clobetasol and Pemphigoid--Benign-Mucous-Membrane

Topical corticosteroids are considered first-line therapy in patients with chronic inflammatory oral mucosal diseases; among them, clobetasol propionate is one of the most widely used in oral medicine. Under physiological conditions, the transmucosal application is characterized by a significantly greater absorption than the skin application. Contrary to many publications about the side effects of topical corticosteroids in dermatology, few studies have investigated the systemic effects due to local application of these drugs on oral mucosa. Although topical steroid therapy for the management of oral diseases is generally associated with local adverse effects (candidiasis, stomatopyrosis, and hypogeusia), these drugs can also lead to systemic side effects, such as suppression of the hypothalamic-pituitary-adrenal axis and Cushing's syndrome. This review reports five cases of systemic adverse effects caused by clobetasol propionate topical treatment.

Topics: Administration, Topical; Clobetasol; Cushing Syndrome; Female; Glucocorticoids; Humans; Iatrogenic Disease; Lichen Planus, Oral; Middle Aged; Pemphigoid, Benign Mucous Membrane

This paper describes a case of benign mucous membrane pemphigoid which affected the periodontal tissues and complicated ocular prosthesis placement. The clinical findings, diagnostic criteria, and therapeutic management of this disorder are reviewed.

Topics: Administration, Topical; Anti-Infective Agents; Anti-Inflammatory Agents; Clobetasol; Dapsone; Diagnosis, Differential; Eye, Artificial; Female; Glucocorticoids; Humans; Middle Aged; Orbital Diseases; Pemphigoid, Benign Mucous Membrane; Periodontal Diseases

Cicatricial pemphigoid is at present an incurable, autoimmune disease that involves mucosa and skin. We have documented the clinical, microscopic, and therapeutic features of 23 patients with cicatricial pemphigoid and added these to reports of past literature. The mean age at the time of diagnosis was 63 years, and women were involved twice as often as men. Eighty-three percent of patients had oral mucosal involvement, 70% had conjunctival involvement, and 22% had skin involved. Direct immunologic evaluation revealed IgG at the basement membrane in 57% of cases and C3 in 66%. We have been able to manage the disease adequately in most patients with topical or systemic corticosteroids. The most commonly encountered side effect was oral candidiasis.

Topics: Aged; Autoantibodies; Autoimmune Diseases; Basement Membrane; Clobetasol; Complement C3; Female; Humans; Immunoenzyme Techniques; Immunoglobulin Idiotypes; Male; Middle Aged; Pemphigoid, Benign Mucous Membrane; Prednisone; Retrospective Studies; Sex Ratio; Triamcinolone Acetonide

Clobetasol is the most potent topical corticosteroid used in oral medicine for muco-cutaneous diseases. Several papers reported about patients with cushingoid appearance, suggesting an adrenal suppression related to clobetasol systemic absorption after local application. Owing to the lack of studies, our goal is to assess whether transmucosal assimilation, after its application on oral mucosa, really occurs and to define clobetasol pharmacokinetics profile.. Data were recorded by collecting blood samples both on 10 patients in clobetasol therapy and on 14 healthy volunteers instructed about standardized clobetasol applications. A new technique of analytical chemistry was employed to detect its serum concentrations.. Clobetasol absorption was ascertained, showing a certain accumulation rate. Different levels have been found in relation to oral disease and individual features (as smoking habits and presence of oral mucosa erosion).. Our study validates clobetasol systemic transmucosal absorption, also recommending a careful monitoring of patients in corticosteroid therapy to avoid local and systemic adverse effects.

Topics: Absorption; Administration, Buccal; Aged; Anti-Inflammatory Agents; Chromatography, High Pressure Liquid; Clobetasol; Cross-Sectional Studies; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Mouth Diseases; Mouth Mucosa; Pemphigoid, Benign Mucous Membrane; Smoking; Tandem Mass Spectrometry; Young Adult

The aim of this study was to evaluate the therapeutic benefit of minocycline in mucous membrane pemphigoid (MMP) predominantly involving the oral cavity. A descriptive, open clinical study with no control group, including 9 patients, was developed. The diagnosis was confirmed by histopathological examination and direct and salt-split-skin indirect immunofluorescence analysis. Target antigens were sought by immunoblotting. Patients received minocycline (200mg/day) for a variable period. All patients were followed up for at least 2 years after initial diagnosis. Therapeutic response was assessed by clinical improvement in three categories: major response, minor response and no response. A major response was observed in 3 patients (33%), a minor response in 4 (44%) and 2 (22%) patients showed no improvement. Two of the 3 patients with a major response showed no immunoblot reactivity; 80% of patients with circulating autoantibodies (autoAb) against BP180 had a minor or no response. Permanent remission of signs with no relapse was only obtained in one patient. 5 patients (55%) stopped the drug because of adverse effects, such as vertigo and gastralgia. The results revealed temporary clinical benefits in MMP predominantly involving the oral cavity with minocycline, although frequently side effects led to drug withdrawal.

Topics: Administration, Oral; Administration, Topical; Aged; Anti-Bacterial Agents; Clobetasol; Complement C3; Drug Combinations; Female; Fluorescent Antibody Technique, Indirect; Gingival Diseases; Glucocorticoids; Humans; Immunoglobulin A; Immunoglobulin G; Middle Aged; Minocycline; Pemphigoid, Benign Mucous Membrane; Treatment Outcome; Vertigo

We sought to analyze the results of topical treatment with a mouthwash of 0.05% clobetasol in aqueous solution in 30 patients with severe oral erosive lesions.. Over a 48-week period, we evaluated the evolution of pain, ulcerations, atrophy, and interference of the disease in the patient's daily life, classifying the response as complete (100% remission/recovery), excellent (75%), good (50%), poor (<50%), or failed.. The pain and ulceration totally disappeared in 93.3% of cases and 90% reported a full recovery in their daily life activities. Atrophy response was complete in 28.5%, excellent in 60.7%, and good in 3.5%. Two patients showed no response to the treatment. Five patients suffered mild adverse effects (moon face and hirsutism) between week 4 and week 6 of treatment, which were speedily reversed by reducing the frequency of mouthwash.. Clobetasol mouthwash is a safe and efficacious option for the treatment of severe oral erosive lesions.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Drug Administration Schedule; Female; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Mouth Mucosa; Mouthwashes; Pemphigoid, Benign Mucous Membrane; Stomatitis, Aphthous; Treatment Outcome

Because of their chronic nature treatment of oral vesiculoerosive diseases remains a challenge to the oral medicine specialist. Even though oral vesiculoerosive diseases respond well to systemic steroids, adverse side effects sometimes limit their use. Potent topical steroids are becoming increasingly useful to treat these chronic conditions with good control. The purpose of this double-blind clinical trial was to compare clobetasol propionate and fluocinonide ointment in orabase as treatments for controlling oral vesiculoerosive diseases. Sixty patients were asked to participate (43 women and 17 men). Data are reported for 55 patients. Each patient was seen at baseline and at days 7, 14, 21, and 28. Variables evaluated were pain, erythema, atrophy, and size of lesion. Overall, both medications had a beneficial effect in the control of symptoms and signs of oral vesiculoerosive diseases with minimal side effects. Clobetasol propionate was better than fluocinonide as measured by more rapid control of pain (within 7 days). Candidiasis was observed in 13 patients at the end of treatment (most of them carriers of Candida). Therefore normal carriers should be identified and treatment with antifungal therapy instituted before the patient begins using topical steroids.

Topics: Aged; Carboxymethylcellulose Sodium; Clobetasol; Double-Blind Method; Erythema Multiforme; Female; Fluocinonide; Humans; Lichen Planus, Oral; Linear Models; Male; Middle Aged; Mouth Diseases; Pemphigoid, Benign Mucous Membrane; Pemphigus

Cicatricial pemphigoid is at present an incurable, autoimmune disease that involves mucosa and skin. We have documented the clinical, microscopic, and therapeutic features of 23 patients with cicatricial pemphigoid and added these to reports of past literature. The mean age at the time of diagnosis was 63 years, and women were involved twice as often as men. Eighty-three percent of patients had oral mucosal involvement, 70% had conjunctival involvement, and 22% had skin involved. Direct immunologic evaluation revealed IgG at the basement membrane in 57% of cases and C3 in 66%. We have been able to manage the disease adequately in most patients with topical or systemic corticosteroids. The most commonly encountered side effect was oral candidiasis.

Topics: Aged; Autoantibodies; Autoimmune Diseases; Basement Membrane; Clobetasol; Complement C3; Female; Humans; Immunoenzyme Techniques; Immunoglobulin Idiotypes; Male; Middle Aged; Pemphigoid, Benign Mucous Membrane; Prednisone; Retrospective Studies; Sex Ratio; Triamcinolone Acetonide

Clobetasol propionate (Temovate), a novel high-potency topical corticosteroid, was used in open trial from 1987 to 1988 on 24 patients with persistent oral vesiculoerosive disease of at least 1 month's duration. Fourteen women and 10 men, ranging in age from 27 to 76 years (mean 48 years), participated. Nine patients had erosive lichen planus, one had benign mucous membrane pemphigoid, three had pemphigus vulgaris, seven had persistent major recurrent aphthous stomatitis, and four had chronic oral erythema multiforme. Fifteen patients had complete remission of signs and symptoms, seven had excellent response of signs and complete remission of symptoms, and two failed to respond. All other topical therapy was suspended before and during the study. All patients responded to two or three applications daily of medication. Side effects were minor and reversible, and included localized candidiasis (three patients), stomatopyrosis (two), and hypogeusia (one). Clobetasol propionate ointment in adhesive paste (Orabase) thus seems to be an effective topical steroid alternative to other less potent topical and systemic drugs for recalcitrant oral vesiculoerosive disease.

Topics: Adult; Aged; Clobetasol; Female; Humans; Hydrocortisone; Lichen Planus; Male; Middle Aged; Mouth Diseases; Pemphigoid, Benign Mucous Membrane; Pemphigus; Stomatitis, Aphthous

There is currently a growing interest in new diagnostic tools of the oral cavity and mucosa which are non-invasive, repeatable and reliable. A diagnosis of a suspected, autoimmune pathology was made regarding a 57-year-old patient with desquamative gingivitis. However, a negative Nikolsky's sign did not seem to indicate a diagnosis of mucous membrane pemphigoid neither was there any indication as to the optimum location for an incisional biopsy. As an imaging method, the use of optical coherence tomography (OCT) has enabled the obtaining of tomographic (cross-sectional) scans of tissue. Such images are acquired prior to and after verifying Nikolsky's sign, thereby enabling the clinician to identify the presence (or not) of subepithelial bullae. Thereafter, an assessment of changes in the subepithelium (the split) can be performed, even in the absence of a suitable clinical picture, such as, for example, a negative Nikolsky's sign. Histological analysis and the use of indirect immunofluorescence have facilitated a diagnosis of mucous membrane pemphigoid, an autoimmune pathology, which can be confirmed with the appearance of subepithelial bullae. OCT was found to be a valid, non-invasive, auxiliary diagnostic device, capable of revealing in vivo and real-time bullae, which were hitherto clinically undetectable.

Topics: Administration, Topical; Autoantibodies; Clobetasol; Dystonin; Epithelium; Female; Fluorescent Antibody Technique, Indirect; Gingivitis; Glucocorticoids; Humans; Middle Aged; Mouth Mucosa; Pemphigoid, Benign Mucous Membrane; Tomography, Optical Coherence

Anti-p200 pemphigoid is a recently described autoimmune subepidermal bullous dermatosis characterized by its target antigen and the associated anatomoclinical picture. The treatment is not as yet well defined.. A 73-year-old man consulted for a pruritic bullous eruption with buccal involvement. Direct immunofluorescence revealed linear deposits of IgG and C3 at the dermal-epidermal junction. Elisa screening for circulating anti-BP180 and anti-BP230 antibodies was negative. A diagnosis of bullous pemphigoid was suspected. After an unfavourable clinical outcome under clobetasol and then prednisolone and methotrexate, other immunological tests were performed. Indirect immunofluorescence on NaCl-cleaved skin revealed a deposit of IgG4 antibodies on the dermal side. Immunoblotting showed antibodies directed against a 200-kDa antigen on a dermal extract. A diagnosis of anti-p200 pemphigoid was made. The patient was treated with dapsone combined with prednisolone. Seventy-two hours later, treatment was stopped due to hepatic cytolysis related to immunoallergic hepatitis. Treatment with mycophenolate mofetil was then initiated and resulted in complete remission, which persisted at seven months.. The diagnosis of anti-p200 pemphigoid was made on the basis of a set of clinical and immunological factors. Anti-p200 pemphigoid differs from standard bullous pemphigoid in terms of more frequent cephalic, acral and mucous membrane involvement, as well as a greater degree of miliary scarring. There was no eosinophilia. Elisa screening for anti-BP180 and anti-BP230 antibodies was negative. Immunoblotting showed antibodies directed against a 200kDa protein on dermal extract. The treatment is not well defined, even if dapsone appears to be the most effective therapy. To our knowledge, our patient is the first to be successfully treated with mycophenolate mofetil.. Treatment of anti-p200 pemphigoid is difficult. In our case, treatment by mycophenolate mofetil was effective and could offer an alternative to dapsone.

Topics: Aged; Autoantibodies; Autoantigens; Clobetasol; Dapsone; Drug Resistance; Humans; Immunoglobulin G; Immunosuppressive Agents; Laminin; Male; Methotrexate; Mycophenolic Acid; Pemphigoid, Benign Mucous Membrane; Pemphigoid, Bullous; Prednisolone; Remission Induction; Skin

Cicatricial pemphigoid or benign mucous membrane pemphigoid is an autoimmune bullous disease predominantly affecting the mucosal surfaces and healing with scar formation. Localized cicatricial pemphigoid of the vulva in children is rare. We present a child with this rare condition who was initially investigated on suspicion of her being subjected to child sexual abuse, and discuss its management.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone Valerate; Child; Clobetasol; Female; Humans; Pemphigoid, Benign Mucous Membrane; Treatment Outcome; Vulvar Diseases

Desquamative gingivitis is a condition characterized by intense erythema, ulceration, and desquamation of the free and attached gingiva. Approximately 50% of desquamative gingivitis cases occur on the gingival tissues though it is not uncommon at other intraoral and extraoral sites. Though topical corticosteroids are considered the mainstays in the treatment of desquamative gingivitis, the inability of these medicaments to be in contact with the affected sites for longer duration has been implicated as a factor in reducing the efficacy of this mode of treatment. The case presented here is of a 24-year old male with desquamative gingivitis of 3 years duration. Topical corticosteroid therapy using custom-made acrylic veneers was utilized in the patient with remarkable results. This paper highlights the use of acrylic labial veneers over the gingival tissue as a vehicle for delivering medication and as a way to improve aesthetics.

Topics: Acrylic Resins; Administration, Topical; Adult; Anti-Inflammatory Agents; Clobetasol; Dental Veneers; Drug Delivery Systems; Gingivitis; Humans; Male; Pemphigoid, Benign Mucous Membrane

We sought to describe the response of patients with severe erosive gingival lesions to treatment with clobetasol propionate in Orabase paste administered in trays. The adverse effects were also recorded.. A descriptive pretest/posttest clinical study with no control group (33 patients total) was developed. All patients received repeated applications of 0.05% clobetasol propionate plus 100,000 IU/cc of nystatin in Orabase paste. Over the 48-week period, the pain levels, ulcerations, presence of atrophy, and the patients' daily activities were recorded, and Likert scales were used to classify each outcome as either a complete recovery, excellent, good, poor, or failed. The presence of any adverse effect was also noted.. At the end of the study period, the pain and ulceration had disappeared (complete response) in 100% of the sample (33/33; 95% confidence interval = 89.4%-100%), and there was a complete recovery of daily activities and remission of atrophy in 93.9% (31/33; 95% confidence interval = 79.8%-99.3%) and 21.2% (7/33; 95% confidence interval = 9.0%-38.9%) of the patients, respectively. No adverse effects related to the treatment were observed.. The application of an Orabase paste of 0.05% clobetasol 17-propionate plus 100,000 IU/cc of nystatin by means of a tray appears to be an efficacious treatment for severe erosive gingival lesions.

Topics: Activities of Daily Living; Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Autoimmune Diseases; Clobetasol; Confidence Intervals; Drug Combinations; Female; Follow-Up Studies; Gingival Diseases; Glucocorticoids; Humans; Lichen Planus, Oral; Male; Middle Aged; Nystatin; Pain Measurement; Patient Satisfaction; Pemphigoid, Benign Mucous Membrane; Stomatitis, Aphthous

Desquamation of the gingiva is a sign that may be encountered in clinical practice. Various diseases can affect the gingival tissues. Mild desquamation that is localized may be associated with mechanical irritation or induced by trauma. Moderate to severe generalized desquamation associated with ulceration and erythema may be indicative of a more serious systemic condition. Although often overlooked, mucocutaneous diseases frequently present with gingival desquamation as an early presenting symptom. The most common mucocutaneous diseases that affect the oral cavity are lichen planus, pemphigus, and mucous membrane pemphigoid. This article reviews the etiology, signs and symptoms, and therapies for these disorders. Increased knowledge of mucocutaneous diseases can help the clinician recognize these disorders and enable the patient to receive appropriate therapy.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Autoimmune Diseases; Biopsy; Clobetasol; Dapsone; Diagnosis, Differential; Fluocinonide; Gingivitis; Glucocorticoids; Humans; Immunosuppressive Agents; Lichen Planus, Oral; Pemphigoid, Benign Mucous Membrane; Pemphigus; Prednisone

In the present study the efficacy of systemic and topical steroid treatment in the management of 11 patients with mucous membrane pemphigoid (MMP) confirmed histologically and immunologically has been evaluated. Eight patients were treated with a topically applied clobetasol in a bioadhesive gel (2-3 times/daily) and with chlorexidine mouth-washes (3 times/daily) and myconazole gel (1 time/daily) as antimycotics. The remaining 3 were treated with systemic prednisone (25 to 100 mg/daily) followed by a topical therapy with clobetasol, chlorexidine and myconazole. In 6 cases (54%), 4 topically treated and 2 systemically plus topically treated, we observed a complete clearance of signs and symptoms of MMP in an average period of 5.7 months. In the remaining 5 cases (46%), 4 topically treated and 1 systemically plus topically treated, we observed partial healing of the oral lesions. One patient treated with a high dose of prednisone (100 mg/daily) showed side-effects (insomnia, fluid retention and gastralgia) whereas other 3 subjects had oral candidiasis. In a mean follow-up time of 13 months (range 6 to 27) 6 patients (54%) were free of disease, 3 (27%) had a marked improvement and 2 (18%) had new active lesions of MMP. These results suggest that often in the treatment of MMP a systemic corticosteroid therapy followed by a treatment with high potency topical steroids is useful to obtain a good control of MMP.

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Chlorhexidine; Clobetasol; Female; Humans; Male; Miconazole; Middle Aged; Mouth Diseases; Mouth Mucosa; Pemphigoid, Benign Mucous Membrane; Prednisone