Topical Corticosteroid Treatment Research Articles

Occlusive retinal vasculitis and scleritis following brolucizumab treatment: A case report.

Brolucizumab is an anti-vascular endothelial growth factor agent. Clinical trials have demonstrated excellent efficacy of brolucizumab for neovascular age-related macular degeneration in terms of both visual and anatomic outcomes. However, compared with conventional anti-vascular endothelial growth factor therapy, this new treatment has a higher incidence of complications, particularly the development of occlusive retinal vasculitis. In this case report, we describe a patient who developed occlusive retinal vasculitis following brolucizumab treatment for age-related macular degeneration, followed by scleritis 141 days later. A 67-year-old Japanese man with a diagnosis of polypoidal choroidal vasculopathy in his right eye has received 18 intravitreal injections of aflibercept in the past 4 years. Because of a decline in treatment efficacy, intravitreal brolucizumab injection (IVBr) was initiated. However, 17 days after the second IVBr, the patient developed extensive occlusive retinal vasculitis with intraocular inflammation. Occlusive retinal vasculitis in the right eye was diagnosed as a complication of brolucizumab therapy. Corticosteroid treatment was initiated. The occlusive retinal vasculitis resolved 121 days after the second IVBr, and corticosteroid treatment was discontinued on day 138. However, on day 158 after the second IVBr, scleritis with intraocular inflammation developed. By day 184 after the second IVBr, both the scleritis and intraocular inflammation had resolved with the resumption of topical corticosteroid treatment. This case underscores the potential for brolucizumab-induced scleritis and emphasizes the importance of recognizing and promptly managing this complication. Furthermore, it highlights the need for long-term careful follow-up in patients who develop occlusive retinal vasculitis after brolucizumab treatment.

Hand eczema and changes in the skin microbiome after 2 weeks of topical corticosteroid treatment.

More than 50% of patients with hand eczema (HE) are colonized with Staphylococcus aureus. Comprehensive knowledge of the skin microbiome and its changes in patients with HE may provide insights into future potential therapeutical targets. To describe the skin microbiome in patients with moderate-to-severe chronic HE and assess its changes following treatment with topical corticosteroids (TCS). Bacterial samples were collected from lesional and nonlesional skin before and after 2 weeks of TCS treatment using ESwabs and analysed by 16S rRNA and tuf gene sequencing. Clinically, the disease severity was assessed by the Hand Eczema Severity Index (HECSI). A cohort of 31 patients with HE were included and followed up. Compared to nonlesional skin, lesional skin differed in overall bacterial community composition (p = 0.02), displayed higher relative abundance of Staphylococcus, in particular S. aureus (p = 0.01) and lower abundance of Micrococcus (p = 0.02). As disease severity improved with treatment, these microbial characteristics on lesional skin shifted towards that of nonlesional skin on the hands. The bacterial skin microbiome was altered in lesions of HE and partly driven by S. aureus colonization, however, shifted towards nonlesional skin following treatment. Our results emphasize the future possibilities for anti-S. aureus treatment strategies.

Early real-world experience with intravitreal Faricimab for neovascular AMD: FAN study

PurposeThis study presents real-world experiences and clinical outcomes of patients who switched to faricimab after prior treatment with other anti-vascular endothelial growth factor medication for patients with neovascular age-related macular degeneration (nAMD) in 2022. DesignWe evaluated all consecutive patients that received an intravitreal injection (IVI) with faricimab for nAMD and had complete follow-up visits after at least three IVI. MethodsFunctional and structural parameters including best-corrected visual acuity (BCVA, logMAR), foveal centre point (FCP, µm), central subfield retinal thickness (CSRT, µm) and macular volume (mm3) were evaluated after three (n=71) and five (n=57) faricimab injections with complete follow-up visits. ResultsWe included 71 eyes of 63 patients. Mean BCVA at baseline was 0.49 logMAR (0 – 1.6) and did not change significantly after five faricimab injections (p=0.33). Significant reductions were seen for FCP, CSRT and macular volume after the first five consecutive injections when compared to baseline (p<0.0001 respectively). FCP was 388.35 µm (173-924 µm) at baseline and decreased to 279.16 µm (97 – 667) at visit 5. CSRT was 370.68 µm (202 – 1074) and decreased to 307.75 µm (168 – 590) at visit 5. Macular volume was reduced from 2.59 mm3 (1.83 – 4.90) to 2.31 mm3 (1.80 – 3.19) at visit 5. Intraocular inflammation was observed in one eye showing anterior chamber cells that resolved with topical corticosteroid treatment. ConclusionsThe results of the FAN (FAricimab for Neovascular AMD) study indicate that faricimab improves structural outcomes in patients with recalcitrant fluid due to nAMD with no major complications observed.

Polarization of circulating Follicular Helper T cells correlates with the severity of Bullous Pemphigoid.

T-follicular-helper (Tfh) cells form a distinct population of T-helper cells with different polarizations (type 1, type 2 and type 17) that regulates humoral responses and may participate in the pathophysiology of B-cell mediated autoimmune diseases, such as bullous pemphigoid (BP), a dermatosis mediated by auto-antibodies specific for hemidesmosomal proteins. The aim was to evaluate the impact of superpotent topical corticosteroid (TCS) treatment, which is more effective and safer than high doses of oral corticosteroids and recommended first-line treatment of BP, on circulating Tfh cells. We compared by flow cytometry the frequency, polarization and activation of blood Tfh cells from patients with BP at baseline and longitudinally after initiation of TCS treatment to age- and sex-matched healthy subjects. We observed that circulating Tfh cells were more frequent in patients with BP at baseline than in healthy subjects and exhibited an activated phenotype. We further showed a decrease of type 1 and an increase of type 17 Tfh cells in the blood of patients, which resulted in a higher (type 2+type 17) to type 1 Tfh cell ratio. This ratio correlated positively with disease severity as measured by the Bullous Pemphigoid Disease Area Index. Remarkably, along TCS treatment, although the frequency of Tfh cells returned to a level similar to control, the activated phenotype persisted. Interestingly serum IL-21 levels and the Tfh cell subset ratio, similarly to disease activity and serum anti-BP180 and anti-BP230 auto-antibodies, were decreased under the TCS treatment. Overall, our findings suggest an involvement of the polarization of Tfh cells in the pathophysiology of BP and open the door to a modulation of their activity for therapeutic purposes.

Long-term topical corticosteroid treatment for atopic dermatitis: an in-depth analysis of safety, efficacy, withdrawal, and patient experiences

Long-term topical corticosteroid treatment for atopic dermatitis: an in-depth analysis of safety, efficacy, withdrawal, and patient experiences

Case Report: Bullous Pemphigoid and the Association with Dipeptidyl-peptidase 4 Inhibitors

&lt;p&gt;大皰性類天皰瘡(bullous pemphigoid)是一種自體免疫表皮下水泡疾病，表現為全身性瘙癢性蕁麻疹斑塊和緊繃的表皮下水泡。發生率大約每百萬人年為4至22例個案，而且有逐漸增加之趨勢。這種疾病最常影響老年人，除了老年化社會增加罹患風險外，神經疾病增加、與可能誘發類天皰瘡之藥物使用增加皆與該疾病增加的趨勢有關。&lt;/p&gt; &lt;p&gt;本個案為一位90歲的女性，過去疾病包括小腦出血性中風、帕金森氏症、失智症、高血壓、及糖尿病。糖尿病於一年前新診斷並開始使用 linagliptin及glimepiride等藥物控制血糖。主訴近半年多來開始會有全身的癢疹，尤其是軀幹及四肢，兩週前開始在皮膚縐摺處出現水泡及破裂傷口，經過臨床檢驗後診斷為大皰性類天皰瘡，搜索相關文獻後懷疑與 Linagliptin 的使用有關，於是改用其他藥物控制血糖，並開始使用外用及口服類固醇治療。經治療後皮膚明顯改善，不再有新水泡產生。本個案報告簡介大皰性類天皰瘡，亦討論該疾病與降血糖藥物dipeptidyl-peptidase 4 inhibitors (DPP4-inhibitor)之關係，研究發現某些類型的DPP4-inhibitor例如linagliptin與大皰性類天皰瘡的發生機率相關。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Bullous pemphigoid is an autoimmune subepidermal blistering disease characterized by generalized pruritic urticarial plaques and tense subepidermal blisters. The incidence is approximately 4 to 22 cases per million people per year, with a rising trend. This disease predominantly affects the elderly, and the increasing trend is attributed to the aging population, rising incidence of neurological disorders, and the use of medications that may trigger bullous pemphigoid.&lt;/p&gt; &lt;p&gt;This case is a 90-year-old female with a medical history of cerebellar hemorrhagic stroke, Parkinson’s disease, dementia, hypertension, and diabetes. Diabetes was newly diagnosed a year ago, and medications like linagliptin and glimepiride were initiated for blood sugar control. The patient complained of generalized itching and rash for the past six months, particularly on the trunk and limbs. Two weeks ago, blisters and ruptured wounds appeared in the skin folds. After clinical examination, the diagnosis of bullous pemphigoid was made. After reviewing relevant literature, it was suspected to have connection with the use of linagliptin and bullous pemphigoid. We shifted linagliptin to other drugs to control blood sugar, and topical and oral corticosteroid treatment was initiated. The skin significantly improved after treatment. This case report not only introduces bullous pemphigoid but also discusses the association between this disease and dipeptidyl-peptidase 4 inhibitors (DPP-4 inhibitors). Research suggests a correlation between certain types of DPP-4 inhibitors, such as linagliptin, and the occurrence of bullous pemphigoid.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Risk of death, major adverse cardiac events and relapse in patients with bullous pemphigoid treated with systemic or topical corticosteroids.

According to current guidelines, systemic or topical corticosteroids are both recommended as first-line treatments for bullous pemphigoid (BP). There is evidence to suggest that topical application may be associated with a lower risk of mortality. However, there is a lack of comprehensive large-scale data comparing mortality rates, as well as the risk of major adverse cardiac events (MACE), infections and relapse, between systemic and topical corticosteroid treatments. To evaluate the risk of death, MACE, infections and relapse in patients with BP treated with systemic or topical corticosteroids. A population-based retrospective cohort study was performed using the TriNetX US Collaborative Network. As a measure against bias, propensity score matching for age, sex, 10 diseases and 6 medications was done, and 3 sensitivity analyses were conducted. All-time risk of death was increased in US patients with BP exposed to any dose of systemic corticosteroids (n = 2917) vs. patients treated with topical clobetasol propionate [n = 2932; hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.28-1.58 (P < 0.001)]. This was consistent in time-stratified analysis (1- and 3-year mortality rates) and in analysis contrasting prednisone (equivalent) doses of 1-10 mg (low) or 30-100 mg (medium-high) systemic corticosteroid to topical treatment. The increased risk of death in US patients with BP exposed to any dose of systemic corticosteroids vs. topical treatment was accompanied by increased risks for MACE (HR 1.33, 95% CI 1.08-1.64; P = 0.008) and infections (HR 1.33, 95% CI 1.15-1.54; P < 0.001). The risk of continued disease or relapse was decreased in patients treated with systemic vs. topical corticosteroids (HR 0.85, 95% CI 0.77-0.94; P = 0.002). Results regarding mortality and continued disease or relapse persisted in three sensitivity analyses. Potential limitations included the retrospective data collection, bias for treatment selection and miscoding. Pending validation in prospective studies, where feasible - and despite the heightened risk of relapse - topical corticosteroid treatment may be advantageous over systemic corticosteroid treatment owing to its significantly lower risk of death.

Topical Corticosteroid Phobia among Danish Pharmacy Staff

Introduction: Topical corticosteroid (TCS) phobia may negatively impact treatment adherence. Currently, there are few studies exploring trust and knowledge of TCS use among pharmacy staff. The objective of this work was to examine TCS knowledge and possible phobia among Danish pharmacy staff. Methods: A questionnaire, based on Topical Corticosteroid Phobia (TOPICOP©) questionnaire, was developed and rephrased to fit pharmacy staff. The questions were Likert scales and numerical rating scales (NRS) (0–10). In October/November 2021, 64 pharmacies were invited. If the pharmacies agreed to participate, a researcher visited the pharmacies and distributed the questionnaires. Results: A total of 244 pharmacy workers from 59 pharmacies participated. The majority (95.4%) responded that they were aware of side effects of TCS; however, misconceptions regarding side effects were found in up to 34% of participants. Regarding TCS use, 40% sometimes advised the patients to wait as long as possible before initiating treatment with TCS. Confidence in dispensing TCS to patients was high, with a mean of 8.45 (NRS). Conclusion: Danish pharmacy staff generally reported high confidence in TCS use. Misconceptions regarding side effects were common, and there was a tendency to giving advices on TCS treatment that may indicate low confidence in TCS. Thorough education of pharmacy staff is needed to improve the knowledge of TCS.

Abstract 2647: Topical corticosteroids stimulate T cell-dependent melanoma growth control

Abstract Melanoma is the deadliest form of skin cancer. Treatment with immune checkpoint blockade (ICB) has transformed outcomes. However, half of melanoma patients do not derive long-term benefit. Side-effects of ICB are frequent, and typically managed by systemic or topical treatment with corticosteroids, widely known for their immunosuppressive effects. However, clinical data is contradictory as to the effect on prognosis of patients receiving ICB that also receive corticosteroids, with some studies suggesting a negative effect of steroid use, and others suggesting no effect or even positive outcomes with steroid use. Additionally, our lab recently showed that combining corticosteroids with ICB improves treatment responses in certain preclinical cancer models. Thus, understanding the role of corticosteroids in cancer progression, and their effect on the tumor immune microenvironment, is critical. In an intradermal murine melanoma model unresponsive to ICB, we found that topical corticosteroid treatment significantly impairs tumor growth. After just two doses, glucocorticoid-treated tumors shrank, whereas control-treated tumors doubled in volume. Intriguingly, this effect was lost in Rag1−/− mice (deficient in B and T cells) or in mice depleted of CD8+ T cells, uncovering a key role for T cells in corticosteroid-induced tumor growth control. Genetic ablation of the glucocorticoid receptor in tumor cells abrogated this effect, suggesting corticosteroids act directly on tumor cells to stimulate anti-tumor immunity. Analysis of TCGA RNA sequencing data showed melanoma patients with high glucocorticoid receptor expression have better overall survival than those with low expression, a finding repeated in a large, independent cohort of primary melanoma specimens of the Leeds Melanoma Cohort (n=703). Through cellular and molecular profiling using multiparametric flow cytometry and whole exome RNA sequencing, we have identified promising candidate pathways that might underlie the immune-dependent tumor control induced by steroids. Steroids induce tumor control in other, but not all, melanoma and non-melanoma tumor models studied, suggesting this may be a conserved immune-evasive pathway in a subset of tumors. Ongoing work aims to characterize the molecular and cellular effects of topical corticosteroid treatment, and to investigate their relevance in human melanoma. Given the widespread use of corticosteroids in patients receiving ICB, these unexpected findings may have significant clinical impact. Citation Format: Charles H. Earnshaw, Shih-Chieh Chiang, Agrin Moeini, Maria Koufaki, Eduardo Bonavita, Laetitia Nebot-Bral, Massimo Russo, Charlotte Bell, Theophile Bigirumurame, Jérémie Nsengimana, Julia Newton-Bishop, Christopher E. Griffiths, Santiago Zelenay. Topical corticosteroids stimulate T cell-dependent melanoma growth control [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2647.

Efficacy and safety of topical corticosteroid treatment under occlusion for severe alopecia areata in children: asingle-centre retrospective analysis.

Alopecia areata (AA) has a poor clinical course in children. There are no reliable therapeutic options for children with severe AA, including alopecia totalis (AT) and alopecia universalis (AU). We evaluated the efficacy and adverse effects of a potent topical corticosteroid (TCS) under occlusion in paediatric patients with severe AA. We reviewed records of 23 patients under the age of 10 years with AT or AU treated with a potent TCS (0.05% clobetasol propionate or 0.3% diflucortolone valerate) for 8 h under occlusion with a plastic film. We used the Severity of Alopecia Tool (SALT) to measure clinical improvement. The primary endpoint was a SALT score of ≤ 20 at 6 months. We analysed the change in cortisol levels to identify the long-term safety of TCS therapy on the hypothalamus-pituitary-adrenal axis. Nineteen of the 23 patients (83%) reached SALT ≤ 20 at 6 months. Six patients relapsed over the 6-month follow-up period. Four patients were suspected of having adrenal insufficiency. However, the cortisol levels of the patients recovered to normal within 1 month of lowering the TCS potency or changing to nonsteroidal treatments. Limitations include the retrospective design and small sample size. This study shows that a potent TCS occlusion may be a safe treatment option in paediatric patients with severe AA. Further long-term studies are required to evaluate the safety and recurrence of TCS occlusion therapy for paediatric AA.

Differentiated vulvar intraepithelial neoplasia long-term follow up and prognostic factors: An analysis of a large historical cohort.

Differentiated vulvar intraepithelial neoplasia (dVIN) is a high-risk preinvasive vulvar lesion and precursor of human papillomavirus-independent vulvar squamous cell carcinoma (VSCC). Due to its rarity, literature data on its malignant potential are scant. The aim of the study is to assess the risk of developing VSCC in patients surgically treated for dVIN not associated with VSCC (solitary dVIN) and the risk of VSCC recurrence in patients treated for dVIN associated with VSCC (dVIN-VSCC) at first diagnosis. A historical cohort study was performed in a northern Italy referral center for vulvar neoplasms. All consecutive women surgically treated for histologically confirmed dVIN from 1994 to 2021 were collected. Primary outcome was cancer risk or recurrent cancer risk, secondary outcomes were risk factors associated with VSCC development or recurrence. Kaplan-Meier method and log-rank test were used to estimate cancer risk or recurrent cancer risk differences and uni- and multivariate Cox regression analyses to identify risk factors associated with VSCC development in solitary dVIN and recurrence of dVIN-VSCC. Seventy-six patients with dVIN at preoperative biopsy were included: at excisional specimens 44 were solitary dVIN and 32 were dVIN-VSCC. The absolute risk of VSCC development after solitary dVIN treatment was 43.2% with median time to to VSCC diagnosis of 25.4 months (range 3.5-128.0 months). VSCC recurrence absolute risk in treated dVIN-VSCC patients was 31.3% with median time to VSCC recurrence of 52.9 months (range 6.5-94.8 months). At uni- and multivariate regression analyses, only compliant topical ultrapotent corticosteroid treatment after solitary dVIN excision showed an ability to prevent VSCC development. No protective effect by corticosteroid treatment was shown for VSCC recurrence in dVIN-VSCC patients. Smoking was associated with higher cancer recurrence risk in dVIN-VSCC patients on both uni- and multivariate regression analyses. Patients with dVIN have a high risk of developing both primary and recurring VSCC. Early recognition, long-term follow up, and compliant ultrapotent topical corticosteroid treatment are recommended.

Sympathetic Ophthalmia in Paediatric Post-Surgical Repair, A Case Report

Introduction : Sympathetic Ophthalmia (SO) is a rare and devastating complication of ocular trauma. Incidence reached 0.26% among cohort in paediatric open globe injury. We present a case report of pediatric Sympathetic Ophthalmia.&#x0D; Case Illustration : An 8-year-old boy is present in an outpatient clinic with a history of corneal lacerating injury on LE 1 month ago and had surgical repair 7 days after the injury. The patient complained of redness and blurry vision in both eyes. VA RE 0.5 and LE 0.05. RE revealed ciliary injection, flare/cell (f/s) +2/+2, and vitreous cell +1. LE revealed ciliary injection, corneal scars, f/s +2/+2, and vitreous cell +2 (Fig. 1). Fundus and OCT revealed macular oedema with exudative retinal detachment RE and bilateral optic nerve head swelling (Fig. 2). Patient was diagnosed with sympathetic ophthalmia and treated with prednisolone acetate 8x per day for RLE with high-dose oral steroid methylprednisolone 1 mg/kg body weight (32 mg). One week after treatment, clinical findings were improved, and the steroid was tapered. After 2 months f/s, macular oedema, exudative retinal detachment and optic nerve head swelling were resolved with VA RE 1.0 and LE 0.4.&#x0D; Discussion : Although the etiology of SO is currently unknown, it is believed that hypersensitivity following trauma to the fellow eye may be the trigger. The severity of SO's clinical presentation might range from mild to severe.&#x0D; Conclusion : Sympathetic ophthalmia is a serious complication that rarely occurs after trauma, especially in the pediatric population. Prompt treatment of oral and topical corticosteroids may lower the inflammatory response.

Topical Corticosteroid Phobia Among Women Affected With Vulvar Lichen Sclerosus: Results From a Cross-sectional Survey.

Topical corticosteroid (TC) phobia (TCP) is common in subjects affected with chronic inflammatory skin diseases who need prolonged corticosteroid treatments. The aim of this study was to assess TCP in women affected with vulvar lichen sclerosus (VLS). This observational, cross-sectional study included adult patients with VLS who either started or were undergoing a TC treatment at our vulva unit between May 2022 and May 2023. All patients completed the self-administered TOPICOP questionnaire, which is validated for measuring concerns, worries, and beliefs about TC use. The scores obtained were analyzed in relation to demographic, history, and clinical data. The majority of the 165 (92.1%, 66.5 ± 11.9 years) included patients who had previously undergone TC treatments, mostly for VLS; 81.8% of them had received information about TCs, mainly from dermatologists (86.7%). The median global TOPICOP score was 16.7% (interquartile range. 8.3-30.6), corresponding to a raw median value of 6.0 (interquartile range, 3.0-11.0). The median subscores for the 2 TOPICOP domains, namely, mistaken beliefs and worries about TCs, were equal to each other. At multivariate analysis, none of the collected variables showed a significant association with the degree of TCP. In our VLS patients, TCP resulted rather low, probably because of the small skin area being treated and the high percentage of women who had already used TCs and who had received information about them from a dermatologist. This latter point suggests that adequate counseling could be a strong basis for greater awareness and serenity in the long-term use of TCs.

Prevalence of prescribing topical corticosteroids to patients with lichen sclerosus following surgery for vulvar cancer: a survey among gynaecologic oncologists in The Netherlands

Background Vulvar lichen sclerosus (LS) is a chronic inflammatory dermatosis which can progress to precursor lesion differentiated vulvar intraepithelial neoplasia (dVIN) and vulvar squamous cell carcinoma (VSCC). The risk of developing recurrent vulvar cancer following LS-associated VSCC is high. Evidence suggests that treatment of LS with topical corticosteroids (TCS) can prevent progression to dVIN, VSCC and recurrences. However, current guidelines do not give any recommendation on the management of LS following surgery for VSCC. The aim of this study was to conduct a survey among all registered gynaecologic oncologists (GOs) in the Netherlands to evaluate the current management of LS patients without a history of VSCC (LSnoVSCC) and patients with LS following surgery for VSCC (LSVSCC). Methods An online survey was distributed to all registered GOs in the Netherlands. Primary outcome measures were the frequency, type and duration of TCS treatment prescribed for LSnoVSCC and LSVSCC patients, separately. As a secondary outcome measure, reasons for treating or not treating patients with LSnoVSCC and LSVSCC with TCS were analysed. Results Forty-four GOs completed the survey, resulting in a response rate of 75%. TCS were prescribed more often to patients with LSnoVSCC as compared to patients with LSVSCC (86% versus 52%, respectively, p < 0.001). If treatment was initiated, ultra-potent (class IV) TCS were most commonly prescribed for an indefinite period of time for both patient groups. The most reported reason for treating patients in both groups with TCS was symptoms, followed by clinical aspects of the lesion and prevention of progression to dVIN and VSCC. Conclusion The majority of GOs who participated in our study endorse the utilisation of long-term ultra-potent TCS therapy in both patients with LSnoVSCC and LSVSCC. Nevertheless, Dutch GOs are currently prescribing TCS more frequently to patients with LSnoVSCC than to patients with LSVSCC.

Changes in the Oral-Health-Related Quality of Life of Thai patients with oral lichen planus after topical corticosteroid treatment: a 1-month longitudinal study

BackgroundOral lichen planus (OLP) is a chronic inflammatory disease of the oral cavity that affects many patients’ daily living activities. Topical corticosteroids are the first-line drug for treating OLP. The Oral Impact on Daily Performances index (OIDP) is an Oral-Health-Related Quality of Life (OHRQoL) measure developed to assess the ultimate impacts. The aims of this study were to evaluate the clinical, pain and OHRQoL responses after treating OLP patients with topical corticosteroids for 1 month, and secondly to assess the relationships of changes in the clinical sign score, pain score, and OHRQoL.MethodsSeventy-two OLP patients were treated by topical corticosteroids based on their dentists’ clinical judgments. Clinical and patient-based outcomes were assessed at baseline and follow-up visit. The clinical outcomes were evaluated by the highest and total Thongprasom sign score. Patient-based outcomes were evaluated by numeric rating scale (NRS) and OIDP. The self-rated overall changes in quality of life during the 1-month treatment period using the Patient Global Impression of Change (PGIC) were also recorded at the follow-up visit.ResultsThis study comprised 59 women and 13 men. All clinical and patient-based outcomes were significantly reduced after 1-month treatment with topical corticosteroids (P < 0.01). The most commonly affected activities were Emotional stability, followed by Eating and Cleaning the oral cavity. Forty-six percent reported the same or up to moderately improved, while 54% had a greatly improved quality of life as assessed by PGIC. There were no significant differences in the improvement of clinical and patient-based outcomes between these groups. There were significant relationships between the differences in the highest Thongprasom sign score and the differences in total Thongprasom sign score (r = 0.293; P < 0.05), and the differences in total OIDP percentage score and the difference in pain score (r = 0.427; P < 0.001). The differences in the total Thongprasom sign score also significantly related to the difference in the total OIDP percentage score (r = 0.335; P < 0.01).ConclusionsTopical corticosteroids were significantly effective after 1-month treatment of OLP based on the clinical and patient-based outcomes. The OHRQoL improvement was significantly related to the reductions in pain and clinical severity.Trial registrationThe trial was registered at the Thai Clinical Trials Registry (TCTR identifier: TCTR 20221110001).

Laser Therapy for Vulvar Lichen Sclerosus, a Systematic Review.

Lichen sclerosus (LS) is a chronic inflammatory disease that mainly affects the anogenital area, with a higher incidence in post-menopausal women. In the long term, it can lead to loss of vulvar architecture or progress to squamous cell carcinoma. The evidence-based treatment involves high-potency topical corticosteroids in long regimens. However, second-line treatments are not well-established, including laser therapy. This current study aims to assess the level of evidence supporting this therapy. We conducted a search for primary-level studies published before April 2023 through MEDLINE/PubMed, Embase, Web of Science, Scopus, and CENTRAL, with no restrictions on the publication language or date. The methodological quality and risk of bias of the included studies were evaluated using the updated Cochrane Collaboration's tool for assessing risk of bias (RoB-2). Six studies (177 patients) met our eligibility criteria. Laser therapy was compared to topical corticosteroid treatment in five out of six studies. No significant histological differences were found, except for an increase in collagen production in the laser group. A greater reduction in itching, pain, and dyspareunia at 1 and 3 months of treatment in the laser group, as well as in the Skindex-29 at 6 months, was reported. Patient satisfaction was significantly higher among those who received laser therapy. Tolerability was excellent. No significant differences were observed in any of the previous aspects in the study compared to the placebo. In conclusion, there is not enough evidence to recommend laser therapy as a standalone treatment.

Clinical Features and Treatment Response to Topical Steroids in Ethnic and Racial Minority Patients With Eosinophilic Esophagitis.

Differences in eosinophilic esophagitis (EoE) presentation and outcomes by ethnicity or race remain understudied. We aimed to determine whether EoE patients of Hispanic/Latinx ethnicity or non-White race have differences in presentation at diagnosis or response to topical corticosteroid (tCS) treatment. This retrospective cohort study included subjects of any age with a new diagnosis of EoE and documentation of ethnicity or race. For those who had treatment with tCS and follow-up endoscopy/biopsy, we assessed histologic response (<15 eosinophils/hpf), global symptom response, and endoscopic response. Hispanic EoE patients were compared with non-Hispanics at baseline and before and after treatment. The same analyses were repeated for White vs non-Whites. Of 1,026 EoE patients with ethnicity data, just 23 (2%) were Hispanic. Most clinical features at presentation were similar to non-Hispanic EoE patients but histologic response to tCS was numerically lower (38% vs 57%). Non-White EoE patients (13%) were younger at diagnosis and had less insurance, lower zip code-level income, shorter symptom duration, more vomiting, less dysphagia and food impaction, fewer typical endoscopic features, and less dilation. Of 475 patients with race data treated with tCS, non-Whites had a significantly lower histologic response rate (41% vs 59%; P = 0.01), and odds of histologic response remained lower after controlling for potential confounders (adjusted odds ratio 0.40, 95% confidence intervals: 0.19-0.87). Few EoE patients at our center were Hispanic, and they had similar clinical presentations as non-Hispanics. The non-White EoE group was larger, and presentation was less dysphagia-specific. Non-White patients were also less than half as likely to respond to tCS.

The long-term safety of topical corticosteroids in atopic dermatitis: A systematic review.

Topical corticosteroids (TCS) are a first-line treatment for eczema, but there are concerns about their safety when used long-term. To systematically review adverse effects associated with longer-term use of TCS for eczema. Randomised controlled trials (RCTs), cohort and case-control studies reporting adverse effects of TCS (comparators: no TCS treatment, other topicals) in patients with eczema were identified. Included studies had greater than one year of follow-up, minimum cohort size of 50 participants, or minimum 50 per arm for RCTs. Evidence was GRADE-assessed. Prospero registration CRD42021286413. We found seven studies (two randomised, five observational); two RCTs (n=2570, including 1288 receiving TCS), two cohort (all received TCS n=148) and three case-control studies (cases n=10322, controls n=12201). Evidence from two RCTS (n=2570, children, three and five years' duration) comparing TCS to topical calcineurin inhibitors found intermittent TCS use probably results in little to no difference in risk of growth abnormalities, non-skin infections, impaired vaccine response and lymphoma/non lymphoma malignancies. The five-year RCT reported only one episode of skin atrophy (n=1213 TCS arm; mild/moderate potency), suggesting TCS use probably results in little to no difference in skin thinning when used intermittently to treat flares. No cases of clinical adrenal insufficiency were reported in 75 patients using mild/moderate TCS in the three-year RCT. Small associations between TCS and type-2 diabetes and lymphoma were identified in two case-control studies compared to no TCS, but the evidence is very uncertain. No long-term studies concerning topical steroid withdrawal or eye problems were identified. This review provides some reassuring data on growth and skin thinning when TCS are used intermittently for up to 5years, but many knowledge gaps remain.

Topical corticosteroids inhibit allergic skin inflammation but are ineffective in impeding the formation and expansion of resident memory T cells.

Tissue-resident memory T (TRM ) cells are detrimental in allergic contact dermatitis (ACD), in which they contribute to the chronicity and severity of the disease. We assessed the impact of a standard topical corticosteroid (TCS) treatment, triamcinolone acetonide (TA), on the formation, maintenance and reactivation of epidermal TRM cells in a preclinical model of ACD to 2,4-dinitrofluorobenzene. TA 0.01% was applied at different time points of ACD response and we monitored skin inflammation and tracked CD8+ CD69+ CD103+ TRM by flow cytometry and RNA sequencing. The impact of TA on TRM formation depended on treatment regimen: (i) in a preventive mode, that is, in sensitized mice before challenge, TA transiently inhibited the infiltration of effector T cells and the accumulation of TRM upon hapten challenge. In contrast, (ii) in a curative mode, that is, at the peak of the ACD response, TA blocked skin inflammation but failed to prevent the formation of TRM . Finally, (iii) in a proactive mode, that is, on previous eczema lesions, TA had no effect on the survival of skin TRM , but transiently inhibited their reactivation program upon allergen reexposure. Indeed, specific TRM progressively regained proliferative functions upon TA discontinuation and expanded in the tissue, leading to exaggerated iterative responses. Interestingly, TRM re-expansion correlated with the decreased clearance of hapten moieties from the skin induced by repeated TA applications. Our results demonstrate that TCS successfully treat ACD inflammation, but are mostly ineffective in impeding the formation and expansion of allergen-specific TRM , which certainly restricts the induction of lasting tolerance in patients with chronic dermatitis.

Dupilumab Treatment Leads to Rapid and Consistent Improvement of Atopic Dermatitis in All Anatomical Regions in Patients Aged 6 Months to 5 Years.

Atopic dermatitis (AD) is heterogeneous in distribution pattern and clinical features. This analysis assessed the effect of dupilumab on the extent and severity of AD across various signs (erythema, edema/papulation, excoriation, lichenification) in different anatomical regions (head and neck, trunk, upper extremities, lower extremities) in patients aged 6months to 5years. In LIBERTY AD PRESCHOOL, a double-blind, placebo-controlled, phase III clinical trial, children aged 6months to 5years with moderate-to-severe AD were randomized 1:1 to subcutaneous dupilumab or placebo with concomitant low-potency topical corticosteroids (TCS) every 4weeks for 16weeks. Changes in AD signs across anatomical regions were assessed using unweighted Eczema Area and Severity Index (EASI) body region scores. Overall, 162 patients were randomized to dupilumab (n = 83) or placebo (n = 79). A significant improvement in least squares mean EASI area score was seen by week 2 in all four anatomical regions (P < 0.0001 for dupilumab vs. placebo) and sustained throughout treatment. Least squares mean EASI sign scores in erythema, excoriations, and infiltration/papulation showed significant improvement by week 2 in all regions (P < 0.001), while lichenification showed significant improvement in all regions by week 4 (P < 0.001). Dupilumab use with concomitant low-potency TCS treatment resulted in rapid and consistent improvement in AD signs in all anatomical regions, in patients aged 6months to 5years with moderate-to-severe AD. ClinicalTrials.gov Identifier: NCT03346434 Part B.