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Retinoids in Psoriasis
Published in Ayse Serap Karadag, Berna Aksoy, Lawrence Charles Parish, Retinoids in Dermatology, 2019
Uwe Wollina, Piotr Brzezinski, André Koch
A multicenter, randomized, double-blind, vehicle-controlled phase 2 study in moderate or severe psoriasis (n = 212) compared a once-daily application of a fixed combination of halobetasol propionate 0.01% and tazarotene 0.045% (HP/TAZ) with the single components and placebo. At week 8, the HP/TAZ lotion was superior in reducing erythema, infiltrations, and scaling at the target lesion. The most frequently reported adverse effects were application site reactions associated with the tazarotene component. Side effects such as skin atrophy were rare (87).
Age-Related Changes in the Autonomic Nervous System
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
Sheila M. Ryan, Lewis A. Lipsitz
Sweating and vasodilatation normally occur in response to elevations in environmental temperature to prevent an excessive rise in the core temperature. Epidemiological studies suggest that elderly individuals are more vulnerable to heat stroke. Skin atrophy which accompanies normal aging results in a loss of sweat glands. As a result, elderly individuals exhibit reduced sweating in response to heat and neurochemical stimulation (Foster et al., 1976). In addition, the elderly have a higher core temperature threshold for the onset of sweating and vasodilatation. Vasodila-tory responses to radiant heat on the forearm have been investigated using doppler skin blood flow measurements (Richardson, 1989). Young subjects demonstrated an increased forearm cutaneous blood flow in response to heat, measured as the increase in velocity and volume of blood cells flowing through the vessels. This response may result from the combination of increased blood flow through dilated veins, and from the opening of capillary vessels that increase the cutaneous vascular bed. Elderly subjects showed attenuated cutaneous blood flow responses to local heat, although it is not clear if this is secondary to reduced vasodilatation or less recruitment of capillary vessels. When the effect of age, cholesterol and plasma glucose on cutaneous blood flow response to ambient heat was investigated, age was the most important variable (Richardson, 1989).
Medical therapy
Published in Dimitris Rigopoulos, Alexander C. Katoulis, Hyperpigmentation, 2017
Alexander C. Katoulis, Efthymia Soura, Antigone Alevizou, Dimitris Rigopoulos
The topical use of corticosteroids has been associated with various adverse events. Steroid-induced acne is not uncommon and is characterized by the appearance of a rosacea-like eruption with persistent erythema, pustules, and papules, distributed in a centrofacial manner. This type of acne may flare if the corticosteroids are withdrawn abruptly, but usually improves after 1–3 months. Perioral dermatitis, seen predominately in adult women, is also possible. Another possible adverse event of topical corticosteroids, which are often used to treat allergic disorders, is allergic contact dermatitis. This adverse event has been observed with most topical corticosteroids.61 Skin atrophy may also be observed after long-term use. The skin becomes thinner and underlying vessels may become apparent. Telangiectasias may also be observed.61 For instance, in a study by Kanwar et al., a number of patients had to cease treatment after 4 weeks of treatment with clobetasol propionate 0.05% owing to local atrophy and appearance of telangiectasias.17 At this point, corticosteroids are not recommended as monotherapy for the treatment of melasma. However, when used in combination therapy, fluorinated steroids have been found to be superior to nonfluorinated steroids, both in efficacy and in safety.6
Long-term maintenance treatment of psoriasis: the role of calcipotriol/betamethasone dipropionate aerosol foam in clinical practice
Published in Journal of Dermatological Treatment, 2022
Gabriella Fabbrocini, Clara De Simone, Paolo Dapavo, Perigiorgio Malagoli, Alessandro Martella, Piergiacomo Calzavara-Pinton
The median time to first relapse, primary endpoint of the trial, was 56 days with the proactive treatment with Cal/BD foam compared with 30 days with the reactive strategy, with a 43% reduction in the risk of experiencing a first relapse in patients on proactive therapy (HR: 0.57; 95% CI: 0.47–0.69; p < .001). After 52 weeks, patients assigned to proactive Cal/BD foam had experienced additional 41 days in remission when compared with those on the reactive regimen (p < .001). The number of relapses was lower with the proactive regimen (3.1 vs. 4.8) and the rate of relapse was also 46% lower (95% CI: 37–54%; p < .001). Both groups responded to rescue treatment with Cal/BD foam. The tolerability profile and the incidence of adverse events were similar in the two groups, with the wide majority of events of mild severity and no signs of skin atrophy.
Comparative efficacy and safety of verapamil and triamcinolone in keloid and hypertrophic scar treatment: a meta-analysis
Published in Journal of Cosmetic and Laser Therapy, 2021
Furthermore, we compared the adverse reaction of the verapamil and triamcinolone in the treatments of keloids and hypertrophic scars. A total of six studies (22–26,28) reported the skin atrophy, five studies (22–26) recorded the telangiectasia, five studies (23–26,28) reported the pricking pain, four studies (26–29) reported the hyperpigmentation, and three studies (26–28) recorded the hypopigmentation. As shown in Figure 5, the pooled results showed a statistically significant difference between the two groups in skin atrophy (RR = 0.13, 95% CI: 0.04 to 0.42, P = .001), telangiectasia (RR = 0.08, 95% CI: 0.02 to 0.28, P < .001), and hyperpigmentation (RR = 0.12, 95% CI: 0.03 to 0.44, P = .001). However, there was no significant difference in pricking pain and hypopigmentation (all P > .05).
A Randomized Controlled Ixekizumab Vs Secukinumab Trial to Study the Impact on Sexual Activity in Adult Patients with Genital Psoriasis
Published in Expert Opinion on Biological Therapy, 2021
Nawaf AlMutairi, Bayoumy Ibrahim Eassa
Well-established treatment decisions for genital psoriasis are restricted and there have been very few clinical studies evaluating therapies for genital psoriasis [7,15,33,34]. Even with recent improvements, the ideal treatment approach for GenPso patients still remains elusive. Furthermore, treatment options for treating GenPso are reduced because of the highly sensitive nature of genital skin, which does not tolerate many of the standard topical or UV-based treatments known to be safe for other body sites [16]. Low-to-mid-potency topical corticosteroids are recommended as the first-line treatment for GenPso [35]. Even though, low potency topical corticosteroids may not lead to clinical remission in all the cases [36]. But, they rarely cause skin atrophy. Atrophic genital skin is associated with negative impact on sexual life, due to burning or stinging caused by constant rubbing during the sexual act [10]. Agents like topical calcineurin inhibitors and vitamin D analogs can be used as second-line therapies, they are generally effective and well tolerated. Except, in few cases they might cause minor burning or Itching [27]. Vitamin D preparations, can often be combined with topical steroids for better efficacy [37,38].