clobetasol and Genital-Diseases--Male

Genital dermatophytosis has been considered rare by most Western authorities. However, to the contrary, Indian reports have shown a higher prevalence of genital dermatophytosis due to warm and humid climate, overcrowding and lack of hygiene. A review is presented for 24 cases of male genital dermatophytosis occurring in patients suffering from tinea cruris in India who have been randomly applying various broad-spectrum steroid antifungal and antibacterial creams containing one or more antifungal and antibiotic in addition to potent corticosteroids, mainly clobetasol propionate. This is such a common phenomenon that Indian dermatologists are witnessing an epidemic of sorts of steroid-modified dermatophytosis and we hereby share various clinical presentations of dermatophytosis of penis and/or scrotum in patients with tinea cruris who have been applying the above-mentioned creams. The review also discusses the bleak scenario that prevails in India regarding the drug regulatory affairs that allow such dangerous and irrational combinations that are sold over the counter because of misinterpretation of the law and lax implementation of existing laws.

Topics: Administration, Topical; Adolescent; Adrenal Cortex Hormones; Adult; Anti-Infective Agents, Local; Antifungal Agents; Clobetasol; Genital Diseases, Male; Humans; India; Male; Middle Aged; Penis; Prescription Drug Misuse; Prevalence; Scrotum; Steroids; Tinea; Young Adult

Lichen sclerosus is a chronic, inflammatory skin condition that most commonly occurs in adult women, although it may also be seen in men and children. It primarily affects the genital area and around the anus, where it causes persistent itching and soreness. Scarring after inflammation may lead to severe damage by fusion of the vulval lips (labia); narrowing of the vaginal opening; and burying of the clitoris in women and girls, as well as tightening of the foreskin in men and boys, if treatments are not started early. Affected people have an increased risk of genital cancers.. To assess the effects of topical interventions for genital lichen sclerosus and adverse effects reported in included trials.. We searched the following databases up to 16 September 2011: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE (from 2005), EMBASE (from 2007), LILACS (from 1982), CINAHL (from 1981), British Nursing Index and Archive (from 1985), Science Citation Index Expanded (from 1945), BIOSIS Previews (from 1926), Conference Papers Index (from 1982), and Conference Proceedings Citation Index - Science (from 1990). We also searched ongoing trial registries and scanned the bibliographies of included studies, published reviews, and papers that had cited the included studies.. Randomised controlled trials (RCTs) of topical interventions in genital lichen sclerosus.. Two authors independently selected trials, extracted data, and assessed the risk of bias. A third author was available for resolving differences of opinion.. We included 7 RCTs, with a total of 249 participants, covering 6 treatments. Six of these RCTs tested the efficacy of one active intervention against placebo or another active intervention, while the other trial tested three active interventions against placebo.When compared to placebo in one trial, clobetasol propionate 0.05% was effective in treating genital lichen sclerosus in relation to the following outcomes: 'participant-rated improvement or remission of symptoms' (risk ratio (RR) 2.85, 95% confidence interval (CI) 1.45 to 5.61) and 'investigator-rated global degree of improvement' (standardised mean difference (SMD) 5.74, 95% CI 4.26 to 7.23).When mometasone furoate 0.05% was compared to placebo in another trial, there was a significant improvement in the 'investigator-rated change in clinical grade of phimosis' (SMD -1.04, 95% CI -1.77 to -0.31).Both trials found no significant differences in reported adverse drug reactions between the corticosteroid and placebo groups. The data from four trials found no significant benefit for topical testosterone, dihydrotestosterone, and progesterone. When used as maintenance therapy after an initial treatment with topical clobetasol propionate in another trial, topical testosterone worsened the symptoms (P < 0.05), but the placebo did not.One trial found no differences between pimecrolimus and clobetasol propionate in relieving symptoms through change in pruritus (itching) (SMD -0.33, 95% CI -0.99 to 0.33) and burning/pain (SMD 0.03, 95% CI -0.62 to 0.69). However, pimecrolimus was less effective than clobetasol propionate with regard to the 'investigator-rated global degree of improvement' (SMD -1.64, 95% CI -2.40 to -0.87). This trial found no significant differences in reported adverse drug reactions between the pimecrolimus and placebo groups.. The current limited evidence demonstrates the efficacy of clobetasol propionate, mometasone furoate, and pimecrolimus in treating genital lichen sclerosus. Further RCTs are needed to determine the optimal potency and regimen of topical corticosteroids, examine other topical interventions, assess the duration of remission or prevention of flares, evaluate the reduction in the risk of genital squamous cell carcinoma or genital intraepithelial neoplasia, and examine the efficacy in improving the quality of the sex lives of people with this condition.

Topics: Adult; Anti-Inflammatory Agents; Child; Clobetasol; Dermatologic Agents; Dihydrotestosterone; Female; Genital Diseases, Male; Humans; Lichen Sclerosus et Atrophicus; Male; Mometasone Furoate; Pregnadienediols; Randomized Controlled Trials as Topic; Tacrolimus; Testosterone Propionate; Vulvar Lichen Sclerosus

Topics: Adult; Biopsy; Clobetasol; Diagnosis, Differential; Drug Eruptions; Genital Diseases, Male; Glucocorticoids; Humans; Male; Skin; Thigh

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Antifungal Agents; Antitrichomonal Agents; Clobetasol; Disease Progression; Drug Combinations; Genital Diseases, Male; Glucocorticoids; Groin; Humans; Leg Dermatoses; Male; Naphthalenes; Ofloxacin; Ornidazole; Terbinafine; Thigh; Tinea; Young Adult

Topics: Clobetasol; Diagnosis, Differential; Genital Diseases, Male; Glucocorticoids; Hepatitis C, Chronic; Humans; Lichen Planus; Male

Topics: Administration, Topical; Aged, 80 and over; Clobetasol; Genital Diseases, Male; Glucocorticoids; Humans; Male; Pemphigoid, Bullous; Scrotum

To assess the efficacy of clobetasol propionate 0.05% cream in male patients suffering from genital lichen sclerosus (GLS), as well as the efficacy of methylprednisolone aceponate 0.1% cream and tacrolimus 0.1% ointment as maintenance therapy.. The study was conducted retrospectively. At baseline, male patients with GLS (n = 41) were treated with clobetasol propionate 0.05% cream applied twice daily for 8 weeks. Visual Analog Scale (VAS) score for pruritus, Investigator's Global Assessment (IGA) score and Dermatology Life Quality Index (DLQI) were recorded at baseline, week 8 and week 20. At week 8, patients responsive to treatment (n = 37) were further treated with methylprednisolone aceponate 0.1% cream twice weekly (n = 17) or tacrolimus 0.1% ointment once daily (n = 20), as maintenance therapy until week 20.. VAS, IGA and DLQI median scores were significantly decreased from baseline to week 8 (p < 0.001). At week 20, patients treated with methylprednisolone aceponate 0.1% cream presented no significant difference in median IGA score (p = 0.865), median DLQI score (p = 0.853) or median VAS score (p = 0.474) compared with patients treated with tacrolimus 0.1% ointment.. Clobetasol propionate 0.05% cream is effective as first-line treatment in male GLS. The data suggest that there is no difference between methylprednisolone aceponate 0.1% cream and tacrolimus 0.1% ointment in preventing the relapses.

Topics: Adult; Clobetasol; Genital Diseases, Male; Humans; Lichen Sclerosus et Atrophicus; Maintenance Chemotherapy; Male; Methylprednisolone; Pruritus; Quality of Life; Retrospective Studies; Secondary Prevention; Skin Cream; Tacrolimus

When not recognized and treated aggressively, lichen sclerosus may progress and cause debilitating symptoms. It also may result in significant morbidity in patients undergoing treatment for urethral strictures because unrecognized, it may result in rapid and severe recurrence after surgical treatment. We present our experience treating patients with lichen sclerosus in an equal access health care system.. We performed an institutional review board approved retrospective review of all adult men with lichen sclerosus treated at our institution during a 10-year period. We analyzed all patients diagnosed with lichen sclerosus, and recorded patient demographics and therapies. We recorded characteristics of the disease process including external and internal manifestations. We also recorded the various treatments, and whether the patients experienced recurrence.. A total of 43 patients were diagnosed with lichen sclerosus during the review period. Of those patients presenting with more severe (urethral) involvement and undergoing 1 or 2-stage urethroplasties, we noted 7 with recurrence. In the remainder of patients presenting with less severe disease who were treated aggressively with clobetasol and/or minor procedures, no recurrences were noted on followup examination, and all of these patients had documented normal flow patterns on noninvasive urodynamics.. Our data suggest that early aggressive topical therapy plus minimally invasive surgical therapy to relieve high pressure voiding may prevent the progression of lichen sclerosus in patients who present with limited disease involving the skin and meatus.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Clobetasol; Disease Progression; Genital Diseases, Male; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Retrospective Studies; Urethral Stricture; Young Adult

The ulcerative variant of lichen planus (LP) commonly involves the oral mucosa but is uncommon and difficult to treat when located on other areas. We describe an unusual case of ulcerative LP involving several surfaces, including the palms and scrotum, in a 50-year-old man with hepatitis C. The patient was recalcitrant to treatment with conventional therapy but obtained clearance with a sustained response using low molecular weight heparin (LMWH). This treatment is an option for patients with LP who are not ideal candidates for standard therapy.

Topics: Anti-Inflammatory Agents; Anticoagulants; Clobetasol; Genital Diseases, Male; Hand Dermatoses; Heparin, Low-Molecular-Weight; Hepatitis C; Humans; Immunosuppressive Agents; Lichen Planus; Male; Middle Aged; Scrotum; Skin Ulcer; Tacrolimus

We describe the case of a 66-year-old Hispanic man with an atypical presentation of lichen sclerosus (LS). The unusual presentation included bilateral axilla involvement (not previously reported to our knowledge), scrotal involvement (not common in men, despite common vulvar involvement in women), and an uncommonly thick plaque on his back.

Topics: Administration, Topical; Aged; Anti-Inflammatory Agents; Axilla; Clobetasol; Genital Diseases, Male; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Skin; Triamcinolone

To characterise the clinical presentation and response to treatment of lichen sclerosus (LS) in men attending a department of genitourinary medicine.. A case note review of all men attending a GUM department over a 32 month period, who had been diagnosed as having LS.. 66 men were seen with genital LS. The mean age at diagnosis was 36.5 years but symptoms had been present for up to 10 years before the diagnosis was made. 55 men underwent biopsy and the diagnosis was made histologically in 47 of these men. At the time of presentation 30% of men had no symptoms relating to their LS. All were treated with potent topical steroids and surgery was avoided in nearly all of them.. LS is not uncommon in men presenting to a GUM department, and is often asymptomatic. The disease responds well to potent topical steroids allowing the normal anatomy to be preserved in most individuals.

Topics: Administration, Topical; Adult; Aged; Ambulatory Care; Anti-Inflammatory Agents; Circumcision, Male; Clobetasol; Dilatation; Genital Diseases, Male; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Urethra

Pyoderma gangrenosum (PG) of the scrotum is extremely rare. We report a case of scrotal PG associated with dermatomyositis. Initial healing was slow despite the use of oral prednisolone and azathioprine. Healing was accelerated by the local use of a potent topical corticosteroid. PG should be considered in the differential diagnosis of ulcerating lesions of the genitalia.

Topics: Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Dermatomyositis; Genital Diseases, Male; Glucocorticoids; Humans; Male; Middle Aged; Pyoderma Gangrenosum; Scrotum