pulmicort and hydrocortisone-17-butyrate

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Budesonide; Clinical Trials as Topic; Double-Blind Method; Female; Glucocorticoids; Humans; Hydrocortisone; Male; Middle Aged; Pregnenediones; Psoriasis

The systemic effect of the topical glucocorticoid ointments budesonide 0.025% (Preferid), hydrocortisone-17-butyrate 0.1% (Locoid) and betamethasone-17,21-dipropionate 0.5% (Diproderm) was studied in 9 healthy volunteers. Five g ointment was applied on about 13% of the total body surface, using occlusive technique for three consecutive nights. The cortisol values in plasma and urine were measured before, during, and 3 days after applications. Although budesonide and betamethasone-17,21-dipropionate are equipotent drugs from a therapeutic point of view, the halogenated betamethasone-17,21-dipropionate caused significantly greater decrease in both plasma- and urinary cortisol levels. Between the two non-halogenated glucocorticosteroids, budesonide and hydrocortisone-17-butyrate, no significant difference was found despite the large difference in anti-inflammatory effects. The results indicate that it is possible to improve the ratio between the local therapeutic effect and the systemic activity of a glucocorticosteroid. Budesonide represents such an improvement.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Betamethasone; Budesonide; Glucocorticoids; Humans; Hydrocortisone; Male; Occlusive Dressings; Ointments; Pregnenediones

Observations made in a controlled double-blind investigation of two non-halogenated topical steroids, hydrocortisone-17-butyrate (HCB) and budesonide in thirty-six patients with psoriasis revealed a clear difference in therapeutic effect between the two ointments, indicating that they belong to different groups of topical steroids according to a classification accepted in the Nordic countries. Budesonide had a good therapeutic effect in all the patients studied, while, as a rule, HCB was clearly less effective.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Clinical Trials as Topic; Dermatologic Agents; Double-Blind Method; Female; Glucocorticoids; Humans; Hydrocortisone; Male; Middle Aged; Ointments; Pregnenediones; Psoriasis

Topics: Administration, Topical; Adrenal Cortex Hormones; Budesonide; Drug Eruptions; Female; Humans; Hydrocortisone; Hypersensitivity, Delayed; Injections, Intra-Articular; Middle Aged

Topics: Adult; Budesonide; Chronic Disease; Cross Reactions; Dermatitis, Allergic Contact; Female; Glucocorticoids; Hand Dermatoses; Humans; Hydrocortisone; Patch Tests; Prednisolone

Corticosteroids are used to treat dermatoses, including allergic contact dermatitis, but can also cause contact allergy. The frequency of corticosteroid allergy varies between studies and is influenced by treatment traditions and availability.. To estimate the prevalence of tixocortol-21-pivalate, budesonide and hydrocortisone-17-butyrate allergy in a Danish patch test population and characterize individuals with corticosteroid allergy.. Three thousand five hundred and ninety-four patients were patch tested with tixocortol-21-pivalate, budesonide, and hydrocortisone-17-butyrate. Characterization was performed according to the MOAHLFA index and duration of disease.. Two per cent had a steroid allergy: 0.8% had a tixocortol-21-pivalate allergy, 1% a budesonide allergy, and 1% a hydrocortisone-17-butyrate allergy. Tixocortol-21-pivalate and budesonide allergy were associated with atopic dermatitis in crude analyses, but only tixocortol-21-pivalate allergy and atopic dermatitis remained associated in adjusted analyses. Leg dermatitis was uniquely associated with tixocortol-21-pivalate allergy. Hydrocortisone-17-butyrate allergy was associated with duration of disease in both crude and adjusted analyses.. Chronic dermatoses (atopic dermatitis and leg dermatitis) were identified as risk factors for group A corticosteroid allergy, probably because of more pronounced exposure to group A steroids resulting from ease of access that is exploited by patients with a chronic dermatosis. The duration of disease rather than the dermatosis itself seemed to be important for group B and D2 corticosteroid allergy.

Topics: Adult; Budesonide; Chronic Disease; Denmark; Dermatitis, Allergic Contact; Dermatitis, Atopic; Dermatitis, Occupational; Dermatologic Agents; Facial Dermatoses; Female; Hand Dermatoses; Humans; Hydrocortisone; Leg Dermatoses; Male; Middle Aged; Patch Tests; Prevalence; Risk Factors

This study investigated whether a corticosteroid mix containing tixocortol pivalate, budesonide, and hydrocortisone-17-butyrate could detect contact allergy to corticosteroids. 2 corticosteroid mixes, 1 with a high (mix I) and 1 with a low (mix II) concentration and the 3 individual constituents, each at 2 concentrations, were inserted into the standard series of 16 participating clinics. Tests were read on day (D) 3 or 4. 5432 patients were tested, and 110 (2.0%) had positive reactions to at least 1 of the 8 test preparations. Of the 8 preparations, mix I identified most allergic patients, followed by mix II, budesonide 0.10%, budesonide 0.002%, and tixocortol pivalate, both concentrations (1.0 and 0.10%) tracing the same number. With the mixes, 53.2-59.6% of tixocortol pivalate allergy was missed. 47 patients were allergic to either concentration of tixocortol pivalate, 25% of these only to 1.0% and another 25% only to 0.10%. Testing with mix I and tixocortol pivalate 0.10% picked up 98/110, testing with tixocortol pivalate 1.0% and 0.10% and budesonide 0.10% picked up 105/110. 3379 patients were read on both D3 or D4 as well as on D7. Without a late reading (D7), up to 30% of contact allergy to corticosteroid markers was missed.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Combinations; Drug Hypersensitivity; Female; Humans; Hydrocortisone; Male; Patch Tests

This study investigated the stability of tixocortol pivalate, budesonide, and hydrocortisone-17-butyrate (Hc-17-B) when present in a mix with petrolatum and when the corticosteroids were kept separately in petrolatum. The concentrations chosen for the corticosteroids were the same as those used in a study within the European Environmental Contact Dermatitis Research Group (EECDRG), in which 2 corticosteroid mixes (1 with a high concentration and 1 with a low concentration) and the 3 individual constituents, each at 2 concentrations, were patch tested. Ethanolic solutions of each corticosteroid, as well as 2 mixtures of these 3 corticosteroids, were also made up at corresponding concentrations. The preparations were kept at room temperature, refrigerated, and deep frozen, and repeatedly for 1 year, investigations to check stability by high performance liquid chromatography were carried out. A decrease of < or =20% of the initial value at time 0 was used as the threshold for stability. The petrolatum preparations and the ethanolic solutions of budesonide and tixocortol pivalate were stable for at least the whole investigative period, irrespective of storage conditions, while Hc-17-B 1.0% in ethanol kept deep frozen was stable at least during the same period. The latter corticosteroid when kept at room temperature was stable for 3 months only.

Topics: Administration, Topical; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Drug Stability; Hydrocortisone; Patch Tests

Tixocortol pivalate is an established marker to topical corticosteroid allergy. The prevalence of tixocortol pivalate hypersensitivity is well established in Europe, where exposure to this corticosteroid as a therapeutic agent varies. In the United States, tixocortol pivalate is not commercially available and the prevalence of hypersensitivity to it is unknown.. We investigated the prevalence of tixocortol pivalate hypersensitivity in our patch-tested population. We further characterized these patients by clinical background, other contact allergens, and the reactivity to other corticosteroids.. Tixocortol pivalate has been incorporated in our standard 1-52 patch test series since November 1992. We reviewed the histories and patch test results in all patients tested with the standard 1-52 series from November 1992 to December 1996.. Of 1536 patch-tested patients, 45 had hypersensitivity to tixocortol pivalate. Dermatitis involving the face was the most common (14 patients). Of the 45 patients, 40 had another allergen identified on patch testing. Eighteen patients underwent further patch testing to an extended corticosteroid panel, and 14 had sensitivity to another steroid agent.. The 2.9% prevalence of tixocortol pivalate hypersensitivity in our patch test population is within the range reported in Europe. Patients with tixocortol pivalate hypersensitivity tend to have other contact allergens on patch testing. Predisposing factors to tixocortol pivalate hypersensitivity include facial dermatitis and sensitivity to other contact allergens.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Allergens; Anti-Allergic Agents; Anti-Bacterial Agents; Anti-Inflammatory Agents; Budesonide; Cross Reactions; Dermatitis, Allergic Contact; Europe; Facial Dermatoses; Female; Humans; Hydrocortisone; Male; Middle Aged; Minnesota; Neomycin; Patch Tests; Prevalence; Risk Factors; Triamcinolone

The correct concentration and vehicle for patch testing with corticosteroids is in many instances not known. The results of this study suggest that 1% in ethanol should be the initial choice, unless it can be shown that petrolatum as a vehicle is as sensitive (tixocortol pivalate and budesonide). We could find no evidence for the anti-inflammatory effects of corticosteroids inhibiting the patch test at higher concentrations. Using ethanol as the vehicle resulted in reactions developing at earlier time points than with petrolatum.

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Dermatitis, Allergic Contact; Dermatologic Agents; Drug Eruptions; Ethanol; Humans; Hydrocortisone; Patch Tests; Petrolatum; Pharmaceutical Vehicles; Pregnenediones

Corticosteroids (CS) are very potent immunosuppressive agents and are widely used to treat inflammatory diseases. On the basis of their clinical efficacy and potency CS have been divided into different classes. In the present study we investigated whether the class-associated effects of CS are correlated with a differential in vitro effect on cytokine production by T lymphocytes. Therefore, we determined the in vitro effects of CS on the production of Th1- and Th2-type cytokines. The addition of CS, in the range of 10(-9) to 10(-4) M, resulted in a class- and dose-dependent inhibition of the production of both IFN-gamma and IL-4. Notably, at the lowest doses tested, hydrocortisone and hydrocortisone 17-butyrate had a stimulatory effect on IL-4 production. CS class-dependently inhibited the IL-2 production by T cells but did not affect IL-2R expression of the T cells. Addition of rIL-2 could not completely restore the inhibitory effect of the CS on proliferation and on IFN-gamma and IL-4 production, indicating that CS act only partially via inhibition of IL-2 production. The demonstrated positive correlation between the clinical efficacy and the in vitro effects of the different classes of CS strongly suggests that the effect of CS on T-cell-mediated inflammation follows from inhibition of proliferation and cytokine production by T lymphocytes. The in vitro method used will be valuable for investigating and classifying new types of CS and other substances for applications in T-cell-mediated diseases.

Topics: Adrenal Cortex Hormones; Animals; Budesonide; Clobetasol; Cytokines; Drug Interactions; Humans; Hydrocortisone; In Vitro Techniques; Interferon-gamma; Interleukin-2; Interleukin-4; Lymphocyte Activation; Mice; Pregnenediones; Receptors, Interleukin-2; Th1 Cells; Th2 Cells

Topical corticosteroids are increasingly recognized as relatively common contact sensitizers. Between July 1988 and December 1991 2687 patients undergoing routine patch testing were also tested with tixocortol pivalate (TP). Over the same time period 528 patients were selected for testing with a series of 18 steroids. One-hundred and thirty-one cases (4.9%) of corticosteroid hypersensitivity were detected and 119 (90.8%) of these cases were positive to TP. Thirty-seven patients reacted to one or more steroids in the steroid series, the most frequent sensitizers being hydrocortisone, budesonide (3.6%) and hydrocortisone 17-butyrate (2.5%). Of these 37 cases, 20 (54%) reacted to more than one steroid simultaneously, but the patterns of cross-reaction were not consistent with previously suggested groupings. Screening for steroid allergy should be performed as part of standard patch testing. The value of TP as a marker of corticosteroid hypersensitivity is reinforced by this study, but no satisfactory marker was found for the 9.2% of cases not detected by TP. There remains a need for further markers of corticosteroid hypersensitivity. A prevalence of 4.9% of corticosteroid allergy amongst our patients suggests that the frequency of this finding is generally underestimated.

Topics: Administration, Topical; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Budesonide; Child; Dermatitis, Allergic Contact; Female; Humans; Hydrocortisone; Male; Middle Aged; Patch Tests; Pregnenediones; Prevalence

A high potency at the application site and a low incidence of glucocorticoid side-effects form the desired profile of glucocorticosteroids for anti-inflammatory therapy. A new type of glucocorticosteroid 16,17-acetals with an improved topical/systemic activity ratio has been developed. Non-symmetric 16,17-acetal substitution increased the topical anti-inflammatory activity more than the systemic activity in rodents, whereas fluorine substitution in 9 alpha- or 6 alpha,9 alpha-positions increased the systemic more than the topical potency. The non-fluorinated, non-symmetric 16 alpha,17 alpha-acetal budesonide reached the highest ratio, which was five to ten times better than that of the earlier known 16,17-acetonides such as triamcinolone acetonide, or that of the 17 alpha-esters such as beclomethasone 17 alpha,21-dipropionate. Although budesonide and betamethasone 17 alpha,21-diproprionate have the same topical anti-inflammatory potency, the latter decreased plasma and urinary cortisol levels significantly more when ointment preparations were compared in volunteers. Budesonide is efficiently biotransformed in the liver to metabolites such as 6 beta-hydroxybudesonide and 16 alpha-hydroxyprednisolone, which are 50-100 times less potent than the parent steroid. In homogenates of rat or human adult livers budesonide is biotransformed two to five times more rapidly than desonide and triamcinolone acetonide.

Topics: Administration, Topical; Animals; Anti-Inflammatory Agents; Betamethasone; Betamethasone Valerate; Biotransformation; Budesonide; Dose-Response Relationship, Drug; Humans; Hydrocortisone; Liver; Male; Mice; Pregnenediones; Rats; Rats, Inbred Strains; Structure-Activity Relationship