clobetasol and Dermatitis--Atopic

Topical corticosteroids are the most common treatment modality for patients with psoriasis and atopic dermatitis; however, the efficacy of topical corticosteroids is often hampered by barriers to patient adherence, such as lack of efficacy, side effects and inconvenience. Recently published studies have investigated the safety and efficacy of a novel emollient foam (EF) formulation of clobetasol propionate (CP), a class I topical corticosteroid in psoriasis and atopic dermatitis.. To summarize recent literature on CP EF foam, and to evaluate recent Phase II and III clinical trials of CP EF foam in psoriasis and atopic dermatitis.. The MEDLINE (1950 - January 2008) database was searched using the following terms: 'clobetasol propionate foam', 'topical corticosteroids', 'topical glucocorticoids', 'psoriasis' and 'atopic dermatitis'. Results were evaluated for relevance and quality, and additional references were obtained from bibliographies of selected articles.. CP EF foam appears to be safe and effective for corticosteroid-responsive dermatoses in adults and children > or = 12 years of age. As compared to its hydroethanolic foam predecessor, CP EF presents a potential advance for patients who are less likely to tolerate alcohol-based foam. As alcohol-based foams can be irritating and cause stinging in non-hair-bearing areas, this new emollient formulation has the potential to widen the use of CP foam to more patients with atopic dermatitis and to more non-scalp body sites in patients with psoriasis.

Topics: Administration, Cutaneous; Adult; Anti-Inflammatory Agents; Child; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Clobetasol; Dermatitis, Atopic; Glucocorticoids; Humans; Patient Compliance; Psoriasis

Clobetasol propionate is the most potent of all topical steroids. It is successfully applied in the treatment of various skin diseases such as atopic dermatitis, psoriasis and vulvar lichen sclerosus. The therapy is, however, mainly symptomatic. A preventive effect is only reported in the treatment of the latter. Clobetasol propionate exerts antiinflammatory, immunosuppressive and antimitotic effects influencing the growth, differentiation and function of various cells and inhibiting cytokine production. Seven different dosage forms are available to deliver the drug to the living cells of the skin. Their choice might additionally affect patient compliance. The potency of clobetasol propionate, however, is accompanied by local and systemic side effects, such as skin atrophy and hypothalamic-pituitary-adrenal axis suppression. Patients applying clobetasol propionate must be well instructed in how to use it. Physicians prescribing clobetasol propionate should consider a diversity of factors and be able to answer the questions where, when and why.

Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Clobetasol; Dermatitis, Atopic; Female; Humans; Immunosuppressive Agents; Psoriasis; Vulvar Lichen Sclerosus

Topical corticosteroids have been the mainstay of topical anti-inflammatory therapy of psoriasis and are available in different treatment strengths or doses and various formulations or vehicles. Traditional formulations have included ointments, creams, and lotions. More recently, the mid-potency corticosteroid betamethasone valerate (BMV) and the ultra-high-potency corticosteroid clobetasol propionate (CP) have become available in a novel, thermolabile, low-residue foam vehicle for topical application. This review examines recent clinical studies on efficacy and safety of these two new formulations, BMV 0.12% foam (Luxiq; Connetics Corp, Palo Alto, Calif) and CP 0.05% foam (OLUX, Connetics Corp), as treatments for scalp and nonscalp psoriasis. The studies demonstrated that BMV foam and CP foam are safe and effective treatments for psoriasis affecting scalp and nonscalp regions of the body. BMV foam and CP foam were absorbed more rapidly and demonstrated greater total absorption than their respective comparison formulations, namely BMV lotion and CP solution. The foam vehicle also appears to be associated with better compliance and improvements in quality of life. The unique nature of the foam vehicle, together with the positive findings of in vitro studies suggest these new foam formulations may expand the options currently available for combination therapy.

Topics: Administration, Cutaneous; Adult; Betamethasone Valerate; Clobetasol; Cross-Over Studies; Dermatitis, Atopic; Dosage Forms; Double-Blind Method; Female; Forecasting; Humans; Hydrocortisone; Male; Multicenter Studies as Topic; Ointments; Pharmaceutical Vehicles; Psoriasis; Randomized Controlled Trials as Topic; Scalp Dermatoses; Single-Blind Method; Treatment Outcome

Atopic dermatitis (AD) presents a large unmet need for treatments with better safety and efficacy. To facilitate development of topical therapeutics, we need an efficient model for assessing different formulations and concentrations. The "plaque model" has been successfully implemented in patients with psoriasis, another common inflammatory disease, to assess the efficacy of topical treatments. This model has not been validated for AD, which has higher placebo responses and less stable lesions than psoriasis.. We aimed to assess changes in molecular signatures of intrapatient target lesions treated with topical therapeutics.. We enrolled 30 patients with mild-to-moderate AD in a randomized, double-blind, intraindividual comparison of 3 approved agents applied blindly at the investigator site daily for 14 days: pimecrolimus, betamethasone dipropionate, clobetasol propionate, and a vehicle/emollient control. Changes in total sign scores (TSSs), transepidermal water loss, and tissue biomarkers (determined by using RT-PCR and immunohistochemistry) were evaluated.. TSSs showed improvements of 30%, 40%, 68%, and 76% at 2 weeks with vehicle, pimecrolimus, betamethasone, and clobetasol, respectively, with parallel changes in transepidermal water loss (P < .05). Significant differences versus vehicle values were limited to steroids (P < .0001). Steroids (particularly clobetasol) restored epidermal hyperplasia and terminal differentiation versus minimal changes with vehicle or pimecrolimus (P < .001). Levels of cellular infiltrates and cytokines (IL-13, IL-22, and S100As) were similarly reduced only by steroids (P < .001). TSS improvement correlated with changes in hyperplasia, infiltrates, and differentiation markers.. We detected significant clinical and tissue differences between agents, providing a novel approach to study the differential effects of topical formulations using a limited sample size.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Betamethasone; Biomarkers; Cell Differentiation; Clobetasol; Cytokines; Dermatitis, Atopic; Female; Humans; Hyperplasia; Male; Middle Aged; Placebo Effect; Psoriasis; Skin; Tacrolimus; Young Adult

This study measured skin hydration and occlusivity of two test products [halobetasol propionate lotion, 0.05% (HBP Lotion) and Ultravate® (halobetasol propionate) cream, 0.05% (HBP Cream)] at 2, 4, and 6 hours after application to skin test sites previously challenged by dry shaving, which was performed to compromise the integrity of the stratum corneum barrier.. Trans-epidermal water loss (TEWL), an indicator of skin barrier function, was measured using cyberDERM, inc. RG-1 evaporimeter. Skin hydration was evaluated using IBS SkiCon-200 conductance meter. Test products were applied bilaterally on dry-shaved sites on the volar forearm sites, according to a randomization scheme, with two test sites untreated to serve as "dry-shaved" controls. TEWL and conductance were measured at 2, 4, and 6 hours post-treatment.. HBP Lotion displayed a significant increase in skin hydration at 2, 4, and 6 hours post-treatment compared to the baseline values and dry-shaved controls (each, P less than 0.001). However, HBP Cream produced statistically significant increased skin hydration only after 6 hours (P less than 0.05). HBP Lotion was significantly more effective than HBP Cream in increasing skin hydration at 2 and 4 hours post-treatment (each, P less than 0.001), and had a directional advantage (not statistically significant) at 6 hours. Neither test product had a significant occlusive effect as measured by TEWL at 2, 4, and 6 hours post-application.. Both formulations of HBP (Lotion and Cream) contributed to skin moisturization, as measured by skin conductance. HBP Lotion produced a significantly more rapid onset and higher level of moisturization at 2 and 4 hours post-application compared to HBP Cream. The TEWL results indicate that neither HBP Lotion nor HBP Cream provided any significant occlusivity to the skin.

J Drugs Dermatol. 2017;16(2):140-144.

Topics: Administration, Cutaneous; Adult; Clobetasol; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Drug Compounding; Emollients; Female; Forearm; Humans; Male; Middle Aged; Skin Cream; Vasoconstrictor Agents; Water Loss, Insensible; Young Adult

Recent findings have established the 308-nm xenon chloride excimer laser (EL) as a new option in the area of ultraviolet (UV) B phototherapy. As this laser enables high radiant exposure of narrowband UVB and precise targeting of affected skin, it appears to be a promising treatment for the prurigo form of atopic dermatitis (AD).. To investigate the efficacy and safety of the EL compared with clobetasol propionate (CP) in the prurigo form of AD.. In a prospective randomized within-patient controlled study, 13 patients with a prurigo form of AD were randomized to receive EL on one side and topical CP on the other side. Laser treatment was performed twice a week for 10 weeks. Clinical responses were evaluated using Physician Assessment of Individual Signs, Physician Global Assessment, Patient Global Assessment and photographic documentation. Histopathological changes were evaluated and duration of remission was monitored during a 6-month follow-up period.. Both treatments resulted in a significant improvement of all outcome measures after 10 weeks of treatment. During follow up, the EL showed more improvement compared with CP. Histopathology demonstrated marked decrease of epidermal thickness and inflammatory infiltrate at the EL-treated sites. No significant side-effects occurred.. This study suggests that the EL can safely and effectively be used in the treatment of the prurigo form of AD. For the long term, the EL might be a good alternative to topical corticosteroids and an option in case of therapy-resistant patients.

Topics: Adult; Aged; Biopsy; Clobetasol; Dermatitis, Atopic; Dermatologic Agents; Epidemiologic Methods; Female; Glucocorticoids; Humans; Lasers, Excimer; Male; Middle Aged; Prurigo; Skin; Treatment Outcome

A bioanalytical assay for the topical corticosteroid clobetasol propionate was developed and validated. For the quantitative assay 0.5 ml human serum samples, supplemented with clobetasone butyrate as internal standard, were extracted with hexane-ether. Evaporated and reconstituted extracts were injected on a polar embedded octadecyl silica column with isocratic elution using formic acid in water-methanol as mobile phase. The eluate was led into the electrospray interface with positive ionization and the analyte was detected and quantified using the selective reaction monitoring mode of a triple quadrupole mass spectrometer. The assay was validated in the range 0.04-10 ng/ml, the lowest level of this range being the lower limit of quantification. Precisions were 5-10% and accuracies were between 102 and 109%. The drug was stable under all relevant conditions. Finally, the assay was successfully applied on patients suffering from severe atopic dermatitis treated topically with clobetasol propionate.

Topics: Aged; Anti-Inflammatory Agents; Calibration; Chromatography, Liquid; Clobetasol; Dermatitis, Atopic; Drug Stability; Female; Humans; Limit of Detection; Reproducibility of Results; Tandem Mass Spectrometry; Young Adult

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Betamethasone; Clobetasol; Dermatitis, Atopic; Female; Humans; Male; Severity of Illness Index; Skin Absorption

Clobetasol propionate 0.05% emulsion foam was recently developed for use on multiple body sites.. We sought to evaluate safety and efficacy of clobetasol emulsion foam 0.05% to treat steroid-responsive dermatoses in multiple age groups.. A phase II open-label study evaluated the effect of clobetasol foam on the hypothalamic-pituitary-adrenal axis in 52 participants aged 6 years or older with mild-to-severe atopic dermatitis (AD). Cosyntropin stimulation test was used to determine the effect of clobetasol foam on hypothalamic-pituitary-adrenal axis, with a normal response considered to be a postinjection serum cortisol level greater than 18 mug/dL. Another phase II open-label pharmacokinetic safety study was conducted in 32 participants aged 12 years or older with mild-to-moderate plaque-type psoriasis. Pharmacokinetic parameters evaluated included maximal plasma concentration of clobetasol propionate, time to achieve maximum concentration, and area under the curve. Two phase III, randomized controlled studies assessed treatment success in participants aged 12 years or older with moderate-to-severe AD (N = 377) or mild-to-moderate plaque-type psoriasis (N = 497). In all studies, participants received study drug for 2 weeks. In the AD study, treatment success was determined using a composite end point requiring an Investigator's Static Global Assessment (ISGA) score of 0 or 1, erythema score of 0 or 1, induration/papulation score of 0 or 1, and improvement in the ISGA score of at least two grades from baseline. Likewise, the study in plaque-type psoriasis used a composite end point requiring an ISGA score of 0 or 1, erythema score of 0 or 1, scaling score of 0 or 1, plaque thickness score of 0, and improvement in the ISGA score of at least two grades from baseline.. Significantly more participants achieved treatment success on clobetasol foam than vehicle foam (P < .0001 and P = .0005 for each study). Reversible hypothalamic-pituitary-adrenal axis suppression was observed in 27% of participants aged 18 years or older and 47% in participants aged between 6 and younger than 12 years, but 0% in participants aged between 12 and younger than 18 years.. The studies evaluated short-term use only.. Clobetasol emulsion formulation foam is safe and effective for treatment of moderate-to-severe AD and mild-to-moderate plaque-type psoriasis in patients aged 12 years or older.

Topics: Administration, Cutaneous; Adolescent; Adrenal Insufficiency; Adult; Age Factors; Aged; Area Under Curve; Biological Availability; Child; Clobetasol; Cosyntropin; Dermatitis, Atopic; Emulsions; Humans; Hydrocortisone; Immunosuppressive Agents; Middle Aged; Pituitary-Adrenal Function Tests; Psoriasis; Treatment Outcome

The main objective of this explorative study was to evaluate if tacrolimus ointment could be safer than corticosteroid ointment, with special reference to the intraocular pressure in the treatment of eyelid eczema in patients with atopic keratoconjunctivitis (AKC). Secondary aims were to compare the effects of the treatments on eyelid eczema and their potential impact on ocular surface inflammation.. Tacrolimus 0.1% ointment and clobetasone butyrate 0.05% ointment were compared in a double-masked explorative crossover study. In total, 25 AKC patients were included. Each ointment was applied twice daily for 3 weeks, with 2 weeks of washout before, between, and after treatments. Efficacy was determined by eye examination and the patients' own symptom scoring. Cytology and cytokine measurements were performed on tear samples. Safety parameters were intraocular pressure, presence of bacteria and fungi, and the patients' reports of adverse events. The validity of the crossover design was explored with analysis of variance, and the effect of each medication was calculated with paired t-test and Wilcoxon paired test.. A total of 20 patients completed the study. Both treatments were effective in reducing signs and symptoms of eyelid eczema, with a near superior benefit for tacrolimus in terms of eczema (total skin score) signs (P=0.05). No serious adverse events occurred and interestingly, intraocular pressure was not evidently affected by either treatment.. Tacrolimus 0.1% ointment is a promising alternative therapy for eyelid eczema in AKC patients. Long-term studies are needed to further determine the value of tacrolimus in this patient group.

Topics: Adolescent; Adult; Aged; Antibodies, Bacterial; Biomarkers; Blepharitis; Clobetasol; Cross-Over Studies; Cytokines; Dermatitis, Atopic; Eyelids; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Inflammation Mediators; Intraocular Pressure; Keratoconjunctivitis; Male; Middle Aged; Ointments; Tacrolimus; Tears; Treatment Outcome

To investigate the effects of honey, olive oil and beeswax mixture on patients with atopic dermatitis (AD) or psoriasis vulgaris (PV).. Twenty-one patients with dermatitis and 18 patients with psoriasis were entered for patient-blinded, partially controlled study; 11 patients with dermatitis used topical betamethasone esters and 10 patients with psoriasis used clobetasol propionate. Honey mixture contained honey, beeswax and olive oil (1:1:1). Mixtures A, B, and C contained honey mixture with the corticosteroids ointment in a ratio of 1:1, 2:1, and 3:1 respectively. Patients with dermatitis were subjected to controlled bilateral half-body comparison to evaluate the efficacy of honey mixture against Vaseline, or mixture A against Vaseline-betamethasone esters mixture (1:1) in patients using topical corticosteroid treatment. In patients with psoriasis, the effect of honey mixture was compared with paraffin in an individual right/left-sites comparison, or mixture A against paraffin-clobetasol propionate mixture (1:1) in patients using corticosteroid topical therapy. In dermatitis, body lesions on right or left half-body were assessed for erythema, scaling, lichenification, excoriation, indurations, oozing and itching on a 0-4 points scale. In psoriasis, lesions of selected site were assessed for redness, scaling, thickening and itching, on a 0-4 points scale.. In honey mixture group, 8/10 patients with dermatitis showed significant improvement after 2 weeks, and 5/11 patients pretreated with betamethasone esters showed no deterioration upon 75% reduction of corticosteroid doses with use of mixture C. In psoriasis, 5/8 patients showed a significant response to honey mixture. In patients using clobetasol propionate, 5/10 patients showed no deterioration upon 75% reduction of corticosteroid doses with use of mixture C.. Honey mixture appears useful in the management of dermatitis and psoriasis vulgaris.

Topics: Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Betamethasone; Child; Child, Preschool; Clobetasol; Dermatitis, Atopic; Female; Honey; Humans; Male; Middle Aged; Olive Oil; Plant Oils; Psoriasis; Single-Blind Method; Waxes

A 4-week, double-blind, randomized clinical trial, comparing the efficacy and safety of clobetasol propionate emollient cream 0.05% and its vehicle, was conducted at four private dermatology clinics in 81 non-hospitalized patients (> or = 12 years old) with moderate-to-severe atopic dermatitis covering 2% or more of their body surface. All patients had at least one lesion 2 cm or more in diameter. Three signs/symptoms of target lesions (erythema, pruritus, and induration/papulation) were scored by investigators on a scale of 0-3 (in 0.5-point increments; 0 = absent, 1 = mild, 2 = moderate, and 3 = severe); the total of the three scores had to be > or = 6 for patients to qualify for study entry. Patients were excluded if they were immunocompromised, pregnant, or nursing; had skin atrophy, telangiectasia or striae in skin areas to be treated; or had received topical treatments for atopic dermatitis within 1 week prestudy, intramuscular triamcinolone within 6 weeks prestudy, or long-term systemic corticosteroid usage within 6 months prestudy. Patients were randomized in a 1:1 ratio to receive either clobetasol propionate emollient 0.05% twice daily (n = 41), or the emollient vehicle twice daily (n = 40), for 4 weeks. A fingertip unit, equaling approximately 0.5 g in males and 0.43 g in females (enough to cover approximately 2% of the body), was used to measure and apply a thin film of study drug to the affected areas. The efficacy was evaluated by investigators and patients on days 4, 8, 15, and 29 after initiation of therapy, and 2 weeks after the end of treatment (day 43). Investigators performed a physician's gross assessment based on the percentage improvement of the target lesion. They also rated changes from baseline in mean severity scores for six individual signs/symptoms (erythema, pruritus, induration/papulation, lichenification, erosion/oozing/crusting, and scaling/dryness) and for total signs/symptoms according to the severity scoring system described above. Patients rated their response to treatment as excellent, good, fair, poor, or worse. Laboratory assessments were made on days 15, 29, and (if necessary) day 43.

Topics: Administration, Topical; Adolescent; Anti-Inflammatory Agents; Clobetasol; Dermatitis, Atopic; Double-Blind Method; Emollients; Glucocorticoids; Humans; Ointments; Safety; Treatment Outcome

Fluticasone propionate is a novel and potent corticosteroid. It seems to have an improved therapeutic index on the basis of studies on skin thinning and suppression of hypothalamic-pituitary-adrenal axis.. We assessed the efficacy and safety of fluticasone propionate (FP) 0.05% cream once daily as compared with clobetasone butyrate (CB) 0.05% cream twice daily in children with atopic dermatitis (AD).. Twenty-two children (3 to 8 years old) with moderately active AD received either FP once daily or CB twice daily. Severity of AD was scored weekly by means of the modified Scoring of Atopic Dermatitis system (SCORAD) and treatment was either stopped when skin lesions were almost cleared (SCORAD < 9) or after 4 weeks. Cortisol excretion was determined by means of 24-hour urine before and after treatment.. Twenty-one children completed the study. After 1 week of treatment, mean SCORAD significantly decreased in both treatment groups. After 2, 3, and 4 weeks cumulatively, 8, 12, and 16 children, respectively, were clinically healed (SCORAD < 9). No significant differences in efficacy were observed between the two treatments. Urinary cortisol excretion was not altered by either of the treatments. Two weeks after discontinuation of active treatment, mean SCORAD had increased to 22, but still was significantly lower than that at the beginning of the study.. Once-daily treatment with FP is as safe and effective as twice-daily treatment with CB in children with AD. All children experienced an exacerbation of AD within 2 weeks after treatment was withdrawn, indicating the need for long-term "intermittent" treatment.

Topics: Administration, Topical; Androstadienes; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Dermatitis, Atopic; Double-Blind Method; Female; Fluticasone; Glucocorticoids; Humans; Male; Ointments; Severity of Illness Index; Statistics, Nonparametric; Time Factors

Atopic dermatitis is commonly colonized with Staphylococcus aureus in high densities.. Our purpose was to study the effect of topical corticosteroids on the colonization of S. aureus in atopic dermatitis.. Sixty-six patients were treated with moderately potent, or very potent corticosteroids. Quantification of S. aureus and evaluation of the severity of the eczema was performed before, after 1 week, and after 2 weeks of treatment.. Fifty-three patients carried S. aureus in the most pronounced lesion before treatment. The colonization was significantly correlated with the severity of the eczema. The density of S. aureus was reduced by topical corticosteroids. The reduction increased with the potency of the corticosteroid and was most pronounced during the first week. S. aureus was eliminated after a successful 2-week treatment with a very potent corticosteroid. Propylene glycol 25% added to a moderately potent corticosteroid did not significantly increase the reduction of S. aureus.. Topical corticosteroids of sufficient potency reduce the density of S. aureus in atopic dermatitis.

Topics: Administration, Cutaneous; Adolescent; Adrenal Cortex Hormones; Adult; Child; Child, Preschool; Clobetasol; Dermatitis, Atopic; Drug Therapy, Combination; Female; Humans; Male; Methylprednisolone; Middle Aged; Neomycin; Staphylococcal Infections; Staphylococcus aureus

In a double-blind, parallel-group, multicenter comparative trial in 127 evaluable patients with chronic, localized atopic dermatitis or lichen simplex chronicus, healing was reported in a higher percentage of patients treated with halobetasol propionate ointment than in those in the clobetasol propionate treatment group (65.1% versus 54.7%). The success rates (described as "healed" and "marked improvement") were practically identical in the two treatment groups (93.7% versus 92.2%). Early onset of therapeutic effect, that is, within 3 days of the start of treatment, was similar in the two treatment groups (24% versus 28%). Both preparations were well tolerated. Adverse effects were reported in 5% and 2% of the patients treated with halobetasol propionate and clobetasol propionate ointments, respectively.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; Clobetasol; Dermatitis, Atopic; Double-Blind Method; Female; Germany; Humans; Male; Middle Aged; Neurodermatitis; Ointments; Patient Satisfaction; Remission Induction; Vasoconstrictor Agents; Wound Healing

In a double-blind, parallel-group, multicenter, comparative trial in 120 evaluable patients with chronic, localized atopic dermatitis or lichen simplex chronicus, the success rate (described as "healed" and "marked improvement") was 91.5% in patients treated with halobetasol propionate ointment and 83.6% in those in the diflucortolone valerate treatment group. Of patients treated with halobetasol propionate ointment, 40.7% reported healing within 17 days, whereas of those in the diflucortolone valerate treatment group, 32.8% reported healing within that time. Early onset of therapeutic effect, that is, within 3 days of the start of treatment, was reported in a higher percentage of patients treated with halobetasol propionate ointment than in those treated with diflucortolone valerate ointment (70% versus 59%). Adverse effects at the site of application were less frequently reported in patients belonging to the halobetasol propionate treatment group than in those treated with diflucortolone valerate ointment (3% versus 8%).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Austria; Chronic Disease; Clobetasol; Dermatitis, Atopic; Diflucortolone; Double-Blind Method; Female; Humans; Male; Middle Aged; Neurodermatitis; Ointments; Patient Satisfaction; Remission Induction; Vasoconstrictor Agents; Wound Healing

In two double-blind, parallel-group, multicenter trials, 0.05% halobetasol propionate cream was compared with 0.05% clobetasol 17-propionate cream and 0.05% betamethasone dipropionate cream in 264 patients with acute, severe exacerbations of atopic dermatitis. The efficacy of halobetasol propionate cream and betamethasone dipropionate cream was similar with regard to the success rate, as indicated by ratings of "healed" and "marked improvement" (88% versus 90%) and by an onset of therapeutic effect within 3 days of the start of treatment (40% versus 39%). The efficacy of halobetasol propionate cream and clobetasol 17-propionate cream was also similar with regard to success rates (89% versus 93%) and an onset of therapeutic effect within 3 days of the start of treatment (41% versus 38%). All three creams were well tolerated. Dryness of the skin and itching at the site of application were the reported adverse effects. Treatment was discontinued because of severe dryness of the skin in 1 of the 121 patients treated with halobetasol propionate cream and in 1 of the 59 patients treated with betamethasone dipropionate cream.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Betamethasone; Clobetasol; Dermatitis, Atopic; Double-Blind Method; Female; Germany, West; Glucocorticoids; Humans; Male; Middle Aged; Patient Satisfaction; Remission Induction; Vasoconstrictor Agents

In a multicenter, 14-day pediatric study in 81 evaluable patients with severe, localized corticosteroid-susceptible dermatoses, the combined treatment with halobetasol propionate cream once during the day and halobetasol propionate ointment once at night produced a very satisfactory therapeutic effect. The success rates, as indicated by ratings of "healed" and "marked improvement," were 100% and 90.9% in patients with atopic dermatitis and psoriasis vulgaris, respectively. Healing was reported in 86.8% and 72.7% of patients treated for atopic dermatitis and psoriasis, respectively. Both the cream and ointment preparations were well tolerated. Adverse effects at the site of application were reported in only 3 of 81 patients. Mild skin atrophy was observed in one patient. No systemic adverse effects were observed.

Topics: Administration, Cutaneous; Adolescent; Child; Child, Preschool; Chronic Disease; Clobetasol; Dermatitis, Atopic; Drug Tolerance; Female; Humans; Male; Ointments; Psoriasis; Remission Induction; Switzerland; Vasoconstrictor Agents; Wound Healing

The efficacy and safety of 0.05% halobetasol propionate ointment were evaluated in patients with chronic atopic or other eczematous dermatoses in two vehicle-controlled, double-blind studies: a paired-comparison study in 124 patients (study A) and a parallel-group study in 100 patients (study B). In study A, patients applied both treatments twice daily for 2 weeks and were evaluated by investigators on days 0, 7, and 14 with 0 to 3 severity scales and by self-assessment with two 5-step end-of-treatment rating scales. In study B, patients applied treatments twice daily for 2 weeks, and investigators made evaluations on days 0, 3, 7, and 14 with 0 to 6 scales and also made a 5-step end-of-treatment physician's global assessment. In study A, both severity scores and patient ratings favored halobetasol propionate significantly on days 7 (p less than or equal to 0.0013) and 14 (p less than 0.0001); in study B, severity scores on days 3 (p less than or equal to 0.045, pruritus, erythema, and overall lesion severity), 7, and 14 (p less than 0.001, all comparisons) also favored halobetasol propionate significantly, and global assessments showed complete resolution or marked improvement for 83% of patients using halobetasol propionate versus 28% of those using vehicle (p less than 0.0001). No instances of systemic effects or skin atrophy were reported in either study. We conclude that 0.05% halobetasol propionate ointment is highly effective and well tolerated in the treatment of the conditions studied, with the rapid action and high degree of clearing associated with superpotent corticosteroid formulations.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chronic Disease; Clobetasol; Dermatitis; Dermatitis, Atopic; Eczema; Female; Humans; Male; Middle Aged; Neurodermatitis; Ointments; Pharmaceutical Vehicles; Remission Induction; Safety; Treatment Outcome; United States; Vasoconstrictor Agents

Six investigators evaluated 0.05% halobetasol propionate cream and its vehicle in 111 patients with chronic atopic dermatitis and several other eczematous dermatoses. Patients applied treatment twice daily to bilateral lesions for 14 days. Investigators graded pruritus, erythema, scaling, papulation, and lichenification using 4-point severity scales on days 0, 7, and 14. On day 14 patients provided an assessment of efficacy for both treatments. Statistically significant differences favoring halobetasol propionate over the vehicle were seen for all signs and symptoms (p less than 0.001). Substantial improvements were achieved by the active treatment by day 7 (p less than 0.001). Patients assessments of efficacy were significantly higher for halobetasol cream than for vehicle (p less than 0.001). No instances of systemic effects or skin atrophy were reported and adverse experiences were limited to burning or stinging and other minor, nonspecific complaints distributed uniformly between active treatment and vehicle. These results demonstrate that 0.05% halobetasol propionate cream is highly effective in the treatment of atopic dermatitis and other eczematous dermatoses.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Chronic Disease; Clobetasol; Dermatitis; Dermatitis, Atopic; Double-Blind Method; Eczema; Female; Humans; Male; Middle Aged; Neurodermatitis; Patient Satisfaction; Pharmaceutical Vehicles; Remission Induction; Safety; Vasoconstrictor Agents

Twenty-nine patients with symmetrical eczematous lesions were treated with 0.05% clobetasone butyrate cream. Clinical conditions and cortisol and ACTH concentrations were evaluated at the beginning and after 1 week in 12 children and after 2 weeks of treatment in 17 patients respectively. The lesions and symptoms improved steadily and no significant change in cortisol and ACTH plasma levels was observed throughout the study in all children. This steroid offers clinically effective topical antiinflammatory activity with a wide margin of safety.

Topics: Adolescent; Adrenocorticotropic Hormone; Anti-Inflammatory Agents; Betamethasone; Child; Child, Preschool; Clinical Trials as Topic; Clobetasol; Dermatitis, Atopic; Female; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Infant; Male; Pituitary-Adrenal System; Random Allocation; Time Factors

Topics: Adolescent; Adult; Aged; Betamethasone; Clinical Trials as Topic; Clobetasol; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Male; Middle Aged; Ointments; Psoriasis

A randomized, double-blind, parallel-group study was conducted comparing the efficacy and safety of alclometasone dipropionate cream 0.05% and clobetasone butyrate cream 0.05% in the treatment of atopic dermatitis in 43 children. The medications were applied to study areas as a thin layer of cream twice daily for 2 weeks. Efficacy was assessed by evaluation of three disease signs (erythema, induration, and pruritus) and by mean of a physician's global evaluation following treatment. Safety was evaluated through patient-reported and clinically observed adverse experiences. Both treatments were effective. At the end of the trial, average reduction in disease signs was 85% for alclometasone dipropionate-treated patients and 86% in the clobetasone butyrate-treated group. In the global evaluation, the physician rated symptoms as cleared in 9 of 22 alclometasone dipropionate-treated patients and in 10 of 21 clobetasone butyrate-treated patients.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone; Child; Child, Preschool; Clinical Trials as Topic; Clobetasol; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Male; Methylprednisolone

Six groups of children suffering from widespread atopic dermatitis were treated once daily with six topical steroids of different potency. Systemic effects were measured by the morning estimation of plasma cortisol. A clear relationship was demonstrated between clinical efficacy of the steroid treatment and degree of reduced adrenal function. This study demonstrated that a rapid and marked therapeutic effect can be obtained with potent topical steroids applied once daily without occlusion, but in children is accompanied by a fall in plasma cortisol.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone; Child; Child, Preschool; Clobetasol; Dermatitis, Atopic; Desonide; Diflucortolone; Drug Administration Schedule; Female; Fluocortolone; Halcinonide; Humans; Hydrocortisone; Infant; Male; Ointments

The clinical effect of two topical corticosteroids, one of very strong potency (clobetasol propionate), and one of medium potency (flupredniden acetate), was studied in the maintenance therapy of 55 patients with chronic hand eczema. Initially, 61 patients were treated on both hands continuously for 1 to 3 weeks with clobetasol only which brought about healing in 90% of cases (mean time to healing: 11 days). In a subsequent double-blind left/right study, the capacity of the two corticosteroids for keeping the dermatitis in remission was compared using an intermittent schedule of 2 applications a week. The protocol was followed by 46 patients and the mean observation period was 138 days. Treatment with clobetasol kept patients free from relapses during the entire observation period in 70%, with flupredniden in 30%. Relapses occurred with clobetasol after a mean of 66 days, with flupredniden after 36 days. Side-effects, occurring with similar frequency with both drugs, were few and mild. It is suggested that an intermittent schedule is advantageous when using a corticosteroid of high potency.

Topics: Betamethasone; Chronic Disease; Clinical Trials as Topic; Clobetasol; Dermatitis, Atopic; Double-Blind Method; Drug Administration Schedule; Eczema; Hand Dermatoses; Humans; Pregnadienetriols

In a double-blind, randomized study, 0.05% clobetasone butyrate cream was found to be as effective as 0.1% betamethasone valerate in the treatment of 48 patients with atopic or contact dermatitis, after 2 weeks as well as after 4 weeks of treatment. Side-effects with both drugs were rare and mild.

Topics: Adolescent; Adult; Aged; Betamethasone; Betamethasone Valerate; Child; Clobetasol; Dermatitis, Atopic; Dermatitis, Contact; Double-Blind Method; Female; Humans; Male; Middle Aged; Time Factors

Three hundred and fifty-four patients with symmetrical dermatoses took part in a multicentre, doubleblind, half-side study in order to compare the efficacy of a new topical steroid, diflucortolone valerate 0.3% (Nerisone Forte) against that of an established, potent topical steroid, clobetasol propionate 0.05% (Dermovate). The assessment of overall response, as judged by the physicians' preference for one side or another, showed no difference between the two compounds. However, when the results were examined by separate diagnostic category, the number of preferences was greater for diflucortolone valerate 0.3% in eczema, and for clobetasol propionate 0.05% in psoriasis, although neither of these differences reached levels of statistical significance. The graded assessments of response indicated that both compounds were highly effective, potent, topical steroids. Eighty-one percent of all patients showed marked improvement or healing with diflucortolone valerate 0.3%, and 84% showed marked improvement or healing with clobetasol propionate 0.05%. This difference was not statistically significant. Analysis of response, either by diagnosis or grade of severity, showed no statistically significant differences between the two compounds. No significant differences in the incidence of severity of side-effects were observed. It was concluded that the two compounds were of equal clinical efficacy.

Topics: Adrenal Cortex Hormones; Adult; Betamethasone; Clinical Trials as Topic; Clobetasol; Dermatitis, Atopic; Double-Blind Method; Eczema; Female; Humans; Male; Middle Aged; Psoriasis

Topics: Betamethasone; Child; Child, Preschool; Clobetasol; Dermatitis, Atopic; Female; Humans; Infant; Male

The long-term use of topical corticosteroids (TCS) is associated with side effects such as skin atrophy and barrier deterioration. Moisturizers, such as mucopolysaccharide polysulfate (MPS), have been reported to prevent relapses in atopic dermatitis (AD) when used in combination with TCS. However, the mechanisms underlying the positive effects of MPS in combination with TCS in AD are poorly understood. In the present study, we investigated the effects of MPS in combination with clobetasol 17-propionate (CP) on tight junction (TJ) barrier function in human epidermal keratinocytes (HEKa) and 3D skin models.. The expression of claudin-1, which is crucial for TJ barrier function in keratinocytes, and transepithelial electrical resistance (TEER) was measured in CP-treated human keratinocytes incubated with and without MPS. A TJ permeability assay, using Sulfo-NHS-Biotin as a tracer, was also conducted in a 3D skin model.. CP reduced claudin-1 expression and TEER in human keratinocytes, whereas MPS inhibited these CP-induced effects. Moreover, MPS inhibited the increase in CP-induced TJ permeability in a 3D skin model.. The present study demonstrated that MPS improved TJ barrier impairment induced by CP. The improvement of TJ barrier function may partially be responsible for the delayed relapse of AD induced by the combination of MPS and TCS.

Topics: Claudin-1; Clobetasol; Dermatitis, Atopic; Dermatologic Agents; Glucocorticoids; Humans; Keratinocytes; Skin; Tight Junctions

The vast majority of atopic dermatitis follows a mild, chronic relapsing course. In this article, we highlight the art and practice of treating atopic dermatitis based upon a foundation of maintenance care and a ladder of therapy that can teach patients and their families how to best tailor their pharmaceutical options to optimize the management of their disease.

Topics: Clobetasol; Dermatitis, Atopic; Disease Management; Drug Administration Schedule; Glucocorticoids; Humans; Methylprednisolone; Phosphodiesterase 4 Inhibitors; Severity of Illness Index; Triamcinolone

Topical corticosteroid and calcineurin inhibitor have similar therapeutic benefits in atopic dermatitis (AD), but the differences in therapeutic mechanisms of action of these agents against AD symptoms are not fully understood.. This study was performed to examine the different effects of topical betamethasone valerate (BMV), clobetasol propionate (CBP), and tacrolimus (TAC) on itch-related behavior and dermatitis in NC/Nga mice with AD-like symptoms.. AD-like dermatitis was induced in the dorsal skin of NC/Nga mice by repeated topical application of Dermatophagoides farinae body (Dfb) ointment twice weekly for three weeks. Mice with dermatitis scores over 5 were divided into five groups with equal dermatitis scores and treated with BMV, CBP, TAC, or Vaseline (Vas) once daily for two consecutive days, or were not treated (NT). Scratching behavior was analyzed using a SCLABA. After the second treatment, dermatitis showed significantly greater improvement in the CBP and TAC-treated groups than in the Vas-treated and NT groups. The numbers of scratching bouts were significantly lower in CBP and TAC-treated mice than in Vas-treated mice. TEWL was significantly lower in TAC-, but not in CBP-, treated mice than in Vas-treated mice. Immunohistochemical examination showed that BMV, CBP and TAC did not reduce the increased densities of epidermal protein gene product 9.5- and substance P-immunoreactive fibers. The numbers of dermal CD4-immunoreactive T cells were significantly lower in BMV and CBP-treated mice than in Vas-treated and NT mice. The numbers of dermal eosinophils were significantly lower in BMV, CBP and TAC-treated mice than in Vas-treated and NT mice, with CBP showing the strongest effect. CBP significantly reduced epidermal thickness compared with Vas and NT. There were no significant differences in the numbers of interleukin-31-immunoreactive cells and mast cells, or in expression of epidermal thymic stromal lymphopoietin among all five groups.. The therapeutic potency of TAC against AD-like symptoms, including pruritus, is equal to that of the corticosteroid CBP. Epidermal innervation of sensory nerves itself might not be related to the therapeutic effects of topical tacrolimus and corticosteroids in its early phase.

Topics: Administration, Topical; Adrenal Cortex Hormones; Animals; Betamethasone Valerate; Clobetasol; Cytokines; Dermatitis, Atopic; Dermatophagoides farinae; Disease Models, Animal; Emollients; Epidermis; Humans; Immunosuppressive Agents; Male; Mast Cells; Mice; Ointments; Petrolatum; Pruritus; Tacrolimus; Thymic Stromal Lymphopoietin; Treatment Outcome; Ubiquitin Thiolesterase

Percutaneous absorption of topically applied 0.05% clobetasol propionate (CLO) can be assessed indirectly by measuring cortisol levels. A direct way is to measure systemic levels of topically applied CLO.. Serum concentrations of CLO were measured by liquid chromatography-tandem mass spectrometry (LC/MS/MS), and were related to serum cortisol levels in 25 patients with an exacerbation of atopic dermatitis (AD) before and after the first day of treatment with 0.05% CLO in hospital. The body surface area (BSA) affected by AD was measured.. Before the start of 0.05% CLO treatment, normal cortisol levels were measured (0.47 ± 0.18 μmol/l) and CLO concentrations could not be detected. After the first day of treatment, cortisol levels decreased to 0.04 ± 0.05 μmol/l. Serum concentrations of CLO could be detected in all patients (0.112-4.504 ng/ml). Levels did not differ between patients who had received two applications versus one application of 0.05% CLO. There was no correlation between the affected BSA and serum concentrations of CLO.. Serum levels of CLO can be measured by LC/MS/MS. When prescribing 0.05% CLO, one must bear in mind that, even after an application of 20-30 g, CLO is systemically available and potent enough to induce adrenal gland suppression.

Topics: Adolescent; Adrenal Glands; Adrenal Insufficiency; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Dermatitis, Atopic; Female; Humans; Hydrocortisone; Male; Middle Aged; Young Adult

Topics: Ambulatory Care; Betamethasone; Clobetasol; Dermatitis, Atopic; Glucocorticoids; Humans; Hydrocortisone; Patient Compliance

Although topical glucocorticoids (GCs) show potent anti-inflammatory activity in inflamed skin, they can also exert numerous harmful effects on epidermal structure and function. In contrast, topical applications of ligands of peroxisome proliferator-activated receptor-α (PPARα) not only reduce inflammation but also improve cutaneous barrier homeostasis. Therefore, we examined whether sequential topical GCs followed by topical Wy14643 (a ligand of PPARα) might be more effective than either alone for atopic dermatitis (AD) in a hapten (oxazolone (Ox))-induced murine model with multiple features of AD (Ox-AD). Despite expected anti-inflammatory benefits, topical GC alone induced (i) epidermal thinning; (ii) reduced expression of involucrin, loricrin, and filaggrin; and (iii) allowed outside-to-inside penetration of an epicutaneous tracer. Although Wy14643 alone yielded significant therapeutic benefits in mice with mild or moderate Ox-AD, it was less effective in severe Ox-AD. Yet, topical application of Wy14643 after GC was not only significantly effective comparable with GC alone, but it also prevented GC-induced structural and functional abnormalities in permeability barrier homeostasis. Moreover, rebound flares were largely absent after sequential treatment with GC and Wy14643. Together, these results show that GC and PPARα ligand therapy together is not only effective but also prevents development of GC-induced side effects, including rebound flares, in murine AD.

Topics: Adjuvants, Immunologic; Animals; Clobetasol; Dermatitis, Atopic; Disease Models, Animal; Drug Synergism; Drug Therapy, Combination; Epidermis; Female; Glucocorticoids; Haptens; Mice; Mice, Hairless; Naphthols; Oxazolone; Peroxisome Proliferators; PPAR alpha; Pyrimidines; Secondary Prevention; Triazines

Addition of medical ingredients to cosmetics is prohibited. However, last year some cases of illegal cosmetics containing steroids were successfully identified. We have already reported an analytical method to detect steroids in cosmetics [Bull. Natl. Inst. Health Sci, 126, 51-56 (2008)]. In this study, we initially examined whether this method could be applied for the detection of some new steroids as target chemicals. We then used this developed method to detect steroids in cosmetics obtained from manufacturers by spot checks. These manufacturers have been advertising the effectiveness of a steroid-free cream against atopic dermatitis. The results revealed that clobetasol propionate (CP) was present in this facial moisturizing cream, which was available in the market. The steroid was extracted with methanol. After ultrasonication and centrifugation, the resulting supernatant was injected into the high-performance liquid chromatography system equipped with an ODS column. The separation was achieved using a mixture of acetonitrile and water as the mobile phase. The retention times of the observed peaks were in accordance with those of some preservatives and CP. The presence of CP was also confirmed by thin-layer chromatography. The concentration of CP in the cream was approximately 0.039%. CP is a steroid that has the strongest effect as compared to those of other steroids. The cream was therefore recalled for safety reasons.

Topics: Chromatography, High Pressure Liquid; Chromatography, Thin Layer; Clobetasol; Consumer Product Safety; Cosmetics; Dermatitis, Atopic; Legislation, Drug

Leptin, the obese gene product, is a 16-kDa peptide hormone secreted by adiposities. Systemic administration of exogenous glucocorticoids has been found to increase circulating leptin levels. In this study, we aimed to assess serum leptin in children with atopic dermatitis (AD)-treated with local steroids. Twenty children with AD were included during the 2001-2002 time period. The study was conducted prospectively. Atopy was defined as the presence of at least one aeroallergen-specific immunoglobulin E (IgE) antibody. Serum leptin was determined using a commercially available radioimmunoassay kit with 3.4-8.3% intra-assay and 3.0-6.2% interassay coefficients of variation, and 0.5 ng/ml sensitivity. Fourteen boys and six girls with AD, the mean age of the patients was 3.1 +/- 2.2. Forty-three percentage of the family histories for atopy were positive, 60% of the cases passive smoking histories were positive. In seven patients the aeroallergen-specific IgE were positive. All 20 patients treated clobetasone 17-butirate (0.05%). There was no significant difference in serum leptin between patients (mean +/- s.d.: 4.6 +/- 3.8), and controls (mean +/- s.d.: 6.2 +/- 3.6) (p > 0.05). Local steroid does not influence circulating leptin levels, suggesting that regulation of body weight is unaffected.

Topics: Administration, Topical; Case-Control Studies; Child; Child, Preschool; Clobetasol; Dermatitis, Atopic; Female; Glucocorticoids; Humans; Immunoglobulin E; Infant; Leptin; Male; Prospective Studies

To understand further the possible clinical effects of tinidazole ointment at relatively high concentration (2%) for atopic dermatitis (AD), we performed a comparative study with readily available topical corticosteroids, clobetasol propionate (0.005 or 0.05%) and hydrocorotisone butyrate (0.1%) (hereafter referred as clobetasol and hydrocortisone, respectively), on inflammatory dermatitis in mice. We also observed the effects of combined application of tinidazole with clobetasol (0.005%, one tenth of the clinical use) in comparison with tinidazole itself, clobetasol (0.05%) or hydrocortisone (0.1%) on the animal model. All ointments suppressed inflammatory dermatitis induced by trinitrochlorobenzen (TNCB) or oxazolone. The rank order of the potency to suppress the ear edema was clobetasol (0.05%), tinidazole (2%) with clobetasol (0.005%) > clobetasol (0.005%) > tinidazole (2%) in TNCB-induced dermatitis, and hydrocortisone (0.1%), clobetasol (0.05%) > tinidazole (2%), tinidazole with clobetasol (0.005%) > clobetasol (0.005%) in case of oxazolone-induced dermatitis. We confirmed that tinidazole (2%) suppresses immediate and late phase reactions in mice passively sensitized with anti-DNP IgE Mab. In addition, tinidazole (2%) was much more potent than hydrocortisone (0.1%) in suppressing the amount of scratching, presumably due to itching, in passively sensitized mice. These results indicate that the advantage of using ointments of tinidazole would be that it has stronger anti-itching effects than corticosteroids.

Topics: Adjuvants, Immunologic; Administration, Topical; Animals; Antibodies, Monoclonal; Clobetasol; Dermatitis, Atopic; Dinitrophenols; Disease Models, Animal; Drug Therapy, Combination; Hydrocortisone; Immunoglobulin E; Male; Mice; Mice, Inbred Strains; Ointments; Ovalbumin; Oxazolone; Picryl Chloride; Tinidazole

Levels of interleukin 1 alpha (IL-1 alpha) were studied from blister fluids collected from 14 patients with various types of blistering diseases. In all the fluids, IL-1 alpha could be detected, the concentrations varying from 5 to 1730 pg/ml. For comparison IL-1 alpha was also assayed from suction blisters of 13 subjects; 8 atopic patients and 5 healthy controls. IL-1 alpha was also present in suction blisters in measurable quantities, suggesting that during suction IL-1 alpha is released into the blister cavity. Since IL-1 alpha has been shown to have marked effects on collagen metabolism, the marker of collagen synthesis (carboxyterminal propeptide of type I procollagen (PICP)) and gelatinase were assayed from the same samples. There was no apparent correlation between the levels of IL-1 alpha, PICP or gelatinase in blister fluids. The possible association of IL-1 alpha and collagen metabolism was further studied in experimental conditions. Topical glucocorticoid markedly decreased the level of PICP in suction blisters but did not have any significant effect on IL-1 alpha. UVB-radiation, on the other hand, caused increase in IL-1 alpha but did not have any profound effect on collagen metabolism. During the re-epithelialization of the blister floor the level of IL-1 alpha decreased markedly, and at the same time the expression of gelatinase was increased. The results indicate that IL-1 alpha is released in large quantities into blister fluid when using the suction blister model. However, no apparent correlation could be observed in healthy or diseased skin between the levels of IL-1 alpha, collagen synthesis marker or gelatinase.

Topics: Administration, Topical; Blister; Clobetasol; Collagen; Dermatitis, Atopic; Gelatinases; Humans; Interleukin-1; Peptide Fragments; Procollagen; Skin; Skin Diseases, Vesiculobullous; Suction; Ultraviolet Rays

Steroid creams applied topically to the skin are routinely used in the treatment of many dermatoses. Their use on the face in severe atopic eczema is relatively common. We report a series of three patients who whilst using topical facial steroids developed advanced glaucoma. A further two cases of ocular hypertension secondary to topical facial steroids are also described. This is the first series of cases to be reported demonstrating the potentially blinding complications of topical facial steroids. Recommendations are made with regard to screening such patients for glaucoma.

Topics: Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Clobetasol; Dermatitis, Atopic; Desoximetasone; Facial Dermatoses; Female; Glaucoma; Humans; Hydrocortisone; Male; Ocular Hypertension; Prednisolone; Vision Disorders; Visual Acuity

During recent years, 48 patients with therapy-resistant chronic skin lesions of atopic dermatitis have been treated once a week with clobetasol propionate lotion left under Duoderm occlusive patches. They had previously failed to respond, or responded only sparsely, to topical corticosteroids. The lesions resolved completely in 44 patients, while partial remission was observed in the remaining 4. The mean time needed to obtain complete remission was, for lichenifications, 2 weeks; pruriginous lichenoid papules, 12 days; chronic hand eczema, 2.5 weeks; nummular eczema, 8 days; perioral eczema, 11 days, and breast eczema, 10 days. Adverse experiences were mild and infrequent. The amount of topical corticosteroid required was reduced to at most one-twentieth and to as little as one-hundredth of the amount of common topical steroid treatment needed. We conclude that clobetasol propionate and Duoderm once a week is the best treatment for resistant lesions of atopic dermatitis.

Topics: Adolescent; Adult; Aged; Bandages, Hydrocolloid; Child; Chronic Disease; Clobetasol; Colloids; Dermatitis, Atopic; Female; Humans; Male; Middle Aged; Occlusive Dressings

Topics: Administration, Topical; Adolescent; Betamethasone; Child; Child, Preschool; Clobetasol; Dermatitis, Atopic; Dermatologic Agents; Detergents; Drug Evaluation; Drug Therapy, Combination; Eczema; Emollients; Female; Humans; Male; Plant Extracts; Surface-Active Agents

Twelve children with chronic atopic dermatitis and elevated IgE levels (age range: 2-13 years; mean age = 8.2 +/- 3.5 years) were selected for the study and treated with clobetasone butyrate (0.05% cream) thrice daily during the first week, then twice daily for three weeks. Adrenocortical function was evaluated at the beginning and the end of treatment period. The results show that there was no statistically significant change in adrenal function during the study period (tetracosactrin test). The results of the immunological studies, namely total IgE using the paper disc radioimmunoassay technique, specific IgE using the radioallergosorbent test and immunoglobulin levels are given.

Topics: Adolescent; Adrenal Cortex; Adrenal Cortex Function Tests; Anti-Inflammatory Agents; Betamethasone; Child; Child, Preschool; Chronic Disease; Clobetasol; Dermatitis, Atopic; Eczema; Female; Humans; Hydrocortisone; Immunoglobulin E; Male; Time Factors

Topics: Administration, Topical; Adult; Aged; Betamethasone; Clobetasol; Dermatitis, Atopic; Dermatitis, Contact; Female; Humans; Male; Middle Aged

Topics: Adult; Clobetasol; Cresols; Dermatitis, Atopic; Dermatitis, Contact; Female; Humans; Male; Pharmaceutic Aids; Propylene Glycols