sch-22219 and Dermatitis--Atopic

Atopic dermatitis is commonly colonized with Staphylococcus aureus in high densities.. Our purpose was to study the effect of topical corticosteroids on the colonization of S. aureus in atopic dermatitis.. Sixty-six patients were treated with moderately potent, or very potent corticosteroids. Quantification of S. aureus and evaluation of the severity of the eczema was performed before, after 1 week, and after 2 weeks of treatment.. Fifty-three patients carried S. aureus in the most pronounced lesion before treatment. The colonization was significantly correlated with the severity of the eczema. The density of S. aureus was reduced by topical corticosteroids. The reduction increased with the potency of the corticosteroid and was most pronounced during the first week. S. aureus was eliminated after a successful 2-week treatment with a very potent corticosteroid. Propylene glycol 25% added to a moderately potent corticosteroid did not significantly increase the reduction of S. aureus.. Topical corticosteroids of sufficient potency reduce the density of S. aureus in atopic dermatitis.

Topics: Administration, Cutaneous; Adolescent; Adrenal Cortex Hormones; Adult; Child; Child, Preschool; Clobetasol; Dermatitis, Atopic; Drug Therapy, Combination; Female; Humans; Male; Methylprednisolone; Middle Aged; Neomycin; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Clinical Trials as Topic; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Hydrocortisone; Male; Methylprednisolone; Middle Aged; Random Allocation; Skin Diseases

A randomized, double-blind, parallel-group study was conducted comparing the efficacy and safety of alclometasone dipropionate cream 0.05% and clobetasone butyrate cream 0.05% in the treatment of atopic dermatitis in 43 children. The medications were applied to study areas as a thin layer of cream twice daily for 2 weeks. Efficacy was assessed by evaluation of three disease signs (erythema, induration, and pruritus) and by mean of a physician's global evaluation following treatment. Safety was evaluated through patient-reported and clinically observed adverse experiences. Both treatments were effective. At the end of the trial, average reduction in disease signs was 85% for alclometasone dipropionate-treated patients and 86% in the clobetasone butyrate-treated group. In the global evaluation, the physician rated symptoms as cleared in 9 of 22 alclometasone dipropionate-treated patients and in 10 of 21 clobetasone butyrate-treated patients.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone; Child; Child, Preschool; Clinical Trials as Topic; Clobetasol; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Male; Methylprednisolone

Alclometasone dipropionate cream 0.05% was compared to hydrocortisone butyrate cream 0.1% in the treatment of atopic dermatitis in forty children, 5 to 11 years old. In this double-blind, parallel-group trial, the experimental creams were applied twice daily for 2 weeks, without occlusion, to the study areas. Efficacy was evaluated 1 and 2 weeks after the start of treatment. Both creams were effective treatments for atopic dermatitis; however, alclometasone dipropionate was judged slightly more efficacious. Improvement in erythema, induration, and pruritus averaged 76% for alclometasone dipropionate-treated patients and 70% for hydrocortisone butyrate-treated patients. At the end of treatment, the physician's global evaluation indicated nineteen of twenty patients in the alclometasone dipropionate group had between 51% and 100% improvement in disease signs and symptoms, compared with sixteen of twenty patients treated with hydrocortisone butyrate. Two patients in the alclometasone dipropionate-treated group and one in the hydrocortisone butyrate-treated group reported mild stinging.

Topics: Child; Child, Preschool; Clinical Trials as Topic; Dermatitis, Atopic; Double-Blind Method; Female; Humans; Hydrocortisone; Male; Methylprednisolone; Random Allocation

The vast majority of atopic dermatitis follows a mild, chronic relapsing course. In this article, we highlight the art and practice of treating atopic dermatitis based upon a foundation of maintenance care and a ladder of therapy that can teach patients and their families how to best tailor their pharmaceutical options to optimize the management of their disease.

Topics: Clobetasol; Dermatitis, Atopic; Disease Management; Drug Administration Schedule; Glucocorticoids; Humans; Methylprednisolone; Phosphodiesterase 4 Inhibitors; Severity of Illness Index; Triamcinolone

Tacrolimus (FK506) ointment showed remarkable efficacy against atopic dermatitis in animal models and clinical trials. The suppressive effect of tacrolimus on the production of the cytokines involved in atopic dermatitis (IL-2, IL-3, IL-4, IL-5, IFN-gamma and GM-CSF) from human peripheral blood mononuclear cells (PBMC) was investigated. We constructed a new cytokine production system in which T cells are activated by direct stimulation in vitro with anti-CD3/CD2 or anti-CD3/CD28 antibody combination. Tacrolimus inhibited the production of these cytokines by both stimulations. In a comparative study with steroids (alclometasone dipropionate and betamethason valerate) in anti-CD3/CD2 system, tacrolimus and both steroids inhibited Th1 cytokines (IL-2, IFN-gamma), Th2 cytokines (IL-4, IL-5) and IL-3, GM-CSF (produced by both Th1 and Th2). The suppressive effect of tacrolimus on cytokine production was stronger than that of alclometasone dipropionate and equal to or stronger than that of betamethason valerate. The effective dose of tacrolimus (IC50, 0.02-0.11 ng/ml) is almost the same as for Th1 and Th2 cytokines, and 1 ng/ml of tacrolimus suppressed all cytokines completely. These results suggest that tacrolimus suppresses the allergic cytokines from T cells, and that tacrolimus ointment is effective against atopic dermatitis through the inhibition of cytokine production.

Topics: Betamethasone; CD28 Antigens; CD3 Complex; CD4 Antigens; Cell Separation; Cells, Cultured; Cytokines; Depression, Chemical; Dermatitis, Atopic; Enzyme-Linked Immunosorbent Assay; Humans; Immunosuppressive Agents; Indicators and Reagents; Methylprednisolone; Monocytes; Steroids; Tacrolimus

The safety and efficacy of twice-daily applications of alclometasone dipropionate cream 0.05% were evaluated in 39 children with eczema during a three-week open study. Early-morning plasma cortisol levels were monitored at weekly intervals (visits 1, 2, and 3) for six children. For the remaining 33 children, levels were measured at visits 1 and 2 and two weeks later, at visit 4. Improvement in signs and symptoms of erythema, induration, and pruritus and a global response to therapy were determined weekly. Plasma cortisol levels remained within the acceptable normal range of 7 to 25 micrograms/100 ml throughout the study in all 39 children. At the conclusion of treatment, a favorable global response--complete clearing of monitored signs and symptoms--was observed in 28 (72%) children, and marked or moderate improvement was recorded for seven (18%) children.

Topics: Administration, Topical; Anti-Inflammatory Agents; Child; Child, Preschool; Dermatitis, Atopic; Dermatitis, Seborrheic; Diaper Rash; Drug Evaluation; Eczema; Erythema; Humans; Hydrocortisone; Infant; Methylprednisolone; Pruritus