fluticasone and Facial-Dermatoses

Presenile diffuse familial sebaceous hyperplasia (PDFSH) presents as extensive yellowish papules with central umbilication on the face without involvement of periorificial regions and occurs in adolescents or young adults with a positive family history. Thirteen cases of PDFSH have been reported in the English-language published work, 10 of which responded to oral isotretinoin from 0.5 to 1 mg/kg per day but recurrences were often observed. Herein, we report two cases of PDFSH, which were successfully managed without recurrence with prolonged low-dose isotretinoin (0.2 mg/kg per day, a cumulative dose of 41 and 64 mg/kg, respectively). Treatment protocols among different published works were reviewed to verify the efficacy of isotretinoin.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Biopsy; Cheek; Clinical Protocols; Dermatologic Agents; Facial Dermatoses; Female; Fluticasone; Humans; Hyperplasia; Isotretinoin; Maintenance Chemotherapy; Male; Recurrence; Sebaceous Glands; Treatment Outcome; Tretinoin

No specific data are available on tacrolimus ointment as a second-line treatment in adults with facial eczema.. To compare tacrolimus 0.1% and fluticasone 0.005% ointments in adults with moderate to severe atopic dermatitis (AD) of the face in whom conventional treatment was ineffective or poorly tolerated.. Patients were randomized to double-blind treatment of facial AD with twice-daily tacrolimus ointment (n = 288) or fluticasone ointment (n = 280) for 3 weeks or until clearance. After day 21, patients could continue without the study treatment, apply the same ointment once daily, or switch to the other medication twice daily, depending on lesion clearance and patient/physician satisfaction. The primary endpoint was the day-21 response [> or = 60% reduction in the modified Local Eczema and Severity Index (mLEASI) score]. Secondary endpoints included facial erythema and pruritus, global clinical response, treatment switching at day 21 and safety. RESULTS Response with tacrolimus ointment (93%) was superior to that with fluticasone (88%; P = 0.026). Improvements in mLEASI components were also greater with tacrolimus ointment. Facial erythema and pruritus improved in both groups. Global clinical response was rated 'marked improvement' or better in 88% and 79% of patients in the tacrolimus ointment and fluticasone groups, respectively. At day 21, 9% of patients switched from fluticasone to tacrolimus ointment, while 4.5% switched from tacrolimus ointment to fluticasone. Adverse events were more frequent with tacrolimus ointment as a result of the higher incidence of application-site skin burning sensation. Safety of both drugs was in line with their respective summary of product characteristics.. Tacrolimus 0.1% ointment has superior efficacy to fluticasone 0.005% ointment for twice-daily treatment of adults with moderate to severe facial AD in whom conventional therapy was inadequately effective or not tolerated. Tacrolimus 0.1% ointment is a safe and effective second-line treatment for the control of moderate to severe AD of the face.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Androstadienes; Dermatitis, Atopic; Dermatologic Agents; Double-Blind Method; Drug Administration Schedule; Facial Dermatoses; Female; Fluticasone; Humans; Immunosuppressive Agents; Male; Middle Aged; Ointments; Tacrolimus; Treatment Outcome; Young Adult

Facial and intertriginous skin is more susceptible to corticosteroid-induced atrophy. Dosing regimens are needed for long-term management of corticosteroid-sensitive sites.. The safety and efficacy of 0.005% fluticasone propionate ointment were assessed in the short-and long-term management of moderate to severe psoriasis of facial and intertriginous areas compared with nonfacial, nonintertriginous areas.. Affected areas in 20 patients with psoriasis were treated twice daily for 2 weeks, then once daily for 2 consecutive days every week for 8 more weeks.. More than 50% improvement occurred after 2 weeks (day 15) in 100% of facial and intertriginous lesions and was maintained during long-term therapy in more than 85% of facial and intertriginous lesions. More than 50% improvement for nonfacial, nonintertriginous areas reached only 80% by day 15. Recurrence rates for facial and intertriginous areas were lower than in the nonfacial, nonintertriginous areas. Skin atrophy and telangiectasia did not occur. Facial and intertriginous sites responded more quickly to topical fluticasone propionate ointment than nonfacial, nonintertriginous skin.. Limited application of fluticasone propionate ointment over a period of 10 weeks is effective and delays lesion recurrence without causing skin atrophy in patients with moderate to severe psoriasis in areas at risk for corticosteroid application, such as facial and intertriginous areas.

Topics: Administration, Topical; Adult; Aged; Androstadienes; Anti-Inflammatory Agents; Dermatologic Agents; Drug Administration Schedule; Facial Dermatoses; Female; Fluticasone; Glucocorticoids; Humans; Male; Middle Aged; Ointments; Psoriasis; Recurrence; Treatment Outcome

The treatment options for facial and intertriginous skin are limited because these sites are more susceptible to corticosteroid-induced atrophy. The long-term management of these corticosteroid-sensitive sites requires the use of dosing regimens that are effective, but also safe.. The affected areas in 21 patients with atopic dermatitis were treated twice daily for 2 weeks, and then once daily for two consecutive days each week for eight more weeks.. After 2 weeks, treatment success occurred in 95% of facial and intertriginous lesions and also in 95% of nonfacial, nonintertriginous lesions. During long-term therapy, treatment success was maintained in > 76% of facial and intertriginous lesions, and > 76% of other lesions. Recurrence rates were low, and skin atrophy and telangiectasia did not occur.. Patients with atopic dermatitis of facial and intertriginous areas were successfully treated with a limited application of fluticasone propionate ointment, 0.005%. The treatment resulted in rapid healing and provided efficacy with a low rate of recurrence and no evidence of skin atrophy or telangiectasia over 8 weeks.

Topics: Administration, Topical; Adolescent; Adult; Aged; Analysis of Variance; Androstadienes; Anti-Inflammatory Agents; Dermatitis, Atopic; Drug Administration Schedule; Facial Dermatoses; Female; Fluticasone; Glucocorticoids; Humans; Male; Middle Aged; Ointments; Recurrence; Severity of Illness Index; Treatment Outcome