Fluticasone Propionate Cream Research Articles

Efficacy Analysis of Fluticasone Propionate Cream Combined with Hedan Tablets in the Treatment of Head and Face Seborrheic Dermatitis

Efficacy Analysis of Fluticasone Propionate Cream Combined with Hedan Tablets in the Treatment of Head and Face Seborrheic Dermatitis

Efficacy Analysis of Fluticasone Propionate Cream Combined with Tanshinone Capsule in the Treatment of Head and Face Seborrheic Dermatitis

Efficacy Analysis of Fluticasone Propionate Cream Combined with Tanshinone Capsule in the Treatment of Head and Face Seborrheic Dermatitis

Afebrile and Leukopenic Sweet's Syndrome Following Partial Ileectomy in an Elderly Woman

Afebrile and Leukopenic Sweet's Syndrome Following Partial Ileectomy in an Elderly Woman

Efficacy of fluticasone propionate ointment 0.005% in childhood lichen planus

Background: Treatment of childhood lichen planus (LP) is challenging owing to high rate of relapses. Moreover, majority of treatment options for LP have been extrapolated from studies done in adults. Topical corticosteroid remains the first line of treatment in localized classic form of LP, but till date, no consensus exists regarding standardized therapy in children. Hence, we conducted this study to evaluate the efficacy of mid-potent topical steroid fluticasone propionate 0.005% in childhood LP. Aims and Objectives: The aim of this study was to evaluate the therapeutic efficacy of fluticasone propionate ointment 0.005% in childhood LP. Materials and Methods: Thirty-one patients (6 months to 18 years of age) with clinical and histopathologically confirmed diagnosis of LP were subjected to routine baseline severity assessment, patient/parent assessment, pretreatment photographic record of the fixed anatomical site under treatment, and then received topical mid-potent steroid therapy (fluticasone propionate ointment 0.005%) twice daily and cetirizine dihydrochloride in predefined doses for 8 weeks. Follow-up was done at the end of 2 weeks, 4 weeks, 6 weeks, and 8 weeks. After 8 weeks, a proportion of patients achieving clinical improvement and side effects were assessed. Observation and Results: The difference between pre- and posttreatment induration was not statistically significant (P = 0.336). The mean number of lesions before the start of treatment was 50.29, which reduced to 14.77 (P = 0.000) after treatment, and the mean of patients' itching score before treatment was 6.74 ± 1.6, which reduced to 2.61 ± 2.3 (P = 0.000) following treatment, which was statistically significant. Clinical improvement was seen in 67.7%, whereas 32.3% showed no improvement over a period of 8 weeks. Conclusion: Mid-potency steroid fluticasone propionate ointment twice daily is an effective therapeutic agent for localized childhood LP, with minimal side effects.

A Randomized, Double-Blind, Placebo-Controlled Trial Assessing the Oral Administration of a Heat-Treated Lactobacillus paracasei Supplement in Infants with Atopic Dermatitis Receiving Topical Corticosteroid Therapy

Background/Aims: Atopic dermatitis (AD) is a common disease in infancy, for which topical steroids are the first-line therapy but have side effects. Innovative approaches are needed to reduce the burden of AD and corticosteroid usage in infants. Methods: The once-daily consumption of heat-treated probiotic Lactobacillus paracasei GM-080 or placebo for 16 weeks as supplementary approach to topical treatment with fluticasone propionate cream was compared in AD infants aged 4–30 months. Outcomes were SCORAD and its subscores, TEWL, Infants’ Dermatitis Quality of Life Index (IDQOL), corticoid “sparing effect,” CCL17/TARC, and IgE status. Results: SCORAD, objective SCORAD, itching, and IDQOL decreased significantly (p < 0.001) over the treatment period in both treatment groups. Slight decreases (ns) were noted in TEWL in lesional and unaffected skin and CCL17 levels. There were no differences between the treatment groups. Total IgE increased over the treatment period in both groups, with significantly higher increase in the heat-treated probiotic group (p = 0.038). There was no evidence of a corticoid “sparing effect” by the probiotic. Conclusions: In this design, the probiotic L. paracasei was not beneficial as a complementary approach to topical corticosteroids in infants with AD. However, slight beneficial effects may have been masked by the moderate potency corticoid.

Qingpeng ointment for treafment of chronic eczema: a Meta analysis

Objective To investigate the efficacy and safety of Qingpeng ointment treating adult chronic eczema. Methods In May 2018, cases of chronic eczema were searched in databases of Chongqing Weipu (2000-2017), China Knowledge Resource Integrated Database (2000-2017) and Wanfang (2000-2017) through Nanjing Medical University Library website in the Department of Dermatology, Suzhou Science and Technology Town Hospital. RevMan5.3 software provided by Cochrane collaboration was used for Meta-analysis. To ensure data reliability, only the documents from Grade three hospitals were included. The experimental group was treated with Qingpeng ointment, while the control group was treated with weakly potent glucocorticosteroid, such as glucocorticoid cream, or moderately potent glucocorticosteroid, such as hydrocortisone butyrate cream, fluticasone propionate, halometasone and triamcinolone urea cream. Results Totally, 7 randomized controlled trials, among which 258 patients in the trial group and 242 patients in the control group were included. The odds ratio (OR) values of Qingpeng ointment relative to glucocorticoid group at 2 and 4 weeks were 0.95 (0.52, 1.72) and 0.80 (0.29, 2.25) respectively, showing no significant difference (P=0.54 and P=0.60, respectively, 95% Confidence Interval). Compared with hydrocortisone butyrate treating group, the OR value was 0.75 (0.31, 1.82). And compared with moderately potent mometasone furoate, there was no significant difference in two-week and four-week treatment groups 0.99 (0.50, 1.95), 1.10 (0.18, 6.53) (P=0.38 and P=0.36). No obvious adverse reactions were found in Qingpeng ointment treated group. Conclusions Qingpeng ointment is safe and effective in treating chronic eczema. There is no significant difference between Qingpeng ointment treating group and glucocorticosteroid treating group. Qingpeng ointment can be used as a safe external medicine for the treatment of chronic eczema. Key words: Eczema; Randomized controlled trial; Meta-analysis; Glucocorticoids; External preparations; Qing Peng ointment

Response to "Case series study of the efficacy of compounded antibacterial, steroid, and moisturizer in atopic dermatitis".

Pediatric DermatologyVolume 35, Issue 4 p. 539-539 CORRIGENDUMFree Access Response to “Case series study of the efficacy of compounded antibacterial, steroid, and moisturizer in atopic dermatitis” This article corrects the following: Response to “Case series study of the efficacy of compounded antibacterial, steroid, and moisturizer in atopic dermatitis” Peter A. Lio MD, Kachiu Lee MD, Fatima Lakhani BS, Volume 34Issue 6Pediatric Dermatology pages: 745-746 First Published online: November 16, 2017 First published: 09 July 2018 https://doi.org/10.1111/pde.13637AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL In Lio et al1 the reference information for Harris and Fischer, 2017 and Lakhani et al, 2017 were not included in the published article. Also, “Harris and Fischer1” should have been cited as the first reference instead of “Fischer and Harris” in all instances in the published article. Here is the first reference to the letter in the text as well as the renumbered reference list: Page 745, first paragraph We would like to thank Harris and Fisher1 for their interest in our recent paper.2 Not only do we agree wholeheartedly with almost every point that they made, we made a concerted effort to address each point in detail in the paper itself. Renumbered reference list Harris V, Fischer G. Comment on “Case Series Study of the Efficacy of Compounded Antibacterial, Steroid, and Moisturizer in Atopic Dermatitis”. Pediatr Dermatol. 2017;34:744. Lakhani F, Lee K, Lio PA. Case series study of the efficacy of compounded antibacterial, steroid, and moisturizer in atopic dermatitis. Pediatr Dermatol. 2017;34:322-325. Hon KL, Tsang YC, Lee VW, et al. Efficacy of sodium hypochlorite (bleach) baths to reduce Staphylococcus aureus colonization in childhood onset moderate-to-severe eczema: a randomized, placebocontrolled cross-over trial. J Dermatolog Treat. 2016;27:156-162. Gonzalez ME, Schaffer JV, Orlow SJ, et al. Cutaneous microbiome effects of fluticasone propionate cream and adjunctive bleach baths in childhood atopic dermatitis. J Am Acad Dermatol. 2016;75:481. e8–493.e8. Perez-Nazario N, Yoshida T, Fridy S, De Benedetto A, Beck LA. Bleach baths significantly reduce itch and severity of atopic dermatitis with no significant change in S. aureus colonization and only modest effects on skin barrier function. J Invest Dermat. 2015;135:S37. Bath-Hextall FJ, Birnie AJ, Ravenscroft JC, Williams HC. Interventions to reduce Staphylococcus aureus in the management of atopic eczema: an updated Cochrane review. Br J Dermatol. 2010;163:12-26. We apologize for these errors. REFERENCE 1Lio PA, Lee K, Lakhani F. Response to “Case series study of the efficacy of compounded antibacterial, steroid, and moisturizer in atopic dermatitis”. Pediatr Dermatol. 2017; 34: 745- 746. Volume35, Issue4July/August 2018Pages 539-539 ReferencesRelatedInformation

Cutaneous microbiome effects of fluticasone propionate cream and adjunctive bleach baths in childhood atopic dermatitis

Patients with atopic dermatitis (AD) are prone to skin infections, with microbes such as Staphylococcus aureus suspected of contributing to pathogenesis. Bleach baths might improve AD by reducing skin microbial burden. We sought to characterize the microbiota of lesional and nonlesional skin in young children with AD and control subjects and compare changes after treatment with a topical corticosteroid (TCS) alone or TCS+dilute bleach bath. In a randomized, placebo-controlled, single-blinded clinical trial in 21 children with AD and 14 healthy children, lesional and nonlesional AD skin was examined at baseline and after 4-week treatment with TCS alone or TCS plus bleach bath. Microbial DNA was extracted for quantitative polymerase chain reaction of predominant genera and 16S rRNAsequencing. At baseline, densities of total bacteria and Staphylococcus, including Staphylococcus aureus, were significantly higher at the worst AD lesional site than nonlesional (P=.001) or control (P<.001) skin; bacterial communities on lesional and nonlesional AD skin significantly differed from each other (P=.04) and from control (P<.001). After TCS+bleach bath or TCS alone, bacterial compositions on lesional skin normalized (P<.0001), resembling nonlesional skin, with microbial diversity restored to control skin levels. The 4-week time period and/or the twice-weekly baths may not have been sufficient for additional impact on the cutaneous microbiome. More detailed sequencing may allow better characterization of the distinguishing taxa with bleach bath treatment. Treatment with a TCS cream suffices to normalize the cutaneous microbiota on lesional AD; after treatment, bacterial communities on lesional skin resemble nonlesional skin but remain distinct from control.

The reservoir effect of topical steroids in vitiliginous skin: A cross-sectional study.

Prolonged and frequent use of topical steroids may lead to decrease in efficacy as well as many local adverse effects. Stratum corneum has a unique property of reservoir effect. To study the reservoir effect of topical steroids in a steroid-responsive condition which may enable a decrease in the dosing frequency of topical steroids. A cross-sectional study design was used. Patients with at least three vitiliginous patches of more than 2 cm 2 present over the trunk or limbs were included. Exclusion criteria were topical or systemic corticosteroid use within the previous 4 weeks, antihistamine use within the previous 7 days, history of any allergy in the past and immunosuppression. Clobetasol propionate cream was applied on the first vitiliginous area (site A) and fluticasone propionate ointment was applied on the second vitiliginous area (site B). The third vitiliginous area, site C (control site) was left without applying any medication. Histamine-induced wheal suppression test was performed on each site, at the same time of the day, on every consecutive day following steroid application, until the values obtained at sites A and B approached those obtained at site C. SPSS software for Windows, version 16.0 was used for statistical analysis. The mean and standard deviation of the various studied parameters were calculated for various treatment groups and compared using analysis of variance (ANOVA) test. Forty patients were included in the study. The average wheal volumes and average erythema sizes at sites A and B were significantly smaller than the corresponding values at site C for up to 5 days after applying medication (P < 0.001). The presence of a cutaneous reservoir of topical steroid was confirmed based on its suppressive effect on the wheal and flare response to histamine. It is not certain that the concentration that suppresses histamine-induced wheal and flare is sufficient for therapeutic efficacy in vitiligo. The reservoir effect of topical clobetasol propionate and fluticasone propionate persisted for 5 days in vitiliginous skin. Hence, it may be possible to reduce the frequency of topical steroid application in vitiligo.

A Statistical Model to Predict the Reduction of Lichenification in Atopic Dermatitis

Acute symptoms of atopic dermatitis (AD), such as erythema, oedema/papulations and excoriations, respond quickly to topical corticosteroid treatment. Conversely, lichenification is regarded as a troublesome non-acute symptom of chronic AD which can take months of treatment before any improvement is seen. However, very little data actually support this opinion. Here, we analyse lichenification scores in 3 multicentre, short-term studies of nearly similar design. Two of these studies were active comparator dosage trials administered with either fluticasone propionate cream or ointment once or twice daily, the third study was a placebo control. In each of these 4-weeks studies lichenification was measured weekly. For the evaluation of the lichenification score over time a random-coefficients regression model was used. In all active treatments lichenification significantly improved (p < 0.005) within one week. Improvement continued afterwards, with > 80% of patients scoring no, very mild or mild lichenification after 4 weeks. We developed a model in which the lichenification score drops off linearly with the square root of time. The resulting convexly shaped downward time trend of lichenification was significant during all treatments and was significantly stronger during active treatment than with placebo. Fluticasone propionate can improve moderate to severe lichenification in a relative short period of time.

Segmental vitiligo: A randomized controlled trial to evaluate efficacy and safety of 0.1% tacrolimus ointment vs 0.05% fluticasone propionate cream

Segmental vitiligo is a small subset of vitiligo which responds very well to surgical therapy, but the role of medical treatment is not very well defined. To compare the efficacy and safety of 0.1% tacrolimus ointment versus 0.05% fluticasone propionate cream in patients of segmental vitiligo. A randomized control trial was conducted in a tertiary care hospital on 60 consecutive patients with segmental vitiligo. Patients with segmental vitiligo exclusively or along with focal vitiligo, untreated or had not taken any topical treatment in previous 1 month or systemic treatment in previous 2 months, from May 2005 to January 2007, were block randomized into two groups. Children <5 years, pregnant and lactating women, and patients with known hypersensitivity to either drug and with associated multiple lesions of vitiligo were excluded. Group A (n = 29) patients were treated with tacrolimus 0.1% ointment twice daily and group B (n = 31) patients were treated with 0.05% of fluticasone cream once daily for 6 months. Response and side effects were recorded clinically and by photographic comparison. Nineteen patients treated with tacrolimus and 21 patients treated with fluticasone completed the treatment with median repigmentation of 15% and 5%, respectively, at 6 months (P = 0.38). Transient side effects limited to the application site were observed. Both tacrolimus and fluticasone propionate produce variable but overall unsatisfactory repigmentation in segmental vitiligo.

Comparison of reservoir effect of topical corticosteroids in an experimental animal model by histamine-induced wheal suppression test

Introduction:Topical corticosteroids used in various dermatological diseases are available in different potencies and different formulations. The reservoir effect of different potency corticosteroids in the stratum corneum will help the clinicians to choose an appropriate topical steroid to maximize their efficacy and safety as therapeutic agents.Aims:This study was designed to compare the duration of reservoir of different potency topical corticosteroids experimentally in rabbits using histamine-induced wheal suppression test.Materials and Methods:The study was carried out in albino rabbits (as their skin is similar to humans) using four different concentrations of topical steroids, namely mometasone furoate ointment (0.1%), fluticasone propionate ointment (0.005%), betamethasone valerate cream (0.1%), and hydrocortisone butyrate cream (0.1%). These were applied on the back of rabbit on one side and the vehicle was applied on the other. One hour later, histamine-induced wheal suppression test was performed on both sides and wheal area was measured at 10 min for 7 days. Statistical analysis was done by ANOVA followed by post hoc test.Results:Maximum wheal suppression was seen on day 1 (P<0.001) in all four groups, both at test and at control sites. Interday comparison of mean wheal size by topical steroids showed that the reservoir of mometasone furoate ointment (0.1%) persisted till day 4 in the stratum corneum of the skin. In case of fluticasone propionate ointment (0.005%) and betamethasone valerate cream (0.1%), the reservoir persisted till day 2 and for hydrocortisone butyrate cream (0.1%), the reservoir was present only on day 1.Conclusions:It is concluded that the duration of reservoir depends on the potency of topical steroids. Higher the potency more is the duration of reservoir in stratum corneum and vice versa.

Wet-wrap treatment using dilutions of tacrolimus ointment and fluticasone propionate cream in human APOC1 (+/+) mice with atopic dermatitis

Wet-wrap treatment (WWT) with diluted topical steroids is widely used in atopic dermatitis (AD). Mice with transgenic overexpression of human apolipoprotein C1 (APOC1) in the liver and the skin are not only characterized by hyperlipidaemia and raised IgE levels, but also by pruritic dermatitis and a disturbed skin barrier function, providing a novel in vivo mouse model for AD. We investigated an adapted WWT method in the AD model in APOC1 mice in order to establish its efficacy. The effect of topical 0.1% and 0.03% tacrolimus ointment, tacrolimus base ointment, different dilutions of 0.05% fluticasone propionate (FP) cream and emollient on the development of dermatitis in APOC1 mice was investigated. WWT was performed with 0.03% tacrolimus ointment or 0.017% FP cream. AD in APOC1 mice responded to topical treatment with tacrolimus or FP. In contrast to tacrolimus treatment, FP treatment was associated with loss of body weight. WWT reinforced several therapeutic aspects, notably improvements in transepidermal water loss and in epidermal thickness. WWT using tacrolimus 0.03% ointment was more effective than WWT using FP 0.017% cream. AD in APOC1 mice responds to treatment with (diluted) tacrolimus or FP; treatment with FP cream, but not tacrolimus ointment, was associated with weight loss. In this study, the adapted WWT using tacrolimus or FP in mice had a limited improving effect as compared with open application of tacrolimus or FP.

Successful Treatment of Long‐Standing, Recalcitrant Subcorneal Pustular Dermatosis With Etanercept

Successful Treatment of Long‐Standing, Recalcitrant Subcorneal Pustular Dermatosis With Etanercept

Emerging Treatment of Atopic Dermatitis

Atopic dermatitis is a chronically relapsing eczematous disease of the skin. A wide range of therapeutic regimens has been used for atopic dermatitis. A better understanding of its pathogenesis will also lead to the development of novel approaches to treating this disease. This article reviews the recent advances in allergen-specific sublingual immunotherapy and therapy with antileukotriene drugs, probiotics, mycophenolate mofetil, leflunomide, and intermittent fluticasone propionate ointment, which the authors expect will be clinically useful therapies in the near future.

Wound healing potential of Tephrosia purpurea (Linn.) Pers. in rats

Tephrosia purpurea is a well-known herb for its hepatoprotective, anticancer, antiulcer, antibacterial and in healing bleeding piles, etc. The present study was aimed for wound healing potential of ethanolic extract of Tephrosia purpurea (aerial part) in the form of simple ointment using three types of wound models in rats as incision wound, excision wound and dead space wound. The results were comparable to standard drug Fluticasone propionate ointment, in terms of wound contraction, tensile strength, histopathological and biochemical parameters such as hydroxyproline content, protein level, etc. Histopathological study showed significant ( P < 0.05) increase in fibroblast cells, collagen fibres and blood vessels formation. All parameters were observed significant ( P < 0.05) in comparison to control group.

Anti‐IL‐5 recombinant humanized monoclonal antibody (Mepolizumab) for the treatment of atopic dermatitis

Eosinophils may play an important role in the pathogenesis of atopic dermatitis (AD). Interleukin-5 is essential for eosinophil growth, differentiation and migration. A monoclonal antibody to human interleukin-5 (mepolizumab) was developed for atopic diseases. This study was designed to study the effect of mepolizumab in AD. Two single doses of 750 mg mepolizumab, given 1 week apart, were studied in patients with moderate to severe AD using a randomized, placebo-controlled parallel group design. The primary endpoint of 'success' to treatment was defined as the percentage of patients with at least 'marked improvement' after 2 weeks as assessed by the Physician's Global Assessment of Improvement (PGA). Furthermore, SCORing AD (SCORAD), pruritus scoring, number of blood eosinophils and serum thymus and activation-regulated chemokine (TARC) values served as secondary endpoints. Fluticasone propionate cream 0.05%, once daily could be used as rescue medication from day 16 if no improvement was recorded. Eighteen patients received mepolizumab and 22 placebo treatment. Peripheral blood eosinophil numbers were significantly reduced in the treatment group compared with placebo (P < 0.05). No clinical success was reached by PGA assessment (P = 0.115), SCORAD (P = 0.293), pruritus scoring and TARC values in the mepolizumab-treated group compared with placebo. However, modest improvement (<50% improvement) assessed by PGA was scored significantly more in the mepolizumab-treated group compared with placebo (P < 0.05). Two single doses of 750 mg mepolizumab did not result in clinical success in patients with AD, despite a significant decrease in peripheral blood eosinophils.

Clinical and cost-effectiveness of once-daily versus more frequent use of same potency topical corticosteroids for atopic eczema: a systematic review and economic evaluation

To assess the clinical and cost-effectiveness of once-daily use of topical corticosteroids versus more frequent use of same-potency topical corticosteroids in the treatment of people with atopic eczema. Electronic databases. Bibliographies of included studies and related papers. Experts in the field. Manufacturer submissions to the National Institute for Clinical Excellence. Studies were assessed for inclusion according to predefined criteria by two reviewers. Data extraction and quality assessment were undertaken by one reviewer and checked by a second reviewer. Clinical effectiveness data were synthesised through a narrative review with full tabulation of results. One RCT comparing moderately potent corticosteroids, eight RCTs comparing potent corticosteroids and one RCT comparing very potent corticosteroids were included. No RCTs or CCTs of mild corticosteroids were eligible. Most RCTs were of poor methodological quality, although two were judged to be of good quality. The only study that compared moderately potent corticosteroids found no significant difference between once- and twice-daily application. For potent corticosteroids, some statistically significant differences in numbers of patients responding to treatment were identified favouring twice-daily treatment, but these were inconsistent between physician and patient assessment and outcomes selected for analysis. Two studies found a significant improvement in some symptoms with once-daily mometasone furoate compared with twice-daily application of a different active compound, while a third study found no significant differences. One good-quality study favoured twice-daily application of fluticasone propionate ointment, while other studies found no significant difference or an improvement in one symptom but not others. The only study comparing very potent corticosteroids found a statistically significant difference in comparative clinical response in favour of three-times daily treatment, but no difference in number of patients with at least a good response. There appears to be little difference in the frequency or severity of short-term events, however data are limited. No published economic evaluations were identified. Given findings on clinical effectiveness, where outcomes from the comparators are similar, the relative cost-effectiveness of once-daily versus more frequent application of topical corticosteroids becomes a case of cost-minimisation, where the least-cost alternative should be favoured, all else being equal. Topical corticosteroid products included in this review have a wide variation in price; the cost per 30 g/30 ml varies between GBP0.60 and GBP4.88. Specific decisions on the least-cost alternative, between once-daily and more frequent application of products, will be determined by the relative price of the products being compared. Where patients can be appropriately prescribed once-daily treatment of a similarly priced product, a reduction in the quantity of topical corticosteroid used will be expected. However, issues related to pack size for prescribed products and subsequent waste (unused product) could easily erode any potential saving. The potential cost-savings on prescribed products are very small at a patient level; although given the large numbers of patients with atopic eczema, cost savings in theory could be substantial. The presence of specifically marketed 'once-daily' topical corticosteroids, which are relatively expensive (per unit price), may result in additional costs should there be a general recommendation in favour of once-daily use of topical corticosteroids, compared to more frequent use. The literature is very limited; that available indicates the clinical effectiveness of once-daily and more frequent application of potent topical corticosteroids is very similar, but it does not offer a basis for favouring either option. The cost-effectiveness of once-daily versus more frequent use will depend on the generalisability of the findings to the specific treatment decision and the relative product prices. The trials included in this review generally refer to moderate to severe atopic eczema, whereas most patients have mild disease, and furthermore most of the included trials report on potent topical corticosteroids (eight of 10 RCTs); therefore the generalisability of the findings is limited. Further research is required on the clinical and cost-effectiveness of once-daily versus more frequent use of same potency corticosteroids, specifically on mild potency products for mild to moderate atopic eczema. Outcomes should include quality of life and compliance.

An infant with generalized rash and abnormal hair

HISTORY OF PRESENT ILLNESS A 14-month-old girl presented with a severe erythematous pruritic rash that has been persistent since birth and involved her entire body, including the scalp. She was breast-fed for a total of 7 months and fed with cow’s milk formula supplementation from 41⁄2 months of age. She exhibited severe failure to thrive at 8 months of age that required gastrostomy tube feeding, which resulted in satisfactory weight gain. Homogenized cow’s milk was introduced at 12 months of age and was well tolerated. Her rash persisted, with recurrent exacerbations, but no precipitating factors were identified. Previous treatments included skin moisturizers; 0.03% tacrolimus ointment (Protopic; Fujisawa, Deerfield, IL), which resulted in significant improvement; and 0.05% fluticasone propionate cream (Cutivate; Glaxo Wellcome, Research Triangle Park, NC), which resulted in some improvement. Results of review of other systems were unremarkable, except for occasional recurrent wheezing.

Acute and maintenance treatment of atopic dermatitis in children – two comparative studies with fluticasone propionate (0.05%) cream

BACKGOUND: Two multicentre, randomised, parallel group, double‐blind, comparative studies in children (2–14 yr) evaluated fluticasone propionate (FP) 0.05% cream for both acute and maintenance treatment of moderate to severe atopic dermatitis (AD).METHODS: One study compared FP with hydrocortisone (HC) 1% cream (FP 70, HC 67) and the other with hydrocortisone butyrate (HCB) 0.1% cream (FP 67, HCB 62). Treatments were applied twice daily, for 2–4 weeks until the AD was stabilised, and thereafter intermittently (‘as required’) for up to 12 weeks.RESULTS: The primary outcome measure, Total AD Score, recorded at the end of the acute and maintenance phases, was significantly lower (indicating improvements in disease severity) following treatment with FP compared with either HC or HCB (acute phase difference vs. HC, −2.39, 95%CI −3.47, −1.31; p<0.001 and vs. HCB, −1.25, 95%CI −2.46, −0.05; p=0.042) and (maintenance phase difference vs. HC, −1.88, 95%CI −3.20, −0.56; p=0.006 and vs. HCB, −1.39, 95%CI −2.72, −0.05; p=0.042). In both studies treatments were equally well tolerated with no visible signs of skin atrophy.CONCLUSION: In both the acute and longer term management of AD in children, FP demonstrated a high level of efficacy and maintenance of disease control with a tolerability similar to HC 1%, a lower potency corticosteroid.