clobetasol and Eczema

Clobetasol-17-propionate, the most potent of currently available topical steroids as predicted by the vasoconstrictor assay, has just been approved in the United States. In psoriasis, it has proved significantly more effective than class II steroids and as or more effective than the only marketed class I steroid. In the more steroid-responsive eczemas, the superior efficacy of clobetasol is also apparent, but less striking. Clobetasol prolongs remission rates, making intermittent treatment schedules feasible and minimizing inherent potential steroid side effects. Clobetasol may also be useful in the treatment of a myriad of other skin conditions. A review of the pharmacology, efficacy, and side effects of this addition to our dermatologic armamentarium is presented here.

Topics: Administration, Topical; Betamethasone; Clobetasol; Combined Modality Therapy; Drug Administration Schedule; Eczema; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Psoriasis

The aim of this study was to evaluate efficacy, tolerability and safety of a combination treatment with fluticasone propionate 0.05% cream and clobetasole ointment 0.05% in patients suffering from chronic hand eczema.. The study examined 30 patients with a clinical diagnosis of chronic hand eczema.. The treatment with topical corticosteroids resulted effective and topical corticosteroids proved their efficacy in mild and moderate hand eczema.. In according to the severity of the disease, authors suggest two different clinical strategies in the management of hand eczema.

Topics: Administration, Cutaneous; Androstadienes; Anti-Inflammatory Agents; Chronic Disease; Clobetasol; Drug Therapy, Combination; Eczema; Emollients; Fluticasone; Hand Dermatoses; Humans; Ointments; Severity of Illness Index; Skin Cream; Treatment Outcome

Many therapeutic modalities have been suggested for treatment of the chronic hand eczema. Despite good immediate efficacy of some of these treatments, there is high recurrence of the dermatitis following cessation of the treatment.. Regarding the beneficial effects of the zinc sulfate on the skin, we designed a double blind study to evaluate the efficacy of the '0.05% Clobetasol + 2.5% zinc sulphate' cream versus '0.05% Clobetasol alone' cream in the treatment of the chronic hand eczema.. This study was a double-blind, right to left, prospective, clinical trial. In total, 47 patients with chronic hand eczema admitted to dermatology center of Isfahan University of Medical Sciences were selected and their right hand or left hand were selected at random to be treated with either the '0.05% Clobetasol + 2.5% zinc sulphate' cream or '0.05% Clobetasol alone' cream twice daily for 2 weeks. All of the patients were treated for 2 weeks and were followed up at weeks 2, 4, 6 and 8 after starting the treatment. For determining the severity of chronic hand eczema, we assessed and scored 4 different characteristics of the lesions including redness; scaling; lichenification and pruritus. The data were analyzed using SPSS program (release 13) and statistical tests including Mann-Whitney test.. Overall, 47 patients (94 samples) were evaluated. All of these patients had similar and symmetrical lesions on their right and left hands. Out of them, 35 patients were females and 12 patients were male. In all of the evaluated characterisitics, the '0.05% Clobetasol + 2.5% zinc sulphate' cream was more effective than '0.05% Clobetasol alone' cream (P < 0.05). The recurrence rate of eczema was significantly lower in the group treated with this combination treatment (P < 0.05).. With regard to the encouraging results of the combination treatment with Clobetasol + zinc sulphate, we suggest that in a more extensive clinical trial, the efficacy of this treatment against chronic hand dermatitis be evaluated. In addition, evaluation of this combination therapy against other inflammatory dermatosis seems to be logical.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Astringents; Child; Chronic Disease; Clobetasol; Double-Blind Method; Drug Therapy, Combination; Eczema; Female; Glucocorticoids; Hand; Humans; Male; Middle Aged; Ointments; Prospective Studies; Recurrence; Severity of Illness Index; Zinc Sulfate

In the present study clobetasol propionate (Cp) was loaded as solid lipid nanoparticles (SLN), incorporated it in suitable cream base and evaluated in vitro and its performance clinically against equivalent marketed formulation. Cp was incorporated into SLN by high-pressure homogenization technique and characterized for mean particle size, surface morphology and per cent drug entrapment. Drug permeation and skin uptake studies from Cp creams were carried out in a validated Franz static diffusion cell across human cadaver skin (HCS). Sixteen chronic eczema patients were enrolled in a controlled double blind clinical trial. Optimized Cp-SLN was smooth and spherical under scanning electron microscopy; with average particle size of 177 nm and per cent drug entrapment of 92.05%. In vitro permeation studies revealed lower mean flux value and higher skin uptake of Cp from Cp-SLN cream compared to marketed drug cream. Both formulations were found to be responsive to manifestations of chronic eczema, while Cp-SLN cream prepared in this investigation registered significant improvement in therapeutic response (1.9 fold; inflammation, 1.2 fold; itching) in terms of per cent reduction in degree of inflammation and itching against marketed cream. Further clinical trials are required to ascertain the efficiency of the present formulation.

Topics: Cadaver; Clobetasol; Double-Blind Method; Drug Carriers; Eczema; Humans; Inflammation; Lipids; Microscopy, Electron, Scanning; Nanotechnology; Particle Size; Pharmaceutical Preparations; Skin; Solubility; Temperature; Time Factors

Mometasone furoate [9a, 21-dichloro-llb, 17dihydroxy-16a-methyl-pregna-14-dione-3, 20-dione-17-(2furoate)] is a synthetic, 17-heterocyclic corticosteroid which has been shown to be highly effective as an anti-inflammatory agent which is approximately half as potent is suppressing hypothalamic-pituitary-adrenal (HPA) axis function as betamethasone valerate.. The present open, randomised, third party blinded, left-right sided study was designed to compare the therapeutic efficacy of mometasone furoate cream 0.1% with clobetasol propionate cream 0.05% applied twice daily in chronic eczema following a 3-week course of therapy.. Sixty consecutive patients with moderate to severe bilateral chronic eczema on the limbs were recruited into the study. The mean scores of various signs/symptoms including erythema, induration, crusting, scaling, excoriation and pruritus before and after 3 weeks treatment with mometasone furoate (MF) and clobetasol propionate (CP) cream, were compared. The baseline scores for MF and CP treated sites were almost identical. There was significant decrease in the mean scores of all signs/symptoms after 3 weeks treatment with MF and CP. There was also a significant difference in the mean scores between MF and CP treated sites after 3 weeks of treatment. The mean scores were significantly lower for CP treated sites than MF treated sites. More CP treated sites achieved "cleared" or "marked improvement" response than MF treated sites. There were more "excellent" or "good" grades on CP treated sites than MF treated sites at the end of 3 weeks of treatment. None of the patients showed any side-effects after 4 weeks of treatment.. Overall, 53% of patients considered the MF treated sites to be good or excellent vs 88% for CP treated sites.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Chronic Disease; Clobetasol; Drug Administration Schedule; Eczema; Female; Glucocorticoids; Humans; Male; Middle Aged; Mometasone Furoate; Pregnadienediols; Treatment Outcome

Two clinical trials were conducted to evaluate the safety and antipsoriatic efficacy of a new 0.05 percent emollient formulation of clobetasol propionate (CP). In a crossover study of hypothalamic-pituitary-adrenal (HPA)-axis effects in 12 patients with psoriasis or eczema, 1.5 gm of CP emollient, applied to lesions twice daily for seven consecutive days, resulted in fewer patients with serum cortisol concentrations < 10 micrograms/100 mL than CP cream 0.05 percent (1vs 4); such concentrations were seen in two other patients during both treatment phases. A double-blind, randomized, parallel-group clinical trial in patients with moderate to severe plaque-type psoriasis showed that four weeks' treatment with CP emollient 0.43 to 0.5 gm twice daily (n = 35) was significantly more effective than emollient vehicle (n = 39) in reducing total signs/symptoms and scaling by Day 4, erythema and skin thickening by Day 8, and pruritus by Day 15. CP emollient was rated superior to vehicle by Day 4 in physician's gross assessment ratings and by Day 15 in patient's self-assessment ratings. In all assessments, CP emollient continued to be superior to vehicle during the remainder of the treatment period and two-week posttreatment period. No significant differences were observed in tolerability or serum cortisol effects during the course of the study.

Topics: Adult; Aged; Aged, 80 and over; Burns, Chemical; Clobetasol; Cross-Over Studies; Dermatologic Agents; Double-Blind Method; Drug Evaluation; Eczema; Emollients; Female; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Male; Middle Aged; Outcome Assessment, Health Care; Pituitary-Adrenal System; Pruritus; Psoriasis; Skin; Skin Physiological Phenomena; Time Factors; Treatment Outcome

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

A double-blind, parallel comparison was made of the short-term efficacy and safety of three times daily regimens of 0.05% clobetasol propionate cream and 0.05% fluocinonide cream in 114 adolescent and adult patients with psoriasis and 113 with eczema. After 2 weeks of topical applications, patients were assessed according to (1) investigators' overall judgment of clinical response, (2) degree of severity of specific signs and symptoms, and (3) patients' evaluation of improvement. In all three response categories in psoriasis, and in two of three in eczema, clobetasol was statistically significantly superior to fluocinonide (p less than 0.05-p less than 0.001). Healing commenced more rapidly with clobetasol and there was no indication of tachyphylaxis. In contrast, the healing rate with fluocinonide slowed noticeably after the first week, and there was a greater tendency to relapse following fluocinonide treatment. Both regimens were safe: drug-related side effects were generally mild and occurred most commonly with fluocinonide therapy in eczema patients. Overall, drug-related effects occurred in 4% of patients receiving clobetasol and 12% receiving fluocinonide (p less than 0.05). Transient morning plasma cortisol reductions below 5 micrograms/dl occurred in 6% of clobetasol-treated patients, reverting to normal within 1 week of the end of treatment.

Topics: Administration, Topical; Adolescent; Adult; Aged; Betamethasone; Clinical Trials as Topic; Clobetasol; Double-Blind Method; Eczema; Female; Fluocinolone Acetonide; Fluocinonide; Humans; Male; Middle Aged; Psoriasis; Random Allocation; Time Factors

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

Clobetasone butyrate 0.05% (Eumovate), a halogenated topical steroid, was compared with hydrocortison butyrate 0.1% (Locoid) which does not contain any halogen atoms. In the treatment of eczema there was not difference between the preparations, but in that of psoriasis the halogen-containing steriod was significantly more effective. Under normal circumstances neither preparation had any detectable effect on adrenal function, but with large doses under total-body polythene occlusion, circulating cortisol levels were reduced less by the halogenated than by the non-halogenated preparation. Corticosteroids which contain a halogen atom are often considered to cause more adverse effects than the non-halogenated preparations with similar clinical efficacy. This study shows that this cannot be assumed for their ability to suppress cortisol levels.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone; Clinical Trials as Topic; Clobetasol; Double-Blind Method; Eczema; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Male; Pituitary-Adrenal System; Psoriasis

90 patients suffering from chronic skin diseases-mainly psoriasis vulgaris-were treated in a double-blind-study for two weeks with topical Clobetasol-17-propionate compared with other topical corticoids. In 81% was seen a better therapeutical effect on the Clobetasol-17-propionate treated skin area.

Topics: Administration, Topical; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Betamethasone; Child; Clinical Trials as Topic; Clobetasol; Desoximetasone; Diflucortolone; Double-Blind Method; Eczema; Humans; Middle Aged; Neurodermatitis; Psoriasis

Topics: Betamethasone; Chronic Disease; Clinical Trials as Topic; Clobetasol; Double-Blind Method; Eczema; Female; Fluocortolone; Humans; Male; Pregnadienediols

Forty patients with symmetrical eczematous lesions on their extremities were treated in a double-blind fashion with 0.05% clobetasone butyrate and 0.1% hydrocortisone butyrate in cream bases. After 2 weeks of treatment, a preference for clobetasone butyrate was observed in 7 cases, for hydrocortisone butyrate in 9 cases and in 24 cases both sides responded equally. The lesions on both sides improved steadily throughout the study in all cases. When completing the trial after 2-weeks' treatment, the clobetasone butyrate-treated lesions had healed in 8 cases and the hydrocortisone butyrate-treated lesions in 10 cases. No local side-effects were observed.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Betamethasone; Clinical Trials as Topic; Clobetasol; Double-Blind Method; Eczema; Female; Humans; Hydrocortisone; 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

Clobetasone butyrate ointment has been shown to be more effective in treating psoriasis and eczema than flurandrenolone ointment yet to cause less epidermal thinning in a human experimental model. This is an indication that the clinical activity of topical glucocorticoids may not necessarily be inseparable from their propensity to cause atrophy of the skin.

Topics: Betamethasone; Cell Count; Clinical Trials as Topic; Clobetasol; Eczema; Flurandrenolone; Humans; Psoriasis; Skin

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone Valerate; Clinical Trials as Topic; Clobetasol; Eczema; Fluocinonide; Glucocorticoids; Humans; Pregnenediones; Psoriasis

Chronic hand eczema (CHE) is a recurrent, frequently disabling skin condition that requires daily skin care to prevent transepidermal water loss, posing a significant burden of society and economy. In recent years, topical 0.05% clobetasol cream is widely used for the treatment of CHE for its efficacy, tolerability and safety. Whereas, no systematic review and meta-analysis has been updated up to now. Therefore, this work aims to assess the effectiveness and safety of topical 0.05% clobetasol cream in patients with CHE.. Study on topical 0.05% clobetasol cream for CHE will be searched from their inception to December, 2020 with the language restrictions of English and Chinese in 8 databases (PubMed, Cochrane Library, Embase, the web of science, VIP, CNKI, CBM, and WAN FANG). According to the heterogeneity test, a fixed or random-effect model will be used to synthesize data. The primary outcome is the proportion of patients achieving more than 75% reduction in signs and symptoms according to the Hand Eczema Severity Index (HECSI). The secondary outcomes include: scored for 4 different characteristics of the lesions (redness, scaling, lichenification, and pruritus), QoL questionnaire, adverse events, and recurrence events. STATA 13.0 and Review Manager software 5.3 will be used for analysis and synthesis. Two or more reviewers will independently conduct the selection of studies, data extraction, and data analysis.. The results of the study expect to provide a high-quality, evidence-based recommendation on topical 0.05% clobetasol cream in the treatment of CHE for clinicians.. The study will provide scientific and useful evidence for better use of topical 0.05% clobetasol cream in treating CHE.. This study is a protocol for an overview of SRs/MAs that did not involve individual data. Thus, ethical approval is not required.. DOI 10.17605/OSF.IO/SPHVZ.

Topics: Chronic Disease; Clobetasol; Eczema; Hand Dermatoses; Humans; Meta-Analysis as Topic; Pruritus; Quality of Life; Randomized Controlled Trials as Topic; Severity of Illness Index; Skin Cream; Systematic Reviews as Topic; Treatment Outcome

The 'soak and smear' regimen is a highly effective method for localised topical therapy employed by dermatologists for widespread inflammatory skin conditions. The regimen involves application of topical medication under occlusion after soaking in water. Complications from this treatment method are rare. We present a case of multiple, generalised methicillin-resistant Staphylococcus aureus (MRSA)-positive furuncles arising in a patient as an unexpected consequence of therapy. The case highlights an unanticipated risk of a commonly employed treatment amid an epidemic of MRSA in the community.

Topics: Aged; Anti-Bacterial Agents; Chlorhexidine; Clobetasol; Diagnosis, Differential; Doxycycline; Eczema; Furunculosis; Glucocorticoids; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Water

Variably considered as a localized subtype of pustular psoriasis, palmoplantar pustulosis (PPP) is commonly treated with topical steroids, acitretin, and local phototherapy with oral or topical psoralen (PUVA). The utility of acitretin for PPP is limited by adverse effects such as myalgias and an extended risk of teratogenicity in female patients. Isotretinoin is a more tolerable retinoid with a shorter teratogenic window, but to date its effectiveness in PPP has not been reported. Herein we present two patients with PPP who responded well to isotretinoin treatment.. Two patients with PPP refractory to topical therapies were started on acitretin. Both patients developed adverse effects (including headache, myalgias, and mood alterations) leading to acitretin discontinuation. Isotretinoin monotherapy was started in one patient resulting in significant clearing of palmar plaques and scale, and the addition of isotretinoin to UVA therapy resulted in near-complete clearing of recalcitrant plantar plaques in the second patient.. Acitretin represents an important treatment for PPP, but is limited by adverse effects and extended teratogenicity. Our experience supports the utility of isotretinoin as a potential therapeutic alternative, which may be particularly beneficial in patients who are poor candidates for or unable to tolerate acitretin therapy.

Topics: Acitretin; Anti-Inflammatory Agents; Biopsy; Calcitriol; Ceramides; Cholesterol; Clobetasol; Combined Modality Therapy; Diagnostic Errors; Drug Combinations; Drug Substitution; Eczema; Emollients; Fatty Acids; Female; Humans; Isotretinoin; Male; Middle Aged; Psoriasis; Ultraviolet Therapy

Topics: Administration, Topical; Adult; Clobetasol; Diagnosis, Differential; Eczema; Female; Glucocorticoids; Humans; Leg

Topical steroids became available, without prescription, in the U.K. in 1987, with hydrocortisone 1% cream first being licensed for irritant contact dermatitis and reactions to insect bites. Since then the number of indications for nonprescription hydrocortisone use has increased and clobetasone has also become available as an over-the-counter (OTC) medicine. Little has been reported about how OTC steroids are used by community pharmacy clients.. We determined how OTC topical steroids are applied by patients, their demographic profile, the products used and the conditions treated, how frequently products were applied and how regularly purchased. The extent to which off-label use takes place was explored.. A patient-completed questionnaire study was used in 100 branches of a national pharmacy in Great Britain.. Questionnaires were completed and returned by 315 clients (16%). Eczema (192 cases, 61%) and dermatitis (66 cases, 21%) were the conditions most frequently treated. Nottingham Eczema Severity Scores calculated for 228 eczema and dermatitis sufferers shows that 164 patients (72%) had mild eczema. Those with more severe eczema were more likely to use clobetasone than hydrocortisone. The use of topical steroids outside OTC marketing authorization guidelines was widespread; however, no patient reported any adverse effects or deterioration in condition following steroid use.. OTC topical steroids are used mainly to treat eczema and dermatitis. Almost 50% of users treating these conditions exceed the limits of the rather restrictive OTC marketing authorization. Clinicians should be aware of the potential for adverse effects as a result of patients self-medicating with hydrocortisone or clobetasone for an extended period.

Topics: Adolescent; Adult; Aged; Anti-Inflammatory Agents; Child; Child, Preschool; Clobetasol; Contraindications; Dermatitis; Drug Administration Schedule; Eczema; Female; Glucocorticoids; Humans; Hydrocortisone; Infant; Male; Middle Aged; Nonprescription Drugs; Patient Satisfaction; Self Administration; Skin Diseases; Surveys and Questionnaires; United Kingdom

This is a report of a 52-year-old man who developed osteonecrosis of the femoral head (ONF) following long-term application of steroid for facial eczema. Before hip pain appeared, the patient had applied 2-3g/day of 0.05% clobetasol propionate for 2 years and 10 months. This steroid is classified as being in the strongest category. ONF was diagnosed based on radiographic and magnetic resonance imaging findings, and the patient received surgical treatment for both hips. ONF was also confirmed by pathological examination of a specimen obtained from the right femoral head during surgery. Because there were no risk factors for ONF besides topical steroid application, this case was considered as ONF associated with topical steroid. Even when steroids are for external use, their dosage and administration should be monitored, and the risk of ONF should also be considered.

Topics: Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Eczema; Femur Head Necrosis; Glucocorticoids; Humans; Male; Middle Aged

Topics: Administration, Topical; Betamethasone; Clobetasol; Eczema; Humans; Psoriasis

It is now well established that epidermis, like many other tissues, contains a phospholipase A2 that is responsible for the initiation of the arachidonic acid cascade. Here we report that human epidermis also contains a second, quite distinct enzyme of the phospholipase A2 group, which is unique in its extreme activity against phospholipids in true solution. It also differs from the classic cutaneous enzyme in that (a) its activity is not reduced by pretreatment of the skin with corticosteroids in vivo nor by treatment of the epidermal homogenate with alkaline phosphatase in vitro, and (b) its activity is reduced, rather than increased, in the lesions of inflammatory diseases such as psoriasis. The enzyme seems to occur mainly in fully differentiated keratinocytes, its level being low in the basal cell layer of epidermis and in keratinocytes cultured in vitro. On the basis of these observations, we suggest that this new phospholipase A2 is responsible for the degradation of phospholipids that accompanies the terminal keratinization process.

Topics: Alkaline Phosphatase; Cells, Cultured; Clobetasol; Eczema; Epidermis; Humans; Keratins; Lichen Planus; Phospholipases; Phospholipases A; Phospholipases A2; Psoriasis; Skin Diseases; Trypsin

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

In conclusion, there can be no doubt that CP is a remarkable local steroid with potency greater than anything previously available to the dermatologist. It may be useful for short-term (less than 2 weeks) and intermittent treatment of widespread inflammatory dermatoses. It is excellent for treating some stubborn localized inflammatory dermatoses before moving on to more dilute preparations. When prescribing CP, it is important to warn the patient of common side effects, such as atrophy and striae, and to instruct the patient carefully in its use, mentioning body areas that should be spared its application. CP should not be applied to flexural, scrotal, or, with a few exceptions such as discoid lupus erythematosus and actinic reticuloid, facial skin. Its use is contraindicated in infants, toddlers, and children under 12 years of age. In addition, adult patients must be told never to use more than 50 gm per week (the manufacturer's recommendation). The prescribing physician must monitor and regularly review the amount used per unit time. Treatment with CP beyond 2 weeks is not recommended in the product information on CP listed in the Physicians' Desk Reference (1988). Those few patients taking CP for a long period should be managed as though they are on systemic steroids. Episodes of acute stress, such as surgery and intercurrent infection, should be managed with supplemental, if necessary parenteral, glucocorticoid administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Topical; Betamethasone; Clobetasol; Eczema; Humans; Psoriasis; Skin Diseases

Twenty patients with hand eczema were studied with the use of quantitative bacteriologic cultures before and after successful topical treatment with a potent corticosteroid. One sample was taken from the most pronounced eczematous lesion, a second from skin affected with only erythema, and a third from clinically normal skin. Before quantitative bacteriologic analysis, the different species were combined into three main groups: Staphylococcus aureus, other aerobes, and anaerobes. Before treatment, S. aureus colonized the most pronounced eczematous lesion in eighteen of twenty patients and exceeded 10(5) cfu/cm2 in fifteen of twenty patients. The geometric mean count of S. aureus before treatment was significantly higher in eczema (10(4.8) cfu/cm2) than in erythema (10(3.4) cfu/cm2) and significantly higher in erythema than in normal skin (10(1.7) cfu/cm2). The density of other aerobes and anaerobes was similar in the three sampling sites. After treatment, the mean count of S. aureus was significantly reduced at all three sampling sites, and the densities became equal. Treatment did not affect the mean count of other aerobes or anaerobes.

Topics: Administration, Topical; Adolescent; Adrenal Cortex Hormones; Adult; Bacteria; Clobetasol; Eczema; Female; Hand Dermatoses; Humans; Male; Middle Aged; Skin; Staphylococcus aureus

Topics: Adult; Betamethasone; Clobetasol; Eczema; Humans; Male; Psoriasis

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: Adolescent; Adult; Anti-Inflammatory Agents; Betamethasone; Child; Child, Preschool; Clobetasol; Eczema; Female; Humans; Male; Middle Aged; Ointments; Psoriasis; Skin Diseases

Topics: Administration, Oral; Administration, Topical; Adrenal Cortex; Adult; Anti-Inflammatory Agents; Betamethasone; Budesonide; Clobetasol; Diflucortolone; Dose-Response Relationship, Drug; Eczema; Female; Humans; Hydrocortisone; Male; Middle Aged; Ointments; Pregnenediones; Psoriasis

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Betamethasone; Clobetasol; Eczema; Female; Humans; Hydrocortisone; Kinetics; Male; Middle Aged; Ointments; Psoriasis; Radioimmunoassay

A study to demonstrate methods of using topical preparations to control chronic skin conditions is described. 25 patients with atopic eczema or psoriasis were followed for an average of 10 months. Both self-assessment using a diary card and clinical assessment were used to evaluate the treatment. The study shows that, when used correctly, topical corticosteroids can provide an effective means of controlling these intractable conditions without producing the side-effects associated with their misuse.

Topics: Administration, Topical; Betamethasone; Butyrates; Chronic Disease; Clobetasol; Drug Evaluation; Eczema; Humans; Patient Education as Topic; Propionates; Psoriasis

Clobetasone butyrate is a new corticosteroid, selected for study because of its combination of good activity in the vasoconstriction test and low systemic activity in animals. Formulated as an 0.05% ointment and cream (Molivate) it was clinically effective in patients with eczema, its activity being significantly greater than that of hydrocortisone 1% or fluocortolone 0.2% (Ultradil). Under conditions that predispose to maximal percutaneous absorption clobetasone butyrate ointment had minimal effect on hypothalamic-pituitary-adrenal function. In an animal model of cutaneous atrophy it caused less thinning of the epidermis than steroids other than hydrocortisone. Clobetasone butyrate 0.05% ointment and cream gave every indication of offering clinically effective topical anti-inflammatory activity with a wide margin of safety.

Topics: Administration, Topical; Animals; Betamethasone; Clobetasol; Cosyntropin; Eczema; Fluocortolone; Humans; Insulin; Pituitary-Adrenal Function Tests; Pituitary-Adrenal System; Psoriasis; Skin; Swine