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Excimer light was reported to be effective in treating alopecia areata (AA), as it induces T-cell apoptosis, however its combination with topical steroids in the management of AA still needs to be investigated. The study objectives were to determine the efficacy and safety of combining 308 nm–Excimer light and topical steroid versus either Excimer light or topical steroid alone in treating AA. Thirty AA patients were included, each patient had at least three patches, patches in each patient were randomly classified in to 3 groups. Group I patch: was treated by topical steroid only. Group II patch: was treated by Excimer light only. Group III patch: was treated by topical steroid and Excimer light. The response for hair growth was assessed at the baseline, week 8, week 12 then at 3months after the last session using a hair regrowth scale and trichoscopy. Any encountered adverse effects were recorded. All treatment groups showed significant improvement at the end of the study compared to the baseline, although hair regrowth was significantly better in group III where 60% of patches showed > 50% hair regrowth. All treatment groups showed significant decrease in black dots (BD) (trichoscopic sign of activity), and increase in signs of improvement (upright growing and pigtail hairs). However, BD and exclamation mark hair (EMH) were significantly reduced in the mixed therapy group compared to the other two groups. We concluded that excimer light is an effective and safe treatment option for AA, particularly when combined with topical steroid. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is a common, acquired, discoloration of the skin, characterized by well circumscribed, ivory or chalky white macules which are flush to the skin surface. Although majority of cases are managed by medical therapies, surgical methods are reserved for lesions not responding to medical treatment and are stable in nature. The basic principle surgical method is the transfer of melanocytes from uninvolved skin to the stable vitiligo patch in the form of either tissue graft or cellular graft. Purpose: To evaluate the effects of topical corticosteroids and PUVAsol in repigmentation of vitiligo patch following split-thickness skin grafting. Methods: Twenty patients of stable vitiligo having total 30 patches were included in the study of which 15 completed it. Each patch is subjected to split-thickness skin grafting and then randomly divided into two groups of fifteen each. Group A received PUVAsol therapy while other received topical steroid therapy started 4 weeks after surgery. During the follow-up of 6 months, five patients were lost to follow-up; fifteen patients were evaluated for pigment spread and side effects at 1st, 4th, 8th, and 24th week. Results: Eight patients (61.53%) in PUVA sol group and seven patients (58.3%) in steroid group had excellent (>90%). Color matching of grafted area was observed to be better with steroid therapy (83.3%), then PUVAsol (76.9%). Conclusion: Although the extent of repigmentation was more in Group A (PUVAsol) then in Group B, the color matching and the side effect profile were improved in Group B (topical steroid). The use of topical corticosteroid is much less cumbersome, cheaper, and easy to administer at home. The limitation of our study was short follow-up and small sample size.

Background: Dermatophytosis is widespread in India due to recalcitrant and resistant infection. Tinea incognito (TI) is modified dermatophytosis due to the inadvertent use of topical steroids (TS). Similarly, topical steroid-damaged face (TSDF) is caused by prolonged use of TS. Distinction of TI and TSDF is difficult when the face is affected. Dermoscopy can assist in the differentiation of both by revealing characteristic features. We evaluated the dermoscopic features in TI affecting the face and TSDF. Aims and Objectives: To evaluate the clinical and dermoscopic features of TI affecting the face and TSDF. To observe the involvement of eyelids in TI as opposed to TSDF. Materials and Methods: The study was conducted in a tertiary hospital after obtaining ethical clearance and informed consent. Patients with signs of TI or TSDF were enrolled and demographic data were collected. Patients who had applied TS/combination creams were included. A handheld dermoscope with 10x magnification was used. A potassium hydroxide mount was used to confirm the diagnosis of TI. Results: Out of 80 patients, 27 males and 53 females were present. The mean duration of application was 8.25 ± 7 months. Clinical features were pruritus, erythema, scaling, and burning sensation. Eyelid involvement was noted in TI while it was spared in TSDF. On dermoscopy, morphological features were predominant in TI whereas vascular structures were found in TSDF in addition to white rosettes. Conclusion: Dermoscopy distinguishes TI from TSDF comprehensively by demonstrating definitive features. In addition, the involvement of the eyelid is an excellent clinical sign of TI.

Background: Dermatophytosis is highly prevalent in India owing to resistant and recalcitrant infection. TI (tinea incognito) is a modified form of dermatophytosis resulting from inadvertent TS (topical steroid) use. Similarly, TSDF (topical steroid-damaged face) is also caused by prolonged topical steroid use. Differentiation of TSDF and TI is difficult in face-affected cases. Dermoscopy can help in differentiating both by revealing their characteristic features. Aim: The present study aimed to assess dermoscopic and clinical features of tinea incognito affecting the face and topical steroid-damaged face. The study also observed the involvement of eyelids in tinea incognito as opposed to topical steroid-damaged face. METHODS: The present study assessed 160 subjects including 54 male and 106 female subjects with signs of tinea incognito or topical steroid-damaged face. In all the included subjects, demographic characteristics were gathered. Subjects that had applied tinea incognito or combination cream were finally included in the study. The study utilized a handheld dermoscope of 10X magnification and a potassium hydroxide mount was used for confirmation of tinea incognito diagnosis. Results: Among 160 study subjects assessed, there were 106 females and 54 male subjects where the meantime of application was 8.23±6.8 months. Clinical features seen in study subjects were burning sensation, scaling, erythema, and pruritus. Involvement of eyelids was seen in tinea incognito and was not seen in topical steroid-damaged face. On dermoscopic assessment, morphological features were dominant in tinea incognito, whereas, vascular features had dominancy in topical steroid-damaged face and white rosettes. Conclusions: The present study concludes that Dermoscopy is vital and helpful for distinguishing tinea incognito from topical steroid-damaged face comprehensively demonstrating the definitive features. In addition, the involvement of eyelids is an excellent clinical presenting sign in tinea incognito. [ABSTRACT FROM AUTHOR]

Objective: Eczema is the most burdensome skin condition worldwide and topical anti‐inflammatory treatments are commonly used to control symptoms. The relative effectiveness and safety of different topical anti‐inflammatory treatments is uncertain. Design: Network meta‐analysis performed within a Cochrane systematic review to compare and statistically rank efficacy and safety of topical anti‐inflammatory eczema treatments. Data Sources: Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase and trial registries to June 2023. Eligibility Criteria for Selected Trials: Included trials were within‐participant or between‐participant randomised controlled trials. Participants had eczema that was not clinically infected and was not contact dermatitis, seborrheic eczema or hand eczema. Interventions were topical anti‐inflammatory treatments but not complementary treatments, antibiotics alone, wet wraps, phototherapy or systemic treatments. Comparators were no treatment/vehicle or another topical anti‐inflammatory. Results: We identified 291 trials (45,846 participants), mainly in high‐income countries. Most were industry‐funded with median 3 weeks treatment duration. Risk of bias assessed using the Cochrane Risk of Bias 2.0 tool was high in 89% of trials, mainly due to risk of selective reporting. Network meta‐analysis of binary outcomes ranked potent and/or very potent topical steroids, tacrolimus 0.1% and ruxolitinib 1.5% among the most effective treatments for improving patient‐reported symptoms (40 trials, all low confidence) and clinician‐reported signs (32 trials, all moderate confidence). For investigator global assessment, the Janus kinas inhibitors ruxolitinib 1.5%, delgocitinib 0.5% or 0.25%, very potent/potent topical steroids and tacrolimus 0.1% were ranked as most effective (140 trials, all moderate confidence). Continuous outcome data were mixed. Local application site reactions were most common with tacrolimus 0.1% (moderate confidence) and crisaborole 2% (high confidence) and least common with topical steroids (moderate confidence). Skin thinning was not increased with short‐term use of any topical steroid potency (low confidence) but skin thinning was reported in 6/2044 (0.3%) participants treated with longer‐term (6–60 months) topical steroids. Conclusion: Potent topical steroids, Janus kinase inhibitors and tacrolimus 0.1% were consistently ranked as among the most effective topical anti‐inflammatory treatments for eczema. [ABSTRACT FROM AUTHOR]

Key points: Chitosan is a promising drug delivery vector for therapeutics owing to its biocompatibility.Once crosslinked with chitosan, prolonged drug release was noted regardless of hydrophilicity.Hydrophilic drugs may require different strategies to obtain a sustained release profile. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis is widespread in India due to recalcitrant and resistant infection. Tinea incognito (TI) is modified dermatophytosis due to the inadvertent use of topical steroids (TS). Similarly, topical steroid-damaged face (TSDF) is caused by prolonged use of TS. Distinction of TI and TSDF is difficult when the face is affected. Dermoscopy can assist in the differentiation of both by revealing characteristic features. We evaluated the dermoscopic features in TI affecting the face and TSDF. Aims and Objectives: To evaluate the clinical and dermoscopic features of TI affecting the face and TSDF. To observe the involvement of eyelids in TI as opposed to TSDF. Materials and Methods: The study was conducted in a tertiary hospital after obtaining ethical clearance and informed consent. Patients with signs of TI or TSDF were enrolled and demographic data were collected. Patients who had applied TS/combination creams were included. A handheld dermoscope with 10x magnification was used. A potassium hydroxide mount was used to confirm the diagnosis of TI. Results: Out of 80 patients, 27 males and 53 females were present. The mean duration of application was 8.25 ± 7 months. Clinical features were pruritus, erythema, scaling, and burning sensation. Eyelid involvement was noted in TI while it was spared in TSDF. On dermoscopy, morphological features were predominant in TI whereas vascular structures were found in TSDF in addition to white rosettes. Conclusion: Dermoscopy distinguishes TI from TSDF comprehensively by demonstrating definitive features. In addition, the involvement of the eyelid is an excellent clinical sign of TI. [ABSTRACT FROM AUTHOR]

Background: Vitiligo is an acquired depigmentation condition. It affects around 0.1%-2% of the general population, regardless of ethnicity, gender, or socioeconomic status of the affected individuals. Vitiliginous patches contain either reduced melanin or no pigment at all. Objective: This study aimed to evaluate the efficacy of Erbium: YAG (Er: YAG) laser plus pimecrolimus and narrowband ultraviolet B (NB-UVB) (on the right side) in comparison with Er: YAG laser plus topical steroid and NB-UVB (on the left side of the same patient) in treatment of vitiligo in the resistant localizations. Patients and methods: The study comprised thirty patients with persistent non-segmental vitiligo and at least two symmetrical lesions on bony prominences and/or extremities. Patients were selected from the Outpatient Dermatological Clinic of Mataria Teaching Hospital. Results: Regarding the area of the lesion on the right side, there was statistically significant difference between the area of the lesion before and after treatment at the 1st, 2nd, 3rd and 6th month of treatment. On the left side, there was also statistically significant difference between the area of the lesion before and after treatment at the 1st, 2nd, 3rd and 6th month of treatment. The higher percentage of improvement was seen in the knees followed by the elbows, while the lateral malleolus has 0% of improvement on both the right and left sides. Conclusion: From this study we concluded that skin ablation by Er: YAG laser followed by NB-UVB in combination with either pimecrolimus or hydrocortisone is one of the alternative treatment modalities in treatment of stable, resistant vitiligo patches with almost no difference between the two treatment lines. [ABSTRACT FROM AUTHOR]

Abstract Background Oral lichen planus (OLP) is a chronic illness of immune origin that is typically treated with corticosteroids as a gold standard therapy. Photobiomodulation (PBM) may represent an alternative remedy that has the potential to treat a variety of pathological conditions by alleviating pain, reducing inflammation, and promoting tissue healing without the drawbacks of steroid therapies. Thus, the aim of the current study was to compare the effect of photobiomodulation to topical 0.1% triamcinolone acetonide on erosive oral lichen planus. Methods This randomized controlled clinical trial involved 44 patients complaining of erosive oral lichen planus. Patients were assigned to one of two groups: control group (n = 22) received 0.1% topical triamcinolone acetonide three times daily with miconazole oral gel once daily for 4 weeks, and photobiomodulation group (n = 22) received laser therapy by 980 nm diode laser utilizing output power 300 mW twice weekly for 5 weeks (a total of 10 sessions). The evaluation of patients was performed at baseline, 6 weeks, and 12 weeks postoperatively in terms of pain, clinical scores, and biochemical evaluation of salivary malondialdehyde levels. All recorded data were analyzed using Mann–Whitney test to compare the two studied groups regarding pain, lesion size, and salivary levels of malondialdehyde. Friedman test, followed by post hoc test, was used for comparison of the data within the same group along the 3 periods at baseline, 6 weeks, and 12 weeks. Results Both groups showed significant improvement in pain and clinical scores, with no statistical difference between them. Moreover, there was a significant improvement in salivary malondialdehyde levels for both groups, with no significant difference between them. Conclusions Photobiomodulation could be a promising therapeutic modality for management of erosive oral lichen planus without the side effects of steroid therapy. The salivary malondialdehyde level could be used as a biomarker to evaluate the disease severity and its response to the treatment. Trial registration The study has been registered at ClinicalTrials.gov (NCT05951361) (19/07/2023).

INTRODUCTION: The autoimmune disorder, oral lichen planus (OLP), primarily affects oral mucous membranes. Current drug treatments are only palliative and have serious side effects. Pomegranate has been used as a potential herbal remedy for the treatment of OLP. MATERIALS AND METHODS: The study consisted of a sample size of 30 individuals who were diagnosed with symptomatic OLP based on both clinical and histological evidence and were equally assigned to Group A (4% topical Punica granatum seed extract gel, which has been customized for this particular study purpose only) and Group B (0.1% topical steroid). All patients were evaluated for the outcome criteria of pain, burning sensation, and lesion size. RESULTS: In the present study, results were highly statistically significant (P = 0.001) in intragroup observation for both Group A and Group B from baseline to the end of 30 days of follow-up for all three parameters. There was no statistically significant difference between groups for each week of follow-up. CONCLUSION: P. granatum has been used in very few studies, but this is one of the few where a gel made from P. granatum seed extract is used as an oral gel. In conclusion, it can be said that topical P. granatum extract gel is as good as topical corticosteroids at getting rid of the signs and symptoms of OLP, so it can be used as an alternative treatment. [ABSTRACT FROM AUTHOR]

Mooren’s ulcer is an idiopathic peripheral ulcerative keratitis whose pathogenesis is thought to be due to an autoimmune reaction. The first-line treatment for Mooren’s ulcer is the use of topical steroids, which can be difficult to discontinue. The 76-year-old patient in this case was receiving topical steroids for bilateral Mooren’s ulcer and developed a feathery corneal infiltration and perforation in the left eye. On suspicion of a fungal keratitis complication, we started topical voriconazole treatment and performed lamellar keratoplasty. Topical betamethasone was continued twice a day. The identified causative fungus was Alternaria alternata, which is known to be susceptible to voriconazole. The minimum inhibitory concentration of voriconazole was later proven to be 0.5 μg/mL. After 3 months of treatment, the residual feathery infiltration disappeared and the left vision recovered to 0.7. In this case, topical voriconazole was effective, and the eye was successfully treated with continuing topical steroids. Fungal species identification and antifungal susceptibility test proved helpful for symptom management.

Objective: To determine whether budesonide (Bud) and triamcinolone acetate (TA) cause DNA fractures in the nasal mucosa and septal cartilage cells through examinations using the comet assay technique. Study design: Prospective, controlled experimental study. Setting: University hospital. Methods: Septal mucosal epithelial and cartilage tissue samples were taken from 9 patients. Cell cultures were prepared from these samples. Then, budesonide and triamcinolone acetate active ingredients at 2 different doses of 0.2 and 10 µM were separately applied to the cell cultures formed from both tissues of each patient, except the control cell culture, for 7 days in one group and 14 days in one group. After the applications, genotoxic damage was scored with the comet assay technique and the groups were compared. Results: In both the budesonide and triamcinolone acetate groups, the comet scores at low and high doses, on the 7th and 14th days were found to be significantly higher in both cartilage and epithelial tissue than in the control group. Conclusion: The study results showed that budesonide and triamcinolone acetate lead to a significantly high rate of genotoxic damage in both epithelial tissue and cartilage tissue. [ABSTRACT FROM AUTHOR]

Idiopathic granulomatous mastitis is characterized by non-caseating granuloma and microabscess formation limited to mammary gland lobules. It is a form of chronic mastitis of unknown pathogenesis. In this study, the effectiveness of intralesional steroid injection with topical steroids is compared to systemic steroid therapy in the treatment of idiopathic granulomatous mastitis. Between June 2017 and December 2020, patients were collected and assessed. Idiopathic granulomatous mastitis was diagnosed histopathologically by tru-cut biopsy in patients with breast mass, pain, and erythema with suspicion of idiopathic granulomatous mastitis. Included in the study were one hundred and eleven patients who were diagnosed with idiopathic granulomatous mastitis and were treated with local or oral administration of corticosteroids, with at least 6 months of follow-up. The patients were divided into 2 groups: a local corticosteroid–treatment group (n = 57) and a peroral corticosteroid–treatment group (n = 54). Demographic characteristics, treatment responses, recurrence rates, side effects of the steroid, and the need for surgery were compared. The rate of smoking was 12.3% in the local corticosteroid–treatment group and 20.4% in the peroral corticosteroid–treatment group. There was no history of oral contraceptive use in either group. Previous steroid use was significantly lower in the local corticosteroid–treatment group (10.5%) compared to the peroral corticosteroid–treatment group (55.6%) (p = 0.001). Previous antibiotic use was significantly lower in the local corticosteroid–treatment group (75.4%) compared to the peroral corticosteroid–treatment group (100%) (p = 0.001). Those who responded after the first course of treatment were 96.5% in the local corticosteroid–treatment group versus 75.9% in the peroral corticosteroid–treatment group (p = 0.001). Complete responders after the third course of treatment was 98.2% in the local corticosteroid–treatment group versus 87.0% in the peroral corticosteroid–treatment group (p = 0.003). Recurrence had been 7% of the patients in the local corticosteroid–treatment group compared to 37% in the peroral corticosteroid–treatment group (p = 0.001). Steroid-related side effects were lower in the local corticosteroid–treatment group (0 compared to the peroral corticosteroid–treatment group (11.1%) (p = 0.010). Surgery was performed in 3.5% of the local corticosteroid–treatment group and in 57.3% of the peroral corticosteroid–treatment group (p = 0.001). A comparative open-label study in idiopathic granulamatous mastitis between local infiltration of corticosteroid compared to oral methyl prednisilone both used as single modality therapy has shown better and sustained response to local infiltration of corticosteroids. [ABSTRACT FROM AUTHOR]

الملخص: أهداف البحث: يعتبر استخدام قناع الوجه ضروريا للعلاج اثناء جائحة كوفيد -۱٩. قد تسبب اقنعة الوجه اعتلال جلدي بالوجه. قد تقلل الكريمات الموضعية من مضاعفات اقنعة الوجه. تبحث هذه الدراسة السريرية تأثير الكريمات الموضعية المختلفة على تحمل قناع الوجه ومضاعفاته. طرق البحث: أجريت هذه الدراسة المستقبلية المبنية على المشاهدة على ٨٠ بالغا. اختار المشاركون طواعية استخدام الكريمات الموضعية أثناء استخدام قناع الوجه. تم جمع البيانات باستخدام مقاييس تم التحقق من صحتها قبل وبعد وضع الكريم الموضعي. النتائج: استخدم ٢۳٫٨٪ من المشاركين جل ليدوكاين، استخدم ۱٧٫٥٪ الفازلين، استخدم ۱٦٫٢٪ كريم الهيدروكورتيزون، استخدم ۱٦٫٢٪ كريم دايفين هيدرامين، استخدم ۱۳٫٨٪ كريم أرنيكا، واستخدم ۱٢٫٥٪كريم أوكسيد الزنك. كانت مدة استخدام قناع الوجه ٦ ساعات بين الموظفين و٤ ساعات بين المرضى. كانت مدة استخدام قناع الوجه مماثلة مع الكريم الموضعي وبدونه. كان ارتفاع درجة حرارة الوجه أقل مع جميع الكريمات. كان احمرار الوجه أقل مع جميع الكريمات. كان ألم الوجه أقل لجميع الكريمات. كان التوافق مع قناع الوجه أفضل مع جميع الكريمات. كان ارتفاع درجة حرارة الوجه الأقل مع ليدوكاين الموضعي. كان احمرار الوجه المبكر الأقل مع الهيدروكورتيزون الموضعي أو دايفين هيدرامين. كان الاحمرار الشديد الأقل مع الهيدروكورتيزون الموضعي أو أوكسيد الزنك. كان ألم قناع الوجه الأقل مع ليدوكاين الموضعي. كان التوافق مع قناع الوجه الأفضل مع ليدوكاين الموضعي. حصل الفازلين على أفضل رضا ورائحة من قبل المستخدمين. الاستنتاجات: تقلل الكريمات الموضعية مضاعفات قناع الوجه، وذلك بتعزيز توافق قناع الوجه. يعتبر الليدوكاين الموضعي الأكثر فعالية في تقليل الألم وتمكين التوافق لقناع الوجه. تعتبر الكريمات الموضعية الهيدروكورتيزون ودايفين هيدرامين وأكسيد الزنك فعالة لتقليل احمرار الوجه. حصل الفازلين الموضعي على أفضل رضا من المستخدمين. Abstract: Objectives: Facemask use is essential for managing the COVID-19 pandemic, but may cause facial dermopathy. Topical creams may minimise facemask complications. This clinical study explores the impact of different topical creams on facemask tolerability and complications. Methods: This was a prospective observational study involving 80 adults. Participants voluntarily chose and used topical creams during facemask use. Data were collected using validated scales before and after topical cream application. Results: About 23.8% of the participants used lidocaine gel, 17.5% used petrolatum, 16.2% used hydrocortisone cream, 16.2% used diphenhydramine cream, 13.8% used arnica cream, and 12.5% used zinc oxide cream. Duration of facemask use was 6 h amongst staff and 4 h amongst patients, and was similar both with and without topical cream. Facial temperature rise was lower with all creams (p = 0.033), as was facial redness (p = 0.037) and facial pain (p = 0.025). Facemask compliance was better for all creams (p = 0.015). The facial temperature rise was the lowest with topical lidocaine (p = 0.021). Early facial redness was lowest with topical hydrocortisone or diphenhydramine (p = 0.042). Severe redness was lowest with topical hydrocortisone or zinc oxide (p = 0.044). Facemask pain was lowest with topical lidocaine (p = 0.035), and facemask compliance was best with topical lidocaine (p = 0.001). Petrolatum had the best user satisfaction and odour ratings (p = 0.041). Conclusion: Topical creams minimise facemask complications, thereby promoting compliance; topical lidocaine was the most effective in reducing pain and enabling facemask compliance. Topical hydrocortisone, diphenhydramine, and zinc oxide were effective in reducing facial redness, and topical petrolatum produced the best user satisfaction.

Atopic dermatitis (AD), sometimes referred to as eczema, is the most common chronic skin condition in children. Children of color have a higher reported prevalence of AD compared with their White counterparts. The purpose of this article is to discuss the differences of AD in skin of color (SOC), including clinical findings and management, with an emphasis on early recognition to avoid more severe, persistent disease. School nurses are on the frontline for these students with their ability to guide families and help support students with AD in the school setting. [ABSTRACT FROM AUTHOR]

Abstract Background Although topical steroids are an effective treatment for oral lichen planus, they can have suppressive effects on oral immunity and predispose the patients to Candida overgrowth. Lactoferrin is a crucial local immunity protein in the oral cavity with important antimicrobial activity. The aim of this study was to prospectively investigate salivary lactoferrin secretion levels and Candida colonization in oral lichen planus patients treated with fluocinolone acetonide 0.1% in orabase. Methods Saliva samples were collected from 15 oral lichen planus subjects who had never received topical steroid treatment prior to this study and 15 healthy volunteers to determine their salivary lactoferrin levels using an enzyme-linked immunosorbent assay and to investigate the presence of oral Candida species at baseline and 3 months after treatment with fluocinolone acetonide 0.1% in orabase. Statistical analysis was performed to compare lactoferrin secretion and Candida colonization levels between the groups using the Mann–Whitney U test for independent data or the Wilcoxon Signed-Rank test for paired data. Results The salivary lactoferrin secretion level was not significantly different between the control group and oral lichen planus patients or between before and after treatment with fluocinolone acetonide 0.1% in orabase (P > 0.05). Candida was detected in 11 (73.33%) healthy volunteers, 8 (53.33%) oral lichen planus patients before treatment, and 9 (60%) oral lichen planus patients after treatment with fluocinolone acetonide 0.1% in orabase. There was no significant difference in Candida counts between the groups (P > 0.05). Conclusion Our study indicates that using fluocinolone acetonide 0.1% in orabase to treat oral lichen planus for 3 months did not affect salivary lactoferrin protein secretion or Candida carriage. Trial registration The trial was registered at the Thai Clinical Trials Registry (TCTR identifier: TCTR20200723002).

Abstract Background Otitis media with effusion (OME) is one of the commonest causes of hearing loss in children. Oral and nasal topical steroids alone or combined with antibiotics lead to its quicker resolution. The aim of this study was the assessment of the efficacy of mometasone furoate nasal spray in conjunction with oral antibiotics for management of OME in children. One hundred sixty-eight children aged (4–12 years old) diagnosed with bilateral OME for at least 3 months were randomly allocated into two equal groups: the 1st group received mometasone furoate aqueous nasal spray plus oral amoxicillin–clavulanate for 4 weeks, and the 2nd group received amoxicillin–clavulanate alone for the same period. Results The tympanometric results after 1 month of medical treatment was much better in the 1st group compared to the 2nd group with 60% of patients of the 1st group having type A tympanogram versus 16% of patients of the 2nd group having this type (p = 0.0001). However, the average air-bone gap was not statistically different between the two groups. Conclusion Mometasone furoate nasal spray is effective in OME as adjunctive treatment when combined with antibiotics as it helps to normalize the Eustachian tube function and middle ear status.

Alopecia areata (AA), a polygenic and chronic autoimmune disease and there is no definitive cure. We aimed to evaluate latanoprost effects in patients with AA. In this controlled randomized double‐blind clinical trial, we enrolled patients with AA randomly assigned to six groups of 18; Group 1 received latanoprost eye drops; group 2 minoxidil 5% solution; group 3 latanoprost eye drops and minoxidil 5% solution; group 4 betamethasone and minoxidil 5% solution; group 5 betamethasone solution and latanoprost eye drops; group 6 (the control group) betamethasone solution. The alopecia severity in patients before and after treatment was assessed by severity of alopecia tool (SALT). One hundred and eight patients, 50% male (mean age: 32.6 ± 10.4) were studied. The overall SALT score decreased in all. After 2 weeks, patients receiving betamethason‐minoxidil and betamethason‐latanoprost showed more decline in their SALT than other groups. In final, there was statistically significant difference among betamethasone‐latanoprost group with minoxidil, betamethasone‐minoxidil and betamethasone groups. Regrowth was higher in latanoprost and betamethasone‐latanoprost groups than minoxidil. Topical latanoprost added to therapeutic efficacy of topical betamethason and minoxidil in treating patchy AA, suggesting it being beneficial and safe adjuvant therapy and add to efficacy of topical treatments without any adverse effects. [ABSTRACT FROM AUTHOR]

To evaluate the relative efficacy of topical steroids in preventing radiation dermatitis (RD). Multiple databases including Medline, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), China Biological Medicine (SinoMed), and Wanfang Database were searched for randomized controlled trials (RCTs) of RD prevention in patients with cancer from inception to November 26, 2021, followed by an update on June 1, 2021. Six RCTs evaluating the efficacy of topical steroids in preventing RD in a total of 661 patients with cancer were included. RD incidence was lower with topical steroids compared with placebo at week 3 (relative risk [RR] = 0.68, 95% confidence interval [CI]: 0.31–1.50) and at radiation therapy (RT) completion (RR = 0.97, 95% CI: 0.93–1.00). Topical steroids demonstrated a less risk of developing dermatitis of Radiation Therapy Oncology Group (RTOG) grades 2 and 3 at the completion of RT (RR = 0.66, 95% CI: 0.55–0.80 and RR = 0.54, 95% CI: 0.38–0.77, respectively). However, topical steroids did not reduce RTOG grades 1 and 2 dermatitis at week 3(RR = 0.73, 95% CI: 0.45–1.14 and RR = 0.66, 95% CI: 0.27–1.60, respectively). Notably, the use of topical steroids did not decrease RD incidence when patients received combined chemotherapy (RR = 0.60, 95% CI: 0.42–0.86), and an obvious reduction in the incidence of RD at RT completion was found when patients used the topical steroids twice‐daily (RR = 0.66, 95% CI: 0.47–0.93, P = 0.02). Topical steroids reduced RD incidence in patients receiving RT. Thus, twice‐daily topical steroids may be recommended for patients at the beginning of RT. [ABSTRACT FROM AUTHOR]

Objective:Idiopathic granulomatous mastitis (IGM) is an inflammatory and chronic benign breast disease that has proven difficult to diagnose and treat. Since most treatment modalities cannot be used in pregnant patients, the choice of treatment is more difficult and the need for surgery is more pressing. In this first and innovative study, we assess the results of local corticosteroid therapy of IGM in pregnant women.Materials and Methods:Pregnant women with IGM were evaluated between June 2017 and May 2019. The six pregnant women were treated using intralesional steroid injections and topical steroid administration. The treatment response was evaluated, both clinically and radiologically, at the end of 2 weeks and once more at the end of 1 month.Results:The median patient age was 26 years. The mean duration of complaints was 4.3 months. The median number of children was 2, and the mean breastfeeding time was 41 months. The predominant complaints at onset were a breast mass or local pain and inflammation in four (66.7%) patients and a breast mass with pain and without signs of local skin inflammation in two (33.3%) patients. Diagnosis was made using a tru-cut biopsy in two patients, and with an incisional biopsy in four patients who had abscess drainage and fistulation to the skin. Five (83.3%) patients achieved a complete response, and one (16.7%) patient responded only partially after the first course of treatment. A second course of treatment was given to the patient with partial response. All patients achieved complete response at the end of the second course of treatment. The mean follow-up time was 19.5 months. During the follow-up period, one patient experienced a recurrence at 4 months after giving birth, and she then received a third course of treatment. Topical and systemic side effects of the corticosteroids were not observed in any patient.Conclusion:While the state of pregnancy generally precludes the use of most drugs, the use of local corticosteroid in the treatment of IGM is effective in terms of treatment response, treatment duration, need for surgery, and reduced recurrence and side effects.

Background: India is witnessing an epidemic of dermatophytosis. The role of host immune response against fungi in chronicity and dissemination is topic of ongoing research. We conducted cross‐sectional comparative study to determine the difference in Th1 (IFN‐γ) and Th2 (IL4) response in serum and tissue between acute and localised vs. chronic and disseminated cases. Methods: Patients (18–60 years) were divided in two groups—group A (n = 114, BSA <5%, single anatomic site, duration <6 months, n = 118) and group B (n = 107 BSA >10%, > one anatomic site, duration >12 months, n = 118). Clinical parameters along with serum levels of IgE, IL‐4 and IFN‐γ and expression of IL4 and IFN‐γ in dermal infiltrate were compared between group. Results: Trichophyton mentagrophytes complex was commonest causative fungi. Serum levels of IgE were significantly higher (median A‐539.2, B‐2901.0, p <.001) whereas levels IL‐4(median A‐21.3, B‐20.4, p <.001) and IFN‐γ(median A‐9.6, B‐5.1, p <.001) were significantly lower in chronic cases. Expression of IL‐4 was observed in most biopsy specimens in both groups without any difference in intensity of staining. Expression of IFN‐γ was not detected in all but one specimen across both the groups. Severe itching (OR:0.050, CI:0.018, 0.139, p <.001), sign of topical steroid abuse (OR:0.203,CI:0.077, 0.537; p =.001), ↓IFN‐γ (OR:4.683, CI:1.634, 13.418; p =.004) correlated significantly and independently with chronic dermatophytosis. Conclusion: Our study shows chronic and disseminated cases of dermatophytosis differ immunologically in terms of higher IgE, and lower IL4 and IFN‐γ. Expression of IL4 is present in tissue of both acute, localised and chronic disseminated cases. Expression of IFN‐γ cannot be established in our study. [ABSTRACT FROM AUTHOR]

Objective: Adherence to topical corticosteroids (TCS) is essential for the effective treatment of atopic dermatitis but some families have fears and concerns about TCS phobia. In this study, it was aimed to investigate the knowledge, opinions and fear about topical steroids among mothers of patients who used topical steroid therapy for their atopic dermatitis (AD) and its effect on drug compliance and disease severity. Materials and Methods: Mothers were asked to fill in a questionnaire that consisted of 12 questions that evaluate the fears, beliefs, knowledge and behaviors about TCS usage. Results: The questionnaire was answered by mothers of 141 children with AD. The mothers' most common (44.7%) beliefs about TCS were determined as "Cortisone creams damage your skin "and "Cortisone creams will effect my future health''. The most common (71.6%) fear mothers had about TCS creams was determined as 'Using cortisone creams too much''. It was found that 83.3% of mothers who were found to be afraid of using TCS often were well educated (p=0.002). Conclusion: Most of our patients and mothers have fears about TCS and they don't have enough knowledge about their treatment. Therefore, they need assurance and information about TCSs that may include written and/or video-assisted information about TCS treatment given by healthcare professionals in order to decrease TCS phobia and increase compliance with the treatment. [ABSTRACT FROM AUTHOR]

Aim: To compare the efficacy of combination therapy (low level laser therapy [LLLT] and topical steroids) with topical steroid therapy alone in individuals with symptomatic oral lichen planus. Materials and Methods: The study was conducted on 30 patients who reported to our department with clinically and histologically proven symptomatic oral lichen planus (OLP). All the patients were assessed for the criteria of outcome—pain, burning sensation, size of the lesion, clinical resolution, and recurrence. The patients were randomly assigned into two groups each comprising of 15 patients. Group I (study group) patients received a combination of topical steroid and LLLT while Group II (control group) patients received only topical steroid therapy. Results: A significant pain and burning sensation reduction were found in the patients who were given LLLT (P: 0.05). There was a decrease in the size of the lesion which was statistically significant. A complete clinical resolution was achieved and only 11% recurrence occurred in the study group. This therapy appears to be effective in patients with symptomatic OLP. Conclusion: The LLLT therapy appears to be useful in relieving pain and burning sensation, reduction in the size of the lesion, with complete clinical resolution and minimal recurrence, and hence, can be considered as a valuable aid in managing symptomatic OLP. Thus, the LLLT therapy serves as a potent and independent therapeutic modality in symptomatic OLP.

Objectives:To evaluate the functional and anatomical results of patients with non-infectious intraocular inflammation (IOI) following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of neovascular age-related macular degeneration (nAMD).Materials and Methods:The medical records of patients receiving anti-VEGF treatment for nAMD between January 2015 and March 2019 were retrospectively analyzed. Preoperative and postoperative routine ophthalmological examinations, central macular thickness, duration of inflammation, and follow-up time of the patients with non-infectious IOI following anti-VEGF injection were recorded.Results:Non-infectious IOI was determined in 13 eyes (11 eyes with aflibercept, 2 eyes with ranibizumab) of 1,966 patients who received a total of 12,652 anti-VEGF (4,796 aflibercept and 7,856 ranibizumab) injections. IOI was detected after a mean of 7 injections (2-12 injections). All eyes had both anterior chamber reaction (Tyndall +1/+3) and vitritis (grade 1-3). None of the patients had pain, hypopyon, or fibrin reaction. Visual acuity progressed to baseline levels within 28.3 days. Vitritis continued with a mean of 40 days. All patients recovered with topical steroid therapy. In 11 eyes, injection of the same anti-VEGF agent was continued. No recurrence of IOI was observed in any patients.Conclusion:Non-infectious IOI following intravitreal anti-VEGF injection typically occurs without pain, conjunctival injection, hypopyon, or fibrin and responds well to topical steroid therapy. Visual acuity returns to baseline levels within weeks according to the severity of inflammation.

Pityriasis alba is a common skin condition that may be challenging to treat, especially in patients with darker skin type where the hypopigmentation may be more noticeable and represents a major cosmetic concern. This study aims to evaluate the efficacy of three cost-effective treatments of PA in comparison with placebo. This prospective study was conducted on 80 patients complaining from PA and divided into 4 equal groups according the received topical treatment on the target lesions twice daily for 8 weeks (Calcipotriol 0.005% cream, Tacrolimus 0.03% ointment, topical corticosteroid; Clobetasone butyrate 0.05% cream and Petrolatum as Placebo). Clinical evaluation, Physician Global Assessment, Patient's satisfaction levels as well as point counting planimetry were done for evaluation of the response. Significant improvement of scaling and erythema within 3 weeks after initiation of therapy and hypopigmentation by the 8th week, except for those received placebo. Tarolimus 0.03% ointment showed simple superiority over both Calcipotriol 0.005% cream and topical corticosteroid as regards repigmenation, although, the later received the highest level of patient satisfaction. The three treatments were superior to placebo with relative superiority to Tacrolimus 0.03% due to limited side effects. [ABSTRACT FROM AUTHOR]

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Objective: To determine the efficacy of topical steroid in treatment of hyper granulation tissue in burn patients in term of healing time. Study Design: Randomized Control Trial (RCT). Setting: Jinnah Burn & Reconstructive Surgery Center, Allama Iqbal Medical College, Lahore. Period: May 2017 to November 2017. Material & Methods: A total of 32 patients fulfilling the inclusion criteria were enrolled in the study. Patients were randomly divided into 2 groups with 16 patients in each group by lottery method. Written informed consent was obtained from all patients. In group A, topical 1% hydrocortisone (Fusidin H) cream was applied and Group B received Medicated Paraffin gauze (bactigrass) dressing. Wound assessment was done weekly by 2 consultant plastic surgeons and final assessment was done at 3weeks after the treatment. Results: The mean age of patients was 28.6 + 8.81 years, among them 22(68.8%) were male and 10(31.3%) were females. Mean healing time in Group A and Group B was 12.8 +2.08 days and 15.4+1.6 days respectively. Efficacy was calculated as P value of 0.12 which is significant (p < 0.05). Conclusion: Topical steroid (hydrocortisone 1%) is more effective in treatment of hyper granulation in post burn wounds with early healing than medicated paraffin gauze dressing. [ABSTRACT FROM AUTHOR]

Background: Although topical steroids are an effective treatment for oral lichen planus, they can have suppressive effects on oral immunity and predispose the patients to Candida overgrowth. Lactoferrin is a crucial local immunity protein in the oral cavity with important antimicrobial activity. The aim of this study was to prospectively investigate salivary lactoferrin secretion levels and Candida colonization in oral lichen planus patients treated with fluocinolone acetonide 0.1% in orabase. Methods: Saliva samples were collected from 15 oral lichen planus subjects who had never received topical steroid treatment prior to this study and 15 healthy volunteers to determine their salivary lactoferrin levels using an enzyme-linked immunosorbent assay and to investigate the presence of oral Candida species at baseline and 3 months after treatment with fluocinolone acetonide 0.1% in orabase. Statistical analysis was performed to compare lactoferrin secretion and Candida colonization levels between the groups using the Mann–Whitney U test for independent data or the Wilcoxon Signed-Rank test for paired data. Results: The salivary lactoferrin secretion level was not significantly different between the control group and oral lichen planus patients or between before and after treatment with fluocinolone acetonide 0.1% in orabase (P > 0.05). Candida was detected in 11 (73.33%) healthy volunteers, 8 (53.33%) oral lichen planus patients before treatment, and 9 (60%) oral lichen planus patients after treatment with fluocinolone acetonide 0.1% in orabase. There was no significant difference in Candida counts between the groups (P > 0.05). Conclusion: Our study indicates that using fluocinolone acetonide 0.1% in orabase to treat oral lichen planus for 3 months did not affect salivary lactoferrin protein secretion or Candida carriage. Trial registration The trial was registered at the Thai Clinical Trials Registry (TCTR identifier: TCTR20200723002). [ABSTRACT FROM AUTHOR]

Abstract We report four cases of ulcerated striae following misuse of fixed dose combinations creams containing clobetasol propionate with antifungal and antibacterial agents.

Purpose: Radiation dermatitis is one of the most common acute toxicities induced by chemoradiation therapy (CRT) for head and neck cancer (HNC). The benefit of topical steroids in the management of radiation dermatitis is still unclear. This phase 3, multi-institutional, randomized, double-blind, placebo-controlled trial evaluated the efficacy and safety of topical steroids for radiation dermatitis in patients with locally advanced HNC receiving CRT.Methods and Materials: Eligible patients were scheduled to receive bilateral neck irradiation (≥66 Gy) with concurrent cisplatin (≥200 mg/m2) as definitive or postoperative CRT. Patients were randomly assigned to receive either topical steroid or placebo when grade 1radiation dermatitis was observed or the total radiation dose reached 30 Gy. Basic skin care including gentle washing and moistening in the head and neck region was performed in both groups. The primary endpoint was the frequency of grade ≥2 radiation dermatitis, in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Grading of radiation dermatitis was performed by independent central review using photographs taken weekly.Results: A total of 211 patients were enrolled (intention to treat: steroid 101 and placebo 102). The frequency of grade ≥2 radiation dermatitis was not significantly reduced with the steroid (73.3%; 95% confidence interval, 64.6%-81.9%) compared with the placebo (80.4%; 95% confidence interval, 72.7%-88.1%; P = .23), whereas the steroid significantly reduced the frequency of grade ≥3 radiation dermatitis (13.9% vs 25.5%; P = .034). No significant differences in adverse events, including local infection or compliance with CRT, were observed between the groups.Conclusions: Topical steroid may reduce the severity of radiation dermatitis in patients with HNC and thus may become an important therapeutic tool in the management of radiation dermatitis. [ABSTRACT FROM AUTHOR]

Background: Radiodermatitis is a frequent side effect of breast cancer radiotherapy (RT). Treating radiation oncologist should know the prevention and treatment of every grade of radiodermatitis. Aims: The aim of this study was to compare the topical corticosteroid and moisturizer usage in breast cancer RT. Materials and Methods: Fifty patients with early-stage breast cancer undergoing breast-conserving surgery referred to our department for adjuvant RT between October 2009 and October 2016 were compared with regard to topical steroid or moisturizer usage. Patients were followed up weekly after the start of treatment. Results: Mean age was 46 years. Twenty-four patients had stage 1 breast cancer and 26 patients had stage 2 disease. KPS (Karnofsky performance score) was 100 for all patients. Five patients (20.8%) had grade 2 and seven (29.1%) patients had grade 1 acute radiodermatitis in the first group. Eleven (42.3%) patients had grade 2 and 12 (46.1%) patients had grade 1 acute radiodermatitis in the second group. Thirteen (54.1%) patients in the first group had no acute radiodermatitis and three (11.5%) patients in the second group had no acute radiodermatitis. No patient in either group experienced grade 3 radiodermatitis. Conclusions: Daily use of topical betamethasone for breast cancer RT improves dermal sparing, reduces acute radiodermatitis, and may be recommended for patients receiving RT to the breast.

Objective To evaluate patients clinically diagnosed as having topical steroid damaged skin clinically as well as by dermoscopy. To tabulate the common side effects observed, source and potency of the steroid used. Methods A thorough history, clinical evaluation, photography and dermoscopy of lesions performed. Details entered in a structured 14 point questionnaire. Results 189 patients were studied. Common diagnoses which led to steroid abuse were dermatophytosis (40.2%), pigmentary abnormalities, (30.1%) and acne scars (12.1%). Dermatologists (51.2%) and pharmacists (21.2%) were the foremost prescribers; The average duration of use was 2 weeks to 2 years. The common steroids abused were betamethasone (34%), mometasone (28%), clobetasol and halobetasol derivatives. Common side effects included erythema, hypopigmentation, tinea incognito, striae, atrophy and visible veins. White to translucent hairs admixed with the normal pigmented vellus facial hair was a novel dermatoscopic observation. Early changes of TSDS in users of less than four weeks were found to be erythema and hypopigmentation which on dermatoscopy showed loss of rete pigmentary network, tortuous dilated vessels with brown clods and white to pink structureless zones. Conclusion Topical steroid damaged skin is a common dermatological concern. Dermoscopy can be used to detect early steroid induced changes to prevent its further unmonitored use and side effects along with creating awareness in general population about potential harm of indiscriminate use. [ABSTRACT FROM AUTHOR]

Objective: Idiopathic granulomatous mastitis (IGM) is an inflammatory and chronic benign breast disease that has proven difficult to diagnose and treat. Since most treatment modalities cannot be used in pregnant patients, the choice of treatment is more difficult and the need for surgery is more pressing. In this first and innovative study, we assess the results of local corticosteroid therapy of IGM in pregnant women. Materials and Methods: Pregnant women with IGM were evaluated between June 2017 and May 2019. The six pregnant women were treated using intralesional steroid injections and topical steroid administration. The treatment response was evaluated, both clinically and radiologically, at the end of 2 weeks and once more at the end of 1 month. Results: The median patient age was 26 years. The mean duration of complaints was 4.3 months. The median number of children was 2, and the mean breastfeeding time was 41 months. The predominant complaints at onset were a breast mass or local pain and inflammation in four (66.7%) patients and a breast mass with pain and without signs of local skin inflammation in two (33.3%) patients. Diagnosis was made using a tru-cut biopsy in two patients, and with an incisional biopsy in four patients who had abscess drainage and fistulation to the skin. Five (83.3%) patients achieved a complete response, and one (16.7%) patient responded only partially after the first course of treatment. A second course of treatment was given to the patient with partial response. All patients achieved complete response at the end of the second course of treatment. The mean follow-up time was 19.5 months. During the follow-up period, one patient experienced a recurrence at 4 months after giving birth, and she then received a third course of treatment. Topical and systemic side effects of the corticosteroids were not observed in any patient. Conclusion: While the state of pregnancy generally precludes the use of most drugs, the use of local corticosteroid in the treatment of IGM is effective in terms of treatment response, treatment duration, need for surgery, and reduced recurrence and side effects. [ABSTRACT FROM AUTHOR]

Introduction: Alopecia Areata (AA) is a hair disorder characterised by non-scarring, patchy loss of hair from scalp and other parts of the body. For the treatment of AA, topical steroid is one of the first line therapeutic options. Topical vitamin D analogue Calcipotriol has immunomodulatory action. Vitamin D Receptors (VDR) are present in the hair follicles, therefore for treatment of AA topical vitamin D analogue Calcipotriol can be considered. Aim: To comparatively evaluate the role in terms of efficacy of topical vitamin D analogue Calcipotriol when used along with topical Clobetasol in comparison to topical Clobetasol used alone for AA treatment. Materials and Methods: In this randomized, open label, clinical study, sixty patients (age 20-32 years) diagnosed with AA were randomly assigned into two groups, thirty patients in each from September 2019 to February 2020. Topical Clobetasol (0.05%) was applied on the affected area twice a day for 24 weeks by Group A patients. While both topical Clobetasol (0.05%) and topical Calcipotriol (0.005%) was applied on the affected area twice daily for 24 weeks by Group B patients. Parametery like Age, Serum Hydroxy Vitamin D (25(OH)D) and Severity of Alopecia Tool (SALT) Score were mesured at baseline. At regular intervals of time (i.e baseline, 6,12,24 weeks), SALT score was evaluated. Mean values of the data were evaluated using student’s t-test and chi-square test based on whether the data was quantitative or qualitative in nature respectively. A p0.05). For patients of group A and group B the mean values of SALT score at baseline were 10.45±5.25 and 9.85±4.95, respectively (p=0.65). In patients of Group A and Group B towards the end of 24 weeks the mean values of SALT score decreased to 5.98±4.32 (p=0.0007) and 3.66±3.53 (p=0.0001), with a greater decrease in SALT score seen in Group B (p=0.05) i.e., the group in which patients were treated with topical calcipotriol 0.005% along with topical Clobetasol 0.05%. Conclusion: Topical calcipotriol 0.005% lotion used along with topical Clobetasol 0.05% lotion had higher efficacy than topical Clobetasol 0.05% lotion used alone, in the treatment of AA.

Introduction: Alopecia Areata (AA) is a hair disorder characterised by non-scarring, patchy loss of hair from scalp and other parts of the body. For the treatment of AA, topical steroid is one of the first line therapeutic options. Topical vitamin D analogue Calcipotriol has immunomodulatory action. Vitamin D receptors (VDR) are present in the hair follicles, therefore for treatment of AA topical vitamin D analogue Calcipotriol can be considered. Aim: To comparatively evaluate the role in terms of efficacy of topical vitamin D analogue Calcipotriol when used along with topical Clobetasol in comparison to topical Clobetasol used alone for AA treatment. Materials and Methods: In this randomised, open label, clinical study, sixty patients (age 20-32 years) diagnosed with AA were randomly assigned into two groups, thirty patients in each from Sept 2019 to Feb 2020. Topical Clobetasol (0.05%) was applied on the affected area twice a day for 24 weeks by Group A patients. While both topical Clobetasol (0.05%) and topical Calcipotriol (0.005%) was applied on the affected area twice daily for 24 weeks by Group B patients. Parametery like Age, Serum Hydroxy Vitamin D (25(OH) D) and SALT Score were mesured at baseline. At regular intervals of time (i.e baseline, 6,12,24 weeks), SALT (Severity Of Alopecia Tool) score was evaluated. Mean values of the data were evaluated using student's t-test and chi-square test based on whether the data was quantitative or qualitative in nature respectively. p<0.05 was considered statistically significant. Results: With respect to age and gender distribution both the groups were comparable (p>0.05). For patients of group A and group B the mean values of SALT score at baseline were 10.45±5.25 and 9.85±4.95, respectively (p=0.65). In patients of Group A and Group B towards the end of 24 weeks the mean values of SALT score decreased to 5.98±4.32 (p=0.0007) and 3.66±3.53 (p=0.0001), with a greater decrease in SALT score seen in Group B (p=0.05) i.e., the group in which patients were treated with topical calcipotriol 0.005% along with topical Clobetasol 0.05%. Conclusion: Topical calcipotriol 0.005% lotion used along with topical Clobetasol 0.05% lotion had higher efficacy than topical Clobetasol 0.05% lotion used alone, in the treatment of AA. [ABSTRACT FROM AUTHOR]

We aimed to elucidate the dermoscopic vasculature of patients with Bowen Disease (BD) that was misdiagnosed as chronic eczema and had branched and/or reticular vessels after topical steroid application. The medical records of 19 patients with BD on the upper trunk were retrospectively reviewed for steroid use history, vascular structure observed in dermoscopy, and corresponding histological findings. Four patients treated with strong topical steroids showed remarkable branched and/or reticular vessels on dermoscopy. Histopathology showed partial epidermal atrophy with irregular thin elongation of the rete ridges, atypical keratinocyte proliferation in the epidermis, and vasodilation in the superficial dermis. We considered that vasodilation and partial epidermal atrophy may be induced by topical steroid application in BD-affected areas. In cases of suspected BD with reddish-brown plaque showing branched and/or reticulated vessels in dermoscopy, confirming a history of topical steroid use is helpful.

Background and Aim: Stress has been associated with recurrent aphthous stomatitis (RAS). The common treatment of RAS is a topical steroid. This study aimed to investigate the difference of salivary cortisol between RAS patients treated with a topi-cal steroid and those without treatment. Materials and Methods: Thirty-two female patients with RAS participated in this case-control study and were randomly divided into two groups: the case group (n=16) treated with a topical steroid and the control group (n=16) without any treatment. The inclusion criteria comprised of non-pregnant women with RAS. The exclusion criteria consisted of having other diseases, taking medications, and smoking. All subjects were examined for pre- and post-treatment salivary cortisol at the onset of the ulcers in the case group and when the ulcers were healed in the control group. Data on the characteristics of the subjects were collected and presented descriptively, and the difference in salivary cortisol was analyzed using Mann-Whitney-U test and independ-ent t-test with a 95% confidence interval (CI) in SPSS 17.00 software. Results: The mean salivary cortisol in the pre-treatment group (10.51±5.15 ng/ml) was higher than that in the post-treatment group (9.30±3.77 ng/ml). The mean salivary cortisol at the onset of RAS (9.55±4.03 ng/ml) was lower than when RAS was healed (13.07±3.82 ng/ml) in the control group. There was a significant difference in the mean of pre- and post-treatment salivary cortisol levels between the case and the control groups (P

Aim. This paper presents guidelines on the diagnostics and treatment of eosinophilic esophagitis, which can be used by practitioners in their everyday practice.Summary. Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized by the symptoms of esophageal dysfunction and a pronounced eosinophilic infiltration of the esophageal mucosa. The EoE diagnostics is based on the clinical manifestations of the disease (dysphagia, food impaction, chest pain regardless of swallowing), as well as on the combination of endoscopic and histological signs. The diagnostic criterion is the eosinophilic infiltration of the esophageal mucosa with an eosinophil density of ≥ 15 per high power field (×400) in at least one of the biopsy specimens (about 60 eosinophils in 1 mm2). Total IgE levels, peripheral blood eosinophilia and skin allergy tests are considered to be additional diagnostic means. Several approaches are used for the treatment of EoE, including proton pump inhibitors (PPIs) and topical glucocorticosteroids (GCS), as well as elimination diets. The choice of therapy should be individualized, with the mandatory assessment of the treatment efficacy after 6–12 weeks using esophagogastroduodenoscopy with biopsy sampling. Endoscopic dilatation should be considered in patients suffering from severe dysphagia due to esophagus stricture.Conclusion. Increased incidence of EoE predominantly among children and young people, as well as its chronic character requiring long-term maintenance therapy, make EoE a significant issue to the practice of gastroenterology.

Asymptomatic phimosis is normal in young children which self-corrects itself but leads to parental anxiety. Topical steroids lead to correction of this physiologic phimosis avoiding the need of circumcision. Six male children aged between 3 and 14 years presented with asymptomatic tight phimosis present since birth. All the children were advised application of small amount of clobetasol propionate cream at night along with manual retraction during bath. At the end of 2 months, all the children had fully retractable prepuce. By the first visit (2 weeks), all the patients showed at least partial retractability of the prepuce. Till the follow-up period of 6 months, there was no recurrence in any patient. No side effects were observed.

Alopecia areata is the most common form of nonscarring alopecia. It may vary from a single round patch to that involving large surface area termed as alopecia totalis (AT). Pediatric age of onset, more extensive disease, and recalcitrance to initial therapies are more challenging to treat and require the synergy of two or more established therapy. Here, we have treated a case of AT with scalp micro-needling with topical steroids.

Abstract Background To date, the clinical benefit of topical steroid use has only been demonstrated for radiation dermatitis induced by 50–60 Gy irradiation in breast cancer. However, these agents are also often used clinically for the control of radiation dermatitis induced by high-dose (>60Gy) irradiation with chemotherapy in head and neck cancer. Despite this, the prophylactic efficacy of topical steroids for radiation dermatitis induced by high-dose irradiation is still unclear. The aim of this study is to clarify the benefit of topical steroids in basic nursing care for radiation dermatitis induced by chemoradiotherapy in patients with head and neck cancer. Methods The study is being conducted as a multicenter 2-arm randomized double-blinded placebo-controlled Phase 3 trial in Japan. The study was started in May 2017, with participant enrollment between May 2017 and April 2019. Patients scheduled to receive definitive or postoperative chemoradiotherapy for head and neck cancer are eligible for enrollment. All patients will receive chemoradiotherapy, consisting of single agent CDDP and 70-Gy irradiation. Bilateral neck irradiation is mandatory. Supportive care for radiation dermatitis will consist of basic nursing care with topical steroid or placebo. When radiation dermatitis grade 1 is seen or total radiation dose reaches 30 Gy, minimally required intervention will be started as a first step. If radiation dermatitis worsens to grade 2, the irradiated area will be covered with a moderately absorbent surgical pad and steroid or placebo topical cream. The primary endpoint is a comparison of the proportion of patients with ≥ grade 2 radiation dermatitis by NCI Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0. Ethical approval has been obtained from all participating sites. The results of this study will be submitted for publication in international peer-reviewed journals and the key findings will be presented at international scientific conferences. Discussion Evidence supporting the benefit of adding topical steroids in general nursing care for radiation dermatitis induced by high-dose irradiation with chemotherapy is insufficient. This trial aims to clarify the clinical benefit of topical steroid for radiation dermatitis induced by high-dose irradiation with chemotherapy. The trial is ongoing and is currently recruiting. Trial registration number UMIN000027161. Protocol version 3.0, 18 April 2017.

Background: Idiopathic granulomatous mastitis (IGM) is a rare form of nonlactational mastitis. Due to the small number of case series and consequently inadequate prospective studies, there is still no consensus on the optimal treatment of IGM. In this study, we aimed to compare the efficacy of intralesional steroid injection with concomitant topical steroids to systemic steroid therapy only in the treatment of noncomplicated IGM. Methods: Between June 2015 and April 2018, the patients' data was prospectively collected and analyzed retrospectively. The study included a total of 78 female patients diagnosed with IGM. Patients were divided into 2 groups: the local steroid treatment group (intralesional steroid injection with topical steroid administration; group 1, n = 46) and the peroral systemic steroid treatment group (group 2, n = 32). Response to the therapy, side effects, recurrence, the need for surgical treatment, and complication rates were compared. Results: Forty-three patients (93.5%) in group 1 achieved a partial or complete response compared to 23 patients (71.9%) in group 2 after 3 months; this difference was significant (p = 0.012). The recurrence rates were significantly lower in group 1 (8.7%) compared to group 2 (46.9%; p = 0.001), and the need for surgical treatment was significantly less in group 1 (2.2%) than in group 2 (9.4%; p = 0.001). While the complication rates were similar between groups, a higher rate of systemic side effects was observed in group 2. Conclusion: Based on the results of our study, combined steroid injection and topical steroid treatment in IGM is as effective as systemic steroid treatment. We suggest that this combination therapy of topical steroids and local steroid injection should be used as first-line therapy in patients with noncomplicated IGM. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the functional and anatomical results of patients with non-infectious intraocular inflammation (IOI) following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of neovascular age-related macular degeneration (nAMD). Materials and Methods: The medical records of patients receiving anti-VEGF treatment for nAMD between January 2015 and March 2019 were retrospectively analyzed. Preoperative and postoperative routine ophthalmological examinations, central macular thickness, duration of inflammation, and follow-up time of the patients with non-infectious IOI following anti-VEGF injection were recorded. Results: Non-infectious IOI was determined in 13 eyes (11 eyes with aflibercept, 2 eyes with ranibizumab) of 1,966 patients who received a total of 12,652 anti-VEGF (4,796 aflibercept and 7,856 ranibizumab) injections. IOI was detected after a mean of 7 injections (2-12 injections). All eyes had both anterior chamber reaction (Tyndall +1/+3) and vitritis (grade 1-3). None of the patients had pain, hypopyon, or fibrin reaction. Visual acuity progressed to baseline levels within 28.3 days. Vitritis continued with a mean of 40 days. All patients recovered with topical steroid therapy. In 11 eyes, injection of the same anti-VEGF agent was continued. No recurrence of IOI was observed in any patients. Conclusion: Non-infectious IOI following intravitreal anti-VEGF injection typically occurs without pain, conjunctival injection, hypopyon, or fibrin and responds well to topical steroid therapy. Visual acuity returns to baseline levels within weeks according to the severity of inflammation. [ABSTRACT FROM AUTHOR]

Objectives: To address concerns related to the safety profile of both Food and Drug Administration (FDA)–approved and non–FDA-approved intranasal corticosteroid (INCS) use in the adult population. Data Source: Systematic review of MEDLINE, PubMed, and EMBASE databases using a comprehensive search strategy including all INCS formulations and adverse events. The study design was developed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additional sources were identified from study references of relevant articles. Review Methods: A structured literature search was conducted. Each study was graded for level of evidence using the Oxford Centre for Evidence-Based Medicine. Extracted data included population size, study design, drug (dosage, route, and frequency), presence of hypothalamus pituitary axis suppression, ocular symptoms, and treatment-related adverse events. Results: A total of 60 studies met inclusion criteria. The studies included use of INCS as metered nasal sprays, drops, injections, aerosols, and irrigations. There were no persistent abnormalities in cortisol level or intraocular pressure change. Meta-analysis of epistaxis showed a significantly increased risk in the FDA-approved treatment group in comparison with control (risk ratio 1.56; 95% confidence interval, 1.13-2.14; P =.007). Conclusions: Overall, it appears that the use of both FDA and published non-FDA application of INCS are safe in the adult population. Meta-analysis demonstrated an increased risk of epistaxis in patients using INCS compared with placebo. Otherwise, there was no significant difference between in adults in the treatment group and placebo group. As an important caveat, the interpretation of safety of nonstandard INCS is restricted to delivery methods and dosages published in the literature. [ABSTRACT FROM AUTHOR]

Objectives: To address concerns related to the safety profile of both Food and Drug Administration (FDA)–approved and non-FDA-approved intranasal corticosteroid (INCS) use in the pediatric population. Data Source: Systematic review of MEDLINE, PubMed, and EMBASE databases using comprehensive search strategy, including all INCS formulations and adverse events. The study design was developed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additional sources were identified from study references of relevant articles. Review Methods: A structured literature search was conducted. Extracted data included age, population size, study design, drug (dosage, route, and frequency), presence of hypothalamic-pituitary-adrenal (HPA) axis suppression, ocular symptoms, and growth velocity adverse events. Results: A total of 33 studies met inclusion criteria. The studies included use of INCS as nasal sprays and drops. There were no persistent abnormalities noted in cortisol level or intraocular pressure change. Growth velocity reduction was reported in 3 of 10 randomized trials. Meta-analysis of epistaxis and headache showed no significant difference in the incidence of headache or epistaxis when FDA-approved INCSs were compared to placebo, with a relative risk of 1.12 (95% CI, 0.77-1.63; P =.56) and 0.84 (95% CI, 0.60-1.18; P =.32), respectively. Meta-analysis was not performed for growth velocity, HPA axis suppression, and ocular change. Conclusions: INCSs in FDA-approved routes of administration are generally safe to use in the pediatric population. Use of non-FDA-approved INCS drops may increase risk of iatrogenic Cushing's syndrome. Growth velocity reduction, HPA axis suppression, and visual changes due to INCS are uncommon. [ABSTRACT FROM AUTHOR]

Nonprescription use of topical corticosteroids (TCS) is a significant concern. This can lead to cutaneous adverse effects, altered morphology of skin disorders and chronicity of cutaneous infections. To record and analyze the patterns of TCS use in patients with tinea corporis/cruris and analyze factors determining the development of cutaneous side effects. Hundred patients with a clinical diagnosis of tinea corporis/cruris who could recall the TCS preparation/s used were included. The TCS usage patterns were recorded and analyzed. Most patients had used very potent TCS (n = 66). Most reported using TCS intermittently for duration ranging from 1 to 4 weeks (n = 78). Relapse of symptoms occurred within 1 to 2 weeks of stopping TCS, triggering reuse. Cutaneous adverse effects were present in 44 patients (striae [n = 29], hypo/depigmentation [n = 11], skin thinning [n = 8], hypertrichosis [n = 1], tinea pseudoimbricata [n = 1]). There was a significant correlation between presence of cutaneous adverse effects and the total duration of TCS use (P =.0016), duration of disease (P =.016), and total amount of TCS used (P =.012). Use for >60 days and of >32 g were associated with 89% and 96.3% (respectively) probability of developing cutaneous adverse effects. Self‐use of TCS is a worrisome trend. Intermittent use is a plausible reason for development of cutaneous side effects in only 44% patients. [ABSTRACT FROM AUTHOR]

Background: Radiodermatitis is a frequent side effect of breast cancer radiotherapy (RT). Treating radiation oncologist should know the prevention and treatment of every grade of radiodermatitis. Aims: The aim of this study was to compare the topical corticosteroid and moisturizer usage in breast cancer RT. Materials and Methods: Fifty patients with early-stage breast cancer undergoing breast-conserving surgery referred to our department for adjuvant RT between October 2009 and October 2016 were compared with regard to topical steroid or moisturizer usage. Patients were followed up weekly after the start of treatment. Results: Mean age was 46 years. Twenty-four patients had stage 1 breast cancer and 26 patients had stage 2 disease. KPS (Karnofsky performance score) was 100 for all patients. Five patients (20.8%) had grade 2 and seven (29.1%) patients had grade 1 acute radiodermatitis in the first group. Eleven (42.3%) patients had grade 2 and 12 (46.1%) patients had grade 1 acute radiodermatitis in the second group. Thirteen (54.1%) patients in the first group had no acute radiodermatitis and three (11.5%) patients in the second group had no acute radiodermatitis. No patient in either group experienced grade 3 radiodermatitis. Conclusions: Daily use of topical betamethasone for breast cancer RT improves dermal sparing, reduces acute radiodermatitis, and may be recommended for patients receiving RT to the breast. [ABSTRACT FROM AUTHOR]

Background The trend in psoriasis therapy in recent years has been to combine different agents in the hope that the combination will deliver better results. Topical corticosteroids are frequently used along with PUVA (Psoralen+ ultraviolet A) therapy in the treatment of psoriasis. But there is no consensus whether they enhance the therapeutic response of phototherapy. Our aim was to assess the effect of topical corticosteroids in combination with bath PUVA therapy on psoriasis with respect to time of clearance & duration of remission. Methods It was a double blind randomized placebo controlled study. Twenty patients were divided into two groups by block randomization. One group was treated with bath PUVA and betamethasone propionate cream in (30/70) dilution cream while the other group was treated with PUVA and placebo cream. Bath PUVA was given for 15 treatments or until 90% clearance of disease whichever is earlier. The assessment was done by PASITUL scoring at the baseline, 3rd, 6th, 9th, 12th and 15th sittings. Results Complete remission was achieved in all patients of steroid group and 8 patients of placebo group. The mean baseline PASITUL score decreased from 19.7 to 0.4 in steroid group and from 23.9 to 1.5 in placebo group. The mean cumulative UVA dose used in steroid and placebo groups were 32.85 Joules/cm2 and 40.60 Joules/cm2 respectively. The median number of UVA exposures used for >90% clearance in steroid group was 11 and for placebo group was 14 (p=.035). Out of 10 patients of steroid group 7 patients relapsed within six months while only 1 out of 8 patients who cleared completely in placebo group relapsed before 6 months (P=.023). Conclusion While there was tendency of early clearance in steroid group, there was no statistically significant difference in overall clearance and mean cumulative dose of UVA used. There were early relapses in steroid group which was statistically significant. [ABSTRACT FROM AUTHOR]

Objective: Study the effect of simvastatin ointment on tissue expression of inflammatory mediators associated with pathogenesis of Psoriasis such as TNF-α,, IL-6 and ICAM-1. Background: Psoriasis is a common and complex inflammatory disease, which was described as the chronic systemic T-cell-mediated inflammatory condition characterized by the skin and joint manifestation. The patients with psoriasis are usually presented with a white-silvery scaly lesion covering various parts of the body. In psoriatic lesions, epidermal Keratinocytes produce a variety of inflammatory mediators, such as TNF-α, IL-6, ICAM-1 will stimulate the abnormal proliferation which will cause the psoriasis characteristics to appear. Simvastatin is an anti-hyperlipidemic agent that acts by competitive, reversible inhibition of the HMG-CoA, the rate-limiting step in cholesterol biosynthesis. Materials and Method: The study has been carried out on 44 patients suffering from mild to moderate chronic plaque psoriasis; patients with plaque psoriasis will be randomly divided into two groups, the first group was the Placebo group (n 22) whose patients have directed to have placebo plus topical steroid (Dermosalic ointment) ® ( Betamethasone dipropionate 0.5 mg /g and salicylic acid 30 mg /g) two times for a period of 8 weeks. The second group was the Simvastatin group (n-22) whose patients have been directed to have Simvastatin ointment 5% two times per day in addition to (Dermosalic ointment)® ( Betamethasone dipropionate 0.5 mg /g and salicylic acid 30 mg /g) for a period of 8 weeks. Before and after the eight weeks; The skin biopsy samples have been taken from patients in the two groups at baseline and after eight weeks of treatment used to measure concentrations of TNF-α, IL-6, and ICAM-1. Conclusion: The present study indicated the fact that Simvastatin ointment plus topical steroid improvement of psoriasis by reduce concentration of inflammatory mediators. [ABSTRACT FROM AUTHOR]

Background: An association between allergic rhinitis (AR) and digestive diseases (DDs) has been reported; however, studies have only focused on the prevalence of DDs in populations of patients with AR. In individuals with specific DDs, the impact of AR on the frequency of clinical visits for each DD has not been studied. Moreover, the association between topical steroid usage for AR and DDs has not been investigated. Methods: Data from 16 526 men and 18 438 women, aged 21 to 30 years, were collected from a national database. Individuals were separated into the AR and non‐AR groups. Eight common DDs were studied: (1) gastroesophageal reflux disease (GERD), (2) gastritis and duodenitis, (3) peptic ulcers, (4) irritable bowel syndrome, (5) gastric functional disease, (6) intestinal functional disease, (7) gastroenteritis and colitis, and (8) constipation. The rate of each DD was compared between groups. In individuals with specific DDs, the frequency of clinical visits for each DD was also compared between groups. Between users and nonusers of topical steroids in the AR group, the rate of DDs was compared. Results: Significant associations were observed between all eight DDs and AR in both sexes. In comparison to the non‐AR group, women with AR visited clinics more frequently for gastritis/duodenitis, gastric and intestinal functional disease, gastroenteritis/colitis, and constipation, while men with AR visited clinics more frequently for gastritis/duodenitis, gastric functional disease, gastroenteritis/colitis, and constipation. Female topical‐steroid users with AR had higher rates of GERD, irritable bowel syndrome, gastric or intestinal functional disease, and gastritis/colitis. Male topical‐steroid users with AR had higher rates of GERD and peptic ulcers. Conclusion: AR was associated with DDs in both sexes. However, the influence of AR on clinical visit frequency varied among specific DD groups. Topical steroid usage for AR was associated with some DDs, but the association requires future evaluation. [ABSTRACT FROM AUTHOR]