Clobetasone 0.05% cream 50% in Aqueous cream

Đặt vấn đề: Nốt ghẻ là thương tổn viêm thường gặp trong bệnh ghẻ, điều trị nốt ghẻ là một thách thức. Chúng tôi tiến hành nghiên cứu này nhằm đánh giá kết quả điều trị nốt ghẻ ở trẻ em bằng Clobetasone butyrate 0,05% tại Bệnh viện Da liễu Trung ương. Đối tượng và phương pháp nghiên cứu: Nghiên cứu thử nghiệm lâm sàng ngẫu nhiên có đối chứng trên 100 bệnh nhân được chẩn đoán là nốt ghẻ ở độ tuổi từ 2 - 15 tuổi tại Bệnh viện Da liễu Trung ương. Nhóm nghiên cứu sử dụng thuốc thoa Clobetasone butyrate 0,05% kết hợp Desloratidin, nhóm đối chứng dùng Cetaphil dưỡng ẩm kết hợp Desloratidin, đánh giá hiệu quả điều trị sau hai tuần. Kết quả: Số lượng thương tổn nốt ở nhóm nghiên cứu trước điều trị 8,72 ± 8,93 và sau điều trị giảm còn 4,2 ± 3,5. Nhóm đối chứng, số lượng nốt trước điều trị 9,8 ± 9 sau điều trị giảm còn 6,7 ± 6,5. Sau hai tuần điều trị, số lượng nốt giảm có ý nghĩa thống kê ở nhóm nghiên cứu. Đáp ứng điều trị ở nhóm nghiên cứu cho kết quả tốt, khá, trung bình, kém lần lượt là 12%, 66%, 22%, 0%; trong khi nhóm đối chứng là 0%, 4%, 46%, 50%; sự khác biệt có ý nghĩa thống kê ở hai nhóm. Triệu chứng ngứa ở nhóm nghiên cứu cải thiện tốt hơn nhóm đối chứng. Không ghi nhận tác dụng không mong muốn ở cả hai nhóm. Kết luận: Điều trị nốt ghẻ bằng Clobetasone butyrate 0,05% ở trẻ em làm giảm số lượng, giảm ngứa và chưa ghi nhận tác dụng không mong muốn.

Abstract licence: CC BY-NC-ND 4.0

A 28-year-old woman presented with a 4-day history of a sudden-onset painful rash on both arms, diarrhea, and a hoarse voice after recent travel to Senegal and the Gambia. The symptoms started on the second day of her trip to the Gambia. There was no relevant past medical history. On examination, there were multiple erythematous and hyperpigmented patches with mild peripheral scaling on the right upper limb, the medial aspect of the left arm, and the left breast. The rest of the physical examination was normal. Photographs of early lesions showed central desquamation. The distribution of the lesions on the distal right arm and proximal right forearm (Figure 1A) and those on the left arm and breast (Figure 1B) exhibited the characteristics of “kissing lesions.” These are discrete, well-defined lesions occurring in mirror-image locations on opposing skin surfaces. 1 This is consistent with a diagnosis of paederus dermatitis, likely acquired in the Gambia. 2 The rash was treated with clobetasone butyrate 0.05% cream twice daily and emollients. The diarrhea and hoarse voice resolved spontaneously. Salmonella DNA was detected in the stool. A respiratory viral swab result was negative, and HIV and syphilis serology results were also negative. Paederus dermatitis is an acute irritant dermatitis caused by contact with the hemolymph of rove beetles ( Paederus sp), which contain a vesicant toxin called pederin. 3 Direct skin contact is not necessary; lesions often appear in areas where the beetle has been crushed or moved. Paederus species are widely distributed, and outbreaks have

Abstract licence: CC BY

Background Atopic dermatitis, a chronic recurring inflammatory skin disease, often requires long-term use of topical corticosteroids that may cause serious adverse effects. Therefore, steroid sparing topical agent is needed.   Objective In this open, randomized and comparative study, the efficacy and safety of 0.03% tacrolimus ointment, 0.05% clobetasone butyrate cream and their combination were evaluated in patients with AD.   Patients and methods 45 patients with moderate to severe AD involving with moderate to severe AD involving ≤50% of the total body surface area (BSA) were randomly assigned to three groups. 15 patients in each group received 0.03% tacrolimus ointment twice daily (arm A) or 0.05% clobetasone butyrate cream twice daily (arm B) or 0.05% clobetasone butyrate cream in the morning and 0.03% tacrolimus ointment in evening (arm C). The treatment duration was 4 weeks and was followed-up for 6 weeks. The modified eczema area and severity index (mEASI) and the extent of the affected BSA were assessed and evaluated.   Results All treatment groups showed significant improvement throughout the treatment period. At the end of 4 weeks treatment, a median improvement of ≥75% in mEASI was observed in 53.3%, 73.3% and 93.3% of patients in arms A, B and C, respectively (endpoint analysis 1) and at the end of follow-up this improvement remained at the rate of 87.5%, 63.6% and 85.7% respectively (endpoint analysis 2). Only 13.3% patients who received 0.03% tacrolimus ointment experienced excellent improvement and clearance by the end of the treatment compared with 66.7% patients who received 0.05% clobetasone butyrate and 93.3% patients who received combination regimens. Skin burning was common in the 0.03% tacrolimus treatment group than in the 0.05% clobetasone butyrate group (7/15 vs. 1/15, p=0.010) and in the combination regimen group (7/15 vs.2/15, P=0.042).   Conclusion The overall therapeutic effectiveness and safety were in favor of combination regimens.

Abstract licence: CC BY 4.0

RationaleImmune checkpoint inhibition has dramatically altered the therapeutic landscape in the treatment of a range of locally advanced and metastatic skin cancers. In particular, the treatment of metastatic melanoma with combined anti-programmed cell death protein 1 (anti-PD1) and anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA4) antagonists has resulted in median 5-year survival rates of over 50%. However, combined immune checkpoint inhibitor therapy frequently results in the development of immune-related adverse events (irAE) which can be severe and life-threatening. While the typical irAEs, namely colitis, thyroiditis, and hepatitis are well recognized, cutaneous irAEs are varied and can be difficult to accurately diagnose.Patient concernsA 61-year-old female with metastatic melanoma presented with widespread indurated, waxy skin changes, and weight loss following combined anti-PD1 and anti-CTLA4 immunotherapy.DiagnosesGeneralized morphea in the setting of combined immunotherapy.InterventionsDexamethasone pulse therapy (100 mg i.v. over 3 days) was combined with topical therapy (clobetasone propionate ointment) and physiotherapy. Four cycles of dexamethasone pulse therapy, at 4 weekly intervals, led to an improvement in the skin changes, accompanied by increased mobility. However, the changes did not resolve completely.OutcomeStaging examinations revealed progressive melanoma brain metastases and despite 2 further cycles of combined anti-PD1 and anti-CTLA4 immunotherapy followed by 1.5 cycles of Fotemustine, the patient died 22 months after the development of the scleroderma-like skin changes.LessonsCutaneous irAEs are varied in nature and severity. Sclerotic skin changes are rare, but unlike cutaneous irAEs related to immune checkpoint inhibitor therapy, they are often refractory to standard treatment with systemic corticosteroids. Clinicians should be aware of immunotherapy-related scleroderma to prompt dermatological evaluation to facilitate early recognition and initiate treatment. Administration of systemic immunosuppression should be carefully balanced against the risk of promoting melanoma progression.

Abstract licence: CC BY