Oral Topical Corticosteroids Research Articles

Diagnosis and Treatment of Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. The diagnostic criteria for EoE have changed with our growing knowledge over the past two decades. Esophageal eosinophilia, which responds histologically to a proton pump inhibitor (PPI) is not a distinct disease but a subset of EoE. An endoscopic scoring system that relies on the assessment of exudates, rings, edema, furrows, and strictures is a useful tool for assessing endoscopic severity. PPIs are regarded as safe and effective first-line treatments for EoE. Oral topical corticosteroids or dietary therapy are also options for first-line treatment. Endoscopic dilation is effective for relieving the dysphagia symptoms of a patient with an esophageal stricture.

The role of diet in the treatment of eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a chronic immuno- or antigen-mediated condition leading to eosinophilic inflammation of the esophagus. As a result, esophageal dysfunction develops, presenting in adults mainly with dysphagia and heartburn. In children, the main symptoms are abdominal pain, refractory reflux complaints, nausea and vomiting. Treatment with oral topical corticosteroids and proton-pump inhibitors are well-established therapeutic tools. Dietary restrictions have a proven beneficial effect on clinical symptoms. Elimination diets are not without risk and can impact nutritional status, eating pleasure and quality of life. With adequate selection and balance, dietary therapy can be effective and the adverse effects on lifestyle can be minimized. The review presents a brief overview of the possibilities and guidance for dietary therapy of this increasingly recognizable disease.

HPA‐suppressive effects of aqueous clobetasol propionate in the treatment of patients with oral lichen planus

Oral topical corticosteroids have potential to produce inhibition of the hypothalamus-pituitary-adrenal (HPA) axis. To assess whether clobetasol propionate (CP) in aqueous solution causes HPA inhibition. Sixty-two patients with oral lichen planus or oral lichenoid lesions presenting with severe lesions were treated with topical oral 0.05% CP plus 100,000 IU/cm(3) nystatin in aqueous solution. Initial treatment of three 5-min mouthwashes (10 mL) daily was reduced, when the response was deemed complete or excellent, to a maintenance treatment of one 5-min mouthwash on alternate days for 6 months; treatment was then withdrawn and patients were followed up for 1 year. HPA function was assessed by plasma cortisol measurement and adrenocorticotropin (ACTH) stimulation at the end of the initial and maintenance treatment regimens. The HPA axis was more frequently inhibited during initial (53/62; 85.5%) vs. maintenance (2/49; 4%) regimens of aqueous CP. In patients with morning plasma cortisol levels between 3 and 18 microg/dL, a normal result for the ACTH stimulation test only moderately reduces the possibility that a patient has secondary adrenal insufficiency. This can be considered a minor limitation in our study, as only three patients required additional assessment with the ACTH stimulation test. Hypothalamus-pituitary-adrenal inhibition is substantial during initial treatment with aqueous CP three times daily.