Topical Steroid Cream Research Articles

Facilitated delivery of topical steroids after fractional ablative carbon dioxide laser benefits postthyroidectomy hypertrophic scar

Background: Thyroidectomy results in unsightly scarring at the anterior neck of the patient. Objectives: This prospective clinical study aimed to assess the effectiveness of laser assisted drug delivery (LADD) of topical steroid ointment for the treatment of postthyroidectomy hypertrophic scars. Methods: Five courses of a fractional ablative carbon dioxide laser combined with topical 0.05% clobetasol propionate were applied every 4 weeks to treat postthyroidectomy hypertrophic scars in ten adult female patients. The effectiveness was assessed by the patient themselves according to the Patient and Observer Scar Assessment Scale (POSAS) and by three different doctors according to photography evaluations before and 1 year after the first treatment. Results: Assessments of the scars by POSAS revealed significant improvements in terms of itchiness, color, softness, thickness, irregularity, and distorted appearance of the scars, albeit without any significant pain relief. In addition, all indicative characteristics of the scar, namely, vascularity, pigmentation, thickness, relief, pliability, surface area, and overall opinion, as assessed by the treating doctor and based on photographic evaluations by three different doctors, revealed significant improvements in the scars after treatment. Conclusion: In this study, we demonstrated that the topical delivery of steroids after fractional ablative carbon dioxide laser treatment showed an encouraging outcome in postthyroidectomy hypertrophic scarring.

28144 Cobblestoned skin on neck: The differential

Pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-like PDE) is a benign cutaneous condition that mimics pseudoxanthoma elasticum (PXE). PXE is a hereditary distortion and calcification of elastic fibers, not only in cutaneous tissue, but in cardiac and ocular tissues. Histopathology is an important diagnostic tool to distinguish between the two and can save the patient from an extensive work-up if misdiagnosed as PXE. We present, herein, a 62-year-old healthy female of with an asymptomatic papular rash on her neck for 8 months. She wears a hijab, and reports frequent heat and sweat. The patient failed topical steroid creams given by her primary care provider. Exam showed multiple skin-colored to yellow smooth papules on the bilateral and posterior neck, and bilateral antecubital fossae. Biopsy from her left neck showed abrupt loss of elastic fibers in the papillary dermis with a Verhoeff-van Gieson stain. A von Kossa stain did not demonstrate calcium deposition, ruling out PXE. PXE-LPDE is likely an underdiagnosed acquired condition that occurs most commonly in women after the sixth decade of life and has overlapping clinical and histopathologic features with white fibrous papulosis, another benign condition that can be argued is the same entity. We favored PXE-LPDE in our patient due to the band-like loss of elastic fibers in the papillary dermis. Although chronic sun exposure has been implicated in its pathogenesis, our patient has been sun protected for most of her life. Unfortunately, no specific therapy has been shown to be successful in the treatment of PXE-like PDE.

P–598 Further evidence for a functional hormonal adrenal-ovarian axis affecting female infertility

Abstract Study question How does here presented case offer further evidence for existence of a functional hormonal adrenal-ovarian axis? Summary answer This is the first case of iatrogenic Cushing syndrome leading to severe adrenal and ovarian insufficiency, as evidenced by undetectable estrogen and low androgen levels. What is known already Animal models and human data have convincingly demonstrated that hypo-androgenism affects follicle recruitment and growth, especially at small growing follicle stages, in most severe cases even mimicking primary ovarian insufficiency (POI). In milder forms, hypoandrogenism reduces follicle number, egg numbers as well as egg quality, unless reconstituted in timely fashion before IVF cycle start. Study design, size, duration We here report a 34-year-old G1P1, who presented for a second opinion with a diagnosis of secondary “unexplained” infertility after two IVF cycles at another fertility center. Participants/materials, setting, methods Since our center considers a diagnosis of “unexplained” infertility as subjective, the patient underwent a thorough diagnostic evaluation. She was using oral contraceptive pills for one week at the time her laboratory results were drawn. Main results and the role of chance: Her free (FT) and total testosterone (TT) (0.4 pg/ml and 5.0 ng/dL, respectively), DHEA and DHEAS (103.0 ng/dL and 92.0 µg/dL, respectively) were low and her estradiol was undetectable (<25 pg/mL), reflecting significant adrenal as well as ovarian suppression. Morning ACTH was undetectable at < 5 pg/mL but cortisol was abnormally elevated (17.7mcg/dL), leading to diagnoses of secondary adrenal insufficiency as well as secondary ovarian insufficiency (SOI) due to adrenal hypo-androgenism from lack of ACTH production. She, in addition, revealed a positive ANA titer (1:160). Because of eczema, she for over a year had been on a super-potent topical steroid ointment. Upon termination of this steroid, adrenal as well as ovarian function, as evidenced by her hormonal values, normalized. Limitations, reasons for caution This is the first case in the literature where iatrogenic-induced insufficiency of adrenal androgen production resulted in secondary ovarian insufficiency (SOI), characterized by undetectable estradiol, reversible by withdrawal of topical steroid treatment. Wider implications of the findings: This case offers further evidence that the traditional hypothalamic-pituitary-ovarian axis (HPAA) extends downstream to ovaries (HPAOA), reaffirming the ability of adrenals to control ovarian function. Trial registration number n/a

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

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

Refractory dermatitis contributed by pityriasis versicolor: a case report

BackgroundDermatologic toxicity is a very common immune-related adverse event (irAE) for patients with melanoma who are receiving immune checkpoint inhibitor therapy (ICI). Concurrent skin infection, such as in the case of pityriasis versicolor reported here, can mimic and/or exacerbate dermatologic toxicity from irAE.Case presentationA 58-year-old Caucasian man with a history of pityriasis versicolor infection and metastatic melanoma received ICI therapy. He developed progressively worsening pruritic maculopapular lesions 22 weeks into his treatment that ultimately covered 40% of his body. He was diagnosed with dermatologic toxicity due to ICI therapy with concurrent pityriasis versicolor. He was initially started on topical steroid and topical antifungal cream but achieved minimum improvement. His treatment was then escalated to oral prednisone, but it only achieved modest control of his dermatitis. All subsequent attempts to wean him from oral prednisone resulted in worsening of his dermatitis. Eventually he was started on oral fluconazole in combination with prednisone, which led to rapid resolution of his dermatitis.ConclusionWe report a case of dermatological toxicity due to an irAE with concurrent pityriasis versicolor. The steroid treatment for irAE was likely exacerbating the underlying fungal infection, and the fungal infection was in term mimicking the symptoms of irAE. This patient’s severe dermatitis was only brought under control after receiving a more potent antifungal therapy in combination with a steroid. It is vital to look beyond the irAE when managing dermatitis in patients receiving ICI therapy.

Treatment of mycosis fungoides: results from a large international study

British Journal of DermatologyVolume 184, Issue 4 p. e129-e129 Plain Language Summary Treatment of mycosis fungoides: results from a large international study First published: 09 April 2021 https://doi.org/10.1111/bjd.19840AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Mycosis fungoides is a type of blood cancer. The early phases of mycosis fungoides are represented by patches (flat lesions) or plaques (solid lesions) on the skin. Treatment usually consists of topical steroid creams, phototherapy (using ultraviolet light) or radiotherapy (using radiation). Together these methods are called skin-directed treatments. This study enrolled 395 patients with a new diagnosis of mycosis fungoides from 41 centres across 17 countries in Europe, North and South America, and Australia. The results show that the majority of patients (82%) received skin-directed treatment as the first medication, while 11% first received tablets or injections. Patients who were treated first with tablets or injections showed more severe disease, plaques more frequently than patches, thicker skin lesions, and mycosis fungoides involving hair follicles. The presence of plaques was associated with a worse outcome and lower response to therapy. We also showed that half of these patients had significantly reduced quality of life, which improved after treatment. The proportion of patients who achieved a complete or partial clearance of the skin lesions was 67%. Overall, 73% more people receiving skin-directed treatments responded to therapy than those receiving tablets or injections. This means that it is generally preferable to start therapy with skin-directed treatment in most cases. This study suggests that treatment of patients with early-stage mycosis fungoides should focus on patients with high-risk skin features and evaluation of quality of life. Linked Article: Quaglino et al. Br J Dermatol 2021; 184:722–730. Volume184, Issue4April 2021Pages e129-e129 RelatedInformation

Intravenous immunoglobulin-induced severe vesicular eczematous eruption successfully treated with narrow band-ultraviolet B therapy.

Intravenous immunoglobulins (IVIg) are increasingly being used to treat a wide spectrum of dermatological and neurological autoimmune diseases. Although the administration of IVIg does not usually result in severe adverse reactions, side effects of IVIg reportedly occur in 6-13% of patients. Most reported cases were not severe, and IVIg is considered a relatively safe drug. Some reports described a vesicular eczematous eruption caused by IVIg that was cured by applying topical steroid ointments or systemic steroids. Herein, we present, to the best of our knowledge, the first case of severe vesicular eczematous eruption all over the body induced by IVIg that was unresponsive to topical steroid ointment and was subsequently treated with narrow band-ultraviolet B (NB-UVB) therapy successfully. NB-UVB was started at a dose of 400mJ/cm2 once a week, and swift improvement was observed. The skin rash disappeared in the first 2months, and the pathogenesis of IVIg-induced eczematous eruption remains unelucidated. No change in eosinophils and complement levels were observed in our case. Given the increase in the widespread use of IVIg, we have shown that NB-UVB therapy is a candidate choice for the treatment of IVIg-induced severe vesicular eczematous eruption.

Effect of corticosteroid ointment on radiation induced dermatitis in head and neck cancer patients: A prospective study.

Almost all the patients receiving curative radiotherapy for head and neck cancer develop radiation dermatitis, which many a times leads to treatment interruption and reduce patient compliance. In this study, we evaluated the effect of potent topical steroid (Betamethasone Valerate 0.1%) cream on acute radiation dermatitis in head and neck cancer patients receiving curative radiotherapy. A total 106 patients of head and neck cancers were randomly divided into arm A (52 patients) and arm B (54 patients). The patient in study arm A were treated with topical betamethasone 0.1% twice daily during radiotherapy/chemo-radiotherapy and arm B was kept as control. The radiation reaction in both the groups was monitored weekly according to Radiation Therapy Oncology Group (RTOG) acute radiation dermatitis grading. Out of 106 patients, 85 (80.2%) patients completed treatment. Patient in control arm had earlier onset of grade 1 reaction (5.7% in arm A vs 16.7 % in arm B at 2nd week, P value 0.157 and 28.8% in arm A vs 50% in arm B at 3rd week, P value 0.028) and progression of radiation dermatitis. In 7th week patient in arm A had higher grade 1 reaction (17.3% in arm A vs 0% in arm B), while arm B had higher grade 2 reaction (66.7% arm B vs 55.8% in arm A). There was no difference in incidence of grade 3 and 4 reaction. No difference was observed in time taken for reaction to heal. Topical Betamethasone can delay the onset and progression of radiation dermatitis in head and neck cancer, without significant delay in wound healing.

Termokoterle Yapılan Sünnet Sonrası Gelişen Fimozisin Tedavisinde Topikal Steroid Kremin Etkinliği

Objective : In our country, thermocautery device is used extensively for circumcision performed under local anesthesia for fast and safe circumcision. One of the complications that may occur after circumcision with thermocautery is pathological phimosis. However, there aren’t studies in the literature regarding the medical treatment of pathological phimosis after circumcision with thermocautery. We aimed to investigate the effectiveness of topical corticosteroid application in the treatment of pathological phimosis developed after circumcision with thermocautery. Material&Methods: Data of 68 patients (aged: 1-8 years) who developed phimosis secondary to circumcisions performed by one surgeon between the years 2009 and 2018 were analysed retrospectively from a computerised database. Cases of phimosis developed after circumcisions performed using thermocautery and scalpel were analysed in two separate groups, and the effectiveness of topical steroid treatment was evaluated. Results : In the thermocautery group, 32 patients who developed Grade 5 phimosis didn’t respond to steroid therapy, while only three of 16 (18.75%) cases with Grade 4 phimosis responded partially to topical steroid treatment. All these 48 cases were treated with surgery. In the scalpel group, no therapeutic response was elicited in four cases who developed Grade 5 phimosis. However, four out of eight (50%) patients with Grade 4 and six out of eight (75%) patients with Grade 3 phimosis responded to steroid therapy, and full retraction of the foreskin was achieved. In the scalpel group, ten cases underwent surgical revision. Conclusion : Topical steroid creams may be partially beneficial in cases of pathological phimosis after circumcision. However, they do not show efficacy in cases of high-grade phimosis after thermocautery use.

Sorafenib-triggered radiation recall dermatitis: case report and literature review

Sorafenib-induced radiation recall dermatitis (RRD) is rare. Here we present a case of sorafenib- induced RRD previously irradiated for bone metastasis from hepatocellular carcinoma (HCC). The patient was an 86-year-old Taiwanese woman. Radiotherapy with 3,000 cGy in 10 fractions was delivered for her bone metastasis in palliative intention. A month after completion of irradiation, sorafenib 400 mg was administered orally twice daily. Pruritus occurred on the same day of initiated sorafenib, restricted to the previous irradiated skin, which progressed, one week after, to grade 1 pruritus, erythema, desquamation and hyperpigmentation of lower back without pain. (CTCAE v4.03) Topical steroid cream was prescribed without sorafenib adjustment. Her skin reaction resolved in several days later. To the best of our knowledge, this is the first case report of a female patient presenting sorafenib-triggered RRD. Our case report highlights the possibility in both genders and could provide more information for further understanding given its rarity. Clinicians should be alert to the possibility of RRD in patients with dermatologic reaction in previously irradiated skin after receiving sorafenib.

Effect of Topical Periocular Steroid Use on Intraocular Pressure: A Retrospective Analysis.

To study the effect of periocular steroid use on intraocular pressure (IOP). Charts of adult patients with atopic dermatitis or eczema treated with topical periocular steroid creams and ointments from January 1st, 2007 to October 1st, 2017 were reviewed. Patients with the following were excluded: glaucoma, ocular hypertension, known systemic/topical/injectable steroid history, and lack of documented IOP prior to or during treatment with periocular steroid ointment. Patient data were collected regarding gender, treatment regimen, as well as IOP prior to and during treatment. Steroid responders were identified. Statistical analysis was performed using linear mixed effects models adjusting for follow-up time to test the relationship between pre and posttreatment IOP change adjusting for intereye correlations. Thirty-one patients were identified. Twenty-one were treated bilaterally and 10 unilaterally. Five patients were glaucoma suspects. The mean treatment period was 14.2 weeks with a range of 0.1-83.9 weeks. Patients were treated with fluorometholone (42%), loteprednol etabonate (23%), dexamethasone-neomycin-polymyxin B (13%), hydrocortisone 1% or 2.5% (3%), and tobramycin-dexamethasone (19%). In the combined sample, there was no significant IOP change even after adjusting for follow-up time (mean change: +0.44 mm Hg, p = 0.126). However, eyes with baseline IOP ≥ 14 mm Hg had a significant increase (+0.73 mm Hg/year, p = 0.032). Individual steroid responses included the following: 1 intermediate and 30 low responders, of which 19 patients had an IOP change of <1 mm Hg. One patient had a clinically significant intermediate steroid response of 7 mm Hg. Periocular steroid treatment causes a statistically significant rise in IOP in eyes with higher baseline IOP measurements, the risk of which increases with follow up. While this change is not always correlated with a clinically significant rise in IOP, clinicians should monitor more closely patients at greatest risk of steroid response.

The use of steroid cream for physiologic phimosis in male infants with a history of UTI and normal renal ultrasound is associated with decreased risk of recurrent UTI

An uncircumcised male infant with a history of urinary tract infection (UTI), physiologic phimosis, and a normal renal ultrasound is a common patient referred to pediatric urology clinics. Topical steroid creams have been shown to effectively release physiologic phimosis. The objective of this study was to test the hypothesis that use of steroid cream for physiologic phimosis is associated with a lower UTI recurrence in uncircumcised male infants with normal renal ultrasounds. Uncircumcised males younger than 12 months referred for a UTI with a normal renal ultrasound were included. A longitudinal data set was created, and recurrent UTIs were identified. The proportion with a recurrent UTI was compared between those who received a prescription for a steroid cream for phimosis and those who did not. The morbidity of the initial and recurrent UTIs was also described. The association of recurrent UTI with vesicoureteral reflux (VUR) was also evaluated. A total of 192 uncircumcised males with a median age of 5.8 months (interquartile range [IQR]: 3.5-7.9 months) were included. Twenty-seven patients were treated with a course of betamethasone valerate 0.1% cream, and 165 were not (Summary Table). There were no significant differences between groups in the frequency of voiding cystourethrogram (VCUG), diagnosis of VUR, or use of continuous prophylactic antibiotics (CAP). During a median follow-up of 8.7 months (IQR: 3.1-17.5 months), none of the patients treated with steroid cream had a recurrent UTI compared with 27 of 165 (16%) patients not treated (P=0.02). Among the 173 patients whose initial UTI was febrile, recurrent febrile UTIs occurred in no treated patients and 23 of 150 (15%) untreated patients (P=0.047). The results of this study are consistent with those of a previous randomized trial of steroid cream for physiologic phimosis which found lower recurrent UTI in those whose foreskins became retractable. In addition, the results are consistent with the declining incidence of UTIs in uncircumcised males mirroring the natural history of physiologic phimosis resolving. This study is limited by its retrospective nature and non-standardized follow-up. The use of steroid cream for physiologic phimosis is associated with a decreased risk of recurrent UTIs in uncircumcised male infants with a normal renal ultrasound. In this group, steroid cream for physiologic phimosis is a well-tolerated and simple alternative to circumcision to potentially decrease risk of recurrent UTI.

Factors associated with severe oral mucositis and candidiasis in patients undergoing radiotherapy for oral and oropharyngeal carcinomas: a retrospective multicenter study of 326 patients.

The present retrospective multicenter study intended to investigate the factors associated with severe oral mucositis and candidiasis in patients undergoing radiotherapy for oral and oropharyngeal carcinomas. A total of 326 patients who underwent radiotherapy for oral and oropharyngeal cancers were enrolled in the study. The patients' age, sex, body mass index, primary site, diabetes, serum albumin, creatinine, hemoglobin, leukocyte and lymphocyte, concurrent cisplatin or cetuximab, method of radiation, total radiation dose, feeding route, use of spacers, pilocarpine hydrochloride, and corticosteroid ointment were examined, and the associations of each variable with oral mucositis and candidiasis were analyzed by multivariate Cox regression analysis. Grade 3 oral mucositis occurred in 136 (41.7%) patients. Male sex, oropharyngeal cancer, low hemoglobin levels, low leukocytes or lymphocytes, concurrent cisplatin or cetuximab, and oral feeding were found to be significantly associated with a higher incidence of severe oral mucositis. Oral candidiasis occurred in 101 (31.0%) patients. Oropharyngeal cancer, low leukocyte count, and oral mucositis of grade 2 or higher were found to be significantly associated with a higher incidence of oral candidiasis. The use of a topical steroid ointment was not found to be a risk factor for oral candidiasis. The present retrospective study demonstrated that certain factors may predispose patients with oral and oropharyngeal cancers receiving radiotherapy to develop severe oral mucositis and oral candidiasis. A preventive strategy for severe oral mucositis needs to be established in the future for high-risk cases.

Long-term follow-up of intradermal injection of methylene blue for intractable, idiopathic pruritus ani

BackgroundWhile various medical treatments such as topical steroid ointment, antihistamine agent, and sedatives have been used for treating idiopathic intractable pruritus ani, they are not long-term solutions, due to the high recurrence rate. The aim of this study was to determine the effect of methylene-blue intradermal-injection therapy for treating patients with idiopathic intractable pruritus ani. Symptom improvement and recurrence rates were determined with a long-term follow-up.MethodsA retrospective study was conducted from January 2011 to October 2013 on consecutive patients with intractable pruritus ani treated with methylene-blue intradermal injection. The therapy included 5 ml of 1% methylene blue and 15 ml of 1% lidocaine. Follow-up included a physical exam and satisfaction-score survey (1 = much worse, 2 = worse, 3 = no improvement, 4 = much better, 5 = gone completely) before treatment, 6 weeks after treatment, and 3 years after treatment to check patient status and recurrence rate.ResultsOf 103 treated patients, 96 were able to attend the 6-week follow-up visit. There were 58 (60.4%) males and 38 (39.6%) females with a mean age of 48.34 ± 10.21 years. Their mean satisfaction score at 6 weeks was 4.23 ± 0.86. Of the total of 96 patients, 9 (9.4%) patients scored 3 or less in their satisfactions score at 6 weeks. 62 (64.6%) patients were evaluated 3-year post-treatment. The satisfaction score at 3 years after treatment was 4.74 ± 0.57. Besides the 9 patients who initially failed treatment, 4 of the remaining 53 patients scored 3 or less in their satisfaction score surveys. Thus, the recurrence rate at 3 years was 7.5% (4/53).ConclusionsMethylene-blue intradermal injection can result in a high symptom improvement rate with low recurrence rate for patients with idiopathic pruritus ani.

A clinico-epidemiological study on urticaria cases in various tertiary care hospitals affiliated to a medical college in Mangalore, India

BACKGROUND: Urticaria affects one in every five persons in the population. OBJECTIVES: This study was done to study the risk factors, clinical presentation, and management practices among patients with urticaria. METHODS: Information from the medical case records of confirmed cases of urticaria at a government and private tertiary care hospital over the recent 4 years were recorded in a semi-structured pro forma. RESULTS: Mean age of 115 patients was 31.2 ± 20.7 years. Majority of patients (69, 60%) had acute urticaria. The most common risk factors of urticaria in this study were allergy to food substances (27, 23.5%) and allergy to medications (18, 15.6%), followed by insect bites (16, 13.9%). Family history of urticaria was present in 8 (7%) patients. The most common symptom in urticaria was pruritus (68, 59.1%) and the most common sign was hives (40, 34.8%). Lesions were present all over the body in 52 (45.2%) and were bilateral in distribution in 59 (51.3%) patients. Sixty-eight (59.1%) and 69 (60%) urticaria patients were prescribed nonsedating and second-generation antihistamine (sgAH) drugs, respectively. Among chronic urticaria (CU) cases, 35 (76.1%) each received nonsedating and sgAH. Systemic steroids and topical steroid creams were prescribed in 21 (18.3%) and 7 (6.1%) urticaria patients, respectively. Mean duration of application of the topical steroid creams was 10 ± 4.8 days. Leukotriene antagonists were used in the management of greater proportion of patients (54.5%) with dermographism in comparison to 16.1% without dermographism (P CONCLUSION: The study reported few important risk factors and certain common clinical presentation in urticaria. Second-generation nonsedating type of antihistamine drugs was the most preferred drug for the management of urticaria.

Extensive tinea corporis and tinea cruris et corporis due to trichophyton interdigitale

Background: India is facing a gruesome epidemic-like scenario of chronic, extensive and recalcitrant dermatophytosis for the past 5-6 years. Dermatophytosis, also commonly known as tinea, used to be considered as trivial infection and was easy to treat. Unethical and irrational mixing of antibacterial and topical corticosteroid with antifungal agents has been instrumental for this extremely challenging situation. Applying such topical preparations for the treatment of dermatophytosis, without any oral antifungal agents can result in extensive lesions and also, fungal resistance. Objective: To find out the cause and dermatophyte species associated with the extensive lesions of tinea corporis. Patients and methods: A study was carried out in the tertiary care centre by the Department of Dermatology and Microbiology during the period starting from October 2016 to April 2017. A total of 158 patients were consented. Any patient with clinical findings of Tinea corporis and KOH and/or culture positive was enrolled in the study. A detailed history was taken. Samples were collected after cleaning the part with 70% alcohol and all KOH positive or negative samples were inoculated on Sabouraud’s dextrose agar supplemented with chloramphenicol and cycloheximide. The culture plates were incubated at 25°C and were observed for four weeks. Lacto Phenol Cotton Blue (LPCB) mounts were prepared to study the microscopic structures in detail. Other tests like urease and in vitro hair perforation tests were also set up to differentiate Trichophyton interdigitale from Trichophyton rubrum. Results: A total of 149(94.30%) were KOH and 158 (100%) were culture positive. We isolated only Trichophyton interdigitale from 158 patients. None of the patients was HIV positive, 6patients (4%) had diabetes. About 70% of the patients gave history of using various combinations of antifungal, antibiotic and topical steroid creams and nearly 10% used pure steroid creams. Rest did not know the name of the cream they applied. Limitations: Molecular characterization was not done to see genetic relatedness. Conclusion: Topical steroid lowers the local immunity and contribute to the extensive and atypical lesions. Dermatophytosis has acquired epidemic proportions in this region of western UP. Misuse of unregulated combinations of steroid is rampant in this region.

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

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

Combination treatment for cicatrix after neonatal circumcision: An office-based solution to a challenging problem

Cicatrix formation, which can form after neonatal circumcision to entrap the glans penis, presents a therapeutic challenge. Previous studies in the literature have described either using a topical steroid cream or stretching of the scar tissue with an instrument but not a combination of both modalities. In our experience, monotherapy has resulted in significant recurrence and/or need for further treatment. We present our successful experience that combines cicatrix stretching with a hemostat using local anesthesia in the office followed by several weeks of topical steroids with a minority of patients needing any additional therapy.

Awareness of and phobias about topical corticosteroids in parents of infants with eczema in Hangzhou, China.

Knowledge of and phobias about topical corticosteroids in parents of infants with eczema affect efficacy of eczema treatment. We surveyed 300 parents of children with eczema using a questionnaire to investigate knowledge of and phobias about topical corticosteroids. Overall, 85.7% (n = 257) of children had used topical corticosteroids, with 12.8% (n = 33) of children having steroids applied for only 1-3 days per episode; 79.4% (n = 204) of patients discontinued topical steroid therapy immediately after improvement. Twenty-five percent (n = 75) of parents refused a prescription of steroid ointment, and 32.3% (n = 97) did not use the steroid ointment on their children despite having received a prescription. During steroid treatment, 95.7% (246) of parents were very concerned about the side effects of topical steroids. One hundred eight parents (42%) did not use a topical steroid ointment for recurrence of eczema because of concerns about using topical corticosteroids. Most parents of infants with eczema had excessive concerns about topical corticosteroids, leading to inadequate treatment of atopic dermatitis. In clinical practice, physicians should reinforce parents' understanding of steroid treatment for eczema and guide rational use of topical steroids for infantile eczema.

Majocchi's granuloma: current perspectives.

Majocchi’s granuloma (MG) is a rare fungal infection of the dermis that is mainly caused by dermatophytes (in ≥95% of cases); the most frequently identified cause is anthropophilic Trichophyton rubrum. In the rest of the cases, the causes are non-dermatophytic fungi such as Aspergillus species. This review aimed to provide information about the current perspectives on MG regarding its clinical characteristics, predisposing factors, laboratory diagnosis, and treatment strategies. Although the lower extremities were reported to be the most common site of infection, facial involvement has been predominant in the past 5 years. Our literature research showed that the most common predisposing factor (55%) is the use of topical steroid creams without potassium hydroxide examination during treatment of erythematous squamous dermatoses. A reliable diagnosis of MG is based on histopathological examination, including fungal culture and molecular analyses. MG should be treated not only with topical agents but also with systemic antifungal agents that are continued until the lesions are completely resolved. In systemic treatment, the most preferred drug is terbinafine, because of its efficacy, side effects, and safety.