clobetasol and hydrocortisone-acetate

Genital erosive lichen planus (GELP) in women is a chronic inflammatory disease characterized by painful vulval and vaginal erosions. Topical photodynamic therapy (PDT) is increasingly used in premalignant and malignant diseases and may have an effect in inflammatory diseases.. To assess the feasibility, efficacy and safety of hexyl 5-aminolevulinate-hydrocloride (HAL)-PDT in GELP.. Forty women, diagnosed with GELP at a specialized vulva clinic, were randomized to one session HAL-PDT in vulva and/or vagina (n = 20) or daily applications of clobetasol propionate 0·05% ointment in vulva and optional hydrocortisone acetate 1·0% foam in vagina for 6 weeks (n = 20). After 6 weeks, all patients were allowed to use topical corticosteroids as needed. Clinical examinations were performed at weeks 0, 6 and 24, using a clinical score developed for the study. All patients wrote a weekly log on pain, topical corticosteroid use and adverse events.. Three patients, all in the corticosteroid group, withdrew from the study after 1-3 weeks. The mean reduction in clinical scores was similar in the PDT group and the corticosteroid group; 25% vs. 22% after 6 weeks (P = 0·787) and 35% vs. 38% after 24 weeks (P = 0·801). The mean reduction in pain visual analogue scale scores was 38% vs. 55% after 6 weeks (P = 0·286) and 39% vs. 12% after 24 weeks (P = 0·452). Patients in the PDT group reported significantly less topical corticosteroid use during weeks 7-24 than those in the corticosteroid group. No major adverse events were reported.. Vulvovaginal HAL-PDT seems to be an effective and safe treatment for GELP.

Topics: Administration, Cutaneous; Administration, Intravaginal; Aminolevulinic Acid; Clobetasol; Dermatologic Agents; Feasibility Studies; Female; Glucocorticoids; Humans; Hydrocortisone; Lichen Planus; Middle Aged; Photochemotherapy; Treatment Outcome; Vaginal Creams, Foams, and Jellies; Vaginal Diseases; Vulvar Diseases

The vasoconstrictor effect of 7 proprietary corticosteroid creams was compared with their effect on patches of allergic contact dermatitis provoked by patch testing in 20 subjects. A parallel between the blanching effect on the normal skin and the anti-inflammatory effect on the eczematous skin was generally found. A modified patch test method using the Finn chamber technique is described, which (with certain restrictions) offers an opportunity of studying the anti-inflammatory effect of corticosteroids on allergic dermatitis under standard conditions.

Topics: Acute Disease; Adrenal Cortex Hormones; Adult; Betamethasone; Betamethasone Valerate; Clobetasol; Dermatitis, Contact; Female; Humans; Hydrocortisone; Male; Middle Aged; Patch Tests; Skin; Triamcinolone Acetonide; Vasoconstriction

A double-blind, half-side comparative dermal atrophy study of fluocortin butylester 0.75% clobetasone butyrate 0.05%, hydrocortisone acetate 1% and placebo creams was carried out in 29 healthy human male volunteers. Skin thickness was measured by a modified radiographic technique before and after an 8-week application period of the test preparations. Significant skin thinning occurred in 3 of the 10 subjects treated with clobetasone butyrate and atrophy of marginal significance in 1 of the 29 subjects treated with fluocortin butylester. The results suggest that, compared with other fluorinated topical steroids, fluocortin butylester 0.75% is unlikely to produce significant dermal atrophy when used in the short and medium term.

Topics: Administration, Topical; Adolescent; Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents; Atrophy; Clobetasol; Double-Blind Method; Fluocortolone; Humans; Hydrocortisone; Male; Middle Aged; Placebos; Skin

The aim of this study was to assess the efficacy of a postoperative steroid regimen in maintaining vulvovaginal architecture and vaginal patency following surgical adhesiolysis in severe erosive lichen planus (ELP) and genital graft versus host disease (GVHD). Sixteen women applied potent topical steroids to the vulva and vagina from 48 hours after surgery. Sexual and urinary function and vulvovaginal anatomy were assessed at 6 weeks, 6, 12 and 24 months. All of the patients had failed sexual function due to vaginal stenosis. Eleven patients were unable to have cervical smears and three had associated haematocolpos. Vaginal adhesiolysis achieving complete patency occurred in all patients with stenosis. Fifteen (93.7%) patients were compliant with the regimen. After two years, 12 (75%) patients had maintained complete vaginal patency. Four patients (25%) developed vaginal restenosis. This study demonstrates that the potent topical steroids used post-operatively are very effective in maintaining vaginal patency and function. Impact statement What is already known on this subject? Potent topical steroids are the first line treatment for ELP and GVHD and have been reported to be helpful after surgery to release adhesions. What do the results of this study add? Topical steroids used immediately after surgical adhesiolysis in patients with vulvo-vaginal lichen planus and graft-versus-host disease improves the outcomes and maintains function, which can give a prolonged benefit. What are the implications of these findings for clinical practice and/or further research? The use of potent topical steroids should be considered as routine practice after surgery in erosive inflammatory disease to control inflammation and improve the long term outcomes for these patients.

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Clobetasol; Female; Graft vs Host Disease; Humans; Hydrocortisone; Lichen Planus; Postoperative Care; Retrospective Studies; Sexual Dysfunction, Physiological; Vaginal Diseases; Vulvar Diseases

The human skin blanching assay is a well established method for ranking the efficacy of corticosteroids after epicutaneous application. Vasoconstriction is a pharmacological activity, which correlates well with the clinical efficacy, the intensity of skin blanching after a single application under occlusion corresponding, generally, to the clinical efficacy after repeated application without occlusion. However, in studies dealing with the comparison between the vasoconstriction assay and the evaluation of the clinical effects on inflammatory skin diseases, some exceptions to this correlation have been reported. Therefore, in a pre-clinical phase, it would be useful to combine the blanching assay with at least one anti-inflammatory assay. In the present study the blanching assay and the allergic contact dermatitis inhibition test were performed in parallel, in order to compare the two testing procedures in the same group of subjects, utilizing standardized study designs supported by objective means of evaluation. Three commercial preparations of corticosteroids containing clobetasol propionate (CP), clobetasone butyrate (CB) and hydrocortisone acetate (HA), respectively, were employed both to treat nickel-induced positive patch test responses on the volar forearms, and to perform a vasoconstrictor assay on normal forearm skin in 16 nickel-sensitized healthy volunteers. For evaluating skin blanching, we employed colorimetric measurements, whereas for the quantitative determination of the inhibition of the intensity of allergic patch test reactions, 20 MHz B-scanning supported by image analysis was used. Both colorimetric and echogenicity values enabled us to distinguish between the three corticosteroids (at the 17 h evaluation and the 64 h assessment, respectively). A fair correlation was noted between colorimetric and echogenicity values. Both testing procedures ranked the three corticosteroids in the expected order. Corticosteroid preparations should be compared using methods which allow different effects to be simultaneously monitored, without involving a high number of patients. We are proposing this double procedure for the parallel intraindividual evaluation of the vasoconstrictory action and the anti-allergic activity of topical steroids.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Clobetasol; Colorimetry; Dermatitis, Allergic Contact; Drug Evaluation; Female; Humans; Hydrocortisone; Image Processing, Computer-Assisted; Male; Nickel; Patch Tests; Skin; Ultrasonography; Vasoconstriction; Vasoconstrictor Agents

We measured the superoxide dismutase (SOD) activity in human skin from tissue homogenates after topical application of hydrocortisone-21-acetate and clobetasol proprionate, dissolved in propylene glycol. SOD was measured spectrophotometrically. SOD activity was higher in the treated skin than in the control untreated skin. We separated epidermis from the dermis by curettage and measured the level of SOD in each homogenized layer; SOD activity was higher in the epidermis compared to the dermis in untreated skin. After corticoid application, SOD activity was higher in the dermis compared to the epidermis to a degree dependent on corticoid potency. These experiments demonstrate that the epidermis may have a role in the barrier function of the skin by its antioxidant capacity and that the dermis is the major location of the metabolic activity in the skin. On the other hand, our results suggest that these corticosteroids may stimulate SOD production and may release antioxidants. This could be another anti-inflammatory property of corticosteroids.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Epidermis; Female; Humans; Hydrocortisone; In Vitro Techniques; Male; Middle Aged; Skin; Superoxide Dismutase

By modifying the blood supply in the upper part of the dermis, the colour of the skin is changed by any material in contact with it. This is a great difficulty when we want to measure the colour intensity in erythema or blanching. To avoid this problem, we designed and built a device which measures the skin reflectance value without any contact with the skin. The use of this device on man to study the skin blanching after application of dermocorticoids allows us to determine the more potent drug among a series (clobetasol propionate) and, for a given drug (betamethasone), the more efficient preparation (oil-in-water emulsion). The study of the effect of increasing irradiation doses of ultraviolet light show that the sensitivity of the device is equivalent to that of the clinical assessment and that the relationship between the irradiation dose and the skin reflectance is sigmoidal.

Topics: Betamethasone Valerate; Clobetasol; Color; Dermatology; Erythema; Humans; Hydrocortisone; Light; Skin; Skin Physiological Phenomena; Triamcinolone Acetonide

In order to quantify the intensity of skin blanching and thus predict the bioavailability of topical corticoids, a physical device allowing the measurement of light reflected from skin without any contact between the probe and the skin was used (Leveque et al., 1984). Three series of experiments were carried out: firstly, to assess the vasoconstrictor potency of four corticoids; secondly, to show the influence of the vehicle on the bioavailability of the same drug under various galenic forms, such as fatty ointments or water in oil (W/O) and oil in water (O/W) creams; thirdly, to determine the reservoir effects, if any, of some of these formulations. The results confirm previous findings about the potency of hydrocortisone acetate, triamcinolone 17-acetonide, betamethasone 17-valerate, diflucortolone valerate and clobetasol 17-propionate.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone Valerate; Biological Availability; Clobetasol; Color; Diflucortolone; Humans; Hydrocortisone; Ointments; Pharmaceutical Vehicles; Photometry; Skin; Triamcinolone Acetonide; Vasoconstriction