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Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
In a report on contact allergy to nystatin, the patient had a negative reaction to fluocinolone, present in the combination product containing nystatin. However, the authors stated that they had observed a case of contact allergy to fluocinolone acetonide a few years previously. Clinical and patch testing details were not provided (3).
Fluocinolone acetonide sustained drug-delivery implant for posterior segment eye diseases
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Ideally, a corticosteroid delivery device should provide therapeutic drug levels over the duration of the patient’s disease. Fluocinolone acetonide is a synthetic corticosteroid with low solubility in aqueous solution. The solubility of fluocinolone acetonide is that of dexamethasone, which itself is relatively insoluble. Theoretically, this low solubility should allow very extended drug release from a delivery device without the need for an excessively bulky polymer system. A study was undertaken to determine the feasibility of constructing a fluocinolone acetonide device, to test the hypothesis that this device would provide sustained drug delivery in vitro and in vivo, and to evaluate the safety of this device in the rabbit eye.
Vulvar therapies
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Natalie Moulton-Levy, Howard I. Maibach
Pharmacologic treatment consists of mid- to high-potency topical corticosteroids, such as triamcinolone, betamethasone, and fluocinolone (2), usually for 14 days or until symptoms have resolved. At this point, a weaker corticosteroid, such as 1% hydrocortisone, can be continued for an additional 2–3 months. This cycle can be repeated if disease activity flares. In cases of mild disease, low-potency steroids are safer and are typically preferred. Use low-potency topical steroids, such as hydrocortisone 2.5%, on thinner skin and for patients who prefer to use a topical preparation regularly. Alternatives include intralesional triamcinolone injections every 3–6 months. Brief courses of systemic corticosteroids are reserved for severe or recalcitrant dermatitis. Adequate dosage and an adequate taper length are important points to consider. Treatment with topical corticosteroids should be limited, as long-term use may induce telangiectasias, skin friability, striae formation, and easy bruising. Caution must also be taken to avoid rebound inflammation upon withdrawal from long-term, high-potency corticosteroids. See Chapter 29 for a more thorough discussion of contact dermatitis of the vulva.
Local versus Systemic Therapy for Noninfectious Uveitis (NIU)
Published in Seminars in Ophthalmology, 2023
There is limited data comparing systemic and local therapy for NIU. The MUST trial compared the fluocinolone intravitreal implant with systemic corticosteroids and immunosuppression.102 Interestingly, the type of systemic immunosuppression was not dictated by the clinical trial, but rather based on expert panel guidelines.103 Results of the MUST trial suggest that the fluocinolone intravitreal implant had a much higher risk of causing ocular complications such as cataract and glaucoma as compared to systemic therapy, but that systemic risks from local and systemic therapy were similar. Quality of life and health utility outcomes were similar between the two groups. Patients treated with long-term immunosuppressive therapy including azathioprine, methotrexate, mycophenolate mofetil, cyclosporine, systemic corticosteroids, or dapsone were found to have no increased risk of malignancy or mortality when retrospectively compared with patients not on immunosuppressive therapy.104
Advances in ophthalmic drug delivery technology for postoperative management after cataract surgery
Published in Expert Opinion on Drug Delivery, 2022
Kangmin Lee, Gahye Lee, Soomin Lee, Choul Yong Park
Corticosteroids are among the most widely used anti-inflammatory drugs in ophthalmology clinics. The predominant effect of corticosteroids is switching off multiple inflammatory genes, including cytokines, chemokines, adhesion molecules, inflammatory enzymes, receptors and proteins [43]. Generally, after cataract surgery, patients are prescribed corticosteroid eye drops, NSAID eye drops, or sometimes both drugs for a potent anti-inflammatory effect. The most common topical corticosteroids used for ocular treatment are dexamethasone, prednisolone, fluorometholone, loteprednol, and triamcinolone. Dexamethasone, prednisolone, fluorometholone, and loteprednol are usually prepared as eye drops for topical medication, whereas triamcinolone is administered as a subconjunctival injection or intraocular injection [44]. Fluocinolone, a long acting potent corticosteroid, was also developed as an intraocular implant. Fluocinolone has about 180 times the cellular glucocorticoid receptor activation potency of cortisol, and is much more potent than other steroid drugs such as prednisolone, dexamethasone, and triamcinolone (9 times, 24 times, and 72 times more potent than cortisol, respectively) [44].
Development of Nanofibrous Ocular Insert for Retinal Delivery of Fluocinolone Acetonide
Published in Current Eye Research, 2019
Jatin Singla, Tanya Bajaj, Amit K Goyal, Goutam Rath
Fluocinolone acetonide at a working dose on assisting formulation minimizes tissue damage when compared with plain drug. Histopathological analysis showed that the retinal pigment epithelium (RPE) which helps in the nourishment of retinal visual cells was found to be of 28.4 µm. Figure 7 represents the density of cons 400 to 500/µm2 and the density of rods was found to be 100 to 200/µm2, considering optimum for the colour vision for the eye. This shows that the drug has no effect on retina.15 However, relatively higher toxicity was observed in marketed formulation characterized by typical tissue structure, which could be attributed with pharmacokinetic profile with multifold higher Cmax compared to prepared formulation. However, these variations can be neglected. No inflammatory cells were found in the histological sections of the retina, indicating that the prepared formulation has no sign of ocular toxicity at the target site.