Potent Topical Steroids Research Articles

Apremilast − a fairly effective drug to manage palmoplantar psoriasis

Aim To present real world data for the treatment of palmoplantar psoriasis with Apremilast. Objectives To study the efficacy and safety of apremilast in palmo-plantar psoriasis. Background Palmoplantar psoriasis (PPP) is a disabling condition that is refractory to treatment. Apremilast an approved oral PDE4 inhibitor was used as a twice daily dose to treat our patients. Methods 30 patients of PPP were administered apremilast tablets, along with mid potent topical steroids and emollient cream. 23 patients completed the study. Results The primary end point was the assessment of clinical response in patients achieving Palmoplantar Physicians Global Assessment 0/1 (ppPGA) at 16 weeks which was seen in 34.7% patients. Secondary end points were assessed as follows: Change in mean ppPGA from baseline to week 24, ppPGA 0/1 was seen in 48.7% patients, three patients who continued long term therapy maintained ppPGA 0/1 and adverse events (AE) reported during the course of the therapy were seen in 26% of the patients. Conclusions Apremilast is a fairly effective and safe drug for the management of PPP. It is capable of not only inducing clinically meaningful responses but also keeping PPP under control in the long run.

Effectiveness of a treatment algorithm for hemodialysis-associated pruritus in terms of changes in medications

BackgroundHemodialysis-associated pruritus (HAP) is a serious complication that occurs in 60–80% of hemodialysis patients, which not only decreases quality of life but also worsens prognosis. We have developed a treatment algorithm to take a comprehensive cause-specific approach to HAP and used it at our facility since June 2009. In this treatment algorithm, moisturizers and topical steroids are used depending on skin condition and severity of pruritus; administration of nalfurafine hydrochloride is considered in treatment-resistant cases. If pruritus improves, we attempt to taper topical steroids by switching to lower potency or by dose reduction or discontinuation. Here, we examined the effectiveness of the treatment algorithm over 9 years in terms of changes in medications.MethodsSubjects were hemodialysis patients who received treatment for HAP at our facility: 89 in May 2009 before introduction of the algorithm, and 131 in April 2013, 164 in October 2014, 190 in October 2015, 181 in October 2016, 215 in October 2017, and 224 patients in October 2018 after its introduction. A questionnaire survey was conducted on the presence of pruritus, severity (using a visual analogue scale [VAS] and Shiratori severity scores), frequency, and insomnia due to pruritus. Changes in medications were investigated using medical records and compared.ResultsThe proportion of patients with pruritus decreased significantly from 96.6% in 2009 to 66.8% in 2018 (p < 0.001). Median VAS score significantly decreased from 53.0 mm in 2009 to 24.5 mm in 2018 (p < 0.001), and the proportion of patients with insomnia due to pruritus also significantly decreased from 25.8% in 2009 to 2.2% in 2018 (p < 0.001). The proportion of patients who used moisturizers significantly increased from 34.8 to 89.7% (p < 0.001). The proportion of patients receiving topical steroids decreased from 47.2 to 35.7%, but the difference was not significant (p = 0.085).ConclusionsThe treatment algorithm was shown to be useful for improving HAP, but future challenges were identified, including promoting use of lower potency topical steroids or discontinuation. Further prospective studies are required to confirm the role of each treatment intervention in a comprehensive cause-specific approach to HAP.

Erosive pustular dermatosis of the scalp may not be mutually exclusive with other dermatoses

Erosive pustular dermatosis of the scalp is an uncommon neutrophilic process representing a diagnostic and therapeutic challenge. It often occurs in older patients with prior sun exposure and manifests with hyperkeratosis and crust that may be difficult to distinguish from other inflammatory or neoplastic processes. Although erosive pustular dermatosis of the scalp may respond effectively to high potency topical steroids or other antiinflammatory regimens, caution is advised to avoid overlooking differential diagnoses that may not be mutually exclusive, especially squamous cell carcinoma.

Cutaneous toxicities occurring during palbociclib (CDK4/6 inhibitor) and endocrine therapy in patients with advanced breast cancer: a single-centre experience.

Treatment with Palbociclib, a cyclin-dependent kinase 4/6 inhibitor, has demonstrated significantly improved progression-free survival in patients with hormone receptor-positive, HER2-negative, advanced breast cancer, when used in combination with letrozole or fulvestrant endocrine therapies. However, limited information exists on its cutaneous adverse effects (AE). Hence, we conducted a retrospective cohort study to investigate the prevalence and management of cutaneous AE during palbociclib and endocrine therapy. We included 324 adult patients with advanced breast cancer who received palbociclib between March 2016 and August 2020 within a tertiary comprehensive cancer centre. Patient demographics, details of previous and concurrent treatments, as well as treatment-related cutaneous AE were recorded from electronic records. The incidence of treatment-related cutaneous AE was 14.2% (46 from a total of 324 patients). The most frequent cutaneous reactions included maculopapular rash (41%), asteatosis (37%), pruritus and urticaria (20%), and bullous dermatitis reactions (9%). We identified two patients with treatment-induced subacute cutaneous lupus erythematosus, one case of bullous pemphigoid, and a single erythema multiforme. Patients received an average of 9 cycles of treatment, completing an average of 6 cycles before developing cutaneous AE, which persisted for a median of 43days. Only 15% (n = 7) of affected patients required temporary suspension, and 4% (n = 2) required discontinuation. The majority were managed with potent topical steroids, with oral corticosteroids being required in 3 patients, and one patient required hydroxychloroquine. Our study describes both the spectrum of cutaneous AE of palbociclib and endocrine therapy, and approaches to management. Prompt management may limit the negative impact on patients, facilitating beneficial continuation of palbociclib and endocrine therapy.

BOWEN'S BLOWN AWAY! - SUCCESSFUL MANAGEMENT OF BOWEN'S DISEASE BY TOPICAL 5% 5-FU AND CRYOTHERAPY

BACKGROUND: Bowen disease (BD) is a rare, persistent, and progressive form of in situ Squamous Cell Carcinoma characterized by a solitary red, scaly or crusted plaque with potential for malignant change around 8%. Persistent growth usually occurs but partial regressions are not uncommon. Several modalities of treatment are available which show varying results. In our Case Report, we present a 74-year-old male who was diagnosed with Bowen's Disease clinico-pathologically and was treated with cyclical topical 5% 5-FU cream and Cryotherapy using Liquid Nitrogen. CASE DESCRIPTION: A 74-year-old male came to our OPD with complaints of a single, persistent, asymptomatic psoriasiform plaque of size measuring 4x4 cm over his abdomen for 3 years. The plaque was progressively enlarging and showed resistance to topical therapies with salicylic acid, potent topical steroids, and emollients for the past 3 years. A clinical diagnosis of Bowen's Disease was made, and biopsy was done. Histopathological Examination revealed intra-epidermal dysplasia with characteristic 'wind-blown' appearance of keratinocytes in the epidermis. Atypical mitotic gures were seen. Dense lymphocytic inltrate with pigment laden macrophages were seen at DEJ. Patient was started on topical 5% 5-Fluorouracil (5-FU) cream which he applied three nights a week along with Cryotherapy using Liquid Nitrogen (8 sessions of cryotherapy with two 5-10 secs Freeze-Thaw cycles were done at 3 weekly intervals). Biopsy taken at end of 6 months showed a normal epidermis with no evidence of in situ changes. Next evaluation will be after 3 months. CONCLUSION: There are multiple treatment modalities available for BD with no option superior to other. 5% 5-FU is showing increasing effectiveness (up to 96.2%) especially when combined with other treatment options such as cryotherapy which on its own showed great clearance rates (greater than 90%) depending on the duration of freeze-thaw cycles. Main advantage of this combination is its ease of application, low cost and non-invasiveness.

Potent Topical Steroids Are Associated with Osteoporosis and Fractures

Prolonged use of potent topical corticosteroids can have systemic effects — for example, suppression of the hypothalamic-pituitary axis. But whether

Iatrogenic Cushing's Syndrome in Patients with Superficial Dermatophytosis.

Background:The epidemic-like scenario of superficial fungal infections in India has been complicated by the prescription of systemic and topical potent steroids. As a result, alarming number of patients are presenting with exogenous Cushing's syndrome.Methods:This cross-sectional study involved 23 patients of superficial dermatophytosis on steroids who presented with clinical features like that of Cushing's syndrome. Their clinical details and laboratory investigations including fungal culture and serum cortisol, were recorded on a pre-designed proforma.Results:There were 23 patients (14 males and 9 females) with mean age of 29.47 ± 15.5 years, majority with extensive tinea cruris and corporis. All of them received oral (Betamethasone) or parenteral corticosteroids along with potent topical steroids (clobetasol propionate and betamethasone valerate) for at least two months. In majority (56.5%), treatment was prescribed by unqualified medical practitioners and in the rest by alternative medical practitioners. Striae, buffalo hump, hirsutism were observed in 16 (69.5%), 15 (65.2%), 13 (56.5%) patients, respectively. Serum cortisol estimation revealed low levels and ranged from 0.66 to 6 μg/ml with a mean of 1.53 ± 1.27 μg/ml (normal 7-25 μg/ml).Conclusions:Corticosteroids are life saving for many dermatological diseases; their injudicious use (topical, oral, and parenteral) for prolonged periods in the treatment of superficial dermatophytosis can lead to Cushing's syndrome.

Dupilumab Injection in the Management of Steroid-Induced Rosacea: A New Case Report

Background: Topical corticosteroids (TCS) are used frequently for various inflammatory skin conditions. The prolonged daily and inappropriate use of TCS may cause adverse effects such as erythema, atrophy, and telangiectasia. Steroid rosacea or addiction is a distinct adverse effect of inappropriate use of TCS. It occurs most commonly in adult women applying mid- or high-potency TCS to the face. Dupilumab is an interleukin 4 (IL-4) receptor α-antagonist approved for treatment Moderate-to-Severe Atopic Dermatitis in childhoods and adults. The role of dupilumab injection in steroid-induced rosacea management is rarely discussed. Aim: To document a new case presentation of atopic dermatitis on high potency topical facial steroid addiction for a duration of 4 years in a young female patient who was successful treated with dupilumab injection and withdrawal therapy. Case Report: A 32-year-old female patient with a history of atopic dermatitis presented with a history of worsening pruritic facial rashes for a one-month duration and on high potency TCS (Clobetasol Propionate ointment 0.05%) since 4 years ago with multiple treatments failure of steroidal withdrawal treated successfully in combination with dupilumab injection. Conclusion: Dupilumab injection considers effective and inducing rapid resolution of signs and symptoms of steroid-induced rosacea in patients with a history of atopic dermatitis in combination with withdrawal therapy without a rebound effect.

Effect of corticosteroid ointment on radiation induced dermatitis in head and neck cancer patients: A prospective study.

Almost all the patients receiving curative radiotherapy for head and neck cancer develop radiation dermatitis, which many a times leads to treatment interruption and reduce patient compliance. In this study, we evaluated the effect of potent topical steroid (Betamethasone Valerate 0.1%) cream on acute radiation dermatitis in head and neck cancer patients receiving curative radiotherapy. A total 106 patients of head and neck cancers were randomly divided into arm A (52 patients) and arm B (54 patients). The patient in study arm A were treated with topical betamethasone 0.1% twice daily during radiotherapy/chemo-radiotherapy and arm B was kept as control. The radiation reaction in both the groups was monitored weekly according to Radiation Therapy Oncology Group (RTOG) acute radiation dermatitis grading. Out of 106 patients, 85 (80.2%) patients completed treatment. Patient in control arm had earlier onset of grade 1 reaction (5.7% in arm A vs 16.7 % in arm B at 2nd week, P value 0.157 and 28.8% in arm A vs 50% in arm B at 3rd week, P value 0.028) and progression of radiation dermatitis. In 7th week patient in arm A had higher grade 1 reaction (17.3% in arm A vs 0% in arm B), while arm B had higher grade 2 reaction (66.7% arm B vs 55.8% in arm A). There was no difference in incidence of grade 3 and 4 reaction. No difference was observed in time taken for reaction to heal. Topical Betamethasone can delay the onset and progression of radiation dermatitis in head and neck cancer, without significant delay in wound healing.

17156 Psoriasis improvement and satisfaction in patients using a clobetasol spray and oral apremilast combination regimen: A pilot study

Background: Psoriasis vulgaris is a common chronic inflammatory skin disease that significantly impacts patients’ quality of life. Approximately 30% of patients with moderate to severe psoriasis achieve PASI 75 reduction at 16 weeks after utilizing oral apremilast. Clobetasol, a potent topical steroid, is effective at achieving rapid PASI 75 reduction at 4 weeks but is not a long-term option because of its potential to cause skin atrophy and adrenal suppression. This study investigated whether an initial 6-week tapering regimen of clobetasol spray could improve PASI 75 and sPGA response at 16 weeks in patients with moderate to severe psoriasis who initiate apremilast.

Brunsting-Perry pemphigoid: A retrospective case series of a frequently unrecognized condition

Brunsting-Perry pemphigoid: A retrospective case series of a frequently unrecognized condition

A Case Study to Evaluate the Treatment of Shwitra with Ayurveda Modalities

In Ayurveda all the skin diseases are explained under the term Kushtha. The references of shwitra are found in almost all the Samhitas like Bruhatrayees and Laghutrayees. In shwitra disease the white patch is seen and considering these symptom it can be compared to vitiligo. Vitiligo is characterized clinically by the development of areas of depigmentation. These are often symmetrical and occur mainly on extensor surfaces. This hypopigmentation results due to destruction of melanocytes, which may be unknown in origin or due to autoimmune endocrinopathies selective IgA deficiency. In contemporary science treatment of vitiligo is not very effective. Potent topical steroids and tacrolimus is used which produces harm to skin on continuous use. So the effective medicines are expected from Alternative sciences. To evaluates the role of Ayurveda treatment modalities in shwitra. A female patient, aged 15 year suffering from white patch below the left eye since 3year was treated with both Shodhan and Shaman Chikitsa for a period to 5 months with follow up at every 15 days in between, Relief from the complaints was assessed by noting the changes in the size of patch. After 5 months of treatment the size of patch was reduced. The present case study revealed the efficacy of Ayurveda therapy both internal and external for duration of 5 months in the management of shwitra.

Current and Future Monoclonal Antibodies in the Treatment of Atopic Dermatitis.

Atopic dermatitis is a common immunologic skin disease. Mild atopic dermatitis can be managed with emollients and topical therapies such as low potency topical steroids, which have a favorable safety profile. Severe atopic dermatitis, in contrast, is a challenging disease to treat. Topical therapies are typically inadequate for control of severe atopic dermatitis. When topical therapies fail, the mainstay of therapy for severe atopic dermatitis has traditionally been phototherapy or off-label use of systemic immunosuppressant treatment, yet systemic immunosuppressants all have significant potential toxicities, drug interactions, and contraindications, requiring close monitoring. Targeted biologics are therefore attractive treatment options for topical therapy-refractory cases of atopic dermatitis, with the potential to offer effective, safer treatment of uncontrolled atopic dermatitis. Dupilumab, as the only biologic therapy currently FDA-approved for atopic dermatitis, is effective for many patients, but there is need for continuing study of additional biologic therapies to address the needs of diverse patients with uncontrolled atopic dermatitis.

Management of immune checkpoint inhibitor–induced bullous pemphigoid

Management of immune checkpoint inhibitor–induced bullous pemphigoid

Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Topical steroid-modified tinea corporis and tinea cruris is on the rise due to the ease of availability of over-the-counter potent topical corticosteroid preparations and their inappropriate use, alters the true morphology of lesion. As there is paucity of literature about increasing prevalence and varied presentation of this condition, we aimed to study the clinical profile and dermoscopic features of &lt;em&gt;Tinea pseudoimbricata&lt;/em&gt; due to topical steroid abuse. We present a case-series of 77 cases of a distinct morphological pattern with central erythematous, scaly, pruritic concentrically spreading plaques with raised and scaly borders known as &lt;em&gt;Tinea pseudoimbricata&lt;/em&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We evaluated 77 clinically diagnosed patients of &lt;em&gt;Tinea pseudoimbricata&lt;/em&gt; with positive 10% potassium hydroxide examination and culture. Dermoscopy was performed in all patients. The demographic, clinical, and mycological features of each patient were recorded on a predesigned proforma.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 52 male and 25 female patients with a mean age of 28.66 and a mean disease duration of 7.6 months. There was a history of application of potent or super-potent topical steroid for varying durations. Culture isolates were &lt;em&gt;Trichophyton rubrum&lt;/em&gt; species. Dermoscopic analysis showed features of steroid abuse.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Injudicious and inappropriate use of topical steroid causes &lt;em&gt;Tinea pseudoimbricata&lt;/em&gt;; a special subset of tinea incognito, which is very common now a days. This should alert the dermatologist about the steroid abuse and requires systemic anti-fungal treatment for prolong time.&lt;/p&gt;

Positive nikolsky sign and “pinpoint lake of pus” in acute generalized exanthematous pustulosis: a case report

Introduction: Acute generalized exanthematous pustulosis (AGEP) is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base and spontaneous resolution usually within two weeks. Current report aims to present management of AGEP in our center at Singaraja Regional Hospital, Bali-Indonesia.Case: A 78 years old woman with a history of acute coronary syndrome, was reported to have a severe allergic drug reaction. Patients reported taking cefixime medication for the past 2 days because of acute bronchitis. The patient was hospitalized because of the complaint, and diffuse miliary pustules were found above the base of erythematous skin. On examination of lesions, the Nikolsky sign was positive on lesions in the back and abdomen without any tenderness. Histopathological examination was suitable for the diagnosis of acute generalized exanthema pustulosis (AGEP). Systemic intravenous corticosteroid with oral antihistamines was choosen as a primary treatment for this patient.Conclusion: Treatment is based on the removal of the causative drug, supportive care, infection prevention and use of potent topical or systemic steroids

Treatment of erosive pustular dermatosis: a systematic review of the literature.

Erosive pustular dermatosis (EPD) is a rare chronic inflammatory condition of the scalp and legs that is often difficult to manage. Currently, there are no treatment guidelines. To systematically assess the existing literature on various treatment modalities and their efficacies when used in the management of EPD. We searched PubMed, Cochrane Libraries, Scopus, and clicnialtrial.gov databases for articles in the English language with no limited time frame. Emphasis was placed on articles that reported on treatment for EPD. Of the 168 articles identified by the literature search, 92 met eligibility criteria and were included for qualitative analysis. Efficacious topical treatments included clobetasol, betamethasone, and tacrolimus. Ninety-three and 88% of cases utilizing clobetasol and betamethasone respectively demonstrated improvement or resolution. All 32 cases utilizing tacrolimus reported improvement. Efficacious systemic treatments included oral steroids such as prednisone, methylprednisolone, and dexamethasone. Topical dapsone, photodynamic therapy, systemic steroids, cyclosporine, and oral zinc derivatives were also described with some success. According to available data, limited solely to case reports and case series, potent topical steroids are an effective treatment option for EPD. Topical tacrolimus may also be considered in cases that require long-term use or maintenance. Other treatment modalities shown to be successful based on high reported efficacy and low rates of recurrence after treatment include topical dapsone, systemic steroids, zinc derivatives, and cyclosporine. Further studies are needed to compare treatment modalities and to establish treatment protocols.

Bullous lichen planus-like reactions in a patient with renal cancer after receiving anti-programmed cell death-1 therapy

Anti-programmed cell death 1 (anti-PD-1) agent is a promise in cancer immunotherapy for various advanced malignancies, but dermatologic toxicities are common during therapy. We report one advanced transitional cell carcinoma patient who developed multiple bullous skin lesions over bilateral lower extremities after anti-PD-1 antibody pembrolizumab treatment. Skin biopsy revealed subepidermal cleft, wedge-shaped hypergranulosis, saw-tooth acanthosis, and presence of interface band-like lymphohistiocytic infiltrate compatible with bullous lichen planus-like reactions. Potent topical steroid and temporary cessation of pembrolizumab relieved the skin eruptions. Early recognition and appropriate management of rare bullous dermatologic toxicities are critical in patients receiving immune checkpoint blockade therapy.

Safe and effective use of alitretinoin in children with recalcitrant hand eczema and other dermatoses - a retrospective analysis.

Alitretinoin is a systemic retinoid licensed for use in adult patients suffering from chronic hand eczema recalcitrant to potent topical steroids. Experience with its use in childhood is lacking. To report on the efficacy and safety of alitretinoin treatment in a cohort of children and adolescents with chronic hand eczema (CHE) and other inflammatory skin diseases. We performed a retrospective chart review of all consecutive patients under the age of 18years treated with alitretinoin at our paediatric skin centre. Physician's Global Assessment (PGA) was used as the primary outcome measure. Thirteen children (9 girls and 4 boys) were enrolled in this study. The median age at start of treatment with alitretinoin was 11.5years (range 5.8-15.8years). Nine children were diagnosed with CHE, two with severe atopic dermatitis (AD), and two with inherited ichthyosis [netherton syndrome (NS), autosomal recessive congenital ichthyosis (ARCI)]. Moderate to excellent response (PGA decrease of ≥1 point) was observed in 7 (78%) of the nine patients with CHE, one of the two patients with extensive AD and in the one patient with ARCI. In the remaining four subjects, no convincing effect was documented. Tolerability was overall very good. The most common adverse event was headache in 10 patients (77%) during the initiation of treatment, leading to interruption of therapy in one subject. Alitretinoin seems to be highly effective and safe for the treatment of paediatric CHE and should thus be considered in children with refractory disease under topical therapy. Larger studies are required to corroborate these findings.

A comparative study of the outcomes of potent topical steroids versus topical tretinoin in patchy alopecia areata of scalp

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Alopecia areata (AA) is a common condition causing patchy alopecia of scalp. It can follow an unpredictable course with spontaneous exacerbations and remissions. Various therapeutic options have been tried to alleviate the cosmetic concern of the patient. The objective of this study is to compare the efficacy and safety of potent topical steroid versus topical 0.05% tretinoin in limited patchy alopecia areata of scalp.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this study 50 patients of age group above 5 years and of both sexes having localized alopecia areata of scalp (&amp;lt;5 patches and &amp;lt;25% scalp involvement) were included in the study after taking an informed consent. It was a randomized prospective study done for a period of 12 weeks. Excluding the age and sex bias, patients were distributed into two treatment groups A and B. Group A was treated with 0.05% betamethasone dipropionate (BMD) cream applied twice daily. Group B was treated with topical 0.05% tretinoin cream applied twice daily. The response was assessed in every patient subjectively as well as objectively by alopecia grading scale and regrowth score (RGS) at the end of 12 weeks.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; We found that 72% of patients in Group A showed statistically significant clinical improvement (RGS 3 and 4) when compared to 36% patients in Group B.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; It can be concluded that 0.05% BMD is still the most effective and economical topical treatment in less extensive forms of AA. However topical 0.05% tretinoin also gives a fairly good response. But further studies with tretinoin are needed to establish its role in limited alopecia areata.&lt;/p&gt;