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Skin problems in infancy and old age
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
The condition rarely starts before 4–6 weeks of age and usually begins between the ages of 2 and 3 months. It may first show itself on the face but spreads quite quickly to other areas, although the napkin area is conspicuously spared – presumably as a result of the area being kept moist. The ability to scratch develops after about 6 months of age and the appearance of the disorder alters accordingly, with excoriations and lichenification. At this time, the predominantly flexural distribution of the disorder begins, with thickened, red, scaly, and excoriated (and sometimes crusted and infected) areas in the popliteal and antecubital fossae. The eyes are often affected, eye rubbing being the probable cause of sparseness of eyebrows and eyelashes. It may also be the cause of corneal softening (keratomalacia) and its deformity (keratoconus). Emollients are important in management and mothers should be carefully instructed on their benefit and how to use them. Similarly, bathing should be in lukewarm water, with patting dry, rather than long-lasting hot scrubs with vigorous towelling afterwards. Weak topical corticosteroids only should be used – 1% hydrocortisone and 0.1% clobetasone butyrate are appropriate. For more severely affected infants, topical tacrolimus (Protopic) or pimecrolimus (Elidel) has proved a useful alternative to steroids.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Three similar case reports had been published previously (6,7,8). The patients all noted an exacerbation of eczema while using clobetasone butyrate cream and/or ointment. Patch tests were positive to the topicals and to clobetasone butyrate, tested in various concentrations. All three patients also reacted to clobetasol propionate. These were more likely co-sensitizations than cross-reactions, as the patients all had used pharmaceuticals with this corticosteroid also (6,7,8).
Skin problems in infancy and old age
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
The condition rarely starts before 4–6 weeks of age and usually begins between the ages of 2 and 3 months. It may first show itself on the face, but spreads quite quickly to other areas, although the napkin area is conspicuously spared – presumably as a result of the area being kept moist. The ability to scratch develops after about 6 months of age and the appearance of the disorder alters accordingly, with excoriations and lichenification. At this time, the predominantly flexural distribution of the disorder begins, with thickened, red, scaly and excoriated (and sometimes crusted and infected) areas in the popliteal and antecubital fossae. The eyes are often affected, eye rubbing being the probable cause of sparseness of eyebrows and eyelashes. It may also be the cause of corneal softening (keratomalacia) and its deformity (keratoconus). For more severely affected infants topical tacrolimus (Protopic®) or pimecrolimus (Elidel®) has proved helpful. Emollients are important in management and mothers should be carefully instructed on their benefit and how to use them. Similarly, bathing should be quick ‘dunks’ in lukewarm water, with patting dry, rather than long-lasting hot scrubs with vigorous towelling afterwards. Weak topical corticosteroids only should be used – 1 per cent hydrocortisone and 0.1 per cent clobetasone butyrate are appropriate. Preparations of 1 per cent hydrocortisone containing urea are helpful.
Seasonal facial erythema in a patient with allergic rhinitis treated using a combination of tranilast and roxithromycin
Published in Immunopharmacology and Immunotoxicology, 2023
A 42-year-old female patient consulted with this institute and, from the beginning of March, exhibited diffuse erythema (Figure 1(A)) with pruritus on the face, mainly on both cheeks, and pale erythema on the forehead. Even during the non-pollen season, she was examined for warts; however, no erythema on the face was observed at that time. She also reported rhinitis symptoms, such as nasal discharge. Pruritus was observed on the eyelid skin, but no evidence of conjunctivitis was observed. Over the last few years, she has experienced repeated facial erythema during the spring season. Wearing a mask to protect herself against the coronavirus (COVID-19) seemed to have been an exacerbating factor this year. As a teenager, she started to have symptoms of hay fever in early spring. The patient had no atopic eczema symptoms. The entire family has allergic rhinitis. Allergic antigen tests (fluorescence enzyme immunoassay) revealed the following sensitivity results: Japanese cedar pollen, extensively positive (5+); Japanese cypress pollen, (1+); orchard grass, negative (−); mites, negative (−); and house dust, negative (−). This patient was unable to undergo a skin test for cedar pollen, but this possibility cannot be ruled out. She reported that she had used 0.05% clobetasone ointment for similar facial erythema 2 years prior. Thus far, this patient had not used any external steroid, and steroid-induced rosacea-like changes, which did not show seasonality, were ruled out.
Tinea versicolor of the neck as side effect of topical steroids for alopecia areata
Published in Journal of Dermatological Treatment, 2019
Nicolò Brandi, Michela Starace, Aurora Alessandrini, Bianca Maria Piraccini
Ten patients with AA, 8 females and 2 males, aged 18–38 years, were prescribed with high potency topical corticosteroids (clobetasone propionate 0.05% cream) under occlusion every other day for 4 months after being visited at the Hair Disease Outpatient Consultations of the Dermatology Unit of the Department of Experimental, Diagnostic and Specialty Medicine (DIMES) of the University of Bologna. Nine patients were diagnosed with patchy AA, involving > 40% of the scalp, while 1 patient was affected by alopecia areata totalis. When, after 3–4 months, the patients returned to our facility for the control visit, we noticed the appearance of multiple white or red-brown round or oval macules of 3–5 mm in diameter, in the neck area (Figures 1 and 2). The lesions, that were not present during the first visit, extended to the neck and the shoulders in 7 patients, and also involved and the upper back in 2 of them. Some patients complained mild pruritus, although most of them were asymptomatic and not even aware of their condition.
The Use of Topical Corticosteroids for Treatment of Dry Eye Syndrome
Published in Ocular Immunology and Inflammation, 2019
Carlo Alberto Cutolo, Stefano Barabino, Chiara Bonzano, Carlo Enrico Traverso
Clobetasone butyrate is widely available for dermatologic use but marketed for ophthalmic use only in a few countries. When compared with prednisolone phosphate, no difference in therapeutic efficacy was observed and clobetasone butyrate showed little effect on intraocular pressure when compared with dexamethasone or hydrocortisone.72 A single RCT has been conducted to study the effect of clobetasone butyrate 0.1% administered two times a day for 1 month in patients with SS. Compared to controls, patients treated with clobetasone butyrate 0.1% showed a significant improvement in corneal, conjunctival stain, and symptoms during the follow-up. The HLA-DR expression, a biomarker of inflammation, was also significantly reduced in the group treated with clobetasone.73