clobetasol and Lupus-Erythematosus--Discoid

To compare the efficacy and safety between 0.1% Tacrolimus ointment twice a day and 0.05% clobetasol propionate.. Twenty-one Thai patients 18 to 60 years old with DLE lesions on both right and left sides of the body, without SLE, were included in the present study. Each patient was randomly allocated to determine the use of one side for twice-daily 0.1% topical tacrolimus ointment and the other side for once-daily 0.05% clobetasol propionate ointment for six weeks. Clinical outcomes were evaluated by modified cutaneous lupus erythematosus disease area and severity index (CLASI) and global assessment score for patient efficacy evaluation.. Disease activity score were significantly decreased from baseline in both groups but clobetasol had better efficacy (p < 0.05). No significant change in disease damage score between the two groups. Both drugs were well tolerated. Transient pruritus and burning sensation were found in the tacrolimus group. Telangiectasia and acneiform eruption were found in the clobetasol group.. The present study proved the efficacy of twice-daily tacrolimus and once-daily clobetasol treatment for DLE lesion. Clobetasol has significantly higher efficacy and tacrolimus may be an alternative treatment.

Topics: Adolescent; Adult; Anti-Inflammatory Agents; Clobetasol; Double-Blind Method; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Discoid; Male; Middle Aged; Severity of Illness Index; Tacrolimus; Young Adult

Topics: Administration, Topical; Adult; Biopsy; Chilblains; Clobetasol; Cold Temperature; Female; Glucocorticoids; Humans; Lupus Erythematosus, Cutaneous; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Skin; Treatment Outcome

In recent years, calcineurin inhibitors have been used as the first line alternative to topical corticosteroids in the treatment of discoid lupus erythematosus (DLE). We aim to evaluate the efficacy and safety of topical tacrolimus 0.1% vs topical halobetasol propionate 0.05% in patients with DLE. This comparative study was carried out in the Department of Dermatology and Venereology, Chittagong Medical College Hospital (CMCH), Bangladesh between the period of July 2018 and June 2019. The change of DLE activity assessed with the cutaneous lupus erythematosus disease area and severity index was used as a primary outcome measure. The effective sample was 40 patients in each group. Both groups were similar in terms of baseline demographic and clinical characteristics. After 8 weeks of treatment, the mean total erythema score decreased significantly in both groups (in tacrolimus treated group [TTG] from 12.53 ± 8.05 to 8.03 ± 5.69, [P < .001] and in halobetasol propionate treated group [HTG] from 11.83 ± 7.17 to 7.30 ± 4.56 [P < .001]), as well as the mean total scale/hypertrophy score (in TTG from 8.08 ± 5.30 to 4.33 ± 3.21; [P < .001] and in HTG from 7.40 ± 4.73 to 3.68 ± 2.01, [P < .001]. The magnitude of reduction was significantly better in HTG [P = .032]). The mean total activity score decreased significantly in both groups (in TTG from 22.95 ± 13.40 to 14.33 ± 8.89, [P < .001] and in HTG from 22.15 ± 11.95 to 13.7 ± 7.22, [P < .001]). The present study demonstrated that tacrolimus 0.1% ointment and halobetasol propionate 0.05% ointment had a comparable efficacy in DLE patients; however, halobetasol showed significantly better improvement regarding scaly, hypertrophic lesions.

Topics: Bangladesh; Clobetasol; Humans; Hydroxychloroquine; Lupus Erythematosus, Discoid; Tacrolimus

Topics: Administration, Topical; Aged; Biopsy; Breast Neoplasms; Clobetasol; Female; Glucocorticoids; Humans; Lupus Erythematosus, Discoid; Piperazines; Protein Kinase Inhibitors; Pyridines; Treatment Outcome

Topics: Administration, Topical; Anti-Inflammatory Agents; Biopsy; Clobetasol; Female; Humans; Hydrocortisone; Lupus Erythematosus, Discoid; Middle Aged; Wounds and Injuries

Marginal vitiligo, or inflammatory vitiligo with raised borders is a unique subset of vitiligo vulgaris presenting with scattered depigmented, pruritic patches surrounded by a raised, erythematous border. Alternative diagnoses include discoid lupus erythematosus and cutaneous T-cell lymphoma.. To properly guide treatment, it is important to exclude other conditions that present with a similar pattern of depigmentation. This requires the ability to identify specific cutaneous and histologic clues that support this diagnosis.. A 22 year-old man presented with a history of depigmented, pruritic patches and surrounding raised, erythematous borders. Several areas of depigmentation on the scalp were associated with alopecia. Punch biopsy of the rim of a patch was performed and sent for routine hematoxylin and eosin staining and direct immunofluorescence.. Histopathology revealed a spongiotic dermatitis with superficial dermal lymphocytic infiltrate and eosinophils; DIF demonstrated no immunoreactants. A diagnosis of inflammatory vitiligo with raised borders was thus made based on consistent clinical and histopathologic features. The symptoms improved with topical clobetasol 0.05% cream twice daily.

Topics: Administration, Cutaneous; Clobetasol; Diagnosis, Differential; Glucocorticoids; Humans; Lupus Erythematosus, Discoid; Lymphoma, T-Cell, Cutaneous; Male; Vitiligo; Young Adult

Topics: Adolescent; Antirheumatic Agents; Biopsy; Clobetasol; Diagnosis, Differential; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Hydroxychloroquine; Lupus Erythematosus, Discoid; Ointments; Skin

Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are the most common causes of lymphocytic primary cicatricial alopecia. The management of scarring alopecia can be difficult. The combination of clinical, dermoscopy and reflectance confocal microscopy (RCM), a noninvasive, high-resolution imaging technique, examinations have already been demonstrated to be useful for choosing the correct biopsy site in patients with inflammatory skin disease and obtaining microscopic diagnostic criteria.. We evaluated the usefulness in practice of RCM for the identification of criteria for LPP and DLE involving the scalp and their management during therapeutic follow-up.. Seven white patients with a previously established histological diagnosis of DLE (three) and LPP (four), were included in the study. RCM criteria for primary scarring alopecia were selected: epidermal disarray, spongiosis, exocytosis of inflammatory cells in the epidermis, interface dermatitis, peri- and intra-adnexal infiltration of inflammatory cells, dilated vessels in the dermis, dermal infiltration of inflammatory cells and melanophages and dermal sclerosis. All patients were followed up using RCM during the treatment. During follow-up the RCM evolution of the epidermal, junctional and dermal inflammation were evaluated.. A series of RCM features of scalp LPP and DLE were identified that show correlation with the histopathological evaluation. During the treatment follow-up of the cases RCM was shown to be sensitive for the identification of therapeutic response.. In our preliminary study the effective usefulness of RCM for the diagnosis of scarring alopecia and follow-up seemed to be evident. Moreover, RCM seems to be also promising for differential diagnosis between the different entities.

Topics: Aged; Alopecia; Anti-Inflammatory Agents; Clobetasol; Dermatologic Agents; Female; Humans; Hydroxychloroquine; Keratinocytes; Lichen Planus; Lupus Erythematosus, Discoid; Male; Microscopy, Confocal; Middle Aged; Observer Variation

A 49-year-old woman presented with a seven-year history of pruritic, erythematous, scaling plaques on sun-exposed skin that localized only to pre-existing depigmented patches. Histopathologic examination showed changes consistent with cutaneous lupus erythematosus with lichenoid features and confirmed contiguous vitiligo. Diagnosis of chronic cutaneous lupus erythematosus localized to areas of vitiligo was determined by clinicopathologic correlation and may reflect an autoimmune diathesis. Consequently, hydroxychloroquine and topical glucocorticoids therapy were initiated with reported improvement in pruritus, erythema, and scale. Clinical monitoring for development of squamous-cell carcinoma in areas of chronic inflammation and sun-exposure is imperative.

Topics: Autoimmunity; Carcinoma, Squamous Cell; Clobetasol; Diabetes Complications; Diagnostic Errors; Drug Therapy, Combination; Female; Fluocinolone Acetonide; Humans; Hydroxychloroquine; Lupus Erythematosus, Discoid; Middle Aged; Photosensitivity Disorders; Pruritus; Psoriasis; Skin Neoplasms; Sunlight; Ultraviolet Rays; Vitiligo

Genital involvement is a rare manifestation in discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE), and there are few reports on vulvar clinical features. We describe a 41-year old Caucasian woman with bilateral vulvar DLE. Although vulvar lesions in lupus are probably more common than is realized, the present report is the first case of genital DLE documented in a female.

Topics: Adult; Clobetasol; Complement System Proteins; Dyspareunia; Female; Glucocorticoids; HLA Antigens; Humans; Immunoglobulins; Lupus Erythematosus, Discoid; Ointments; Vulvar Diseases

A case of discoid lupus erythematosus with oral manifestations only is presented. The patient complained of painful palatal ulcers that limited her dietary intake. A topical therapeutic regimen using plastic carriers containing clobetasol propionate was beneficial in significantly relieving the oral discomfort. The clinical and microscopic differential diagnoses for this mucocutaneous disease are also discussed.

Topics: Clobetasol; Female; Humans; Lupus Erythematosus, Discoid; Middle Aged; Mouth Diseases; Mouth Mucosa