treatment. TRAb was measured as thyroid stimulating antibody (TSAb) or TSH-binding inhibitory immunoglobulin (TBII). PTM was noted several months after (131)I treatment. The PTM-development seems to be associated with the increased TRAb-activities. The localized pretibial myxedema was effectively treated with topical steroid (triamcinolone acetonide) ointment application with sealing cover (steroid occlusive dressing technique: steroid ODT). We also report our experience of PTM-treatment with steroid ODT in 5 other PTM patients with positive TRAb. PTM was successfully treated with steroid ODT in two patients. In these two patients, the treatment was started within several months of the appearance of PTM. In the other 4 patients, the treatment was started 5-10 years after the appearance of PTM without any beneficial effects. Early detection and early treatment are necessary for the remission of PTM.

口腔内に初発症状を呈した急性骨髄性白血病の3例

The initial symptoms of leukemia include oral manifestations such as gingival hemorrhage and swelling. In patients with these symptoms, attention should be paid to the early diagnosis of acute leukemia. This report describes three cases of acute myelogenous leukemia (AML) with initial manifestations in the oral cavity.Patient 1: A 32-year-old woman. Ulcer lesions of the oral mucosa were diagnosed as decubital ulcers, and symptoms did not respond to the application of steroid ointment. She also had appetite loss, general malaise, and bloody stools. Blood examination showed a low white-cell count (1,600/μl).Patient 2: A 52-year-old man. He received anti-inflammatory treatment and had pain at the mandibular third molar region and gingival swelling, but the symptoms did not improve. At the initial visit, pericoronitis of the mandibular third molar with fever and general malaise were observed. Blood examination showed a low white-cell count (2,300/μl) and remarkably increased myeloblasts (20 %) .Patient 3: A 54-year-old woman. She received medication to treat full-mouth gingival swelling. However, fever and general malaise persisted. Blood examination showed a high white-cell count (47,000/μl).All three patients were given a diagnosis of AML on bone marrow biopsy.When the patients present with oral symptoms such as gingival swelling and ulcers accompanied by fever and general malaise, blood examinations should be promptly performed for the differential diagnosis of acute leukemia.

Weaning from long-term application of steroid ointment to peristomal skin－A trial of treatment with tacrolimus ointment－

Weaning from long-term application of steroid ointment to peristomal skin－A trial of treatment with tacrolimus ointment－

表在性真菌症および深在性皮膚真菌症の病態と防御機構

To determine the pathophysiology of the fungal infection and defense mechanisms against superficial dermatomycosis, two series of experimental infections of Trychophyton mentagrophytes were made on the forearm of a male volunteer. One series was applied topical steroid ointment, the other the vehicle alone. The infected sites were biopsied from each row weekly up to the 4th week, and the set of sites were studied and compared clinically, histopathologically and immunohistochemically. For the study against subcutaneous fungal infection, the same experiments were studied using the subcutaneous inoculation of Sporothrix schenckii. The pathophysiology of the superficial dermatophytosis was thought to be the same as those of the contact (allergic) dermatitis, including the physiodynamics of CD-1 cells. The principal mechanism of the defense lay in the removal of the foreign materials (fungi) together with keratinocytes whose turnover increased because of the eczematous reaction. It was proved that the topical application of steroid ointment suppressed the immune reactions locally, thus forming a paradoxical feature with little inflammatory reaction and abundant fungal elements (so-called atypical tinea). The pathophysiology of the subcutaneous fungal infection was thought to be a suppurative granulomatous reaction and pathologically showed a mixed cell granuloma. The neutrophils and macrophages engulfed and digested the fungi in the forefront, but the circumference was surrounded by epithelioid cells and/or foreign body granuloma. Transepithelial elimination also played some role in the defense. It was proved that when the defense mechanism was weakened by the topically applied steroid ointment, not only the clinical symptoms but also the fungicidal tissue reaction were subdued, and histocytes only engulfed fungi to protect them from dispersion. The trichophytin reaction turned positive on the 14th day, and the sporotrichin reaction on the 7th day.

メルケル細胞癌の１例

A 79-year-old woman with Merkel cell carcinoma is reported. She noticed an asymptomatic red papule on her left thigh about 6 months previously. The papule expanded gradually despite application of steroid ointment. Therefore, she visited our hospital. She developed a red, domeshaped tumor, 5mm in diameter, at the flexor surface on her left thigh. Histologically, the tumor invaded the dermis and subcutaneous tissue and did not extend into the epidermis. Atypical small cells were seen, with a trabecular pattern. Immunohistochemistry revealed positivity to CK18, CK20, chromogranine A and NSE. We performed wide local excision. [Skin Cancer (Japan) 2002; 17: 238-240]

The response of phimosis to local steroid application

The effectiveness of topical steroid application in relieving phimosis was studied in 63 boys treated with local application of steroid ointment to the foreskin. Betamethasone valerate 0.05% (42 patients), hydrocortisone 1% (18 patients), or hydrocortisone 2% (3 patients) was applied three times daily for 4 weeks. Thirty-seven of the patients treated with 0.05% betamethasone valerate ointment (half-strength Betnovate) showed an initial improvement and circumcision was performed on 5 non-responders. Six patients showed initial improvement but later redeveloped phimosis: they were given a further course of treatment, resulting in 2 satisfactory responses and 4 failures requiring circumcision. Two patients using 2% hydrocortisone and 16 using 1% hydrocortisone ointment showed improvement, but 2 of the latter group ultimately required circumcision. Overall, a permanent improvement was achieved in 51 of the 63 patients, with the ability to retract the foreskin after one or more treatments. The remaining 12 boys required circumcision. Local application of steroid ointment to the foreskin results in resolution of phimosis in the majority of cases, but if the foreskin has a circumferential white scar, it is slightly less likely to respond. Following cessation of steriods, phimosis redevelops in a proportion of patients.