clobetasol and Atrophy

Side effects of topical corticosteroids limit their long-term use. Calcipotriene/calcipotriol (Dovonex/Daivonex) ointment is not associated with any of the side effects of corticosteroids and has been shown to thicken the skin in contrast to the cutaneous atrophy caused by topical steroids.. We attempted to determine whether the addition of calcipotriene to a regimen of topical steroids results in an improved benefit/risk ratio.. Published and unpublished data on combination regimens were reviewed.. In long-term regimens for psoriasis, substituting calcipotriene for topical corticosteroids may result in a steroid-sparing effect. Conversely, topical corticosteroids may suppress the development of local cutaneous irritation that occurs in patients treated with calcipotriene ointment.. Psoriasis regimens combining calcipotriene ointment with superpotent steroids such as halobetasol ointment can result in greater improvement and fewer side effects.

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Atrophy; Calcitriol; Clobetasol; Dermatitis, Irritant; Dermatologic Agents; Drug Combinations; Drug Interactions; Glucocorticoids; Humans; Irritants; Longitudinal Studies; Ointments; Psoriasis; Risk; Skin

Topics: Administration, Cutaneous; Adult; Atrophy; Betamethasone Valerate; Biopsy; Cell Count; Clobetasol; Drug Evaluation; Female; Glucocorticoids; Humans; Hydrocortisone; Keratinocytes; Male; Middle Aged; Occlusive Dressings; Pharmaceutical Vehicles; Prednisolone; Skin; Telangiectasis; Ultrasonography

A major deleterious side effect of glucocorticoids is skin atrophy. Glucocorticoids activate the glucocorticoid and the mineralocorticoid (MR) receptor, both present in the epidermis. We hypothesized that glucocorticoid-induced epidermal atrophy may be related to inappropriate occupancy of MR by glucocorticoids. We evaluated whether epidermal atrophy induced by the topical glucocorticoid clobetasol could be limited by coadministration of MR antagonist. In cultured human skin explants, the epidermal atrophy induced by clobetasol was significantly limited by MR antagonism (canrenoate and eplerenone). Blockade of the epithelial sodium channel ENaC by phenamil was also efficient, identifying a role of MR-ENaC cascade in keratinocytes, acting through restoration of clobetasol-induced impairment of keratinocyte proliferation. In the SPIREPI randomized double-blind controlled trial, gels containing clobetasol, the MR antagonist spironolactone, both agents, or placebo were applied on four zones of the forearms of 23 healthy volunteers for 28 days. Primary outcome was histological thickness of the epidermis with clobetasol alone or clobetasol+spironolactone. Spironolactone alone did not affect the epidermal thickness but coapplication of clobetasol and spironolactone significantly limited clobetasol-induced atrophy and was well tolerated. Altogether, these findings identify MR as a factor regulating epidermal homeostasis and suggest that topical MR blockade could limit glucocorticoid-induced epidermal atrophy.

Topics: Administration, Topical; Adult; Atrophy; Biopsy, Needle; Clobetasol; Dermoscopy; Double-Blind Method; Epidermis; Female; Glucocorticoids; Healthy Volunteers; Humans; Immunohistochemistry; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Receptors, Mineralocorticoid; Reference Values; Risk Assessment; Spironolactone; Statistics, Nonparametric; Treatment Outcome; Young Adult

Currently, there are no accurate and simple methods available to measure this risk of atrophy in patients treated with topical glucocorticosteroids. In the present clinical trial, we validated a new score (Dermaphot(®) score) to assess the atrophogenic potential of glucocorticosteroids. 36 healthy adult volunteers were included in an investigator-initiated, blinded, randomized, intra-individual comparison, vehicle controlled multi-centre study. Subjects were treated in a randomized manner for 3 weeks with pimecrolimus cream 1 %, mometasone furoate (1 mg/g), clobetasol propionate 0.05 % and vehicle. In addition, ultrasound examination for skin thickness was performed. Data demonstrated a direct correlation of the achieved Dermaphot(®) score and the ultrasound thickness measurements. Our study shows that the Dermaphot(®) score can be used as a simple method to evaluate the atrophogenic potential of glucocorticosteroids. Respectively, we showed that the new score is an easy, valid and sensitive new tool for early detecting and quantifying even subclinical glucocorticosteroid-induced skin damage. We demonstrated that the score is able to differentiate the extent of skin atrophy (damage) after 3 weeks of topical glucocorticosteroid application with different levels of skin transparency and levels of telangiectasia.

Topics: Adult; Atrophy; Clobetasol; Female; Glucocorticoids; Humans; Male; Middle Aged; Mometasone Furoate; Pregnadienediols; Reproducibility of Results; Severity of Illness Index; Skin; Tacrolimus; Telangiectasis; Young Adult

To compare the atrophogenic effects of fluocinonide cream 0.1% versus clobetasol propionate cream 0.05%, 20 participants with corticosteroid-responsive dermatoses were randomly assigned to receive fluocinonide cream 0.1% on one arm and clobetasol propionate cream 0.05% on the other arm. Study medications were applied to disease-free target areas on the inner arms twice daily for 2 weeks. The epidermal thickness of pretreatment and posttreatment punch biopsy specimens was measured. Skin examinations were performed evaluating clinical signs of atrophy. No significant reduction in epidermal thickness was observed in the fluocinonide-treated sites (mean, -0.0318 mm; standard deviation, 0.0239; P=.1991). A significant reduction in epidermal thickness was seen in the clobetasol-treated sites (mean, -0.1825 mm; standard deviation, 0.0239; P<.0001). This reduction was significantly greater than results from sites treated with fluocinonide cream 0.1% (difference, -0.1507; standard deviation, 0.0131; P<.0001). Although topical corticosteroids often are the first-line treatment for patients with various dermatoses, a side effect of continuous use is cutaneous atrophy. Our study demonstrated that clobetasol propionate cream 0.05% caused a significantly greater reduction in epidermal thickness compared with fluocinonide cream 0.1% when used twice daily for 2 weeks (P<.001). However, neither drug caused significant clinical signs of atrophy.

Topics: Administration, Cutaneous; Adult; Atrophy; Clobetasol; Double-Blind Method; Drug Administration Schedule; Epidermis; Fluocinonide; Glucocorticoids; Humans; Skin Diseases

Prolonged topical corticosteroid use is often associated with atrophic skin changes. This trial compared signs of skin atrophy related to 3 super-high-potency corticosteroids: fluocinonide 0.1% cream, clobetasol propionate 0.05% cream, and 0.05% foam.. The test treatments were applied to the forearms 10 females twice daily for 21 days. Skin characteristics were assessed pretreatment and posttreatment for atrophic changes. Further punch biopsies obtained from 5 subjects were assessed histologically.. Clobetasol foam produced mild changes in noninvasive tests, but stained skin biopsies revealed structural changes nearly comparable to clobetasol cream, which showed substantial atrophic changes. Fluocinonide cream was the least atrophogenic, producing no or only mild effects that were slightly greater than vehicle.. Fluocinonide cream has a lower potential to produce atrophic changes of the skin than either clobetasol cream or clobetasol propionate foam.

Topics: Administration, Cutaneous; Adult; Atrophy; Clobetasol; Dose-Response Relationship, Drug; Emollients; Erythema; Female; Fluocinonide; Glucocorticoids; Humans; Middle Aged; Severity of Illness Index; Skin; Skin Diseases; Telangiectasis; Water Loss, Insensible

Clobetasol propionate is known to be a very effective treatment for psoriasis; however, its use is limited by potent corticosteroid class related side effects such as hypothalamic-pituitary-adrenal (HPA) axis suppression and atrophogenicity. The aim of this single-center, parallel group, randomized study was to assess the HPA axis suppression potential, atrophogenicity, and ocular tolerability of clobetasol propionate shampoo in 26 patients with scalp psoriasis. Suitable subjects were treated once daily for 4 weeks with clobetasol propionate shampoo, to be rinsed off after 15 minutes or with a leave-on clobetasol propionate gel. The study demonstrated that clobetasol propionate shampoo did not lead to HPA axis suppression or to skin atrophy. Conversely, the gel led to HPA axis suppression and a decrease in skin thickness. Neither formulation had an impact on ocular safety. Despite the short contact application time, the clobetasol propionate shampoo provides similar efficacy results to the gel.

Topics: Administration, Cutaneous; Adult; Atrophy; Clobetasol; Drug Administration Schedule; Female; Hair Preparations; Humans; Hypothalamo-Hypophyseal System; Male; Middle Aged; Ocular Physiological Phenomena; Pituitary-Adrenal System; Psoriasis; Scalp Dermatoses; Skin; Time Factors; Treatment Outcome

Skin atrophy is one of the main side-effects of topical corticosteroid therapy. Although the use of high-frequency ultrasound is an established method that has been studied previously, it allows measurements of the slow-reacting dermal thickness only.. To investigate the decreasing epidermal thickness, which occurs earlier, we used optical coherence tomography (OCT), a high-resolution noninvasive imaging technique, and compared it with 20-MHz ultrasound and profilometry.. In this double-blind placebo-controlled trial 20 healthy volunteers applied four different corticosteroids and the cream base formulation as placebo to the volar part of both arms once a day over a 4-week period. The epidermal thickness, the dermal thickness and the skin surface roughness were assessed using OCT, high-frequency ultrasound and profilometry.. Each of the three methods allowed the detection and monitoring of significant corticosteroid-induced skin atrophy and its reversibility. The changes correlated with the potency of the steroids. The epidermal thickness decreased significantly in all test areas, even in the placebo and the untreated fields. As expected, the reduction in epidermal thickness was more pronounced and could be detected earlier by OCT than the reduction of dermal thickness using ultrasound. The epidermal surface roughness investigated using profilometry showed a slight smoothing.. OCT allows a simple, fast and noninvasive in vivo measurement of the epidermal thickness. To evaluate the atrophogenic potential of corticosteroids it is more suitable than high-frequency ultrasound as epidermal thickness decreases earlier. In addition, epidermal thickness is a more sensitive indicator of steroid atrophy as the degree of thinning is much higher compared with the dermal atrophy. Profilometry might give further information; however, it would not be suitable for clinical use as the results were generally less pronounced. In the future, OCT might be useful to detect corticosteroid-induced side-effects at the beginning for monitoring the therapy.

Topics: Adult; Anti-Inflammatory Agents; Atrophy; Betamethasone Valerate; Clobetasol; Double-Blind Method; Epidermis; Female; Glucocorticoids; Humans; Hydrocortisone; Male; Middle Aged; Ointments; Skin; Tomography, Optical Coherence; Ultrasonography

We investigated the value of the dermoscope for monitoring the long term safety of high potency topical steroids in patients with chronic psoriasis. We observed for the first time that the overuse of topical steroids resulted in the appearance of clinically unapparent but dermoscopically apparent "red lines" (linear telangiectasias) in the treated plaques and/or skin adjacent to the treated plaques (P < .03). We concluded that dermoscopy may help reveal the early signs of impending steroid-induced atrophy ("red lines") before they become clinically evident with the naked eye and before the atrophy becomes permanent.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Atrophy; Calcitriol; Chronic Disease; Clobetasol; Dermatologic Agents; Dermoscopy; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Patient Compliance; Pilot Projects; Psoriasis

Topics: Administration, Cutaneous; Adolescent; Adult; Anti-Inflammatory Agents; Atrophy; Child; Child, Preschool; Clobetasol; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Ointments; Skin; Skin Diseases, Vesiculobullous; Skin Pigmentation; Telangiectasis; Treatment Outcome; Vitiligo

Topics: Administration, Cutaneous; Atrophy; Child; Clobetasol; Drug Eruptions; Follow-Up Studies; Humans; Methoxsalen; Ointments; PUVA Therapy; Remission Induction; Skin; Skin Pigmentation; Sunlight; Vitiligo

The most frequent side effect of a long-term topical corticosteroid therapy is skin atrophy. To avoid or to reduce atrophy often an initial continuous application is followed by an intermittent maintenance therapy.. In this study we measured the skin thickness before and after the two-phase application schedule with the superpotent topical steroid clobetasol propionate (CP). For 16 days CP samples were applied twice daily on the test areas of 12 volunteers (phase 1). Then CP was applied to the same skin areas in accordance with the following timing: every 5th day, every 7th day, every 10th day, every 14th day (phase 2). Phase 2 lasted for 45 days. During the entire period of the study the skin thickness was measured regularly by the skin compression and thickness method as described previously.. It could be seen that in phase 1 the skin became about 15% thinner. In phase 2 the steroid-induced skin thinning was approximately the same when CP was applied every 5th or 7th day. The skin thickness reached a more or less normal level when CP was applied every 10th day. After the 14th day a completely normal level was found. By measuring the skin thickness every day it was further shown that the skin thinning process lasted for 3 days when CP was applied once only.. These results demonstrate that skin thinning must be expected by an intermittent maintenance therapy applied at relatively short intervals. The longer the intervals, the weaker the skin thinning. Moreover, these investigations showed that the skin thinning effect after a single CP application persists for nearly 3 days.

Topics: Administration, Topical; Adult; Analysis of Variance; Atrophy; Clobetasol; Drug Administration Schedule; Female; Humans; Male; Skin

In this study, we investigated the effect of calcipotriol, prednicarbate and clobetasol 17-propionate on skin thickness over a treatment period of 6 weeks. The study was conducted as a controlled, randomized, double-blind comparison. The influence of these drugs on normal skin under occlusive conditions was assessed visually and by measuring skin thickness using 20 MHz B mode ultrasound. Both topically applied glucocorticosteroids lead to a significant decrease in skin thickness. In contrast to the glucocorticosteroid-induced atrophy, calcipotriol application on normal skin leads to an increase in skin thickness in all volunteers. The effect remains constant for the duration of treatment. The cause of this increase seems to be an irritative reaction of the skin which was histologically investigated in one volunteer. The histological features of this reaction are characteristic for a subacute dermatitis. The implications of these findings for the therapeutic mechanism of calcipotriol are discussed.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Atrophy; Calcitriol; Clobetasol; Dermatitis, Contact; Dermatologic Agents; Double-Blind Method; Female; Glucocorticoids; Humans; Male; Middle Aged; Prednisolone; Skin; Ultrasonography

Topics: Administration, Cutaneous; Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Atrophy; Betamethasone Valerate; Clobetasol; Dermatitis, Phototoxic; Double-Blind Method; Drug Tolerance; Female; Humans; Irritants; Male; Methylprednisolone; Occlusive Dressings; Ointments; Prednisolone; Skin; Skin Tests

The atrophogenic potential of medium-potent topical glucocorticoids is still controversial. In a double-blind controlled trial 24 healthy volunteers either applied 0.25% prednicarbate cream or the corresponding vehicle to one and 0.1% betamethasone-17-valerate cream or 0.05% clobetasol-17-propionate cream to the other forearm twice daily. Skin thickness was regularly assessed during the six week period of application and for further three weeks thereafter, using both the B- and A-mode of a 20 MHz ultrasound scanner. Both betamethasone-17-valerate and clobetasol-17-propionate cream significantly reduced skin thickness as compared to cream base while prednicarbate cream did not. Given that 0.1% betamethasone-17-valerate- and 0.25% prednicarbate cream are reported to be about equipotent in the treatment of atopic eczema the latter preparation shows an increased ratio between its desired anti-inflammatory and its unwanted atrophogenic effect.

Topics: Adult; Anti-Inflammatory Agents; Atrophy; Betamethasone Valerate; Clobetasol; Double-Blind Method; Female; Humans; Male; Ointments; Pharmaceutical Vehicles; Prednisolone; Skin

24 healthy volunteers with no history of skin disease were entered in a 6-week double-blind randomized study to compare the atrophogenicity potentials of both cream and ointment forms of triamcinolone acetonide and clobetasol propionate. The atrophogenicity potential of cream preparations turned out to be greater than that of ointment preparations containing identical amounts of the same glucocorticoid. This result proves both the reproducibility of the assay and the general character of the phenomenon in view of the limited previous evidence.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Atrophy; Clobetasol; Double-Blind Method; Female; Glucocorticoids; Humans; Male; Ointments; Skin; Triamcinolone Acetonide; Ultrasonography

The skin thinning effect of discontinuous topical clobetasol-17-propionate applications was tested in human volunteers. Application frequencies were daily (1/0), every third day (1/2), every fifth day (1/4), every seventh day (1/6) and every ninth day (1/8). Clobetasol-17-propionate was administered topically under occlusion for 1 h. The treatment period was 41 days. There were no differences of the skin thinning effect of daily and 1/2 administration. The skin thinning effect of 1/4, 1/6 and 1/8 was smaller but also significant compared to controls. The curves demonstrating skin thinning effects initially were dropping off and reached a plateau within about 2 weeks. After finishing application, skin thickness normalized within 2 weeks. Because of these findings, a treatment interval of 3 days is discussed as therapeutically efficient.

Topics: Administration, Topical; Adult; Atrophy; Clobetasol; Drug Administration Schedule; Female; Humans; Male; Ointments; Skin

Overt iatrogenic cutaneous atrophy is easily recognized; however, the earliest signs of such an adverse event may be covert. Preatrophy is proposed as a term to describe the subtle unmasking or normally covert subpapillary vascular channels found by the use of enhanced skin surface magnification techniques. We conducted a randomized double-blind, bilaterally paired comparison clinical trial in patients with chronic plaque psoriasis treated with twice-daily (nonoccluded) superpotent topical steroids for 2 weeks. Occult reversible delicate networks of horizontally oriented vascular channels were found within and surrounding 20% (23/118) of the involved psoriatic plaques during the course of the study. The use of a hand-held magnifying lens (8X), mineral oil, a coverglass, and adequate illumination allow recognition of preatrophy. Preatrophy was more frequently found in women than in men.

Topics: Adult; Aged; Atrophy; Betamethasone; Clinical Trials as Topic; Clobetasol; Double-Blind Method; Female; Humans; Male; Middle Aged; Ointments; Prospective Studies; Psoriasis; Random Allocation; Skin

Five corticosteroid ointments and placebo were compared in 17 volunteers with regard to their influence on normal skin under occlusive conditions. Each volunteer had six simultaneous applications on the forearms and six on the back. The trial was double-blind and lasted 4 weeks. The ointments were placed in randomized order. The treatments were 0.1 and 0.03% domoprednate, 0.1% hydrocortisone butyrate, 0.1% betamethasone valerate, 0.05% clobetasole propionate and placebo. Skin thickness was measured on days 0, 7, 14, 21 and 28, transepidermal water loss on days 0, 14 and 28, while blood flow and telangiectasias were evaluated only on day 28 at termination of the trial. The skin thickness became significantly reduced on all corticosteroids, but not on placebo; 0.03% domoprednate, however, tended to have an intermediate position between placebo and the other ointments. The transepidermal water loss did not change. Rating of telangiectasia under stereomicroscope showed a significantly lower score after 0.03% domoprednate and placebo as compared to the other ointments. Assessment of telangiectasia by laser-Doppler flowmetry showed a similar tendency. It is concluded that 0.1% domoprednate is comparable to other topical corticosteroids with respect to atrophogeneity and formation of telangiectasia, but the 0.03% concentration seems to result in fewer side effects.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Atrophy; Betamethasone; Betamethasone Valerate; Clinical Trials as Topic; Clobetasol; Dermatologic Agents; Double-Blind Method; Female; Humans; Hydrocortisone; Male; Pregnadienes; Random Allocation; Skin; Telangiectasis; Ultrasonography

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

A modified radiographic technique was used to assess dermal atrophy induced by topical steriods. The method proved reliable, and significant atrophy occurred with fluocinolone acetonide, clobetasone butyrate, hydrocortisone 17-butyrate and flurandrenolone, but not with hydrocortisone.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Atrophy; Clinical Trials as Topic; Clobetasol; Fluocinolone Acetonide; Flurandrenolone; Humans; Hydrocortisone; Male; Methods; Radiography; Skin

Topical superpotent class I corticosteroids (CSs) are highly effective in the treatment of early-stage mycosis fungoides (MF) and are readily available, easily applied, and have minor side effects compared to other topical therapeutic options. Because MF is a chronic disease, prolonged treatment is needed, raising the concern of CS-induced cutaneous adverse effects (AEs). In this observational study, we aimed to evaluate the risk for skin AEs of clobetasol propionate cream 0.05% in patients with early-stage MF. Thirteen consecutive patients with MF were treated with clobetasol propionate cream 0.05% once or twice daily as monotherapy and were followed for 4 to 17 months. One participant was lost to follow-up, and the remaining 12 participants responded to treatment with topical clobetasol propionate with minimal side effects. With proper education and monitoring, topical CSs are a safe and effective mainstay of treatment for patches and flat plaques in patients with early-stage localized MF.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Atrophy; Clobetasol; Female; Glucocorticoids; Humans; Hypopigmentation; Male; Middle Aged; Mycosis Fungoides; Prospective Studies; Skin; Skin Cream; Skin Neoplasms

The main limitation of using topical corticosteroids in dermatology is their atrophic effects on the skin. We have previously proposed a molecular platform composed of CD44, EGFR, and hyaluronate synthase (HAS) that is functionally defective in dermatoporosis, a chronic cutaneous insufficiency/fragility syndrome. In this study, we explored the molecular mechanisms of the skin atrophy induced by corticosteroids. We observed an important skin atrophy and a significant decrease of hyaluronic acid (HA), its main cell surface receptor CD44, and F-actin in mouse skin treated with topical clobetasol propionate (CP). Human keratinocytes exposed to CP showed an impaired HA secretion and diminished expression of CD44 and HAS3. CP also abolished filopodia of keratinocytes exposed to CP together with a redistribution of CD44 and F-actin depolymerization. We also show that HA fragments of intermediary size (HAFi) induced keratinocyte filopodia and protected them against CP. Topical HAFi induced hyperplasia in mouse epidermis and prevented CP-induced atrophy. Our results suggest that a CD44/EGFR/HAS platform associated with F-actin and filopodia of keratinocytes is the target of corticosteroids for their atrophogenic effects. These observations may lead to the development of new treatment and prevention strategies for corticosteroid-induced skin atrophy.

Topics: Animals; Atrophy; Cell Line, Transformed; Clobetasol; Dermatologic Agents; Drug Interactions; Epidermis; Glucocorticoids; Glucuronosyltransferase; Homeostasis; Hyaluronan Receptors; Hyaluronan Synthases; Hyaluronic Acid; Hymecromone; Keratinocytes; Mice; Mice, Hairless; Molecular Weight; Peptide Fragments; Pseudopodia; Skin Cream; Viscosupplements

Topical glucocorticoid (GC) therapy has been successfully used in the treatment of several common cutaneous diseases in clinical practice for a long time, and skin atrophy is one of the most typical cutaneous side effects of this therapy. The aim of this study was to evaluate the potential of noninvasive fluorescence spectroscopy (FS) technique in the detection and classification of GC-induced skin atrophy. A total of 20 male Wistar rats were used in the experimental protocol under controlled environmental conditions and with free access to food. One group received topical application of clobetasol propionate 0.05% for 14 days to induce cutaneous atrophy (atrophic group) and the other (control) group received only vehicle application following the same protocol and schedule. Histological analyses and FS measurements with laser excitation at both 532 nm and 408 nm were obtained on days 1 and 15. The FS results were classified as "normal" or "atrophic" according by histological analysis. Fluorescence spectra obtained with excitation at 408 nm allowed a clear distinction between the control and atrophic groups, and were more informative than the those obtained at 532 nm. Our results reveal that, if correctly applied, FS allows noninvasive evaluation of corticosteroid-induced skin atrophy, and thus represents an important step towards better monitoring of undesirable side effects of cutaneous therapy.

Topics: Animals; Atrophy; Clobetasol; Disease Models, Animal; Glucocorticoids; Male; Rats; Rats, Wistar; Skin; Spectrometry, Fluorescence

Glucocorticoids (GCs) belong to the most widely used anti-inflammatory drugs at all. However, their topical use is limited by their side effect potential, with skin atrophy being the most prominent one. Thus, determining the atrophogenic potential of novel compounds is of importance for drug development. Currently, the most frequently performed model in the base and pharmaceutical research is the hr/hr rat model of GC-induced skin atrophy that lasts for 19 days. In this study, we analysed statistically skin atrophy experiments retrospectively to ascertain (i) the earliest time-point, at which skin atrophy is significantly induced; and (ii) whether the differences between the GC treatment groups change until the end of the experiment. We show here that the treatment duration of rat skin atrophy models might be reduced to 5 days for economical and ethical reasons.

Topics: Animals; Anti-Inflammatory Agents; Atrophy; Clobetasol; Disease Models, Animal; Glucocorticoids; Linear Models; Methylprednisolone; Mometasone Furoate; Pregnadienediols; Rats; Rats, Hairless; Skin; Time Factors

Erosive pustular dermatosis (EPD) is a rarely reported condition that primarily involves the actinically damaged scalp of elderly women. Although the condition is well recognized in the United Kingdom and Europe, no US cases have heretofore been reported.. We sought to document the presence, and determine the clinical characteristics, of EPD in the US population.. Patients were recruited from the dermatology clinic at a university in California and from the private practices of dermatologists in the Northern California region.. Eleven patients with EPD were identified. Eight were women and 3 were men. The scalp was involved in 9 patients and the extremities in two patients. The involved skin was actinically damaged in 9 patients. The patients were elderly (66-90 years) but one patient was a 15-year-old boy. All lesions resolved or greatly improved with the application of high-potency steroids or tacrolimus.. Not all patients were examined personally by the authors of this article. The length of follow-up was relatively short.. EPD is a fairly common disease and is the most likely diagnosis in instances where chronic, nonhealing, shallow erosions occur on actinically damaged, or otherwise atrophic, skin. In spite of the name, intact pustules are rarely present. The histology is that of moderate to marked, nonspecific chronic inflammation. EPD responds well to high-potency topical steroids.

Topics: Administration, Topical; Adolescent; Aged; Aged, 80 and over; Atrophy; Calcineurin Inhibitors; Clobetasol; Extremities; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Photosensitivity Disorders; Scalp Dermatoses; Skin Diseases; Skin Diseases, Vesiculobullous; Steroids; Tacrolimus; Treatment Outcome

Skin atrophy is one of the most frequent side-effects of the topical glucocorticoid. Skin barrier impairment has also been reported as a steroid-induced side effect. Although there have been various studies on preventing or minimizing this atrophogenic effect, little has been reported about preventing barrier impairment. This study was performed to determine the effects of a multilamellar emulsion (MLE) that had a well-ordered lamellar structure on the steroid-induced barrier impairment and epidermal atrophy. To confirm these effects of MLE, 0.05% clobetasol-17-propionate (CP) and 0.05% clobetasol-17-propionate in MLE (MLE/CP) were topically applied to both flanks of hairless mice for 9 days. The topically applied CP induced a significant impairment of the epidermal permeability barrier, and MLE/CP also did not have a preventive effect on this change. However, skinfold thickness studies and histological studies showed that MLE/CP significantly reduced the steroid-induced atrophy. The topical application of MLE/CP was also shown to have a preventive effect on the steroid-induced increase of the stratum corneum (SC) surface pH. In addition, the electron microscopic findings showed relatively well-conserved lamellar bilayers in the skin treated with MLE, as compared to CP only. The results showed that the topical application of MLE immediately after CP treatment prevented the glucocorticoid-induced transepidermal water loss values increase. Light microscopy measurements showed that the skin treated with MLE immediately after CP treatment for 1 week had a slightly lower decline of skin thickness than did the CP-treated skin. These results suggest that MLE should be effective for preventing glucocorticoid-induced epidermal atrophy and for repairing the barrier impairment.

Topics: Administration, Topical; Animals; Atrophy; Biopsy, Needle; Clobetasol; Disease Models, Animal; Emulsions; Epidermis; Female; Glucocorticoids; Immunochemistry; Male; Mice; Mice, Hairless; Permeability; Probability; Reference Values; Risk Factors; Sensitivity and Specificity; Skin Absorption; Skin Diseases

Atrophic plaques with white borders are occasionally seen on sun-exposed areas of the skin. These patients are usually elderly and have solar elastosis. This condition is referred to as annular atrophic plaques of skin and we describe a typical case.

Topics: Aged; Atrophy; Biopsy; Chronic Disease; Clobetasol; Diagnosis, Differential; Epidermis; Humans; Keratosis; Male; Sclerosis; Skin Diseases

Topics: Aged; Atrophy; Clobetasol; Diagnosis, Differential; Exanthema; Female; Humans; Skin

A case of lichen sclerosus that developed in a pattern corresponding to the lines of Blaschko is described. This pattern of extragenital lichen sclerosus has not, to our knowledge, previously been reported and could result from an epidermal clone with altered androgen sensitivity supporting a hormonal pathogenesis for this disease.

Topics: Abdomen; Administration, Cutaneous; Adult; Anti-Inflammatory Agents; Atrophy; Clobetasol; Clone Cells; Dehydroepiandrosterone Sulfate; Epidermis; Female; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Purpura; Skin; Telangiectasis; Testosterone

Clobetasol-17-propionate (CP), a synthetic glucocorticoid (GC), reduced skin thickness in rats. Both the subcutaneous injection and topical applications of RU 486 counteracted CP-induced reduction in skin thickness. Topical application of the CP cream completely inhibited the ear edema produced by croton oil. A less potent GC, hydrocortisone-17-butyrate, also inhibited ear edema. This antiinflammatory effect was not abolished by the subcutaneous injection or topical application of RU 486. These observations suggest that GC-induced skin atrophy is mediated by glucocorticoid receptors (GRs), while the inhibition of croton oil-induced inflammation by GC is primarily related to the direct effects of GC, which are not mediated by GRs. Our findings suggest that RU 486 inhibits the atrophogenic effect of GCs without interfering with their antiinflammatory effect. Dissociation of antiinflammatory and atrophogenic activity of GC seems favorable in treating inflammatory skin diseases lacking epidermal proliferation.

Topics: Animals; Anti-Inflammatory Agents; Atrophy; Clobetasol; Croton Oil; Dexamethasone; Ear Diseases; Edema; Glucocorticoids; Ligands; Male; Mifepristone; Rats; Rats, Wistar; Receptors, Glucocorticoid; Skin

In an earlier study we showed that tretinoin could prevent corticosteroid-induced skin atrophy in hairless mice. In this study, we examined the histochemical, biochemical, and immunochemical changes that accompanied the atrophy and its prevention. Mice were treated dorsally for 3 weeks in the morning and afternoon (AM:PM) as follows: 1) vehicle:vehicle, 2) steroid:vehicle, 3) steroid:tretinoin. Tretinoin concentration was 0.05% in an ethanol:propylene glycol vehicle. The steroid was clobetasol propionate (0.05%). The normally sparse dermal glycosaminoglycans were further reduced by steroid:vehicle treatment and increased to greater than vehicle:vehicle amounts by steroid:retinoid. Mast cells were similarly affected. Biochemical quantification of glycosaminoglycans confirmed the histochemical findings. Collagen, non-collagenous protein, and total protein content were reduced by the steroid. The latter two were returned to more normal levels by tretinoin whereas with collagen there was only a trend toward normal levels. Fibronectin, which was increased by the steroid:vehicle treatment, was reduced to more normal levels by steroid:tretinoin. We conclude that tretinoin has the ability to prevent the major steroid-induced biomechanical changes in hairless mouse dermal connective tissue that contribute to atrophy.

Topics: Adrenal Cortex Hormones; Animals; Atrophy; Clobetasol; Collagen; Disease Models, Animal; Enzyme-Linked Immunosorbent Assay; Fibronectins; Glycosaminoglycans; Histocytochemistry; Image Processing, Computer-Assisted; Immunohistochemistry; Iron; Mast Cells; Mice; Mice, Hairless; Retinoids; Skin; Tolonium Chloride; Tretinoin

Topics: Administration, Cutaneous; Adult; Atrophy; Betamethasone Valerate; Clobetasol; Double-Blind Method; Glucocorticoids; Humans; Hydrocortisone; Pharmaceutical Vehicles; Prednisolone; Skin; Ultrasonography

Topical corticosteroids produce atrophic changes in skin, including thinning of the epidermis and decrease in dermal ground substance. We observed that 12% ammonium lactate produced an increase in the thickness of epidermis and increased amounts of dermal glycosaminoglycans.. Our purpose was to determine whether 12% ammonium lactate could minimize cutaneous atrophy produced by a potent topical corticosteroid.. Clobetasol propionate, 12% ammonium lactate, and both agents were repetitively applied under occlusive patches as well as in open patches on the forearms of human volunteers for 3 to 4 weeks. Biopsy specimens were analyzed for thickness of the epidermis and dermal glycosaminoglycans by image analysis.. Twelve percent ammonium lactate produced a significant sparing of atrophy in both the epidermis and dermis without any influence on the bioavailability or antiinflammatory properties of the corticosteroid.. Twelve percent ammonium lactate may be useful in mitigating the adverse effects of corticosteroid on skin.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Atrophy; Biological Availability; Clobetasol; Drug Evaluation; Drug Interactions; Female; Glucocorticoids; Humans; Lactates; Lactic Acid; Male; Middle Aged; Skin

Topics: Adolescent; Atrophy; Chronic Disease; Clobetasol; Humans; Male; Thumb

Comparisons of ultrasonic, radiographic and micrometer methods in the measurement of skin thickness were made in 16 volunteers before and after 1-month's treatment with four clobetasol propionate formulations. Correlations between the methods were highly significant (r = 0.68 to 0.75). Correlations in the females were better than in the males suggesting that measurements in women are more easily made. Percentage reductions in skin thickness after steroid treatment were ranked in an identical order, whichever method was used. Each of the three methods, therefore, was shown to be effective. Ultrasound was the preferred technique but the micrometer screw gauge was shown to be a reasonable alternative.

Topics: Adult; Atrophy; Clobetasol; Female; Humans; Male; Radiography; Sex Factors; Skin; Time Factors; Ultrasonography