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Topical Calcineurin Inhibitors
Published in Vineet Relhan, Vijay Kumar Garg, Sneha Ghunawat, Khushbu Mahajan, Comprehensive Textbook on Vitiligo, 2020
The efficacy of pimecrolimus in the treatment of vitiligo was first reported in 2003 in a female patient with facial vitiliginous lesions who showed >90% repigmentation with the use of 1% pimecrolimus for a period of 5 months [26]. Later, a trial including 10 patients with bilaterally symmetrical vitiliginous lesions showed comparable rate of pigmentation with 1% pimecrolimus and 0.05% clobetasol propionate. Side effects like atrophy and telangiectasia were seen in the clobetasol group, whereas the side effects in pimecrolimus included only mild burning sensation in two patients [27]. Several studies since then have proved the efficacy of pimecrolimus in the treatment of vitiligo [28–30]. In a study by Seirafi et al., 30 patients with 135 vitiligo lesions involving <20% of the body surface area were treated with 1% pimecrolimus cream for 12 weeks. Among these, 28 patients developed repigmentation in at least one of their vitiligo lesions at the end of 12 weeks [30].
Dermatologic Disorders Causing Vulvar Disease
Published in William J. Ledger, Steven S. Witkin, Vulvovaginal Infections, 2017
William J. Ledger, Steven S. Witkin
Lichen sclerosus treatment can be a source of confusion for practitioners because of changes in terminology and treatment. More familiar terms to describe this skin condition in the past, including leukoplakia, kraurosis vulvae, and lichen sclerosus et atrophicus are no longer in vogue. Also, there is no evidentiary support for older therapies, based upon topical testosterone in these women. The regimen currently recommended for new cases is clobetasol ointment 0.05% initially once a night for 4 weeks and then on alternate nights for 4 weeks and twice weekly in the third month.26 If the treatment is successful, there will be some resolution of the hyperkeratosis, ecchymosis, fissuring, and erosions, but the atrophy and color changes will remain. Since this is a chronic condition, the clobetasol propionate can be used on occasion, when needed. These patients should also be advised to avoid using soap, a potential irritant, in this area. Other problems may be seen. In the United States, both the clobetasol propionate cream and ointment contain propylene glycol, which can cause a local contact dermatitis. If this occurs, a compounding pharmacy can make a propylene glycol–free preparation, or a less potent steroid ointment free of pro-pylene glycol can be substituted. Since squamous cell cancer has been reported on occasion in this patient population, any suspicious areas of new cell growth should be biopsied.
Vulvar therapies
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Natalie Moulton-Levy, Howard I. Maibach
Effective treatment of lichen sclerosus will control symptoms, minimize scarring, and allow for early detection of malignant change. As a result of compelling data from clinical trials, treatment recommendations have changed recently. The current recommended and accepted treatment for all forms of lichen sclerosus is the potent topical corticosteroid ointment clobetasol propionate (19,20). One RCT comparing clobetasol, testosterone, progesterone, and petroleum jelly showed higher rates of symptom control with clobetasol (75%) (21). Clobetasol 0.05% gel or cream provides rapid symptomatic improvement in over 90% of treated women. It also reverses some of the histological changes and is effective in long-term disease control. The medication should be applied once or twice daily (22), and treatment typically lasts 3 months (23). The dose should be tapered gradually and then used only when symptoms recur, typically fewer than once or twice per week. There is some evidence that lichen sclerosus of the vulva may be treated with long-term maintenance therapy (24). The patient should be advised that this therapy is not curative and recurrence is likely.
Side effect jiu-jitsu
Published in Journal of Dermatological Treatment, 2022
Rithi Chandy, Katherine L. Keith, Steven R. Feldman
Side effect jiu-jitsu may also be used in the treatment of scalp psoriasis and related dermatoses. Clobetasol propionate is a commonly prescribed treatment for scalp psoriasis. Burning or stinging at the application site is a common adverse effect. If patients experience burning unexpectedly, they may discontinue treatment immediately. Even if they are warned that burning may occur, they may feel the need to stop the treatment. However, if told that burning or tingling is a sign that the medication is “working”, patients may be more inclined to use the treatment (10). The burning/stinging sensation does indicate the medication is working, as the burning/stinging is evidence that the medication was successfully applied to the scalp, and not just to the hair. Dermatologists can use this patient belief system to encourage continued use by reassuring patients that the sensation is both expected and normal, and indicates the medication is indeed “doing its job”.
Development and characterisation of clobetasol propionate loaded Squarticles as a lipid nanocarrier for treatment of plaque psoriasis
Published in Journal of Microencapsulation, 2020
Ankita Dadwal, Neeraj Mishra, Ravindra K. Rawal, Raj Kumar Narang
Clobetasol propionate is a very potent topical corticosteroid class compound. Topical steroids are used in addition to moisturisers for treating inflammatory skin conditions such as eczema and dermatitis. Owing to its anti-inflammatory, antipruritic and immune-modulating properties, clobetasol propionate is used to treat psoriasis (Decroix et al.2004). Clobetasol propionate induces phospholipase A2 inhibitory proteins, thereby controlling the release of the inflammatory precursor arachidonic acid from membrane phospholipids by phospholipase A2 (Schäfer-Korting et al.2005). It was also found that if clobetasol propionate (CP) was incorporated in the nanoemulsion it shows significant increase in their anti-inflammatory activity. It was reported that CP-loaded nanoemulsion significantly increased NTPDase (Nucleoside triphosphate diphosphohydrolases) activity in lymphocytes. This membrane protein is responsible for the hydrolysis of extracellular ATP (Adenosine triphosphate) which is responsible for cell proliferation, differentiation and inflammatory processes (Alam et al.2013).
DRM02, a novel phosphodiesterase-4 inhibitor with cutaneous anti-inflammatory activity
Published in Tissue Barriers, 2020
David W.C. Hunt, Iordanka A. Ivanova, Lina Dagnino
Topical DRM02 treatment in mice reduced the acute, edematous reaction to PMA, the antigen-specific Th2 type immune contact hypersensitivity response to FITC, and the development of Th17 immune pathway-related psoriasiform lesions elicited by the TLR7/8 agonist IMQ. DRM02 also reduced mRNA and protein levels of IL-17A, IL-17 F, and IL-22 in the skin. These cytokines, released by T lymphocytes and natural killer cells, trigger innate immunity responses in epithelial cell types, but with distinct response patterns. IL-17 induces inflammatory-type responses, whereas IL-22 predominantly influences epithelial cell differentiation.45,46 Importantly, DRM02 exerted anti-inflammatory effects in a variety of mouse models of inflammation, without detectable negative systemic effects. In contrast, we found that adverse systemic effects accompanied clobetasol treatment in IMQ-induced psoriasiform inflammation, including weight loss and immune-system organ size alterations.