Hydrocortisone Butyrate Ointment Research Articles

Topical application of Artemisia annua L. essential oil ameliorates 2,4-dintrochlorobenzene-induced atopic dermatitis in mice

Ethnopharmacological relevanceVolatile oil is widely used in traditional Chinese medicine owing to its unique hydrophobic and lipophilic properties and rapid skin absorption. Artemisia annua L. (A.annua) essential oil (AAEO), a volatile oil extracted from A. annua, exhibits anti-inflammatory properties. However, few studies have investigated its effects on skin inflammation. Aim of the studyTo investigate and elucidate the mechanisms of action of AAEO in the treatment of atopic dermatitis (AD). Materials and methodsNetwork pharmacology was used to predict the targets and pathways of AAEO for the treatment of AD. The AD mouse model was established by topical application of 2,4-dintrochlorobenzene (DNCB), AAEO, and the positive control drug hydrocortisone butyrate cream (HBC). We evaluated the symptoms of AD, SCORAD scores, histological analysis, and serum IgE and TNF-α levels in mice. Immunofluorescence, western blotting, and qPCR were used to investigate the signaling pathways. ResultsNetwork pharmacology analysis indicated that AAEO may exert its effects via the MAPK/NF-κB signaling pathway. Animal experiments demonstrated that topical application of AAEO and HBC significantly ameliorated skin lesions, reduced dermatitis score, and decreased spleen weight compared to DNCB treatment. AAEO reduced skin epidermal thickness and mast cell infiltration. DNCB markedly reduced the protein levels of filaggrin (FLG) and loricrin (LOR), whereas AAEO reversed these changes. Notably, the 5% concentration of AAEO demonstrated substantial improvement in skin barrier function. Compared to the DNCB group, the levels of FLG and LOR remained almost unchanged following HBC treatment. DNCB markedly elevated IgE and TNF-α levels, which were reversed by AAEO and HBC treatment. Among the inflammatory cytokines, DNCB increased mRNA expression of TNF-α, IL-1β, and IL-6, however, it reduced IL-10, with AAEO and HBC reversing these changes to various degrees. Additionally, DNCB-induced ERK, JNK, and P38 phosphorylation, associated with the upregulation of phosphorylation of NF-κB, whereas, AAEO and HBC exhibited potent inhibition of the MAPK/NF-κB signaling pathway. ConclusionsThis study systematically demonstrated the possible therapeutic effects and mechanisms of AAEO in AD via network pharmacological analysis and experimental confirmation. These results revealed that topical application of AAEO can suppress skin inflammation and restore skin barrier function. These findings provide the potential application of AAEO in synthesizing external preparations for both pharmacological and cosmetic industries.

外用丁酸氢化可的松乳膏联合一种皮肤膏剂敷料治疗特应性皮炎的随机开放对照研究

外用丁酸氢化可的松乳膏联合一种皮肤膏剂敷料治疗特应性皮炎的随机开放对照研究

Guideline-Driven Medical Decision Support Methods for Family Healthcare

Medical guidelines are effective to guide medical practice and improve therapeutic effect. Currently, medical guidelines are primarily used in medical institutions but are still not available to the public. To improve the practicality of guidelines in family practice, this paper proposes a novel approach to assisting family medical decision support using semantic technology and open data analysis. A disease-specific knowledge model is constructed using semantic guideline expressions, which provide standard care plans to the public. A medical text corpus is formed by collecting medical information from open data sources online. Via text mining and sentiment analysis of the medical text corpus, the word frequency and sentiment score of different medical procedures are calculated, which are used to provide detailed instructions for public treatment. A guideline-based knowledge model is constructed to create eczema-specific standard care plans. According to the resulting frequencies, hydrocortisone butyrate cream (HBC) elicited the most concern among hormone drugs (54%), followed by mometasone furoate cream (MFC), accounting for 28% among all hormone drugs. According to the average sentiment score, MFC is more frequently recommended than HBC. For skin care products, YMJ elicited the most concern, while Cetaphil was the most recommended. The results of the word frequency analysis and sentiment analysis are combined to provide detailed and clear recommendations to supplement standard care plans for family medical decision support. The method proposed by this paper is an important supplement and extension to in-hospital data analysis.

Can topical cefazolin be a useful treatment for psoriasis?

Introduction: A better understanding of psoriasis pathogenesis resulted in significant development of new, effective anti-psoriatic therapies, albeit new treatment options, especially topical ones, are still awaited. In vitro studies have shown that cefazolin, the first-generation cephalosporin, has the properties of a specific inhibitor of several pro-inflammatory cytokines. This study aimed to evaluate the effects of cefazolin in 3D human psoriasis skin model and to assess the efficacy and tolerability of topical cefazolin in comparison to topical hydrocortisone butyrate in the treatment of psoriasis. Material and methods: Commercially available 3D human psoriasis skin model was used to evaluate the effect of cefazolin on psoriasis-related gene expression: human β-defensin 2 (HBD2, DEFB-4A), psoriasin (S100A7) and skin-derived peptidase inhibitor 3 (PI3), as well IL-6 and IL-8 secretion. H&E staining was performed to evaluate tissue morphology. The clinical test was an open-label, comparative, left to right study with an active comparator. Ten adult subjects with psoriasis were asked to apply 5% cefazolin emulsion twice daily on the psoriatic plaques located in extensor area of the right elbow, and 0.1% hydrocortisone butyrate ointment on the same body area on the opposite side. The treatment continued for 7 days. The disease severity was assessed according to the modified PASI (mPASI) and Investigator Global Assessment (IGA). Patients were also asked to rate concomitant subjective symptoms, treatment tolerability and global therapeutic effect. Results: Cefazolin down-regulated gene expression of HBD2 (DEFB-4A) and psoriasin (S100A7) and did not affect PI3. In the tested conditions the drug did not reduce IL-6 and IL-8 secretion. Histological evaluation revealed a slight thinning of the epithelium in tissues treated with cefazolin. In patients, both of the treatments resulted in a significant reduction of psoriatic plaques, although the therapeutic effect was significantly better for hydrocortisone butyrate ointment. Both drugs equally significantly reduced pruritus intensity. The treatment with cefazolin was well tolerated and any significant adverse events were observed. Conclusions: Cefazolin can be considered an interesting therapeutic option as a topical immunomodulatory, anti-inflammatory drug, but its anti-psoriatic properties have to be confirmed in well-designed, prospective and vehicle-controlled studies.

722 Type 2 helper T-cell (Th2) effects of crisaborole versus 3 topical corticosteroids (TCSs) with a range of potencies: An ex vivo human skin model study

The Th2 pathway plays a central role in the pathophysiology of atopic dermatitis (AD). Crisaborole ointment, 2%, is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild-to-moderate AD. An ex vivo human skin model with Th2 cytokine and T-cell stimulation was used to compare the T-cell and Th2 cytokine activation effects of crisaborole with TCSs of varying potencies (hydrocortisone cream, 1% [lowest], hydrocortisone butyrate cream, 0.1% [lower-medium], and betamethasone valerate cream, 0.1% [medium]). Test articles were applied topically to human skin explants from 4 healthy (ie, non-AD) donors (5 replicates each) 16 hours prior to Th2 activation via a proprietary Th2 stimulation cocktail. To determine the effect of TCS application on the Th2-mediated inflammatory state of the tissue, 4 AD-associated biomarkers were chosen. RNA was isolated 24 hours after stimulation and quantitative-PCR was used to measure the gene expression of 4 biomarkers (interleukin [IL]-13, IL-31, interferon [INF]-γ, and matrix metallopeptidase 12 [MMP12]) in the explants. Topical application of crisaborole or any of the 3 TCSs resulted in a significant reduction (>50%) in activity for all 4 AD-associated biomarkers. There were no differences in biomarker expression between crisaborole and the 3 TCSs except for a numerically greater reduction in MMP12 for crisaborole compared with hydrocortisone cream, 1%.

Chinese herbal remedy found to contain steroids and antifungals

A 14-year-old boy with early-onset guttate psoriasis vulgaris presented at our clinic with several reddish-purple, horizontal streaks on the distal part of his shins. Previously, he had been treated with narrow-band ultraviolet B, topical corticosteroids ranging from mild (hydrocortisone 17-butyrate cream 1 mg/g) to moderate (mometasone furoate cream 1 mg/g and betamethasone valerate ointment 1 mg/g), and tacrolimus ointment 1 mg/g—but the response to treatment was not long lasting. The family consulted a licensed practitioner of traditional Chinese medicine who prescribed a so-called herbal cream (figure). The patient applied the cream topically on the psoriatic lesions twice a day. After 9 months of doing this, he developed a new rash on his shins that was later confirmed to be striae distensae (figure). We suspected that the cause was exposure to a corticosteroid—but the patient had not been using a corticosteroid either topically or systemically during this time. The so-called herbal cream was suspected as a possible source; however, the content label only listed herbal ingredients including Chinese sumac, Sophora flavescens, Stemona tuberosa Lour. Nevertheless, the location of the striae was very unusual, and as a simple test, the herbal cream was applied on the upper arm of the senior physician; after 12 h, a strong vasoconstriction effect was seen (figure), which further raised our suspicion that the cream contained a corticosteroid. We therefore sent it for analysis at the Department of Official Medicines Control Laboratory, Swedish Medical Products Agency, Uppsala, Sweden. The laboratory used liquid chromatography-tandem mass spectrometry and nuclear magnetic resonance, and reported that the cream contained both a potent corticosteroid (0·065% clobetasol propionate) and the antifungals ketoconazole and miconazole. We then reported this herbal product to the Danish Medicines Agency to ensure that it was dealt with appropriately.

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

Efficacy and safety of Chushizhiyang ointment for the treatment of mild atopic dermatitis in infants: a multicenter clinical study

Objective To evaluate the efficacy and safety of Chushizhiyang ointment for the treatment of mild atopic dermatitis in infants. Methods A multicenter, randomized, open, active-controlled clinical trial was conducted. A total of 204 infants with atopic dermatitis were enrolled and randomly divided into 2 groups to be topically treated with Chushizhiyang ointment (test group, n= 103) and hydrocortisone butyrate cream (control group, n= 101) , respectively, for 2 weeks. The improvement of eczema area and severity index (EASI) scores and quality of life was evaluated at 7 days and 14 days after the treatment, so was the incidence of adverse events and adverse reactions. Results Ninety-eight infants in the test group and 101 in the control group were included in the full analysis set, which revealed that the disease severity significantly decreased after the treatment in both groups. The EASI scores at the baseline and on days 7 and 14 were 2.47 ± 4.04, 0.92 ± 1.25 and 0.39 ± 1.04 respectively in the test group, as well as 2.13 ± 2.01, 0.85 ± 1.58 and 0.45 ± 1.65 respectively in the control group. Furthermore, the test group and control group both showed that EASI scores on days 7 and 14 significantly decreased compared with those at the baseline (the test group: T=-1 666, -1 793, respectively, both P 0.05) . The response rates in the test group and control group were 47.96% (47/98) and 55.44% (56/101) respectively on day 7, as well as 79.59% (78/98) and 84.16% (85/101) respectively on day 14, and there were also no significant differences between the two groups (both P > 0.05) . The adverse reactions mainly manifested as erythema, itching and scaling in the test group, as well as hypopigmentation, telangiectasia, scaling and hyperpigmentation in the control group. No significant difference in the incidence of adverse events was found between the test group (2.9%, 3/103) and control group (6.9%, 7/101) . Conclusion Chushizhiyang ointment shows definite efficacy for mild atopic dermatitis in infants with good safety and tolerability, and can be a teatment option for mild atopic dermatitis in infants. Key words: Dermatitis, atopic; Randomized controlled trial; Chushizhiyang ointment; Infant

Evfficacy of Qizheng Qingpeng ointment combined with Hydrocortisome Butyrate cream on treatment of eczema

Objective To investigate the effect and safety of Qizheng Qingpeng ointment in the treatment of eczema. Methods Ninety-eight patients of eczema were randomly divided into two groups,who received either Qizheng Qingpeng ointment plus hydrocortisone butyrate cream or only hydrocortisone butyrate cream at the first 2 weeks,and all patients were treated of Qizheng Qingpeng ointment plus hydrocortisone butyrate cream at the further 2 weeds. Results At 1 week and 2 week post-treatment,the efficacy rates were 68.52%,87.03% for the study groups and 27.91%,58.13% for the control groups,the efficacy rate of the study groups was statistically better than that of the control groups(χ2= 14.21,8.99,all P 0.05). Conclusion The clinical efficacy of Qizheng Qingpeng ointment associated with corticosteriod for treatment of eczema was better than corticosteriod alone. Key words: Eczema; Qizheng Qingpeng ointment; Treatment Out

The efficacy of probiotics for infantile eczema and the effect of probiotics on serum IgE

Objective To observe the efficacy of oral probiotics for infantile eczema and the effect of probiotics on serum IgE.Methods 75 cases of infantile eczema were randomly divided into two groups.34 patients in the control group received conventional therapy with oral hydrochloride cetirizine drops and topical hydrocortisone butyrate cream,and 41 patients in the study group received probiotics for 30 days in addition to the conventional therapy.The effectiveness rate and 3-month relapse were observed in the two groups serum total IgE level was detected three months after the treatment.Results The study group was superior to the control group in the effectiveness rate and the relapse rate( 80.49％ vs.55.88％ and 31.70％ vs.58.82％,P＜ 0.05 ).There was significant difference between the two groups in total serum IgE level [( 117.15 ± 72.26 )U vs.( 205.96 ± 129.18 )U,P＜ 0.01 )].Conclusions Oral probiotics in the treatment of infantile eczema can lower serum IgE level,relieve symptoms,and reduce the rate of eczema relapse. Key words: Probiotics; Infantile eczema; Efficiency; Relapse; IgE

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.

Effect of a preceding laser dermabrasion on the outcome of combined therapy with narrowband ultraviolet B and potent topical steroids for treating nonsegmental vitiligo in resistant localizations

The treatment of vitiligo remains unsatisfactory. To assess in patients with vitiligo the effect of a laser dermabrasion in addition to the association of topical steroids and ultraviolet (UV) B in difficult-to-treat areas. This was a single-centre prospective randomized trial including patients with nonsegmental vitiligo who had at least two symmetrical lesions located on bony prominences and/or extremities. An erbium laser-assisted dermabrasion was first performed on one side (randomly assigned). After 48 h, hydrocortisone 17-butyrate cream applied daily for three periods of 3weeks followed by a 1-week steroid-free interval and narrowband UVB treatment was performed on both sides twice weekly for 12weeks. The evaluation was performed on standardized pictures by two physicians blinded to the type of treatment received. The criterion of success was a repigmentation of at least 50%, 1month after the end of the treatment. Eighteen patients were included (24 paired lesions treated). Two patients dropped out for personal reasons. Almost 50% of lesions achieved at least 50% repigmentation in the dermabrasion side while only 4·2% did so with topical steroids and UVB alone (P<10(-4) ). Side-effects were delayed healing, pain and two hypertrophic scars. The tolerance and patient satisfaction were 4·2 and 4/10 for the laser-treated side and 8·4 and 3/10 in the UVB+ steroids alone group, respectively. Laser dermabrasion significantly improves the repigmentation rate in vitiligo lesions. Despite a high rate of repigmentation in such difficult-to-treat areas the high rate of side-effects and the poor tolerance strongly limit its use in current practice.

PSS15 CHANGES IN HEALTH RELATED UTILITY AMONG ADULTS WITH ATOPIC DERMATITIS TREATED WITH TACROLIMUS OINTMENT COMPARED TO A STANDARD CORTICOSTEROID REGIMEN

OBJECTIVES: Long-term treatment with 0.1% tacrolimus ointment (TO) has been demonstrated as well-tolerated and effective for the treatment of atopic dermatitis (AD) but its impact on utility has not been reported. The purpose of this study was to estimate utility changes associated with TO versus a standard corticosteroid regimen (CR) in the treatment of moderate-to-severe AD in adults. METHODS: Data were analysed from a double-blind RCT. Patients were treated with either TO applied twice-daily for six months to the head, neck, trunk and extremities, or alternatively 0.1% hydrocortisone butyrate ointment administered to the trunk and extremities and 1% hydrocortisone acetate ointment applied to the head and neck. Health-related utility (EQ5Dindex) was estimated by Monte Carlo simulation from SF12 responses collected during the clinical trial by applying a published mapping algorithm. RESULTS: Data were available for 972 patients (intention-to-treat), 46% of whom were male with a mean age of 32 years (SD 12). At baseline the mean EQ5Dindex was similar between both arms (0.721 vs. 0.730; p = 0.461, for CR vs. TO, respectively). After 28 days the mean EQ5Dindex improved in both treatment arms (0.820 vs. 0.849; p = 0.004, respectively). The incremental EQ5Dindex between the treatment arms increased as the trial progressed. At 6-months subjects treated with TO had signifi cantly higher utility than CR-treated subjects (0.789 vs. 0.831; p = 0.001; respectively). CONCLUSIONS: Patients with AD had considerable decrement in health-related utility at baseline. Treatment with 0.1% tacrolimus ointment was associated with a consistently improved, clinically-signifi cant, incremental increase in health-related utility compared to the corticosteroid regimen, increasing over a six month period.

Randomized controlled trial comparing the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck

Vitiligo is a pigmentary disorder which may have disfiguring consequences. Its treatment remains a challenge. We designed a parallel-group randomized controlled trial to compare the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in patients with vitiligo unresponsive to previous treatment with topical steroids or narrow-band ultraviolet (UV) B phototherapy. Consecutive patients aged 18-75 years with nonsegmental vitiligo localized on the face and/or neck lacking response to previous conventional treatment were eligible. In total, 84 patients (44 women and 40 men, mean age 44 years) were randomized to 308-nm excimer laser phototherapy twice weekly alone or in combination with topical hydrocortisone 17-butyrate cream twice daily for three periods of 3 weeks followed by a 1-week steroid-free interval. The primary outcome was a reduction of at least 75% of the overall lesional areas as judged by automatic image analysis on reflected UV photographs, conducted blind to treatment assignment, at 12 weeks compared with baseline. Secondary outcomes were clearance, and improvements on Physician's Global Assessment (PGA) and Skindex-29 scores. A total of 76 (90%) patients completed the study. In an intention-to-treat analysis, seven [16.6%; 95% confidence interval (CI) 5.3-27.8%] patients in the excimer monotherapy arm and 18 (42.8%; 95% CI 27.8-57.8%) in the combination arm showed > or = 75% reduction of vitiligo lesions at 12 weeks (chi(2) test 6.89, P = 0.0087). Clearance was observed in two (4.7%; 95% CI 1.6-11.2%) and nine (21.4%; 95% CI 9.0-33.8%) patients, respectively (Fisher's exact test P = 0.04). A significant difference also emerged for PGA scores, while no difference was documented for Skindex-29. Recalcitrant vitiligo of the face and neck may benefit from the combination of excimer laser phototherapy with topical hydrocortisone 17-butyrate cream.

Skin Colonization by Staphylococcus aureus in Patients With Eczema and Atopic Dermatitis and Relevant Combined Topical Therapy: A Double-Blind Multicentre Randomized Controlled Trial

Gong JQ, Lin L, Lin T, et al. Br J Dermatol. 2006;155:680–687 PURPOSE OF THE STUDY. To investigate the colonizing features of Staphylococcus aureus in the lesional and nonlesional skin of patients with eczema and atopic dermatitis (AD) in China and to compare the therapeutic effect of mupirocin plus hydrocortisone butyrate with vehicle ointment plus hydrocortisone butyrate. STUDY POPULATION. There were 327 patients with AD and eczema (177 male and 150 female); 75 were aged &amp;lt;10 years, 48 between 10 and 18 years, and 204 &amp;gt;18 years. METHODS. A multicenter, double-blind randomized trial was conducted. Eczema area and severity index scores were evaluated before the start of the trial and on the 7th, 14th, and 28th day of treatment. Swabs for bacterial isolation were taken from lesional skin before the start of the trial and on the 7th, 14th, and 28th day of treatment and from nonlesional skin only before the start of the trial. A combination topical therapy with mupirocin plus hydrocortisone butyrate ointment was used in the experimental group, with vehicle ointment plus hydrocortisone butyrate ointment as a control. RESULTS. Of 327 patients enrolled onto the study, bacteria were isolated from 74.8% of lesional and 34% of nonlesional skin samples from patients with AD, of which S aureus accounted for 79.8% and 80.5%, respectively. The colonization density of S aureus was markedly higher in lesional than in nonlesional skin and was positively correlated with lesion severity. Both groups had equivalent clearing of AD and improvement of skin lesions. The patients with severe AD improved faster with combination therapy compared with monotherapy with hydrocortisone butyrate ointment. However, the patients with severe AD were equivalent at days 14 and 28. CONCLUSIONS. This study confirmed that lesional skin of patients with AD was more frequently colonized with S aureus than was nonlesional skin. The more severe the eczema, the higher the colonization rate of S aureus. S aureus infection is related to the pathogenesis of eczema and AD. An antibiotic-corticosteroid combination and corticosteroid alone both provided good therapeutic effect in eczema and AD, and both reduced colonization by S aureus. Early combined topical therapy is beneficial to patients with moderate-to-severe eczema and AD, and it is unnecessary to use antibiotics at later stages of disease or in mild eczema or AD. REVIEWER COMMENTS. S aureus colonization has been recognized as a long-standing issue in AD. This study confirmed a high rate of colonization and correlation with AD severity. The important new finding was that treatment with topical steroids only decreased S aureus colonization without treatment of antibiotics. This is important as the rate of resistant S aureus rises. Maintaining good control of AD will keep the use of unnecessary antibiotics down. Therefore, antibiotic treatment is probably just necessary for the patients with severe AD flares.

The comparative effects of tacrolimus and hydrocortisone in adult atopic dermatitis: an immunohistochemical study

While many studies have demonstrated the efficacy and safety of tacrolimus ointment in the treatment of atopic dermatitis (AD), only a few have investigated the effects of tacrolimus on inflammatory cells and their cytokine gene expression in patients with AD. To characterize further the immunophenotype of infiltrating cells and the production of certain cytokines before and after treatment with topical tacrolimus and hydrocortisone butyrate. Nine adult patients with moderate to severe AD were treated with tacrolimus ointment, while seven control patients were treated with hydrocortisone butyrate ointment. We performed lesional skin biopsies before and after treatment. These were stained immunohistochemically with a panel of monoclonal antibodies including those to CD1a, CD3, CD4, CD8, myeloperoxidase, EG1, EG2, tryptase, interferon-gamma, interleukin (IL)-4, IL-5, IL-12, IL-13, receptors for CXC chemokines (CXCR) 3 and 4, and receptor 3 for CC chemokines. CD3+, CD4+ and CD8+ lymphocytes, and eosinophil and neutrophil granulocytes were significantly reduced in post-treatment tacrolimus specimens, while CD1a+ cells and mast cells were not. The expression of cytokines and chemokine receptors tested, except for CXCR3, was diminished by tacrolimus treatment. Moreover, tacrolimus produced a greater reduction of lymphocytes, eosinophils and most cytokines than that induced by hydrocortisone butyrate. Tacrolimus not only inhibits T-lymphocyte proliferation and cytokine production, but also plays an important role in the IL-12-induced shift from a T-helper (Th) 2 to a Th1 cytokine profile that characterizes the development of chronic AD. Tacrolimus also demonstrates wider pharmacodynamic effects than hydrocortisone.

Expression of adhesion molecules in atopic dermatitis is reduced by tacrolimus, but not by hydrocortisone butyrate: a randomized immunohistochemical study

Topical tacrolimus represents an effective and well-tolerated treatment for atopic dermatitis (AD). Its known effects include reduced production of proinflammatory cytokines and reduced chemokine gradient. We performed lesional skin biopsies on adult patients affected by moderate-to-severe AD. Then, patients were randomized to receive local treatment with tacrolimus ointment 0.1% and hydrocortisone butyrate ointment 1%. On the 21st day of treatment, another skin specimen was taken. Nine patients treated with tacrolimus and seven treated with hydrocortisone successfully concluded the trial. By immunohistochemistry (alkaline phosphatase/antialkaline phosphatase method), we demonstrated that endothelial leucocyte adhesion molecule (ELAM)-1, vascular cell adhesion molecule (VCAM)-1 and intercellular adhesion molecule (ICAM)-1 showed different intensities and patterns of expression in untreated AD lesions. Tacrolimus-treated specimens featured a significant reduction of the expression of ELAM-1, VCAM-1 and ICAM-1, while hydrocortisone-treated lesions did not. Inhibition of adhesion molecule expression may represent another selective mechanism of action of topical tacrolimus in AD.

Skin colonization byStaphylococcus aureusin patients with eczema and atopic dermatitis and relevant combined topical therapy: a double-blind multicentre randomized controlled trial

Staphylococcus aureus has a peculiar ability to colonize the skin of patients with eczema and atopic dermatitis (AD), and is consistently found in eczematous skin lesions in these patients. A correlation between the severity of the eczema and colonization with S. aureus has been demonstrated, and it has been determined that bacterial colonization is an important factor aggravating skin lesions. Patients colonized with S. aureus have been treated with antibiotics in several open and double-blind placebo-controlled studies, with conflicting results. To investigate the colonizing features of S. aureus in the lesional and nonlesional skin of patients with eczema and AD in China and to compare the therapeutic effect of mupirocin plus hydrocortisone butyrate with vehicle ointment plus hydrocortisone butyrate. A multicentre, double-blind randomized trial was conducted. Eczema Area and Severity Index (EASI) scores were evaluated before the start of the trial and on the 7th, 14th and 28th day of treatment. Swabs for bacterial isolation were taken from lesional skin before the start of the trial and on the 7th, 14th and 28th day of treatment, and from nonlesional skin only before the start of the trial. A combination topical therapy with mupirocin plus hydrocortisone butyrate ointment was used in the experimental group, with vehicle ointment plus hydrocortisone butyrate ointment as a control. Of 327 patients enrolled in the study, 208 had eczema and 119 had AD. Bacteria were isolated from 70.2% of lesional and 32.7% of nonlesional skin samples from patients with eczema, of which S. aureus accounted for 47.3% and 27.9%, respectively. Bacteria were isolated from 74.8% of lesional and 34.5% of nonlesional skin samples from patients with AD, of which S. aureus accounted for 79.8% and 80.5%, respectively. The colonization density of S. aureus was markedly higher in lesional than in nonlesional skin, both in patients with eczema and with AD (P < 0.01, P < 0.05), and was positively correlated with lesion severity. Considering the EASI scores before and after treatment and the final effective rate, good therapeutic effects were obtained in both the combination experimental groups and the control groups (P < 0.01), and there were no differences in the global therapeutic effect between the two groups in patients with eczema and with AD (P > 0.05). However, in patients with eczema with a clinical score of > 8 or in patients with AD with a clinical score of > 7, the therapeutic effect in the experimental groups was superior to that in the control groups (P < 0.05) on the 7th day of treatment. There were no differences between the two groups on the 14th and 28th days of treatment (P > 0.05). Following the improvement of symptoms and signs of eczema and AD, the positive rates of bacteria and S. aureus were reduced on the 7th day of treatment. This study confirmed that lesional skin of patients with eczema and AD was more frequently colonized with S. aureus than was nonlesional skin. The more severe the eczema, the higher the colonization rate of S. aureus, and S. aureus was also more often present in lesional and nonlesional skin in patients with AD than in those with eczema. Staphylococcus aureus infection is related to the pathogenesis of eczema and AD. An antibiotic-corticosteroid combination and corticosteroid alone both gave good therapeutic effect in eczema and in AD, and both reduced colonization by S. aureus. Early combined topical therapy is beneficial to patients with moderate to severe eczema and AD, and it is unnecessary to use antibiotics at later stages of disease or in mild eczema or AD.

Tacrolimus ointment does not affect the immediate response to vaccination, the generation of immune memory, or humoral and cell-mediated immunity in children

Background: Concern exists that the prolonged application of immunomodulators to treat atopic dermatitis may cause systemic immunosuppression. Aims: In a 7-month, multicentre, randomised, controlled trial, we investigated the equivalence of...

The Effects of Tacrolimus Ointment on Regulatory T Lymphocytes in Atopic Dermatitis

Only very recently studies were conducted in order to evaluate the impact of regulatory T (Treg) cells in the pathophysiology of atopic dermatitis (AD). Nine adult patients with moderate-to-severe AD in riacutization period of a chronic disease were given tacrolimus ointment, while seven hydrocortisone butyrate ointment, that served as controls. We performed lesional-skin biopsies before and after treatment, that were stained immunohistochemically with monoclonal antibodies to CD4, CD25, forkhead/winged helix transcription factor (FoxP3), interleukin (IL)-10 and transforming growth factor (TGF)-beta. CD4+ cells were significantly reduced in post-treatment series. Tacrolimus treatment achieved a significant reduction of CD25+ cells. FoxP3+ cells were present in untreated AD lesions. Both treatments did not significantly modify the number of FoxP3+ cells. The number of IL-10+ cells increased in post-treatment series. Tacrolimus enhanced the production of TGF-beta, while hydrocortisone did not. Restoration of TGF-beta-producing Treg cells may represent another important pharmacodynamic effect of tacrolimus on AD.