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Haddad F, Abou Shahla W, Saade D. Investigating Topical Steroid Withdrawal Videos on TikTok: Cross-Sectional Analysis of the Top 100 Videos. JMIR Form Res 2024; 8:e48389. [PMID: 39208411 DOI: 10.2196/48389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/24/2023] [Accepted: 10/11/2023] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Social media platforms like TikTok are a very popular source of information, especially for skin diseases. Topical steroid withdrawal (TSW) is a condition that is yet to be fully defined and understood. This did not stop the hashtag #topicalsteroidwithdrawal from amassing more than 600 million views on TikTok. It is of utmost importance to assess the quality and content of TikTok videos on TSW to prevent the spread of misinformation. OBJECTIVE This study aims to assess the quality and content of the top 100 videos dedicated to the topic of TSW on TikTok. METHODS This observational study assesses the content and quality of the top 100 videos about TSW on TikTok. A total of 3 independent scoring systems: DISCERN, Journal of the American Medical Association, and Global Quality Scale were used to assess the video quality. The content of the videos was coded by 2 reviewers and analyzed for recurrent themes and topics. RESULTS This study found that only 10.0% (n=10) of the videos clearly defined what TSW is. Videos were predominantly posted by White, middle-aged, and female creators. Neither cause nor mechanism of the disease were described in the videos. The symptoms suggested itching, peeling, and dryness which resembled the symptoms of atopic dermatitis. The videos fail to mention important information regarding the use of steroids such as the reason it was initially prescribed, the name of the drug, concentration, mechanism of usage, and method of discontinuation. Management techniques varied from hydration methods approved for treatment of atopic dermatitis to treatment options without scientific evidence. Overall, the videos had immense reach with over 200 million views, 45 million likes, 90,000 comments, and 100,000 shares. Video quality was poor with an average DISCERN score of 1.63 (SD 0.56)/5. Video length, total view count, and views/day were all associated with increased quality, indicating that patients were interacting more with higher quality videos. However, videos were created exclusively by personal accounts, highlighting the absence of dermatologists on the platform to discuss this topic. CONCLUSIONS The videos posted on TikTok are of low quality and lack pertinent information. The content is varied and not consistent. Health care professionals, including dermatologists and residents in the field, need to be more active on the topic, to spread proper information and prevent an increase in steroid phobia. Health care professionals are encouraged to ride the wave and produce high-quality videos discussing what is known about TSW to avoid the spread of misinformation.
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Affiliation(s)
- Firas Haddad
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - William Abou Shahla
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dana Saade
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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Zhang W, Zhao J, Zou X, Yu J, Liao J, Huang F. Multifunctional hydrogels for the healing of oral ulcers. J Biomed Mater Res A 2024. [PMID: 39210659 DOI: 10.1002/jbm.a.37776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024]
Abstract
Oral ulcers are one of the most common oral diseases in clinical practice. Its etiology is complex and varied. Due to the dynamic nature of the oral environment, the wound surface is painful due to contact and wear, which seriously affects the quality of life of patients. Oral ulcers are often treated with topical drug therapy. Studies have shown that functional hydrogels play a positive role in promoting wound healing, showing unique advantages in wound dressings. In this paper, the causes and healing characteristics of oral ulcers are discussed in depth, and then the common treatment methods for oral ulcers are summarized and compared. Finally, the potential of functional hydrogels in the treatment of oral ulcers is discussed and projected through a review of the literature in recent years.
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Affiliation(s)
- Wenjie Zhang
- Department of Pharmaceutical Microbiology, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Jie Zhao
- Department of Pharmaceutical Microbiology, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Xinxin Zou
- Department of Pharmaceutical Microbiology, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Jingrong Yu
- Department of Pharmaceutical Microbiology, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Jinlong Liao
- Department of Pharmaceutical Microbiology, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Fengjie Huang
- Department of Pharmaceutical Microbiology, School of Life Science and Technology, China Pharmaceutical University, Nanjing, China
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Bradic J, Petrovic A, Nikolic M, Nedeljkovic N, Andjic M, Kladar N, Bolevich S, Jakovljevic V, Kocovic A. Newly Developed Semi-Solid Formulations Containing Mellilotus officinalis Extract: Characterization, Assessment of Stability, Safety, and Anti-Inflammatory Activity. Pharmaceutics 2024; 16:1003. [PMID: 39204348 PMCID: PMC11359922 DOI: 10.3390/pharmaceutics16081003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
Melilotus officinalis has been traditionally used as an anti-inflammatory agent; nevertheless, a comprehensive evaluation of its efficacy and safety and comparison with standard drugs are lacking. Taking into consideration concerns with current therapies, like efficacy limitations, side effects, and resistance, we aimed to develop a natural gel and cream based on Melilotus officinalis extract and explore their anti-inflammatory potential. After the chemical analysis of the extract confirmed the presence of coumarin, p-coumaric acid, gallic acid, and quercetin, formulations were prepared and subjected to physical and chemical stability evaluations over 6 months. The safety potential was tested in rats, while the anti-inflammatory activity was assessed both via in silico tests and in a rat model of inflammation. The examined formulations showed stable physical characteristics at the defined storage conditions and did not exert any sign of adverse skin reaction. The gel formulation exhibited a remarkable effect in inflammation reduction comparable with hydrocortisone. The in silico results suggest that coumarin, p-coumaric, and gallic acid bind to COX-1 and COX-2 with a lower affinity compared to diclofenac. On the other hand, quercetin demonstrated comparable inhibitory activity and stronger interaction compared to the control drug. Our results indicate that the examined formulations are stable and safe and may be promising dermal products for the alleviation of inflammatory skin conditions.
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Affiliation(s)
- Jovana Bradic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.B.); (A.P.); (M.N.); (N.N.); (A.K.)
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia;
| | - Anica Petrovic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.B.); (A.P.); (M.N.); (N.N.); (A.K.)
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia;
| | - Milos Nikolic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.B.); (A.P.); (M.N.); (N.N.); (A.K.)
| | - Nikola Nedeljkovic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.B.); (A.P.); (M.N.); (N.N.); (A.K.)
| | - Marijana Andjic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.B.); (A.P.); (M.N.); (N.N.); (A.K.)
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia;
| | - Nebojsa Kladar
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
- Center for Medical and Pharmaceutical Investigations and Quality Control, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Stefani Bolevich
- Department of Pathological Physiology, 1st Moscow State Medical, University I.M. Sechenov, 119991 Moscow, Russia;
| | - Vladimir Jakovljevic
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia;
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Human Pathology, 1st Moscow State Medical, University I.M. Sechenov, 119991 Moscow, Russia
| | - Aleksandar Kocovic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia; (J.B.); (A.P.); (M.N.); (N.N.); (A.K.)
- Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia;
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Velasco RC, Simpson EL, Grinich EE. Treatment of Topical Corticosteroid Withdrawal: A Case Series. Dermatitis 2024; 35:418-419. [PMID: 38150554 DOI: 10.1089/derm.2023.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Rose C Velasco
- School of Medicine, University of Illinois College of Medicine, Chicago, IL,USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Erin E Grinich
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
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5
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Yamamoto-Hanada K, Ohya Y. Management of Infant Atopic Eczema to Prevent Severe Eczema and Food Allergy. Clin Exp Allergy 2024. [PMID: 38866599 DOI: 10.1111/cea.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024]
Abstract
Early intervention and active management of infant atopic eczema may play a crucial role in limiting eczema severity and preventing the onset of immediate-type food allergy. Eczema management involves education, skincare and medications targeting skin inflammation and barrier repair. Topical corticosteroids are the mainstay of anti-inflammatory therapy, with nonsteroidal options available for some infants. Proactive therapy, addressing subclinical inflammation, is useful for preventing eczema flares, especially in infants with recurrent eczema flares despite reactive therapy. In clinical practice, holistic consideration of overall infant and family health is essential. Providing advice on maternal stress management, nutritional guidance and recommendations for proper sleep and lifestyle is crucial for the well-being of children and their families, not limited to eczema treatment alone.
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Affiliation(s)
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Department of Occupational and Environmental Health, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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6
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Jarrell L. Therapeutic management of atopic dermatitis. Nurse Pract 2024; 49:39-46. [PMID: 38941080 DOI: 10.1097/01.npr.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
ABSTRACT Atopic dermatitis (AD), a chronic inflammatory, pruritic skin disorder, is seen primarily in the pediatric population but can be found among all age groups. The symptoms of AD can cause embarrassment in patients and can interrupt daily activities and productivity, potentially resulting in avoidance of social situations. In addition to nonpharmacologic management, mainstay pharmacologic treatments for AD are topical medications including corticosteroids, calcineurin inhibitors, phosphodiesterase-4 inhibitors, and topical Janus kinase (JAK) inhibitors. Promising new drugs-oral JAK inhibitors and monoclonal antibodies-have emerged as new treatment options for moderate-to-severe AD.
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Affiliation(s)
- Lynda Jarrell
- Lynda Jarrell is a clinical associate professor of nursing in the graduate program at the University of Texas at Arlington in Fort Worth, Tex
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7
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Shea M, Grinich E, Simpson E. Topical steroid withdrawal treated with ruxolitinib cream. JAAD Case Rep 2024; 48:5-7. [PMID: 38745830 PMCID: PMC11091456 DOI: 10.1016/j.jdcr.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Affiliation(s)
- Moira Shea
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Erin Grinich
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Eric Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
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8
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Shobnam N, Saksena S, Ratley G, Yadav M, Chaudhary PP, Sun AA, Howe KN, Gadkari M, Franco LM, Ganesan S, McCann KJ, Hsu AP, Kanakabandi K, Ricklefs S, Lack J, Yu W, Similuk M, Walkiewicz MA, Gardner DD, Barta K, Tullos K, Myles IA. Topical Steroid Withdrawal is a Targetable Excess of Mitochondrial NAD. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.17.24305846. [PMID: 38712043 PMCID: PMC11071640 DOI: 10.1101/2024.04.17.24305846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background Topical corticosteroids (TCS) are first-line therapies for numerous skin conditions. Topical Steroid Withdrawal (TSW) is a controversial diagnosis advocated by patients with prolonged TCS exposure who report severe systemic reactions upon treatment cessation. However, to date there have been no systematic clinical or mechanistic studies to distinguish TSW from other eczematous disorders. Methods A re-analysis of a previous survey with eczematous skin disease was performed to evaluate potential TSW distinguishing symptoms. We subsequently conducted a pilot study of 16 patients fitting the proposed diagnostic criteria. We then performed: tissue metabolomics, transcriptomics, and immunostaining on skin biopsies; serum metabolomics and cytokine assessments; shotgun metagenomics on microbiome skin swabs; genome sequencing; followed by functional, mechanistic studies using human skin cell lines and mice. Results Clinically distinct TSW symptoms included burning, flushing, and thermodysregulation. Metabolomics and transcriptomics both implicated elevated NAD+ oxidation stemming from increased expression of mitochondrial complex I and conversion of tryptophan into kynurenine metabolites. These abnormalities were induced by glucocorticoid exposure both in vitro and in a cohort of healthy controls (N=19) exposed to TCS. Targeting complex I via either metformin or the herbal compound berberine improved outcomes in both cell culture and in an open-label case series for patients with TSW. Conclusion Taken together, our results suggest that TSW has a distinct dermatopathology. While future studies are needed to validate these results in larger cohorts, this work provides the first mechanistic evaluation into TSW pathology, and offers insights into clinical identification, pharmacogenomic candidates, and directed therapeutic strategies.
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9
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Marshall HF, Leung DYM, Lack G, Sindher S, Ciaccio CE, Chan S, Nadeau KC, Brough HA. Topical steroid withdrawal and atopic dermatitis. Ann Allergy Asthma Immunol 2024; 132:423-425. [PMID: 38142858 DOI: 10.1016/j.anai.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Hannah F Marshall
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Gideon Lack
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Sayantani Sindher
- Department of Medicine and Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Christina E Ciaccio
- Departments of Pediatrics and Medicine, The University of Chicago, Chicago, Illinois
| | - Susan Chan
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Kari C Nadeau
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Helen A Brough
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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10
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Ch'en PY, Lio PA. Nonsteroidal Approaches for Atopic Dermatitis: A Clinical Update. Dermatitis 2024. [PMID: 38320243 DOI: 10.1089/derm.2023.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Topical corticosteroids (TCSs) are the most widely used treatment for atopic dermatitis (AD), but they can have adverse effects such as skin atrophy, telangiectasias, and hypopigmentation, especially with prolonged use of higher potency steroids. Many patients also have a fear of using TCSs, known as "corticophobia." With the development of biologics and Janus kinase inhibitors, a nonsteroidal approach to the treatment of AD may be possible and may be preferred by certain patients. Given what is known about these nonsteroidal therapies, we propose a structured treatment ladder and action plan that can guide clinicians and patients on the use of these therapies for the treatment of AD. The ladder divides nonsteroidal medication classes into treatments for exacerbation versus maintenance therapies in an escalating order of increasing potential for adverse effects, both real and perceived. This treatment algorithm proposal paves the way for a potential nonsteroidal approach to managing AD.
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Affiliation(s)
- Peter Y Ch'en
- From the Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Peter A Lio
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Medical Dermatology Associates of Chicago, Chicago, Illinois, USA
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11
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Zhao S, Hwang A, Miller C, Lio P. Safety of topical medications in the management of paediatric atopic dermatitis: An updated systematic review. Br J Clin Pharmacol 2023; 89:2039-2065. [PMID: 37075252 DOI: 10.1111/bcp.15751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 04/21/2023] Open
Abstract
AIM New topical agents have been developed for the treatment of atopic dermatitis (AD) in recent years. This systematic review is intended to synthesize the clinical trial literature and concisely report the updated safety and adverse effects of topical medications used to treat atopic dermatitis in children. METHODS A systematic search of Cochrane Library, Embase, PubMed and ClinicalTrials.gov from inception to March 2022 was conducted for trials of topical medications used to treat AD in patients <18 years (PROSPERO #CRD42022315355). Included records were limited to English-language publications and studies of ≥3 weeks duration. Phase 1 studies and those that lacked separate paediatric safety reporting were excluded. RESULTS A total of 5005 records were screened; 75 records met inclusion criteria with 15 845 paediatric patients treated with tacrolimus, 12 851 treated with pimecrolimus, 3539 with topical corticosteroid (TCS), 700 with crisaborole and 202 with delgocitinib. Safety data was well reported in tacrolimus trials with the most frequently reported adverse events being burning sensation, pruritus and cutaneous infections. Two longitudinal cohort studies were included, one for tacrolimus and one for pimecrolimus, which found no significant increased risk of malignancy with topical calcineurin inhibitor (TCI) use in children. Skin atrophy was identified as an adverse event in TCS trials, which other medications did not. Systemic adverse events for the medications were largely common childhood ailments. CONCLUSION Data discussed here support the use of steroid-sparing medications (tacrolimus, pimecrolimus, crisaborole, delgocitinib) as safe options with minimal adverse events for managing paediatric AD, although a larger number of TCI studies reported burning and pruritus compared to TCS studies. TCS was the only medication class associated with reports of skin atrophy in this review. The tolerability of these adverse events should be considered when treating young children. This review was limited to English-language publications and the variable safety reporting of trial investigators. Many newer medications were not included due to pooled adult and paediatric safety data that did not meet inclusion criteria.
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Affiliation(s)
- Sharon Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Austin Hwang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Corinne Miller
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Peter Lio
- Departments of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Sidbury R, Alikhan A, Bercovitch L, Cohen DE, Darr JM, Drucker AM, Eichenfield LF, Frazer-Green L, Paller AS, Schwarzenberger K, Silverberg JI, Singh AM, Wu PA, Davis DMR. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol 2023; 89:e1-e20. [PMID: 36641009 DOI: 10.1016/j.jaad.2022.12.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND New evidence has emerged since the 2014 guidelines that further informs the management of atopic dermatitis (AD) with topical therapies. These guidelines update the 2014 recommendations for management of AD with topical therapies. OBJECTIVE To provide evidence-based recommendations related to management of AD in adults using topical treatments. METHODS A multidisciplinary workgroup conducted a systematic review and applied the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS The workgroup developed 12 recommendations on the management of AD in adults with topical therapies, including nonprescription agents and prescription topical corticosteroids (TCS), calcineurin inhibitors (TCIs), Janus kinase (JAK) inhibitors, phosphodiesterase-4 inhibitors (PDE-4), antimicrobials, and antihistamines. LIMITATIONS The pragmatic decision to limit the literature review to English-language randomized trials may have excluded data published in other languages and relevant long-term follow-up data. CONCLUSIONS Strong recommendations are made for the use of moisturizers, TCIs, TCS, and topical PDE-4 and JAK inhibitors. Conditional recommendations are made for the use of bathing and wet wrap therapy and against the use of topical antimicrobials, antiseptics, and antihistamines.
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Affiliation(s)
- Robert Sidbury
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Ali Alikhan
- Department of Dermatology, Sutter Medical Foundation, Sacramento, California
| | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David E Cohen
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Jennifer M Darr
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Lawrence F Eichenfield
- University of California San Diego and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | | | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peggy A Wu
- Department of Dermatology, University of California, Davis, Sacramento, California
| | - Dawn M R Davis
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
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13
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Dou X, Li G, Wang S, Shao D, Wang D, Deng X, Zhu Y, Gao P, Liu J, Deng N, Yuan C, Zhou Q. Probiotic-loaded calcium alginate/fucoidan hydrogels for promoting oral ulcer healing. Int J Biol Macromol 2023:125273. [PMID: 37301354 DOI: 10.1016/j.ijbiomac.2023.125273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
Probiotics are beneficial bacteria located in the oral cavity which exhibit antimicrobial properties and contribute to the regulation of immune function and the modulation of tissue repair. Fucoidan (FD), a marine prebiotic, may further enhance the ability of probiotics to promote ulcer healing. However, neither FD nor probiotics are attached to the oral cavity and neither are well-suited for oral ulcer healing owing to the wet and highly dynamic environment. In this study, probiotic-loaded calcium alginate/fucoidan composite hydrogels were developed for use as bioactive oral ulcer patches. The well-shaped hydrogels exhibited remarkable wet-tissue adhesion, suitable swelling and mechanical properties, sustained probiotic release, and excellent storage durability. Moreover, in vitro biological assays demonstrated that the composite hydrogel exhibited excellent cyto/hemocompatibility and antimicrobial effects. Importantly, compared to commercial oral ulcer patches, bioactive hydrogels show superior therapeutic capability for promoting ulcer healing in vivo by enhancing cell migration, inducing epithelial formation and orderly collagen fiber deposition, as well as facilitating neovascularization. These results demonstrate that this novel composite hydrogel patch demonstrates great potential for the treatment of oral ulcerations.
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Affiliation(s)
- Xue Dou
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China; School of Stomatology, Qingdao University, Qingdao 266023, China
| | - Guotai Li
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao 266071, China
| | - Shuang Wang
- Department of Medical Chemistry, School of Pharmacy, Qingdao University, Qingdao, China; Huangdao District Central Hospital, Qingdao, China
| | - Dan Shao
- Huangdao District Central Hospital, Qingdao, China
| | - Danyang Wang
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China; School of Stomatology, Qingdao University, Qingdao 266023, China
| | - Xuyang Deng
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China; School of Stomatology, Qingdao University, Qingdao 266023, China
| | - Yanli Zhu
- Department of Stomatology, Qingdao Women and Children's Hospital, Qingdao, Shandong 266000, China
| | - Pengyu Gao
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China; School of Stomatology, Qingdao University, Qingdao 266023, China
| | - Jia Liu
- Huangdao District Central Hospital, Qingdao, China
| | - Na Deng
- Department of Scientific Research, Qingdao East Sea Pharmaceutical Co., Ltd., Qingdao, China
| | - Changqing Yuan
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China; School of Stomatology, Qingdao University, Qingdao 266023, China; Dental Biomaterials Technology Innovation Center of Qingdao, Qingdao 266003, China.
| | - Qihui Zhou
- School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao 266071, China.
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14
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Howells L, Broome H, Burleigh A, Hammond H, Ismail F, Proctor A, Roberts A, Thomas KS, Leighton P. Topical corticosteroid withdrawal syndrome: the patient community call for high-quality research, clear definitions and diagnostic criteria. Br J Dermatol 2023; 188:288-289. [PMID: 36763872 DOI: 10.1093/bjd/ljac067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/18/2022] [Accepted: 10/22/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | | | | | | | | | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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15
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Feschuk AM, Pratt ME. Topical steroid withdrawal syndrome in a mother and son: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231164268. [PMID: 37051261 PMCID: PMC10084575 DOI: 10.1177/2050313x231164268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Topical corticosteroids are first-line treatment for many dermatoses, and are generally considered safe and effective. However, topical steroid withdrawal syndrome can result from use of topical corticosteroids, and this condition is not well-known among physicians. This article reports a mother and son whose presentations of topical steroid withdrawal syndrome following the discontinuation of prolonged, high-potency topical corticosteroid use were nearly identical. This report adds to the growing body of evidence that topical steroid withdrawal syndrome is its own entity, rather than an exacerbation of the underlying dermatosis, and adds to the few pediatric reports of topical steroid withdrawal syndrome. Management for both patients involved topical corticosteroid discontinuation; however, it took approximately 2 years before the majority of their topical steroid withdrawal syndrome manifestations resolved. Increased awareness surrounding this condition is essential to facilitate topical steroid withdrawal syndrome prevention and diagnosis and to decrease topical corticosteroid phobia and increase patient–physician trust.
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Affiliation(s)
- Aileen M Feschuk
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Michelle E Pratt
- Division of Dermatology, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
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16
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Cotter C, Burton T, Proctor A, Moss C, Flohr C. Topical steroid withdrawal syndrome: time to bridge the gap. Br J Dermatol 2022; 187:780-781. [PMID: 35833942 DOI: 10.1111/bjd.21770] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/09/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Chantal Cotter
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Celia Moss
- Department of Dermatology, Birmingham Children's Hospital, Birmingham, UK
| | - Carsten Flohr
- Unit for Paediatric & Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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17
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Nguyen AP, Kong JS, Teuber SS. Reply to "Severe topical corticosteroid withdrawal syndrome or enigmatic drug eruption?". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1126-1127. [PMID: 35397813 DOI: 10.1016/j.jaip.2022.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Anh P Nguyen
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of California Davis, School of Medicine, Sacramento, Calif.
| | - James S Kong
- Alameda Centre Physicians, Alameda, Calif; Department of Internal Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Sacramento, Calif
| | - Suzanne S Teuber
- Department of Internal Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, School of Medicine, Sacramento, Calif; Veterans Affairs Northern California Healthcare System, Mather, Calif
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18
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Bowe S, Masterson S, Murray G, Haugh I. Topical steroid withdrawal through the lens of social media. Clin Exp Dermatol 2022; 47:1554-1557. [PMID: 35340034 DOI: 10.1111/ced.15194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/22/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The term topical steroid withdrawal (TSW) describes an adverse effect that generally occurs with inappropriate prolonged use of high-potency topical corticosteroids (TCS). The presence of user-generated content relating to TSW on social media has not been well-defined to date. OBJECTIVE We aimed to explore content relating to topical steroid withdrawal on social media. METHODS Using a data analytics platform, we retrospectively analysed the hashtag #topicalsteroidwithdrawal on social media over a 5 year period, from the 8th of February 2016 until the 8th of February 2021. We assessed: interactions, performance, shares, likes, mentions, language and country of origin using descriptive statistics. RESULTS Across all social media platforms there was a 274% increase in mentions of the hashtag #topicalsteroidwithdrawal in the year 2020(7992) compared with the year 2016(2138). Top associated hashtags included #TSW, #eczema, and #topicalsteroidaddiction. On Instagram, we found a 288% increase in number of mentions and a 592% increase in performance of #topicalsteroidwithdrawal in 2020(618,354) when compared to 2016(89,390). CONCLUSION Our results confirm an increase in the presence of user-generated content relating to TSW on social media and also highlight its extent. Large numbers of patients are exposed to this content which could influence their engagement with TCS.
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Affiliation(s)
- Stephanie Bowe
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Sophie Masterson
- University of Limerick, Medical School Limerick, Limerick, Ireland
| | - Gregg Murray
- Department of Dermatology, Beaumont Hospital, Leinster, Dublin, Ireland
| | - Isabel Haugh
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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19
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Clinical insights into topically applied multipronged nanoparticles in subjects with atopic dermatitis. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Tan SY, Chandran NS, Choi ECE. Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal. Clin Drug Investig 2021; 41:835-842. [PMID: 34409577 PMCID: PMC8481181 DOI: 10.1007/s40261-021-01072-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/01/2022]
Abstract
There is a growing concern amongst patients about topical corticosteroid (TCS) side effects, with increasing discussion of topical steroid addiction (TSA) and topical steroid withdrawal (TSW) particularly on social media platforms. However, the acceptance of TSA/TSW as a distinct condition remains controversial within the dermatological community. We conducted a literature search using PubMed, MEDLINE, Cochrane Library, Google Scholar, Embase and Web of Science to identify original articles addressing TSA/TSW. We described the definition and reported clinical features of TSA/TSW including its classification into erythemato-edematous and papulopustular subtype. To assess the validity of TSA/TSW, we summarised and objectively appraised the postulated mechanisms for this condition, including tachyphylaxis, dysregulation of glucocorticoid receptors, rebound vasodilation and impaired skin barrier leading to a cytokine cascade. Understanding the evidence including its limitations and uncertainties highlights areas for future research and helps medical practitioners better counsel and provide care to patients who may be experiencing or who have concerns about TSA/TSW.
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Affiliation(s)
- Sean Yilong Tan
- Division of Dermatology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Nisha Suyien Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore. .,Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
| | - Ellie Ci-En Choi
- Division of Dermatology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
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