Contact allergy to hydrocortisone and systemic contact dermatitis from prednisolone with tolerance of betamethasone

BACKGROUND

Contact allergy to corticosteroids is not uncommon. As the clinical pattern that the patients exhibit may be misleading, the discovery at patch testing may be unexpected and solely a result of the fact that marker molecules for corticosteroid contact allergy are incorporated into standard series and that tests are read twice, on D3/4 and D7.

OBJECTIVE

We describe a patient allergic to hydrocortisone who was given a cross-reacting corticosteroid, prednisolone, that led to a systemic contact dermatitis. The patient cleared when betamethasone, a non¿Ncross-reacting corticosteroid, was administered.

METHODS

The patient was patch tested to a standard series including tixocortol pivalate, and an extended corticosteroid series including betamethasone.

RESULTS

Patch testing with tixocortol pivalate provoked an allergic patch test reaction (+? D3, +D7), whereas betamethasone did not.

CONCLUSION

Our patient's allergy was undiagnosed for 5 years, and it was not until she was given a cross-reacting corticosteroid, which led to exacerbation of her dermatitis, that her physician suspected corticosteroid allergy. The incorporation of marker molecules for the detection of corticosteroid contact allergy into standard series with two reading occasions, 3 to 4 days apart, is advocated.

Differences in the in vitro sensitivity of ovine myometrium and mesometrium to oxytocin and prostaglandins E2 and F2alpha

We compared the in vitro response to oxytocin, prostaglandin (PG)E2, and PGF2alpha of myometrium and mesometrium from six ovariectomized ewes and 53 ewes at 106-145 days gestational age (dGA), including 14 ewes in spontaneous or betamethasone-induced labor. Myometrial baseline activity increased from 217+/-27 mN/cm2 of cross-sectional area (mean +/-SEM) in ovariectomized ewes to a plateau of 696+/-39 mN/cm2 at 126-135 dGA. No gestation-related changes were observed in mesometrial baseline activity. Myometrial, but not mesometrial, maximum tension in response to agonists increased with gestation to a plateau at 126-135 dGA. The pD2 (negative logarithm of the EC50) values for oxytocin were similar in both tissues and did not change with gestation. During pregnancy, the myometrial pD2 of both PGs was one order of magnitude higher than the mesometrial pD2. The results indicate an increase in myometrial uterotonic receptor-mediated activity that precedes labor with no increase at labor, suggesting that in sheep, activation of the basic mechanisms responsible for strength of myometrial activity at labor occurs by 135 dGA. The greater sensitivity of the myometrium than the mesometrium to PGs supports a major role for intrauterine paracrine factors in regulating myometrial contractility.

Betamethasone-induced ocular hypertension in rabbits

The effect of subconjunctivally injected betamethasone on intraocular pressure (IOP) was studied in 85 albino New Zealand rabbits. IOP was measured with a Mentor Model 30 classic pneumatonograph that was manometrically calibrated to the rabbit eye. Ocular hypertension was induced by weekly subconjunctival injections of a betamethasone suspension into the left eye. In one experiment, 70 rabbits were given betamethasone for 4 weeks, while a second group of 10 rabbits received betamethasone for 11 weeks. The short-term effects of subconjunctival injections of betamethasone on IOP were also recorded in a third group of 5 rabbits. Weekly injections over 4 weeks resulted in an increase in IOP in the treated eye, which was prolonged to 11 weeks by repeated weekly injections. A sustained increase in IOP was observed in the treated eye for a period of 7 weeks. During the early hours after betamethasone injection, a transient decrease in IOP was registered in both eyes. The results show that weekly subconjunctival injections of betamethasone cause a predictable increase in IOP in the treated eye which may be suitable for testing the short- and long-term effects of antiglaucoma drugs. Evidence suggesting that endogenous glucocorticoids may play a role in the development of ocular hypertension in humans strengthens the potential value of this glaucoma model.

SOME ASPECTS OF THE METABOLISM AND DISPOSITION OF BETAMETHASONE

Following the administration of 4 mg of tritiated betamethasone, with specific activity 75 μc/mg, the concentration of betamethasone and some of its metabolites were measured repeatedly in saliva, plasma and urine. The finding of particular interest was the metabolism of betamethasone within the salivary glands to a steroid provisionally identified as 11-oxobetamethasone. The significance of this finding and of the extra-hepatic metabolism of corticosteroids in general were discussed. Also discussed was the bearing of other findings upon the nature of the factors responsible for a cortisol analogues potency.

CHEMOTHERAPY OF ARTHRITIS INDUCED IN RATS BY MYCOBACTERIAL ADJUVANT

Arthritis induced in rats by mycobacterial adjuvant has been used for the study of compounds of known value in the treatment of rheumatoid arthritis in man. The development of the arthritic syndrome in treated and control rats was followed by measuring the changes in foot thickness of both hind-feet with a micrometer. This method allowed the effect of anti-inflammatory compounds to be expressed quantitatively. Anti-inflammatory activity was readily observed in certain steroids, pyrazolidines, salicylates and sodium aurothiomalate. Chloroquine and hydroxychloroquine were inactive. The inhibition obtained by daily treatment with the steroid paramethasone disappeared when treatment was withdrawn.

Pharmacokinetic and pharmacodynamic aspects of an ophthalmic pilocarpine nanoparticle-delivery-system

The regional pharmacokinetics as well as the pharmacodynamics of pilocarpine-loaded nanoparticles for the treatment of glaucoma were investigated and compared to a solution of this drug. Polybutylcyanoacrylate nanoparticles were prepared by an emulsion polymerization process. Formulations with different drug concentrations (2-6%) as well as different particle concentrations were investigated and analyzed for size and drug loading. Drug binding to the particles was achieved at a level of 10-18% of the total drug content. The colloidal nanoparticles were sufficiently small (diameter: 100-300 nm) for a non-irritating application to the eye. All preparations were applied to the eyes of New Zealand white rabbits which were treated with betamethasone before to create an elevated intraocular pressure (IOP). Pilocarpine concentrations, assayed from aqueous humor using gaschromatography, increased by 23% (AUC) for nanoparticle suspensions compared to aqueous reference solutions. Additionally, t1/2 was prolonged and the elimination coefficient was significantly decreased. Pharmacodynamic effects such as miosis and IOP reduction were investigated. tmax values of aqueous humor concentration were observed to be in a similar time range as miosis tmax readings. It was found that at lower drug contents a more pronounced prolongation of miosis was achieved with nanoparticles versus a standard solution. The IOP-reduction was significantly prolonged with nanoparticles preparations; whereas maximum reduction was obtained with a reference solution after 1-2 hours, it was reached with nanoparticles at about 2-3 hours. Differences between nanoparticles and aqueous solutions were most pronounced at lower drug concentrations.

Brain amines in glucocorticoid-induced hypertension in the rat

A two week administration of the glucocorticoid betametasone to male Wistar rats produced a mild hypertensive state. The brain of these rats showed some significant changes in amine and metabolite content with respect to normotensive controls. Epinephrine and metanephrine were increased in the rostral ventrolateral medulla and in the preoptic area. Epinephrine also increased in the septal area. Normetanephrine decreased in the rostral ventrolateral medulla. Dopamine and homovanillic acid increased in septal and preoptic areas. Dopamine alone increased in rostral ventrolateral medulla. Serotonin and 5-hydroxyindole-3-acetic acid increased in the septal area and dorsal medulla. These changes suggest significant alterations in the aminergic activity of the brain circuitry known to regulate cardiovascular functions; the changes may play a basic role in the development and maintenance of glucocorticoid-induced hypertension.

Pneumocystis carinii infection in corticosteroid-treated cats

Corticosteroids were administered to produce Pneumocystis carinii infection in cats. Six of 10 cats, injected intramuscularly for 97-141 days with 2 mg/cat twice weekly of betamethasone sodium phosphate, developed a light infection with P. carinii. Six of 7 cats, injected intramuscularly for 11-168 days with 10-25 mg/cat weekly of prednisolone acetate, also developed a light infection with P. carinii. There was no significant difference in the infection rate between the sexes and ages of the cats. Using Giemsa staining and Gomori's methenamine silver nitrate stain, P. carinii organisms were indistinguishable morphologically from human and rat P. carinii. The cysts and trophozoites were usually present singly or in small groups, and they always were adhering to the periphery of alveoli. The inflammatory changes were inconspicuous except for the fact that alveolar macrophages often were seen. Corticosteroid-treated cats should be useful in the study of experimental P. carinii infection. This is the first reported case of experimentally induced P. carinii infection in cats.

Judgement of the hypothalamic-pituitary-adrenocortical function in psychiatric patients by betamethasone-induced cortisol suppressibility

Betamethasone induced cortisol suppressibility was examined in 62 drug free consecutively admitted psychiatric inpatients. Betamethasone was choosen instead of the commonly used dexamethasone, because its double half-life compared to dexamethasone and its higher tissue availability. After a base-line evaluation with blood samples drawn at 8 a.m., 4 p.m., and 11 p.m., 0.5 mg or 1.0 mg betamethasone was given orally at 11 p.m. Postbetamethasone cortisol as well as betamethasone blood levels were then measured at the same time points as on the baseline day. In the groups receiving 1.0 mg betamethasone non-depressed patients had significantly (p less than 0.05) lower postbetamethasone cortisol levels than depressed patients for each time point measured whereas 0.5 mg betamethasone did not differentiate depressed from non-depressed patients. Patients with other depressions like schizoaffective psychosis-depressive subtype- or organic brain syndrome with depressive symptomatology demonstrated similar postbetamethasone cortisol profiles as the group of patients with major depression. Betamethasone plasma concentrations differed significantly (p less than 0.001) with respect to the oral dosage with higher values for the 1.0 mg betamethasone groups.

[The betamethasone test in the diagnosis of placental insufficiency]

A trial to evaluate a functional test of the fetoplacental unit by measuring the extent of suppression of maternal estriol serum levels by glucocorticoids is described. 21 women between the 30th and 40th week of gestation received 4 mg betamethason intravenous injection at 8.30 a.m. Blood samples were collected immediately before betamethason application and at 1.00 p.m., 4.00 p.m., 8 p.m. o'clock and at 8.30 a.m. on the next day. Estriol (E3), cortisol, dehydroepiandrosterone sulfate (DHEA-S) and human placental lactogen (HPL) were determined from serum samples by radioimmunologic methods. Patients were divided into 3 groups: severe placental insufficiency (group I, n = 6) described by growth retardation of the fetus of more than 2 weeks, normal gestations (group II, n = 8) and slight growth retardation (group III, n = 7). After temporary suppression in groups II and III, E3, DHEA-S and cortisol levels showed a significant increase the day after betamethason. In group I an increase of these parameters was observed 2 to 5 days after betamethason. These results show that a low intravenous dosage of betamethason and collection of blood samples for E3 assays in intervals of 12 hours can be used as a functional test of the fetoplacental unit.

Is osteonecrosis of the femoral head avascular? Bone blood flow measurements after long-term treatment with corticosteroids

Since nontraumatic osteonecrosis of the femoral head is usually considered primarily as an ischemic disease, blood flow has been studied in femoral segments in two groups of geese, one control group and the other treated with a high dose of corticosteroids for 5 months. There was no histologic evidence of osteonecrosis in femoral heads, and mean bone blood flow in any femoral segments was not reduced in the treated group. These results suggest that osteonecrosis of the femoral head is not caused primarily by ischemia, even if ischemia may play a secondary role in the evolution of the disorder.

Glucocorticoid receptors in human polymorphonuclear and mononuclear leucocytes. Concentrations and binding characteristics

Both polymorphonuclear (PMN) and mononuclear (MN) leucocytes constitute targets for glucocorticoid hormones. In order to comparatively characterize the earliest steps of steroid action in these cell populations, we investigated the concentrations and specificities of glucocorticoid receptors in purified human PMNs and MNs by a whole-cell binding assay using (3H)dexamethasone as the ligand. PMNs and MNs were found to contain the same amounts of glucocorticoid receptors (4720 and 4900 receptor sites/cell, respectively). The equilibrium dissociation constant (KD) of the interaction between the cellular receptor and (3H)dexamethasone was about the same (1 x 10(-8)M) in both cell populations. No significant difference in the specificities of the steroid binding sites in PMNs and MNs were found; competition studies revealed the following order of relative binding affinities for a number of compounds: betamethasone greater than dexamethasone greater than prednisolone greater than cortisol greater than deoxycorticosterone = progesterone greater than aldosterone greater than testosterone greater than estradiol-17 beta. We conclude that known differences in the sensitivities of PMNs and MNs to glucocorticoids are apparently not caused by differences in the concentrations or characteristics of their glucocorticoid receptors.