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Erdem B, Gonul M, Ozturk Unsal I, Ozdemir Sahingoz S. Evaluation of psoriasis patients with long-term topical corticosteroids for their risk of developing adrenal insufficiency, Cushing's syndrome and osteoporosis. J DERMATOL TREAT 2024; 35:2298880. [PMID: 38156462 DOI: 10.1080/09546634.2023.2298880] [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: 07/14/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE In this study, we will investigate the possible side effects of psoriasis patients using long-term topical corticosteroids (TCS) such as adrenal insufficiency, Cushing's Syndrome (CS) and osteoporosis and determine how these side effects develop. MATERIAL AND METHODS Forty-nine patients were included in the study. The patients were divided into two groups based on the potency of the topical steroid they took and the patients' ACTH, cortisol and bone densitometer values were evaluated. RESULTS There was no significant difference between the two groups regarding the development of surrenal insufficiency, CS and osteoporosis. One patient in group 1 and 4 patients in group 2 were evaluated as iatrogenic CS. ACTH stimulation tests of these patients in group 2 showed consistent results with adrenal insufficiency, while no adrenal insufficiency was detected in the patient in Group 1. Patients who used more than 50g of superpotent topical steroids per week compared to patients who used 50g of superpotent topical steroids per week. It was identified that patients who used more than 50g of superpotent topical steroids had significantly lower cortisol levels, with a negatively significant correlation between cortisol level and the amount of topical steroid use (p < .01).Osteoporosis was detected in 3 patients in group 1 and 8 patients in Group 2. Because of the low number of patients between two groups, statistical analysis could not be performed to determine the risk factors. CONCLUSIONS Our study is the first study that we know of that investigated these three side effects. We have shown that the development of CS, adrenal insufficiency and osteoporosis in patients who use topical steroids for a long time depends on the weekly TCS dosage and the risk increases when it exceeds the threshold of 50 grams per week. therefore, our recommendation would be to avoid long-term use of superpotent steroids and to choose from the medium-potent group if it is to be used.
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Affiliation(s)
- Betul Erdem
- Department of Dermatology, Van Training and Research Hospital, Van, Turkey
| | - Muzeyyen Gonul
- Department of Dermatology, Ministry of Health, Ankara Etlik City Hospital, Ankara, Turkey
| | - Ilknur Ozturk Unsal
- Department of Endocrine and Metabolic Disease, Ministry of Health, Ankara Etlik City Hospital, Ankara, Turkey
| | - Seyda Ozdemir Sahingoz
- Department of Biochemistry, Ministry of Health, Ankara Etlik City Hospital, Ankara, Turkey
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Purt B, Nugent A, Wu PS, Paulus YM. Sub-Tenon Triamcinolone and Anti-HIV Medication-Induced Cushing Syndrome. JAMA Ophthalmol 2024:2822890. [PMID: 39207740 DOI: 10.1001/jamaophthalmol.2024.3284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
This case report describes a diagnosis of iatrogenic Cushing syndrome as a result of sub-Tenon triamcinolone injection in a patient receiving treatment for HIV who presented with decreased visual acuity in both eyes.
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Affiliation(s)
- Boonkit Purt
- Department of Ophthalmology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | | | - Patricia S Wu
- Southern California Permanente Medical Group, Pasadena
- University of California San Diego, San Diego
| | - Yannis M Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
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3
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Guo Y, Peng X, Liu F, Zhang Q, Ding L, Li G, Qiu F. Potential of natural products in inflammation: biological activities, structure-activity relationships, and mechanistic targets. Arch Pharm Res 2024; 47:377-409. [PMID: 38739203 DOI: 10.1007/s12272-024-01496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/23/2024] [Indexed: 05/14/2024]
Abstract
A balance between the development and suppression of inflammation can always be found in the body. When this balance is disturbed, a strong inflammatory response can damage the body. It sometimes is necessary to use drugs with a significant anti-inflammatory effect, such as nonsteroidal anti-inflammatory drugs and steroid hormones, to control inflammation in the body. However, the existing anti-inflammatory drugs have many adverse effects, which can be deadly in severe cases, making research into new safer and more effective anti-inflammatory drugs necessary. Currently, numerous types of natural products with anti-inflammatory activity and distinct structural features are available, and these natural products have great potential for the development of novel anti-inflammatory drugs. This review summarizes 260 natural products and their derivatives with anti-inflammatory activities in the last two decades, classified by their active ingredients, and focuses on their structure-activity relationships in anti-inflammation to lay the foundation for subsequent new drug development. We also elucidate the mechanisms and pathways of natural products that exert anti-inflammatory effects via network pharmacology predictions, providing direction for identifying subsequent targets of anti-inflammatory natural products.
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Affiliation(s)
- Yajing Guo
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Xuling Peng
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Fanfei Liu
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Qi Zhang
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Liqin Ding
- State Key Laboratory of Component-Based Chinese Medicine, Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China
- Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China
| | - Gen Li
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China.
- Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China.
| | - Feng Qiu
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China.
- State Key Laboratory of Component-Based Chinese Medicine, Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China.
- Tianjin Key Laboratory of Therapeutic Substance of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, Jinghai District, Tianjin, 301617, People's Republic of China.
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Chindris A, Rao SN, Chirila RM, Dumitrascu AG. A case of celiac plexus block causing iatrogenic Cushing's syndrome. Clin Case Rep 2024; 12:e8777. [PMID: 38623358 PMCID: PMC11017460 DOI: 10.1002/ccr3.8777] [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: 12/31/2023] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/17/2024] Open
Abstract
Treatment with corticosteroids can lead to iatrogenic Cushing's syndrome when used for longer intervals and in high doses. Less common administration routes may conceal the exposure, raising the possibility of misdiagnosis and mismanagement.
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Affiliation(s)
- Ana‐Maria Chindris
- Division of Endocrinology, Department of Internal MedicineMayo ClinicJacksonvilleFloridaUSA
| | - Sarika N. Rao
- Division of Endocrinology, Department of Internal MedicineMayo ClinicJacksonvilleFloridaUSA
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Psomadakis C, Tweddell R, Lewis F. Too much of a good thing? Iatrogenic Cushing syndrome secondary to excessive topical steroid use in lichen sclerosus. Clin Exp Dermatol 2023; 48:429-430. [PMID: 36763764 DOI: 10.1093/ced/llac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 01/22/2023]
Abstract
We report a patient using excessive quantities of topical steroid treatment for lichen sclerosus without supervision who developed Cushing syndrome. These treatments are very safe when used appropriately and this highlights the importance of good follow-up and patient education.
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Affiliation(s)
| | - Rebecca Tweddell
- St John's Institute of Dermatology, Guy's & St Thomas Hospital, London, UK
| | - Fiona Lewis
- St John's Institute of Dermatology, Guy's & St Thomas Hospital, London, UK
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6
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Gether L, Storgaard H, Kezic S, Jakasa I, Hartmann B, Skov-Jeppesen K, Holst JJ, Pedersen AJ, Forman J, van Hall G, Sørensen OE, Skov L, Røpke MA, Knop FK, Thyssen JP. Effects of topical corticosteroid versus tacrolimus on insulin sensitivity and bone homeostasis in adults with atopic dermatitis-A randomized controlled study. Allergy 2023. [PMID: 36824052 DOI: 10.1111/all.15690] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Topical corticosteroids (TCS), used to treat atopic dermatitis (AD), have been associated with type 2 diabetes and osteoporosis in epidemiological studies, possibly explained by systemic absorption. OBJECTIVES We examined whether intensive daily whole-body TCS treatment over 2 weeks followed by twice weekly application for 4 weeks could elicit insulin resistance and increase bone resorption in adults with AD. METHODS A randomized parallel-group double-blind double-dummy non-corticosteroid-based active comparator study design was completed in Copenhagen, Denmark. Thirty-six non-obese, non-diabetic adults with moderate-to-severe AD were randomized to whole-body treatment with betamethasone 17-valerate 0.1% plus a vehicle once daily or tacrolimus 0.1% twice daily after washout. Insulin sensitivity assessed by the hyperinsulinemic-euglycemic clamp combined with tracer infusions and biomarkers of bone formation (P1NP) and resorption (CTX) were evaluated at baseline, after 2 weeks of daily treatment and after further 4 weeks of twice-weekly maintenance treatment. RESULTS AD severity improved with both treatments and systemic inflammation was reduced. After 2 weeks, we observed similar increase in peripheral insulin sensitivity with use of betamethasone (n = 18) and tacrolimus (n = 18). Bone resorption biomarker, CTX, was unchanged, while bone formation marker, P1NP, decreased after betamethasone treatment after both 2 and 6 weeks but remained unchanged in the tacrolimus arm. CONCLUSIONS Whole-body treatment with TCS leads to systemic exposure but appears not to compromise glucose metabolism during short-term use, which may be a result of reduced systemic inflammatory activity. The negative impact on bone formation could be regarded an adverse effect of TCS.
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Affiliation(s)
- Lise Gether
- Center for Clinical Metabolic Research, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Dermatology and Allergy, Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- LEO Pharma A/S, Ballerup, Denmark
| | - Heidi Storgaard
- Center for Clinical Metabolic Research, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Sanja Kezic
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ivone Jakasa
- Department of Chemistry and Biochemistry, Laboratory for Analytical Chemistry, Faculty of Food Technology and Biotechnology, University of Zagreb, Zagreb, Croatia
| | - Bolette Hartmann
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirsa Skov-Jeppesen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens J Holst
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Julie Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gerrit van Hall
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Clinical Metabolomics Core Facility, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mads A Røpke
- LEO Pharma A/S, Ballerup, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Pontoppidan Thyssen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology and Venereology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Sulewska ME, Tomaszuk J, Sajewicz E, Pietruski J, Starzyńska A, Pietruska M. Treatment of Reticular Oral Lichen Planus with Photodynamic Therapy: A Case Series. J Clin Med 2023; 12:jcm12030875. [PMID: 36769523 PMCID: PMC9917588 DOI: 10.3390/jcm12030875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The aim of the study was to clinically evaluate the efficacy of photodynamic therapy in treatment of the reticular form of oral lichen planus (OLP). MATERIALS AND METHODS Twenty patients aged 40-76, with 40 confirmed OLP lesions in total, underwent photodynamic therapy (PDT) following the authors' own protocol, which used 5% 5-aminolevulinic acid as a photosensitizer applied two hours prior to illumination with a diode lamp emitting light at 630 nm and 300 mW. The therapy comprised of 10 weekly illumination sessions and was clinically evaluated between its completion and the end of a 12-month follow-up. RESULTS While the baseline mean size of all 40 lesions was 2.74 ± 3.03 cm2, it was 2.97 ± 3.4 cm2 for the 30 lesions on the buccal mucosa and 2.02 ± 1.32 cm2 for the remaining 10 on the gingiva and tongue. On completion of the therapy, 37 sites improved, including 14 showing complete remission. From that point, the mean size reduction of 56.2% (1.2 ± 1.4 cm2) rose to 67.88% (0.88 ± 1.3 cm2) 12 months later. CONCLUSIONS The results suggest that ALA-mediated photodynamic therapy was effective for the reticular form of OLP and may become an optional or complementary treatment.
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Affiliation(s)
- Magdalena Ewa Sulewska
- Department of Periodontal and Oral Mucosa Diseases, Medical University of Białystok, ul. Waszyngtona 13, 15-269 Białystok, Poland
- Correspondence:
| | - Jagoda Tomaszuk
- Department of Periodontal and Oral Mucosa Diseases, Medical University of Białystok, ul. Waszyngtona 13, 15-269 Białystok, Poland
| | - Eugeniusz Sajewicz
- Department of Biocybernetics and Biomedical Engineering, Białystok University of Technology, ul. Wiejska 45c, 15-351 Białystok, Poland
| | - Jan Pietruski
- Dental Practice, ul. Waszyngtona 1/34, 15-269 Białystok, Poland
- Department of Oral Surgery, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Małgorzata Pietruska
- Department of Periodontal and Oral Mucosa Diseases, Medical University of Białystok, ul. Waszyngtona 13, 15-269 Białystok, Poland
- Dental Practice, ul. Waszyngtona 1/34, 15-269 Białystok, Poland
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Andabak-Rogulj A, Vindiš E, Aleksijević LH, Škrinjar I, Juras DV, Aščić A, Brzak BL. Different Treatment Modalities of Oral Lichen Planus-A Narrative Review. Dent J (Basel) 2023; 11:dj11010026. [PMID: 36661563 PMCID: PMC9857452 DOI: 10.3390/dj11010026] [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: 09/27/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology which affects the oral mucosa. OLP varies in its clinical features from a reticular form that is, in most cases, asymptomatic, to atrophic-erosive, and is accompanied by symptoms of burning sensation and pain followed by difficulty in eating. Given the fact that OLP is a disease of unknown etiology, the treatment is symptomatic and involves suppressing the signs and symptoms of the disease using various topical and systemic drugs. The first line of therapy for treating symptomatic OLP is topical corticosteroids, whereas systemic corticosteroids are used for treating persistent lesions that do not respond to local treatment. However, the lack of convincing evidence on the efficacy of previous therapies, including topical corticosteroids, and numerous side effects that have appeared over recent years has resulted in the emergence and development of new therapeutic options. Some of the therapies mentioned are tacrolimus, efalizumab, dapson, interferon, retinoic acid, photochemotherapy with psoralen and ultraviolet A rays (PUVA), aloe vera, antimalarials, antibiotics and others. These therapies only partially meet the properties of efficacy and safety of use, thus justifying the continuous search and testing of new treatment methods.
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Affiliation(s)
- Ana Andabak-Rogulj
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Clinical Hospital Zagreb, 10000 Zagreb, Croatia
| | - Ema Vindiš
- Dental Practice at Healthcare Center Ormož, 2270 Ormož, Slovenia
| | | | - Ivana Škrinjar
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Clinical Hospital Zagreb, 10000 Zagreb, Croatia
| | - Danica Vidović Juras
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, Clinical Hospital Zagreb, 10000 Zagreb, Croatia
| | | | - Božana Lončar Brzak
- Department of Oral Medicine, School of Dental Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence:
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Ma B, Shang T, Huang J, Tu Z, Wang Y, Han Y, Wang Y, Wen X, Jin Q. A rare case report of iatrogenic Cushing syndrome caused by direct anti-hepatitis C virus therapy with sofosbuvir/velpatasvir. Medicine (Baltimore) 2022; 101:e30294. [PMID: 36595855 PMCID: PMC9794295 DOI: 10.1097/md.0000000000030294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Sofosbuvir/velpatasvir (SOF/VEL) is a combination of direct-acting antivirals with pan-genotypic activity that is used to treat chronic hepatitis C virus infection. This was a fixed-dose regimen. SOF is a nucleotide nonstructural 5B polymerase inhibitor and VEL is an nonstructural 5A inhibitor. Side effects of this agent on the endocrine system, particularly iatrogenic Cushing syndrome (ICS), are uncommon. Here, we present a case of ICS with significantly low serum adrenocorticotropic hormone and cortisol levels caused by SOF/VEL. PATIENT CONCERNS A 49-year-old Asian woman with chronic hepatitis C and cirrhosis presented with a round face, fat thickening at the clavicle and back of the neck, mild facial edema, facial congestion, skin ulceration on the hands, central obesity, acne, and general status changes after 3 months of treatment with SOF/VEL (400 mg/dose, 1/day). DIAGNOSES The patient's serum adrenocorticotropic hormone and cortisol levels dropped significantly, and her normal rhythm vanished, with no visible aberrant lesions on computed tomography or across the abdomen. The patient was diagnosed with ICS. OUTCOMES Symptoms improved after withdrawing SOF/VEL and taking low-dose oral hydrocortisone. Thus, the SOF/VEL was suspected to be an offender. To our knowledge, this is the first time that SOF/VEL has been linked to ICS. LESSONS Hepatologists and primary care physicians treating hepatitis C virus should be more aware of this uncommon adverse event so that direct-acting antiviral therapy can be stopped sooner if it recurs. The findings of this study emphasize the importance of collaboration between hepatologists and endocrinologists in co-management of complications.
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Affiliation(s)
- Bo Ma
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Tianling Shang
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jianjie Huang
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhixin Tu
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yan Wang
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yujin Han
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yang Wang
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiaoyu Wen
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Qinglong Jin
- Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin Province, China
- * Correspondence: Qinglong Jin, Department of Hepatology, The First Hospital of Jilin University, No. 1, Xinmin Street, Chaoyang District, Changchun, Jilin 130021, China (e-mail: )
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Matejek N, Hoos J, Holterhus PM, Bettendorf M, Choukair D. Topical glucocorticoid application causing iatrogenic Cushing's syndrome followed by secondary adrenal insufficiency in infants: two case reports. J Med Case Rep 2022; 16:455. [PMID: 36476353 PMCID: PMC9730575 DOI: 10.1186/s13256-022-03659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Iatrogenic Cushing's syndrome induced by oral and parenteral glucocorticoid administration is a well-known complication. Immediate withdrawal from exogenous steroids can lead to life-threatening adrenal insufficiency. However, Cushing's syndrome caused by topical treatment with glucocorticoids, such as dexamethasone eye drops or dermal application, is rarely recognized. Young infants in particular are at high risk of suffering from iatrogenic Cushing's syndrome when treated with highly potent topical glucocorticoids. CASE PRESENTATION We present a 6-month-old Syrian boy with cushingoid face after dermal clobetasol cream treatment and a 2-year-old Iranian girl with severe growth retardation after application of dexamethasone eye drops. Both families have a migration background and language barriers. In both cases no endogenous cortisol secretion was initially detected in serum and in 24-hour collected urine. After dose reduction of glucocorticoids, severity of symptoms was reversible and serum cortisol was detectable. DISCUSSION AND CONCLUSION Young infants are at high risk of developing Cushing's syndrome from topically applied highly potent glucocorticoids. Precise recommendations of treatment dosage, duration, and frequency must be given to the parents, and if necessary, with the help of an interpreter. Monitoring of height and weight as well as regular pediatric follow-ups should be scheduled. Physicians should be aware of potential adrenal insufficiency following withdrawal from long-term topical glucocorticoid treatment, and hydrocortisone treatment should be considered.
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Affiliation(s)
- Nicola Matejek
- Paediatric Endocrinology and Diabetes, Children’s Department Klinikum Worms, Worms, Germany
| | - Johannes Hoos
- grid.5253.10000 0001 0328 4908Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Children’s Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Paul Martin Holterhus
- grid.412468.d0000 0004 0646 2097Division of Paediatric Endocrinology and Diabetes, Department of Pediatrics I, University Hospital of Schleswig Holstein, UKSH, Campus Kiel, Kiel, Germany
| | - Markus Bettendorf
- grid.5253.10000 0001 0328 4908Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Children’s Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Daniela Choukair
- grid.5253.10000 0001 0328 4908Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Children’s Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
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Dubashynskaya NV, Skorik YA. Patches as Polymeric Systems for Improved Delivery of Topical Corticosteroids: Advances and Future Perspectives. Int J Mol Sci 2022; 23:12980. [PMID: 36361769 PMCID: PMC9657685 DOI: 10.3390/ijms232112980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 12/25/2023] Open
Abstract
Mucoadhesive polymer patches are a promising alternative for prolonged and controlled delivery of topical corticosteroids (CS) to improve their biopharmaceutical properties (mainly increasing local bioavailability and reducing systemic toxicity). The main biopharmaceutical advantages of patches compared to traditional oral dosage forms are their excellent bioadhesive properties and their increased drug residence time, modified and unidirectional drug release, improved local bioavailability and safety profile, additional pain receptor protection, and patient friendliness. This review describes the main approaches that can be used for the pharmaceutical R&D of oromucosal patches with improved physicochemical, mechanical, and pharmacological properties. The review mainly focuses on ways to increase the bioadhesion of oromucosal patches and to modify drug release, as well as ways to improve local bioavailability and safety by developing unidirectional -release poly-layer patches. Various techniques for obtaining patches and their influence on the structure and properties of the resulting dosage forms are also presented.
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Affiliation(s)
| | - Yury A. Skorik
- Institute of Macromolecular Compounds of the Russian Academy of Sciences, Bolshoy pr. V.O. 31, 199004 St. Petersburg, Russia
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12
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Serum cortisol and adrenocorticotrophic hormone (ACTH) in infants receiving topical and subconjunctival corticosteroids following cataract surgery. Graefes Arch Clin Exp Ophthalmol 2021; 259:3159-3165. [PMID: 33959809 DOI: 10.1007/s00417-021-05221-0] [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: 01/29/2021] [Revised: 04/03/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Cushingoid features are occasionally encountered in infants after pediatric cataract surgery. The aim of this study is to evaluate whether the use of topical glucocorticoids (GCs) following congenital cataract surgery can result in endogenous adrenal suppression and/or systemic side effects similar to those seen with systemic steroids. METHODS A prospective study was performed on 20 infants with bilateral congenital cataract. All infants received a single subconjunctival betamethasone injection of 1 mg at the end of surgery in addition to topical dexamethasone eye drops 1 mg/ml for 6 weeks. All infants had anthropometric measurements and blood pressure measurements, serum cortisol, and ACTH level measurements before surgery and 2 months after. In addition, the total administered glucocorticoid adjusted per weight was calculated. RESULTS The mean age of the infants was 4.93 ± 2.58 months. Thirteen were males (65%). The total administered glucocorticoid dose was 18.7 mg and the mean cumulative dexamethasone equivalent dose administered was 2.75 ± 1.31 mg/kg. There was a statistically significant increase in the adjusted weight percentile for age (P = 0.009). Both the systolic and diastolic blood pressure were significantly elevated (P = 0.005 and P = 0.025 respectively). There was a statistically significant reduction in both the morning and afternoon serum ACTH levels (P = 0.023 and P = 0.014). The reduction in serum cortisol levels was statistically non-significant. CONCLUSIONS Topical steroids following pediatric cataract surgery can result in both subclinical and clinical changes in the hypothalamic-pituitary-adrenal axis that can be easily overlooked and need careful attention and follow-up.
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Didona D, Scarsella L, Fehresti M, Solimani F, Juratli HA, Göbel M, Mühlenbein S, Holiangu L, Pieper J, Korff V, Schmidt T, Sitaru C, Eming R, Hertl M, Pollmann R. Autoreactive Peripheral Blood T Helper Cell Responses in Bullous Pemphigoid and Elderly Patients With Pruritic Disorders. Front Immunol 2021; 12:569287. [PMID: 33841390 PMCID: PMC8027500 DOI: 10.3389/fimmu.2021.569287] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
Bullous pemphigoid (BP) is a prototypic autoimmune disorder of the elderly, characterized by serum IgG autoantibodies, namely anti-BP180 and anti-BP230, directed against components of the basal membrane zone that lead to sub-epidermal loss of adhesion. Pruritus may be indicative of a pre-clinical stage of BP, since a subset of these patients shows serum IgG autoantibodies against BP230 and/or BP180 while chronic pruritus is increasingly common in the elderly population and is associated with a variety of dermatoses. Clinical and experimental evidence further suggests that pruritus of the elderly may be linked to autoimmunity with loss of self-tolerance against cutaneous autoantigens. Thus, the objective of this study was to determine autoreactive T cell responses against BP180 in elderly patients in comparison to patients with BP. A total of 22 elderly patients with pruritic disorders, 34 patients with bullous or non-bullous BP and 34 age-matched healthy controls were included in this study. The level of anti-BP180 and anti-BP230 IgG serum autoantibodies, Bullous Pemphigoid Disease Area Index (BPDAI), and pruritus severity were assessed for all patients and controls. For characterization of the autoreactive T cell response, peripheral blood mononuclear cells were stimulated ex vivo with recombinant BP180 proteins (NH2- and COOH-terminal domains) and the frequencies of BP180-specific T cells producing interferon-γ, interleukin (IL)-5 or IL-17 were subsequently determined by ELISpot assay. Patients with BP showed a mixed Th1/Th2 response against BP180 while autoreactive Th1 cells were identified in a minor subset of elderly patients with pruritic disorders. Furthermore, our T cell characterization revealed that therapeutic application of topical clobetasol propionate ointment in BP patients significantly reduced peripheral blood BP180-specific T cells, along with clinically improved symptoms, strongly suggesting a systemic immunosuppressive effect of this treatment.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Luca Scarsella
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Milad Fehresti
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Farzan Solimani
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hazem A. Juratli
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Manuel Göbel
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Stefan Mühlenbein
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Lily Holiangu
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Josquin Pieper
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Vera Korff
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Thomas Schmidt
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Cassian Sitaru
- Department of Dermatology and Allergology, Universität Freiburg, Freiburg, Germany
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Robert Pollmann
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
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14
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Chirayath D, Shaheena S. Iatrogenic hypercortisolism in a Persian kitten after topical application of a skin lotion containing clobetasol. Vet Dermatol 2020; 31:486-488. [PMID: 33029837 DOI: 10.1111/vde.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022]
Abstract
Hypercortisolism is a rare endocrine disorder in cats. This report describes the clinicopathological findings and successful management of iatrogenic hypercortisolism in a Persian kitten. The disorder was presumed to be a consequence of prolonged topical application of a lotion containing clobetasol.
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Affiliation(s)
- Deepa Chirayath
- Department of Veterinary Clinical Medicine, Ethics & Jurisprudence, College of Veterinary and Animal Sciences, Mannuthy, Kerala Veterinary and Animal Sciences University, Thrissur, Kerala, 680 651, India
| | - Sahla Shaheena
- Department of Veterinary Clinical Medicine, Ethics & Jurisprudence, College of Veterinary and Animal Sciences, Mannuthy, Kerala Veterinary and Animal Sciences University, Thrissur, Kerala, 680 651, India
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15
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Sachdeva S, Arora P, Kulhari A, Sardana K. Iatrogenic Cushing's syndrome due to topical steroid abuse in a child with Psoriasis presenting as septicaemia. Dermatol Ther 2020; 33:e13514. [DOI: 10.1111/dth.13514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/25/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Soumya Sachdeva
- Department of Dermatology, Venereology and Leprosy Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences New Delhi Delhi India
| | - Pooja Arora
- Department of Dermatology, Venereology and Leprosy Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences New Delhi Delhi India
| | - Anita Kulhari
- Department of Dermatology, Venereology and Leprosy Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences New Delhi Delhi India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprosy Dr. Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences New Delhi Delhi India
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16
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17
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Infantile Iatrogenic Cushing Syndrome due to Topical Steroids. Case Rep Pediatr 2019; 2019:2652961. [PMID: 31871810 PMCID: PMC6913302 DOI: 10.1155/2019/2652961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/27/2019] [Accepted: 09/21/2019] [Indexed: 12/27/2022] Open
Abstract
Cushing syndrome is an endocrinological disorder characterized by increased free plasma glucocorticoids level. It is either due to an excessive endogenous release of steroids (e.g., pituitary adenoma or adrenal hyperplasia) or exogenous administration of steroids. In children, iatrogenic Cushing syndrome is the most common form of Cushing syndrome occurring in this age group. The vast majority of cases are due to oral or parenteral preparation of steroids, which are commonly prescribed for pulmonary, hematological, renal, or autoimmune pathologies. Topical preparations can rarely cause Cushing syndrome in young children, and only a few cases were reported in the literature, where the patients were older than 5 months of age. In this report, we present a three-month-old girl who developed iatrogenic Cushing syndrome due to prolonged and inappropriate use of topical clobetasol cream for napkin dermatitis.
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18
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Carrozzo M, Porter S, Mercadante V, Fedele S. Oral lichen planus: A disease or a spectrum of tissue reactions? Types, causes, diagnostic algorhythms, prognosis, management strategies. Periodontol 2000 2019; 80:105-125. [PMID: 31090143 DOI: 10.1111/prd.12260] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oral lichen planus and lichenoid lesions comprise a group of disorders of the oral mucosa that likely represent a common reaction pattern to 1 or more unknown antigens. The coexistence of hyperkeratotic striation/reticulation, varying degrees of mucosal inflammation from mild erythema to severe widespread ulceration, and a band-like infiltrate of mononuclear inflammatory cells including activated T lymphocytes, macrophages, and dendritic cells, are considered suggestive of oral lichen planus and lichenoid lesions. Several classification systems of oral lichen planus and lichenoid lesions have been attempted, although none seem to be comprehensive. In this paper, we present a classification of oral lichen planus and lichenoid lesions that includes oral lichen planus, oral lichenoid contact lesions, oral lichenoid drug reactions, oral lichenoid lesions of graft vs. host disease, discoid lupus erythematosus, and systemic lupus erythematosus, lichen planus-like variant of paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome, chronic ulcerative stomatitis, lichen planus pemphigoides, solitary fixed drug eruptions, and lichen sclerosus. We present the clinical and diagnostic aspects of oral lichen planus and lichenoid lesions, and discuss related treatment options.
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Affiliation(s)
- Marco Carrozzo
- Centre for Oral Health Research, Oral Medicine Department, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Porter
- UCL Eastman Dental Institute, University College London, London, UK
| | | | - Stefano Fedele
- UCL Eastman Dental Institute, University College London, London, UK.,NIHR University College London Hospitals Biomedical Research Centre, London, UK
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19
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Abstract
The human stress response has evolved to maintain homeostasis under conditions of real or perceived stress. This objective is achieved through autoregulatory neural and hormonal systems in close association with central and peripheral clocks. The hypothalamic-pituitary-adrenal axis is a key regulatory pathway in the maintenance of these homeostatic processes. The end product of this pathway - cortisol - is secreted in a pulsatile pattern, with changes in pulse amplitude creating a circadian pattern. During acute stress, cortisol levels rise and pulsatility is maintained. Although the initial rise in cortisol follows a large surge in adrenocorticotropic hormone levels, if long-term inflammatory stress occurs, adrenocorticotropic hormone levels return to near basal levels while cortisol levels remain raised as a result of increased adrenal sensitivity. In chronic stress, hypothalamic activation of the pituitary changes from corticotropin-releasing hormone-dominant to arginine vasopressin-dominant, and cortisol levels remain raised due at least in part to decreased cortisol metabolism. Acute elevations in cortisol levels are beneficial to promoting survival of the fittest as part of the fight-or-flight response. However, chronic exposure to stress results in reversal of the beneficial effects, with long-term cortisol exposure becoming maladaptive, which can lead to a broad range of problems including the metabolic syndrome, obesity, cancer, mental health disorders, cardiovascular disease and increased susceptibility to infections. Neuroimmunoendocrine modulation in disease states and glucocorticoid-based therapeutics are also discussed.
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Affiliation(s)
- Georgina Russell
- Translational Health Sciences, Dorothy Hodgkin Building, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Stafford Lightman
- Translational Health Sciences, Dorothy Hodgkin Building, Bristol Medical School, University of Bristol, Bristol, UK.
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20
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Piaserico S, Linder D, Messina F, Alaibac M. Osteoporotic vertebral fracture caused by topical corticosteroid abuse: A case report. Exp Ther Med 2019; 18:2746-2748. [DOI: 10.3892/etm.2019.7825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/17/2019] [Indexed: 01/29/2023] Open
Affiliation(s)
- Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padua, Padua I‑35128, Italy
| | - Dennis Linder
- Department of Dermatology and Venereology, Ben Gurion University of The Negev, Beer‑Sheva 84101, Israel
| | - Francesco Messina
- Dermatology Unit, Department of Medicine, University of Padua, Padua I‑35128, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padua, Padua I‑35128, Italy
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21
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Kurt MH, Kolsuz ME, Eren H. Corticosteroid injection in treatment of persistent oral lichen planus: Three cases. Dermatol Ther 2019; 32:e13015. [PMID: 31268212 DOI: 10.1111/dth.13015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/27/2019] [Accepted: 06/23/2019] [Indexed: 01/15/2023]
Abstract
Oral lichen planus (OLP) is a chronic inflammatory disease with unknown etiology. There are many clinical types of OLP. OLP cases are often asymptomatic; however, atrophic or erosive forms may cause sensitivity, burning, and discomfort. The best model of the OLP treatment modality is to evaluate the restorations that may lead to oral mucosa hypersensitivity as the first step. Local corticosteroid injection therapy may be preferred to eliminate the possible systemic side effects of systemic corticosteroid medication in patients with OLP. The aim of this case series is to evaluate treatment alternatives in OLP.
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Affiliation(s)
- Mehmet H Kurt
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Ankara University, Ankara, Turkey
| | - Mehmet E Kolsuz
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Ankara University, Ankara, Turkey
| | - Hakan Eren
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Ankara University, Ankara, Turkey
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22
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Negrini S, Murdaca G, Ferone D, Borro M. Adult iatrogenic Cushing's syndrome induced by topical skin corticosteroid misuse. Therapie 2019; 74:547-549. [PMID: 31023618 DOI: 10.1016/j.therap.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/09/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Simone Negrini
- Department of Internal Medicine, Clinical Immunology Unit, University of Genoa and Policlinico San Martino, 16132 Genova, Italy.
| | - Giuseppe Murdaca
- Department of Internal Medicine, Clinical Immunology Unit, University of Genoa and Policlinico San Martino, 16132 Genova, Italy
| | - Diego Ferone
- Department of Internal Medicine, Endocrinology Unit, University of Genoa and Policlinico San Martino, 16132 Genova, Italy
| | - Matteo Borro
- Department of Internal Medicine, Clinical Immunology Unit, University of Genoa and Policlinico San Martino, 16132 Genova, Italy
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23
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Ruellan AL, Boels D. Iatrogénie et syndromes de Cushing. ACTUALITES PHARMACEUTIQUES 2019. [DOI: 10.1016/j.actpha.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Ghalayani Esfahani A, Altomare L, Varoni EM, Bertoldi S, Farè S, De Nardo L. Electrophoretic bottom up design of chitosan patches for topical drug delivery. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:40. [PMID: 30919137 DOI: 10.1007/s10856-019-6242-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
Clobetasol propionate (CP) is a high-potency corticosteroid, representing the standard of care for the symptomatic treatment of different skin disorders as well as oral mucosal diseases. Several topical delivery systems are available for treating oral lesions, but the ideal one is still lacking. In this work, we propose a novel class of chitosan (CS) patches, loaded with CP, for the topical treatment of inflammatory chronic oral diseases. Chitosan patches have been fabricated via electrophoretic deposition (EPD), by using a one-pot approach in order to load controlled quantity of CP. Optimized structures showed a water uptake in the range of 200-360% and mechanical properties that allow the design of flexible patches in wet state (E = 0.6 MPa and σbr = 0.55 MPa). Ultraviolet-visible (UV-Vis) spectroscopy was used for the evaluation of both loading and release profile of CP in CS patches. The CP loading has been tuned by adjusting CP concentration in deposition bath-in the range 0.002-0.12 mg cm-2-while releasing curves show an in vitro CP burst of about 80% in the first two hours. Overall, the obtained properties paved the way for the application of this new class of patches for the local oral release of CP.
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Affiliation(s)
- Arash Ghalayani Esfahani
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Miiano, Piazza Leonardo da Vinci 32, Milano (Ml), Italy.
| | - Lina Altomare
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Miiano, Piazza Leonardo da Vinci 32, Milano (Ml), Italy
| | - Elena M Varoni
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Via Beldiletto 1, Milano (MI), Italy
| | - Serena Bertoldi
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Miiano, Piazza Leonardo da Vinci 32, Milano (Ml), Italy
| | - Silvia Farè
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Miiano, Piazza Leonardo da Vinci 32, Milano (Ml), Italy
| | - Luigi De Nardo
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Miiano, Piazza Leonardo da Vinci 32, Milano (Ml), Italy
- Consorzio Interuniversitario Nazionale per la Scienza e Tecnologia dei Materiali (INSTM), Local Unit Politecnico di Milano, Via Giusti 9, 50121, Firenze (Fl), Italy
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25
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López-Morales CA, Vázquez-Leyva S, Vallejo-Castillo L, Carballo-Uicab G, Muñoz-García L, Herbert-Pucheta JE, Zepeda-Vallejo LG, Velasco-Velázquez M, Pavón L, Pérez-Tapia SM, Medina-Rivero E. Determination of Peptide Profile Consistency and Safety of Collagen Hydrolysates as Quality Attributes. J Food Sci 2019; 84:430-439. [PMID: 30768685 PMCID: PMC6593667 DOI: 10.1111/1750-3841.14466] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/13/2018] [Accepted: 01/17/2019] [Indexed: 11/28/2022]
Abstract
Abstract Collagen hydrolysates are dietary supplements used for nutritional and medical purposes. They are complex mixtures of low‐molecular‐weight peptides obtained from the enzymatic hydrolysis of collagen, which provide intrinsic batch‐to‐batch heterogeneity. In consequence, the quality of these products, which is related to the reproducibility of their mass distribution pattern, should be addressed. Here, we propose an analytical approach to determine the peptide pattern as a quality attribute of Colagenart®, a product containing collagen hydrolysate. In addition, we evaluated the safety by measuring the viability of two cell lines exposed to the product. The consistency of peptide distribution was determined using Size Exclusion Chromatography (SEC), Mass Spectrometry coupled to a reversed phase UPLC system (MS‐RP‐UPLC), and Shaped‐pulse off‐resonance water‐presaturation proton nuclear magnetic resonance spectrometry [1Hwater_presat NMR]. The mass distribution pattern determined by SEC was in a range from 1.35 to 17 kDa, and from 2 to 14 kDa by MS‐RP‐UPLC. [1Hwater_presat NMR] showed the detailed spin‐systems of the collagen hydrolysates components by global assignment of backbone Hα and NH, as well as side‐chain proton resonances. Additionally, short‐range intraresidue connectivity pathways of identified spin‐regions were obtained by a 2D homonuclear shift correlation Shaped‐pulse solvent suppression COSY scheme. Safety analysis of Colagenart® was evaluated in CaCo‐2 and HepG2 cells at 2.5 and 25 μg/mL and no negative effects were observed. The results demonstrated batch‐to‐batch reproducibility, which evinces the utility of this approach to establish the consistency of the quality attributes of collagen hydrolysates. Practical Application We propose state‐of‐the art analytical methodologies (SEC, MS, and NMR) to evaluate peptide profile and composition of collagen hydrolysates as quality attributes. These methodologies are suitable to be implemented for quality control purposes.
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Affiliation(s)
- Carlos A López-Morales
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, Insto. Politécnico Nacional, Ciudad de México, 11340, México
| | - Said Vázquez-Leyva
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, Insto. Politécnico Nacional, Ciudad de México, 11340, México
| | - Luis Vallejo-Castillo
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, Insto. Politécnico Nacional, Ciudad de México, 11340, México.,Depto. de Farmacología, Cinvestav IPN. Ciudad de México 07360, México
| | - Gregorio Carballo-Uicab
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, Insto. Politécnico Nacional, Ciudad de México, 11340, México
| | - Leslie Muñoz-García
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, Insto. Politécnico Nacional, Ciudad de México, 11340, México
| | - José Enrique Herbert-Pucheta
- Consejo Nacional de Ciencia y Tecnología-Laboratorio Nacional de Investigación y Servicio Agroalimentario Forestal, Univ. Autónoma de Chapingo, Chapingo, 56230, México
| | - L Gerardo Zepeda-Vallejo
- Depto. de Química Orgánica, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, 11340, México
| | - Marco Velasco-Velázquez
- Depto. de Farmacología y Unidad Periférica de Investigación en Biomedicina Translacional (CMN 20 de noviembre ISSSTE), Facultad de Medicina, Univ. Nacional Autónoma de México, Ciudad Universitaria, Ciudad de México, 04510, México
| | - Lenin Pavón
- Laboratorio de Psicoinmunología, Dirección de Investigaciones en Neurociencias del Insto. Nacional de Psiquiatría Ramón de la Fuente, Ciudad de México, 14370, México
| | - Sonia M Pérez-Tapia
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, Insto. Politécnico Nacional, Ciudad de México, 11340, México
| | - Emilio Medina-Rivero
- Unidad de Desarrollo e Investigación en Bioprocesos (UDIBI), Escuela Nacional de Ciencias Biológicas, Insto. Politécnico Nacional, Ciudad de México, 11340, México
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26
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Gonzales L. Chronic corticosteroid use causing insidious suppression of the hypothalamic-pituitary-adrenal axis with acute decompensation: A case of iatrogenic adrenal insufficiency. CARIBBEAN MEDICAL JOURNAL 2018. [DOI: 10.48107/cmj.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Glucocorticoids are used to treat many medical conditions commonly encountered in clinical practice; and is associated with many well-known adverse effects. Iatrogenic suppression of the hypothalamic-pituitary-adrenal axis occurs commonly with all forms of corticosteroids and may be easily missed. We present the case of a 62-year-old patient who presented with non-specific symptoms of: malaise, fatigue, anorexia, anaemia, and weight loss following an elective orthopaedic surgery. After receiving packed red cells, the patient did not have significant symptomatic improvement. A short corticotropin stimulation test confirmed hypoadrenalism, and the patient improved following a therapeutic trial of hydrocortisone. It was later discovered that the patient was receiving regular intra-articular corticosteroid for osteoarthritis from a private family practitioner. This case highlights the importance of searching for potential iatrogenic corticosteroid exposure in high risk patients; and having a low index of suspicion for hypoadrenalism in patients with non-specific symptoms that cannot be otherwise explained. Early recognition of hypoadrenalism can be lifesaving, especially during periods of physiological stress.
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Affiliation(s)
- Lorenzo Gonzales
- Department of Internal Medicine & Endocrinology, Medical Associates Hospital, St. Joseph, Trinidad and Tobago, West Indies
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27
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Thongprasom K. A Review of the Effectiveness and Side-Effects of Fluocinolone Acetonide 0.1% in the Treatment of Oral Mucosal Diseases. Acta Stomatol Croat 2017; 51:240-247. [PMID: 29225365 PMCID: PMC5708326 DOI: 10.15644/asc51/3/8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Topical steroids have been widely used in the treatment of symptomatic oral lesions to reduce pain and inflammation. Potent topical steroids such as clobetasol propionate, fluocinolone acetonide (FA), and fluocinonide have been widely used in the treatment of severe oral mucosal lesions. Many reports have demonstrated that these steroids were effective in treating oral lesions with only minor side-effects. This review describes the effectiveness and side-effects of using FA 0.1% in the treatment of symptomatic oral lichen planus (OLP), oral lichenoid drug reaction (OLDR), oral pemphigus, and herpes associated erythema multiforme (HAEM). FA 0.1% was effective and safe in the treatment of patients with multiple systemic diseases and a pregnant patient with HAEM. Moreover, this topical steroid rapidly reduced pain, inflammation, and enhanced lesion healing with no serious side-effects other than pseudomembranous candidiasis, which is easily treated. In some cases, a long-term treatment with FA 0.1% resulted in hyperpigmentation at the areas of previously healed oral lesions; however, this hyperpigmentation was gradually resolved after discontinuing topical steroid treatment.
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Affiliation(s)
- Kobkan Thongprasom
- Oral Medicine Department, Faculty of Dentistry Chulalongkorn University Bangkok, Thailand
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Manubolu S, Nwosu O. Exogenous Cushing's syndrome secondary to intermittent high dose oral prednisone for presumed asthma exacerbations in the setting of multiple emergency department visits. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2017. [DOI: 10.1016/j.jecr.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pektas SD, Dogan G, Cinar N. Iatrogenic Cushing's Syndrome with Subsequent Adrenal Insufficiency in a Patient with Psoriasis Vulgaris Using Topical Steroids. Case Rep Endocrinol 2017; 2017:8320254. [PMID: 29259830 PMCID: PMC5702924 DOI: 10.1155/2017/8320254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/24/2017] [Indexed: 11/17/2022] Open
Abstract
Iatrogenic Cushing's syndrome (ICS) is usually related to prolonged and/or high-dose oral or parenteral steroid use. Psoriasis vulgaris (PV) is chronic inflammatory disease and characterized by periods of attack and remission. Topical steroid (TS) is the first choice of treatment for localized and mild PV. The development of systemic side effects of the steroids is usually not observed after TS application. But the risk of developing ICS still exists. In the literature, there are a few adult cases who developed ICS and subsequent adrenal insufficiency associated with TS. In this article, a male patient with PV developing ICS and secondary adrenal insufficiency after treatment of TS for 12 years is presented.
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Affiliation(s)
- Suzan Demir Pektas
- Department of Dermatology, Mugla Sitki Kocman University, Faculty of Medicine, 48000 Mugla, Turkey
| | - Gursoy Dogan
- Department of Dermatology, Mugla Sitki Kocman University, Faculty of Medicine, 48000 Mugla, Turkey
| | - Nese Cinar
- Department of Endocrinology and Metabolic Diseases, Mugla Sitki Kocman University, Faculty of Medicine, 48000 Mugla, Turkey
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Paragliola RM, Papi G, Pontecorvi A, Corsello SM. Treatment with Synthetic Glucocorticoids and the Hypothalamus-Pituitary-Adrenal Axis. Int J Mol Sci 2017; 18:E2201. [PMID: 29053578 PMCID: PMC5666882 DOI: 10.3390/ijms18102201] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 02/07/2023] Open
Abstract
Chronic glucocorticoid (GC) treatment represents a widely-prescribed therapy for several diseases in consideration of both anti-inflammatory and immunosuppressive activity but, if used at high doses for prolonged periods, it can determine the systemic effects characteristic of Cushing's syndrome. In addition to signs and symptoms of hypercortisolism, patients on chronic GC therapy are at risk to develop tertiary adrenal insufficiency after the reduction or the withdrawal of corticosteroids or during acute stress. This effect is mediated by the negative feedback loop on the hypothalamus-pituitary-adrenal (HPA) axis, which mainly involves corticotropin-release hormone (CRH), which represents the most important driver of adrenocorticotropic hormone (ACTH) release. In fact, after withdrawal of chronic GC treatment, reactivation of CRH secretion is a necessary prerequisite for the recovery of the HPA axis. In addition to the well-known factors which regulate the degree of inhibition of the HPA during synthetic GC therapy (type of compound, method of administration, cumulative dose, duration of the treatment, concomitant drugs which can increase the bioavailability of GCs), there is a considerable variation in individual physiology, probably related to different genetic profiles which regulate GC receptor activity. This may represent an interesting basis for possible future research fields.
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Affiliation(s)
- Rosa Maria Paragliola
- Unit of Endocrinology, Università Cattolica del Sacro Cuore, Largo "A. Gemelli" 8, I-00168 Rome, Italy.
| | - Giampaolo Papi
- Unit of Endocrinology, Università Cattolica del Sacro Cuore, Largo "A. Gemelli" 8, I-00168 Rome, Italy.
| | - Alfredo Pontecorvi
- Unit of Endocrinology, Università Cattolica del Sacro Cuore, Largo "A. Gemelli" 8, I-00168 Rome, Italy.
| | - Salvatore Maria Corsello
- Unit of Endocrinology, Università Cattolica del Sacro Cuore, Largo "A. Gemelli" 8, I-00168 Rome, Italy.
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Blauvelt A, de Bruin-Weller M, Gooderham M, Cather JC, Weisman J, Pariser D, Simpson EL, Papp KA, Hong HCH, Rubel D, Foley P, Prens E, Griffiths CEM, Etoh T, Pinto PH, Pujol RM, Szepietowski JC, Ettler K, Kemény L, Zhu X, Akinlade B, Hultsch T, Mastey V, Gadkari A, Eckert L, Amin N, Graham NMH, Pirozzi G, Stahl N, Yancopoulos GD, Shumel B. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet 2017; 389:2287-2303. [PMID: 28478972 DOI: 10.1016/s0140-6736(17)31191-1] [Citation(s) in RCA: 776] [Impact Index Per Article: 110.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Dupilumab (an anti-interleukin-4-receptor-α monoclonal antibody) blocks signalling of interleukin 4 and interleukin 13, type 2/Th2 cytokines implicated in numerous allergic diseases ranging from asthma to atopic dermatitis. Previous 16-week monotherapy studies showed that dupilumab substantially improved signs and symptoms of moderate-to-severe atopic dermatitis with acceptable safety, validating the crucial role of interleukin 4 and interleukin 13 in atopic dermatitis pathogenesis. We aimed to evaluate the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids versus placebo with topical corticosteroids in adults with moderate-to-severe atopic dermatitis. METHODS In this 1-year, randomised, double-blinded, placebo-controlled, phase 3 study (LIBERTY AD CHRONOS), adults with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids were enrolled at 161 hospitals, clinics, and academic institutions in 14 countries in Europe, Asia-Pacific, and North America. Patients were randomly assigned (3:1:3) to subcutaneous dupilumab 300 mg once weekly (qw), dupilumab 300 mg every 2 weeks (q2w), or placebo via a central interactive voice/web response system, stratified by severity and global region. All three groups were given concomitant topical corticosteroids with or without topical calcineurin inhibitors where inadvisable for topical corticosteroids. Topical corticosteroids could be tapered, stopped, or restarted on the basis of disease activity. Coprimary endpoints were patients (%) achieving Investigator's Global Assessment (IGA) 0/1 and 2-point or higher improvement from baseline, and Eczema Area and Severity Index 75% improvement from baseline (EASI-75) at week 16. Week 16 efficacy and week 52 safety analyses included all randomised patients; week 52 efficacy included patients who completed treatment by US regulatory submission cutoff. This study is registered with ClinicalTrials.gov, NCT02260986. FINDINGS Between Oct 3, 2014, and July 31, 2015, 740 patients were enrolled: 319 were randomly assigned to dupilumab qw plus topical corticosteroids, 106 to dupilumab q2w plus topical corticosteroids, and 315 to placebo plus topical corticosteroids. 623 (270, 89, and 264, respectively) were evaluable for week 52 efficacy. At week 16, more patients who received dupilumab plus topical corticosteroids achieved the coprimary endpoints of IGA 0/1 (39% [125 patients] who received dupilumab plus topical corticosteroids qw and 39% [41 patients] who received dupilumab q2w plus topical corticosteroids vs 12% [39 patients] who received placebo plus topical corticosteroids; p<0·0001) and EASI-75 (64% [204] and 69% [73] vs 23% [73]; p<0·0001). Week 52 results were similar. Adverse events were reported in 261 (83%) patients who received dupilumab qw plus topical corticosteroids, 97 (88%) patients who received dupilumab q2w, and 266 (84%) patients who received placebo, and serious adverse events in nine (3%), four (4%), and 16 (5%) patients, respectively. No significant dupilumab-induced laboratory abnormalities were noted. Injection-site reactions and conjunctivitis were more common in patients treated with dupilumab plus topical corticosteroids-treated patients than in patients treated with placebo plus topical corticosteroids. INTERPRETATION Dupilumab added to standard topical corticosteroid treatment for 1 year improved atopic dermatitis signs and symptoms, with acceptable safety. FUNDING Sanofi and Regeneron Pharmaceuticals Inc.
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Affiliation(s)
| | | | - Melinda Gooderham
- SKiN Centre for Dermatology, Queen's University, and Probity Medical Research, Peterborough, ON, Canada
| | - Jennifer C Cather
- Modern Dermatology and Modern Research Associates, and Probity Medical Research, Dallas, TX, USA
| | | | - David Pariser
- Eastern Virginia Medical School and Virginia Clinical Research Inc, Norfolk, VA, USA
| | | | - Kim A Papp
- K Papp Clinical Research and Probity Medical Research, Waterloo, ON, Canada
| | - H Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, and Probity Medical Research, Surrey, BC, Canada
| | - Diana Rubel
- Australian National University, Canberra, and Probity Medical Research, Phillip, ACT, Australia
| | - Peter Foley
- The University of Melbourne, Parkville, Skin & Cancer Foundation Inc, Carlton, and Probity Medical Research, Carlton, VIC, Australia
| | - Errol Prens
- Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Christopher E M Griffiths
- The Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Takafumi Etoh
- Tokyo Teishin Postal Services Agency Hospital, Tokyo, Japan
| | | | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar, Barcelona, Spain
| | | | - Karel Ettler
- Dermatology and Venereology, Hradec Kralove, Czech Republic
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Xiaoping Zhu
- Regeneron Pharmaceuticals Inc, Basking Ridge, NJ, USA
| | | | | | - Vera Mastey
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | | | | | - Neil Stahl
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
| | | | - Brad Shumel
- Regeneron Pharmaceuticals Inc, Tarrytown, NY, USA
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Sukhumthammarat W, Putthapiban P, Sriphrapradang C. Local Injection of Triamcinolone Acetonide: A Forgotten Aetiology of Cushing's Syndrome. J Clin Diagn Res 2017; 11:OR01-OR02. [PMID: 28764237 DOI: 10.7860/jcdr/2017/27238.10091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
Abstract
Many different non systemic corticosteroid administrations can cause iatrogenic Cushing's Syndrome (CS). We herein report a case series of iatrogenic CS from keloid scars treatment and aesthetic regimen called mesotherapy. Our first patient developed CS after having exceeded recommended dose of intralesional injection of Triamcinolone Acetonide (TAC). Second case presented with CS followed by unidentified mesotherapy treatment for local fat reduction. Subcutaneous injections of dexamethasone were found to be the part of mesotherapy regimen in one case. Physicians should be insightful in prescribing TAC especially in those patients who have high predisposing factors for developing CS. In the same way, off-label mesotherapy combine with corticosteroid can lead to iatrogenic CS and Hypothalamic-Pituitary-Adrenal (HPA) axis suppression. Currently, there are no standard guidelines for mesotherapy treatment. Therefore, further clinical trials on dosage, duration and effective combination of mesotherapy regimens are needed to increase safety uses.
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Affiliation(s)
- Weera Sukhumthammarat
- Research Fellow, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prapaipan Putthapiban
- Research Fellow, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutintorn Sriphrapradang
- Assistant Professor, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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El-Khoury M, Thay R, N'Diaye M, Fardet L. Use of topical glucocorticoids: a population-based cohort study. J Eur Acad Dermatol Venereol 2017; 31:1044-1047. [DOI: 10.1111/jdv.14149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/17/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M. El-Khoury
- Department of Dermatology; Henri Mondor hospital; Paris France
| | - R. Thay
- Department of Dermatology; Henri Mondor hospital; Paris France
| | - M. N'Diaye
- Department of Dermatology; Henri Mondor hospital; Paris France
| | - L. Fardet
- Department of Dermatology; Henri Mondor hospital; Paris France
- EA 7379 EpiDermE; Université Paris Est Créteil; UPEC Paris 12; Créteil France
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Zadik Y, Elad S, Shapira A, Shapira MY. Treatment of oral mucosal manifestations of chronic graft-versus-host disease: dexamethasone vs. budesonide. Expert Opin Pharmacother 2017; 18:235-242. [PMID: 28081677 DOI: 10.1080/14656566.2017.1282464] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The oral mucosa is commonly involved in chronic graft-versus-host disease (cGVHD). Oral mucosal cGVHD markedly affect individual's daily function and wellbeing. In some cases, it might become a life threating complication. Areas covered: This article describes the rationale for treatment, method of topical application in the oral cavity, evidence supporting the topical administration of dexamethasone and budesonide for oral cGVHD, and their adverse effects. Expert opinion: Evidence supports the use of topical dexamethasone and budesonide for treatment of oral cGVHD. Topical corticosteroid choice for oral cGVHD, takes into consideration the potency, bioavailability, preferred concentration, and possible adverse effects. Budesonide's pharmacological characteristics mark it as a preferable topical agent for oral cGVHD.
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Affiliation(s)
- Yehuda Zadik
- a Department of Oral Medicine, Sedation and Maxillofacial Imaging , Hadassah-Hebrew University School of Dental Medicine , Jerusalem , Israel.,b Department of Oral Medicine , The Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces , Tel Hashomer , Israel
| | - Sharon Elad
- c Division of Oral Medicine, Hospital General Dentistry, Eastman Institute for Oral Health , University of Rochester Medical Center , Rochester , NY , USA.,d Wilmot Cancer Center , University of Rochester Medical Center , Rochester , NY , USA
| | - Anat Shapira
- e Pharmacy Division , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - Michael Y Shapira
- f Bone Marrow Transplantation and Cancer Immunotherapy Department , Hadassah-Hebrew University Medical Center , Jerusalem , Israel
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Abstract
Lichen planus is an inflammatory mucocutaneous disease that can affect the skin, hair, nails, and mucosal surfaces. Mucosal sites of involvement include oral, genital, ocular, otic, esophageal, and, less commonly, bladder, nasal, laryngeal, and anal surfaces. Oral lichen planus is a mucosal variant of lichen planus, which tends to affect women more often than men, with a typically more chronic course and potential for significant morbidity. Treatment can be challenging, and there is potentially a low risk of malignant transformation; however, therapeutic benefits can be obtained with various topical and systemic medications. Clinical monitoring is recommended to ensure symptomatic control. Increasing awareness and recognition of this entity have continued to fuel advances in therapy and in our understanding of the disease.
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Affiliation(s)
| | - Roy S Rogers
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ
| | - Alison J Bruce
- Department of Dermatology, Mayo Clinic, Jacksonville, FL.
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Rottenstreich A, Wexler ID, Abu-Libdeh A, Berkun Y. Iatrogenic Cushing Syndrome due to Intranasal Dexamethasone. Clin Pediatr (Phila) 2015; 54:1215-7. [PMID: 25533884 DOI: 10.1177/0009922814563927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amihai Rottenstreich
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Isaiah D Wexler
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Abdulsalam Abu-Libdeh
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Yackov Berkun
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
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Vigarios E, Fricain JC, Projetti F, Boulanger M, Sibaud V. [Oral hairy leukoplakia induced by topical steroids]. Ann Dermatol Venereol 2015; 142:572-6. [PMID: 26362131 DOI: 10.1016/j.annder.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/02/2015] [Accepted: 08/05/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral hairy leukoplakia (OHL) is an EBV-associated condition of the oral mucosa, which is often painless. It is found predominantly in HIV-positive patients and is considered a clinical indicator of immunosuppression. OHL has rarely been described in HIV-negative patients, being found most often in association with iatrogenic immunosuppression. OHL induced by topical steroids remains extremely rare. PATIENTS AND METHODS An 81-year-old HIV-negative woman, treated for 3 months with topical steroids for oral lichen planus, developed an asymptomatic white, corrugated, non-removable plaque with vertical folds on the lateral edge of the tongue. Associated oral candidiasis was noted. Based upon histological findings and in situ hybridisation showing numerous EBV-infected epithelial cells, a diagnosis of oral hairy leucoplakia was made. DISCUSSION AND CONCLUSION To our knowledge, we report herein only the second recorded case of OHL induced strictly by topical steroids. Self-medication and poor adherence to dosage recommendations were noted in the patient's medical history. Physicians must be aware of the rare but nevertheless possible adverse events associated with topical steroid use, particularly when such medication is prescribed over a long period for inflammatory diseases of the oral mucosa.
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Affiliation(s)
- E Vigarios
- Médecine bucco-dentaire, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France; UFR d'odontologie, 3, rue des Maraîchers, 31062 Toulouse, France.
| | - J-C Fricain
- Chirurgie orale, consultation pluridisciplinaire de pathologies de la muqueuse buccale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; UFR d'odontologie, 16-20, cours de la Marne, 33082 Bordeaux cedex, France
| | - F Projetti
- Anatomie et cytologie pathologiques, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - M Boulanger
- UFR d'odontologie, 3, rue des Maraîchers, 31062 Toulouse, France; Chirurgie orale, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - V Sibaud
- Dermatologie, consultation pluridisciplinaire de pathologies de la muqueuse buccale, institut Claudius-Regaud, institut universitaire du cancer Toulouse Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
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Wilken R, Li CS, Sharon VR, Kim K, Patel FB, Patel F, Maverakis E. Topical clobetasol for the treatment of toxic epidermal necrolysis: study protocol for a randomized controlled trial. Trials 2015; 16:374. [PMID: 26297574 PMCID: PMC4546316 DOI: 10.1186/s13063-015-0879-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 07/20/2015] [Indexed: 12/02/2022] Open
Abstract
Background Toxic epidermal necrolysis (TEN) is a rare systemic allergic drug eruption with high patient mortality. Currently, no established treatments have been shown to be effective for TEN beyond supportive care. Prior studies of systemic corticosteroids have yielded conflicting data, with some showing a possible benefit and others reporting in increased mortality. However, topical steroids have shown promise for treatment of ocular sequelae of TEN, such as scarring and vision loss. We have designed a randomized controlled trial to evaluate topical clobetasol for treatment of the epidermal manifestations of TEN. In addition, we propose genetic studies to characterize the TEN transcriptome and alterations in cutaneous gene expression that might occur following topical steroid treatment. Methods/Design This split-body randomized, double-blind, placebo-controlled Phase IIa proof-of-concept trial will evaluate the safety and efficacy of once-daily topical clobetasol applied to the skin of patients with TEN. This multicenter trial will recruit a total of 15 patients between the ages of 12 and 85 from the University of California Davis Medical Center and Shriners Hospital for Children inpatient burn units. Designated treatment areas on opposite sides of the body will be treated with blinded clobetasol 0.05 % ointment or control petrolatum ointment daily for 14 days. On day 3 of therapy, a biopsy will be taken from the treated area for genetic studies. The primary study aims will be to establish the safety of topical clobetasol treatment and determine the time to cessation of skin detachment for the control and clobetasol-treated areas. Secondary endpoints will evaluate efficacy using parameters such as time to 90 % re-epithelialization and percentage of affected skin at 0, 3, 6, 9, 12 and 15 days. Genomic DNA and RNA will be obtained from biopsy samples, to characterize the TEN transcriptome and identify changes in gene expression after topical steroid treatment. Discussion Topical steroids have shown promise for treating ocular complications of TEN, but to date have not been evaluated for cutaneous manifestations of the disease. This trial will investigate clinical and molecular outcomes of topical clobetasol application and hopefully provide insight into the disease pathophysiology. Trial registration ClinicalTrials.gov NCT02319616. https://clinicaltrials.gov/ct2/show/NCT02351037
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Affiliation(s)
- Reason Wilken
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA, 95816, USA.
| | - Chin Shang Li
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA, 95816, USA.
| | - Victoria R Sharon
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA, 95816, USA.
| | - Kyoungmi Kim
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA, 95816, USA.
| | - Falin B Patel
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA, 95816, USA.
| | - Forum Patel
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA, 95816, USA.
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA, 95816, USA.
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Russell GM, Lightman SL. Can side effects of steroid treatments be minimized by the temporal aspects of delivery method? Expert Opin Drug Saf 2014; 13:1501-13. [DOI: 10.1517/14740338.2014.965141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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