Use Of Topical Corticosteroids Research Articles

CORNEAL TRANSPLANTATION

Corneal transplantation is an ophthalmic surgery that aims to restore vision in patients with corneal diseases. Advances in transplantation techniques and in the treatment of rejection have improved the results of this procedure, making it more effective and safer. This paper seeks to analyze the latest developments in transplantation techniques and treatments for rejection in corneal transplantation, highlighting not only scientific advances, but also the emotional and social aspects involved in this procedure, providing a comprehensive overview of the latest innovations in the field of corneal transplantation, highlighting improvements in surgical techniques and post-operative treatments, which are helping to transform the lives of thousands of patients around the world. This is a bibliographical review, using qualitative premises, with the PubMed, Scopus, Web of Science and Scielo databases. The health descriptors “corneal transplantation”, “corneal graft rejection” and “penetrating keratoplasty” were used to better refine the research. Corneal transplantation is indicated for various conditions, such as keratoconus, corneal dystrophies, corneal opacities, among others. The most common transplant techniques include complete (penetrating) corneal transplantation, anterior lamellar transplantation and endothelial transplantation (DSAEK/ DMEK). In recent years, there have been significant advances in lamellar transplantation techniques, which allow specific layers of the cornea to be replaced while preserving the healthy layers. This has resulted in better success rates and faster visual recovery compared to penetrating transplantation. Treatment of corneal graft rejection includes the use of topical and systemic corticosteroids, immunosuppressants and anti-inflammatory agents. New approaches, such as biological and immunomodulatory therapies, are also being investigated to improve results in cases of refractory graft rejection. In conclusion, corneal transplantation remains an important option for restoring vision in patients with corneal diseases. Updates in transplantation techniques and advances in the treatment of rejection have improved the results of this procedure, providing patients with a better quality of life and faster and more effective visual recovery.

Papular acantholytic dermatosis: a rare cause of genital rash.

A 52-year-old female presented to our hospital’s STD unit with multiple asymptomatic skin coloured papules along both inguinal folds. The patient noted the onset of these lesions approximately two months before her presentation A punch biopsy was performed, which revealed hyperkeratosis and hypergranulosis in the epidermis along with acantholytic and dyskeratotic foci, leading to the diagnosis of papular acantholytic dermatosis (PAD). Our patient showed a remarkable response after topical corticosteroid use followed by topical calcineurin inhibitor use.

Exfoliative Cheilitis Associated with Chronic Lip Licking - A Case Report

Exfoliative cheilitis is a troublesome condition of lips which can be caused by different factors. One of them is a parafunctional habit of lip liking. This article describes such a case whose outcome was very successful as the patient was able to control her unrelented habit of moisturizing the lips with her tongue, along with a brief use of moderate potency topical corticosteroids.

New Topical Treatment for Atopic Dermatitis

The primary approach for managing atopic dermatitis (AD) involves the use of topical corticosteroids as the first-line treatment.While high-potency topical corticosteroids have shown to be effective, they come with an increased risk of local and, rarely, systemic adverse effects. Additionally, patients often experience a relapsing and remitting course. A revolutionary topical treatment for psoriasis and AD has recently received patent approval from the Spanish Ministry of Industry, Trade, and Tourism. This innovative treatment, presented in the form of a lotion, includes a combination of clobetasol, papaverine hydrochloride, spironolactone, a milk-peptide complex, and propylene glycol. An 18-year-old female presented with AD on the back of her neck and scalp. The patient had no significant past medical history and primarily complained of intense pruritus in the AD lesions. The patient received guidance to apply our recently patented lotion, Psorisbye, once a day for 5 days. In total, 50 ml of Psorisbye was utilized over 4 days. On the fifth day, the patient underwent an examination at the outpatient clinic. The patient reported a significant improvement in pruritus sensations and observed a reduction in scaled lesions. Upon evaluating our patient, a comparison of the lesions before and after applying the topical treatment for 4 days revealed a notable improvement in the SCORAD index, decreasing from 49.95 to 0. While the results of Psorisbye in this case show promise, it is crucial to conduct further studies with larger sample sizes and extended follow-up periods to validate the findings presented in our case report.

Pattern of Inappropriate use of Topical Corticosteroid and Cutaneous Adverse Effects at a Tertiary Level Hospital in Kathmandu

Introduction: Topical corticosteroids are anti-inflammatory, immunosuppressive, and anti-proliferative drugs with profound efficacy. As it provides rapid relief, it is used for a wide spectrum of dermatological conditions. Rampant use of topical corticosteroids due to their easy availability gives rise to difficult-to-treat cutaneous adverse effects. Objectives: To determine the pattern of inappropriate use of topical corticosteroids and cutaneous adverse effects Materials and Methods: This was a hospital based cross-sectional prospective study conducted among 84 participants in the Department of Dermatology, Tribhuvan University Teaching Hospital, Kathmandu, from October 2020 to September 2021. Ethical clearance was obtained from the Institutional Review Committee. The participants fulfilling the inclusion criteria were included in the study. Results: Out of 84 cases, 59.5% were females and 40.5% were males. The mean age of participants was 30.4±9.1years. Dermatophytoses (71.4%) were the most common cause of inappropriate use of topical corticosteroids. The most common adverse effect was tinea incognito (23.8%). The most potent class (60%) of topical corticosteroids were misused. Most of the participants used topical steroids either for the duration of 1 week to 1 month ( 23.8%) or for more than 12 months (23.8%). Conclusion: Inappropriate topical corticosteroid use is a common problem due to its easy accessibility, resulting in several difficult-to-treat cutaneous adverse effects. So, awareness-raising activities regarding the proper use of corticosteroids have to be conducted.

Improper Use of Topical Corticosteroids in Tinea Infections in a Tertiary Care Hospital.

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Through Indian Eyes: A Case Series on Steroid-induced Secondary Cataract

Lichen planus, a chronic autoimmune dermatological disorder, often necessitates the use of topical corticosteroids for symptom management. However, this case series highlights the emergence of topical steroid-induced secondary cataracts in two patients, emphasizing a previously underrecognized complication. Both patients, females aged 36 and 43, presented with gradual vision loss in their left eyes, attributed to prolonged corticosteroid use for lichen planus and skin allergies, respectively. Ophthalmological examinations confirmed the diagnosis, leading to cataract surgeries. The pathogenesis involves complex cellular and molecular mechanisms, emphasizing the need for vigilant monitoring during corticosteroid therapy. Moreover, the lack of stringent reporting systems for adverse drug reactions in India underscores the necessity for comprehensive monitoring to mitigate economic and quality of life burdens. The study emphasizes the importance of judicious corticosteroid use, tapering regimens, and patient education to minimize complications while effectively managing dermatological conditions. This underscores the critical need for heightened awareness, surveillance, and patient-centred approaches to mitigate the risk of corticosteroid-induced secondary cataracts, ensuring optimal therapeutic outcomes and long-term ocular health.

Integrative Approaches for the Diagnosis and Management of Erosive Oral Lichen Planus.

Erosive oral lichen planus (EOLP) represents a significant challenge in dental and medical management due to its chronic inflammatory nature, painful symptoms, and impact on quality of life. This study aims to evaluate the current diagnostic approach with novel non-invasive techniques, such as dermoscopy, and also the landscape of treatment options for EOLP, focusing on its efficacy, safety, and the challenges that it present in clinical practice. Through a comprehensive literature review, we explored the use of topical corticosteroids, systemic immunosuppressants, biologics, and Janus kinase (JAK) inhibitors in treating EOLP, alongside examining patient compliance, psychological impacts, and the risk of adverse effects and recurrence. Our findings reveal that while topical corticosteroids are the cornerstone of EOLP treatment, offering symptomatic relief, their long-term use is limited by side effects and tolerance development. Systemic therapies and biologics provide alternatives for refractory cases but necessitate careful adverse effect monitoring. JAK inhibitors show promise as an innovative treatment avenue but require more evidence on long-term safety and efficacy. This study highlights the necessity of personalized treatment approaches due to the variable disease course and response to treatment, underscoring the importance of a multidisciplinary strategy in managing EOLP. The complexity of EOLP treatment, compounded by its psychological and quality of life impacts, demands ongoing research into targeted therapies, the establishment of standardized treatment protocols, and the development of effective outcome measures to improve patient care and treatment outcomes.

Roflumilast Cream 0.3% for the Treatment of Recalcitrant Lichen Nitidus

Introduction:
 Lichen nitidus is a rare chronic inflammatory condition that presents as shiny, flat-topped papules. The pathophysiology of lichen nitidus is not well understood but has been theorized to stem from allergens that cause antigen presenting cells to activate, thus causing a cell-mediated response that ultimately creates the distinct inflammatory papules1. Cytokines produced by this cell-mediated response may cause an increase in T-helper 2 cells which have the potential to produce the superficial dermal granulomas seen in lichen nitidus2. Currently, no FDA approved treatments for lichen nitidus exist. Due to the inflammatory nature of the disease, off-label therapies may include topical corticosteroids, topical calcineurin inhibitors and UV light1. Lichen nitidus can be a chronic condition and in cases where long term topical corticosteroid use is required, has been associated with hypopigmentation in African Americans. Roflumilast cream 0.3% is a highly selective, non-steroidal and potent topical phosphodiesterase 4 (PDE4) inhibitor approved in 2022 by the FDA for the treatment of psoriasis, including intertriginous disease. Here, we report the case of a 51-year-old African American patient with lichen nitidus that is pruritic and refractory to typical off-label treatments including emollients, triamcinolone and clobetasol. The patient was started on roflumilast cream 0.3% daily with complete resolution of lesions and pruritus in 4 weeks.
 
 Case Report:
 We report the case of a 51-year-old African American patient presenting to the clinic with a history of firm, pruritic, white colored papules on both of his hands that made it hard for him to drive. These lesions had been present for 2 years and did not respond to previous treatment with emollients and topical corticosteroids including triamcinolone cream 0.1% and clobetasol ointment 0.05% both twice daily. A biopsy was performed and demonstrated lymphocytic infiltrate in the upper dermis and the classic “claw and ball” configuration consistent with lichen nitidus. The patient was subsequently started on topical roflumilast 0.3% daily which resulted in complete resolution of lesions and pruritus within 4 weeks.
 
 Conclusion:
 We reported a case of a 51-year-old African American papules on both hands that were consistent with lichen nitidus. In this case, the patient’s lichen nitidus was refractory to topical corticosteroids and emollients. Long term corticosteroid use is also associated with hypopigmentation in this population. After starting topical roflumilast 0.3% daily, the patient reported complete resolution of the lesions and puritus. This report suggests reduction of inflammation with roflumilast cream 0.3%, can offer a treatment option for patients with lichen nitidus.

Development of Crystalline Corneal Opacities (Steroid Keratopathy) in Dogs After Treatment With Ophthalmic Corticosteroids.

To retrospectively evaluate and describe the relationship between the use of topical corticosteroids and the development of crystalline corneal opacities (steroid keratopathy) in a colony of research Beagles and Beagle-derived dogs. Medical records of 73 purpose-bred Beagles and Beagle-derived dogs were reviewed from June 2012 to May 2021. All dogs were treated with topical ophthalmic corticosteroids for at least 21 days. In addition to regular ophthalmic examination, some dogs also had a systemic lipid profile (n = 6) performed to work up further and characterize the crystalline corneal opacities. Globes of 3 dogs were examined histopathologically. Axial stromal crystalline corneal opacities were appreciated in 25 eyes of 14 dogs after a median of 141 days after initiating treatment (35-396 days). Multiple corticosteroids were used, including neomycin-polymyxin b-dexamethasone 0.1% ophthalmic ointment, prednisolone acetate 1% ophthalmic suspension, and difluprednate 0.05% ophthalmic emulsion (Durezol). Resolution of corneal opacity was documented in 4 of 25 eyes when ophthalmic corticosteroids were discontinued after a median of 406.5 days (271-416 days). Histopathologic examination revealed a dense band of acellular material, poorly staining with periodic acid-Schiff, subtending the corneal epithelium, and being surrounded by spindle cells. This case series documents the onset of steroid keratopathy in Beagles and Beagle-derived dogs after treatment with ophthalmic corticosteroids. Clinical resolution of steroid keratopathy lesions may be possible after discontinuation of ophthalmic corticosteroids.

Screening of dermatology drugs for aberrant use-patterns: An application of epidemiologic estimates and measures of inequality in drug use.

Dermatology treatments require adherence for safe and effective use. Real-world healthcare databases can reveal drug utilization patterns and uncover inappropriate or unexpected use. This study aimed to analyse dermatology drug utilization patterns using epidemiological and inequality measures, leveraging Danish nationwide registries. It also assessed the feasibility of this method for detecting aberrant drug use. We formed a 2019 cohort of all patients treated for skin conditions through Danish healthcare registries. We calculated prevalence, incidence rates and treatment duration for dermatological drugs. Inequality in drug utilization was assessed using Lorenz curves, Gini coefficients and other measures. The study encompassed 1 021 255 patients using 94 dermatology drugs. Most usage aligned with 'expected clinical use', but we detected inequality, with some drugs having high Gini coefficients and disproportionate consumption by the top percentile of users. Notable findings included potential inappropriate antibiotic use, excessive topical corticosteroid use and unexpected drug use duration. In Denmark, dermatology drugs are used primarily as anticipated, with minimal unexpected patterns. Specific follow-up is required to draw conclusions about inappropriate use. This approach demonstrates broad applicability for screening aberrant drug utilization.

Use of Topical Corticosteroids in the Treatment of Noninfectious Inflammatory Dermatoses of the Scalp: A Survey of Practicing Dermatologists and Dermatology Residents Using Delphi Methodology.

Noninfectious inflammatory dermatoses of the scalp are common, and their symptomsin particular, those affecting appearance, can have a psychological effect that may be disproportionate to their clinical severity. Effective, cosmetically acceptable treatments are important to manage these conditions. Topical corticosteroids form the cornerstone of acute treatment for many of these conditions. We surveyed practicing dermatologists and dermatology residents to determine the current clinical practice in prescribing topical corticosteroids for these disorders in their various preparation formats. A Delphi method was used, consisting of 2 questionnaire rounds. The first round contained 34 questions and was completed by 612 dermatologists and dermatology residents via email. The first round of responses was analyzed, and points that had >70% agreement were used to form a second questionnaire of 21 statements. This second round was completed by 346 participants, and their responses were used to generate a final report. Participants were practicing in both public and private practices. Clobetasol propionate 0.05% topical solution was considered to be the most appropriate treatment for noninfectious inflammatory scalp dermatoses in general, with 75.1% agreement in the second round of questionnaire. The main advantages of clobetasol propionate over other topical corticosteroids were reported as potency, effectiveness, and broad action spectrum (94.8% agreement). The preferred pharmaceutical format was the solution of clobetasol propionate. Clobetasol propionate was the preferred topical treatment for the management of scalp dermatoses, usually as first-line treatment; solution was the preferred preparation.

Comparison of the Efficacy of Tazarotene 0.045% versus Halobetasol Propionate 0.01% Lotion for the Treatment of Scalp Psoriasis at Tertiary Care Hospital, Karachi

Background: Psoriasis is a chronic, genetically determined inflammatory skin condition characterized by erythematous plaques with silvery scales, affecting about 2% of the global population. It significantly impacts patients' quality of life, encompassing physical, emotional, and psychosocial dimensions. While the use of topical corticosteroids (TCS) with tazarotene has shown benefits in plaque psoriasis treatment, limited data are available on the efficacy of combining halobetasol and tazarotene. Objective: This study aimed to compare the efficacy of Tazarotene 0.045% cream (TAZ) versus Halobetasol Propionate 0.01% lotion (HP) for the treatment of scalp psoriasis at a tertiary care hospital in Karachi, providing insight into their comparative effectiveness and informing clinical decision-making. Methods: A randomized control trial was conducted at the Dermatology Department of Jinnah Postgraduate Medical Centre, Karachi, from August 2022 to February 2023. Ninety participants with scalp psoriasis were recruited and randomly assigned to two groups: Group A (n=45) received Tazarotene 0.045% cream, and Group B (n=45) received Halobetasol Propionate 0.01% lotion, both applied once daily for 6 weeks. The primary outcome was the change in Investigator's Global Assessment (IGA) score from baseline to week 6. Data analysis was performed using SPSS version 25, focusing on descriptive statistics and inferential analyses to evaluate treatment efficacy. Results: The study observed a significant reduction in IGA scores from baseline in both groups, with Group A (TAZ) showing a decrease from 3.89 ± 0.68 to 1.29 ± 0.62 and Group B (HP) from 3.87 ± 0.66 to 2.49 ± 0.62. The paired difference in IGA scores indicated a more pronounced improvement in the TAZ group (2.60 ± 0.75) compared to the HP group (1.37 ± 0.57), with significant differences between the groups (p<0.0001). Treatment success was observed in 82.2% of participants in the TAZ group compared to 51.1% in the HP group, with an odds ratio of 4.424 (95% CI: 1.690—11.578; p=0.002). Conclusion: Tazarotene 0.045% cream demonstrates significantly greater efficacy in treating scalp psoriasis compared to Halobetasol Propionate 0.01% lotion. The findings suggest Tazarotene as a preferable treatment option for scalp psoriasis, offering a better therapeutic outcome.

Analysis of a Combination Therapy Protocol for the Treatment of Oral Mucous Membrane Pemphigoid: A Retrospective Case Series Study.

Mucous membrane pemphigoid (MMP) is an autoimmune-based bullous disease affecting the mucous membranes, mainly oral and ocular. One of the most common clinical manifestations is desquamative gingivitis (DG), characterized by intense symptoms and functional limitations. The dentist is among the first specialists to observe DG and, therefore, must be able to diagnose it. In this regard, the purpose of the present study was to evaluate the efficacy and safety of a clinical protocol for the topical management of patients with DG and MMP buccal lesions. Thirteen patients with clinical and histologic diagnoses of MMP-localized DG in the oral cavity were retrospectively enrolled. Each patient received topical treatment with clobetasol propionate oral gel 0.05%; nicotinamide; oral probiotic (contains Bifidobacterium lactis HN019, Kluyveromyces marxianus fragilis B0399, colostrum, and biotin); and doxycycline. Before and after 3 months of therapy, clinic records were collected for each patient. Seven patients (53.8%) had a complete response to treatment; four patients (30.8%) had a partial response to treatment; and, finally, two patients (15.4%) had no benefit from therapy. Dental management of patients presenting solely with oral manifestations of MMP may involve the use of topical corticosteroids, doxycycline, vitamin supplements, and probiotics and associating professional oral hygiene procedures.

510 - Dupilumab is efficacious in patients with prurigo nodularis regardless of stable use of topical corticosteroids and topical calcineurin inhibitors: pooled results from two phase 3 trials (LIBERTY-PN PRIME and PRIME2)

Abstract Introduction Prurigo nodularis (PN) is a chronic inflammatory skin condition characterized by severely itchy skin nodules, which substantially affects quality of life. Although topical treatments are frequently prescribed, these therapies are limited by insufficient demonstrated evidence for efficacy, and/or associated side effects. Objectives This study reports the effect of dupilumab on pruritus, skin lesions, and quality of life in patients with PN, with or without stable use of topical corticosteroids (TCS) and/or topical calcineurin inhibitors (TCI), in an analysis of pooled data from two phase 3 trials. Materials & Methods LIBERTY-PN PRIME (NCT04183335) and PRIME2 (NCT04202679) were two randomized, double-blind, placebo-controlled, 24-week studies. Adults with PN inadequately controlled by topical prescription therapies, or for whom those therapies are inadvisable, were randomized 1:1 to dupilumab 300 mg every 2 weeks or matched placebo. “Stable use” was defined as maintaining the same medicine (low-to-medium potency TCS and/or TCI) during the study, with the same frequency of treatment (once or twice daily) as from 2 weeks prior to screening. Efficacy was assessed from baseline to Week 24 through the Worst Itch Numerical Rating Scale (WI-NRS; scored 0–10; high scores represent a poorer outcome), and the Investigator’s Global Assessment for PN-Stage score (IGA PN-S; scored 0–4; high scores represent a poorer outcome). Impact on Health-Related Quality of Life (HRQoL) was assessed through the Dermatology Life Quality Index questionnaire (DLQI; 10 questions scored 0–3 with a maximum score of 30; high scores represent poorer HRQoL). Results 311 patients were randomized (dupilumab/placebo n = 153/158), including 182 patients with stable use of TCI/TCS (dupilumab/placebo N = 91/91) and 129 patients without (dupilumab/placebo N = 62/67). Baseline demographics and disease characteristics were well balanced in both subgroups. At Week 24, significantly more patients treated with dupilumab with or without stable use of TCI/TCS achieved a ≥ 4-point improvement in WI-NRS (59.3%/58.1%) vs placebo (13.2%/26.9% [nominal P < 0.0001/P < 0.0001]). The proportion of patients achieving an IGA PN-S score of 0 or 1 at Week 24 was also significantly higher in the dupilumab group for patients with or without stable use of TCI/TCS (48.4%/43.5%), vs placebo (11.0%/25.4% [nominal P < 0.0001/P = 0.0319]). The positive impact of dupilumab treatment on HRQoL was greater, for patients with and without a stable use of TCI/TCS vs placebo, as suggested by the mean change from baseline in DLQI at Week 24 (−12.9/−11.9 vs −5.5/−7.1 [nominal P < 0.0001/P < 0.0001], respectively). Although the placebo response was higher for patients without stable use of TCI/TCS, the effect of dupilumab treatment was comparable in the two subgroups. Treatment-emergent adverse events (TEAEs) occurred with similar rates in dupilumab-treated patients with or without stable use of TCI/TCS (59.3%/60.7%), compared with placebo (53.3%/47.8%). Patients with or without stable use of TCI/TCS had similar rates of severe TEAEs in the dupilumab groups (2.2%/4.9%) and placebo groups (3.3%/4.5%). Conclusion Dupilumab treatment improves itch, skin lesions, and quality of life in patients with PN, with an acceptable safety profile, with little to no influence from concomitant treatment with topical therapies (TCI/TCS).

525 - Real-world effectiveness of upadacitinib in moderate-to-severe atopic dermatitis (AD): Results from cross-sectional analyses of the CorEvitas AD Registry

Abstract Introduction/Background Upadacitinib is an oral Janus kinase inhibitor approved to treat moderate-to-severe atopic dermatitis (AD). While clinical trials have demonstrated its efficacy in treating the signs and symptoms of AD, less is known about its effectiveness in a real-world setting. Objectives This cross-sectional study describes the real-world clinical and patient-reported outcomes of adults with AD enrolled in the CorEvitas AD Registry and treated with upadacitinib for at least four or more weeks. Methods The CorEvitas AD Registry is a prospective, non-interventional registry of adults diagnosed with AD by a dermatologist or qualified dermatology practitioner. The current analysis included participants enrolled between July 21, 2020 through August 7, 2023 who were treated with upadacitinib for at least 4 weeks at the time of evaluation by their provider. Outcome measures included assessments of: skin clearance (Validated Investigators Global Assessment Scale for Atopic Dermatitis [vIGA-AD™], Eczema Area and Severity Index [EASI]); worst itch in the past 24 hours (Peak Pruritus Numeric Rating Scale [PP-NRS]); symptom frequency (Patient-Oriented Eczema Measure [POEM]); quality of life (Dermatologic Life Quality Index [DLQI]); and disease control (Atopic Dermatitis Control Tool [ADCT]). Outcomes were cross-sectionally summarized using data collected at the latest registry visit (Overall cohort), as well as 1 to less than 5 months (1-5 months) and 5-9 months following upadacitinib initiation (Month 1-5 cohort and Month 5-9 cohort, respectively). Subgroup analyses were also conducted based on prior use of biologics indicated for AD (bio-naïve, bio-experienced). Data were analyzed as observed with no imputation. Safety events were not assessed in this ­analysis. Results A total of 335 patients (mean age 45.6 years; 51.6% female; 64.2% White) were treated with upadacitinib (15 mg: n=221 [70.8%]; 30 mg: n=91 [29.2%]; median treatment duration: 6.9 months). Some patients reported concomitant use of topical corticosteroids (28.1%) and prior use of biologics indicated for AD (dupilumab: 45.4%; tralokinumab: 6.0%). For the Overall cohort, 57.3% had clear or almost clear skin (vIGA-AD 0/1). An EASI ≤3 was observed in 74.8% of patients and 45.3% reported no/minimal itch (PP-NRS 0/1); 40.9% had both EASI ≤3 and PP-NRS 0/1. Most patients (69.3%) reported that their AD was controlled (ADCT <7), 36.4% reported clear or almost clear disease (POEM 0–2), and 39.8% reported no impact of AD on their quality of life (DLQI 0/1). Similar results were observed for the Month 1-5 (n=144) and Month 5-9 (n=194) cohorts; results in bio-naïve and bio-experienced patients were comparable. Conclusions More than half of patients with ≥4 weeks of upadacitinib treatment had clear or almost clear skin and greater than two-thirds reported controlled disease, with similar results observed in both bio-naïve and bio-experienced patients. Over a third reported no/minimal symptom and disease burden. These findings suggest that low levels of disease severity are observed with real-world use of upadacitinib. Future analyses will aim to report changes in disease severity and burden due to persistent upadacitinib treatment.

Observational Study of the Changes in Skin Thickness Among Children with Atopic Dermatitis Treated with Topical Mometasone Furoate 0.1% Cream

Background: Atopic dermatitis (AD) affects up to 20% of children worldwide and, as of now, it has no cure. The primary treatment for AD in children involves the use of topical corticosteroids. Objectives: Our objective was to evaluate the potential for skin atrophy caused by the application of mometasone furoate 0.1% cream in children with moderate to severe AD. Methods: This study was a single-center, prospective cohort study involving 22 children aged 6-12 years with moderate to severe AD. The children applied topical mometasone furoate 0.1% cream for 6 weeks in a non-occlusive manner. We conducted dermoscopic and ultrasonographic assessments of skin atrophy at 0, 2, and 6 weeks into the treatment. Results: All patients exhibited an improvement in skin erythema. At the beginning of the study, 91% of the patients had mild to moderate erythema, while 9.1% had severe erythema. After 6 weeks of using topical mometasone, 27.3% had mild erythema, and 72.7% had completely resolved erythema (P

Prospective Randomized Double-Blind Vehicle-Controlled Study of Topical Coconut and Sunflower Seed Oil-Derived Isosorbide Diesters on Atopic Dermatitis.

Background: Preliminary studies support the use of topical coconut and sunflower seed oil for atopic dermatitis (AD). However, standardized topical formulations of fatty acids from these sources have not been studied. Objective: This study investigates whether coconut oil- and sunflower seed oil-derived isosorbide diesters can be used in conjunction with colloidal oatmeal to improve itch, AD severity, and the need for topical steroids in adults. Methods: This was a single-center, 4-week, randomized, double-blind, and vehicle-controlled study conducted between 2021 and 2022. Thirty-two male and female adults with mild-to-moderate AD were enrolled and completed the study. Participants were randomized to receive either 0.1% colloidal oatmeal (vehicle) or isosorbide diesters (IDEAS, 4% isosorbide dicaprylate and 4% isosorbide disunflowerseedate) along with 0.1% colloidal oatmeal. The main outcomes of the study were changes in the visual analogue rating of itch and 75% improvement in the Eczema Area and Severity Index score (EASI 75) at 4 weeks. Other measures included the use of topical steroids and the relative abundance of skin Staphylococcus aureus. Results: Participants in the IDEAS group had a 65.6% improvement in itch compared with 43.8% in the vehicle group (P = 0.013). In total, 56.5% and 25% of the those in the IDEAS and vehicle groups, respectively, achieved EASI 75 at 4 weeks (P = 0.07). There was no difference in skin hydration or transepidermal water loss. The relative abundance of S. aureus was decreased in the IDEAS group at week 4 compared with no change in the vehicle group (P = 0.044). Topical corticosteroid use increased in the vehicle group compared with a decrease in the IDEAS group at week 1 (292.5% vs 24.8%; P value = 0.039) and week 2 (220% vs 46%; P value = 0.08). Conclusions: Topical application of emollients containing coconut oil- and sunflower seed oil-derived fatty esters may improve itch, reduce topical steroid use, and reduce the relative abundance of S. aureus in mild-to-moderate AD. CTR number: NCT04831892.

Efficacy of dupilumab plus topical corticosteroids in children with atopic dermatitis: Ameta-analysis of randomized controlled trials.

Children with atopic dermatitis (AD) bear a significant burden of illness that adversely affects their quality of life. To determine the efficacy of dupilumab and topical corticosteroids for the treatment of pediatric AD. A comprehensive literature search was conducted using three prominent databases: Web of Science, PubMed, and Embase. Using a fixed-effects or random-effects model, the standard mean differenceor risk ratioswith 95% confidence intervals were calculated, and the trial protocol was listed as CRD42023408546. A total of 3 studies were included, and 896 participants met the inclusion criteria. The combined estimate showed that dupilumab plus topical corticosteroids had numerically greater efficacy in terms of Eczema Area and Severity Index(EASI)-50, EASI-75, EASI-90, and Investigator Global Assessment (IGA) score of 0 or 1. Children who received topical corticosteroids and dupilumab achieved significantly higher Children's Dermatological Life Quality Index scores compared to those who received placebo. The number of individuals who achieved IGA 0/1 increased with the use of dupilumab and topical corticosteroids. Dupilumab and topical corticosteroids can be used to treat symptoms in children with AD. However, given the substantial variation in treatment outcomes among studies, the findings should be interpreted with caution.

Unveiling the potential: Enhancing caregiver knowledge through video education to address topical corticosteroid concerns in children with eczematous dermatitis.

Concerns about the use of topical corticosteroids (TCS) in pediatric eczematous dermatitis management often hinder effective treatment. Limited data exist regarding the prevalence of these concerns and the effectiveness of interventions. This study aimed to assess the prevalence of TCS concerns among caregivers and determine the effectiveness of video education in mitigating these concerns. A single-center prospective study was conducted from 2022 to 2023, involving caregivers of children under 18 years with eczematous dermatitis. Baseline and post-intervention questionnaires were administered after a 4-week period. Caregivers received video education on TCS use, and the TOPICOP score was evaluated before and after viewing the video. The study included 150 caregivers, 85.3% female and 74% had a child with atopic dermatitis. The prevalence of TCS concerns among Thai caregivers was 62%. Following video education, the prevalence of TCS concerns significantly decreased to 10.7%. Mean belief score decreased from 43.81 ± 13.45 to 31.85 ± 16.56, mean worry score decreased from 56.22 ± 18.27 to 40.41 ± 18.55 and mean total TOPICOP score decreased from 50.02 ± 12.65 to 36.13 ± 13.52 (p-value <.001). The intervention also resulted in reduced disease exacerbations, duration of the rash, and duration of TCS use. The optimal TOPICOP cut-off score to predict TCS concerns was identified as 43.06. Video education effectively alleviated TCS concerns among caregivers, addressing beliefs, worries, disease exacerbations, and side effects. Integration of this intervention into the management of pediatric eczematous dermatitis can yield optimal outcomes.