hoe-777 and Dermatitis--Atopic

Topical glucocorticoids are still among the dermatologicals most frequently used. This is due to their undebatable potency in inflammatory skin disease. Their use is limited by the fear of side effects both systemic and topical, especially skin atrophy. Hence, congeners with an increased benefit-risk ratio are urgently needed and research on new drugs no longer focuses on more active drugs but safer ones. Only recently, evidence has been forwarded that the goal is realistic. Some new glucocorticoids, especially the nonfluorinated double-ester type such as prednicarbate, appear promising. In fact, they seem to affect fibroblast growth in vitro as well as skin thickness in vivo less than equipotent conventional glucocorticoids. Pertinent findings in humans have been obtained with the use of ultrasound equipment. The relevant aspects of chemistry, pharmacology, clinical benefits, and toxicology of the various glucocorticoids old and new are reviewed, as are potential future alternatives.

Topics: Administration, Topical; Anti-Inflammatory Agents; Atrophy; Betamethasone Valerate; Dermatitis, Atopic; Glucocorticoids; Humans; Mometasone Furoate; Odds Ratio; Prednisolone; Pregnadienediols; Psoriasis; Skin

To investigate if pimecrolimus cream 1% reduces the need for steroids in the long-term management of severe pediatric atopic dermatitis (AD).. A total of 184 pediatric patients (aged 2-17 years) with a history of severe AD according to Rajka and Langeland were enrolled. Patients were randomized to treatment with pimecrolimus cream or vehicle cream for a 24-week period. Prednicarbate 0.25% was applied as rescue medication.. Patients on pimecrolimus required steroids on a mean of 29% of study days, compared with 35% of patients on vehicle (p = 0.1841). On the head and neck only, the respective figures were 10 versus 19% (p = 0.0009). In patients enrolled with acute severe disease (Investigator's Global Assessment > or = 4), steroids were used on 28% of the days in the pimecrolimus group compared to 45% in the control group (p = 0.0024). On the head and neck, steroids were used on 10% of study days with pimecrolimus versus 30% with vehicle (p < 0.0001).. The results indicate that the need for topical steroids on the head and neck is reduced with pimecrolimus cream 1% in the management of severe pediatric AD according to the definition of Rajka and Langeland.

Topics: Administration, Topical; Adolescent; Calcineurin Inhibitors; Child; Child, Preschool; Dermatitis, Atopic; Dermatologic Agents; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Ointments; Prednisolone; Tacrolimus; Treatment Outcome

The wet-wrap treatment has been reported to be beneficial in acute episodes of atopic dermatitis (AD) skin lesions.. The efficacy of topical corticosteroid prednicarbat with and without additional wet-wrap dressing was investigated in a prospective, randomized and controlled study.. In the left-right comparison study, 24 adults and children with an acute episode of AD were included. One arm or leg was randomly treated with the topical corticosteroid prednicarbat plus wet-wrap dressing; only prednicarbat was applied on the leg or arm of the other side.. After 48-72 h of treatment, in both groups an improvement of the local SCORAD was observed. In comparison to the side of the body treated with corticosteroid alone, the decrease of the local SCORAD in the corticosteroid plus wet-wrap dressing group was significantly better. The severity of AD improved in the wet-wrap group at an average of 4.4 points, in the corticosteroid group 3.0 (p<0.011).. Wet-wrap therapy with a topical corticosteroid is an effective treatment option in patients with exacerbated AD. The treatment is helpful in improving skin conditions, shortening the time of corticosteroid application.

Topics: Adolescent; Adult; Arm; Bandages; Child; Dermatitis, Atopic; Glucocorticoids; Humans; Leg; Middle Aged; Ointments; Prednisolone; Prospective Studies; Skin; Time Factors; Treatment Outcome

Patients with atopic dermatitis (AD) have an increased tendency to develop bacterial skin infections. Colonization with Staphylococcus aureus is known to be a major trigger and might also play a pathophysiological role. Because of their antiseptic action, silver-coated textiles suppress S. aureus colonization and toxin formation, thus damping the inflammatory reaction.. To evaluate the clinical effectiveness and safety of a special silver textile in the treatment of patients suffering from acute AD.. In a randomized phase II monocenter parallel-group comparative study 30 patients were recruited (average age 25.5 years, min. 4 years, max. 70 years) who were affected by AD in an acute phase. During the first study phase from Day 1 to Day 14, 10 patients received a silver textile (Group 1), 10 a silver-free textile (Group 2), and 10 prednicarbate ointment (Group 3). In the second phase from Day 15 to Day 28 all patients wore the silver textile, and during the follow-up period from Day 28 to Day 56 no textiles were used. Prednicarbate ointment was allowed as emergency medication, but ointment consumption was measured. The overall severity of the disease was evaluated using the SCORAD index as the primary efficacy parameter. Secondary parameters included severity of pruritus and the patients' assessment of their disease control (uncontrolled, limited, good or complete). Safety tests included hematology, blood chemistry, urinalysis for silver, and physical examination for silver deposits in the skin and mucous membranes.. The initial SCORAD was 61.6 (IQR 26.6, min. 30.6, max. 99.9). At the end of the Study Phase 1 the SCORAD had improved significantly in the patients of Groups 1 (74.6-29.9, p = 0.005) and 3 (57.8-24.0, p = 0.009). During Study Phase 2 healing of eczema continued in Group 1 (SCORAD 29.9-18.1, p = 0.037), was observed in Group 2 (48.2-24.1, p = 0.015), and remained at an improved level in Group 3 (SCORAD 24-23.5). Consumption of prednicarbate ointment (Phase 1, Phase 2, follow-up period, medians are given): Group 1: 135 g, 10 g, 45 g; Group 2: 13 g, 0 g, 0 g; Group 3: 145 g, 30 g, 90 g. Silver textiles reduced the severity of the pruritus (p = 0.031); silver-free textiles (n.s.) and prednicarbate (n.s.) were less effective. No undesired events were observed.. The elastic silver textile worn directly against the skin led to an impressive improvement of AD and a reduction in the use of prednicarbate ointment.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Child; Child, Preschool; Dermatitis, Atopic; Female; Germany; Humans; Male; Middle Aged; Prednisolone; Pruritus; Silver; Staphylococcal Skin Infections; Staphylococcus aureus; Textiles; Treatment Outcome

The treatment of atopic dermatitis still remains a challenge. Little research has been done on the issue of the extent to which patients correctly use prescribed topical preparations under everyday conditions.. To investigate what quantity of topical preparations is applied by outpatients in daily routine treatment over a 26-week period and to what extent this consumption is related to the course of the severity of patients' skin conditions.. Thirty adult outpatients (20 female and 10 male) with atopic dermatitis were examined at four different times during 26 weeks. For treatment and skin care these patients were given a topical glucocorticoid preparation (prednicarbate) and the corresponding emollient.. The average severity rating (SCORAD) was 29.6 (before therapy 33.9, after 26 weeks 27.4). The SCORAD indices improved by a mean of 6.5 points (p<0.05).. Patients who applied the correct amount of the prednicarbate-containing preparations (not less than 90% of 0.5 g/dm(2)) to the areas of affected skin showed a significant improvement in SCORAD indices across the four measuring times.

Topics: Administration, Topical; Adult; Dermatitis, Atopic; Emollients; Female; Glucocorticoids; Humans; Male; Prednisolone; Self Administration; Severity of Illness Index; Time Factors

In order to achieve a long-term stabilizing effect on the clinical condition of the skin of patients with atopic eczema, it is imperative to perform consistent topical skincare. Because of time pressures during normal office visits, it is impossible to thoroughly counsel patients who suffer from atopic eczema. We performed a randomized and prospective comparative study to evaluate the outpatient effectiveness of a short-time but impressive teaching and counselling method using the skin model developed by Kardorff and Schnelle-Parker.. Thirty outpatients between 3 and 6 years old with moderate or severe atopic eczema were evaluated. Half of the patients were trained by an active, 10-min demonstration with the skin model on day 0 and day 14. Patients in the control group received verbal instructions of the same duration, as in routine dermatological practice. The SCORAD score was measured blindly on days 0, 14 and 42.. After 42 days, the SCORAD score of the patients taught by the use of the Kardorff-Schnelle-Parker skin model was significantly reduced compared to the control group (P < 0.006).. By counselling atopic children, even of preschool age, with the easily understandable skin model incorporating the sense of touch, better compliance concerning regular skincare can be achieved. We expect positive effects in the long-term management of atopic eczema.

Topics: Child; Child, Preschool; Combined Modality Therapy; Counseling; Dermatitis, Atopic; Female; Humans; Male; Models, Anatomic; Patient Compliance; Patient Education as Topic; Prednisolone; Prospective Studies; Skin Care

The aim of the study was to monitor the impact of local application of prednicarbat (Dermatop, Hoechst-Biotika) and oral administration of cetirizin (Zyrtec, UCB) on the development of the acute stage of atopic eczema (AE) or acute exacerbation of the chronic form of AE in two groups of patients. Effectiveness and safety of both preparations were being evaluated in 80 children undergoing an outpatient treatment. In the first group, only prednicarbat cream was applied to affected places twice a day for a maximum of 10 days, while in the other group also cetirizin was administered once a day in a dosage according to the patient's age. On the treated places, erythema, infiltrate and excoriation were evaluated with respect to the intensity of manifestation. The results of the study show favourable effects of both preparations on AE development, already during the first days of the therapy. In both groups there was a complete remission of the monitored symptoms in more than 80 per cent of the patients. There was no deterioration of the disease in any patient, and no cases of adverse reactions were registered.

Topics: Acute Disease; Administration, Topical; Anti-Allergic Agents; Anti-Inflammatory Agents; Cetirizine; Child; Child, Preschool; Dermatitis, Atopic; Glucocorticoids; Histamine H1 Antagonists; Humans; Infant; Prednisolone

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Blister; Dermatitis, Atopic; Double-Blind Method; Drug Tolerance; Erythema; Female; Fluocortolone; Follow-Up Studies; Glucocorticoids; Humans; Keratosis; Lichenoid Eruptions; Male; Middle Aged; Ointments; Prednisolone; Pruritus; Remission Induction

Topics: Administration, Cutaneous; Adult; Anti-Infective Agents; Dermatitis, Atopic; Double-Blind Method; Drug Combinations; Female; Humans; Male; Prednisolone; Quaternary Ammonium Compounds; Staphylococcal Skin Infections; Treatment Outcome

In a double-blind, randomized multicenter study in patients with acute episodes of atopic dermatitis, the efficacy and tolerance of 0.5% halometasone (Sicorten) cream were compared with those of 0.25% prednicarbate cream. A total of 165 patients (88 men, 77 women) were admitted to the study. The halometasone group contained 9% more cases with severe disease than did the prednicarbate group. Two daily nonocclusive applications were permitted, and treatment lasted 14 days. No difference in the onset of the effect was observed between the two groups. With respect to clinical efficacy, higher healing rates were found in the halometasone group: 50.6% versus 34.5% in the patients as a whole, and 39.5% vs. 16.2% in the subgroup of clinically severe cases. Applying stratification, a statistical difference was found in the clinically severe cases. Both creams were well tolerated; undesired side effects were observed neither with halometasone cream nor with prednicarbate cream. Cosmetic acceptance was assessed as very good by 50.6% of patients treated with halometasone cream, and 46.0% of patients treated with prednicarbate cream. Summarizing, it may be noted that halometasone cream is more effective than prednicarbate cream, and is equally well tolerated.

Topics: Acute Disease; Administration, Topical; Adolescent; Adult; Anti-Inflammatory Agents; Betamethasone; Child; Child, Preschool; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Infant; Male; Middle Aged; Ointments; Prednisolone

We report on the results of an openly conducted multicenter study concerning efficacy and tolerance of a new prednisolone derivative free from halogenic groups (prednicarbate 0.25%, Dermatop) prepared as a) emulsifiable greasy ointment without water, b) w/o emulsion (ointment), and c) o/w emulsion (cream). These preparations were therapeutically applied in eczema (allergic, seborrheic, microbic), psoriasis, and atopic dermatitis. The study was carried out in close team work between a clinic and 37 practicing dermatologists and included 383 patients. After 3 weeks therapy, 4% of the patients did not reveal any satisfying results; 16% showed medium outcome with some persisting symptoms; in 80% of the patients, we observed good to very good therapeutic results.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Berlin; Child; Child, Preschool; Clinical Trials as Topic; Dermatitis; Dermatitis, Atopic; Dermatitis, Seborrheic; Eczema; Female; Humans; Male; Middle Aged; Pharmaceutical Vehicles; Prednisolone; Psoriasis

Topics: Anti-Inflammatory Agents; Child; Dermatitis, Atopic; Dermatomycoses; Diagnosis, Differential; Hand Dermatoses; Humans; Male; Prednisolone; Thumb; Video Games

Molluscum contagiosum is a viral disease frequently observed in children and adolescents with atopic dermatitis, in whom it poses a special therapeutic challenge. A 3-year-old girl presented with atopic eczema and disseminated molluscum contagiosum on her buttocks and upper legs. Topical application of 0.05% tretinoin resulted in a steady regression of the lesions. Other therapeutic options include topical anti-viral agents, cryosurgery, laser treatment, and curettage. Further, the therapeutic outcome is highly dependent on an adequate therapy of the concomitant atopic eczema.

Topics: Administration, Oral; Administration, Topical; Child, Preschool; Dermatitis, Atopic; Drug Therapy, Combination; Female; Humans; Molluscum Contagiosum; Prednisolone; Superinfection; Tretinoin

Atopic dermatitis, common among infants and children, is an intensely pruritic, chronic, inflammatory dermatosis that is traditionally treated with emollients for dry skin and topical corticosteroids for inflamed areas. A multicenter, 3-week, open-label study evaluated prednicarbate emollient cream 0.1%, a nonhalogenated midpotency corticosteroid, in 55 patients aged 4 months to 12 years who were diagnosed with atopic dermatitis. No suppression of the hypothalamic-pituitary-adrenal (HPA) axis was evidenced by serum cortisol levels obtained before and after intravenous injection of 250 mg of cosyntropin on days 1 and 22, and biochemical tests detected no other systemic effects. Adverse events were few and within the expected range. Prednicarbate resulted in improvements based on global evaluations and sign/symptom scores. In conclusion, this study found prednicarbate emollient cream 0.1% to be safe and effective for the treatment of atopic dermatitis in pediatric patients for up to 3 weeks.

Topics: Administration, Topical; Adolescent; Anti-Inflammatory Agents; Child; Child, Preschool; Dermatitis, Atopic; Glucocorticoids; Humans; Infant; Ointments; Prednisolone

Topics: Administration, Topical; Anti-Inflammatory Agents; Dermatitis, Atopic; Glucocorticoids; Humans; Neurodermatitis; Prednisolone; Skin

Prednicarbate (Dermatop) was topically applied in 50 children suffering from inflammatory dermatoses. In 12 children, the courses of therapy were documented by photographs. Its rapid onset of action, its lacking suppression of the endogenic biosynthesis of cortisol, as well as its small antiproliferative effect on cutaneous fibroblasts suggest that prednicarbate bears only minor risks especially for children's skin.

Topics: Administration, Topical; Anti-Inflammatory Agents; Child; Child, Preschool; Dermatitis; Dermatitis, Atopic; Dermatitis, Contact; Dermatitis, Seborrheic; Eczema; Female; Humans; Male; Prednisolone

Prednicarbate is a new potent corticoid without halogenic groups which has been developed for topical application. During one week's application of 0.25% prednicarbate ointment (W/O Emulsion) two times daily in an ordinary dose, there could not be proved any significant suppression of the basal production of plasma cortisol in patients suffering from extensive dermatoses (such as psoriasis vulgaris or atopic dermatitis). After the end of treatment, investigation on the reservoir within the adrenal cortex by means of ACTH short test showed sufficient stimulation capacity of the adrenal gland in all patients examined.

Topics: Administration, Topical; Adolescent; Adrenocorticotropic Hormone; Adult; Anti-Inflammatory Agents; Dermatitis, Atopic; Drug Administration Schedule; Female; Humans; Hydrocortisone; Male; Middle Aged; Prednisolone; Psoriasis

In 20 patients suffering from acute or chronic inflammatory dermatoses, topical treatment with prednicarbate (Dermatop) was photographically documented and evaluated. Because of the rapid and pronounced anti-inflammatory and anti-edematous effect of prednisolone-17-ethyl carbonic ester without halogenic groups, therapy took only 7 to 21 days. Since there was practically no suppression of the endogenic biosynthesis of cortisol and no atrophogenic potency, we expected a minimum of side effects along with a maximum of therapeutic results.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Dermatitis; Dermatitis, Atopic; Dermatitis, Contact; Eczema; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prednisolone; Psoriasis

We report on the clinical efficacy of the local corticoid prednicarbate (chemical name: prednisolone-17-ethyl carbonate-21-propionate). In a concentration of 0.25%, it can be assigned to corticoid force class III. We think it's remarkable that even extensive application of 20 g daily in patients with affected skin and 30 g daily in healthy persons does not cause any suppression of plasma cortisol. Extreme long-term application (12 months) in 4 test persons did not result in any clinical, histological, or electron microscopical signs of topical atrophy; only one case showed slight hypertrichosis. These studies show that we may regard the original opinion as disproved that efficacy and side effects of corticoids are always inseparably linked together. To our minds, this preparation constitutes an essential step towards solving the problem of long-term application of a topical corticoid wherever it may be necessary from the dermatologic point of view, e.g. especially in atopic dermatitis and psoriasis.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Betamethasone Valerate; Child; Cortisone; Dermatitis; Dermatitis, Atopic; Dermatitis, Contact; Desoximetasone; Double-Blind Method; Drug Evaluation; Female; Humans; Male; Middle Aged; Prednisolone; Psoriasis