Benign vulval problems
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
The treatment of LS should control symptoms, prevent further skin damage and reduce the risk of developing cancer. Ultrapotent corticosteroids are the cornerstone of treatment for most women with LS. Clobetasol propionate is the most potent topical corticosteroid available and recommended as first-line treatment. Response rates are high with either complete or partial resolution of symptoms [A].8 Relapse of symptoms is common although improved response rates are seen with longer regular use on an ultrapotent steroid, usually on a reducing regime before returning to ‘as required’ use. Lower-potency steroids and topical testosterone are not advocated. The British Association of Dermatology has detailed guidelines based on the best available evidence for the management of LS (see Box 104.3 for summary points) [A].9 Women need clear information and directions on the use of their medicaments. Underuse of topical steroids is a more common problem than overuse. However there are no RCTS to support the frequency and duration of use of topical steroids. A widely used regime is daily clobetasol propionate for one month followed by a gradual reducing regime [E].4
Dermatologic Disorders Causing Vulvar Disease
William J. Ledger, Steven S. Witkin in Vulvovaginal Infections, 2017
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.
Legal Aspects of Atopic Dermatitis
Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld in Atopic Dermatitis and Eczematous Disorders, 2014
Another area of potential litigation with atopic dermatitis is adrenal suppression from inappropriate (usually long-term) use of high-potency topical steroids for atopic or other dermatitides (Kubetin 2003, Ault 2005, Skin-Cap 2008) (Perkins and Perkins v Walker 1987). Many case reports exist that relate class I steroid use (clobetasol propionate) to adrenal suppression, bone pathology, and other serious adverse effects. A lawsuit was successfully waged against a dermatologist who prescribed months of topical high-potency corticosteroids for chronic hand dermatitis which led to adrenal suppression, osteoporosis, and sequelae from the osteoporosis, including damage to the spine. The issue of adrenal suppression from long-term topical steroid use in a psoriatic patient was a legal issue in a surgical case involving proper preoperative preparation. A product named Skin-Cap, which was supposed to contain natural remedies and zinc and instead contained high-potency steroids, prompted the US Food and Drug Administration (FDA) to ban its sale and resulted in a class action lawsuit against its maker.
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).
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”.
Complications and posttreatment care following invasive laser skin resurfacing: A review
Published in Journal of Cosmetic and Laser Therapy, 2018
Dan Li, Shi-Bin Lin, Biao Cheng
The rates of postinflammatory hyperpigmentation differed among skin phototypes III, IV, and V (2.6, 11.6, and 33%, respectively) in an investigation of fractional LSR(37). Obviously, the risk of hyperpigmentation for individuals with a dark complexion may only be controlled to some extent. Wanitphakdeedecha demonstrated that the use of broad-spectrum sunscreen on the first day after fractional LSR may decrease the incidence of PIH during the first week(78). However, in a study by Boonchai, the author found that the early application of sunscreen from day 1 might increase the risk of sensitization because the skin barrier was not fully healed. Thus, he recommended that sunscreen be used from day 3(79). Cheyasak undertook a split-face comparison study of patients after LSR. One side was randomly selected for treatment with clobetasol propionate 0.05% ointment for the first 2 days and then changed to petrolatum for the subsequent 5 days, while petrolatum alone was used on the control side. The results showed that despite the short-term use, the topical corticosteroid reduced the incidence of PIH (40%) more than the petrolatum-only treatment (75%)(80).
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