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Dermatologic diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Holly Edmonds, Dana Ward, Ann G. Martin, Susana Leal-Khouri
Systemic steroids are the mainstay of therapy for moderate to severe pemphigoid gestationis. Recommended prednisone dosing is 0.5 mg/kg/day. One can frequently taper to a daily prednisone dose of 10 mg. Fortunately, the use of low-dose systemic steroids in the second and third trimester of pregnancy is not associated with increased risk of congenital anomalies, although careful monitoring is needed for gestational diabetes and hypertension (52). Mild cases are often treated with mid- to high-potency topical glucocorticoids and oral antihistamines (some studies have shown these medications to be ineffective, but they may offer symptomatic relief) (38). Alternative therapies include dapsone, cyclosporine, plasma-pheresis, and cyclophosphamide, each variably effective at best, and all with significant potential for morbidity (38,53,54).
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
47-year-old man developed a generalized papular rash starting from the anogenital area a few days after commencing topical treatment of an anal fissure with a pharmacy preparation containing 2% lidocaine and 2% diltiazem hydrochloride. The rash improved with topical glucocorticoid treatment and cessation of the diltiazem cream. Two weeks later, the patient restarted treatment of the anal fissure with the same cream, and the rash reappeared. An identical cream without diltiazem was well tolerated. Patch tests were positive to the cream ‘as is’, diltiazem 1% and 10% pet. and to other calcium channel blockers nifedipine and verapamil hydrochloride (both 1% and 10% pet.). One control was negative. This was a case of systemic contact dermatitis (2).
Medical Management for Rhinosinusitis
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Studies of topical glucocorticoids have demonstrated some benefit for the relief of symptoms in both viral and bacterial ARS. A meta-analysis of three studies, with ARS diagnosed by symptoms and confirmed by radiologic or endoscopic studies, found that adult participants receiving INCS were more likely to have resolution or improvement of symptoms than those receiving placebo (73% versus 66.4%; risk ratio (RR) 1.11).10 Higher doses of INCS had a stronger effect on improvement or complete relief of symptoms. When used as an adjunct to antibiotic therapy in the treatment of ABRS, a meta-analysis of placebo-controlled trials suggests that 15 patients would need to be treated with intra-nasal glucocorticoids to improve clinical symptoms in one patient.11 As the risk of adverse events with short-term usage INCS is low, INCS can be recommended in ARS.
Monitoring and Treatment of Juvenile Idiopathic Arthritis-associated Uveitis: Brazilian Evidence-based Practice Guidelines
Published in Ocular Immunology and Inflammation, 2022
LM Neves, LM Haefeli, LM Hopker, F Ejzenbaum, H Moraes do Nascimento, N Aikawa, MO Hilario, CS Magalhães, MT Terreri, F Sztajnbok, CAA Silva, JD Rossetto
Topical glucocorticoid is more effective than systemic glucocorticoid in reducing anterior chamber cells.5 However, the administration of systemic glucocorticoid as a bridge therapy should be considered in severe active uveitis with sight-threatening risk factors until a DMARD effect can be achieved.5 Systemic glucocorticoids are usually given by the oral route. They can be used in oral high doses (1–2 mg/kg/day), intermediate doses (> 0.15 and < 1.0 mg/kg/day) or low doses (≤ 0.15 mg/kg/day) of prednisolone or equivalent (level of evidence and strength of recommendation III0).5,42 Topical glucocorticoids should be tapered within 4 weeks to 0.15 mg/kg/day or less and limited to three months of use to avoid ocular and systemic complications (increased IOP, cataract, weight gain, diabetes mellitus, and growth retardation).5 In very severe cases, intravenous treatment with methylprednisolone (pulse) can be used at 10–30 mg/kg/day in 2 h infusions for 3 days.5,58
Symbiotic microorganisms: prospects for treating atopic dermatitis
Published in Expert Opinion on Biological Therapy, 2022
Rongrong Chai, Zongguang Tai, Yunjie Zhu, Chaochao Chai, Zhongjian Chen, Quangang Zhu
AD is a chronic recurrent inflammatory skin disease. Patients with AD often experience severe itching, which can significantly affect their quality of life [2]. As a disease that may last from infancy to adolescence, and in some cases, even throughout life, AD affects 7‒10% of adults and up to 25% of children worldwide [3]. Basic treatment for AD involves the application of emollients, which moisten the skin and enhance skin barrier function [4]. However, most patients with AD are pharmacologically treated. The choice of treatment, such as topical glucocorticoids, anti-infective treatment, local immune modulators, oral antihistamines, and biological agents, is based on the skin lesions and areas involved. These treatments are not only associated with poor efficacy in patients with moderate-to-severe AD but also trigger adverse effects during long-term administration [5,6]. Therefore, treatments based on existing strategies have several limitations.
Development of a nanotechnological hydrogel containing desonide nanocapsules in association with acai oil: design and in vivo evaluation
Published in Pharmaceutical Development and Technology, 2022
Priscila Rosa, Mariane Lago Friedrich, Juliana dos Santos, Natháli Schopf Pegoraro, Camila Camponogara, Sara Marchesan Oliveira, Cristiane de Bona da Silva, Andréa Inês Horn Adams
Topical glucocorticoids (TG) are among the most common drugs prescribed by dermatologists (Senyiğit et al. 2009) for the treatment of psoriasis and atopic dermatitis (Aubert-Wastiaux et al. 2011). The clinical efficacy of these drugs is related to their anti-inflammatory, immunosuppressive, vasoconstrictive and anti-proliferative effects (Grau 2006; Senyiğit et al. 2009). Desonide is a low potency synthetic non-fluorinated glucocorticoid used for the treatment of sensitive areas such as the face and intertriginous region, in the elderly and children (Kahanek et al. 2008; Horn et al. 2010). Despite the clinical efficacy of this class of drugs in therapy of inflammatory diseases TG can induce local and systemic side effects. Skin reactivity, telangiectasia, atrophy and hypopigmentation are common local side effects induced by these compounds. Among the systemic side effects induced by TG are endocrine effects, such as Cushing syndrome, metabolic events such as hyperglycemia and adrenocortical suppression and electrolyte balance disturbances, which can cause edema and hypertension (Beltrani et al. 2005; Hengge et al. 2006).