hoe-777 and Psoriasis

This is an update of a previous report on the use of topical steroids in the management of psoriasis vulgaris. The current focus is on new combination therapies that enhance the efficacy of corticosteroids while diminishing their potential side effects.

Topics: Administration, Topical; Anti-Inflammatory Agents; Calcitriol; Dermatologic Agents; Drug Therapy, Combination; Glucocorticoids; Humans; Nicotinic Acids; Prednisolone; Psoriasis

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

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

Annular pustular psoriasis (annular PP) is a rare but severe variant of psoriasis, which may even occur in early childhood. At this age, therapeutic options are limited and medication issues can be challenging. We report clinical features, diagnostic findings and treatment of an 11-month-old girl with annular PP. Oral acitretin therapy was initiated at 0.9 mg/kg/d and gradually tapered after complete resolution in the subsequent 10 months without relapse. Acitretin proved to be a highly effective therapeutic option in an infant with annular PP.

Topics: Acitretin; Administration, Oral; Administration, Topical; Female; Humans; Infant; Keratolytic Agents; Prednisolone; Psoriasis; Severity of Illness Index; Skin; Treatment Outcome

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Child; Dermatitis, Contact; Glucocorticoids; Humans; Neurodermatitis; Prednisolone; Psoriasis

Topics: Administration, Topical; Adult; Albinism; Anti-Inflammatory Agents; Astemizole; Female; Glucocorticoids; Histamine H1 Antagonists; Humans; Male; Prednisolone; Psoriasis; PUVA Therapy; Sunlight; Vitiligo

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