Use Of Topical Steroids Research Articles

Use of topical steroids in the setting of corneal subepithelial deposits due to multiple myeloma

Introduction: The aim of this case report was to describe the use of topical steroids in a patient with subepithelial corneal deposits most likely due to multiple myeloma. Case Report: A 58-year-old white female with multiple myeloma was referred to a cornea sub-specialty clinic at Massachusetts Eye and Ear for intermittent blurred vision and development of peripheral corneal deposits in both eyes. On examination, bilateral, superior peripheral corneal deposits were identified with an otherwise clear cornea. There was no corneal neovascularization, epithelial defect, or stromal gelatinous changes. The anterior chamber was quiet without any cell or flare. Dilated fundus examination was unremarkable. The corneal deposits did not resemble nodules found in Salzmann nodular degeneration or pannus from ocular rosacea/contact lens wear/trauma. Given that the patient had no prior history of eye problems or trauma, it was believed that the corneal subepithelial deposits were inflammatory changes due to her relatively recent (within one year) diagnosis of multiple myeloma. The patient was started on loteprednol etabonate 0.5% ophthalmic suspension one drop two times daily in both eyes and one month follow-up was arranged. At her one-month visit, the corneal deposits were much improved and, subsequently, her loteprednol drops were reduced to one drop nightly in both eyes for two months followed by 1 drop Monday/Wednesday/Friday in both eyes for two months. Conclusion: We describe an interesting case in which low dose topical steroid was utilized and may have contributed toward the stabilization and regression of peripheral subepithelial corneal deposits most likely due to multiple myeloma. It is possible that some of the observed improvement in the patient’s corneal deposits were in part due to her systemic treatment of multiple myeloma. Further studies are needed to establish the impact of topical steroids in this patient population, especially in more severely affected eyes.

Atopic dermatitis in children of the first year of life: clinical and pathogenetic aspects, modern views on treatment from the perspective of a dermatologist

Atopic dermatitis is one of the most common skin diseases in children. Genetic disorders that determine the development of persistent dysfunction of cellular immunity play an important role in the development of clinical symptoms of atopic dermatitis. In the new concept of the occurrence of clinical manifestations of atopic dermatitis (AD), T-regulatory lymphocytes are assigned, in the form of CD4+CD25+ phenotype, which is controlled by the transcription factor FoxP3. The study of the mechanism of itching, which is more or less observed in all children with blood pressure, showed that in the case of the island-inflammatory course of Th2-dependent blood pressure, itching is histamine-conditioned. According to the concept of «Outside to Inside – outside – inside», the most significant mechanisms causing the appearance of blood pressure are a genetic predisposition that causes the formation of allergic reactions, changes in the permeability of the epidermal barrier, against the background of transepidermal moisture loss, the occurrence of xerosis phenomena and a decrease in the itching threshold. Significant abnormalities in the state of the skin microbiota were found in children with AD. The species composition of the intestinal microbiota in children with AD differs significantly from that in children with healthy skin. Intestinal microbiocenosis largely determines the direction of morphofunctional processes in the epidermis, by means of translocation of intestinal bacteria regulating the humoral response directly in the skin. Most often, allergic reactions are triggered when food proteins enter the body. Among other allergens, cow’s milk protein is the most significant in the development of allergic reactions in young children. In many cases, in 1-year-old children with AD, goat’s milk mixtures are a good alternative to cow’s milk-based milk mixtures. At the present stage, the most important in the complex of therapeutic measures in children with blood pressure from the first year of life are diet therapy and active external therapy, including the phased use of topical steroids, calcineurin inhibitors, emollients.

Drug-induced Steatohepatitis Caused by Long-term Use of Topical Steroids for Atopic Dermatitis.

Atopic dermatitis is common in children and often treated with topical corticosteroids (TCs). A boy in his late teens who had been using TCs for atopic dermatitis was diagnosed with liver damage during a health checkup. A medical examination revealed severe steatotic liver disease and elevated liver enzyme levels despite the absence of typical symptoms such as central obesity. After discontinuation of TCs, an improvement in liver enzyme levels was observed, leading to the diagnosis of drug-induced steatohepatitis. This case underscores the potential liver risks associated with prolonged TC use in children, highlighting the need for parental education.

The Treatment of Lichen Sclerosus with Topical Roflumilast 0.3% Case Study

Lichen Sclerosus is a chronic inflammatory skin disease predominantly affecting post-menopausal women. Currently, the first line treatment approach for lichen sclerosus is ultra potent topical corticosteroids for 12 weeks. A treatment challenge to this approach is the risk of steroid atrophy due to the use of potent topical steroids on the genital skin. We describe reduction of erythema and symptomatic improvement following treatment with topical roflumilast 0.3% once daily in a patient with lichen sclerosus who refused topical corticosteroids.

Candida parapsilosis keratitis: A case series

Purposeto describe the diagnosis and management of Candida parapsilosis keratitis Designa retrospective, observational case series. Methodsthis study was carried out in a single-centre tertiary referral eye hospital and includes 20 eyes of 19 patients. Electronic case notes and in vivo confocal microscopy (IVCM) records were searched for the keyword ‘parapsilosis’, with inclusion if there was keratitis with either a corresponding positive polymerase chain reaction (PCR) or microbial culture result for Candida parapsilosis. Individual case notes were reviewed to obtain information regarding diagnosis, treatment, and final visual outcomes. Cases were excluded if a patient was lost to follow-up before the end of antifungal treatment. Resultsthe risk factors for C. parapsilosis keratitis were: ocular surface disease, concurrent topical steroid use, previous corneal surgery and long-term contact lens wear. The mean presenting corrected distance visual acuity (CDVA) was LogMAR 1.49 (range 0.2 – 2.3), with a final CDVA of LogMAR 1.11 (-0.2 – 2.3). Where used, microbiological culture was positive in 19 out of 20 cases, PCR in 6 out of 11 cases, and IVCM in 8 out of 13 cases. Two-thirds of cases were managed with either topical voriconazole or amphotericin B, with four cases surgically managed by therapeutic keratoplasty and two cases requiring evisceration. ConclusionsPatients presenting with microbial keratitis with risk factors for C. parapsilosis keratitis should be managed with a high degree of clinical suspicion. Post-infection visual outcomes are poor but reflect pre-existing ocular comorbidities. Delays in diagnosis can be reduced by through the use of ICVM and PCR.

Outcomes of Type-1 Tympanoplasty with and without use of Topical Nasal Steroids; a Comparative Study

Objective: To compare the outcome of Type-1 tympanoplasty procedure in patients given intranasal steroids post-operatively versus those not given intranasal steroids after procedure. Study Design: Quasi-Experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi. Pakistan from May 2021 to May 2023. Methodology: A total of 464 patients, 232 of which were given intranasal steroids (Group-A), and 232 who were not given intranasal steroids (Group-B) were made part of this research. Upon inclusion, all pre-operative demographics were documented. Patients in post-operative follow up period were assessed for condition of tympanic membrane and improvement of hearing ability. Results: In current study, post-operatively, in patients who were given intranasal steroids, graft take-up frequency was 227(97.84%) and residual perforation was 5(2.16%) was better than in patients who were not given intranasal steroids, which came to 224(96.55%) and 8(3.45%), respectively (p=0.399). In terms of post-operative WHO grade of hearing impairment distribution (p<0.001) and post-op hearing status (p=0.005) difference between patients who were given intranasal steroids and those not given intranasal steroids was statistically significant. Conclusion: Addition of intranasal steroid spray to the treatment regimen following tympanoplasty is provides better outcomes in terms of higher graft take-up frequency and an improvement in hearing from preoperative levels.

Topical steroid use for suppression of hypergranulation in burns: Trends across the Atlantic.

Hypergranulated wounds from thermal injury remain a complex and debilitating problem for burn patients. Currently, there is no standard therapy to prevent or treat hypergranulation following burn injury. Many centers use topical corticosteroids; however, their use seems to be geographically dependent and controversial. The primary aim of this study was to quantify the current use of topical corticosteroids for post-burn hypergranulation in North America (NA) and Europe, while secondarily assessing for perceptions of safety and efficacy. We designed a survey that was distributed to the members of the European and American Burn Associations. Data was extracted and analyzed using SPSS software. A total of 165 respondents completed the survey (90 and 75 for the European and NA members, respectively). Seventy-one of the 90 (78.9%) European respondents reported they routinely use topical steroids for suppression of hypergranulation tissue in burns, versus 25 of the 75 (33.3%) NA respondents (p<0.001). European respondents, compared to NA respondents, were significantly more likely to consider topical steroid use safe (100% vs. 74.4%, p <0.001) and effective (98.6% vs. 66.7%, p < 0.001) for treatment of hypergranulated burn wounds. There was no significant difference in reported systemic effects seen after topical steroid use when comparing NA respondents and European respondents (6.5% vs. 6.9%, p > 0.10). The results of this study suggest that the use of steroids for hypergranulation tissue in burn care is more prevalent in Europe than NA, which may be due to discordant views on safety and efficacy despite minimal reported adverse effects.

Deep dermatophyte infections

Deep dermatophytosis is a rare condition in which dermatophytes invade deep into the skin. Predisposing factors include chronic superficial dermatophytosis, immunosuppression or the use of topical steroids. Clinical, mycological, and histological examination are crucial for accurate diagnosis. Microscopy and culture or molecular diagnostic are useful tools when identifying the causative dermatophyte species. Species-directed systemic antimycotic treatment is golden standard and require careful consideration of potential drug-drug interactions and monitoring for both efficacy and side effects, as argued in this review.

The association between atopic dermatitis and linear growth in children- a systematic review.

To evaluate the association between atopic dermatitis (AD) and linear growth in children, and determine factors associated with compromised linear growth in children with AD. A PRISMA-compliant systematic review was conducted. Databases (PubMed, Embase, Scopus and Cochrane) were searched from inception to June 2024 for articles that reported a quantitative relationship between AD and linear growth in children (< 18years old). Quality of included articles was assessed using the Joanna Briggs Institute Critical Appraisal Tools while quality of evidence in these studies was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Fourteen studies (comprising 50,146 patients with AD) were included. Seven studies reported a strong positive or positive association between AD and reduced height standard deviation score (SDS) in children; the others reported no association. Only 3 studies had moderate quality of evidence, all of which reported an association between AD and poorer height SDS; the remaining 11 studies scored low in quality of evidence. Three studies reported the impact of AD on height to be transient. Secondary analysis showed AD severity, earlier AD onset, sleep disruption and, food restriction, to be risk factors for linear growth impairment in patients with AD. Topical steroid use was not associated with shorter stature in patients with AD. Conclusion: Current evidence on the association between childhood AD and poor linear growth is weak and inconsistent. However, patients with more severe AD, earlier disease onset, poorer sleep quality and higher nutritional restrictions appear more susceptible to linear growth impairment. What is known? • There is inconsistent evidence of the association between atopic dermatitis (AD) and linear growth in children in current literature, with some studies suggesting that AD may negatively impact linear height while other studies do not report similar associations. What is new? • There is no strong association between AD in childhood and poorer linear growth. • There may be a transient slowing of linear growth in children with AD, mimicking constitutional growth delay. • Children with severe AD, earlier disease onset, poorer sleep quality and nutritional restrictions may be at risk of more significant linear growth impairment. • Topical steroid use does not appear to contribute to shorter height in children with AD.

Dermoscopic Distinction of Tinea Incognito on the Face and Topical Steroid Damaged Face: A Cross-Sectional Study in Skin of Color.

Dermatophytosis is widespread in India due to recalcitrant and resistant infection. Tinea incognito (TI) is modified dermatophytosis due to the inadvertent use of topical steroids (TS). Similarly, topical steroid-damaged face (TSDF) is caused by prolonged use of TS. Distinction of TI and TSDF is difficult when the face is affected. Dermoscopy can assist in the differentiation of both by revealing characteristic features. We evaluated the dermoscopic features in TI affecting the face and TSDF. To evaluate the clinical and dermoscopic features of TI affecting the face and TSDF. To observe the involvement of eyelids in TI as opposed to TSDF. The study was conducted in a tertiary hospital after obtaining ethical clearance and informed consent. Patients with signs of TI or TSDF were enrolled and demographic data were collected. Patients who had applied TS/combination creams were included. A handheld dermoscope with 10x magnification was used. A potassium hydroxide mount was used to confirm the diagnosis of TI. Out of 80 patients, 27 males and 53 females were present. The mean duration of application was 8.25 ± 7 months. Clinical features were pruritus, erythema, scaling, and burning sensation. Eyelid involvement was noted in TI while it was spared in TSDF. On dermoscopy, morphological features were predominant in TI whereas vascular structures were found in TSDF in addition to white rosettes. Dermoscopy distinguishes TI from TSDF comprehensively by demonstrating definitive features. In addition, the involvement of the eyelid is an excellent clinical sign of TI.

Fungal Keratitis in Northwestern Spain: Epidemiology, Risk Factors and Outcomes.

To review the clinical features, risk factors, microbiological profile, and treatment regimens of fungal keratitis in Galicia, a region in Northwestern Spain with temperate humid weather. A retrospective case series was employed, including patients with fungal keratitis from nine hospitals within the region of Galicia, Spain, between 2010 and 2020. Data obtained from clinical records were analysed. Out of 654 cases of infectious keratitis, 77 cases (9.9%) were identified as fungal keratitis. The median age of affected patients was 68.0 years, with a higher incidence in rural areas (62.3%). Candida spp. infections were the most frequent type (55.8%) and were associated with a higher median age than were the non-dermatophyte mould infections. The primary risk factors included steroid eyedrop use (29.9%), recent keratoplasty (18.2%), ocular trauma (19.5%), and contact with vegetable matter (11.7%). Most ulcers displayed stromal involvement, and 37.7% presented corneal thinning. The median duration of infection was longer in fungal than in bacterial keratitis, and surgical intervention was required in 48.1% of cases. Fungal keratitis, mainly involving Candida spp., accounted for 9.9% of microbial keratitis cases in Galicia, Spain, with significant risk factors being topical steroid use, ocular trauma, and contact with vegetable matter. Delayed diagnosis often resulted in poor outcomes, highlighting the need for early detection through awareness and new technologies to improve prognosis.

Patterns and Motivations of Topical Steroid Use for Skin Whitening in Jazan, Saudi Arabia: A Cross-Sectional Survey.

Background The use of topical steroids for skin whitening is prevalent in many regions, including Saudi Arabia. This study aims to analyze the patterns, motivations, and demographic factors associated with the use of topical steroids for cosmetic purposes in Jazan, Saudi Arabia. Methods This cross-sectional survey was conducted online over three weeks. A structured questionnaire was distributed to adults residing in Jazan, collecting data on demographics, topical steroid use, motivations, and product sources. Descriptive statistics were used to analyze the data. Results Among the 340 participants, 173 (50.9%) reported using topical steroids for skin whitening. The majority of users were female (149, 43.8%) and aged between 20 and 30 years (78, 22.9%). Most participants had used topical steroids for less than a year (127, 73.4%), with usage predominantly in the evening (86, 49.7%). Topical steroids were primarily purchased from pharmacies (70, 40.5%), with significant monthly expenditure variability: 55 participants (31.8%) spent between 50 and 110 SAR, and 62 (35.7%) spent more than 150 SAR. Motivations for use included a preference for lighter skin (49, 28.4%) and treatment of melasma (42, 24.3%). Recommendations from friends (71, 41.0%) and TV advertisements (34, 19.8%) influenced product choice. Conclusion Topical steroid use for skin whitening is widespread among adults in Jazan, with a notable emphasis on cosmetic outcomes and substantial financial investment. There is a critical need for increased public education on the risks associated with topical steroids and enhanced professional guidance to promote safer usage practices.

Chronic Ocular GVHD Treatment at Two Locations of a Tertiary Referral Center.

To compare baseline characteristics and treatment of chronic ocular graft-versus-host disease (oGVHD) patients in two treatment locations. Patients diagnosed with definite chronic oGVHD between September 1, 2014 and September 20, 2021 at two locations were identified. IRB-approved retrospective chart review was conducted for the following data: demographic information, ocular surface disease index (OSDI), corneal fluorescein staining (CFS), and treatment(s) used. Differences by site were assessed using Pearson's Chi-Square tests and two-sample t-tests; differences by time were assessed using paired t-tests. At baseline, Clinic 1 (C1) patients had a worse mean OSDI score (47.8 vs 36.3, p = 0.011) and CFS in both OD (1.3 vs 0.8, p = 0.005) and OS (1.3 vs 0.6, p < 0.001) compared to Clinic 2 (C2). Comparing baseline to endpoint, C1 patients experienced an improvement in OSDI (-17.26, p < 0.001), CFS OD (-0.50, p < 0.001), and CFS OS (-0.51, p < 0.001) at C1. Change in OSDI, CFS OD, or CFS OS was not statistically significant at C2. Despite similar follow-up length, C1 demonstrated more clinic visits (10.4 vs 3.4, p < 0.001) and more treatment trials (4.9 vs 2.4, p < 0.001) compared to C2. Punctal plugs (85.5% vs 61.2%, p = 0.002), punctal cautery (69.7% vs 28.6%, p < 0.001), topical steroids (72.4% vs 22.4%, p < 0.001), and autologous serum tears (AST) (52.6% vs 8.2%, p < 0.001) were used more frequently at C1 than at C2. oGVHD patients at C1 experienced significant improvement in OSDI and corneal fluorescein staining and compared to patients at C2, had more frequent follow-up and use of punctal plugs, punctal cautery, topical steroids, and AST.

An Interesting Case of Cushing Syndrome

An Interesting Case of Cushing Syndrome A 36 year old female presented to dermatology department with Multiple ulcers present in B/L axilla, B/L inframammary fold and B/L gluteal fold (Left &gt; Right) since 3 months. Patient was referred from dermatology department to General Medicine for opinion on puffiness of face and swelling of legs . Patient had history of topical steroid use for itchy lesions in B/L axilla and inframammary folds 4 months back . H/o weight gain present. (6 kg). H/o puffiness of face and striae present over the abdomen. Patient had no known comorbidities previously. On physical examination patient had moon face ,facial plethora + ,Buffalo hump ,Loss of axillary hair, centripetal obesity , Abdominal striae , Sparse pubic hair , Pallor +. Systemic examination was normal. Investigations revealed new onset diabetes , serum cortisol was low (&lt;0.5 mcg/ml) , serum acth was low (1pg/ml) , HB was low (7.9gm/dl) , total count was elevated (15,600) . Patient was diagnosed to have Iatrogenic (Topical steroid induced) Cushing Syndrome with Steroid induced atrophy and ulceration of skin &amp; subcutaneous tissue leading to secondary fungal and bacterial infection , tinea incognito with secondary bacterial infection , iron deficiency anemia and newly detected Type 2 Diabetes mellitus. Patient was appropiately treated with iv antibiotics (Inj Piperacillin Tazobactum 4.5 g iv thrice daily), daily dressing on other supportive measures along with discontinuation of steroids. Patient improved symptomatically after discontinuing topical steroids, the cushingoid features started decreasing. The ulcers also started to heal. The patient was started on Tab. Hydrocortisone 10mg - 0 – 5mg and was referred for Endocrinologist opinion

Barriers to identifying, diagnosing, and treating vulval lichen sclerosus in primary care: a mixed methods survey study.

Vulval lichen sclerosus (VLS) is a skin condition which causes pain, itching, anatomical changes, and increases vulval cancer risk by up to 22 times. VLS is treatable, with use of topical steroids allowing symptom resolution and complication prevention. Diagnostic delay and misdiagnosis of VLS is common. Previous studies found that women attribute this to poor interactions with and knowledge of clinicians. Most VLS is diagnosed in primary care. To investigate primary care clinicians' views on confidence in identifying and managing vulval skin disease and VLS, barriers to diagnosis, education on vulval skin disease, and diagnostic criteria for VLS. A mixed methods survey was distributed via professional events and networks. Qualitative data was analysed in NVivo using inductive thematic analysis. Spearman's rank correlation was used to correlate participant characteristics and confidence. There were 122 responses, the majority from GP trainees (48%) and GPs (43%). Confidence in diagnosing, identifying, and treating VLS positively correlated with female gender, time in role, and examination frequency. Themes identified include patients not knowing normal, male clinicians: deskilling and reluctance, lack of clinician knowledge, and uncertainty around diagnosis and treatment. 38% of participants never participated in teaching or learning on vulval skin disease. Almost all (98%) participants feel diagnostic criteria would be helpful. This study illuminates the multiple barriers to diagnosis and treatment of VLS. The results confirm that clinicians share patient concerns that knowledge is poor, highlight the importance of developing clear diagnostic criteria, and will allow us to target training to those lacking in confidence.

Tinea Incognito: Challenges in Diagnosis and Management.

Tinea incognito is a dermatophyte infection with atypical features, due to the use of topical or systemic steroids or other immunosuppressive medications. Delayed diagnosis, spread of the infection to critical body surfaces, resistance to antifungal drugs, and increased costs due to prolonged hospitalization and multiple treatment regimens often complicate tinea incognito. It can affect individuals of all ages and genders, but it is more common in children. Atypical clinical appearance often necessitates differentiation from other diseases such as eczema, seborrheic dermatitis, lupus erythematosus, psoriasis, or other non-fungal skin conditions. The treatment of tinea incognito usually involves discontinuation of topical steroids or other immunosuppressive medications. Preventive measures and management of the underlying fungal infection are necessary and can be achieved with antifungal drugs. Patients should wear loose cotton clothes, use boiling water for laundry, and iron their clothing before wearing them. Additionally, they should avoid sharing bed linens, towels, clothes, and shoes. This review aims to raise awareness of tinea incognito among health practitioners, provide tips for detecting the disorder, include it in the differentials, and evaluate the available diagnostic procedures.

Experience of using homeopathic ointment in the treatment of patients with anal itching

Introduction. Anal contact or conduction in the anal canal and rectum is a common condition in the coloproctological field, occurring in 5% of the population that affects this country. Treatment consists of hygiene and the use of topical steroids, antibacterial and antifungal agents. No generally accepted attitude towards a private person has been developed.Aim. To study the effectiveness of using homeopathic ointment in the treatment of patients with anal itching.Material and methods. A prospective comparative randomized study was conducted in a specialized advisory center of the Clinics of Samara State Medical University. The study included 96 patients with anal itching without fungal infection of the perianal skin and concomitant purulent pathology. In the main group (n = 46), treatment was carried out using homeopathic ointment in the perianal area 2–3 times a day for 14 days. In the control group (n = 50), treatment was carried out with topical steroid ointments 2–3 times a day for 14 days.Results and discussion. From the data obtained on the use of homeopathic ointment, it follows that it is not inferior in effectiveness to topical steroid ointments in reducing symptoms of the disease (Student’s t-test = 0.35; p &gt; 0.05 and Student’s t-test = 0.28; p &gt; 0.05), and by the number of relapses (χ2 = 0.535; p &gt; 0.05).Conclusion. The use of homeopathic ointment for topical application appears to be a promising new treatment for patients with anal itching and is as effective as topical steroid ointments.

P21 Advancing dermatological care: a comprehensive evaluation of the steroid-free GL-1 formulation

Abstract Introduction and aims The prolonged use of topical steroids introduces notable dermatological risks, including the onset of permanent stretch marks, bruising, discoloration and vascular abnormalities. This study presents an innovative strategy by formulating GL-1, a steroid-free treatment amalgamating seaweed bioactives, sesame oil and naturally occurring salts and minerals. The objective of this study was to address the limitations of conventional topical steroids and introduce pioneering solutions to dermatological care. Methods To assess the safety and efficacy of GL-1 (product 1), a comprehensive battery of in vitro tests was employed. The skin corrosion test (OECD 431) established the noncorrosive nature of GL-1, validating its safety on reconstructed human epidermis. The skin irritation test (OECD 439) demonstrated the nonirritating attributes of GL-1, aligning with the United Nations Globally Harmonized System of Classification and Labelling guidelines. Additionally, the bovine corneal opacity and permeability test (OECD 437) affirmed the noninducing nature of GL-1 in relation to eye irritation or serious eye damage. Results Preliminary outcomes from dermal clinical trials indicate promising Results for GL-1. In vitro experiments on HaCaT and human dermal fibroblasts, adult (HDFa) cell lines highlighted the noncytotoxicity of GL-1, contrasting with the ‘Cortopin’, which exhibited cytotoxicity. GL-1 exhibited a proliferative effect in HDFa cells, signifying its potential for regenerative applications. Furthermore, both GL-1 and ‘Cortopin’ displayed antioxidant activity in HaCaT cells, underscoring the additional merits of our formulation. Conclusions Our steroid-free formulation, GL-1, demonstrates exceptional safety and efficacy through a meticulous series of in vitro assessments and initial clinical trials. These findings position GL-1 as a promising candidate for diverse dermal applications, offering a secure alternative to traditional topical steroids. The potential impact of GL-1 transcends its therapeutic efficacy, emphasizing its robust safety profile validated through multiple in vitro evaluations.

Clinical outcomes with utilization of high-potency topical steroids in patients with lichen sclerosus-associated vulvar cancer

ObjectivesTo evaluate the impact of high-potency topical steroid use on risk of recurrence of lichen sclerosus-associated vulvar cancer. MethodsThis is a retrospective cohort study evaluating patients with lichen sclerosus (LS)- associated vulvar squamous cell cancer (VSCC). Demographic and clinical outcome data were compared between two comparison groups: patients who received steroids, mainly clobetasol, and patients who did not receive steroids following treatment of LS-related vulvar cancer. Categorical variables were compared using Fisher's exact test or chi-square test. Continuous variables were compared using a two-sided student's t-test. Time to recurrence (TTR) and overall survival (OS) were analyzed using Kaplan-Meier survival plot and compared using Mantel-Cox log rank test. Cox proportional hazard regression models were conducted to generate hazard ratios for both TTR and OS. A p value of <0.05 was considered statistically significant. ResultsA total of 49 patients were included, with 36 patients receiving steroid treatment and 13 patients in the expectant management group. The median age of diagnosis was 68. The average BMI was 31.7 +/− 7.0. The median length of follow up was 41 months. The majority of patients were diagnosed with stage I VSCC. There was no difference in demographics or oncologic management of vulvar cancer between the two cohorts. Overall recurrence was decreased among patients who received steroid treatment when compared to patients who did not, 12 patients (33.3%) versus 9 patients (69.2%) respectively (p = 0.048). ConclusionsHigh-potency topical steroid use following treatment of lichen sclerosus-associated vulvar squamous cell carcinoma is associated with decreased risk of recurrence and prolonged median time to recurrence.

Hypothalamus-pituitary-adrenal axis (HPA axis) suppression with inappropriate use of steroids in recalcitrant dermatophytosis - A cross-sectional study.

Improper use of over-the-counter (OTC) steroid medication has been linked to recalcitrant dermatophytosis. There is proven evidence of HPA axis suppression by the use of long-term oral steroids. This study aims to determine the prevalence and pattern of inappropriate OTC steroid use and its effects on the hypothalamus-pituitary-adrenal (HPA) axis in adults with recalcitrant dermatophytosis. This cross-sectional study of 2 months was conducted in a hospital setting and included patients of recalcitrant dermatophytosis with a history of OTC steroid use. Clinico-demographic details and basal serum cortisol levels were recorded in all and analyzed. Of a total of 103 patients, 59.22% (n = 61/103) were males, and the mean duration of steroid abuse was 17.78 months. About 48.54% (n = 50/103), 3.88% (n = 4/103), and 47.57% (n = 49/103) patients reported the use of topical steroids, oral steroids, and both oral and topical steroids, respectively. Among all the topical steroid users (n = 99), clobetasol propionate 48.48% (n = 48/99), while among oral steroid users (n = 53), prednisolone 45.28% (n = 24/53) were the most commonly used agents, respectively. The morning serum cortisol levels (8-9 AM) were found to be decreased in 42.7% (n = 44/103), with a mean value of 44.28 ± 17.34 μg/dL. Improper OTC steroid use in recalcitrant dermatophytosis leads to HPA axis suppression. This highlights the need for intervention from apex health officials.