Potent Topical Corticosteroids Research Articles

Treatment Patterns of Atopic Dermatitis Medication in 0-10-Year-Olds: A Nationwide Prescription-Based Study.

IntroductionThe literature on treatment patterns for paediatric atopic dermatitis (AD) is scarce and is rarely based on real-world data. Using national registers, we sought to establish up-to-date, population-based prevalence estimates, predictors of risk and disease burden and a comprehensive overview of treatment patterns and course for paediatric patients with AD.MethodsDispensed prescriptions for the entire Norwegian child population aged 0–10 years from 2014 to 2020 were analysed.ResultsThere were 176,458 paediatric patients with AD. Of these, 99.2% received topical corticosteroids, 5.1% received topical calcineurin inhibitors, 37.1% received potent topical corticosteroids and 2.1% received systemic corticosteroids. Of the 59,335 live births in Norway (2014), 14,385 [24.8%; 95% confidence interval (CI) 24.5–25.1] paediatric patients were treated for AD before the age of 6 years, and of these, only 934 (6.5%; 95% CI 6.1–6.9) received medication annually for 5 years or more. Compared with girls, 17.9% (95% CI 6.5–27.9) more boys were treated for at least 5 years, receiving 6.4% (95% CI 1.2–11.3) more potent topical corticosteroids and 12.4% (95% CI 6.5–18.0) more were treated for skin infections. Compared with patients with late-onset treatment, 18.9% (95% CI 7.5–29.0) more paediatric patients with early-onset treatment were still receiving treatment at 5 years of age, 15.7% (95% CI 7.1–23.4) more paediatric patients received potent topical corticosteroids and 44.4% (95% CI 36.5–51.2) more paediatric patients were treated for skin infections.ConclusionMost paediatric patients were treated for a mild disease for a limited period. Although the prevalence of AD is higher at a younger age, these paediatric patients were the least likely to receive potent topical corticosteroids. Male sex and early-onset AD are associated with and are potential predictors of long-term treatment and treatment of potent topical corticosteroids, antihistamines and skin infections, which may have clinical utility for personalised prognosis, healthcare planning and future AD prevention trials.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00754-6.

For children and adults with eczema, how does potent topical corticosteroid (TCS) compare with mild- or moderate-potency TCS?

For children and adults with eczema, how does potent topical corticosteroid (TCS) compare with mild- or moderate-potency TCS?

Strategies for using topical corticosteroids in children and adults with eczema.

Strategies for using topical corticosteroids in children and adults with eczema.

Prurigo Pigmentosa Induced by the Ketogenic Diet

Prurigo pigmentosa, also called Nagashima disease or "keto-rash", is a rare inflammatory skin condition. The etiology is unknown, but conditions associated with ketosis (fasting, diabetes, postbariatric surgery) often accompany this rash. Clinical case: A 13-year-old patient with no significant pathological history, overweight, on a ketogenic diet, was consulted for maculopapular skin lesions and erythematous plaques, discretely pruritic, persistent, confluent, with centrifugal extension, located at the posterior cervical, axillary, later thoracic, epigastric and lumbar regions. Hematological, biochemical, and immunological investigations were normal. Initial therapy with medium potency topical corticosteroid and anti-H1 antihistamine was ineffective, instead, under treatment with doxycycline and giving up the ketogenic diet, the resolution of the lesions was obtained, residual hyperpigmentation with a reticulated pattern persisting. Conclusions: We present this case to highlight the increasingly common association between prurigo pigmentosa and the ketogenic diet. Dermatologists should identify the relationship between the timing of rash onset and resolution in relation to diet, with a view to early diagnosis and treatment with optimal patient outcomes.

Baricitinib treatment of severe chronic hand eczema: Two case reports

Baricitinib treatment of severe chronic hand eczema: Two case reports

Iatrogenic Cushing syndrome due to topical corticosteroids after skin graft surgery for giant nevus: A case report

Iatrogenic Cushing syndrome (ICS) may be caused by exposure to corticosteroid therapy. We report a case of ICS caused by topical corticosteroids applied to the skin after skin graft surgery. We presume that the development of ICS, in this case, was attributed to a combination of skin barrier disruption, usage of high-potency corticosteroids, broad application area/ large quantity of the corticosteroid, and the extended treatment period. Patients may be at risk for ICS after extensive skin graft surgery if large amounts of very potent topical corticosteroids are applied for an extended period to prevent scar formation or relieve itching.

A Case Report of ChAdOx1 nCoV- 19 Corona Virus Recombinant Vaccine Related Granuloma Annulare

Background: Granuloma annulare (GA) is a benign, self-limiting inflammatory skin condition of unknown origin that may occur following multiple etiological triggers. GA incited secondary to vaccinations has been rarely reported in the medical literature. The COVID-19 pandemic has introduced extensive global immunization against the SARS-COV-2 virus, bringing a gamut of vaccine-related complications. We elucidate a case report of the spontaneous eventuality of GA following ChAdOx1 nCoV-19 Corona Virus Recombinant Vaccine.
 Case Report: A healthy 26-year male presented with a one-week history of asymptomatic single, flesh-pink patch with a raised margin over his left ventral forearm. On close examination, the margin of the lesion had multiple annularly arranged papules. Biopsy of lesion was done, and histopathology revealed numerous palisading granulomas in the dermis consistent with findings of localized GA. The patient was managed with once-daily external application high potent topical corticosteroids, which was used intermittently by the patient. However, the lesion showed spontaneous resolution in one month.
 Conclusion: Identifying ChAdOx1 nCoV- 19 Vaccine-related adverse events following its first dose is paramount, as evidence of the proportion of local or systemic severe cutaneous adverse skin reaction (SCAR) on subsequent dosing is a paucity. A more extensive systematic review corroborating SCARs and safety profile following immunization with ChAdOx1 nCoV-19 Vaccine prevails to be the need of the hour.

Alitretinoin for the treatment of severe chronic eczema of the hands

ABSTRACT Introduction Chronic hand eczema (CHE) is a frequent skin disorder affecting up to 10% of the population and strongly reduces Quality of Life (QoL). The first-line therapeutic strategies for the management of CHE include a change of lifestyle, an education program for the skin and the application of specific emollients. Topical corticosteroids or calcineurin inhibitors are the most used anti-inflammatory drugs. However, up to 65% of patients require systemic options. Alitretinoin, a retinoid structurally related to vitamin A, is the first systemic treatment approved in the European Union (EU) for severe CHE refractory to potent topical corticosteroids. Areas covered This review summarizes the available data on the pharmacokinetics, pharmacodynamics, efficacy, and safety profile of oral alitretinoin for the treatment of CHE. Expert opinion Alitretinoin can be considered as a valid therapeutic option for the treatment of CHE in patients not responding to ordinary treatments. Clinical trials and real-life experiences showed that it acts effectively on both objective and subjective clinical signs, resulting in a significant improvement in QoL of patients. As for other retinoids, caution should be taken in patients with certain chronic diseases (hepatopathies, kidney failure, hyperlipidemia, thyroid dysfunction) or childbearing potential women.

Retrospective analysis of the clinical characteristics and patient-reported outcomes in vulval lichen planus: Results from a single-center study.

Vulval lichen planus (VLP) is a rare, but often chronic, inflammatory disease whose symptoms include genital pain, discomfort, and dyspareunia. The clinical manifestations include erythema, erosions, and scarring. The aim of this study was to longitudinally investigate patient-reported outcomes and clinical findings in patients with VLP. Patients (>18years) with histologically confirmed VLP were included in the retrospective analysis. Patient demographics, clinical features, symptomatology, quality of life, management, clinical outcomes, and comorbidities associated with VLP were analyzed. Twenty-four patients were identified with a mean (standard deviation [SD]) follow-up time of 19.3 (13.8) months. Classical VLP with glazed erythema was found in seven (29.2%) patients, erosive VLP was present in 15 (62.5%) patients, and hypertrophic VLP in two (8.3%). Seven patients had additional cutaneous involvement, while six patients had both vulval and oral mucosal involvement. The labia minora was the most frequently affected anatomical site (83.3%), followed by the clitoris (58.3%). Scarring lesions were found in 62.5% (n=15) of patients. All study participants received treatment with potent and/or superpotent topical corticosteroids but 50% required systemic therapy (acitretin, corticosteroids, or hydroxychloroquine). Five (20.8%) patients underwent surgery due to adhesions and scarring resulting from VLP. One patient was diagnosed with a vulval squamous cell carcinoma during long-term follow-up. The mean (SD) Dermatology Life Quality Index score was 8.4 (5.5) at presentation and 8.9 (6.8) at the end of follow-up. In conclusion, VLP was associated with moderate quality of life impairments which persisted despite treatment, suggesting that current treatments for VLP are inadequate.

Psoriasiform dermatitis during dupilumab treatment for moderate-to-severe atopic dermatitis in children.

Psoriasiform eruptions after initiation of dupilumab have been previously described in adults. This report details the risk of developing or unmasking psoriasiform eruptions after initiation of dupilumab in children. Records of patients ≤18years of age with atopic dermatitis who developed psoriasiform dermatitis during treatment with dupilumab were reviewed retrospectively. Six children, 4-18years of age, on dupilumab for severe atopic dermatitis developed new-onset psoriasiform dermatitis at a median duration of 8months (range, 6-12months) after dupilumab initiation. Typical locations of psoriasis were involved (face, scalp, trunk, and extensor extremities). The majority showed clearance or near clearance with the use of medium-strength to potent topical corticosteroid ointments and 83% continued use of the dupilumab. A 7th patient had psoriasis, in addition to severe atopic dermatitis, and the psoriasis was unmasked by its failure to respond to dupilumab. Although unusual, psoriasiform lesions can appear during effective treatment with dupilumab for atopic dermatitis, potentially reflecting a shift toward cutaneous IL-23/TH 17 pathway activation with dupilumab-induced suppression of type 2 immunity.

Prevalence and Associations of General Practice Registrars' Management of Atopic Dermatitis: A Cross-Sectional Analysis from the Registrar Clinical Encounters in Training Study.

Atopic dermatitis (AD) is a chronic inflammatory condition which imposes substantial burden upon patients and their families. As a frequent primary care presentation, general practice (GP) trainees must develop adequate skills in AD diagnosis and management. We aimed to explore the prevalence and associations of GP registrars' management of patients with AD. This study used data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study of the clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors were independent variables in multivariable logistic regression with outcome factor 'diagnosis/problem being AD'. From 2010-2019, 2,783 registrars (96% response rate) provided data from 381,180 consultations. AD was encountered in 0.6% of consults. AD was more likely to be seen in patients aged 0-1 years and patients from a non-English speaking background. AD was less likely to be seen in Aboriginal or Torres Strait Islander patients. Learning goals were more likely to be generated for AD and these consultations were associated with registrars seeking information or assistance. AD was strongly associated with a medication being prescribed, of which the most prescribed medications were mild or moderate potency topical corticosteroids. Our findings suggest that, similar to other dermatological presentations, registrars find AD challenging to manage. There may be some gaps in AD management knowledge and application.

A Novel Approach to Assess the Potency of Topical Corticosteroids.

The potencies of topical corticosteroid products have mainly been classified using clinical data but in some instances, the US Food and Drug Administration’s (FDA’s) vasoconstrictor assay (VCA) to assess the skin blanching response has also been used. However, the reported skin blanching response data were often based on a single visual reading and lack information on the dose (amount/quantity) or dose duration. Although several lists classifying potencies of various topical corticosteroid products have been published, the inherent potencies of topical corticosteroid raw materials used as active pharmaceutical ingredients (APIs) have not been investigated. The objective was to rank the inherent potencies of topical corticosteroid APIs and to standardize dosing such that the relevant compounds could be compared on a normalized molar basis. The potencies of clobetasol propionate, halcinonide, mometasone furoate, and fluocinolone acetonide were compared using the resulting Emax data following the fitting of the relevant response data to the Emax model where mometasone furoate > fluocinolone acetonide = clobetasol propionate > halcinonide. This ranking lists the respective inherent potencies of the APIs, which will facilitate the choice of a suitable candidate for incorporation into an appropriate topical corticosteroid product for a specific clinical indication.

Severe Topical Corticosteroid Withdrawal Syndrome from Over-the-Counter Steroids

A 34-year-old man suddenly developed an erythematous and exfoliative facial rash. Within days, his skin became intensely pruritic and painful, and the rash spread to his entire body. He also acquired malaise with fever of 39.7°C, necessitating hospitalization. Examination revealed thickened and oozing plaques covering his face; in addition, multiple erythematous papules erupted on his torso and bilateral extremities, but no mucosal erosions (Figure 1). His history was notable for lifelong atopic dermatitis self-treated with hydrocortisone ointment/cream 1% (up to 2.5%) multiple times daily, with use of class III potency topical corticosteroids (TCS) intermittently for flares.

Management of a Unique Presentation of a Common Dermatologic Condition.

CONTEXTSkin rashes are a common complaint seen in the primary care setting. There are many dermatologic conditions which a primary care provider (PCP) should be able to recognize and manage. One such condition is granuloma annulare (GA), which commonly presents as smooth, annular plaques on the trunk and/or extremities. Rashes like GA rarely present as unique variants and may be difficult for PCPs to determine from patient history and physical exam alone. Patch granuloma annulare (patch GA) is an example that may clinically mimic a cutaneous lymphoma known as mycosis fungoides (MF). PCPs should ideally be able to recognize the utility of performing a skin biopsy and/or referring the patient to a dermatologist when history and physical exam alone are insufficient. The histologic findings of skin biopsies often become essential in establishing a proper diagnosis and guiding patient management in unique dermatologic variants.EXAMPLE CASEThe patient in this clinical practice report is a Caucasian female in her late 60s who presented to a dermatology clinic with a two-year history of a worsening widespread eruption on her trunk and extremities. She had been evaluated previously by her PCP about 4 months prior and, without obtaining skin biopsies, treated her with a medium potency topical corticosteroid cream. The eruption had spread over her hips, buttocks, back, thighs, wrists, and elbows. Multiple skin biopsies of affected sites were taken by the second author and revealed findings consistent with patch GA. The patient was started on topical betamethasone dipropionate 0.05% ointment twice daily and noted marked improvement of her symptoms.CONCLUSIONSAlthough GA is a benign condition of the skin that may be readily detected by PCPs, skin biopsies may be necessary to establish a proper diagnosis when this condition presents as a unique variant (e.g., patch GA). Therapy for patch GA often begins with a trial of high-potency topical steroid therapy in combination with ultraviolet light exposure, depending on disease severity and patient preference. Early evaluation with a skin biopsy by her PCP or an earlier referral to a dermatologist to have skin biopsies performed likely would have helped establish a prompter diagnosis and treatment plan for this patient.

26481 Sensory mononeuritis multiplex: A rare sequela of leukocytoclastic vasculitis

A 36-year-old gentleman presented to our dermatology service with a 1-month history of a burning, purpuric rash affecting both lower limbs. He was otherwise fit and well with no other symptoms. On examination, there was a tender, purpuric, and petechial rash present on both distal lower limbs. A biopsy revealed a leukocytoclastic vasculitis with no IgA deposits on direct immunofluorescence. A serum vasculitic screen was negative. The patient’s symptoms improved with the application of a potent topical corticosteroid.

Safety of topical corticosteroids in atopic eczema: an umbrella review

ObjectiveAn umbrella review summarising all safety data from systematic reviews of topical corticosteroids (TCS) in adults and children with atopic eczema.MethodsEmbase, MEDLINE, PubMed, Cochrane Database of Systematic Reviews and the...

Localised childhood vulvar pemphigoid: a rare case study.

In this case report we present a young patient with localised childhood vulvar pemphigoid. It is a rare variant of bullous pemphigoid with mostly a favourable prognosis and prompt response to potent topical corticosteroids. She presented with relapsing vulvar pain and lesions. Our case enlightens the recognition of this unusual subtype and the importance of performing a cutaneous biopsy.

Neutrophil to lymphocyte ratio is predictive of severe complications and mortality in patients with dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid: A retrospective longitudinal observational study

Neutrophil to lymphocyte ratio is predictive of severe complications and mortality in patients with dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid: A retrospective longitudinal observational study

A real world retrospective analysis of comparison of effectiveness and safety of mometasone furoate and fluticasone propionate in the management of eczema and dermatitis

Contact dermatitis is one the commonest dermatological condition which is managed by topical corticosteroids. Mid potent topical corticosteroids are commonly prescribed but there is no any comparative data between mometasone furoate and fluticasone propionate in the management of dermatitis.A real world retrospective study was conducted across India to compare the clinical assessment of mometasone 0.1% cream and fluticasone 0.005% cream in the management of contact dermatitis at 236 dermatology clinics.A data of 1106 patients were included in this analysis in which 598 were included in mometasone group while 508 in fluticasone group. At the end of 2 weeks, 216 patients (36.1%) in mometasone and 129 patients (25.4%) in fluticasone group achieved complete clearance of symptoms (p<0.05). Additionally, in mometasone group, 354 patients (59.2%) were found to achieve improvement whereas 293 patients (57.7%) achieved the same in fluticasone group. On further sub group analysis on aggravating factors, it was found that, mometasone was statistically significant in relieving symptoms of dermatitis due to artificial jewellery, detergent and occlusive foot ware than fluticasone. Moreover, mometasone demonstrated significant results in physician and patient global assessment as well. Patients in both groups tolerated therapy well.Both, mometasone furoate and fluticasone propionate were effective and safe in treatment of eczema/dermatitis. But mometasone furoate had shown significantly better effectiveness as compared to fluticasone in all predisposing factors for the disease.

Evaluation of Topical Corticosteroid Use in Pregnancy and Risk of Newborns Being Small for Gestational Age and Having Low Birth Weight

Topical corticosteroids are frequently used during pregnancy. Limited data have raised concerns about an increased risk of the newborn being small for gestational age (SGA) and having low birth weight, in particular with use of potent to very potent agents during pregnancy. To evaluate whether topical corticosteroid use in pregnancy is associated with increased risks of SGA and low birth weight. From a source cohort of 1.1 million pregnancies with individual-level informed data from various registries, this nationwide cohort study identified topical corticosteroid-exposed pregnancies in Denmark from January 1, 1997, to December 31, 2016, for a total of 60 497, that were matched with 241 986 unexposed pregnancies on the basis of propensity scores, including a wide set of baseline characteristics. Data analysis was performed from September 8, 2020, to February 23, 2021. Filled prescriptions for topical corticosteroids during pregnancy. Primary outcomes were SGA and low birth weight. Association between outcomes and exposure was assessed by relative risk ratios (RRs) and absolute risk differences (ARDs). Among the 60 497 matched pregnancies exposed to topical corticosteroids, 5678 (9.4%) of the delivered infants were born SGA compared with 22 634 infants (9.4%) among the matched unexposed pregnancies (RR, 1.00; 95% CI, 0.98-1.03 and ARD, 0.3; 95% CI, -2.3 to 2.9 per 1000 pregnancies). Low birth weight occurred in 2006 (3.3%) of the exposed pregnancies compared with 8675 (3.6%) of the unexposed pregnancies (RR, 0.92; 95% CI, 0.88-0.97 and ARD, -2.7; 95% CI, -4.3 to -1.1 per 1000 pregnancies). Exposure to potent to very potent topical corticosteroids at any amount was not associated with an increased risk of SGA (RR, 1.03; 95% CI, 0.99-1.07) or low birth weight (RR, 0.94; 95% CI, 0.88-1.00). Post hoc analyses did not find a significant increased risk among those receiving large amounts of potent to very potent topical corticosteroids (ie, >200 g throughout pregnancy) compared with unexposed pregnancies (RR, 1.17; 95% CI, 0.95-1.46 for SGA and RR 1.14; 95% CI, 0.81-1.60 for low birth weight). This large cohort study found no association between topical corticosteroid use in pregnancy and an increased risk of SGA or low birth weight. These results suggest that a moderate to large increase in the risk is unlikely, even when large amounts of potent to very potent topical corticosteroids are used in pregnancy.