Topical Glucocorticoids Research Articles

Role of Topical Calcipotriol to Potentiate the Effect of Photochemotherapy (PUVA) in Treatment of Vitiligo

Introduction: Vitiligo is a specific, common, often heritable acquired disorder characterized by well-circumscribed milky white cutaneous macules and patches devoid of identifiable melanocyte. Treatment of vitiligo, though quite frustrating, includes repigmentation therapies like Topical glucocorticoids, Topical calcipotrieinene, Topical PUVA (Psoralen + Ultraviolet Light A). The combination of calcipotriol and PUVA proves quite effective for management of this condition. Objectives: To compare the effectiveness of PUVA and the combination of topical calcipotriol and PUVA in treatment of vitiligo. Materials and Methods: This quasi experimental study was undertaken at Combined Military Hospital, Dhaka Cantonment, Dhaka from March to October 2015. A total of 32 patients suffering from vitiligo diagnosed clinically and confirmed by Wood’s lamp examination were selected as study population. Systemic PUVA, thrice weekly was given but Topical calcipotriol applied twice daily at one side of the body and other side used nothing Topically. Response was assessed clinically every 4 weeks along with photographic record and compared between two sides of the body. Results: During the course of the treatment, the calcipotriol plus PUVA treated side showed considerably better improvement than only PUVA treated side. The response was Excellent; 37.8% (12/32), Good; 31.3% (10/32), Fair; 18.8% (6/32), Poor; 12.5% (4/32) in calcipotriol plus PUVA treated side whereas Excellent; 12.5% (4/32), Good; 25% (8/32), Fair; 43.8% (14/32) and Poor; 18.8% (6/32) in only PUVA treated side. Conclusion: This study shown that concurrent topical calcipotriol potentiates the efficacy of PUVA in the treatment of vitiligo along with the fact that this combination achieves earlier pigmentation with a lower total UVA dosage in comparison to only PUVA therapy. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 23-25

Changes in mononuclear cell subsets in capillary and venous blood of patients with psoriasis depending on the treatment

Topical glucocorticoids are conventionally used to treat psoriasis, but such treatment provides a short-term effect, and may cause various complications during long-term usage. A detailed study of the immunopathogenesis of psoriasis has made it possible to use bioengineered drugs that block the main cytokines. It has been shown that IL-36 plays an important regulatory role in pathogenesis of psoriasis. The aim of the study was to study therapeutic effect of patients with psoriasis using topical glucocorticoid hormone versus IL- 36 receptor antagonist (RAIL-36), with respect to clinical course of psoriasis and the subsets of mononuclear cells in venous and capillary blood taken close to the focus of inflammation. 16 patients with psoriasis (group 1a) received 0.1% mometasone cream for 14 days; 20 patients of group 1b received a gel containing 0.4% recombinant RAIL-36 for 14 days. Control group included 20 healthy adults. Treatment efficacy was assessed by PASI, DISHS and DLQI indices. 19 lymphocyte subsets and 3 monocyte subsets were assessed by four-color staining of whole capillary and venous blood with erythrocyte lysis using BD Biosciences (USA) technologies and reagents. It was shown that both drugs led to a decrease in the severity of the disease at the end of treatment. However, 2 weeks after the end of treatment in group 1a, the disease indexes nearly returned to the initial values. Meanwhile, the reduced index levels persisted 2 weeks later in group 1b. Significant deviations (more pronounced in capillary blood) were revealed for the levels of several leukocyte subsets in the psoriasis patients compared with healthy persons. As a result of treatment, we have revealed some changes in the levels of leukocyte subsets common to the two groups, and special differences for the two treatment options, that were more pronounced in capillary blood samples. Both medical preparations used are suitable for treatment of psoriasis.

Glucocorticoid-Induced Bone Loss: Dietary Supplementation Recommendations to Reduce the Risk for Osteoporosis and Osteoporotic Fractures

Glucocorticoids (GCs) are among the most widely prescribed medications in dermatologic practice. Although considered generally safe and efficacious, prolonged use and high dosing regimens may precipitate GC-induced osteoporosis, which contributes to an increased risk for fragility fractures. Dermatologists using and prescribing GCs must be aware of the risk for GC-induced osteoporosis. This review details the risks for osteoporosis and osteoporotic (OP) fractures in the setting of topical, intralesional, intramuscular, and systemic GC treatment, as well as nutritional supplementation recommendations that may reduce the risk of these adverse effects.

S2372 Severe Dysphasia With Eosinophilic Esophagitis Pattern of Injury and Autoimmune Gastritis Related to Pembrolizumab Therapy

Introduction: Immune checkpoint inhibitor (ICI) therapies are effective treatments of many cancer types, including non-small cell lung carcinoma of the lung (NSCLC). While efficacious, ICI therapy can be associated with immune-related adverse effects (irAEs). We present a 67-year-old man with NSCLC who developed severe dysphasia with an eosinophilic esophagitis (EoE) pattern of injury on histopathology and concomitant autoimmune gastritis while on pembrolizumab maintenance therapy. Case Description/Methods: A 67-year-old man with NSCLC on 3 years of maintenance pembrolizumab with stable disease presented to GI clinic for evaluation of progressively worsening solid and liquid food dysphagia with regurgitation. Surveillance CT scans prior to advent of symptoms showed stable mediastinal lymphadenopathy with stable external compression of the mid-esophagus. A barium swallow study showed narrowing of the mid-esophagus. An EGD was performed and showed mid-esophageal lumen narrowing (Figure). Biopsies were obtained from the distal esophagus and showed up to 42 intraepithelial eosinophils (Eo) per high power field, consistent with an EoE pattern of injury. A subsequent EGD with stomach mapping prior to initiation of therapy showed concurrent autoimmune gastritis with no increase of Eo infiltrates. PPI therapy twice a day was initiated but the symptoms did not improve after 2 months. Topical glucocorticoid therapy with budesonide was then started. Despite dual therapy, his dysphagia progressed. Pembrolizumab was discontinued and docetaxel with ramucirumab was started, which resulted in a complete resolution of his dysphagia symptoms. Patient was maintained on PPI therapy with a plan to repeat EGD. Discussion: While GI irAEs are increasingly recognized, ICI-EoE is a rare entity. In the literature, only one other case of ICI-EoE has been reported. This patient’s dysphagia in the context of >15 intraepithelial Eo per high power field without other identifiable etiologies of increased esophageal Eo, and the resolution of symptoms with the discontinuation of pembrolizumab is consistent with ICI-EoE. In addition, the patient had concomitant autoimmune gastritis, which is also a rare but increasingly recognized irAE. Our case demonstrated both entities presenting in one patient. Treatment of irAEs often involves discontinuation of the ICI. Refractory cases may require systemic immunosuppression with corticosteroids or biologic therapy.Figure 1.: 1A – Mid-esophageal narrowing on barium swallow study Figure 1B – Intraepithelial eosinophilia consistent with EoE.

Release of Cervical Muscle Tension Improves Psychological Stress and Symptoms of Moderate-to-Severe Atopic Dermatitis: a Case Series with 20 Patients.

IntroductionAtopic dermatitis (AD) is a chronic relapsing inflammatory skin disease that is triggered by intense pruritus, impaired skin barrier function, and immune responses to allergenic substances. Break-through therapies for AD include molecular-targeted drugs and the effective management of severe symptoms of AD. However, patients with clinical improvements may continue scratching owing to the influence of psychological stress, which might lead to quick relapses of stressors and subsequent intensive scratching. New drugs may be ineffective because of such scratching behavior caused by stressors. Therefore, it may be useful to consider adjunctive treatment options that focus on external stressors as triggers of deterioration of AD. We hypothesized that improvement of psychological stress by relieving cervical muscle tension would reduce pruritus and atopic symptoms.MethodsOverall, 21 patients with moderate-to-severe AD were treated to relieve cervical muscular tension using Spineliner SA201, which assists in osteopathic manipulative treatment. We assessed the subjective and objective symptoms of AD, cervical muscle tension, which was evaluated using cervical range of motion (ROM), and psychological burden. Only moisturizers were applied topically during the study period, and no topical corticosteroid therapy was used.ResultsTwenty patients who completed the treatment demonstrated improvement in the symptoms of AD: changes on the visual analog scale (VAS) for pruritus were −44.2%, Eczema Area and Severity Index (EASI) was −67.9%, thymus and activation-regulated chemokine (TARC) was −56.2%, Hospital Anxiety and Depression Scale (HADS) was −27.2%, sleep disturbance was −49.7%, and Dermatology Life Quality Index (DLQI) was −46.7%. Additionally, the cervical muscle tension improved significantly: changes in cervical ROM were 14.7%.ConclusionsRelease of cervical muscle tension may improve psychological stress and have an effect on moderate-to-severe AD.

Nutritional Sensor REDD1 in Cancer and Inflammation: Friend or Foe?

Regulated in Development and DNA Damage Response 1 (REDD1)/DNA Damage-Induced Transcript 4 (DDIT4) is an immediate early response gene activated by different stress conditions, including growth factor depletion, hypoxia, DNA damage, and stress hormones, i.e., glucocorticoids. The most known functions of REDD1 are the inhibition of proliferative signaling and the regulation of metabolism via the repression of the central regulator of these processes, the mammalian target of rapamycin (mTOR). The involvement of REDD1 in cell growth, apoptosis, metabolism, and oxidative stress implies its role in various pathological conditions, including cancer and inflammatory diseases. Recently, REDD1 was identified as one of the central genes mechanistically involved in undesirable atrophic effects induced by chronic topical and systemic glucocorticoids widely used for the treatment of blood cancer and inflammatory diseases. In this review, we discuss the role of REDD1 in the regulation of cell signaling and processes in normal and cancer cells, its involvement in the pathogenesis of different diseases, and the approach to safer glucocorticoid receptor (GR)-targeted therapies via a combination of glucocorticoids and REDD1 inhibitors to decrease the adverse atrophogenic effects of these steroids.

Management of Atopic Dermatitis: The Role of Tacrolimus.

Atopic dermatitis (AD) is a long-lasting inflammatory dermatological condition characterized by itchy, eczematous, sparsely tiny blisters that hold a clear watery substance. Additionally, the diseased skin can suppurate, occasionally with weeping with thickening of the affected skin. This is considered one of the top skin disorders involving both children and adult populations globally. The principal therapeutic intervention for AD is long-standing topical glucocorticoids, which have been used for several decades. Corticosteroid therapy brings several adverse drug effects (ADRs), including irreversible skin atrophy. Tacrolimus belongs to the class of calcineurin inhibitors, which is a type of immunomodulator possessing promising efficacy in treating AD. Topical tacrolimus is an effective and safe non-corticosteroid substitute treatment for AD. We reviewed the available literature to compare and institute the safety, efficacy, and effectiveness of tacrolimus when equated to corticosteroid therapy in managing AD.

Increased Risk of Ocular Hypertension in Patients With Cushing's Disease.

An increased risk of ocular hypertension was seen in Cushing's disease. Systemic steroid use is a significant risk factor for increased intraocular pressure (IOP). The incidence of ocular hypertension may rise to 30%-40% of the general population due to topical or systemic glucocorticoid usage. However, the incidence of ocular hypertension in endogenous hypercortisolemia, as well as the ophthalmological outcomes after endocrine remission due to surgical resection, remain unknown. The IOP, visual field, and peripapillary retinal nerve fiber layer thickness were documented in all patients with Cushing's disease (CD) admitted to a tertiary pituitary center for surgery from January to July 2019. Patients with acromegaly and patients with nonfunctioning pituitary adenoma (NFPA) during the same study period served as controls. We calculated the odds ratio (OR), identified the risk factors of developing ocular hypertension, and presented postoperative trends of the IOP. A total of 52 patients (38.4±12.4y old) with CD were included. The IOP was higher in patients with CD (left 19.4±5.4mmHg and right 20.0±7.1mmHg) than in patients with acromegaly (left 17.5±2.3mmHg and right 18.6±7.0mmHg, P =0.033) and patients with NFPA (left 17.8±2.6mmHg and right 17.4±2.4mmHg, P =0.005). A total of 21 eyes (20.2%) in patients with CD were diagnosed with ocular hypertension compared with 4 eyes (4.7%) in the acromegaly group and 4 eyes (4.5%) in the NFPA group. The OR of developing ocular hypertension in patients with CD was 5.1 [95% confidence interval (CI), 1.3-25.1, P =0.029] and 6.6 (95% CI, 1.8-30.3, P =0.007) when compared with the 2 control groups. Among patients with CD, those with a higher urine-free cortisol were more likely to develop ocular hypertension (OR=19.4, 95% CI, 1.7-72.6). The IOP decreased at 1 month after surgery in patients with CD, and the change was sustained for 3 months after surgery. An increased risk of ocular hypertension was seen in CD and suggests that endogenous hypercortisolemia should be considered as part of the glaucoma assessment. This result warrants the discretion of both ophthalmologists and neuroendocrinologists.

Biologic therapies for juvenile idiopathic arthritis-associated uveitis.

Juvenile idiopathic arthritis (JIA) is the most frequent rheumatic disease of childhood and uveitis is its most common extra-articular manifestation. JIA-associated uveitis (JIA-U) is one of the main causes of visual impairment in children and represents a major challenge for pediatrician and ophthalmologist, due to its insidious onset and sight-threatening complications. Topical glucocorticoids are the first line of treatment, followed by conventional disease-modifying anti-rheumatic drugs (DMARDs), usually methotrexate (MTX). In recent years, new biological drugs targeting specific molecules involved in disease pathogenesis, have significantly improved the prognosis of the disease, especially for cases refractory to conventional therapies. In this review we discuss the role of biological agents in JIA-U, focusing on cytokine blockers and cell-targeted therapies aimed to control ocular inflammation.

Generalized erythematous scaly rash after glucocorticoids

A 65-years-old woman with a medical history of idiopathic thrombocytopenic purpura and psoriasis in treatment with topical glucocorticoids presented with a three-month history of burning, generalized erythematous, scaly rash, and chills. A few weeks before the rash, the patient presented petechiae on her thighs due to a low platelet count (28.000 platelets per microliter), for which she started treatment with prednisone 25 mg/week. The rash was initially treated with topical ointments including clobetasol, urea, salicylic acid, ammonium lactate, and propylene glycol without improvement.

Experience of switching biological therapy in a patient with juvenile idiopathic arthritis and uveitis. Case report

Uveitis associated with juvenile arthritis can be complicated by cataracts, retinal edema, and glaucoma, which carries a potential risk of disability in the child's organ of vision. Approximately 2540% of patients demonstrate insufficient effectiveness of the ongoing standard antirheumatic therapy, which requires the inclusion of genetically engineered biological therapy. According to the protocols, the drug of choice for juvenile arthritis associated with uveitis is adalimumab, which has shown high efficacy in many studies. However, some patients stop responding to therapy over time, which raises the question of switching to another genetically engineered biological drug (GЕBD). Our article presents a case of severe course with an early onset of juvenile idiopathic arthritis associated with uveitis. Due to the insufficient effectiveness of basic monotherapy with methorexate, as well as topical glucocorticoids, adilimumab was added to therapy a year after the onset of the disease. Over the next 5 years, the child was on this therapy with exacerbations of uveitis about 12 episodes per year. Subsequently, uveitis began to continuously recur, which raised the question of the development of probable resistance to adalimumab and the change of GEBD. The girl was switched to golimumab, which is a human monoclonal antibody that can bind to tumor necrosis factor-. This drug has been used for the treatment of juvenile idiopathic arthritis since 2017 for children weighing 40 kg and above, and after the completion of the multicenter GO-KIDS study, it is registered for children from 2 years of age. According to a number of studies, golimumab has shown its effectiveness in relation to the activity of uveitis in patients with arthritis, including those in childhood. In general, the issues of switching GEBD in cases of ineffective therapy with first-line drugs are a very urgent problem in pediatric rheumatology. In our case, switching to the GIBP golimumab resulted in a positive effect on the activity of rheumatoid uveitis and induction of remission of the articular syndrome.

Stability of dexamethasone sodium phosphate over a 28 day period when added to commercial veterinary wipe and pad products.

Background - Topical glucocorticoids commonly are used in the management of canine atopic dermatitis to control and prevent allergy flares. Compounding commercial veterinary wipe/pad products to include dexamethasone sodium phosphate (Dex SP) can simplify treatment protocols for owners. Dex SP has not been evaluated for stability when added to wipes/pads. Hypothesis/objective - To evaluate the stability of Dex SP when compounded in three commercial veterinary wipe/pad products containing chlorhexidine. Methods and materials - Dex SP (Dexium, Bimeda; Oakbrook Terrace, IL, USA) was added to TrizCHLOR 4 wipes (TCL; Dechra Veterinary Products; Overland Park, KS, USA), KetoHex wipes (KH; VetOne; Boise, ID, USA), and DOUXO Chlorhexidine Pads (DCP; Ceva Animal Health; Lenexa, KS, USA), creating a 0.04% Dex SP solution. The concentration of Dex SP was measured in μg/mL/wipe or pad in triplicate at Day (D)0, D14 and D28 using liquid chromatography with tandem mass spectrometry. The amount of Dex SP at baseline (D0) was compared to the amount recovered at D14 and D28. Results - The amount of Dex SP in TCL and KH was unchanged between D0, D14 and D28. The amount of Dex SP recovered from DCP on D0 (mean 89.40 μg/mL/pad), D14 (mean 65.58 μg/mL/pad) and D28 (mean 68.09 μg/mL/pad) revealed a significant decline from D0 to D14 (P= 0.004). Conclusions and clinical importance - These data provide evidence that Dex SP is stable for 28 days in TCL and KH, and not in DCP from D0 to D14 or D28 days.

Alternative Biologic Therapy in Children Failing Conventional TNFα Inhibitors for Refractory, Noninfectious, Chronic Anterior Uveitis

A significant number of children with noninfectious, chronic anterior uveitis (CAU) fail to respond to conventional therapy; however, successful alternative biologic treatments (ABT) have not been well described. This study aims to review the clinical and treatment characteristics of children with CAU who require ABT. Retrospective, nonrandomized clinical study. Setting: Tertiary center. Children with noninfectious CAU. Clinical characteristics, uveitis course, complications, and treatment were compared among patients treated with methotrexate (MTX) monotherapy, conventional TNFα inhibitors (cTNFi), and ABT for >3 months. Success of ABT (abatacept, tocilizumab, and/or golimumab) in children failing conventional treatment. Of the 52 children with CAU, 75% had juvenile idiopathic arthritis. CAU was controlled in 15 children receiving MTX monotherapy, 28 receiving cTNFi, and 9 receiving ABT (n=1, abatacept; n=3, tocilizumab; n=5, golimumab). Patients in the ABT group had a greater number of total ocular complications per person before ABT than those in the control groups (3.4 vs 0.7 [MTX], P < .001, and 1.5 [cTNFi], P < .001, respectively). In all 9 children on ABT, treatment led to control of CAU and topical glucocorticoids tapered to ≤2 drops/d with no new ocular complications. In this study, alternative biologics (abatacept, golimumab, and tocilizumab) were useful for treating CAU in children who fail MTX and cTNFi therapy. Patients who were controlled on ABT had more disease activity, ocular complications, and anti-cTNFi neutralizing antibodies (before ABT) than those managed with conventional therapy. Larger studies are required to confirm these findings.

Dynamic trafficking patterns of IL-17-producing γδ T cells are linked to the recurrence of skin inflammation in psoriasis-like dermatitis.

SummaryBackgroundPsoriasis recurrence is a clinically challenging issue. However, the underlying mechanisms haven't been fully understood.MethodsRNAseq analysis from affected skin of psoriatic patients treated with topical glucocorticoid (GC) with different outcomes was performed. In addition, imiquimod (IMQ)-induced mouse psoriasis-like model was used to mimic GC treatment in human psoriasis patients. Skin tissues and draining and distant lymph nodes (LNs) were harvested for flow cytometry and histology analyses.FindingsRNAseq analysis revealed that chemokine and chemokine receptor gene expression was decreased in post-treated skin compared to pre-treated samples but was subsequently increased in the recurred skin. In IMQ-induced mouse psoriasis-like model, we found that γδT17 cells were decreased in the skin upon topical GC treatment but surprisingly increased in the draining and distant LNs. This redistribution pattern lasted even two weeks post GC withdrawal. Upon IMQ re-challenge on the same site, mice previously treated with GC developed more severe skin inflammation. There were γδT17 cells migrated from LNs to the skin. This dynamic trafficking was dependent on CCR6 as this phenomenon was completely abrogated in CCR6-deficient mice. In addition, inhibition of lymphocyte egress prevented this heightened skin inflammation induced by IMQ rechallenge.InterpretationRedistribution of pathogenic γδT17 cells may be vital to prevent disease recurrence and this model of psoriasis-like dermatitis.FundingThis work was supported by National Natural Science Foundation of China 81830095/H1103, 81761128008/H10 (J.Z.) and the NIH R01AI128818 and the National Psoriasis Foundation (J.Y.).

Development of new topical substances for the treatment of atopic dermatitis

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. In everyday clinical practice, about 80% of patients present with mild to moderate disease, which is usually treated with topical therapy. Topical anti-inflammatory therapy thus continues to be the standard of care in addition to the basic therapy. Topical glucocorticoids (TGC) and topical calcineurin inhibitors (TCI) are two potent approved substances that are available. In addition to newly developed systemic therapies for moderate to severe AD, there are also new therapeutic approaches in anti-inflammatory topical treatment. Topical Janus kinase inhibitors show ahigh therapeutic effect. However, only delgocitinib and ruxolitinib have so far been approved for topical administration in Japan and the USA since 2021. Crisaborole, aphosphodiesterase4 inhibitor, also received approval in the USA. Other phosphodiesterase inhibitors are currently being investigated in clinical trials. Interesting results of clinical studies give hope for further substances and therapeutic approaches.

The Effects of Intranasal, Inhaled and Systemic Glucocorticoids on Intraocular Pressure: A Literature Review.

Topical glucocorticoids are a well-known risk factor of intraocular pressure (IOP) elevation in one third of the general population and in up to 90% of glaucomatous patients. Whether this steroid response is caused by intranasal, inhaled or systemic glucocorticoids, is less known. This study presents an overview of the current literature on the topic, thereby providing guidance on when ophthalmological follow-up is indicated. A literature study was performed in Medline, and 31 studies were included for analysis. Twelve out of fourteen studies discussing intranasal glucocorticoids show no significant association with an elevated IOP. Regarding inhaled glucocorticoids, only three out of twelve studies show a significant association. The observed increase was either small or was only observed in patients treated with high inhaled doses or in patients with a family history of glaucoma. An elevated IOP caused by systemic glucocorticoids is reported by four out of the five included studies, with one study reporting a clear dose–response relationship. This review concludes that a steroid response can be triggered in patients treated with systemic glucocorticoids. Inhaled glucocorticoids may cause a significant IOP elevation when administered in high doses or in patients with a family history of glaucoma. At present, there is no evidence for a clinically significant steroid response caused by intranasally administered glucocorticoids.

Bioinformatics assessment on the potential of Lipoteichoic Acid (LTA) of Lactic Acid Bacteria (LAB) as topical therapy for inflammatory skin diseases

Background: Lipoteichoic Acid (LTA) of Lactic Acid Bacteria (LAB) is a cell wall component of LAB with immunomodulatory properties towards inflammatory skin diseases due to immune dysregulation, such as atopic dermatitis. Topical glucocorticoids are given as the mainstay therapy in some inflammatory skin diseases. However, the adverse effects of topical glucocorticoids are commonly found, such as skin atrophy, reduced pigmentation, and masking-effect of skin infections. Therefore, safer therapy for inflammatory skin diseases is necessary to be developed. This study aimed to analyze the potential of LTA of LAB against glucocorticoid receptors (GR) as a topical therapy for inflammatory skin diseases. Methods: This study used the bioinformatics method with molecular docking to predict the binding site and the binding affinity of LTA of LAB to GR and analyze the toxicity of LTA of LAB. According to the previous studies, this research was also conducted within silico/ molecular docking. Data were analyzed using Toxtree v 2. 6.13 application to evaluate the skin irritation. Results: LAB’s lipoteichoic acid (LTA) has the same binding site with glucocorticoid control compounds to the GR. Toxicity analysis shows that LTA of LAB is not irritative to the skin. Conclusion: LAB’s lipoteichoic acid (LTA) is potential as alternative topical therapy for inflammatory skin diseases.

Crosslinking as a treatment for infectious crystalline keratopathy

Infectious crystalline keratopathy (ICK) is a rare cornea disease, manifested by gray-and-white tree-like or needle-like stromal opacities with minimal signs of inflammation. The disease is caused by the colonization of microorganisms on the corneal stroma and their formation of biofilms, making them extremely resistant to treatment with antibiotics and to the immune response of the patient. Typically, the most important risk factor for ICK development is the presence of an immunodeficiency cornea condition with long-term topical steroid therapy, which is normally prescribed after keratoplasty. Two clinical cases of ICK are discussed in which the reduction of topical glucocorticoids and the intensive use of antibiotics did not result in positive clinical changes. Only after an accelerated crosslinking procedure (PACK-CXL), needlelike opacities disappeared in the area of microbial invasion and signs of infiltration appeared, indicating the restoration of the local immune response. This phenomenon is likely due to the destruction of the biofilm and the microbial agents themselves, which afterwards contributed to a more effective impact of the antibacterial drug. This combined treatment led to resorption of the inflammatory focus with the formation of local opacification. The effectiveness of PACK-CXL in infectious processes is explained by the effects of both riboflavin and ultraviolet radiation. No literature references on the use of cross-linking in the treatment of ICK are available. In our opinion, cross-linking in early ICK patients after keratoplasty is justified by the inability, in some cases, to completely discontinue glucocorticosteroid therapy, as this will greatly increase the chances of rejection and graft jailure. PACK-CXL can be an effective way of destroying the biofilm in the corneal stroma.

Clinical Guidelines for the Use of Antipruritic Drugs in the Control of the Most Frequent Pruritic Skin Diseases in Dogs.

Pruritus is a common clinical sign in many skin disorders and is currently the main complaint in canine dermatology. Pruritic skin diseases can affect the quality of life of dogs and their owners. Several families of antipruritic drugs are available to help control pruritus in dogs. The aim of this review is to help practitioners select the most appropriate symptomatic treatment in the most frequent situations of dermatological pruritus in dogs. The molecules reviewed here are systemic and topical glucocorticoids, antihistamines, ciclosporin, oclacitinib and lokivetmab. A level of evidence (1, 2 or 3) has been established according to a detailed algorithm for each individual study in the literature published between 1990 and March 2021. The guidelines result from evidence grading using the strength of recommendation taxonomy (SoRT) and clinical recommendations using a thorough methodology.

Formulation, development and characterization of topical organogel of mometasone furoate for the treatment of skin disease

Topical glucocorticoid formulations are widely used for effective treatment and control of a variety of dermatoses. Mometasone furoate is a medium potency, synthetic, non-fluorinated topical corticosteroid, indicated for the relief of inflammatory and pruritic manifestations of corticosteroid responsive dermatoses including psoriasis. The percutaneous absorption increases risk associated with systemic absorption of topically applied formulation. Controlled release of the drug to the skin could reduce the side effects while reducing percutaneous absorption. Organogels are semi-solid materials, in which an organic phase is immobilized by a three-dimensional network composed of self-organized system, forming the aqueous phase. The present study deals with the preparation and evaluation of a pluronic lecithin organogel gel containing mometasone furoate for transdermal delivery. Blank pluronic lecithin organogel were prepared using ricinoleic acid as the oil phase. Formulation, Development and Characterization of Topical Organogel of Mometasone Furoate was carried out and evaluated for the treatment of Skin Disease. The absorption maxima of mometasone furoate were determined by running the spectrum of drug solution in double beam ultraviolet spectrophotometer (Labindia UV 3000+) using concentration range of 5-25μg/ml mometasone furoate in 7.4 phosphate buffers. The IR spectrum of sample drug and drug with excipients shows the peak values which are characteristics of the drug. The formulated gel formulation was evaluated with parameter appearance, consistency, drug content pH, viscosity, spreadability, in-vitro release test, washability, extrudability study and stability studies. FT-IR studies revealed no interaction between the drug and excipients. Selected organogels (F3) showed a drug content of 99.45±0.14% and drug release of 99.12 % in10 hrs. The results suggest that the developed organogels formulation containing mometasone furoate can be of actual value for improving the clinical effectiveness in the treatment of psoriasis.