Combination Of Topical Steroids Research Articles

Paederus Dermatitis: Two Outbreaks of an Entomologic Disease in Austere Expeditionary Care.

Paederus dermatitis, also known as dermatitis linearis, is an acute cutaneous condition caused by contact with the potent vesicant toxin paederin, produced by endosymbiotic Pseudomonas-like bacteria within Paederus spp. beetles. Paederin is a protein synthesis inhibitor that halts cell division, leading to vesiculation and necrotic breakdown of the epidermis. The resultant damage facilitates secondary infection, especially in austere conditions. Between October 2022 and July 2023, several US special operations teams forward deployed to various countries in East Africa reported over 17 cases of painful, blistering skin eruptions consistent with Paederus dermatitis, 2 of which are summarized in this report. To confirm the best treatment approach, 1 team's medic reached back to a deployed infectious disease physician in the same Combatant Command as well as through the DoD ADVISOR line to a dermatologist in the United States. All cases were managed with irrigation, followed by a combination of topical steroid and antibacterial ointments, with resolution occurring after 3 to 7 days, whereas 38% of the cases in July 2023 developed secondary cellulitis by day 7, requiring oral antibiotic treatment. Strict preventative measures were implemented to limit exposure while carefully observing each case, as this was critical to optimize medical readiness of the team. Ultimately, we seek to highlight the identification of beetles specific to East Africa, seasonal prevalence, and the importance of preventative measures as they vary depending on specific beetle characteristics. Additionally, we reiterate classic presentation features that help avoid misdiagnosis for cases that occur outside of the typical epidemiologic criteria.

Dermoscopy Evaluation of Erythema Dyschromicum Perstans Treated with Combination of Topical Steroid and Narrowband-Ultraviolet B: A Case Report

Dermoscopy Evaluation of Erythema Dyschromicum Perstans Treated with Combination of Topical Steroid and Narrowband-Ultraviolet B: A Case Report

Vernal keratoconjunctivitis: Breaking the shield

Abstract A 17-year-old male patient presented with complaints of redness, pain and photophobia in the right eye for a week and itching in both eyes for a year. He was previously diagnosed as vernal keratoconjunctivitis (VKC) a year ago and had discontinued treatment. He was diagnosed as Both eyes VKC, with right eye shield ulcer. He was started on a combination of topical steroids, Tacrolimus and olopatadine eye drops. He started responding to treatment in a weeks’ time and in a month the ulcer healed completely with a vision of 6/6.

THERAPEUTIC RESULTS IN ACTINIC PRURIGO CHEILITIS

This case describes the clinicopathologic features and therapeutic results of a patient with actinic prurigo cheilitis. A 61-year-old Black female patient attended the stomatology clinic presenting a severe ulcerated cheilitis persisting for 5 years. Pruritus, tingling, and pain of the vermilion were recorded. Clinical examination revealed an inflammatory edema whit desquamation and ulceration with serohematic crust as the only manifestation of this condition. Typical histopathologic findings included the presence of acanthosis, spongiosis, basal cell vacuolation, formation, edema of the lamina propria, lymphocytic inflammatory infiltrate with well-defined lymphoid follicles, and variable numbers of eosinophils and melanophages. Initial management was with the combination of topical steroids and propionic tacrolimus 0.1% with no satisfactory results, followed by topical injection of dipropionate of betamethasone. Our report confirms that lip lesions may appear as the only manifestation of this photodermatosis that is considered a specific form of cheilitis.

A Retrospective Study on Alopecia Areata in Children: Clinical Characteristics and Treatment Choices

Background: Although children are affected frequently with alopecia areata (AA), data are limited on clinical characteristics and treatment choices. Materials and Methods: We retrospectively reviewed the records of the pediatric dermatology department over a 12-year period to identify children with AA. Clinical data were collected. Results: Three hundred and sixty-four children with AA were identified, aged 1–12 years, 214 males and 150 females. The mean age of onset was 6.6 years (±3.3). The disease presented with patches on the scalp in the majority (90.7%), whereas only 6 children had alopecia totalis or universalis. The most commonly prescribed treatment was topical steroids (69.1%), followed by the combination of topical steroids and minoxidil 2% (14.3%). Oral steroids were prescribed in only 16 children. Follow-up at 3 months was available for only 70 children and the majority (84.3%) had some hair regrowth. Hair regrowth was unrelated to the number of plaques (p = 0.257), disease location (p = 0.302), and atopy (p = 0.999). Hair regrowth only correlated with the type of treatment (p = 0.003) with potent topical and intralesional steroids giving the best results. Conclusion: AA usually presents with a mild form in children, and potent topical steroids are the mainstay of treatment.

Role of Topical Anesthetics Versus Topical Steroids in The Management of Traumatic Ulcer: A Case Control Study

Traumatic ulcers represent one of the most common types of ulcers occurring in the oral cavity. The etiology for the causation of the traumatic ulcers might be due to mechanical trauma-which is the commonest, thermal and electrical trauma. The ulcers due to trauma are well circumscribed, most often deep with sloping margins and an erythematous halo around the ulcers. The management of traumatic ulcers usually ranges from the prescription of topical anesthetics, steroids to nutritional supplements.The aim of this study was to assess the prevalence of traumatic ulcers and to analyse the frequency of prescription of topical anesthetics and topical steroids in the management of traumatic ulcers.The study sample consisted of 94 patients with traumatic ulcer.The patients with traumatic ulcers included 56 males with a predominance of cases in the 3rd to 4th decade of life. The number of patients who were treated with topical anesthetics is 68 and topical corticosteroids are only 9. A combination of topical steroids and local anesthetics were used in 17 patients. The results reveal that the single most common drug used in the management of traumatic ulcer is the prescription of topical anesthetics. The second most common agent used is corticosteroids. On analysing the results based on the age group to the type of therapy, there was no significance. (P>0.05)The use of topical anesthetics is the commonest in the management of oral traumatic ulcers.

Erosive pustular dermatosis of the scalp: a multicentre study.

Erosive pustular dermatosis of the scalp (EPDS) is characterized by crusted erosions or superficial ulcerations that lead to scarring alopecia. We performed a multicentre retrospective clinical study including 56 patients (29 females and 27 males, mean age 62.7) with a confirmed EPDS in order to describe epidemiology, clinical findings and therapeutic choices of this disease. Mechanical/chemical trauma was reported in 28.6%, a previous infection in 10.7%, a previous cryotherapy in 5.4% androgenetic alopecia in 48.2% and severe actinic damage in 25%. Trichoscopy showed absence of follicular ostia, tufted and broken hair, crusts, serous exudate, dilated vessels, pustules and hyperkeratosis. Histopathology revealed three different features, depending on the disease duration. The most prescribed therapy was topical steroids (62.5%), followed by the combination of topical steroids and topical tacrolimus (8.9%), systemic steroids (7.1%) and topical tacrolimus (5.4%). A reduction of inflammatory signs was observed in 28 patients (50%) treated with topical steroids and in all three patients treated with topical tacrolimus. The relatively high number of patients collected allowed us to identify a better diagnostic approach, using trichoscopy and a more effective therapeutic strategy, with high-potency steroids or tacrolimus, which should be considered as first-line treatment.

Acquired perforating dermatosis: clinicopathologic study of a 10-year period at a tertiary teaching hospital.

Acquired perforating dermatosis (APD) comprises an uncommon group of skin disorders that develop in adulthood in association with systemic diseases. The aim of this study was to characterize clinicopathologic features and treatment outcomes in a series of patients diagnosed with APD. Retrospective study of all patients diagnosed with an APD over a 10-year period (2009-2018) at a tertiary teaching hospital in Lisbon, Portugal. Fifty-seven patients with APD were identified. Thirty-five patients presented lesions in multiple anatomic areas (61.4%), and the lower limbs were the most common location. Forty-six patients reported pruritus (80.7%), which was classified as severe in 21 of them (36.8%). An underlying systemic disease was identified in 53 patients (93.0%). Diabetes mellitus (DM) and chronic kidney disease (CKD) were the most common associated systemic diseases, but psychiatric disorders, malignancies, and chronic infections were present in a significant number of patients. The combination of topical steroids with antihistamines was the most prescribed initial treatment, but only 37.8% of the patients had a complete response. Acitretin, systemic steroids, and phototherapy were the treatments associated with the best outcome. Acquired perforating dermatosis can be associated with many systemic disorders that have pruritus as a common factor. Chronic viral infections and an occult malignancy should be sought, particularly in the absence of DM and CKD. The management of APD is challenging and is best achieved with the control of the underlying systemic diseases.

Management of recalcitrant palmoplantar psoriasis

Management of recalcitrant palmoplantar psoriasis and palmoplantar pustular psoriasis continues to be a challenge. Standardized therapeutic guidelines are not available due to limited data. The recalcitrant nature points to the need for systemic therapy but a trial with topical therapy is needed before planning systemic therapy. Among the topical therapies available topical steroids or combination of topical steroids with calcipotriol are the most effective. Light-based therapies are effective modalities in patients who do not respond to topical therapy. Systemic therapy is indicated in non-responders. Acitretin, methotrexate and cyclosporine are widely used. There are increasing data on the use of biologicals in non-responders to systemic immunomodulators, but the cost is a deterrent. The biologic agents include etanercept, infliximab, adalimumab, ustekinumab, secukinumab, apremilast and others. Traditional therapies such as phototherapy, acitretin or methotrexate are often preferred over newer antitumor necrosis factor (TNF) agents for patients with comorbid conditions due to the immunosuppressive effects of TNF-α inhibitors and concern about paradoxical exacerbation of disease in some patients.

Evaluation of Combined Topical Ozone and Steroid Therapy in Management of Oral Lichen Planus.

AIM:The present study aims to assess the therapeutic effect of the combination of topical ozone and steroid therapy in comparison to topical ozone alone versus topical steroid as a control in the management of atrophic - erosive oral lichen planus (OLP).METHODS:Sixty-six patients are having atrophic-erosive OLP were included in the study. They were randomly divided into three equal groups to be treated with topical corticosteroids alone (steroid group) as control, topical ozone alone (ozone group) or combination of topical steroids and ozone (combined group). Assessment of pain and sign scores was done before and after each treatment modality.RESULTS:The results revealed that the greatest significant percentage of change and subsequent improvement in pain and sign scores were recorded in the combined group.CONCLUSION:Reported data in this study using the combination of ozone and steroid therapy could provide a new promising safe and effective adjunct therapy for management of OLP.

Calcipotriene/betamethasone dipropionate for the treatment of psoriasis vulgaris: an evidence-based review.

While topical medications remain the cornerstone of the psoriasis treatment paradigm, they also come with the risk of multiple side effects. An alternative topical treatment option, calcipotriene or calcipotriol, is a vitamin D derivative that is thought to work by inhibiting keratinocyte proliferation and enhancing keratinocyte differentiation. Multiple studies have demonstrated its efficacy and safety in improving psoriasis when used in combination with topical corticosteroids. Given the effectiveness and side effect profile seen with this combination of topical steroid and calcipotriene, the US Food and Drug Administration approved a calcipotriene/betamethasone dipropionate product for use in psoriasis patients over the age of 12 in 2006. Our paper seeks to review clinical trial evidence of this combination medication and its use in the treatment of psoriasis vulgaris. While assessment of available evidence indicates that the topical medication is both safe and effective for the treatment of psoriasis vulgaris, addressing limitations of what is known, such as tolerability, adherence, and patient preference, of this combination drug in future high-impact studies is needed.

From genetics to treatment of eosinophilic esophagitis.

Eosinophilic Esophagitis (EoE) is an emerging chronic atopic disease. Recent advances in understanding its genetic and molecular biology pathogenesis may lead to a better management of the disease EoE is an atopic disease. Most of the patients affected by EoE have other atopic diseases such as allergic rhinitis, asthma, IgE-mediated food allergies and/or atopic dermatitis. The local inflammation is a T helper type 2 (Th2) flogosis, which most likely is driven by a mixed IgE and n-IgE-mediated reaction to food and/or environmental allergens. Epidemiological studies show that EoE is an atopic disease with a strong genetic component. Genetic studies have shown that EoE is associated with single nucleotide polymorphism on genes, which are released by the epithelium and important in atopic inflammation such as thymic stromal lymphopoietin located (TSLP) close to the Th2 cytokine cluster [interleukin (IL)-4, IL-5, IL-13] on chromosome 5q22, Calpain 14, EMSY, and Eotaxin3. When the EoE diagnosis is made, it is imperative to control the local eosinophilic inflammation not only to give symptomatic relief to the patient, but also to prevent complications such as esophageal stricture and food impaction. EoE is treated like many other atopic diseases with a combination of topical steroids and/or food antigen avoidance. The new understanding of EoE may lead to more specific and definitive treatments of EoE.

Eosinophilic Esophagitis: A Comprehensive Review.

Eosinophilic esophagitis (EoE) is an emerging chronic atopic clinical-pathologic disease with an estimated prevalence of 1/1000 similar to the one of Crohn's diseases. Usually, EoE is firstly suspected due to symptoms that are caused by esophageal dysfunction and/or fibrosis. EoE diagnosis is confirmed if the esophageal biopsy shows at least 15 eosinophils per high power field (eos/hpf) as a peak value in one or more of at least four specimens obtained randomly from the esophagus. Most of the patients affected by EoE have other atopic diseases such as allergic rhinitis, asthma, IgE-mediated food allergies, and/or atopic dermatitis. The local inflammation is a T helper type 2 (Th2) flogosis, which most likely is driven by a mixed IgE and non-IgE-mediated reaction to food and/or environmental allergens. Recently published genetic studies showed also that EoE is associated with single nucleotide polymorphism (SNP) on genes which are important in atopic inflammation such as thymic stromal lymphopoietin (TSLP) located close to the Th2 cytokine cluster (IL-4, IL-5, IL-13) on chromosome 5q22. When the EoE diagnosis is made, it is imperative to control the local eosinophilic inflammation not only to give symptomatic relief to the patient but also to prevent complications such as esophageal stricture and food impaction. EoE is treated like many other atopic diseases with a combination of topical steroids and/or food antigen avoidance.

English

INTRODUCTION: Paederus dermatitis is an acute irritant contact dermatitis caused by accidental crushing of an insect belonging to the genus Paederus. We came across an epidemic cluster of paederus dermatitits cases in our campus which prompted us to undertake this study to know its clinical manifestations, epidemiology and the most effective topical therapy. METHODS: The study included all clinically diagnosed cases of paederus dermatitis who were subjected to a thorough history and dermatological examination. Comparative assessment of efficacy of three commonly advised topical treatments was done by dividing patients into 3 age and sex matched groups: Group A (topical steroid), Group B (topical antibiotic) and Group C (topical steroid and antibiotic combination). All patients were followed up after 7 days, 15 days and 1month. Polythene bags were used to collect insect specimens and species identification was done. RESULTS: Students residing in various hostels accounted for 251 cases (60.19%) whereas inhabitants of villages accounted for 101 cases (24.22%). Majority of the cases occurred during the summer months of April (90 cases), May (131 cases) and June (72 cases). Moist surroundings, dense vegetations and paddy or sugarcane fields were noticed close to the residences of affected patients. Head and neck were the most commonly affected site (38.60%) followed by the upper extremity (24.40%).Group C patients who used a combination of topical steroid and antibiotic healed fastest with a mean duration of 8.4 days whereas Group A patients and Group B patients had a mean healing time of 12.9 days and 14.7 days respectively. Paederus extraneus and Paederus melampus were identified as the commonest species in this locality. CONCLUSION: We observed that topical steroid and antibiotic combination is more effective than topical steroid and topical antibiotic alone. Prevention of human-insect contact acts as a hindrance for the development of Paederus dermatitis which can be achieved by increased public awareness.

Asthma-Phänotypen und die Phänotyp-spezifische Therapie

Asthma is not a homogenous disease but a bundle of different phenotypes producing common symptoms due to swelling of bronchial mucosa and constriction of the airway smooth muscle. Beyond the treatment with a combination of topical steroids and long-acting beta agonists, new therapeutic options arise with the knowledge of different phenotypes. One option, specifically in allergic asthma, is the long known allergen immunotherapy. To identify the individual phenotype a diagnostic work up is warranted when the asthma is diagnosed and whenever asthma control cannot be maintained.

Eosinophilic Esophagitis – Recognition, Diet and Drugs

Eosinophilic Esophagitis – Recognition, Diet and Drugs

Ulcerative Keratitis in Gastrointestinal Stromal Tumor Patients Treated with Perifosine

Perifosine is a novel alkylphospholipid with antiproliferative properties attributed to protein kinase B inhibition. The authors describe a form of ulcerative keratitis in 5 patients with advanced gastrointestinal stromal tumor (GIST) enrolled in a phase I/II trial of perifosine in combination with imatinib. Interventional case series. Five patients (1 man, 4 women) with imatinib-resistant metastatic GIST who received a combination of imatinib and perifosine orally. The medical records were reviewed retrospectively. Ocular toxicity and ulcerative keratitis associated with perifosine. The ocular symptoms included redness, irritation, tearing, photophobia, and a gradual decrease in vision. Slit-lamp biomicroscopy in each case revealed a peripheral, paralimbal, ring-shaped, superficial corneal stromal infiltration and ulcerative keratitis, reminiscent of the autoimmune keratitis in conditions such as rheumatoid arthritis. The ulcerative keratitis was unilateral in 3 and bilateral in 2 patients; it was National Cancer Institute grade II (symptoms interfering with function but not interfering with activities of daily living) in all patients. All 5 patients had imatinib-resistant metastatic GIST and had continued on the highest dose of imatinib tolerated and initiated therapy with perifosine 100 mg daily or 900 mg weekly. A combination of topical steroids, topical antibiotics, and lubricating drops were used to manage ulcerative keratitis. In the first 3 patients, ulcerative keratitis initially was treated with topical antibiotics without improvement, but subsequently they improved significantly after topical steroids were added. A vision-threatening form of ulcerative keratitis may occur in patients taking perifosine. It is possible that imatinib in combination with perifosine contributes to this corneal toxicity; however, the authors are unaware of this ocular toxicity having been reported for imatinib when used without perifosine. The visual loss associated with perifosine may be reversible if detected and treated early and with judicious early use of topical steroids, topical antibiotic coverage, and lubrication.

Peripheral ulcerative keratitis due to a ‘long lost’ hard contact lens

Peripheral ulcerative keratitis (PUK) is a disorder consisting of a crescent-shaped destructive inflammation of the perilimbal corneal stroma. PUK can occur in a variety of ocular and systemic conditions including infections, lid abnormalities, dermatological disorders and connective tissue disorders. We present a case of PUK associated with a hard contact lens (CL) retained in the superior fornix for over 16 years. After removal of the embedded CL, a superior forniceal conjunctival pedicle graft was performed to prevent corneal perforation. The patient was managed postoperatively with a combination of topical steroids and antibiotics. The use of systemic immunosuppressive therapy was not necessary. Micro-trauma and micro-keratitis may have occurred as a result of the mechanical effect of the CL but if this was the sole mechanism, one would expect presentation at a much earlier date. We discuss the pathogenetic mechanisms which may have contributed to the development of this ulceration. This report highlights the importance of lid eversion when examining patients with anterior segment pathology.

Ulcerative keratitis in gatrointestinal stromal tumor patients treated with perifosine

19664 Background: Perifosine is a novel, oral, alkylphospholipid with antiproliferative properties attributed to Akt inhibition. We describe the ocular findings in 5 patients enrolled in phase I/phase II trials of perifosine in combination with imatinib for treatment of advanced GIST. Methods: The medical records of 5 patients who developed peripheral ulcerative keratitis while receiving perifosine and imatinib were retrospectively reviewed. Results: 1 man and 4 women ranged in age from 43 to 72 (median, 57 years). The ocular symptoms included redness, irritation, tearing, photophobia and a gradual decrease in vision. Slit lamp biomicroscopy in each case revealed a peripheral, paralimbal, ring-shaped, superficial stromal infiltration and ulcerative keratitis (UK), reminiscent of the autoimmune keratitis in conditions such as rheumatoid arthritis. The best corrected visual acuity in the affected eye(s) ranged from 20/25 to 20/300 (median 20/70). The UK was unilateral in 3 and bilateral in 2 patients; it was NCI grade II in all. All 6 patients had imatinib-resistant metastatic GIST and had continued on the highest dose of imatinib tolerated and initiated therapy with perifosine 100 mg daily or 900 mg weekly. Time from start of perifosine therapy to diagnosis of UK ranged from 1 to 3 months (median, 2). A combination of topical steroids, topical antibiotics and lubricating drops were used to manage UK. In the first 3 patients, UK was initially treated with topical antibiotics without improvement, but subsequently improved significantly once topical steroids were added. In 5 of 6 patients, the visual acuity improved with this regimen. Conclusions: UK may occur as a side effect of perifosine and shares features of autoimmune forms of keratitis. It is possible that imatinib in combination with perifosine is contributing to this toxicity. Topical steroids improve the signs and symptoms of UK and early treatment with topical steroids may lessen the potential risk of permanent corneal scarring and visual loss. The visual loss associated with perifosine can be reversible with close monitoring and judicious use of topical steroids, topical antibiotic coverage, and lubrication. No significant financial relationships to disclose.

Severe radiation dermatitis is related to Staphylococcus aureus.

Acute radiation dermatitis commonly occurs following local radiation therapy for various cancers and, when severe, may necessitate disruption of treatment. Intense inflammatory reaction may result in a breakdown of the skin's barrier function and accompanying bacterial colonization. Bacterial superantigens may exacerbate inflammation through activation of T-cells and subsequent cytokine release. We report six cases of severe radiation dermatitis in cancer patients. Four of the six grew pathogenic bacteria, and three had psoriasiform or eczematous reactions at distant sites. Both the radiation dermatitis and the distant cutaneous reactions resolved rapidly on a combination of topical steroids and oral plus topical antibiotic therapy. We suggest that staphylococcal superinfection of acute radiodermatitis intensifies the inflammatory process and hinders repair of the epidermal barrier. Patients with acute radiation dermatitis should be investigated for secondary infection. We emphasize the importance of including topical and oral antibiotic therapy in conjunction with topical corticosteroids to eradicate infection as well as hasten repair of the skin's barrier function. These cases are presented to call attention to the role of Staphylococcus aureus in the pathogenesis of severe radiation dermatitis and the need to include appropriate antibiotic therapy based on culture in the management of acute radiation dermatitis.