Use Of Topical Corticosteroids Research Articles

The efficacy and safety of oral microecological agents as add-on therapy for atopic dermatitis: A systematic review and meta-analysis of randomized clinical trials.

Atopic dermatitis (AD) is a common skin disease that is hard to completely cure in a short time. Guidelines recommend the use of topical corticosteroids (TCS) as first-line anti-inflammatory therapy for AD, but long-term use has significant side effects. Microecological agents (MA), including probiotics, prebiotics and synbiotics, have been widely reported as a potential adjunctive therapy of AD, but whether MA can contribute to AD treatment is currently controversial. Therefore, we conducted a systematic review and meta-analysis to investigate whether MA as an add-on therapy for AD has synergistic and attenuated effects and to further understand the role of MA in clinical interventions for AD. We systematically searched Medline, Embase, Web of Science, Cochrane Library and PsycINFO databases up to Apr 11, 2023, and bibliographies were also manually searched, for potentially relevant studies regarding MA as additional therapy of AD. The Cochrane Risk of Bias Tool for assessing risk of bias was used to assess the quality of randomized controlled trials (RCTs). Two reviewers screened studies, extracted data, and evaluated the risk of bias independently. The primary outcomes (SCORAD scores and the number of adverse events) and the secondary outcomes (pruritus scores, the quality of life and the frequency of TCS) were extracted from each article. The data were combined and analyzed to quantify the safety and efficacy of the treatment. R (V4.4.3) software was used for data synthesis. The certainty of the evidence was evaluated with the Grade of Recommendation, Assessment, Development and Evaluation (GRADE) system. We also performed a trial sequential analysis to assess the reliability of the evidence. A total of 21 studies, including 1230 individuals, were identified, 20 of which met the eligibility criteria for the meta-analysis. Our pooled meta-analyses showed that compared with controls, oral MA as an add-on therapy was associated with significantly lower SCORAD scores (MD=-5.30, 95% CI -8.50, -1.55, p<0.01, I2 =81%). However, adverse events, pruritus scores, quality of life, and frequency of TCS use showed no significant difference in this meta-analysis study (p>0.05). This meta-analysis showed that MA plus TCS could be an effective and safe treatment for patients with AD to relieve relevant symptoms, which might be used as an add-on therapy in the treatment of AD. However, due to the limited number of studies, results should be interpreted with caution. Further studies with a larger sample size are needed to explore the optimal protocol of MA plus TCS.

Clinical features and therapeutic approaches of genital lichen sclerosus in children: results of an observational monocentric study

BackgroundLichen sclerosus is a chronic, progressive, inflammatory skin disease that presents unique challenges, particularly in the pediatric population, where limited data exist regarding its manifestation and optimal management. This retrospective observational monocentric study aims to provide insights into the clinical characteristics and therapeutic strategies employed, in a cohort of children and adolescents with genital lichen sclerosus.MethodsA comprehensive analysis was conducted involving a cohort of 60 pediatric patients ranging from 1 to 15 years old, all diagnosed with lichen sclerosus. These cases were referred to the Pediatric Dermatology Regional Center of the University of Padua, Italy, between January 2018 and January 2022. Moreover, we propose a treatment protocol that showed beneficial outcomes in all of our patients. Specifically, the initial use of mid-potency topical corticosteroids has proven effective in addressing severe acute flares. Following this acute phase, transitioning to long-term treatment with topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, has demonstrated effectiveness in maintaining remission of the disease and also shown efficacy in treating mild cases. The therapeutic effectiveness was assessed by considering various clinical aspects, including erythema, paleness, skin erosions, and specific symptoms such as itching, burning, and pain.ResultsErythema emerged as the predominant clinical sign, reported in 43 (78.3%) patients, followed by paleness, reported in 17 (28.3%) patients. Pruritus was observed in 25 girls (58.1% of females) and 2 boys (11.8% of males), while pain and burning sensations were predominantly reported in female children. Among females, we observed a higher prevalence of cutaneous comorbidities, such as atopic dermatitis, psoriasis, alopecia areata, and linear scleroderma, as opposed to autoimmune systemic diseases, that were more prevalent in males. Regarding therapeutic approaches, 21 (35.0%) patients applied topical corticosteroids, 28 (46,7%) applied topical tacrolimus and 21 (35,0%) applied topical pimecrolimus. All treated patients experienced notable benefits following the initiation of treatment proposed by our protocol.ConclusionsThis study provides further insights into the clinical presentation and management of lichen sclerosus in the pediatric population, shedding light on potential therapeutic pathways for optimizing patient outcomes in this specific demographic. The proposed protocol appears to be a promising strategy, especially when the onset of the disease occurs during childhood.

831. Majocchi’s Granuloma – A Single Institution Retrospective Review

Abstract Background Majocchi’s granuloma (MG) is an uncommon deep fungal folliculitis predominantly caused by dermatophytes. Available data regarding predisposing comorbidities/risk factors, clinical characteristics, offending microbiologic pathogens, diagnostics, pathologic findings, and treatment approaches has been inferred from historical cases. Given these limitations in the existing literature of MG, we sought to conduct a detailed review of our institutional experience with biopsy-confirmed cases of MG. Methods Following IRB approval, we retrospectively identified and analyzed a multicenter cohort of adult patients diagnosed with MG between September 1992 and September 2022 at Mayo Clinic campuses (Figure 1). Data extracted included demographics, comorbid conditions, presenting clinical characteristics, diagnostic, microbiologic, and biopsy characteristics, treatment details, and outcomes. Figure 1 Flow Diagram show exclusion of patients from the final cohort. Results A total of 147 patients with MG with the accompanying baseline characteristics met study criteria (Table 1). One-hundred and five patients were male with a median age of 55.6 years. Immunosuppressant and topical corticosteroid use were common prior to development of MG (Table 1). Dermatologic lesions and their sites of involvement did not differ based on the immune status of patients (Table 2). Trichophyton rubrum was the most common causative pathogen of MG, in addition to other dermatophytes and fungal organisms (Table 3a). Treatment duration for all prescribed agents was median 31.5 days. Oral terbinafine was the most frequently utilized agent and clinical resolution was achieved in 96.6% of cases (Table 3b). Baseline Characteristics of 147 Patients with Majocchi’s Granuloma Diagnostic, Microbiologic, and Biopsy Characteristics, Treatment Characteristics and Outcomes Conclusion While rare and clinically variable in presentation, the diagnosis of MG requires careful clinical examination and history-taking, histopathologic confirmation, and frequently fungal culture. Most cases of MG in our study responded well to a course of oral terbinafine at a median of 31.5 days of treatment. Disclosures All Authors: No reported disclosures

Treatment satisfaction of adult patients with moderate-to-severe atopic dermatitis treated with baricitinib in France, Germany, and the United Kingdom: results from a cross-sectional international patient survey

IntroductionWe explored patient satisfaction with baricitinib, an oral Janus kinase inhibitor, in patients with atopic dermatitis (AD) treated in routine clinical practice.MethodsAdults with moderate-to-severe AD treated with baricitinib in clinical practice for ≥4 weeks in France, Germany, and the UK completed a one-time online survey under market research methodologies. Treatment satisfaction was assessed using a Likert scale and abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9). Patients reported demographic, disease, and treatment information. Data were analyzed descriptively.ResultsThe survey was completed by 170 patients with a mean age of 39.3 years (SD = 13.5), 59% (n = 101) were female. At baricitinib initiation, 79% rated their AD as “Severe”, yet 28% reported body surface area (BSA) involvement ≥10%. Most were “Satisfied” or “Very satisfied” (76%/18%) with baricitinib, with high rates reported for controlling itch (36%/56%). Itch improvements were noted by 97% of patients. Some tapered/stopped (50%/32%) topical corticosteroid use, aligned with reported improvements on the patient global assessment and BSA. Mean TSQM-9 convenience score was 78.0 (SD = 14.0).ConclusionsSatisfaction with itch control was particularly high, reflected in rates of improvement in itch since starting baricitinib. On the TSQM-9, the convenience score was the highest. Many patients tapered/stopped concomitant topicals, indicating baricitinib’s effect in controlling AD symptoms.

Platelet-Rich Plasma (PRP) and Adipose-Derived Stem Cell (ADSC) Therapy in the Treatment of Genital Lichen Sclerosus: A Comprehensive Review.

Lichen sclerosus (LS) is a chronic inflammatory dermatosis mostly localized in the genital area, characterized by vulvar alterations that can severely impact a patient's quality of life. Current treatment modalities often provide incomplete relief, and there is a need for innovative approaches to manage this condition effectively. Platelet-rich plasma (PRP) and adipose-derived stem cells (ADSCs) have emerged as potential regenerative therapies for LS, offering promising results in clinical practice. This comprehensive review explores the utilization of PRP and ADSC therapy in the treatment of genital LS, highlighting their mechanisms of action, safety profiles, and clinical outcomes. PRP is a blood product enriched in growth factors and cytokines, which promotes tissue regeneration, angiogenesis, and immune modulation. ADSC regenerative potential relies not only in their plasticity but also in the secretion of trophic factors, and modulation of the local immune response. Numerous studies have reported the safety of PRP and ADSC therapy for genital LS. Adverse events are minimal and typically involve mild, self-limiting symptoms, such as transient pain and swelling at the injection site. Long-term safety data are encouraging, with no significant concerns identified in the literature. PRP and ADSC therapy have demonstrated significant improvements in LS-related symptoms, including itching, burning, dyspareunia, and sexual function. Additionally, these therapies enable many patients to discontinue the routine use of topical corticosteroids. Several studies have explored the efficacy of combining PRP and ADSC therapy for LS. In combination, PRP and ADSCs seem to offer a synergistic approach to address the complex pathophysiology of LS, particularly in the early stages. The use of PRP and ADSC therapy for genital lichen sclerosus represents a promising and safe treatment modality. These regenerative approaches have shown significant improvements in LS-related symptoms, tissue trophism, and histological features. Combination therapy, which harnesses the synergistic effects of PRP and ADSCs, is emerging as a preferred option, especially in early-stage LS cases. Further research, including randomized controlled trials and long-term follow-up, is warranted to elucidate the full potential and mechanisms of PRP and ADSC therapy in the management of genital LS. These regenerative approaches hold great promise in enhancing the quality of life of individuals suffering from this challenging condition.

Safety of topical tacrolimus and corticosteroids in young children with atopic dermatitis: a 5-year questionnaire-based follow-up study.

We previously conducted a randomized double-blinded clinical cohort study on topical tacrolimus safety issues in 1–3-year-old children with atopic dermatitis. Five years on, the participants were contacted via a postal questionnaire to obtain long-term data. There were no significant differences regarding infections, growth parameters (height, weight, body mass index), quality of life and disease severity between use of topical tacrolimus and topical corticosteroids.

Effectiveness of antibacterial therapeutic clothing vs.nonantibacterial therapeutic clothing in patients withmoderate-to-severe atopic dermatitis: arandomizedcontrolled observer-blind pragmatic trial(ABC trial).

Increased Staphylococcus aureus (SA) colonization is considered an important factor in the pathogenesis of atopic dermatitis (AD). Antibacterial therapeutic clothing aims to reduce SA colonization and AD inflammation; however, its role in the management of AD remains poorly understood. To investigate the effectiveness of antibacterial therapeutic clothing + standard topical treatment in patients with moderate-to-severe AD vs. standard therapeutic clothing + standard topical treatment; and, if effectiveness was demonstrated, to demonstrate its cost-effectiveness. A pragmatic double-blinded multicentre randomized controlled trial (NCT04297215) was conducted in patients of all ages with moderate-to-severe AD. Patients were centrally randomized 1 : 1 : 1 to receive standard therapeutic clothing or antibacterial clothing based on chitosan or silver. The primary outcome was the between-group difference in Eczema Area and Severity Index (EASI) measured over 52weeks. Secondary outcomes included patient-reported outcomes (PROs), topical corticosteroid (TCS) use, SA colonization, safety and cost-effectiveness. Outcomes were assessed by means of (generalized) linear mixed-model analyses. Between 16 March 2020 and 20 December 2021, 171 patients were enrolled. In total, 159 patients were included (54 in the standard therapeutic clothing group, 50 in the chitosan group and 55 in the silver group). Adherence was high [median 7 nights a week wear (interquartile range 3-7)]. Median EASI scores at baseline and at 4, 12, 26 and 52 weeks were 11.8, 4.3, 4.6, 4.2 and 3.6, respectively, in the standard therapeutic clothing group vs. 11.3, 5.0, 3.0, 3.0 and 4.4, respectively, in the chitosan group, and 11.6, 5.0, 5.4, 4.6 and 5.8, respectively, in the silver group. No differences in EASI over 52 weeks between the standard therapeutic clothing group, the chitosan group [-0.1, 95% confidence interval (CI) -0.3 to 0.2; P = 0.53] or the silver group (-0.1, 95% CI -0.3 to 0.2; P = 0.58) were found. However, a small significant group × time interaction effect between the standard and silver groups was found (P = 0.03), in which the silver group performed worse after 26 weeks. No differences between groups were found in PROs, TCS use, SA skin colonization and healthcare utilization. No severe adverse events or silver absorption were observed. The results of this study suggest no additional benefits of antibacterial agents in therapeutic clothing in patients with moderate-to-severe AD.

Efficacy of panthenol- and bisabolol-containing lip care as monotherapy for mild-to-moderate cheilitis.

Cheilitis is a chronic inflammatory condition of the lips, and frequent or prolonged use of topical corticosteroids may lead to various adverse events. Therefore, alternative therapies with fewer side effects are beneficial for the treatment of this condition. To evaluate the efficacy of a lip care formulation containing both panthenol and bisabolol as a monotherapy for mild-to-moderate cheilitis. This single-centre prospective pilot open-label study included 20 patients with mild-to-moderate cheilitis who were treated with the tested lip care for 8 weeks and evaluated by physician and patient assessments before the final efficacy was determined using the Visioscan score. Of the 20 patients, 13 (65.0%) presented with moderate cheilitis with dry and chapped lips. All parameters, including physician and patient clinical scores and bioengineering measurements, showed significant improvements as early as week 2 and sustained until week 8 following the application of the tested lip care. The frequency of cheilitis flareups also decreased significantly. The tested product was well tolerated without any adverse effects. Lip care with panthenol and bisabolol was safe and effective. It can be used as monotherapy for the treatment of mild-to-moderate cheilitis.

Analysis of factors complicating the course of acne

Acne is among the most common conditions encountered in dermatological practice. In recent decades, there has been an increase in severe, complicated forms of acne. Objective — to analyze the factors that affect the deterioration of the clinical course of acne and stimulate the development of moderate and severe forms of acne. Materials and methods. For 3 years (2020—2023) we monitored 95 patients aged 18 to 35 years (45 men and 50 women), suffering from moderate to severe forms of acne. Before starting treatment, all patients completed a special questionnaire developed by us and taking into account known trigger factors. Results and discussion. Factors stimulating the transformation of mild acne into moderate and severe forms of the disease differ in groups of men and women. Among men, stress worsened the clinical course of dermatosis in 5 (11.1 %) cases, in women — in 9 (18 %). Among the factors that influenced the course of acne in women, we can distinguish the use of contraceptives 2 (4 %) and dysmenorrhea in 4 (8 %) people. 2 (4 %) patients clearly noted an improvement in the course of acne after withdrawal of contraceptives. Alcohol stimulated exacerbation of acne in 3 (6.7 %) men. Not sticking to the diet more often contributed to the exacerbation of acne in women — 9 (18 %), compared to only 6 (13.3 %) in men. A significant role in the stimulation of acne activity was played by irrational antibacterial topical therapy: 2 (4.4 %) men and 4 (8 %) women used topical drugs with clindamycin and erythromycin for a long time. There were cases of prolonged use of topical corticosteroids (for more than 3 months), which significantly worsened the clinical course of acne, in one case led to the development of steroid rosacea. 7 (14 %) women and 3 (6.7 %) men associated exacerbation of the disease with the intervention of a cosmetologist who did mechanical cleaning during the activation of acne. 5 (11.1 %) men and 3 (6 %) women were associated with worsening of the course of acne after SARS-CoV-2 infection. Also, the most common factor in acne exacerbation was self-medication: 7 (15.5 %) men and 6 (12 %) women. Some patients were unable to isolate any of the known trigger factors of acne: 9 (20 %) men, 3 (6 %) women. Conclusions. The study made it possible to identify a number of factors that affect the severity of the clinical course of acne. The most common triggers were psycho-emotional stress (18.0 % of women and 11.1 % of men), diet disorders (18 % of women and 13.3 % of men), self-treatment (15.5 % of men and 12 % of women), the COVID-19 pandemic (11.1 % of men and 6.0% of women), the intervention of cosmetologists with irrational aesthetic procedures (6.7 % of men and 14.0 % of women). Thus, the identified trigger factors of acne have gender, nutritional, behavioral characteristics, which requires further study and development of algorithms for their elimination and correction.

Feasibility of a Keratin-Based Topical Cream for Radiation Dermatitis in Patients with Head and Neck Cancer: Results of a Randomized Pilot Study

Acute radiation dermatitis (RD) is a frequent toxicity associated with radiotherapy (RT) for head and neck cancer (HNC). KeraStat Cream (KC), an emulsion-based wound dressing that acts as a protective barrier that promotes the healing of minor skin wounds and partial-thickness burns, has not yet been studied in patients receiving RT for HNC. This randomized, open-label pilot study enrolled patients with HNC planned to receive definitive or postoperative RT to a total dose of at least 60 Gy. The study excluded patients with a history of prior RT, use of topical corticosteroids, scleroderma, lupus, or treatment with anti-EGFR therapy. Eligible patients were randomized to KC or routine skin care (RSC, patient choice of a variety of commercially available topical creams/lotions), applied at least twice daily during and for 1 month after RT. Assessments were performed at baseline, weekly during RT, and 1-month after RT. The primary outcome was adherence to the prescribed skin care regimen (at least 10 applications per week of treatment, starting at week 2). Secondary outcomes were the incidence rates of clinician-rated and patient-reported dermatitis (CTCAE and PRO-CTCAE grades 2+) and the Dermatologic Life Quality Index (DLQI, range 0-30 with a higher number indicating worse skin-related quality of life) at the last assessment before radiotherapy completion (end-RT). Of 29 patients enrolled, 24 (n = 12 in each group) were randomized and completed the study. Most patients had stage III-IV disease (17, 71%), and the most common primary site was the oropharynx (n = 11, 46%), followed by the oral cavity (n = 7), larynx (n = 5), and sinonasal (n = 1). The median RT dose was 68 Gy (range 60-70), median skin V60 was 37.2 cc (range 1.5-107.6), and median skin V70 was 0 cc (range 0-24.9), with no differences between groups. The bilateral neck was treated in most patients (n = 19, 79%), primary site treated in 3 and unilateral neck treated in 2 patients. Most patients received concurrent chemotherapy (n = 18, 75%). Complete adherence to assigned skin care was observed in 7/12 (58%) patients in the RSC group vs. 10/12 (83%) patients in the KC group (p = 0.65). Nearly all patient-weeks were adherent: 64/67 patients in the KC group and 61/68 patients in the RSC group (p = 0.20). Incidence rates of G2+ RD were similar between the KC and RSC groups: CTCAE, 9/12 vs. 7/12 (p = 0.67); PRO-CTCAE, 10/12 vs. 8/12 (p = 0.64). When measured at end-RT, mean RD scores were similar between the KC and RSC groups: CTCAE, 1.4 vs. 1.8 (p = 0.30); PRO-CTCAE, 2.0 vs. 2.0 (p = 1); DLQI (4.8 vs. 4.6, p = 0.92). Repeated measures analysis showed no difference between arms for CTCAE (p = 0.72), PRO-CTCAE (p = 0.96), or DLQI (p = 0.78). A randomized study of KC vs. RSC is feasible with good adherence to assigned skin care, particularly in the KC group. Future randomized trials are warranted to investigate the efficacy of this novel topical approach to RD during radiotherapy for HNC.

Case - Central serous retinopathy following topical intraurethral corticosteroid use for urethral stricture secondary to lichen sclerosus.

Case - Central serous retinopathy following topical intraurethral corticosteroid use for urethral stricture secondary to lichen sclerosus.

Majocchi's granuloma—A multicenter retrospective cohort study

Majocchi's granuloma (MG) is an uncommon deep fungal folliculitis predominantly caused by dermatophytes. Given the rarity of this condition, available data regarding predisposing comorbidities/risk factors, clinical characteristics, offending microbiologic pathogens, diagnostics, pathologic findings, and treatment approaches has been inferred from historical cases. To review our institutional experience with MG. We retrospectively analyzed a multicenter cohort of adult patients diagnosed with MG between 1992 and 2022. We analyzed 147 patients with MG, 105 of which were male with a median age of 55.6years. Immunosuppressant and topical corticosteroid use were common prior to development of MG. Dermatologic lesions and their sites of involvement did not differ based on the immune status of patients. Trichophyton rubrum was the most common causative pathogen of MG, in addition to other dermatophytes. Treatment duration for all prescribed agents was median 31.5days with oral terbinafine being the most frequently utilized agent. Clinical resolution was achieved in 96.6% of cases. Retrospective, nonrandomized study. Although rare and clinically variable in presentation, diagnosis of MG often requires histopathologic confirmation to subsequently direct prolonged treatment with systemic antifungal therapy for mycological cure.

Topical Corticosteroid-Induced Iatrogenic Cushing Syndrome in an Adolescent: A Case Report

Cushing syndrome (CS) is an endocrinological disorder characterized by increased blood cortisol level. It is either due to an excessive endogenous release of steroids (e.g., pituitary adenoma or adrenal hyperplasia) or exogenous administration of steroids. Iatrogenic Cushing syndrome is the most common form of Cushing syndrome. The vast majority of cases are due to oral or parenteral steroid preparations, which are commonly prescribed for pulmonary, renal, hematological or autoimmune diseases. Prolonged use of topical corticosteroids, particularly in children, may cause Cushing syndrome and suppression of the hypothalamo-pituitory-adrenal (HPA) axis, which is less common than that of oral or parenteral route. Iatrogenic CS due to the overuse of topical corticosteroids is rarely reported. There are only few cases that reported young children having Cushing syndrome secondary to misuse of topical corticosteroids.

Pityriasis Rosea of Gibert: A Comprehensive Review of a Common, Self-Limiting Dermatologic Entity

Pityriasis rosea of Gibert is a common, self-limiting dermatologic entity that continues to raise questions regarding its etiology, diagnosis, and clinical management. This comprehensive review focuses on analyzing the distinctive clinical presentation of pityriasis rosea, characterized by the appearance of a herald patch followed by multiple secondary collarete or Christmas tree lesions. Although the exact cause of this disease remains unknown, a possible relationship with an immune reaction triggered by a previous viral infection or environmental factors yet to be identified is postulated. Through a thorough literature search, current findings on the epidemiology, pathogenesis and clinical diagnosis of pityriasis rosea are evaluated. The importance of the clinician's clinical judgment and accurate identification of the distinctive features of the skin lesions to reach an accurate diagnosis is emphasized. Although pityriasis rosea is usually asymptomatic or causes mild pruritus in most cases, symptomatic therapeutic options, such as the use of oral antihistamines and low potency topical corticosteroids, are described to alleviate patient discomfort when necessary. Patient education and psychological support are essential to decrease the anxiety associated with skin lesions and to provide reassurance during the self-limiting course of this condition. In the context of the clinical and epidemiologic relevance of pityriasis rosea, the need for continued research to improve understanding of its etiology and management arises. Although pityriasis rosea does not represent a serious health threat, its high frequency in the population and its distinctive clinical appearance underscore the importance of empathetic and compassionate medical care to ensure the patient's well-being during the process of spontaneous resolution.

Cepharanthine and Oral Lichen Planus Efficacy (COLE) study: protocol for a multicentre randomised controlled study assessing the efficacy and safety of cepharanthine with topical corticosteroids in oral lichen planus

IntroductionOral lichen planus (OLP) is a chronic, inflammatory oral condition leading to a range of symptoms from mild discomfort to severe pain, affecting patients’ quality of life. Standard therapy involves...

Clinical and biochemical assessment of the effect of topical use of coenzyme Q10 versus topical corticosteroid in management of symptomatic oral lichen planus: randomized controlled clinical trial

BackgroundOral lichen planus (OLP) is a chronic mucocutaneous immunologically mediated condition that has a great adverse effect on oral functions. Corticosteroids are still the first drugs of choice used in the treatment of OLP; however, they have extensive medical side effects. The present study was carried out to assess the clinical therapeutic effect of the topical use of coenzyme Q10 (coQ10 or ubiquinol) versus topical corticosteroids in the management of symptomatic OLP and to determine whether the effect, if any, was due to the powerful antioxidant activity of coQ10.Subjects and methodsWe performed a randomized, double blinded controlled trial at the Faculty of Dentistry, Cairo University, Egypt. The study was conducted on 34 patients suffering from symptomatic OLP. Patients were randomly divided into two groups: intervention group (I),who received topical CoQ10 in the form of mucoadhesive tablets (40% CoQ10) 3 times daily for one month and control group (II),who received topical corticosteroid (kenacort in Orabase: triamcinolone acetonide 0.1% 5-g adhesive paste – dermapharm), 4 times daily for one month. Patients were evaluated at one-week intervals using the clinical parameters (score) of pain (VAS) and lesion size. Additionally, salivary levels of malondialdehyde (MDA) were detected in both groups before and after treatment using ELISA. All recorded data were analysed using independent t test, ANOVA followed by Bonferroni post hoc test for lesion size and salivary level of MDA data and Mann–Whitney U test and Friedman test for VAS data.ResultsBoth groups showed a significant reduction in pain and the size of the lesions (p ≤ 0.05) with no statistically significant difference between them (p > 0.05), and this clinical improvement was associated with a reduction in the salivary levels of MDA in both groups.ConclusionsThe topical use of CoQ10 mucoadhesive tablets was as effective as the topical use of triamcinolone acetonide, and its clinical effect was associated with a reduction in the salivary level of MDA.Trial registrationThe study protocol was registered at www.clinicaltrial.gov (NCT04091698) and registration date: 17/9/2019.

Pharmacist’s knowledge about the safe use of TCS in atopic dermatitis: a pre–post-survey study evaluating the impact of TCS reading module

Abstract Objective The aim of this study was to assess pharmacists’ knowledge about the safe use of topical corticosteroids (TCS) in the treatment of atopic dermatitis (AD) and to determine whether their knowledge and beliefs can be modified after reading the designed module on TCS use in AD. Methods A multicentre cross-sectional survey study was conducted among pharmacists working in the healthcare facilities of Malaysia between February 2018 and April 2019. A total of 310 pharmacists were participated and requested to complete the questionnaire before (pre-test) and 1 week after reading the designed TCS module (post-test). Results Pharmacist’s post-module score [median = 8 (interquartile range {IQR} 5–11)] was significantly higher than their pre-module score [median = 5 (IQR1–10; P &amp;lt; 0.001)]. After reading the TCS module, there was a significant increase in correct responses observed to the dispensing activities, application recommendations and side effects associated with the inappropriate use of TCS (P &amp;lt; 0.001). Pharmacists were found highly confident in the use of TCS after reading the designed module with a mean score of 8.0 (95% confidence interval 7.87–8.13) out of 10 measured on the Likert scale. Conclusion TCS module has been proven effective in enhancing pharmacists’ knowledge about the safe use of TCS in the treatment of AD.

Pregnancy, parturition and postpartum considerations among patients with vulvar lichen sclerosus: A retrospective cross-sectional online survey.

Characterise VLS and obstetric considerations among women during pregnancy, parturition and postpartum. Retrospective cross-sectional online survey, 2022. International, English-speakers. Self-identified individuals aged 18-50 diagnosed with VLS with symptom onset prior to pregnancy. Participants recruited from social media support groups and accounts, completed a 47-question survey including yes/no, multiple answer, and free-text responses. Data were analysed with frequency, means and the Chi-square test. VLS symptom severity, mode of delivery, perineal laceration, source and sufficiency of information provided about VLS and obstetrics, anxiety about delivery, and postpartum depression. Of 204 responses, 134 met inclusion criteria, encompassing 206 pregnancies. Mean respondent age was 35 years (SD 6) and mean age of VLS symptom onset, diagnosis and birth, was 22 (SD 8), 29 (SD 7) and 31 (SD 4) years, respectively. Symptoms decreased in 44% (n = 91) of pregnancies and increased during the postpartum period in 60% (n = 123). In all, 67% (n = 137) of pregnancies resulted in vaginal birth and 33% (n = 69) in caesarean birth. Anxiety for delivery due to VLS symptoms was reported by 50% (n = 103); 31% (n = 63) experienced postpartum depression. Of respondents previously diagnosed with VLS, 60% (n = 69) used topical steroids prior to pregnancy, 40% (n = 45) were treated during pregnancy and 65% (n = 75) postpartum. In all, 94% (n = 116) reported receiving an insufficient amount of information on the topic. In this online survey, we found reported symptom severity remained unchanged or decreased during pregnancy, but increased postpartum. Use of topical corticosteroids decreased during pregnancy compared with before and after pregnancy. Half of the respondents reported anxiety regarding VLS and delivery.

Cataract Surgery in Patients With Uveitis Treated With Systemic Therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study: Risk Factors and Outcomes

To evaluate the rate of, risk factors for, and outcomes of cataract surgery in patients with intermediate, posterior, and panuveitides treated with systemic corticosteroids and immunosuppression. Cohort study of participants from a randomized clinical trial. A multicenter clinical trial with extended follow-up comprised the study setting. From the cohort of participants assigned to systemic therapy in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study, 125 phakic eyes of 74 patients with intermediate, posterior, or panuveitides treated with systemic therapy were included. The main outcome measures were cataract surgery and visual acuity after cataract surgery. The cumulative incidence of cataract surgery was 43% at 7 years of follow-up, and the risk did not plateau. Risk factors for cataract surgery included age >50 years (hazard ratio [HR] 2.86, 95% CI 1.52, 5.42; P=.001), topical corticosteroid use (time-updated HR 3.13, 95% CI 1.42, 6.94; P=.005), glaucoma medication use (HR 2.75, 95% CI 1.38, 5.47; P=.004), and possibly history of anterior chamber inflammation (HR 1.90, 95% CI 0.95, 3.84; P=.07). Median gain in acuity and median best corrected visual acuity 1 year after cataract surgery were 4.8 lines and 20/25, respectively, among 42 eyes undergoing cataract surgery with 1-year follow-up data. Among patients with intermediate, posterior, and panuveitides, treated with oral corticosteroids and immunosuppression, there is a substantial long-term risk of cataract surgery. Visual acuity outcomes after cataract surgery are generally good.

Population pharmacokinetic and exposure-response modelling to inform upadacitinib dose selection in adolescent and adult patients with atopic dermatitis.

First, population pharmacokinetic analyses were used to characterize upadacitinib pharmacokinetics in adolescent and adult participants with atopic dermatitis (AD) and to identify patient covariates that may impact upadacitinib pharmacokinetics. Second, the exposure-response relationship for upadacitinib with efficacy and safety endpoints, and the effect of age and concomitant use of topical corticosteroids (TCS) on the exposure-response relationship and dose selection for patients with AD were evaluated. A two-compartment model with combined first- and zero-order absorption adequately characterized the upadacitinib concentration-time profiles in 911 healthy volunteer adolescent and adult participants with AD who received upadacitinib 15 or 30 mg orally once daily (QD) as monotherapy or in combination with TCS for 16 weeks. Logistic regression models were developed to characterize the exposure-efficacy and safety relationships, and simulations were performed based on final exposure-response models to predict efficacy responses in participants with AD who received placebo or upadacitinib as monotherapy or in combination with TCS. Upadacitinib exposures were comparable between adolescents and adults. Mild or moderate renal impairment was predicted to increase the upadacitinib area under the plasma concentration-time curve from time zero to 24 h after dosing (AUC24 ) approximately 12% and 25%, respectively, compared to participants with normal renal function. Female participants were predicted to have 20% higher AUC24 compared to male participants. Participants with AD were predicted to have 18% higher AUC24 compared to healthy participants. Simulated clinical efficacy responses showed added clinical efficacy benefit for all endpoints evaluated (8-14%) with the upadacitinib 30 mg once-daily regimen compared to 15 mg once-daily in both age groups. In participants receiving upadacitinib in combination with TCS, significant exposure-dependent increases in upadacitinib efficacy endpoints were observed. No significant effects of age or weight were identified in any of the exposure-response models. The results of these analyses support the dose justification for upadacitinib in adult and adolescent patients with moderate to severe AD.