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Bufexamac ointment which contains 5 % of nonsteroid antiinflammatory agent 'bufexamac' was testified as effective as topical steroid preparations in the field of dermatology.In this study, bufexamac ointment was locally applied to 181 patients with various anal diseases. The results are ; the drug was effective in 92 % of the cases with thrombosed hemorrhoids, in 81 % with perianal eczema and dermatitis, also effective in 65 % internal hemorrhoids and 70% of internal-external hemorrhoids. The efficacy was also observed in 80% of the cases of anal fissure and 74% of postoperative edema and delayed healing cases. Of all the cases treated, the effect was excellent in 31%, good in 45%, fair in 18% and poor in 6%. Neither a case of exacerbation nor side-effects was observed.From the view-point of the relief of symptoms, the drug was effective on 79 % of pain, 71 % of swelling, 65 % of bleeding and 66 % of pruritus. This efficacy to the various symptoms is also the characteristic of the ointment. The other characteristic is its efficacy on the combined diseases. Statistically, no difference was observed between the efficacy in the cases with one disease and with multiple diseases.

SUMMARY Several cream and ointment vehicles were developed for a new topical steroid, fluclorolone acetonide. The relative activity of the drug in. these formulations was evaluated by vasoconstrictor assays and by release studies. Enhanced drug release and superior vasoconstrictor activity were demonstrated by fluclorolone acetonide when prepared in vehicles in which it was entirely solubilized. Furthermore, the correlation found between solubility, release and in vivo response demonstrated the usefulness of in vitro release studies in predicting vehicle efficacy. The technical aspects of development and evaluation of ointment and cream vehicles for this steroid are discussed.

Tissue eosinophilia has been demonstrated in the skin sites of allergic individuals following application of the allergen. The eosinophilia was greatest with the allergen which clinically seemed to be responsible for the patient's symptoms. Phenergan appeared to increase skin window eosinophilia, although this conclusion must await further study. Application of a topical steroid failed to produce a consistent alteration in eosinophil counts, while oral steroid therapy abolished eosinophilia. The steroid probably exerted its effects by markedly reducing the blood eosinophil level. The suspected chemical mediators of eosinophilia in a skin abrasion were investigated. These studies demonstrated that histamine was capable of inducing tissue eosinophilia in allergic subjects but not in normals, implicating skin-sensitizing antibody as a further prerequisite for the production of tissue eosinophilia.

BACKGROUND:Topical steroid is effective alternative to circumcision in boys with phimosis. We evaluated theeffectiveness of topical steroid therapy as primary treatment in patients with phimosis.MATERIAL AND METHODSThe study was conducted from January 2010 to Jan 2013 in institute of kidney diseases Hayat abadmedical complex Peshawar. A total of 38 male children who had a Kikiros retractability grade of 4 or 5phimosis were included in the study. Topical steroids (0.05% clobetasol propionate cream) were appliedtwice a day. The outcome was defined as successful if the prepuce was retractable with completeexposure of the glans after 4 to 6 weeks of treatment and there was no recurrence at 6-month follow up.RESULTS: A total of 38 male children with mean age of 2.11±1.78 years (range, 3 months to 12 years)were allocated to treatment with topical steroid cream. Three patients were excluded for lost to followup. A successful result (i.e., full retraction of the foreskin), after 4 or 6 weeks treatment with topicalcream was achieved in a total of 29 (82.85%) patients. The remaining 6 patients (17.14%) showed noresponse. Three had circumcision. No significant local or systemic side effects were noted with theadministration of the topical steroidCONCLUSION: Treatment with topical application of 0.05% clobetasol propionate cream and skinstretching for 4-6 weeks is a safe, simple, and effective procedure with no significant side effects forsevere phimosis in boys.KEY WORDS: phimosis, topical steroids, circumcision

Whether antibiotics should be combined with topical steroids in the treatment of chronic dermatoses is a question that is extraordinarily difficult to answer. The alternative proposed in this study is appraisal of efficacy in experimental human infection with Staphylococcus aureus and Candida albicans . With a broad spectrum steroid-antibiotic combination containing triamcinolone acetonide, neomycin gramicidin, and nystatin, it was possible to show that omission of any one component decreased the effectiveness of the mixture. The steroid by itself suppressed the experimental lesion without influencing the multiplication of the pathogen.

SummaryA double-blind trial comparing 0.025% fluclorolone acetonide in FAPG base with 0.1% betamethasone-17-valerate plus 0.5% neomycin has been carried out in 54 patients suffering from skin disease which, in the physician's opinion, required treatment with a topical steroid plus anti-infective agent. Clinical and bacteriological equivalency of the two products has been demonstrated.

Background: Topical steroid application is an effective alternative to circumcision for the treatment of infant and childhood phimosis. Materials & method: prospective study in 42 boys under 13 years of age, with non retractable foreskin with asymptomatic and past history of disease in grade 4 to 6 weeks treatment. the success was defined as full and free retraction, or easy retraction limited only by congenital adhesions to the glans. Results: Forty-two patients completed the treatment. Successful retraction was achieved in 14 (33.33%) at 4 weeks and 32(76.19%) after 6 weeks of application. No adverse systemic side effects were noted. Two patients had failed treatment and were enrolled for circumcision. Two patients refused further treatment. Six patients were lost in subsequent to follow-up. Conclusion: Betamethasone 0.10% ointment is an effective alternative, non surgical method of the treatment for the childhood phimosis. Keywords: Chilhood phimosis; betamethasone DOI: 10.3126/hren.v8i3.4211Health Renaissance, September-December 2010; Vol 8 (No.3);176-180

Using the vasoconstrictive effects of topical steroid application as a marker, we studied the effect of anhidrosis on the percutaneous absorption of a corticosteroid ointment and cream. We found that a decrease in sweating ability resulted in a decrease in blanching and presumably in percutaneous absorption of steroid.

Corrigendum There is correction in the Journal of Dhaka Medical College, April 2009 issue (Vol. 18, No. 1). In the original article titled "Treatment of vitiligo with autologous epidermal transplantation using the roof of suction blisters, first in Bangladesh", the name of the first author will have to be read Khondoker MS instead of Khundkar SH, and in address of correspondence Dr. Md. Sajjad Khondoker instead of Prof. Shafquat Hussain Khundkar at page no. 58. On 15/02/2011, the first author's name was changed from SH Khundkar to MS Khondoker on the online edition of the journal on BanglaJOL. We report our experience of autologous epidermal transplantation for 30 (Thirty) patients with vitiligo. The vitiligo in 25 (Twenty five) patients was stable whereas in the rest (5) it was active. Autologous epidermal transplantation was performed using suction blister roofs from normal pigmented skin to vitiligo skin that was failed to repigment using topical steroid and/or psoralenultraviolet- A treatment. Grafts were well taken in all the patients. Only three of them are presented as case report in this article. There were no complications except mild hyper pigmentation at the donor areas. For the patient who had active vitiligo, depigmentation of the graft and concomitant Koebner‘s phenomenon at the donor site were observed 3 weeks after the procedure. We conclude that autologous epidermal transplantation using the roof of suction blisters is an excellent and safe regimenting procedure for stable, localized vitiligo and the active disease precludes transplantation. Key words: Epidermis surgery; vitiligo therapy; transplantation alutologous. DOI: 10.3329/jdmc.v18i1.6308 J Dhaka Med Coll. 2009; 18(1) : 58-63

Tinea incognito remains diagnostic challenge even to expert specialist because of modified clinical presentation caused by of inappropriate use of topical steroid. Topical steroid are being prescribed frequently for vary many dermatosis including fungal infection of skin and being used by patient as "over the counter drug" leading to varied clinical presentation of common dermatosis. This case report is of iatrogenic dermatosis that was invariably misdiagnosed by general physicians. Key words: Tinea incognito; dermatosis; fungal infection. DOI: 10.3126/jcmsn.v6i3.4076Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.46-49

SUMMARY. —Beclomethasone dipropionate is a new topical steroid with marked vasoconstrictor and anti-inflammatory activity. At a concentration of 0·025% in a simple, oil-in-water emulsion “cream” base beclomethasone dipropionate is significantly more effective clinically than is fluocinolone acetonide 0·025%) in an apparently similar base. The effectiveness of beclomethasone dipropionate 0·025% in an ointment base is significantly increased by dissolving the steroid in propylene glycol before incorporating it into the ointment. Beclomethasone dipropionate 0·025% in a propylene glycol/ointment base is clinically indistinguishable from fluocinolone acetonide 0·025% ointment. Further investigation of the influence of cream and ointment bases on the clinical effectiveness of topical steroids might prove interesting.

Two main purposes in the present study were: 1. to determine the feasibility of using the tissue adhesive isobutyl 2-cyanoacrylate in reconstructive middle ear surgery; and 2. to learn whether a potent topical corticosteroid (0.1 percent dexamethasone) would have beneficial anti-inflammatory effects when placed in the tympanic cavity at the time of middle ear surgery. Tympanoplastic surgery was performed on 26 cat ears and six squirrel monkey ears; the animals were followed for six weeks to nine months postoperatively. The conclusions to be drawn from this experimental study are that presently the tissue adhesive isobutyl cyanoacrylate appears too toxic for use on the delicate middle ear structures; likewise, corticosteroids placed in the middle ear do not appear to have any beneficial effects in tympanoplasty surgery.

The cause of granuloma annulare is unknown. The disease runs an unpredictable course, with lesions persisting for months or years. Partial or total involution does occur, and often the disorder clears without treatment; however, recurrences are not uncommon. The most common and effective therapy is topical steroid cream under plastic occlusion or use of steroid tape.

The hydrocortisone diethylaminoacetate ointment and the hydrocortisone ointment were supplied through the courtesy of Dr. M. Carlozzi, of Charles Pfizer & Company, Inc., Brooklyn. It is generally accepted that lipid-soluble substances penetrate the epidermis better than water-soluble substances.1Rothman2states that, despite extensive discussion of this point, it has not been established that absorption is a straight function of the distribution coefficient lipid solubility/water solubility. Consequently it was unexpected to find that an ointment containing 0.5% hydrocortisone diethylaminoacetate, which is a water-soluble and lipophobic ester of hydrocortisone, was the therapeutic equivalent clinically, on topical application, of a 1% hydrocortisone in the same base. The water solubility of hydrocortisone diethylaminoacetate is 11 mg. per cubic centimeter in contrast to that of hydrocortisone (0.28 mg cc.) and hydrocortisone acetate (0.01 mg cc.). One hundred fifty-four patients with conditions usually responsive to topical steroid

ALLOTT, E. N., and SKELTON, M. 0. (I960): Increased Adrenocortical Activity Associated with Malignant Disease, Lancet, ii, 278. BAGSHAWE, K. D. (ig6oa): Hypokalsemia, Carcinoma and Cushing's Syndrome, Ibid., ii, 284. (ig6ob): Hyperfunction of the Adrenal Cortex with Adrenal Metastases, Ibid., ii, 287. REES, J. R., ROSALKI, S. B., and MACLEAN, A. D. W. (I960): Hyponatrsemia and Impaired Renal Tubular Function with Carcinoma of Bronchus, Ibid., ii, IOO5. ROBERTS, H. J. (1959): The Syndrome of Hyponatremia and Renal Sodium Loss Probably Resulting from Inappropriate Secretion of Antidiuretic Hormone, Ann. intern. Med., 51, 1420. SCHWARTZ, W. B., BENNETT, W., CURELOP, S., and BARTTER, F. C. (1957): A Syndrome of Renal Sodium Loss and Hyponatrxemia Probably Resulting from Inappropriate Secretion of Antidiuretic Hormone, Amer. J. Med., 23, 529. , TASSELL, D., and BARTTER, F. C. (I960): Further Observations on Hyponatrmmia and Renal Sodium Loss Probably Re3ulting from Insppropriate Secretion of Antidiuretic Hormone, New Engl J. Med., 262, 743. TURNER, P., and WILLIAMS, R. (I962): Unexplained Steatorrhoea in the Syndrome of Hyponatreemia and Carcinoma of Bronchus, Brit. med. J7., i, 287.

This report describes the influence of the vehicle base of an applied topical steroid on the therapeutic efficacy of the medication. Fluocinolone acetonide in a 0.025% concentration was the steroid used. This was applied in a cream (a water-washable aqueous base of stearic acid, propylene glycol, sorbitan monostearate and mono-oleate, polyoxyethylene sorbitan monostearate with methyl and propylparaben as preservatives) * and an ointment (white petrolatum)† vehicle. Fluocinolone acetonide has been shown to be therapeutically effective when utilized topically in the treatment of psoriasis and eczematous dermatoses. 1-5 Eighteen patients with psoriasis and 32 patients with atopic, contact, seborrheic, hypostatic, or nummular dermatitis were included in the study. The cream and ointment preparations were applied in two ways: simultaneous paired comparison, and alternating consecutive weekly trial usage. Each trial comparison was judged at weekly intervals. In instances where Saran wrap was used, the cream and ointment applications were exactly matched. Where indicated

A previous paper on the efficacy of methylprednisolone acetate in an ointment base reported good results in the treatment of dermatoses amenable to topical steroid therapy. 1 Because the ointment vehicle was unsuitable for application to weeping lesions or to unexposed body areas, the author (Goldberg) selected only patients with subacute or chronic lesions on exposed surfaces. Early clinical impressions concerning another methylprednisolone product have been favorable. 2-4 In this product * methylprednisolone acetate is contained in a new watermiscible base, which in composition closely simulates the composition of normal skin lipids, allowing more physiological topical therapy. Hydrocortisone serves as the reference standard for the evaluation of new topical steroid preparations. Accordingly, the present study was designed to compare the relative effectiveness of 0.25% methylprednisolone acetate and 1% hydrocortisone acetate in the new water-miscible base. Materials and Methods Four hundred seventy-seven patients with dermatoses expected to respond to topical steroid therapy

The effects of steroid eye drops were tested on isolated preparations of the sphincter, dilator, and ciliary muscles of the monkey. The resting tension of sphincter and ciliary muscle strips decreased in the presence of the topical steroid preparations while that of the dilator muscle increased, and muscle contractions evoked by acetylcholine, epinephrine, serotonin, or potassium chloride were markedly inhibited. In all cases the steroids when tested without vehicles were ineffective while responses to the vehicles alone were identical to those of the steroid-containing eye drops. Some ingredients of the vehicles are capable of altering smooth muscle function in vitro possibly by disturbance of the permeability of the cell membrane.

SUMMARY The judicious use of steroid preparations under polythene film has revolutionized the treatment of chronic psoriasis and other intractable genodermatoses such as atopic eczema. However, occlusive therapy can be tedious and many patients who have established satisfactory control with occlusion become neglectful in its use and suffer disappointing recurrences. There is no suitable alternative treatment for those patients, who must persist with occlusion in order to maintain maximal control of their dermatoses, other than methotrexate and/or oral steroids. It would indeed be ideal if a relatively inexpensive topical steroid could be presented in a base so penetrating that it would obviate the need for occlusion in the management of persistent recurring dermatoses.

Eighty-one patients with a previous differential ocular response to topically administered steroids were evaluated for a change in plasma cortisol after being given 0.75 mg of orally administered dexamethasone. Twenty-four hours after administration, a differential response in plasma cortisol was noted. A statistically significant negative correlation was found between the previous change in ocular pressure and the present change in plasma cortisol. The correlation was significant for white patients but not for Negroes. Patients with a high ocular pressure response to topically administered steroids and a small decrease in plasma cortisol resemble patients with Cushing's Syndrome in their response to orally given dexamethasone. Unlike the topical steroid test, the dexamethasone suppression test does not depend on the patient's cooperation for a long-term treatment. The dose is accurately administered, and the response is objectively evaluated within a short period of time.

Background: Steroid induced glaucoma is an important cause of ocular morbidity and blindness. Objective: To determine the incidence of steroid induced ocular hypertension following pterygium surgery. Methods: A total of 202 eyes of 202 patients with primary pterygium which received steroid eye drops after undergoing surgical excision were selected. Pre-operative and post-operative intra-ocular pressure (IOP) were measured and followed up after 2nd and 6th weeks following surgery. Results: Ocular hypertension developed in 47 (23.27 %) eyes. The IOP returned to normal after two weeks following discontinuation of topical steroid drops (dexamethasone) and initiation of anti-glaucoma medication (Timolol drops 0.5% BD). Conclusion: Nearly one fourth of the patients receiving topical steroid following pterygium surgery presented with ocular hypertension. Measurement of IOP as early as 2 weeks of initiation of steroid drops helps identify steroid induced ocular hypertension. DOI: http://dx.doi.org/10.3126/hren.v10i1.6009 HREN 2012; 10(1): 57-58

The treatment of dermatoses of the scalp is often made more difficult by the unpleasantness of the preparations commonly in use. Women in particular are loath to apply creams and ointments which leave the hair darkened, greasy, smelly, and in need of frequent washing. Psoriasis of the scalp, a frequent and sometimes the only manifestation of the disease, can often be treated successfully with ointments containing tar. However, the application of tar ointments results in all the cosmetic disadvantages we have mentioned. Betamethasone 17-valerate (Betnovate) has been shown to be the most effective topical steroid in the treatment of psoriasis (Williams et al., 1964), and McKenzie and Atkinson (1964) have demonstrated that this steroid is highly active in an alcoholic solution. It was felt that an alcoholic formulation of betamethasone 17-valerate would thus provide a more acceptable treatment for psoriasis of the scalp. A double-blind clinical trial was carried out with a lotion containing 0.1% betamethasone 17-valerate in 50% isopropyl alcohol. The alcohol was slightly gelled, to render the lotion less mobile and thus easier for the patient to control when applying it to the scalp. As it was thought that the cosmetic advantages of this preparation might in part be offset by the patient's having to wear a dressing on the head at night, the formulation was not used under polyethylene occlusion.

In a society that demands a drug for the cure of every illness, Reay's remarks (p 830) contribute to "overkill." His premise is that childhood asthma can be managed by drugs. Brief remarks are made about dust control and animal exposure while the subject of desensitization is dismissed with the statement "some older children whose clinical history points clearly to one specific allergen and in whom skin tests are confirmatory are helped by desensitization." Such a regimen may do the child and his family a disservice. Reay prescribes three drugs; (1) an aerosol adrenergic agent such as albuterol (salbutamol), (2) cromolyn sodium, and (3) an aerosol topical steroid. Aminophylline is reserved for intravenous use in hospitalized patients, along with oxygen, steroids, and antibiotics. Such management of childhood asthma is not representative of the prevailing attitude of pediatric allergists in the United States, who believe that any child who requires this

A young woman being treated for linear scleroderma became allergic to fluocinonide (Lidex) cream while using it with occlusion. She was able to continue treatment with fluocinonide ointment without an adverse reaction. Patch testing with the ingredients of the cream demonstrated sensitization to an impurity in commercial stearyl alcohol and irritation from propylene glycol. The woman had no adverse reactions to fluocinonide ointment because this preparation contains no stearyl alcohol and very little propylene glycol. This case reemphasizes the important role of vehicles in contact allergy and indicates that allergic sensitization may be induced despite the presence of a potent topical steroid.

The clinical significance of the ocular hypertension induced by topical steroid application is ultimately dependent upon the nature and magnitude of its effect on visual function. It has been shown in preceding publications that the effect of dexamethasone on aqueous humor dynamics was reversible in nature 1,2 ; complete recovery of the pretreatment values of intraocular pressure and outflow facility was achieved one to two weeks after the cessation of dexamethasone application in all the cases studied. It should be pointed out, in this respect, that the duration of dexamethasone application in these studies did not exceed, in general, four to five weeks. The possibility that longer duration of drug application and of hypertension might result in a permanent change in outflow facility has not been definitively ruled out. The relationship between intraocular pressure level and visual field damage is not a simple one. The involved variables and their relative contribution

Two patients with epidermolysis bullosa hereditaria dystrophica treated with fluocinolone acetonide 0.2% cream and observed for eight months and five months, respectively, are presented. The results, though preliminary, are encouraging with respect to the rapid healing of individual bullous lesions so treated and also to the gradual but definite increase in tolerance of friction and trauma which has been observed in the treated areas. The local use of highly concentrated corticosteroid preparations is offered as a promising therapeutic modality in management of this discouraging and disabling chronic bullous disease for which so little effective therapy has been available.

Desonide cream, 0.05%, is a new nonfluorinated topical steroid cream. A doubleblind clinical evaluation of 133 patients demonstrates it to be as effective as 0.025% fluocinolone acetonide cream in the treatment of steroid responsive dermatoses with no statistically significant preponderance for either steroid.

To the Editor.— Topical corticosteroids are widely used in skin diseases, and the roster of changes they suppress is extensive. The changes they provoke are rather few but they may cause acneiform eruption, itching, irritation, hypertrichosis, burning sensation, striae, dryness, folliculitis, secondary bacterial infection, hypopigmentation, atrophy, maceration, or miliaria. Occlusive dressings with topical steroids may accentuate the above problems. Report of a Case.— This 14-year-old boy appeared in April 1969, with a red, moist, macerated dermatitis of the distal phalanx of the left index finger, present for five months. For cosmetic reasons, he had kept the area covered almost continuously with a "Band-aid." Skin scrapings and culture for fungi were negative. The lesion was treated with full strength flurandrenolide ointment, but was improved in July. Fluocinolone acetonide cream,.2% three times a day, with Saran Wrap occlusion overnight was then prescribed. The next month the dermatitis was gone, and so was

Idoxuridine (IDU) has been proved effective in the treatment of early epithelial herpetic keratitis. 1-3 In cases with stromal involvement moderate doses of topical steroids in conjunction with idoxuridine are usually indicated. 4 This combination of drugs has saved many eyes with severe herpetic keratitis or uveitis. In many cases treatment with small doses of idoxuridine and steroid must be maintained over a long period in order to prevent recurrence of the disease. If such a schedule is followed without accompanying antibiotics, there is a risk of secondary bacterial infection developing in the cornea. Four cases are presented to illustrate this point. Report of Cases Case 1. —A 60-year-old plasterer was seen early in January of 1962. He stated that four weeks previously he got lime in his left eye and was attended by an oculist who prescribed a topical steroid preparation. Examination revealed a markedly injected left eye with

A case of allergic contact dermatitis to a new nail hardening formula put out by a well-known cosmetic firm is reported. This caused a subacute paronychia, onycholysis, and onychomadesis. Regrowth of the nails occurred normally after a topical steroid ointment was applied. Patch tests with the preparation confirmed the diagnosis.

Triamcinolone acetonide, recently synthesized by Fried et al., 1 has an anti-inflammatory effect 40 times as great in animals as cortisone or hydrocortisone. It is the purpose of this report to give the results of a preliminary evaluation of this highly active steroid as a topically applied therapeutic agent. Materials and Methods Triamcinolone acetonide * was supplied initially as a 0.05% and 0.1% lotion. These two creams were compared in a double-blind study with 0.1% fludrocortisone(fluorohydrocortisone) cream. Thepreliminary evaluation revealed the triamcinolone acetonide to possess such a highdegree of effectiveness that a second double-blindsymmetrical paired comparison study3'3 was performed. Hydroeortisone in 1% concentration was supplied in lotion,cream, and ointment forms and compared with 0.1% triamcinolone acetonide in the same bases. Neither the investigator nor the patient knew the identity of the preparations, one of which was applied to lesions on one side of the body and the other, to contralateral similarly involved sites.