Corticosteroid Ointment Research Articles

The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline

To develop a practice guideline report on the questions: What are the optimal methods to prevent acute skin reactions (occurring within the first 6 months of irradiation) related to radiation therapy? What are the optimal methods to manage acute skin reactions related to radiation therapy? Cancer Care Ontario's Supportive Care Guidelines Group (SCGG) conducted a systematic review of literature on this topic. Evidence-based recommendations were formulated to guide clinical decision making, and a formal external review process was conducted to validate the relevance of these opinions for Ontario practitioners. Twenty-eight trials meeting the inclusion criteria were identified. Of the twenty-three trials that evaluated preventative methods, washing was the only practice which significantly prevented skin reaction. Some evidence suggested topical steroid creams and calendula ointment might be effective. None of the five trials evaluating skin reaction management detected a positive effect using steroid cream, sucralfate cream, or dressings. Skin washing, including gentle washing with water alone with or without mild soap, should be permitted in patients receiving radiation therapy to prevent acute skin reaction. There is insufficient evidence to support or refute specific topical or oral agents for the prevention or management of acute skin reaction. In the expert opinion from the SCGG, the use of a plain, non-scented, lanolin-free hydrophilic cream may be helpful in preventing radiation skin reactions. In addition, a low dose (i.e., 1%) corticosteroid cream may be beneficial in the reduction of itching and irritation.

Tacrolimus ointment vs steroid ointment for eyelid dermatitis in patients with atopic keratoconjunctivitis

The main objective of this explorative study was to evaluate if tacrolimus ointment could be safer than corticosteroid ointment, with special reference to the intraocular pressure in the treatment of eyelid eczema in patients with atopic keratoconjunctivitis (AKC). Secondary aims were to compare the effects of the treatments on eyelid eczema and their potential impact on ocular surface inflammation. Tacrolimus 0.1% ointment and clobetasone butyrate 0.05% ointment were compared in a double-masked explorative crossover study. In total, 25 AKC patients were included. Each ointment was applied twice daily for 3 weeks, with 2 weeks of washout before, between, and after treatments. Efficacy was determined by eye examination and the patients' own symptom scoring. Cytology and cytokine measurements were performed on tear samples. Safety parameters were intraocular pressure, presence of bacteria and fungi, and the patients' reports of adverse events. The validity of the crossover design was explored with analysis of variance, and the effect of each medication was calculated with paired t-test and Wilcoxon paired test. A total of 20 patients completed the study. Both treatments were effective in reducing signs and symptoms of eyelid eczema, with a near superior benefit for tacrolimus in terms of eczema (total skin score) signs (P=0.05). No serious adverse events occurred and interestingly, intraocular pressure was not evidently affected by either treatment. Tacrolimus 0.1% ointment is a promising alternative therapy for eyelid eczema in AKC patients. Long-term studies are needed to further determine the value of tacrolimus in this patient group.

Can an imidazolidinyl urea‐preserved corticosteroid cream be safely used in individuals hypersensitive to formaldehyde?

A topical corticosteroid preparation on the Swedish market, Flutivate cream, contains a fairly high concentration of formaldehyde (FA). In this study, we have investigated the clinical relevance of contact allergy to FA when treating an allergic eczema with Flutivate cream, containing an FA-releasing preservative. In a randomized, double-blind study, 7 patients hypersensitive to both FA and nickel repeatedly applied Flutivate cream containing FA or Betnovate cream not containing FA to areas of experimentally induced nickel dermatitis. 17 controls allergic to nickel, but not FA, went through the same procedure. In 29 per cent of the FA-allergic individuals, the experimental dermatitis healed when treated with Flutivate cream compared with 71 per cent of the controls (P = 0.04). The conclusion to draw from this study is that an individual hypersensitive to FA should not use the corticosteroid preparation Flutivate cream on dermatitis skin.

Comparison of the Efficacy and Safety of 0.1% Tacrolimus Ointment with Topical Corticosteroids in Adult Patients with Atopic Dermatitis

Tacrolimus (FK506) ointment is widely used in the treatment of patients with atopic dermatitis. The drug exerts its action by down-regulating antigen-specific T-cell activities and associated proinflammatory cytokine production. A number of clinical studies have evaluated the efficacy and safety of 0.1% tacrolimus ointment compared with vehicle or topical corticosteroids in adult patients with atopic dermatitis. These studies have suggested that topical tacrolimus has a rapid onset of action and exerts sustained therapeutic effects, with an efficacy similar to that of moderate to potent topical corticosteroids, but without causing skin atrophy. Two phase III randomised, controlled clinical trials have been conducted in Japanese adult patients with atopic dermatitis to compare the efficacy and safety of topical 0.1% tacrolimus with topical corticosteroid ointments. In the first study, patients with moderate or severe atopic dermatitis on the trunk and extremities were randomised to 3 weeks of treatment with topical 0.1% tacrolimus or the mid-potency topical corticosteroid 0.12% betamethasone valerate. Over 90% of the patients in each study group experienced at least a moderate improvement at the end of the study. In the second study, patients with moderate or severe atopic dermatitis on the head or neck were randomised to 1 week of treatment with 0.1% tacrolimus or the mild-potency corticosteroid 0.1% alclometasone dipropionate. Significantly greater improvements in individual symptom scores were observed with topical tacrolimus compared with alclometasone dipropionate, with overall global improvement at 1 week being statistically superior with tacrolimus. Furthermore, in a long-term open-label study involving 568 patients, at least a moderate global improvement in symptoms was observed in 85% of patients at 6 weeks, increasing to 91% at both 26 weeks and 52 weeks; this rate was maintained throughout the 2-year duration of the study. 0.1% tacrolimus ointment was considered to be safe in the majority of patients. The most prevalent adverse reactions were local application site irritations, which generally resolved with continued therapy. In summary, these findings suggest that 0.1% tacrolimus ointment is an effective and safe nonsteroidal alternative therapy for adult patients with atopic dermatitis.

Soak and Smear

Atopic dermatitis, nummular eczema, chronic hand dermatitis, palmar plantar psoriasis, and xerotic eczema are common inflammatory skin conditions. They may be refractory to conventional topical and even systemic treatment. Little evidence is available that demonstrates the benefits of aggressive topical treatment of patients with these disorders. To describe a simple, inexpensive, effective topical treatment with an accompanying patient educational sheet. A retrospective study of 28 patients referred to a tertiary care center for refractory chronic pruritic eruptions. Intervention with a plain water 20-minute soak followed by smearing of mid-strength to high-strength corticosteroid ointment led to clearing or dramatic improvement. Objective and symptomatic improvement was obtained from aggressive topical treatment. It was well accepted in this group of referral patients. Hydration for 20 minutes before bedtime followed by ointment application to wet skin and alteration of cleansing habits is an effective method for caring for several common skin conditions. Prospective studies are needed to further validate these findings.

Local steroid application during nerve‐sparing radical retropubic prostatectomy

To evaluate the effect on potency rates after surgery of applying local steroids to the neurovascular bundles (NVBs) of the prostate after bilateral nerve-sparing radical retropubic prostatectomy (BNS-RRP). Sixty potent men undergoing BNS-RRP for clinically localized prostate cancer were prospectively randomized equally into two groups. In group 1, 10 mL of betamethasone cream 0.1% was applied locally to both NVBs, and group 2 had only the usual BNS-RRP with no corticoid cream. Complications and potency were evaluated at 3, 6 and 12 months in all patients and compared between the groups. At 12 months, 57% and 60% of patients were potent in group 1 and 2, respectively; the respective mean International Index of Erectile Function (5-item) scores were 14.76 and 15.43 (P = 0.59). Potency rates at 3, 6 and 12 months were not significantly different between the groups, and the continence rates at 12 months were also similar, with 93% and 90% of patients in groups 1 and 2 being continent, respectively. Ten and five patients in groups 1 and 2, respectively, required a blood transfusion (P = 0.23). There were no fistulae, wound dehiscence or rectal perforations. One patient in group 2 presented 4 months after RRP with a bladder neck contracture. Local application of betamethasone does not improve or expedite the recovery of erectile function after BNS-RRP, but there were no complications associated with its use.

Erythematous scaling eyelids

A 42-year-old woman presented for evaluation of a scaly rash around her eyelids that she described as tremendously itchy. The patient admitted to rubbing and scratching but knew of no specific aggravating factors. Although she had had atopic eczema since early childhood, previous adult flares of eczema had involved only her hands. Physical examination revealed bilateral scaling and erythema with lichenification of the upper and lower eyelids (figure 1). Treatment was initiated with a low-potency topical corticosteroid (desonide 0.05%) cream and a moisturizer (Catrix Correction cream) applied to the eyelids twice a day, and additional doses were applied as needed to relieve itching. The patient was advised to avoid potential irritants and allergens of all kinds. After 2 weeks, she noted marked improvement in the dermatitis. At this time, the dose of the topical corticosteroid was tapered while the patient continued to use moisturizers and avoid allergens and irritants as much as possible. Long-term control was achieved without long-term use of topical corticosteroids.

A multicentre, randomized, double-blind, controlled study of long-term treatment with 0.1% tacrolimus ointment in adults with moderate to severe atopic dermatitis

Atopic dermatis (AD) is a chronic disease that often requires long-term treatment. Topical corticosteroids are the usual therapy for patients with AD, but prolonged usage can result in skin atrophy and other side-effects. In a randomized, double-blind, comparative study, to compare the efficacy and safety of a 6-month treatment period with 0.1% tacrolimus ointment vs. a corticosteroid ointment regimen in adults with moderate to severe AD. Treatment was applied twice daily for a maximum of 6 months. Patients in the tacrolimus treatment group (n = 487) applied 0.1% tacrolimus ointment to all affected areas over the whole body. The patients treated with the corticosteroid regimen (n = 485) applied 0.1% hydrocortisone butyrate ointment to affected areas on the trunk and extremities and 1% hydrocortisone acetate ointment to affected areas on the face and neck. The study primary endpoint was the response rate, i.e. the proportion of patients with at least 60% improvement in the modified Eczema Area and Severity Index (mEASI) between baseline and month 3. By month 3, more patients in the 0.1% tacrolimus group responded to treatment (72.6% vs. 52.3% in the corticosteroid group, P < 0.001). The patients treated with 0.1% tacrolimus also showed greater improvement in mEASI, EASI, affected body surface area and physician and patient assessments of global response. Patients applying 0.1% tacrolimus ointment experienced more skin burning (52.4% vs. 13.8% in the corticosteroid group; P < 0.001). In most patients, skin burning was mild to moderate in severity and decreased rapidly after the first week of treatment. There was no increase in the incidence of infections or malignancies over time in either treatment group. Long-term treatment with 0.1% tacrolimus ointment is significantly more efficacious than a corticosteroid ointment regimen in adults with moderate to severe AD.

Hypereosinophilic dermatitis‐like erythema annulare centrifugum in a patient with chronic lymphocytic leukaemia

A 65-year-old male presented with a history of disseminated erythema annulare centrifugum lesions and a high peripheral blood eosinophilia (55%). Histopathology of a lesion revealed a superficial and deep perivascular and interstitial inflammatory eosinophilic infiltrate. The bone marrow aspirate showed a heavy eosinophilic infiltrate. There was no evidence of any other systemic involvement except for bone marrow eosinophilia. The patient had a 6-year history of chronic lymphocytic leukaemia. The disease is in complete remission for the last 3 years. The clinical and histopathological findings in the reported patient correspond to the diagnosis of hypereosinophilic dermatitis. Topical treatment with corticosteroid creams was successful. The cutaneous lesions gradually resolved in 8 weeks, within 7 months the peripheral blood eosinophilia slowly declined from 55% to 7%.

Influence of Admixture with Urea Ointment and White Petrolatum on the Penetration of Corticosteroids into Yucatan Micropig Skin

Admixtures of two primary corticosteroid ointments, Almeta® and Myser® ointments, were made with urea ointment and white petrolatum. The release rate of corticosteroids from the admixed ointments with urea ointment and white petrolatum to a buffer solution were significantly lower than those expected from a dilution ratio 0.5 for both Almeta® and Myser® ointments. Also, for the admixtures with urea ointment, the amount of corticosteroids penetrating into the model skin was larger than that expected from the dilution ratio, especially for Myser® ointment, while the amounts of corticosteroids penetrating into the skin from the admixtures with white petrolatum were smaller than those expected from the dilution ratio, for both primary ointments.An electron probe micro analyzer was used to observe the actual distribution profile of corticosteroid molecules in a cross section of the skin. In the case of the Myser®-urea ointment admixture, the distribution profile of difulprednate was quite homogeneous, probably due to the softening effect of urea on the skin and the affinity of difulprednate with skin tissue, though the urea ointment did not have much effect on the distribution profile of alclometasone released from the Almeta® ointment. On the other hand, difulprednate was concentrated at the surface for the admixture with white petrolatum.

Treatment of Atopic Eyelid Disease Using Topical Tacrolimus Following Corticosteroid Discontinuation in a Patient With Open-Angle Glaucoma

To report a case of atopic eyelid disease treatment using topical tacrolimus in a patient with open-angle glaucoma following corticosteroid discontinuation. Interventional case report. A 59-year-old white man with a history of treated open-angle glaucoma (latanoprost 0.005%) was referred to our department for atopic eyelid disease. The patient had received previous treatment with topical corticosteroid ointments (hydrocortisone acetate 1%/dexamethasone 0.1% ointments) that, even though they were effective in controlling atopic eyelid disease, were complicated by markedly elevated intraocular pressure (IOP) (steroid responder). Topical steroids were discontinued while other treatment modalities (such as eyelid hygiene, artificial tears, topical antihistamine drugs, topical mast cell stabilizers, or topical/oral antibiotics) were proven ineffective. Topical tacrolimus 0.03% ointment (Protopic; Fujisawa, Dublin, Ireland) was applied to the eyelid skin twice daily. An improvement of eyelid inflammation was observed while eczematous skin lesions and erosions were resolved within 15 days. After 6 months of continued topical tacrolimus treatment, there was no evidence of atopic dermatitis recurrence. During this period IOP remained controlled without any evidence of deregulation. Treatment of atopic eyelid disease with topical tacrolimus, following corticosteroid discontinuation in a steroid responder patient with open-angle glaucoma, seems to be an effective alternative treatment to corticosteroids without the risk of IOP increase.

THE INTERNATIONAL REGISTRY ON HAND AND COMPOSITE TISSUE ALLOGRAFT

O132 Aims: Since May 2002 all groups performing hand transplantations have supplied detailed information to the International Registry on Hand and Composite Tissue Transplantation. This inaugural report provides a comprehensive review of all hand transplants performed to date. Methods: From September 1998 to March 2004 nineteen male patients underwent 25 hand/forearm/digit transplantations (12 monolateral and 4 bilateral hand transplantations, 2 bilateral forearm transplantations, 1 thumb transplantation). Recipients were all males aged between 19 and 52 (average 32 years). Time since amputation ranged from two months to 22 years (mean 5.4 yrs). Immunosuppressive therapy included tacrolimus, mycophenolate mofetil, rapamycin and steroids; polyclonal or monoclonal antibodies were used for induction. Topical immunosuppression was administered in some patients. Results: Acute rejection episodes occurred in 75 % of the patients. In most cases treatment of the first rejection episode included high-dose intravenous steroids; in cases where no steroids were administered intravenously, oral steroid treatment was increased. Tacrolimus, corticosteroid or flumix ointment (alone or in combination between them) was applied in all cases of rejection. Treatment of a second, third or fourth rejection episode varied considerably, but it was completely reversible in all compliant patients. In one case, following the patient’s non-compliance with immunosuppressive therapy, cutaneous lichenoid-like lesions occurred. Side-effects included opportunistic infections, such as CMV infections, and metabolic complications, such as transient hyperglycemia, and increase in creatinine values. No life-threatening complications or malignancies were reported. All transplants were technically successful, and only minor surgical complications were observed. There was one case of early perioperative arterial thrombosis which was quickly reversed. Patient as well as graft survival was 100 % at 2 years. Two cases of graft failure at a later date were caused by severe inflammation and progressive rejection in a non-compliant patient Nerve regeneration was particularly good in all patients, showing a satisfactory degree of protective sensation recovery (i.e. the ability to detect pain, thermal stimuli and gross tactile sensation). A certain degree of discriminative sensation was also reported, although this was not to the same degree at all parts of the graft. At two years post-transplantation 12 hands showed different degrees of discriminative sensation recovery. Motor recovery began with extrinsic muscle function, allowing the patients to perform grasp and pinch activities. Function of intrinsic muscles was only observed at a later stage, starting at 12 months post-transplantation in the majority of patients. Patients showed the ability to perform the majority of daily activities. Conclusions: Despite the enormous antigen load associated with CTA, hand transplantation became a clinical reality with immunosuppression comparable to transplantation of solid organs.

Foot dermatitis from the shoes.

Foot dermatitis from the shoes is a common disorder. Patients with foot complaints seen at the Contact Dermatitis Unit, Department of Dermatology, Gazi University Faculty of Medicine between May 2001 and May 2002 were evaluated. Four patients with foot dermatitis from shoe allergens were found. Their clinical and patch test results of shoe contact dermatitis were reviewed. We also summarized the standard test allergens for shoe dermatitis. All four patients were treated with topical corticosteroid creams and were informed about patch test-positive materials. Patients with foot dermatitis from shoes should undergo patch testing to exclude other causes of foot dermatosis. Contact dermatitis from shoes can be managed by the recognition and avoidance of the allergens responsible. The control of hyperhidrosis and the use of topical and systemic corticosteroid therapies may also be beneficial.

The effect of two skin cleansing systems on moderate xerotic eczema*1

Background Moderate xerotic eczema, characterized by stratum corneum desquamation, erythema, and pruritis is a common condition that can be induced or worsened by skin cleansing. Traditional dermatologic therapy includes the use of emollients, medium or high potency topical corticosteroids, and a change in bathing habits. Objective To investigate the effect of two cleansing systems: a synthetic detergent bar soap applied with a cotton washcloth and a petrolatum-delivering body wash applied with a polyethylene puff as part of a topical treatment approach to moderate xerotic eczema. Method Sixty patients with moderate xerotic eczema were enrolled in a 4-week investigator-blinded study. Half were randomly treated with a strong topical corticosteroid cream (0.05% fluocinonide) and a traditional cleansing system consisting of a synthetic detergent bar soap applied with a washcloth. The remaining patients were treated with a weaker, medium strength topical corticosteroid cream (0.1% triamcinolone acetonide) and a novel cleansing system consisting of a petrolatum-delivering body wash applied with a polyethylene puff. Dermatologist investigator evaluations and patient self-assessments were conducted at baseline, 2 weeks, and 4 weeks. Results Patients using the novel petrolatum-delivering body wash and polyethylene puff cleansing system and the lower potency corticosteroid cream demonstrated significantly greater clinical improvement than those patients using the traditional cleansing system of a synthetic detergent beauty bar and washcloth system and the higher potency corticosteroid cream after both 2 and 4 weeks of treatment. Conclusion The cleansing system of a petrolatum-delivering body wash delivered by a polyethylene puff may be useful as a cleanser for patients with moderate xerotic eczema.

The effect of two skin cleansing systems on moderate xerotic eczema

Background Moderate xerotic eczema, characterized by stratum corneum desquamation, erythema, and pruritis is a common condition that can be induced or worsened by skin cleansing. Traditional dermatologic therapy includes the use of emollients, medium or high potency topical corticosteroids, and a change in bathing habits. Objective To investigate the effect of two cleansing systems: a synthetic detergent bar soap applied with a cotton washcloth and a petrolatum-delivering body wash applied with a polyethylene puff as part of a topical treatment approach to moderate xerotic eczema. Method Sixty patients with moderate xerotic eczema were enrolled in a 4-week investigator-blinded study. Half were randomly treated with a strong topical corticosteroid cream (0.05% fluocinonide) and a traditional cleansing system consisting of a synthetic detergent bar soap applied with a washcloth. The remaining patients were treated with a weaker, medium strength topical corticosteroid cream (0.1% triamcinolone acetonide) and a novel cleansing system consisting of a petrolatum-delivering body wash applied with a polyethylene puff. Dermatologist investigator evaluations and patient self-assessments were conducted at baseline, 2 weeks, and 4 weeks. Results Patients using the novel petrolatum-delivering body wash and polyethylene puff cleansing system and the lower potency corticosteroid cream demonstrated significantly greater clinical improvement than those patients using the traditional cleansing system of a synthetic detergent beauty bar and washcloth system and the higher potency corticosteroid cream after both 2 and 4 weeks of treatment. Conclusion The cleansing system of a petrolatum-delivering body wash delivered by a polyethylene puff may be useful as a cleanser for patients with moderate xerotic eczema.

P12 Measurement of skin edema by a dielectric technique (MoistureMeter‐D)

Easily applicable, cheap, noninvasive and quantitative techniques to measure edema in skin and subcutaneous tissues have not been available. Recently, a new device MoistureMeter‐D based on the local measurement of the dielectric properties of the biological tissues was validated in the quantitation of systemic edema in humans. In the present study the MoistureMeter‐D was applied to quantitate local skin edema related to skin irritation. The irritation was induced in the volar forearms of 12 healthy volunteers with the topical application of 1% sodium lauryl sulfate (SLS) for 6 hours. After induction the volunteers were divided into two groups: the irritation site of group I (six volunteers) had no treatment for the irritation site while for group II (six volunteers) the corticosteroid cream was topically administered on the irritation site. A good correlation was measured between the temporal changes of edema during the three days’ follow‐up by the ultrasound‐measured skin thickness and the edema‐specific MoistureMeter‐D in group I (p &lt; 0.001). The reduction of edema in group II by the corticosteroid treatment was consistently measured by both instruments. The coefficient of variation for a single measurement varied between 2 and 3%. The results demonstrate that the MoistuMeter‐D is an accurate instrument for the quick quantitative evaluation of local oedema and fluid retention in irritated skin.

Intravenous immune globulin (IVIG) in a patient with urticaria and hypogammaglobulinemia

Rationale The patient is a twenty-six year old female who presented to the allergist's office with hives on her arms and legs for a period of four weeks, which was treated with diphenhydramine, loratadine and corticosteroid creams without much success. She denied fever, chills, weight loss, night sweats or any other constitutional symptoms. Methods Cetirizine and ranitidine were started, without improvement. One month later, she returned with complaints of swelling of the extremities and face, which was then treated with a one-week course of prednisone. Hives recurred subsequently despite treatment with ketotifen obtained from Canada and multiple other antihistamines. Results Laboratory investigation revealed normal CBC, chemistries, ANA, complement and thyroid studies. Her IgG and IgA were decreased and SPEP showed hypogammaglobulinemia. Immunofixation showed a faint IgG Kappa band, which resolved spontaneously within months. Skin biopsy showed superficial and deep perivascular dermatitis with eosinophils. Bone marrow biopsy showed no evidence of infiltrative process. Immune workup was normal except for protective levels of antibodies to only 4/12 serotypes after pneumoccal vaccine administration. In light of her hypogammaglobulinemia and decreased antibody response, she received IVIG, which resulted in improvement of her hives. Conclusion This case illustrates an association between hypogammaglobulinemia, monoclonal gammopathy and recalcitrant urticaria in a patient who responded to gammaglobulin therapy. IVIG could be considered for any case of unresponsive severe urticaria, but is particularly indicated with concomitant hypogammaglobulinemia.

Survey of mixing commercially available corticosteroid ointments with other ointments and the anti-inflammatory activity of the admixtures.

We surveyed the prescriptions from the Department of Dermatology in a city hospital to determine the status of the use of admixtures of corticosteroid ointments with other ointments. Thirty percent of the prescriptions of topical ointment therapy for outpatients of the Department were for admixture ointments. They were prescribed for patients aged 2 months to over 90 years. The mixing ratios of corticosteroid ointments with other ointments were 1:1 to 5:3. One-to-one dilution was most frequently used. Corticosteroid ointments classified into strongest, very strong, strong and medium groups were used for admixtures. We studied the effect of admixture ointments on carrageenan-induced edema in rat hind paws to assess the anti-inflammatory activity of these admixtures. Dermovate, its 1:3-diluted preparation with white petrolatum and 1:1-diluted preparation of Lidomex with white petrolatum exerted significant anti-inflammatory activity (p < 0.05, compared with white petrolatum). These results suggest that the admixtures of different corticosteroid ointments have different anti-inflammatory activities. When admixture preparations are used, the properties of the corticosteroid and other ointments should be taken into account individually.

難治性潰よう性口内炎が初発症状と考えられた急性型成人Ｔ細胞白血病の１例

In March 1999, a 70-year-old man presented with ulceration of the oral mucosa and difficulty in swallowing accompanied by pain.Clinically, the oral ulcerations were characterized by a punched-out appearance, and the circumscribed lesions showed a trend toward bleeding with pain. The clinical diagnosis was herpetic gingivostomatitis.After admission, the patient received systemic antiviral agents (aciclovir), and corticosteroid ointment was applied to the oral lesions. Despite treatment, the oral ulcers remained unchanged, and the patient had a fever of unknown origin. Microscopic examination of a specimen of the oral ulcer revealed no definitive evidence of viral infection. On immunological examination, anti-ATLA was positive, and PPD reaction was negative. Subpopulation analysis of blood lymphocytes showed an increase in CD 4-positive cells and an increased CD 4/CD 8 ratio.Viral esophagitis was confirmed histopathologically by gastrointestinal examination. These findings suggested severe immune deficiency. A diagnosis of acute adult T-cell leukemia (ATL) was made at the Third Department of Internal Medicine of our university hospital. Chemotherapy for ATL was performed; however, the patient died of respiratory dysfunction caused by ATL cell infiltration of the lung in May 2000.

Prevention and Treatment of Acute Radiation Dermatitis: A Literature Review

To review historical and current research data on prevention and treatment of acute radiation dermatitis. 18 research trials and 1 case report published from 1967-2001 and 1 unpublished research trial from 1972. Washing the skin with mild soap and water and the hair with mild shampoo is safe during radiation therapy. Biafine (Medix Pharmaceuticals, Inc., Largo, FL), chamomile cream, almond ointment, topical vitamin C, and gentian violet have not been proven effective and should not be used. Transparent, hydrocolloid, and hydrogel dressings have been beneficial, as have sucralfate cream and corticosteroid cream. Aloe vera may be beneficial and is not harmful. The existing scientific data are lacking in quantity and quality. The current body of evidence is unable to provide clinicians with comprehensive guidelines for prevention and management of acute radiation dermatitis. Nurse clinicians and nurse scientists must partner to conduct further research to add to the limited resources about the prevention and management of acute radiation dermatitis and develop comprehensive evidence-based clinical practice guidelines.