clobetasol and Pemphigus

Pyodermatitis-pyostomatitis vegetans is a benign, rare disorder characterized by a pustular eruption in the oral mucosa and vegetating plaques involving the groin and axillary folds. Its association with inflammatory bowel disease is well established. We report the case of a 49-year-old-white man with ulcerative colitis who manifested a vegetating, annular plaque in the left inguinal region of 2 months' duration. Oral examination disclosed an erythematous mucosa with multiple painful pustules involving the labial and gingival mucosa. Histopathologic study demonstrated epidermal hyperplasia and an inflammatory infiltrate composed mostly of neutrophils and eosinophils, grouped into microabscesses within the epidermis and with a bandlike configuration in the upper dermis. Results of direct and indirect immunofluorescence studies were negative. We discuss the differential diagnosis between pyodermatitis-pyostomatitis vegetans and pemphigus vegetans.

Topics: Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Carboxymethylcellulose Sodium; Clobetasol; Colitis, Ulcerative; Diagnosis, Differential; Fluorescent Antibody Technique; Humans; Male; Mesalamine; Middle Aged; Mouth Mucosa; Pemphigus; Pyoderma; Stomatitis; Suppuration

The aim of this study was to evaluate the efficacy of a 0.05% clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Cross-Over Studies; Double-Blind Method; Female; Gingivitis; Humans; Lichen Planus, Oral; Male; Middle Aged; Pemphigus; Severity of Illness Index; 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

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

Topics: Administration, Topical; Clobetasol; Desmoglein 3; Exanthema; Female; Fluorescent Antibody Technique; Glucocorticoids; Humans; Injections, Intralesional; Keratosis; Middle Aged; Pemphigus; Scalp; Skin Diseases; Treatment Outcome; Triamcinolone

Topics: Acantholysis; Administration, Cutaneous; Adult; Arm; Clobetasol; Female; Glucocorticoids; Humans; Leg; Neutrophils; Pemphigus; Torso; Treatment Outcome

To present a clinical report of a patient treated with corticosteroids for oral pemphigus vulgaris (PV) lesions.. PV is the type of pemphigus that most often affects the oral mucosa and tends not to appear in elderly people.. Two biopsies were needed for diagnosis. She was treated with oral prednisone and topically with 0.05% clobetasol propionate.. An early diagnosis and treatment is needed for a good prognosis, especially in elderly patients with multiple systemic pathology.

Topics: Biopsy; Clobetasol; Female; Humans; Pemphigus; Prednisone

Topics: Administration, Cutaneous; Clobetasol; Glucocorticoids; Humans; Male; Middle Aged; Pemphigus

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Clobetasol; Diagnosis, Differential; Female; Humans; Mouth Diseases; Pemphigus; Pregnancy; Pregnancy Complications; Prenatal Diagnosis

The twin goals of long-term disease control and minimizing toxicities related to immunosuppression necessitate efforts to find effective steroid-sparing agents in the management of patients with autoimmune bullous diseases. Pemphigus especially requires a long view, because the disease can persist throughout a patient's lifetime, yet few clinical trial reports exist to guide the practitioner.. We review the response of pemphigus patients to tetracycline, doxycycline, or minocycline plus niacinamide (TCN/NAM) as steroid-sparing therapy and to determine the effects of TCN/NAM on autoantibody levels during the long-term treatment of pemphigus.. This was a retrospective chart review in a private medical dermatology practice setting of all pemphigus patients treated between 1993 and 2013. Clinical responses to TCN/NAM therapy after initial high-dose steroid induction therapy and pemphigus antibody levels were recorded over the course of disease flares and treatment cycles along with any related side effects. Anti-desmoglein 1 and 3 titers were compared in a subset of patients over time, and a statistical analysis was performed to correlate the clinical response with antibody levels.. Fifty-one pemphigus patients (43 with pemphigus vulgaris, 7 with pemphigus foliaceous, and 1 with pemphigus erythematosus) received at least 3 months of TCN/NAM, and 16 patients with pemphigus vulgaris had 1 set of pemphigus antibody titers correlating to a baseline/flare and clinical remission. TCN/NAM was associated with disease control in 43 of 51 patients, with a duration of response ranging from 1 to 13 years (mean, 3.14 ± 2.97 years). Thirteen of 51 patients needed no additional treatment for complete disease control, while 33 of 51 needed intermittent topical clobetasol or short courses of oral steroids for long-term management. There were 5 nonresponders. Antidesmoglein titers trended lower in TCN/NAM responders, but only desmoglein 3 approached statistical significance (anti-desmoglein 1, P = .21; anti-desmoglein 3, P = .02).. This is a retrospective analysis from a single practice. A lack of serial autoantibody titers limited statistical analyses.. TCN/NAM may be useful as a steroid-sparing therapy for pemphigus.

Topics: Anti-Inflammatory Agents; Clobetasol; Doxycycline; Drug Therapy, Combination; Humans; Minocycline; Niacinamide; Pemphigus; Retrospective Studies; Tetracycline; Treatment Outcome

Topics: Administration, Topical; Anti-Inflammatory Agents; Biopsy; Clobetasol; Diagnosis, Differential; Follow-Up Studies; Humans; Immunoglobulin A; Male; Microscopy, Fluorescence; Pemphigus; Skin; Young Adult

Topics: Adult; Anticholesteremic Agents; Clobetasol; Enzyme-Linked Immunosorbent Assay; Female; Fluorescent Antibody Technique, Indirect; Humans; Nonprescription Drugs; Pemphigus; Recurrence

Topics: Administration, Cutaneous; Aged; Anti-Inflammatory Agents; Clobetasol; Female; Humans; Immunosuppressive Agents; Ointments; Pemphigus; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aminoquinolines; Antineoplastic Agents; Carcinoma in Situ; Clobetasol; Contraceptives, Oral; Female; Humans; Imiquimod; Papillomavirus Infections; Pemphigus; Treatment Outcome; Vulvar Diseases; Vulvar Neoplasms

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

Seven patients with mild pemphigus vulgaris (n = 3) or pemphigus foliaceus (n = 4) were treated with a very potent topical corticosteroid alone. Clobetasol propionate 0.05% cream was applied to mucosal lesions and involved skin twice a day for at least 15 days, then progressively tapered. Pemphigus was considered to be controlled if healing of lesions was obtained, with a 75% decrease in the number of new lesions per week without addition of any systemic treatment. In all seven patients, the disease was controlled initially with healing of cutaneous lesions within 15 days, while healing of mucosal lesions took at least 1 month. In four patients, remission was maintained with topical corticosteroid alone for a mean 19-month follow-up. In three patients, relapse occurred after 2-11 months, requiring a systemic treatment.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Middle Aged; Mucous Membrane; Ointments; Pemphigus; Retrospective Studies; Skin; Treatment Outcome

Six patients with pemphigoid and three patients with pemphigus foliaceus were successfully treated with topical corticosteroids. This was especially effective in cases of pretibial localized pemphigoid and in mild cases of bullous pemphigoid and pemphigus foliaceus with negative or low-titer circulating autoantibodies.

Topics: Administration, Topical; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Betamethasone; Betamethasone Valerate; Clobetasol; Dexamethasone; Female; Fluocinonide; Glucocorticoids; Humans; Leg Dermatoses; Male; Middle Aged; Ointments; Pemphigoid, Bullous; Pemphigus; Triamcinolone

A 77-year-old man was seen with florid, vegetating nodules in the umbilical, axillary and inguinal areas, scaly erythema in the trunk and fragile nails. Histologically, marked to moderate acanthosis and papillomatosis with intraepidermal abscesses composed of acantholytic cells, eosinophils and neutrophils were seen in the vegetating lesions which showed intercellular IgG deposit by the direct immunofluorescence technique. There were no circulating pemphigus antibodies. The lesions were successfully treated by topical corticosteroids. However, flaccid bullae with hypopyon showing subcorneal acantholysis and intercellular IgG deposits continued to develop. After 3 1/2 years, circulating pemphigus antibody of IgG2 subclass was demonstrated.

Topics: Acantholysis; Administration, Topical; Aged; Anti-Inflammatory Agents; Betamethasone; Clobetasol; Fluorescent Antibody Technique; Glucocorticoids; Humans; Immunoglobulin G; Male; Pemphigus