fluticasone and Atrophy

To evaluate whether 1 year of continuous treatment with intranasal fluticasone propionate would lead to atrophy in the nasal mucosa compared with an active control, oral terfenadine.. Prospective, randomized, multicenter, open-label, parallel-group study.. Two tertiary care academic institutions.. Seventy-five subjects older than 18 years with perennial allergic rhinitis.. Patients received either fluticasone propionate aqueous nasal spray, 200 microg once daily, or terfenadine, 60 mg twice daily, for 1 year. Nasal biopsy specimens were obtained before and after 1 year of treatment and were evaluated for evidence of atrophy.. Epithelial and collagen layer thickness of the nasal mucosa as assessed by light microscopy and the presence and degree of edema, and regularity of collagen fibrils as assessed by electron microscopy. Analyses were performed without knowledge of subject identity or treatment assignment.. Neither fluticasone nor terfenadine treatment led to atrophy in the nasal mucosa by clinical or histologic observation. No significant changes from baseline were observed for any assessment of atrophy. In contrast to what would have been expected if atrophy were to occur, mean epithelial layer thickness in the fluticasone group significantly increased compared with terfenadine treatment (P = .03).. Treatment with intranasal fluticasone for 1 year increases the thickness of the nasal epithelium as compared with a year's treatment with terfenadine and does not lead to atrophy in the nasal mucosa. The increased thickness in the fluticasone treatment may represent repair from epithelial damage caused by chronic allergic inflammation.

Topics: Administration, Intranasal; Administration, Oral; Adult; Androstadienes; Anti-Allergic Agents; Anti-Inflammatory Agents; Atrophy; Female; Fluticasone; Glucocorticoids; Humans; Male; Middle Aged; Nasal Mucosa; Prospective Studies; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Terfenadine

Fluticasone propionate (FP) 0.05% (CutivateTM) cream is a novel corticosteroid used for the treatment of corticosteroid-responsive dermatoses. To date there are no published data concerning its effect on cutaneous atrophy. This randomized, double-blind study of 40 volunteer subjects was performed to investigate the kinetics of skin thinning induced by topical 0.05% FP cream vs. placebo after once-daily application for 2-8 weeks. The results of this study showed no significant effect on the skin thickness of subjects after 8 weeks' treatment with 0.05% FP cream compared with placebo.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Androstadienes; Anti-Inflammatory Agents; Atrophy; Double-Blind Method; Fluticasone; Humans; Kinetics; Middle Aged; Skin

Esophageal lichen planus (ELP) is a rare condition with unknown prevalence that can sometimes be underestimated due to the subtle and nonspecific findings of diagnostic workup. Oral lesions rarely extend to the esophageal mucosa, but when they do, the most frequent symptoms are dysphagia and odynophagia. There is often a significant delay in diagnosis and inadequate treatment. We report the case of a 59-year-old woman diagnosed with ELP, successfully treated with rituximab, a chimeric monoclonal antibody that depletes CD20+B cells. To our knowledge, this is only the second report of this treatment in ELP.

Topics: Alopecia; Androstadienes; Anti-Inflammatory Agents; Antibodies, Monoclonal, Murine-Derived; Atrophy; Esophageal Diseases; Esophageal Stenosis; Esophagitis, Peptic; Esophagus; Female; Fluticasone; Humans; Immunosuppressive Agents; Lichen Planus; Lichen Planus, Oral; Middle Aged; Mucous Membrane; Prednisone; Proton Pump Inhibitors; Rituximab; Salvage Therapy; T-Lymphocyte Subsets; Vulvar Lichen Sclerosus