Application Of Topical Corticosteroids Research Articles

Pruritic urticarial papules and plaques of pregnancy: An unusual case report from a tertiary care hospital of the Eastern part of India

Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a rare dermatitis of unknown etiology first diagnosed in 1979. It occurs most commonly in the 3rd trimester of pregnancy. Postpartum presentation is extremely rare. Treatment modalities mostly involve the relief of symptoms. We are going to report here one case of a 24-year-old primigravid female who presented in the 9th month of the gestational period with generalized pruritic eruptions in a tertiary care hospital in the Eastern part of India. These eruptions were erythematous, hyperpigmented, and papular, which began within the striae distensae of the abdomen and progressively spread on the skin of upper and lower limbs, trunk, and buttocks. After the delivery of a full-term male child, there was an aggravation of the symptoms such as itching and disturbed sleep. There was also increased spread of the lesions over the skins of the mentioned areas, which persisted for 6 weeks of the postpartum period. The lesions and associated symptoms gradually subsided with topical application of corticosteroids and hydroquinone along with oral antihistaminic for prolonged periods. Our objective behind reporting this case is to make clinicians aware of PUPPP as a differential diagnosis of peripartum and postpartum pruritic eruptions for prolonged periods.

Characterization of isolated and integrated clinical and dermoscopic features of topical steroid-dependent/damaged face: A study from central India

ABSTRACT Background: Topical steroid-dependent/damaged face (TSDF) is defined as semi-permanent or permanent damage to the skin of the face due to unsupervised or prolonged application of topical corticosteroids to the face. Dermoscopy is widely practiced as a non-invasive, effective technique to analyze the immediate or delayed features of TSDF. Objectives: The objective was to evaluate the clinical profile along with dermoscopic features of clinically diagnosed cases of TSDF. Materials and Methods: The study was conducted on seventy-five patients attending the Department of Dermatology, Venereology, and Leprosy between April 2021 and September 2022 with clinical symptoms and signs suggestive of TSDF. Thorough history taking, clinical evaluation, and dermoscopic examination were performed, and data was recorded in a structured proforma with a sixteen-point questionnaire. Results: Sixty-eight percent of the patients were females, yielding a female-to-male ratio of 2.1:1. The most frequently affected age group was 26–35 years (48%), with a mean age of 31.8 years. The most common topical steroid employed was beclomethasone dipropionate 0.25% (33.33%), followed by clobetasol propionate 0.05% (29.33%). The most common clinical findings observed were erythema with hyperpigmentation (74.66%), followed by erythema with telangiectasia (34.66%). The most often observed dermoscopic findings were red, diffuse areas with vessels (61.33%), red, diffuse areas with an exaggerated pigment network (52%), and clustered vellus hairs with white vellus hair (44%). Conclusion: Topical corticosteroids are commonly abused drugs seen in modern clinical practice, resulting in a plethora of symptoms and creating a paramount dermatological concern. Dermoscopy plays a cardinal evaluating role in the early discernment and establishment of TSDF besides determining the gravity of damage. Key words: Topical steroid-dependent/damaged face (TSDF), Topical corticosteroids, Dermoscopy

The relationship between corneal calcareous degeneration and various ophthalmic diseases in dogs: A retrospective study

AbstractObjectiveTo investigate ocular factors that influence the development of corneal calcareous degeneration (CCD) in dogs.Animals and ProceduresThe medical records of 96 eyes of dogs with CCD and 288 eyes without CCD were retrospectively reviewed. Dogs with evidence of causative systemic illness associated with CCD were excluded from the study. Logistic regression analysis was used to identify the ocular factors associated with the development of CCD. To identify the effect of phosphate‐containing eyedrops on CCD, the application periods of phosphate‐containing antiglaucoma eyedrops were compared between the glaucomatous eyes in the CCD and non‐CCD groups.ResultsIncreased age, brachycephalic breed, keratoconjunctivitis sicca, advanced cataract, history of phacoemulsification, and topical corticosteroid application were significantly associated with CCD development. Glaucoma was significantly overrepresented in the non‐CCD group, and the application period of phosphate‐containing antiglaucoma eyedrops was significantly longer in eyes with CCD than in those without CCD.ConclusionsOphthalmic diseases requiring long‐term management of ocular inflammation and long‐term application of phosphate‐containing eyedrops may contribute to the development of CCD. Glaucoma is overrepresented in dogs without CCD, which is thought to be due to the differences in predisposed age and breeds between dogs with glaucoma and CCD.

Study of clinicodermoscopic features of topical steroid damaged face patients

Background: Topical steroid dependent or damaged face is an alarming upcoming entity rampant in India due to over-the-counter availability of topical corticosteroids containing products. The present study aimed to study the clinical and dermoscopic changes in patients with topical steroid damaged face and to correlate them with potency and duration of application of the TCS. Methods: 80 patients visiting the dermatology OPD & IPD at SAIMS Hospital & PG Institute, Indore, with the chief complains of redness, itching, red raised lesions, burning, swelling, photosensitivity, pigmentation; with a history of application of topical corticosteroids of any potency on face for continuous 7 days or intermittent for 15 or more days were enrolled for the study. Results: Mean age of the patients was 31.5±8.13 years. Male to female ratio was 1:9. Twelve (15.2%) patients abused TCS for more than one year. Presenting complains of the patients were redness (82.5%), itching (66.3%), hypertrichosis (47.5%), pigmentation (66.3%), burning (38.8%) and acne (28.8%). The most common dermoscopy findings i.e., unpatterned brown pigmentation (86.3%), polygonal vessels (73.8%), fine scales (52.5%), hypertrichosis (53.8%), follicular plugs (32.5%), micropustules (15%) and ivory patches (11.3%) were observed in a statistically higher proportion of cases dermoscopically Conclusions: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

Sweet’s Syndrome: A Rare Case Report

Sweet’s Syndrome, also known as acute febrile neutrophilic dermatosis is a rare disease of unknown etiology, but has been associated with autoimmune processes, malignancies, infections, GI disorders and drug reactions. It is more prevalent in women than men, except in case of malignancy associated origin. Clinical features of this disorder include acute onset of painful plaques on skin, neutrophilic leukocytosis, fever, dermal infiltrations by neutrophils. Usually, sweet’s syndrome is presented in three main clinical settings which includes: the classical (idiopathic), malignancy-associated, and drug induced. Classical Sweet’s Syndrome (CSS) is usually seen in women between the age of 30 to 50 years. It is frequently preceded by an upper respiratory illness and could be linked to pregnancy, inflammatory bowel disease, and both. Recurrence of the dermatosis is usually seen in one third of the patients experiencing classical sweet’s syndrome. Malignancy associated Sweet’s Syndrome (MASS) is usually present in patients with confirmed cancer and manifested as a paraneoplastic syndrome. Also occurs in those whose solid tumor or hematologic dyscrasia associated with sweet’s syndrome was previously undetected. Drug induced Sweet’s Syndrome (DISS) occurs in patients being treated with granulocyte-colony stimulating factor. Various other drugs including antibiotics like Minocycline, Trimethoprim Sulfamethoxazole, nitrofurantoin, antiepileptics like Carbamazepine, Diazepam, NSAIDS, Diuretics and Retinoids can also cause DISS. Diagnosis of sweet syndrome is usually done by two major criteria (histopathology and acute cutaneous lesion), and four minor criteria’s (infection, malignancy, medications, fever, and extra cutaneous manifestations like leukocytosis and corticosteroid response. Systemic corticosteroids are the golden standard of treatment for Sweet’s Syndrome. Systemic corticosteroids (0.5mg to 1mg/kg/day) for 4-6 weeks improves the systemic symptoms and reduce the skin lesions. For treating localized lesions, topical application of high potency corticosteroids or intralesional corticosteroids are effective. Other first line agents including potassium iodide and colchicine are also used. Second line agents include Indomethacin, Cyclosporine, Dapsone and Clofazimine. Keywords: Sweet’s Syndrome, Corticosteroids, Malignancy, Leukocytosis

Effectiveness of topical tacrolimus treatment in vitiligo patients

Background: Vitiligo is an acquired, pigmentary skin disorder that is disfiguring and difficult to treat. Phototherapy and the application of topical corticosteroids are most commonly prescribed. However, these therapies are often not effective and the use of corticosteroids on the face may lead to cutaneous atrophy, telangiectasia, and ocular complications.
 Objective: To evaluate the effectiveness of topical tacrolimus treatment in vitiligo patients.
 Materials and methods: This prospective, randomized control trial study was conducted among the patients who sought health care in the Dermatology and Venereology out patient department of KYAMC, Enayetpur, Sirajgonj from August 2021 to July 2022. The study was conducted with a view to evaluate the efficacy of topical tacrolimus in vitiligo and to see the adverse effects of topical tacrolimus in the treatment of vitiligo.
 Results: This study shows 70 patients were enrolled them 32 were male and 38 were female. The mean age was 28.52±10.98 years. Monthly evaluations were performed. Maximum 61 patients (87.1%) achieved varying levels of repigmentation. 28 patients (40.0%) had reported up to 50% repigmentation. Sign and symptoms of erythema (8.6%) and burning (7.1%) were minimal.
 Conclusion: This study revealed that tacrolimus ointment may be an effective and safe option for the treatment of vitiligo. The ease of topical self-administration with minimal side effects makes this novel immunomodulatory agent a promising addition to the therapeutic armamentarium for vitiligo.
 Central Medical College Journal Vol 6 No 1 January 2022 Page: 44-48

Lichen sclerosus: The 2023 update.

Lichen sclerosus (LS) is an underdiagnosed inflammatory mucocutaneous condition affecting the anogenital areas. Postmenopausal women are predominantly affected and, to a lesser extent, men, prepubertal children, and adolescents. The etiology of LS is still unknown. Hormonal status, frequent trauma and autoimmune diseases are well-known associations for LS, yet infections do not seem to be clear risk factors. LS pathogenesis involves factors such as a genetic predisposition and an immune-mediated Th1-specific IFNγ-induced phenotype. Furthermore, there is a distinct expression of tissue remodeling associated genes as well as microRNAs. Oxidative stress with lipid and DNA peroxidation provides an enabling microenvironment to autoimmunity and carcinogenesis. Circulating IgG autoantibodies against the extracellular matrix protein 1 and hemidesmosome may contribute to the progression of LS or simply represent an epiphenomenon. The typical clinical picture includes chronic whitish atrophic patches along with itching and soreness in the vulvar, perianal and penile regions. In addition to genital scarring, and sexual and urinary dysfunction, LS may also lead to squamous cell carcinoma. Disseminated extragenital LS and oral LS are also reported. The diagnosis is usually clinical; however, a skin biopsy should be performed in case of an unclear clinical picture, treatment failure or suspicion of a neoplasm. The gold-standard therapy is the long-term application of ultrapotent or potent topical corticosteroids and, alternatively, topical calcineurin inhibitors such as pimecrolimus or tacrolimus. Collectively, LS is a common dermatological disease with a so far incompletely understood pathogenesis and only limited treatment options. To foster translational research in LS, we provide here an update on its clinical features, pathogenesis, diagnosis and (emerging) treatment options.

Termokoterle yapılan sünnet sonrası gelişen fimozisin tedavisinde topikal steroid kremlerin etkinliği var mı?

OBJECTIVE: Thermocautery device is commonly used in circumcisions implemented under local an anaesthesia for a quick and safe circumcision. One of the complications that might evolve after circumcision implemented with thermocautery is pathological phimosis. Treatment of this complication is generally surgical revision. There are very few studies in the literature about it’s medical treatment. In this study, we aimed to search the efficiency of topical corticosteroid application in the the treatment of pathological phimosis evolving after circumcision implemented with thermocautery. MATERIAL and METHODS: Datas of 54 patients aged 1–9 who evolved pathological phimosis complication after circumcision in our hospital between 2011–2021 were examined retrospectively. Efficiency of topical corticosteroid application in the treatment of pathological phimosis evolving after circumcision implemented with thermocautery was evaluated. RESULTS: In 38 cases which grade 5 phimosis evolved after surgery there was no response to steroid treatment. In 6 of the 8 patients who evolved grade 4 phimosis there was no response to steroid treatment. Although there was partial response and regression to grade 3 in two patients, full recovery was not achieved and grade 4 phimosis reevolved in 2–3 weeks. 0.05% clobetasol propionate a highly strong steroid (Dermovate 0.05% 50 gr, Turkey) for 6–8 weeks morning and evening was implemented to all of the patients and circumcision revision was made in all 46 patients with no response. In 8 cases patient’s relatives did not accept topical corticosteroid and circumcision revision was made. CONCLUSION: As a result, topical steroid is not found to be effective in the treatment of phimosis evolving after circumcision implemented with thermocautery. Keywords: thermocautery, phimosis, circumcision, topical steorid, inflammation

Acral Lick Dermatitis (Lick granuloma) in an Adult Male Labrador Retriever Dog

Introduction: Acral lick dermatitis is a skin injury commonly noticed in dogs with obsessive licking behavior. The lesions are usually noticed on the distal extremities which become raised, thickened, and plaque-like. 
 Case report: A five-year-old male Labrador retriever dog was presented to the Small Animal Medicine Unit of Veterinary Clinical Complex (VCC), Rajiv Gandhi Institute of Veterinary Education and Research (RIVER), Puducherry, India, with a history of a superficial wound on the metatarsal region of the right hind limb with bleeding and continuous licking since a month. Clinical examination of the lesion showed a nodular eczematous lesion of 2 cm thickness, while other vital parameters were normal. Based on the licking behavior and other investigations, the skin lesions were diagnosed as acral lick dermatitis. Treatment included the application of Ointment Triamcinolone acetonide (topically) for a month. The licking was controlled using E-collar, and the dog was engaged in playful activities to overcome boredom. The lesion regressed completely within a month and hence was treated uneventfully.
 Conclusion: Diagnosis and identifying the root cause of the skin disorder can determine the course of treatment. Topical application of corticosteroids (triamcinolone acetonide) and methods, such as E-collar, to control the licking behavior, helped the animal’s recovery.

TO ASSESS THE EFFECTIVENESS OF SHORT BURST APPLICATION OF 0.05% FLUTICASONE CREAM IN PREVENTING DYSCHROMIA DUE TO SUPERFICIAL CUTANEOUS PROCEDURES

Background Topical corticosteroids are known for their anti-inammatory effect. Post-procedural dyschromia is a very common in skin of colour and people with excessive sun exposure. In our study we assessed the effect of prior application of uticasone 0.05 % cream in different time period on post procedural dyschromia. This was a single-center, open-label, prospective c Methods ase-control study in which consecutive subjects suffering from small lesion of face (DPN or Milia), belonging to the age group of 18 years and above were recruited. The three equal study Groups-A, -B and -C received 4 hours, 12 hours and no application of uticasone 0.05% cream prior to procedure. Clinical progression and effect on post procedural dyschromia was assessed in follow-up visit after 1 week and 2 week respectively. In our study, we could not found any Results signicant effect of prior applicantion of topical corticosteroid cream over post procedural dyschromia. Our study suggests that Conclusion: uticasone 0.05% cream is ineffective in preventing post procedural dyschromia Summary: Ÿ Post procedural dyschromia is a major complication after removal of smaller leions of face. Ÿ No study was available to address the effect of prior application of topical corticosteroid over the appearance of Post procedural dyschromia Ÿ We have assessed efcacy of short burst application of uticasone 0.05% cream in preventing post-procedural dyschromia (hyper and hypopigmentation)

Early Compression Therapy for Deep Skin Defects: A New Treatment Option to Prevent Hypertrophic Scars or Contractures

Background: Conservative treatment of deep dermal or full-thickness skin defects often results in hypertrophic scars or contractures; thus, compressive therapy has been used after wound closure to prevent or treat scar deformities. However, wound contraction begins in the early proliferative phase and peaks after 2 weeks. We therefore attempted early compression therapy as a means of conservative treatment of deep-skin defects and evaluated its clinical outcomes. Methods: In 21 cases of deep skin defects (19 patients), early compressive therapy was started the second week after injury. Saline-moistened gauze or foam dressings were placed on open wounds, and foam dressings or silastic plates were used after epithelialization. The compression materials included elastic bandages, adhesive tapes, or garments. The final scars were assessed using the Vancouver Scar Scale (VSS) and satisfaction degree.Results: Defect size ranged from 1.4×0.7 to 5×5 cm. The duration of compression was 4 to 12 months. The follow-up periods were 4 to 61 months. Mild scar hypertrophy or contracture occurred in 15 cases and subsided after application of topical corticosteroid or triamcinolone injection. The final scar shapes were linear (n=12), geographic (n=5), and oval (n=4). The mean VSS score was 2.3. The degrees of satisfaction were excellent (61.9%) and good (23.8%). In most cases, aesthetically and functionally satisfactory outcomes without pathologic scars were demonstrated with minimal scar size, high scar quality, and high satisfaction.Conclusion: Early compression therapy might be a good option to prevent pathologic scars in the conservative treatment of deep skin defects.

Community pharmacists’ counseling practices and patient experiences about topical corticosteroids – an online survey in the Klang Valley, Malaysia

BackgroundCommunity Pharmacists (CPs) play an important role in patient counseling regarding the use of topical corticosteroids (TCS). We assessed CP’s self-reported counseling practices regarding TCS and patients’ reported counseling experiences.MethodsA previously developed questionnaire was adapted to the Malaysian context. A random sample of 364 registered CPs practicing in three states, Selangor, Kuala Lumpur, and Putrajaya were invited for an online survey. The questionnaire for CPs explored their perceived patient knowledge about topical corticosteroid (TCS) use, their counseling practices, and perceived barriers to counseling. Thirty patients were also selected from five pharmacies i.e., six consecutive patients who consulted each CP were invited to participate in the patient survey by completing a checklist about their experiences regarding the counseling received.ResultsA majority (> 90%) of the CPs mostly explained to the patients that the medication was TCS and the frequency and duration of application but only 10% correctly identified scenarios needing medical referral. Only about half of the CPs always explained about side effects, strength, efficacy, and storage of TCS. The two main barriers were patients’ negative perception of TCS (65.4%) and pharmacists’ lack of time for counseling (49.7%). Counseling practice score was associated with CPs’ age (aOR 0.86, 95%CI 0.78–0.94), pharmacists’ recommendation on TCS use (aOR 0.11, 95%CI 0.02–0.61), and time spent on counseling (aOR 1.42, 95%CI 1.13–1.64). Patients mentioned they were counselled on the frequency and duration of application of TCS, and potential adverse effects. Most were not counselled on action to take when an adverse event occurs and the storage and use of leftover medication.ConclusionCPs counseling practices to their patient about the use of TCS requires improvement. Continuing education and hands-on training are needed for CPs regarding counseling about TCS use.

Therapeutic approach to atopic dermatitis in children

Background: Atopic dermatitis, a chronic inflammatory skin disease can significantly reduce patients’ quality of life. It is commonly observed in infants or young children but can also occur in adults. Patients with atopic dermatitis are at risk of developing food allergies, allergic rhinitis, and asthma.Current Concepts: Treatment of atopic dermatitis should commence with moisturization of epidermal skin and avoidance of environmental factors that may trigger exacerbation of atopic dermatitis. Topical corticosteroid application remains the gold standard for medical management of atopic dermatitis; however, topical corticosteroids are often avoided owing to concerns regarding the adverse effects of these drugs. Recently, several systemic immunosuppressants and biological agents have been introduced for the treatment of atopic dermatitis. These medications are associated with fewer adverse effects than those observed with previous treatments and have therefore shown positive results for successful management of atopic dermatitis.Discussion and Conclusion: It is expected that new drugs tailored to the disease level of each patient will revolutionize the treatment of atopic dermatitis more effectively in future.

SEVERE PAPULAR ECZEMA SKIN REACTION AFTER INTRAVENOUS IMMUNOGLOBULIN INFUSION IN PATIENT WITH CHRONIC LYMPHOCYTIC LEUKEMIA: A CASE REPORT

Hypogammaglobulinemia is a common finding in Chronic Lymphocytic Leukemia (CLL). Their etiology is multifactorial, due to disease-related immune defects and chemo-immunotherapy treatment as Rituximab. It is present in up to 85 % of patients at some point in their disease course. It is therefore important to monitor patients for the development of an antibody deficiency due to being susceptible to infections. Strategies to prevent infections in patients with secondary antibody deficiencies include replacement Immunoglobulin (Ig). However, nearly 6% develop skin reaction Ig associated, a rare adverse event reported only in case reports. A 64 years-old man was diagnosed with CLL in 2011. Despite treatment with Chlorambucil, in July 2013, the patient had therapeutic failure, so he switched to a 2nd-line regimen, with intravenous chemotherapy with cyclophosphamide, vincristine and prednisone for 2 cycles. In September 2013, due to disease progression, he was switched to a 3rd-line regimen with fludarabine and cyclophosphamide. In 2014, he presented an increase in the size of the cervical lymph nodes, so he used 8 cycles of Rituximab. After Rituximab-therapy, hypogammaglobulinemia was detected due to recurrent infections. Then, the patient received Ig monthly with pre-medication. Fifteen days after this Ig infusion, he developed an extensive pruritic, eczematous rash and lichenified skin lesions on the upper limbs. In the following months, 48 hours after the Ig infusion, he presented excoriated eczematous plaques located in the inguinal region and posterior thighs, with follicular pustules (delayed hypersensitivity reaction, type IV). Histological analysis of a skin biopsy specimen revealed subacute spongiotic dermatitis with intraepidermal microvesiculation. The lesions progressively regressed after stopping Ig infusions, oral prednisone, dapsone and topical application of tacrolimus and corticosteroids. Although the Rituximab used in the treatment of patients with CLL is capable of depleting the population of malignant lymphocytes, they lack specificity and further contribute to the significant immune dysfunction that predisposes these patients to a serious risk of infection. As such, the use of Ig therapy is increasing in the treatment of CLL. However, the severity of its rare adverse effects is often poorly recognized. Dermatologic adverse effects of Ig are rare and include urticaria, papules, eczema, pompholyx, lichenoid dermatitis, and desquamation. The underlying mechanism resulting in skin reactions following treatment with Ig is not clear. Most of these reactions develop within 2 weeks after immunoglobulin administration. The rash is managed with topical/systemic steroids and antihistamine treatment. These adverse events can also lead to cessation of therapy. This case report highlights the fact that cutaneous adverse effects of IgIV are more common than previously believed. Although the precise mechanism of this cutaneous eruption remains to be elucidated, its occurrence within days of Ig infusion, its characteristic distribution at onset, and its clinical course should be recognized by hematologists and dermatologists.

İdiopatik kırmızı lezyon: olgu serisi

The first step in the treatment of periodontal diseases is to mechanically remove plaque and dental calculus, which play a role in the etiology of periodontal diseases, and to establish oral hygiene. In some cases of oral diseases, some drugs and chemical agents can be used for various reasons in addition to mechanical treatment. Corticosteroids are frequently used in oral mucocutaneous diseases because of their strong anti-inflammatory, antiallergic and immunosuppressive effects in the treatment of many other diseases. Although there are different ways of using corticosteroids, the topical form is often preferred in the treatment of oral lesions associated with oral mucosal diseases. This case series aims to evaluate the effect of topical corticosteroid application on red lesions in the gingiva that do not heal with conventional periodontal treatment.

MANAGEMENT OF RECURRENT EXFOLIATIVE CHEILITIS A/R LABIUM SUPERIOR AND INFERIOR IN PATIENT 12-YEAR-OLD

Exfoliative Cheilitis (EC) is a chronic inflammatory condition of the lips, characterized by fissuring, desquamation, and the formation of a bleeding crust. EC causes a burning sensation of varying intensity and sometimes bleeding. EC has no clear etiology but is associated with bad habits such as lip licking and biting, stress or depression, and systemic disease states. The best treatment for EC is to eliminate the cause or predisposing factor. Treatment was given in the form of topical corticosteroid application and petroleum jelly. The use of corticosteroids can be discontinued if there are no complaints and to overcome the dryness of the lips it is recommended to apply petroleum jelly. One week after the treatment, there was a wound healing process, but the condition of the lips still showed redness and the patient's lips were still peeling. After one month, the patient's lips have healed, and the patient's bad habits such as licking the lips and peeling the lips have disappeared.

Evaluating the Efficacy of the Er,Cr:YSGG Fractional Laser Before Treatment With Triamcinolone NN Ointment in Oral Lichen Planus Lesions.

Introduction: It has been demonstrated that laser technology can enhance topical drug absorption. This study aimed to determine the effects of Er,Cr:YSGG laser radiation before the application of topical corticosteroids in the healing of oral lichen planus. Methods: In this double-blind split-mouth clinical trial, 32 lesions were chosen from eight patients affected by oral lichen planus (OLP). The oral lesions were randomly categorized into two groups. The first group had topical treatment with triamcinolone NN ointment and the second group had laser radiation (Er,Cr:YSGG) for eight weeks before starting the ointment. For each lesion, the irritating level based on the VAS score, the lesion level based on the Thongprasom scale score, and the healing time were measured, and the collected data were analyzed by the Friedman test and the Wilcoxon's statistical test. Results: The mean healing time based on the verbal analog scale (VAS) score was not significantly different between the two treatment groups (P>0.05). The mean healing time based on Thongprasom scale scores did not show any significant difference between the two treatment groups (P>0.05). Conclusion: The application of the Er,Cr:YSGG laser before treatment with triamcinolone NN ointment did not show any advantage for the average healing time compared to a medicine regimen with only triamcinolone NN ointment.

Central Serous Chorioretinopathy after Application of Topical Corticosteroid

Central serous chorioretinopathy (CRSC) is a pathology of the retina and the choroid characterized by a vanishing point causing sub-retinal fluid accumulation and focal retinal detachment. We report a case of a 40-year-old male patient followed for 5 years in dermatology for psoriasis treated with topical corticosteroids who presented to the emergency department for a visual acuity at 3/10 in his right eye associated with a macular syndrome. Several cases of corticosteroid-induced CRSC were found in the literature, but only few cases were found after application of topical corticosteroid. Optical coherence tomography was performed urgently and revealed central serous chorioretinitis. Treatment with topical corticosteroids was discontinued. The patient was seen a week later, with visual acuity recovery from 3/10 to 10/10, with improvement in macular syndrome.

Technologies for Type 1 Diabetes and Contact Dermatitis: Therapeutic Tools and Clinical Outcomes in a Cohort of Pediatric Patients.

The increasing use of technological devices for the management of diabetes is related to the prolonged exposure of patients’ skin to chemical and mechanical agents and, consequently, to the increased risk of developing dermatological complications. Among these, contact dermatitis is the most insidious skin disorder. Despite the magnitude of the issue, no universally accepted recommendations on the management of this common complication are currently available. Our observational study aimed to describe all the solutions adopted by patients and their caregivers to treat and prevent the appearance of contact dermatitis and to describe the clinical impact of this cutaneous complication. Twenty-one pediatric patients (mean age 12.1 ± 3.7 years) with type 1 diabetes were recruited in the study. The most common treatment used to treat acute skin lesions was the application of topical corticosteroids, sometimes associated with topical antibiotics (9.5%). In order to prevent the further appearance of dermatitis, the most frequently adopted measure was the use of hydrocolloid and/or silicone-based adhesives, followed by the application of protective barrier films. One patient reported benefit from the off-label use of fluticasone propionate nasal spray. However, only 52.4% of the study participants achieved a definitive resolution of the skin issue, and 38.1% of patients were forced to discontinue insulin pump therapy and/or continuous glucose monitoring. No differences were observed in glycated hemoglobin values between the period before and after the onset of contact dermatitis. Our study confirms the severity of this dermatological complication that may hinder the spread of new technologies for the management of diabetes. Finally, our findings highlight the importance of establishing close collaboration both with pediatric allergy specialists to prescribe the most suitable treatment and with manufacturing companies to ensure that adhesives of technological devices are free of harmful well-known sensitizers.

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

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