Short-term Systemic Corticosteroids Research Articles

Urticaria: Etiology, pathogenesis, diagnosis, and treatment

Urticaria is the most common skin disease, it may be chronic or acute. Infections, medicines, psychogenic factors, food, and respiratory allergens such factors are accused of etiology. But sometimes it may be idiopathic. H1 antihistamines and short-term systemic corticosteroids are taken for the treatment. H2 antagonists may be preferred during resistant cases. Cyclosporine, omalizumab, and leukotriene receptor antagonists are other treatment options considered during missed events.

Clinical efficacy analysis of 110 cases of childhood vitiligo with non-surgical combined therapy

Background Vitiligo has a negative effect on children’s physical and psychological health. Few studies have examined long-term treatment efficacy for childhood vitiligo. Therefore, we evaluated the long-term effectiveness of non-surgical combination therapy in pediatric patients with vitiligo and analyzed factors that affect its efficacy. Methods Pediatric patients (⩽12 years) with vitiligo who were treated with topical corticosteroids/topical calcineurin inhibitors and phototherapy for 12 months were retrospectively studied. Short-term systemic corticosteroids were administered according to individual clinical conditions. All lesions were photographed to assess repigmentation at 3-month intervals. Clinical data, the treatment effectiveness, and factors affecting the therapeutic effect were analyzed. Results Overall, 110 children (51 [53.6%] girls; mean [SD] age, 7.1 ± 3.0 years; 104 [94.5%] with activity status) were treated for a mean period of 23.13 ± 14.03 months (range, 5–86 months). The overall >50% repigmentation rate was 64.5%. A longer duration of treatment was associated with a higher repigmentation rate (X 2 trend = 36.229, P < .001). The vitiligo disease activity score at the first visit was positively correlated with the overall repigmentation rate (rs = 0.301, P = .001). Conclusions Treatment lasting longer than 1 year is recommended in children with vitiligo. The best repigmentation effect can be achieved by combination therapy in the rapid progression stage.

Understanding urticaria, and their management: An appraisal

Urticaria, or hives, is a common skin and mucous membrane illness characterized by erythematous, edematous, irritating, and transitory plaques. It affects roughly 20% of people at some point in their lives. It can produce substantial discomfort, last for months to years, and seldom reflect a major systemic disease or life-threatening allergic reaction, despite being self-limited and benign. In the Unani system of medicine urticaria is labeled as Shara, Avicenna, defined that Shara is a Damwi (sanguineous) disease usually but it may also be due to Safravi Khoon (bilious blood) or Balgham Boraqi (acidic phlegm). Urticaria is induced by the release of histamine and other inflammatory mediators from mast cells and basophils mediated by immunoglobulin E and non-immunoglobulin E. Anaphylaxis must be ruled out before a diagnosis can be made. In 80 percent to 90 percent of instances, chronic urticaria is idiopathic. Treatment with H1 antihistamines and, in certain circumstances, short-term systemic corticosteroids is favored; H2 antagonists may be added in refractory cases, however additional treatment options, including omalizumab, cyclosporine, and leukotriene receptor antagonists, may be examined during missed occurrences. Unani Medicine has its own framework for treating patients based on treatment principles which include; Ilja Bil Ghiza, Ilaj Bit Tadbeer, and Ilaj Bil Dawa.

Protecting medical staff from skin injury/disease caused by personal protective equipment during epidemic period of COVID-19: experience from China.

Linked articles: COVID‐19 SPECIAL FORUM. J Eur Acad Dermatol Venereol 2020; 34: e210–e216.

Efficacy of Short-Term Systemic Corticosteroid Therapy in Chronic Rhinosinusitis With Nasal Polyps: A Meta-Analysis of Randomized Controlled Trials and Systematic Review.

BackgroundCorticosteroids are considered the most effective medication to control chronic rhinosinusitis with nasal polyps (CRSwNP); however, the studies of systemic corticosteroids in this field are relatively few and meta-analyses are lacking.ObjectiveWe aimed to systematically review the efficacy and safety of systemic corticosteroids for patients with CRSwNP via meta-analysis.MethodsData were extracted from relevant and appropriate randomized controlled trials (RCTs) of systemic corticosteroids for patients with CRSwNP from PubMed, MEDLINE, Ovid, Embase, the Cochrane Central Register of Controlled Trials, and Google Scholar. Efficacy was assessed based on clinical outcomes, while safety was assessed based on adverse events (AEs).ResultsA total of 337 relevant publications were identified, of which 7 RCTs including 414 participants were included in the meta-analysis. Compared to placebos or nonsteroid treatments, systemic corticosteroids significantly improved nasal obstruction scores standardized mean difference (SMD −2.81; 95% confidence interval [CI], −4.68 to −0.95; P = .003), reduced the nasal polyp size (SMD −4.76; 95% CI, −6.99 to −2.52; P &lt; .0001), and improved peak nasal inspiratory flow (PNIF) (SMD 42.39; 95% CI, 28.95 to 55.84; P &lt; .00001). The high-dose (more than or equal to 50 mg/day prednisone) and low-dose subgroups (less than 50 mg/day prednisone) experienced similar benefits. However, insomnia and gastrointestinal disturbances were noted more frequently in patients treated with high doses of prednisone. Other AEs were infrequent and were not significantly different between the subgroups.ConclusionSystemic corticosteroids provide significant improvements in nasal symptoms and PNIF as well as a reduction in nasal polyp size for patients with CRSwNP. Prednisone doses less than 50 mg/day were recommended when the efficacy of oral corticosteroids in CRSwNP was balanced against potential adverse effects.

The management and genetic background of pityriasis rubra pilaris: a single‐centre experience

Pityriasis rubra pilaris (PRP) is a rare chronic inflammatory dermatosis with multifactorial aetiology. It is known that particular caspase recruitment domain family member 14 (CARD14) gene mutations are associated with familial PRP and certain forms of psoriasis. Additionally, few data are available about the role of CARD14 gene variants in sporadic PRP. The clinical picture is variable for the different types of PRP, therefore choosing the adequate treatment is often difficult, furthermore there are no specific guidelines for therapy. Our aim was to survey the efficacy of the applied therapies and to screen the CARD14 gene variants in our PRP patients. In this retrospective study, patients diagnosed with PRP between 2006 and 2016 at our clinic were involved. Besides the follow-up study of the treatments, the genetic analysis of CARD14 gene was performed. We analysed 19 patients, among whom 17 were diagnosed with type I, one with type III, and one with type V PRP. The majority of the patients were successfully treated with acitretin in combination with systemic corticosteroids, and the remaining patients were treated with other systemic therapies with diverse effects. The genetic screening of CARD14 gene revealed two previously described mutations (rs114688446, rs117918077) and six polymorphisms (rs28674001, rs2066964, rs34367357, rs11653893, rs11652075, rs2289541). Ten of 19 patients carried different CARD14 genetic variants either alone or in combination. Based on our experience, we propose that acitretin and an initial combination of short-term systemic corticosteroid therapy could be a successful treatment option for PRP. Although we identified several CARD14 variants in almost half of our cases, we did not find a correlation between the therapeutic response and the genetic background. Our data support the previous observation that CARD14 genetic variants are not specific to PRP, although they may indicate chronic inflammation.

Current and emerging therapies for hand eczema.

Although hand eczema (HE) and chronic hand eczema (CHE) are common conditions with significant disease burden, they traditionally have had limited treatment options beyond topical and short-term systemic corticosteroids. We reviewed published and preliminary evidence on the current and emerging topical and systemic therapeutic agents for HE and CHE. The etiologies of various HE subtypes are discussed, and remaining knowledge and practice gaps are highlighted to encourage further investigations. A comprehensive search of ClinicalTrials.gov and PubMed was completed for clinical trials that utilized known and emerging treatment options for HE and CHE. Several agents that target IL-4 and IL-13 signaling, keratinocyte proliferation, inflammatory cytokine production, bacterial protein synthesis, and inflammatory mediator (TNF-α, JAK1, JAK2, and JAK3) proliferation are shown to be involved in the pathogenesis of CHE. Systemic agents include dupilumab, alitretinoin, acitretin, cyclosporine, azathioprine, and probiotics. Topical agents include delgocitinib, retapamulin, halometasone/triclosan, calcipotriol/betamethasone, tacrolimus, and pimecrolimus. These modalities have demonstrated varying degrees of clinical efficacy, evaluated by subjective assessments and scoring indexes. Targeted therapies are emerging for HE, but options are still limited, partially due to our narrow understanding of this heterogeneous condition. Additional and targeted therapeutic options are needed to match the rising prevalence and burden of HE. KEYPOINTS: Hand eczema (HE) is a heterogenous dermatosis with limited therapeutic options due to a lack of international guidelines regarding classification of HE subtypes and treatment. This review discusses current and emerging topical and systemic agents and their efficacies in the treatment of different types of hand eczema.

Diagnosis and treatment of urticaria in primary care.

Urticaria, also known as hives among people, is a very common disease characterized by erythematous, edematous, itchy, and transient plaques that involve skin and mucous membranes. It is classified as acute spontaneous urticaria, chronic spontaneous urticaria, chronic inducible urticaria, and episodic chronic urticaria. Many factors such as infections, medicines, food, psychogenic factors, and respiratory allergens are accused of etiology, but sometimes, it is idiopathic. Clinical presentation involves red, swelling, and itchy plaques. The lesions usually resolve spontaneously within 2–3 h without a trace. The patients are sometimes confronted with an angioedema that can also involve the respiratory tract. In this case mucous membranes, such as eyelids, lips, swell with some pain and burning sensation. If respiratory tracts are involved, it may be life threatening and should be treated urgently. The diagnosis is usually straightforward, urticarial vasculitis, drug eruptions, viral eruptions, and urticaria pigmentosa must also be considered. H1 antihistamines and, sometimes, short-term systemic corticosteroids are preferred for the treatment; H2 antagonists may be added during resistant cases, although other treatment options, such as omalizumab, cyclosporine, and leukotriene receptor antagonists, may be considered during missed events.

Combination therapy with 308-nm excimer laser, topical tacrolimus, and short-term systemic corticosteroids for segmental vitiligo: A retrospective study of 159 patients

Segmental vitiligo (SV) is characterized by a unilateral and localized distribution, early onset, and stable disease after rapid progression. And SV is often associated with poor response to various treatment modalities. We sought to evaluate the effectiveness of combination therapy with 308-nm excimer laser, topical tacrolimus, and short-term systemic corticosteroids for SV, and to search for factors associated with the treatment response. A retrospective interventional case-series study was performed on 159 patients with SV who were treated with the combination therapy for more than 3 months. The rate of 75% or more repigmentation was 50.3% after a median treatment duration of 12.1 months; 36.5% and 13.8% of the patients showed nearly complete (75%-99%) and complete (100%) repigmentation, respectively. Multivariable analysis showed the following to be independent factors withpoor response: disease duration longer than 12 months (odds ratio 0.372, 95% confidence interval 0.157-0.882, P= .025), poliosis (odds ratio 0.494, 95% confidence interval 0.247-0.988, P= .046), and plurisegmental subtype (odds ratio 0.175, 95% confidence interval 0.065-0.474, P= .001). This was a retrospective study. The combination therapy is effective for SV. Prolonged disease duration, poliosis, and plurisegmental subtype were shown to be independent prognostic factors of poor response in patients with SV.

The clinical spectrum of reactions developed based on paraphenylenediamine hypersensitivity two pediatric cases.

The clinical spectrum of reactions developed based on paraphenylenediamine hypersensitivity two pediatric cases.

Efficacy of Corticosteroids after Orthognathic Surgery

Steroids are used in post-operative pain, swelling, trismus, nausea, vomiting and reduction of inflammatory reaction after orthognathic surgery. The use of short term systemic corticosteroid therapy has become common after oral and maxillofacial surgery, especially orthognathic surgery. The most commonly administered types of corticosteroids are betamethasone, dexamethasone, and methylprednisolone, administered intravenously, orally or by injection into the masseter muscle. This article gives a review of the efficacy of corticosteroids after orthognathic surgery.

Evidence for Methotrexate as a Useful Treatment for Steroid-dependent Chronic Urticaria

Chronic urticaria is a relatively common disorder that can be severe and may impair quality of life. The management of recalcitrant chronic urticaria that is not responding to histamine antagonists includes short-term systemic corticosteroids, anti-inflammatory drugs (colchicine, dapsone and sulfasalazine) and immunomodulatory agents, such as cyclosporine, methotrexate, plasmapheresis and intravenous immunoglobulin. We report here our retrospective experience with the use of methotrexate in 8 patients (2 males and 6 females) with recalcitrant chronic urticaria who were not responding to high-dose first- and second-generation antihistamines. The mean duration of the disease prior to methotrexate treatment was 12 ± 8 months. Patients were treated for a mean duration of 4.5 months with a mean dose of 15 mg methotrexate/week. A complete response was achieved in 7 out of 8 patients (87%). Five out of the 7 patients were disease-free during a period of 1-10 months follow-up after discontinuing methotrexate and prednisone therapy. No serious adverse effects were reported. Methotrexate is an effective and safe treatment for chronic urticaria in patients who are not responsive to conventional therapy.

A Case of Incontinentia Pigmenti Treated with Short-term Systemic Corticosteroid

A Case of Incontinentia Pigmenti Treated with Short-term Systemic Corticosteroid

Effects of short‐term treatment with systemic prednisone on bone healing: an experimental study in rats

Long-term systemic use of corticosteroids causes osteoporosis and increased risk of fracture. However, the effect of short-term use of corticosteroids on bone healing is not well defined. The aim of the present study was to test the influence of short-term systemic corticosteroid therapy on bone healing. Standardized bone defects (2 mm diameter) were formed in the middle of the femur in 40 male rats. Rats were divided into two groups; control group (n = 20) and prednisone-treated group (n = 20). Subcutaneous injection of either sterile normal saline (control) or 0.020 mg kg(-1) dose of prednisone was administered just before surgery and thereafter daily for 3 days. Histopathological cross sections were taken 1, 2, 3 and 4 weeks after surgery. There was no statistically significant difference between the prednisone group and the control group. No inhibitory effects were seen following short-term corticosteroid treatment.

Is there a role for systemic corticosteroids in the management of stable chronic obstructive pulmonary disease?

COPD, encompassing both chronic bronchitis and emphysema, usually results from exposure to tobacco smoke. Smoking causes infiltration of the airways with leukocytes, an imbalance between proteases and their naturally occurring inhibitors and local cytokine secretion in the lung, which leads to airway inflammation and alveolar destruction. Corticosteroids have a range of anti-inflammatory actions, particularly inhibition of cytokine secretion, which suggests that they may be effective in COPD. However, data from the highest quality studies available do not show any evidence of significant improvement in symptoms of patients with COPD treated with systemic corticosteroids.A meta-analysis found that about 10% of patients with stable COPD showed an improvement in lung function following treatment with short-term systemic corticosteroids compared with placebo. Exercise capacity in patients with COPD was evaluated in four studies, only one of which found a significant improvement with oral corticosteroids compared with placebo. Long-term systemic corticosteroid treatment in patients with stable COPD has not been found to alter the rate of decline in FEV(1). Although systemic corticosteroids are associated with a range of adverse effects, the data do not allow precise quantification of their contribution to morbidity. However, studies show an increased risk of osteoporosis in COPD. Recent studies have also found an association between oral corticosteroid administration and mortality in patients with stable COPD, but it is not clear if this is a cause and effect relationship. Current data do not support long-term administration of systemic corticosteroids to all patients with stable COPD. Results of studies suggest that short-term oral corticosteroid administration may identify a sub-population of patients with COPD who may benefit through a reduction in the decline in FEV(1) and better control of symptoms by long-term administration of inhaled corticosteroids; these findings need to be tested by further research.

Topical corticosteroids in nasal polyposis.

Nasal polyps are the common end-point of a number of conditions characterised by inflammation and are rarely 'curable' in its true sense. After consideration of the underlying aetiology and confirmation of the diagnosis, they are normally managed by a combination of medical and surgical interventions. Of these, topical corticosteroids have proved to be the medical treatment of choice. The objectives of the medical management are to eliminate or reduce the size of polyps, re-establish nasal airway and nasal breathing, improve or restore the sense of smell, and prevent recurrence of nasal polyps. The mechanism of action of corticosteroids may be by a multifactorial effect on various aspects of the inflammatory reaction, the effect being initiated by their binding to a specific cytoplasmic glucocorticoid receptor. At a cellular level, there is a reduction in the number of antigen-presenting cells, in the number and activation of T cells, in the number of mast cells, and in the number and activation of eosinophils. When polyps are large (grade 3) topical medication is difficult to instil in a very blocked nose and surgery or short term systemic corticosteroids may be required. Topical corticosteroids are of use in the primary treatment of nasal polyps when they are of a small or medium size (grades 1 and 2) and in the maintenance of any therapeutic improvement. The efficacy of topical corticosteroids such as betamethasone sodium phosphate nose drops, beclomethasone dipropionate, fluticasone propionate and budesonide nasal sprays in reducing polyp size and rhinitis symptoms has been demonstrated in several randomised, placebo-controlled trials. Beclomethasone dipropionate, flunisolide and budesonide sprays have also been shown to delay the recurrence of polyps after surgery. Placebo-controlled studies of agents that have shown a significant clinical effect in the management of nasal polyposis are reviewed.