mometasone-furoate and Dermatitis--Contact

We have conducted an open label, non-comparative study in order to assess the efficacy and tolerability of Dexyane Med in combination with corticosteroids in patients with chronic hand eczema (CHE) and contact eczema (CE) in a real-life setting.. Twenty patients, 10 with CHE and 10 with CE, have been enrolled in the study. After the enrollment and the baseline evaluation, patients were treated with topical mometasone once daily and Dexyane Med once daily for one week, followed by Dexyane Med twice daily for three weeks. After the enrollment visit, patients were seen at the end of treatment, after four weeks. A telephone contact was foreseen at the second week. During the visits, mTLSS Score (CHE patients only), IGA Score and VAS for pruritus and pain were calculated. Patients' satisfaction was recorded during the phone contact after two weeks of treatment and at the final visit. Tolerability was evaluated at the end of the study.. All patients experienced a remarkable improvement in mTLSS Score, IGA Score (from a mean of 2.8 to 0.5) and VAS (from 4.5 to 0.6 for pruritus and from 2.9 to 0.3 for pain). The treatment was well tolerated and all patients were satisfied or very satisfied either at the second week or at the end of the study.. Our study has shown that the treatment of chronic hand eczema and contact eczema with a medical device administered twice a day for three weeks, following a one week treatment in combination with a topical corticosteroid, is effective in decreasing the burden of symptoms and well tolerated. To confirm our data, further controlled trials are warranted in order to explore the efficacy and tolerability of Dexyane Med in different types of eczema.

Topics: Adrenal Cortex Hormones; Adult; Chronic Disease; Dermatitis, Contact; Dermatologic Agents; Drug Therapy, Combination; Eczema; Equipment and Supplies; Female; Hand Dermatoses; Humans; Male; Mometasone Furoate; Pain; Pain Measurement; Patient Satisfaction; Pruritus; Treatment Outcome

Chronic hand eczema can be incapacitating, and there is little knowledge of the efficacy and safety of long-term treatment with topical corticosteroids. We compared the efficacy and safety of two different schedules for the treatment of chronic hand eczema with a potent topical corticosteroid, mometasone furoate. In a prospective, open, randomized trial, 120 patients with chronic hand eczema were treated daily with mometasone furoate fatty cream until the dermatitis cleared or for a maximum of 9 weeks. Those who cleared were randomized to treatment for up to 36 weeks with mometasone furoate on Sunday, Tuesday and Thursday (group A), mometasone furoate on Saturday and Sunday (group B) or no further corticosteroid treatment (group C). In the event of relapse, patients were permitted daily treatment with mometasone furoate for 3 weeks on two separate occasions. For 50 of 106 randomized patients, daily treatment for 3 weeks controlled their dermatitis; 29 needed 6 weeks and 27 needed 9 weeks of treatment. During the maintenance phase, 29 of 35 (83%) in group A, 25 of 37 (68%) in group B and nine of 34 (26%) in group C had no recurrences (P = 0.001, chi2-test). Side-effects were minimal. It is concluded that long-term, intermittent treatment of chronic hand eczema with mometasone furoate fatty cream is effective and safe.

Topics: Adolescent; Adult; Aged; Anti-Inflammatory Agents; Dermatitis, Allergic Contact; Dermatitis, Atopic; Dermatitis, Contact; Dermatitis, Irritant; Dermatitis, Occupational; Drug Administration Schedule; Eczema; Hand Dermatoses; Humans; Middle Aged; Mometasone Furoate; Pregnadienediols; Recurrence; Survival Analysis; Time Factors

Painting of haptens onto UVR-exposed skin does not result in sensitization but induces regulatory T cells (Treg). This was explained by UVR-mediated depletion of Langerhans cells (LCs). Furthermore, migration of UVR-damaged but still viable LCs into lymph nodes appears to be essential to induce Treg. Accordingly, the steroid mometasone, which kills LCs, inhibited sensitization but did not induce Treg. In Langerin-diphtheria toxin receptor knock-in (DTR) mice, LCs can be depleted by injection of diphtheria toxin (DT). LC-depleted mice could be sensitized though less pronounced than wild-type mice, but sensitization was not suppressed by UVR. Similarly, Treg did not develop. Langerin is not only expressed in LCs but also in some dermal dendritic cells (dDCs). Langerin-positive dDCs repopulate within 10 days after depletion, whereas LCs are still absent. Langerin-DTR mice treated with DT 10 days before UVR and sensitization were still resistant to UVR-induced inhibition of contact hypersensitivity (CHS). Similarly, Treg did not arise. As in this setting only LCs but not Langerin-positive dDCs are absent, LCs appear to be essential for both the suppression of CHS and the induction of Treg by UVR. This supports the concept that LCs are more important for the downregulation than the induction of immune responses in the skin.

Topics: Animals; Anti-Inflammatory Agents; Cell Movement; Dendritic Cells; Dermatitis, Contact; Dermis; Female; Gene Knock-In Techniques; Heparin-binding EGF-like Growth Factor; Immune Tolerance; Intercellular Signaling Peptides and Proteins; Langerhans Cells; Mice; Mice, Inbred C57BL; Mice, Mutant Strains; Mometasone Furoate; Pregnadienediols; T-Lymphocytes, Regulatory; Ultraviolet Rays

Topical glucocorticosteroids represent the mainstay of antiinflammatory therapy in the treatment of inflammatory skin diseases. Their clinical use, however, is limited by local and systemic side-effects. Thus, in dermatopharmacology there is a large demand for alternative non-steroidal antiinflammatories. Other than transplantation models, most of the frequently used in vivo test systems for assessment of drug-induced immunosuppression measure changes in inflammatory skin responses by means of skin erythema and edema after challenge of sensitized animals. The aim of this study was to develop an alternative mouse model to detect and analyse immunosuppressive effects of topically applied drugs. On the basis of a modified local lymph node assay, we analysed effects of topical hydrocortisone, dexamethasone, mometasone furoate and FK506 (tacrolimus) during the induction phase of contact hypersensitivity. On 4 consecutive days, NMRI mice were treated on the dorsal surfaces of both ears with increasing concentrations of test compound. During the last 3 days, the mice received in addition the contact sensitizer, oxazolone (1%). On day 5, draining auricular lymph nodes were removed in order to assess lymph node cell counts and perform flow cytometric analysis of lymph node cell subpopulations (CD4+/CD25+, Ia+/CD69+, Ia+/B220+). All test compounds proved to exert significant immunosuppressive effects after topical application, but showed differences in their immunomodulatory potential. In conclusion, the local lymph node assay serves as an appropriate model to characterize immunosuppressive effects of topically applied drugs by measuring immunologically relevant end-points.

Topics: Administration, Topical; Animals; Anti-Inflammatory Agents; Dermatitis, Contact; Dexamethasone; Drug Evaluation, Preclinical; Female; Hydrocortisone; Immunosuppressive Agents; Lymph Nodes; Mice; Mometasone Furoate; Oxazolone; Pregnadienediols; Tacrolimus