Application Of Topical Corticosteroids Research Articles

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.

Recurrent aphthous stomatitis (RAS): guideline for differential diagnosis and management.

Recurrent aphthous stomatitis (RAS) is a painful and common ulcerative form that can pose a diagnostic challenge. In fact, similar oral ulcers can appear secondary to a variety of well-defined pathological conditions. Thus, the purpose of this work was to update the current knowledge about RAS METHODS: A narrative review is presented aiming to clarify the extensive differential diagnosis of RAS and its management. As a first aid in relieving the pain, topical applications of corticosteroids, antibiotics, and analgesics are highly recommended, while systemic therapy of RAS should be used in the case of multiple painful ulcerations compromising the quality of life of the patient. Also, natural anti-inflammatory substances from medicinal herbs, in the form of essential oils and extracts are promising agents in the management of RAS.

Targeting therapeutic approaches and highlighting the potential role of nanotechnology in atopic dermatitis.

Atopic dermatitis is a chronic as well as widespread skin disease which has significant influence on the life attributes of affected people and their families. Systemic immunosuppressive drugs can be utilised for effective care of disease, although they are often prescribed for rigorous disruption or disease that is complicated to manage. Therefore, topical applications of corticosteroids are considered the primary pharmacologic therapies for atopic dermatitis, and research recommends that these medications might be helpful in preventing disease flare-ups. However, topical medicine administration to deeper layers of skin is challenging because of the skin anatomic barrier that restricts deeper drug permeation, and also due to barrier function abnormalities in atopic dermatitis skin, which might result in systemic drug absorption, provoking systemic consequences. Hence, effective management of atopic dermatitis needs new, effective, safe and targeted treatments. Therefore, nanotechnology-based topical therapeutics have attracted much interest nowadays because of their tendency to increase drug diffusion and bioavailability along with enormous drug targeting potential to affected cells, and, thereby, reducing the adverse effects of medications. In this review, we mention different symptoms of atopic dermatitis, and provide an overview of the different triggering factors causing atopic dermatitis, with emphasis on its epidemiology, pathophysiology, clinical features and diagnostic, and preventive measures. This review discusses existing therapeutics for treating atopic dermatitis, and the newer approaches as well as the current classical pharmacotherapy of atopic dermatitis against new nanoparticle skin delivery systems. This review has also briefly summarised the recent patents and clinical status of therapeutic modalities for atopic dermatitis.

Effect of the topical administration of corticosteroids and tuberculin pre-sensitisation on the diagnosis of tuberculosis in goats

BackgroundCaprine tuberculosis (TB) is a zoonosis caused by members of the Mycobacterium tuberculosis complex (MTBC). Caprine TB control and eradication programmes have traditionally been based on intradermal tuberculin tests and slaughterhouse surveillance. However, this strategy has limitations in terms of sensitivity and specificity. Different factors may affect the performance of the TB diagnostic tests used in goats and, subsequently, the detection of TB-infected animals. In the present study, the effect of two of the factors that may affect the performance of the techniques used to diagnose TB in goats, the topical administration of corticosteroids and a recent pre-sensitisation with tuberculin, was analysed.MethodsThe animals (n = 151) were distributed into three groups: (1) a group topically treated with corticosteroids 48 h after intradermal tuberculin tests (n = 53); (2) a group pre-sensitised with bovine and avian purified protein derivatives (PPDs) 3 days before the intradermal tuberculin test used for TB diagnosis (n = 48); and (3) a control group (n = 50). All the animals were tested using single and comparative intradermal tuberculin (SIT and CIT, respectively) tests, an interferon-gamma release assay (IGRA) and a P22 ELISA.ResultsThe number of SIT test reactors was significantly lower in the group treated with corticosteroids when compared to the pre-sensitised (p < 0.001) and control (p = 0.036) groups. In contrast, pre-sensitisation with bovine and avian PPDs did not cause a significant reduction in the number of SIT and CIT test reactors compared with the control group. In fact, a higher number of reactors was observed after the prior tuberculin injection in the pre-sensitised group (p > 0.05). No significant effect was observed on IGRA and P22 ELISA due to corticosteroids administration. Nevertheless, a previous PPD injection affected the IGRA performance in some groups.ConclusionsThe application of topical corticosteroid 24 h before reading the SIT and CIT tests can reduce the increase in skin fold thickness and subsequently significantly decrease the number of positive reactors. Corticosteroids used can be detected in hair samples. A previous pre-sensitisation with bovine and avian PPDs does not lead to a significant reduction in the number of intradermal tests reactors. These results are valuable in order to improve diagnosis of caprine TB and detect fraudulent activities in the context of eradication programs.

A Comparative Study of Effectiveness of Cryotherapy with Intralesional Triamcinolone Vs Fractional CO2 Laser with Topical Betamethasone for the Treatment of Keloids.

Keloids are hyperproliferative response of dermal connective tissue to trauma. Their management remains a challenge for practitioners as there is still no universally accepted treatment, leading to recurrences which are frustrating for patients and clinicians alike. Hence, it becomes essential to determine a modality with highest efficacy, least recurrence and produces good aesthetic results. To compare the therapeutic effectiveness of combination of cryotherapy with intralesional corticosteroid and a combination of fractional CO2 laser followed by topical corticosteroids for treatment of keloids. This was a single centre, cross-sectional study consisting of 170 patients. Patients were randomly allocated in two groups, group one received a combination of cryotherapy with intralesional corticosteroid and group two was treated by laser ablation of keloid followed by topical corticosteroid application for four treatment sessions each after which they were evaluated for improvement. There was remarkable difference in the treatment outcome of both the group, with group two showing more improvement (p value <0.001) and markedly fewer side effects. Patients in group two had less pain as compared to patients in group one, making them more compliant to treatment. Majority (31.8%) of patients belonged to 31-40 years of age group. The most common reason for treatment was for cosmetic concerns, seen in 70.6% of the patients. Both regimens showed excellent responses with minimum recurrence rates, indicating their high efficacy in management of keloids. However, regimen II was found to be aesthetically superior for the treatment of these exuberant scars.

Healthcare Utilization in Danish Children With Atopic Dermatitis and Parental Topical Corticosteroid Phobia

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin condition. One foundational component of AD treatment is topical corticosteroids (TCS). With this study, researchers sought to evaluate the association among parental-reported health care use, parental TCS phobia, medication use to treat AD, and AD severity in pediatric patients.In the study, researchers included 1343 children with AD in Denmark.Children were recruited from the Danish National Patient Registry from January 2014 through December 2018 for this cross-sectional study. Children with a chief complaint and diagnosis of AD on the basis of International Classification of Diseases, 10th Revision, codes registered by a dermatology department within the Danish health care system were included. A questionnaire including 158 items assessing family structure, residence, parental education, AD severity (assessed by the Patient-Oriented Eczema Measure [POEM] score), TCS phobia (assessed by validated Topical Corticosteroid Phobia [TOPICOP] score), and AD treatment were sent to parents of eligible children.A total of 3437 children met inclusion criteria, and the parents of 1343 (43%) responded to the questionnaire; the mean age of the children was 8.9 years, and 52.8% were male. Mean POEM scores were significantly higher for girls (8.2 ± 6.3) than for boys (7.3 ± 6.2; P = .009), with scores between 8 and 16, indicating moderate eczema. On the basis of POEM scores, 23.4% had clear or almost clear AD, 29.5% had mild AD, 37% had moderate AD, and 10% had severe AD. With regards to treatment, 95% of all children had received TCS in the past. Severe AD was associated with increased health care visits. With regards to TCS phobia, there was no difference in TOPICOP scores on the basis of AD severity or child age. Higher TOPICOP scores were significantly associated with lower parental educational level as well as delayed TCS application for AD flares but were not associated with increased primary care visits when adjusted for AD severity and parental educational level.Increased TOPICOP scores were associated with lower parental educational levels leading to delayed treatment of AD flares. There was no association between TOPICOP scores and AD severity or the child’s age. Increased health care use was demonstrated in children with severe AD, compared with milder forms of AD, but was not associated directly with increased TOPICOP scores.Although there are no cutoff values for TOPICOP scores to define TCS phobia, in this study, it is suggested that TCS phobia is prevalent and associated with lower parental educational levels and delayed TCS treatment of AD flares. Further study is needed to define the impact of TCS phobia and evidence-based interventions to address this.

Macular‐type cutaneous adverse reaction due to atezolizumab and pembrolizumab

Anti-PD-1/PD-L1 targeted therapy is widely used for the treatment of various intractable malignancies and develops the therapeutic option in the frontier fields of oncology treatment. On the contrary, these immune checkpoint therapies sometimes develop undesirable adverse reaction as the results of activation of immune reaction to various organs. Herein, we report a case of cutaneous adverse reactions during PD-1/PD-L1 targeted treatment in both atezolizumab and pembrolizumab in a patient with lung cancer. Dear Editor, Anti-PD-1-/PD-L1-targeted therapy is widely used for the treatment of various intractable malignancies and develops the therapeutic option in the frontier fields of oncology treatment.1, 2 On the contrary, these immune checkpoint therapies sometimes develop an undesirable adverse reaction as a result of activation of immune reaction to various organs.3, 4 A cutaneous adverse reaction is a representative immune checkpoint treatment-mediated reaction.3 Herein, we report a case of cutaneous adverse reactions during PD-1-/PD-L1-targeted treatment in both atezolizumab and pembrolizumab in a patient with lung cancer. A 68-year-old man noticed erythematous plaques and papules on his trunk and extremities 4 days after first atezolizumab administration for the treatment of his right lung adenocarcinoma clinical stage IV, and his skin eruption gradually developed. On physical examination, erythematous plaques were localized in trunk and extremities without the involvement of the mucosal membrane (Figure 1A). A skin biopsy revealed liquefaction and spongiosis in the epidermis and lymphocyte infiltration in the dermis (Figure 1B). After the treatment with an antihistamine agent, topical application of betamethasone dipropionate, and the discontinuation of additional administration of atezolizumab, his skin eruption was gradually improved without recurrence of skin eruption. As an alternative treatment for his lung cancer, pembrolizumab was next administrated; however, he again recognized erythematous plaques on trunk and extremities after the first administration of pembrolizumab (Figure 1C). The second time cutaneous adverse reaction was more widely spread in his whole body. A skin biopsy again revealed that spongiosis and inflammatory infiltration in the interface of epidermis and dermis (Figure 1D). After the antihistamine agent, topical application of betamethasone dipropionate, and the discontinuation of additional pembrolizumab administration, his skin eruption was improved in several days. One of the unique characteristics of this case was to cause similar cutaneous adverse reactions by the different action point targeted treatment, PD-1 and PD-L1. Although the detailed molecular mechanism remains unclear in our case, we thought 3 possible mechanisms to cause cutaneous adverse reaction by both atezolizumab and pembrolizumab. The first reason is that atezolizumab and pembrolizumab have same additives in the drug, such as L-histidine, white soft sugar, and polysorbate. In particular, polysorbate includes in various drugs and influenza vaccine and is known to cause allergic reaction in some cases.5, 6 Therefore, we speculated that cutaneous allergic reaction to polysorbate might be enhanced by atezolizumab and pembrolizumab. The second reason is another drug contribution to cause adverse reaction. However, he ordinally continued to intake acetaminophen without cutaneous adverse reaction. The third reason is atezolizumab and pembrolizumab might become a trigger to cause a cutaneous autoimmune-like reaction. Because skin eruption is relatively mild form and is improved by topical corticosteroid application and oral antihistamine agent, it seemed to be easy to recover his skin eruption even if his skin eruption is an autoimmunity-related skin eruption. Taken together, clinicians should keep in mind that adverse reaction might occur after switching into another anti-PD-1-/PD-L1-related inhibitor. Approval of the research protocol: No human participant was involved in this study. Informed Consent: N/A. Registry and the Registration No. of the study/trial: N/A. Animal Studies: N/A. The authors declare no conflicts of interest.

Eosinophilic, polymorphic and pruritic eruption associated with radiotherapy (EPPER) in patient with tongue cancer

Eosinophilic polymorphic and pruritic eruption associated with radiotherapy (EPPER) is a rare disease entity that appears in cancer patients after radiotherapy. We describe patient with tonsil cancer who presented with EPPER in an area that had been irradiated. The patient responded to the application of topical corticosteroids and systemic antihistamines.

Topical 5‐fluorouracil as an adjunct treatment in equine corneolimbal squamous cell carcinoma

SummaryAn 11‐year‐old crossbreed mare was presented with a nodular, pink mass at the temporal corneolimbal junction of the right eye. Histopathology confirmed the diagnosis of invasive squamous cell carcinoma. The mare underwent lamellar keratectomy and conjunctivectomy under general anaesthesia, followed by adjunctive topical chemotherapy with 1% 5‐fluorouracil solution for 10 days post‐operatively. Adverse effects included moderate conjunctival inflammation and exuberant granulation tissue formation at the surgical site, responding to surgical debulking and topical corticosteroid application. No mass regrowth was present at 12 months following discharge. This report describes the successful use of topical 1% 5‐FU as an adjunctive treatment for equine ocular squamous cell carcinoma.

The Effect of Topical Corticosteroid Time of Application on Fibroblast and Type III Collagen Expression in Oryctolagus cuniculus with Deep Dermal Burn Wound (As an Indicator for the Best Time to Start Topical Corticosteroid Application in Preventing Hypertrophic Scar)

Background: Hypertrophic scar is an abnormal scar that causes physical deteriorations, psychological problems, and aesthetic issues. An excessive number of fibroblasts and collagen III expressions are histopathology indicators for the hypertrophic scar. The role of topical corticosteroids in suppressing inflammation and hypergranulation had widely demonstrated in previous studies. However, there is no study related to the application of topical corticosteroids as prevention of hypertrophic scars from burn wound found. Hence, this study aimed to examine the evidence of the effects of corticosteroid topical in decreasing the number of fibroblasts and type III collagen expression and the best time to start its application in preventing hypertrophic scars. Methods: This randomized experimental post-test only study involved 54 deep dermal burn wounds on the ventral ear of female Oryctolagus cuniculus that distributed into three groups based on the healing phases. Each group consisted of treatments and controls. Corticosteroid topical application on the first treatment group (inflammatory phase group), the second group (proliferation phase group), and the third group (remodelling phase group) was started on day 3, on day 10, and day 21, respectively. Specimens taken on day 35. Haematoxylin-Eosin and Immunohistochemically staining performed to measure the number of fibroblasts and type III collagen and to observe the epithelization and inflammation process. Results: The number of fibroblasts significantly decreased in the second treatment group (p =0.001) and followed by the first group (p = 0.016), but no significant decrease found in the third group (p = 0.430). The type III collagen decreased significantly in the second treatment group (p = 0.000) and followed by the third group (p = 0.019), but no significant decrease found in the first group. There was no statistically different number of fibroblast and type III collagen discovered between the controls. Complete epithelization found in all groups. Also, no ongoing inflammation found in all groups. Conclusion : Topical corticosteroids on deep dermal burn wound revealed to be effective in reducing the number of fibroblasts and type III collagen with no healing disruption. The proliferation phase found to be the best time to start the application of topical corticosteroids.

Photobiomodulation Therapy vs. Corticosteroid for the Management of Erosive/Ulcerative and Painful Oral Lichen Planus. Assessment of Success Rate during One-Year Follow-Up: A Retrospective Study

Photobiomodulation (PBM) therapy is a promising approach for the management of inflammatory conditions and autoimmune lesions, such as oral lichen planus (OLP). The aim of this retrospective study was to assess the effectiveness of PBM in the management of painful and erosive/ulcerative OLP and to compare it with the standard of care that is the topical application of corticosteroids. 96 patients were included with erosive and painful OLP. 48 patients received PBM therapy and 48 received corticosteroids. Data was collected retrospectively on pain using the visual analogue scale; clinical aspects of lesions were assessed with the REU score, and the recurrence rate was noted. One session of PBM therapy with a helium-neon red light (635 nm) was carried out every 48 h for 6 weeks. Treatments were mainly made in contact mode, using a fiber with a diameter of 600 µm (0.6 mm). The output power of the laser beam was calibrated by a power meter. A delivered power of 0.1 W was used for 40 s in a continuous wave (CW), corresponding to a delivered energy of 4 J. The delivered energy density related to the fiber diameter was 1415 J/cm2. Each treated point was considered as 1 cm2 of diameter. PBM therapy within these parameters was carried out on each point until the totality of the lesion was covered, including the non-erosive OLP area. Furthermore, healthy mucosa within 5 mm of the lesion was also irradiated with the same conditions. This PBM treatment was performed during 6 consecutive weeks. The topical corticosteroid treatment consisted of cortisone application to cover the OLP 3 times/day for 6 weeks. Follow-up was made at 6 weeks and at 3, 6 and 12 months. After 6 weeks, both groups showed complete absence of pain, and a complete disappearance of ulcerative/erosive areas. No significant difference was found for both groups concerning the recurrence rate of erosive OLP during the follow-up period; values were 0% at 6 weeks for both groups and 79% and 87.5% for the corticosteroid and PBM group, respectively, at 12 months of follow-up. PBM is effective for managing OLP and is significantly similar to topical corticosteroids without any need for the use of medication and with no reported side effects.

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.

Duration of topical therapy in the maintenance of atopic dermatitis remission in paediatric age.

BACKGROUND Topical corticosteroids (TCS) are the first-choice treatment for atopic dermatitis (AD) flares. In literature there are clear advice about the potency, dosage and frequency of application of TCS, but there are no shared indications about duration of the treatment during a flare. The aim of the study is to demonstrate if the use of a steroid cream for less than or 5 days, could be equal or more effective than the application for more than 5 days during a flare episode, in keeping a remission state of AD. METHODS The study population (N.=122) was selected according to the following inclusion criteria: at least one specialist allergological and dermatological examination in the period November 2015 to February 2017, age between 1 and 11 years; mild to moderate atopic dermatitis. All patients were given a standardized telephone questionnaire, which concerns on multiple aspects: parents' self-reported perceptions of the severity of their child's condition; actual use of emollients, moisturizers and steroid creams; number of consecutive days of using of topical steroid cream during an exacerbation of AD; average number of AD exacerbations per month in the last year; total number of AD exacerbations in the last year. RESULTS Data from 96 patients was examined. We classified three groups of patients from data collected: group 1 (N.=40): use of TCS for ≤5 consecutive days during an exacerbation event of AD; group 2 (N.=12): use of TCS for >5 consecutive days during an exacerbation event of AD; group 3 (N.=44): nonuse of TCS or use of TCS with a different posology. We found a further subgroup in group 3 (3a, N.=27) with patients using only emollient creme in AD management. In group 1, 27 patients (67.5%) did not show a good AD control; on the contrary, 13 patients (27.5%) reported a good AD control. In group 2, 4 patients (25%) did not show a good AD control; on the contrary, 8 patients (75%) reported a good AD control. By comparing the data obtained in the presence of good AD control, the difference between the percentages obtained was found to be statistically significant (P=0.034). CONCLUSIONS The results obtained show that a therapeutic pattern based on the use of TCS for a duration of more than 5 consecutive days during an episode of AD exacerbation is more efficient than the proposed alternative therapeutic scheme in the maintenance of AD remission.

Dermoscopy of topical steroid-dependent or damaged face: A cross-sectional study.

Topical corticosteroid (TCS) abuse is rampant and results in steroid addiction labeled as topical steroid-dependent or damaged face (TSDF). Indian market is replete with triple combination creams containing TCS sold as over-the-counter products at low cost, luring people to use them without prescription. The resultant damage if detected late is irreversible and difficult to treat. Dermoscopy can help in the early identification of features of TSDF at a preclinical stage resulting in better prognosis. However, the literature on the same is limited. This study is undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS. One hundred and thirty-two patients aged 18 years or above, with clinical symptoms and signs suggestive of TSDF and with history of application of TCS on the face for a period of more than one month, were enrolled in the study. Their demographic details, clinical features, and dermoscopy findings were recorded using a predesigned structured format. Comparison of dermoscopic findings with clinical examination, gender, potency of TCS, and duration of TCS use was done using Chi-square test, Fisher's exact test, and one-tailed Z-test. Mean age of the patients was 31.7 ± 8.1 years. Male to female ratio was 2:9. Sixty-nine (52.3%) patients abused TCS for more than one year. Clinical findings noted in the patients were erythema (81.1%), hyperpigmentation (80.3%), and hypertrichosis (68.2%). The most common dermoscopy findings seen were brown globules (96.2%), red diffuse areas (92.4%), vessels (87.1%), white structureless areas (86.4%), and hypertrichosis (80.3%). Red diffuse areas, vessels, brown globules, white structureless areas, and white hair were observed in a statistically higher proportion of cases dermoscopically. Y-shaped vessels and brown globules were seen in significantly higher number of patients, using TCS for more than three months and in those continuing it beyond six months, polygonal vessels were predominant. Lack of histopathological correlation is the limitation of our study. Furthermore, brown globules seen in 96.2% patients of TSDF on dermoscopy may have been over-estimated and not always signify TSDF; instead, it could represent melasma for which patient applied TCS. 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.

FROM A NONSPECIFIC INFLAMMATORY-LIKE GINGIVAL LESION TO A RAPIDLY PROGRESSING ORAL SQUAMOUS CELL CARCINOMA: A CASE OF DECEPTIVE PRESENTATION OF ORAL CANCER

<h3>Introduction</h3> White/red lesions, exophytic masses with or without ulceration, are well-recognized typical presentations of oral squamous cell carcinoma (OSCC). Rarely, clinical characteristics may mimic benign lesions. <h3>Objective</h3> To report an unusual case of OSCC of the anterior maxillary gingiva and hard palate, with an initial nonspecific clinical and histologic presentation mimicking benign inflammatory lesions. <h3>Case Presentation</h3> A 58-year-old, otherwise healthy woman was referred with mild pain and a reddish, papillary, gingivopalatal, inflammatory-like lesion of 6 months' duration. Medications, systemic medical conditions, tobacco use, and parafunctional habits that could generate the appearance were excluded. Radiographs did not reveal any bone involvement. Repeated periodontal treatment, improvement of oral hygiene, topical applications of disinfectant, an antifungal, and corticosteroids all failed to yield any improvement. During a period of 18 months, 3 biopsies were taken from the affected gingiva, showing only benign epithelial hyperplasia with dense chronic inflammation devoid of any evidence of malignancy. Following rapidly progressing tooth mobility of the lateral incisor concomitant with accelerated overgrowth of the anterior palatal gingiva, dental radiography was repeated, and computed tomography was performed. Both revealed an extensive osteolytic lesion in the premaxilla. A new biopsy taken from the affected gingiva and adjacent maxillary alveolar bone yielded a diagnosis of OSCC. Treatment included resection of the premaxilla and floor of the nose with bilateral neck dissection. <h3>Conclusions</h3> This case emphasizes the possibility of a deceptive initial appearance of OSCC, the sudden burst and rapid disease progression, and the importance of close follow-up of unusual nonspecific inflammatory-like processes in the oral cavity.

Immunological response and clinical profile in patients with recurrent dermatophytosis.

An alarming increase in the number of patients with chronic and recurrent dermatophytosis has invoked the need to study the immunological parameters of the host. To evaluate delayed type of hypersensitivity (DTH) response and immediate hypersensitivity (IH) response by flow cytometry evaluation of immune cells from peripheral blood and intradermal trichophyton skin test in patients with recurrent dermatophytosis. A hundred patients with recurrent dermatophytosis and 50 controls (healthy controls and acute dermatophytosis controls) were included. Relevant risk factors for recurrence were analysed, and serum IgE levels were estimated. Flow cytometry evaluation of immune cells in peripheral blood and intradermal trichophyton skin test was done. Dermatophyte pathogens were isolated, and antifungal susceptibility was performed. Trichophyton mentagrophytes complex (95.84%) and T.rubrum (4.16%) were isolated in culture. Serum IgE was elevated in 83.15% cases (p=.01). IFN-γ+ cells (p=.0501, p=.0001, p=.0014), Th1 cells (p=.1197, p=.0024, p=.0169), IL-17+ cells (p=.0127, p=.0006, p=.0007) and Th17 cells (p=.0634, p=.0001, p=.0054) were reduced, and IL-4+ cells (p=.0108, p=.0175, p=.0018) were increased in cases. Intradermal test demonstrated negative DTH response in all cases (p<.001, p<.001, p<.001), strongly positive IH response in 6%, and borderline positive IH response in 85% cases (p=.018, p<.001, p<.001). Topical corticosteroids application, undergarment types (tight fit), poor frequency of washing clothes, family history of tinea, sharing of towels were significant risk factors for recurrent dermatophytosis. Reduced IFN-γ+ , Th1, IL-17+ and Th17 cells population along with impaired DTH response by the intradermal test was observed in patients with recurrent dermatophytosis.

"Complications in Blepharoplasty and How to Resolve Them"

Any type of eyelid correction or postoperative blepharoplasty complication should be well managed and studied before attempting its correction, as it could lead to a worsening of the original alteration. Although postoperative scars in a blepharoplasty are relatively rare, they can generally be improved by massage and late with the application of topical corticosteroids, with the understanding that their best use is during the first twelve months. An early intervention should be avoided as this can worsen the result and rarely improve the final result, when there is a healing problem, remembering that stress is a determining factor in the final result. The laxity of the canthus tendons should always be evaluated either by directly pulling the eyelid down, with an eyelid glide test, the impingement test, and a poor eyelid position prior to surgery should always be documented. In these cases, the surgeon who operates blepharoplasty must have a perfect knowledge of the management of the canthal tendons and have within his surgical resources the realization of the canthal application or the repositioning of the palpebral canthal tendon.

Incidence of steroid response in microinvasive glaucoma surgery with trabecular microbypass stent and ab interno trabeculectomy

ObjectiveTo determine the incidence and risk factors for steroid response in patients undergoing combined phacoemulsification cataract extraction (PCE) and microinvasive glaucoma surgery with either trabecular microbypass stent implantation (iStent) or ab interno trabeculectomy (Trabectome). DesignRetrospective, noncomparative, single-institutional observational chart review. ParticipantsConsecutive patients with open-angle glaucoma who underwent PCE with iStent or Trabectome with 3 months of follow-up. MethodsData were collected from patient charts, including pre- and postoperative intraocular pressure (IOP) following application of topical corticosteroid on postoperative visits for at least 3 months. A steroid response was defined as an IOP rise of greater than 5 mm Hg beginning at least 3 days after surgery with no other obvious explanation and with IOP < 20 mm Hg following rapid tapering or withdrawal of the steroid. ResultsA total of 118 eyes from 89 patients, average age of 71.4 ±12.1 years, were included. Overall, a steroid response was seen in 12.7% of eyes (n = 15), and no difference was noted between Trabectome (11.8%) and iStent (13.6%, p = 0.782) eyes. Axial length (AL; p = 0.01), younger age (p = 0.009), traumatic glaucoma (p = 0.004), and normal-tension glaucoma (NTG; p = 0.0048) were significant predictors of steroid response in a multivariate analysis. In eyes with AL ≥ 25 mm, the steroid response rate was 40%, in contrast to eyes with AL < 25 mm, where it was 10.2%. ConclusionA steroid response develops in approximately 1 in 8 patients undergoing PCE with Trabectome or iStent. Young age, AL > 25 mm, traumatic glaucoma, and NTG were found to be significant predictors of steroid response.

The Optimal Application of Medium Potency Topical Corticosteroids in Preventing Laser-Induced Inflammatory Responses-An Animal Study.

Background: During ablative fractional resurfacing (AFR) laser therapy, thermal damage to the skin is inevitable, resulting in inflammatory responses and small wounds. Corticosteroids are known for their anti-inflammatory effect. However, inappropriate application of corticosteroids carries the risk of delayed wound healing. Therefore, we aimed to find the optimal administration route, timing, and duration of medium potency corticosteroid treatment to prevent AFR laser-induced inflammatory responses and to minimize the risk of delayed wound healing. Methods: We determined the anti-inflammatory efficacy of corticosteroids by skin erythema and tissue biopsies on C57BL/6 mice. Wound healing was evaluated by crust area and epithelial gap. Finally, Masson’s trichrome stain and α-SMA immunohistochemistry stain were used to analyze scar contracture. Results: Our results demonstrated that one dose of medium-potency topical corticosteroid applied immediately after AFR laser treatment could prevent erythema effectively with minimal disruption to wound healing. Notably, when more than one dose was administered, wound healing was delayed and scar contracture was aggravated by the application of medium-potency topical corticosteroids in a dosage-dependent manner. Conclusion: Our findings suggested that single-dose medium-potency topical corticosteroids could potentially improve AFR laser-induced acute inflammatory responses in clinical applications.