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PubMed1984

[Effect of difluprednate on adrenocortical and gonadal function].

The effects of difluprednate on the deposition of liver glycogen, the inhibition of adrenocortical function, the estrogenic, progestational and androgenic activities, and the excretion of electrolytes were investigated by comparing them with those of fluocinonide. The following results were obtained: 1) the deposition of liver glycogen was remarkably increased by subcutaneous administration of these two glucocorticoids, and in the dose of 0.1 mg/kg, the effect of difluprednate (35.1-fold the control value) was larger than that of fluocinonide (19.4-fold the control value) in mice. 2) the administration of difluprednate and fluocinonide greatly induced the decrease in the corticosterone concentration in the rat serum and adrenal gland (0.1 and 1 mg/kg, s.c.). 3) the estrogenic, progestational and androgenic activities were not recognized by administration of difluprednate in rats. 4) the two glucocorticoids induced an increase in the electrolytes excretion (especially K+) and the urine volume. 5) by the repeated injection of difluprednate (1.0 mg/kg) and fluocinonide (0.1 mg/kg), decrease of the body weight was observed in all of the experimental animals. In these experiments, it was recognized that the glucocortical action of difluprednate was similar or more potent in comparison with the action of fluocinonide and that the systemic effects of fluocinonide such as body weight loss was larger than that of difluprednate.

Adrenal Cortex↗
PubMed1995

Prolonged occlusion in the treatment of psoriasis: a clinical and immunohistologic study.

BACKGROUND: An occlusive dressing that is both cosmetically acceptable and long term is needed for psoriasis treatment. The mechanisms that underlie the efficacy of occlusion in psoriasis are unknown. OBJECTIVE: We performed a clinical and immunohistologic study in patients with psoriasis of the effects of occlusion, topical corticosteroid alone, and occlusion plus corticosteroid, with a new prolonged dressing as the occlusive therapy. METHODS: Nineteen patients completed a 3-week study of efficacy of prolonged occlusion dressing, fluocinonide ointment, or a combination of the two. An immunohistologic study was performed in 10 patients with psoriasis treated for 1 week with prolonged occlusion. RESULTS: The combination of fluocinonide ointment and occlusion produced significantly more improvement than either treatment alone (p < 0.01). There was no significant difference between the efficacy of prolonged occlusion or fluocinonide ointment. On 4-week follow-up plaques treated with occlusion alone or combined fluocinonide and occlusion were still significantly improved (p = 0.05 and p < 0.001, respectively). None of the immunohistologic and proliferation markers assessed in psoriatic plaques was significantly affected by occlusion as compared with untreated plaques. CONCLUSION: Prolonged occlusion is an effective therapy for psoriasis either as monotherapy or in combination with a high-potency topical corticosteroid. However, the mechanism of action of prolonged occlusion alone in the improvement of psoriasis is unknown.

Administration, Cutaneous↗
PubMedDate not supplied

A pharmacoeconomic analysis of topical therapies for patients with mild-to-moderate stable plaque psoriasis: a US study.

Psoriasis is a persistent skin disorder characterized by abnormal keratinocyte differentiation, keratinocyte hyperproliferation, and increased expression of inflammatory markers at the cellular level, leading to erythema, induration, and scaling of the skin. Depending on the severity of the disease, annual outpatient costs range from $1400 to $6600 per patient, totaling $3.2 billion each year in the United States. Because the disease is persistent and progressive, patients receiving a diagnosis of psoriasis early in life can expect to require lifelong care, which translates into lifelong expense. Treatments include topical formulations, systemic therapies, phototherapies, and combination therapies. Of these, topical agents are the first-line treatments, including fluocinonide and other steroids, calcipotriene, and tazarotene, a once-daily retinoid. To establish the relative cost-effectiveness of these drugs (fluocinonide, calcipotriene, and tazarotene), we conducted a pharmacoeconomic study from the perspective of a third-party payer, using a decision-analytic model validated by clinical experts. Data were drawn from a meta-analysis of the contemporary medical literature. Clinical success, clearing, and relapse rates determined the probabilities for therapeutic outcomes and the number of anticipated disease-free days for each study comparator. Costs for physician visits, drug acquisition, laboratory testing, and adverse-events management were added to each branch of the decision tree and multiplied by the appropriate probabilities to establish the expected cost of treatment, stratified by the primary treatment choice. Cost-effectiveness was expressed as the total expected cost of achieving a disease-free day. Tazarotene 0.1% was 16.74% more cost-effective than tazarotene 0.05%, 85.46% more cost-effective than fluocinonide, and 143.75% more cost-effective than calcipotriene. The expected cost of achieving a disease-free day was $49.46 for tazarotene 0.1%, $57.74 for tazarotene 0.05%, $91.73 for fluocinonide, and $120.56 for calcipotriene. Treatment with tazarotene offers an opportunity to reduce the cost of care for patients with mild-to-moderate psoriasis and enhance patient satisfaction by gaining more disease-free days.

Administration, Topical↗
PubMed1988

Double-blind comparison of a dithranol and steroid mixture with a conventional dithranol regimen for chronic psoriasis.

Twenty four of 30 patients with chronic plaque psoriasis completed a double-blind randomized paired comparison of dithranol in Lassar's paste versus dithranol and fluocinonide in Lassar's paste. There was a more rapid reduction in severity of the psoriasis on the side treated with the dithranol and fluocinonide mixture, but no difference in the final time to clearance between the two sides. There were fewer burning episodes on the side treated with dithranol and fluocinonide and greater staining of the skin. Of the 20 patients who were subsequently followed up for up to 3 months, 11 had relapsed more on the side treated with dithranol and fluocinonide, two on the side treated with dithranol alone and in seven there was no appreciable difference. It was concluded that the addition of a topical steroid to a conventional dithranol regimen produced more rapid initial clearance and less burning, but more rapid relapse of the psoriasis.

Adolescent↗
PubMed2001

Drugs for discoid lupus erythematosus.

BACKGROUND: Discoid lupus erythematosus is a chronic form of cutaneous (skin) lupus which can cause permanent scarring if treatment is inadequate. Many drugs have been used to treat this disease and some of these are potentially very toxic. OBJECTIVES: To assess the effects of drugs for discoid lupus erythematosus. SEARCH STRATEGY: We searched the Cochrane Clinical Trials Register (December 1999), MEDLINE (January 1966 to December 1999), EMBASE (January 1980 to January 2000), and the reference lists of relevant reviews. Index Medicus (1956 to 1966) was handsearched and 7 experts in the field were approached for information about unpublished trials. SELECTION CRITERIA: Randomised trials of drugs to treat people with discoid lupus erythematosus. Drugs included in the search were azathioprine, chloroquine, clofazimine, corticosteroids, (oral and topical), dapsone, gold, interferon alpha-2a, methotrexate, phenytoin, retinoids, sulphasalazine and thalidomide. DATA COLLECTION AND ANALYSIS: Two reviewers independently examined each retrieved study for eligibility. MAIN RESULTS: Two trials involving 136 participants were included. In a cross-over study of twelve weeks duration fluocinonide 0.05% cream (a potent topical corticosteroid), appeared to be markedly better than hydrocortisone 1% cream ( a mild corticosteroid). Clearing or excellent improvement was seen in 27% of people using fluocinonide and in 10% of those using hydrocortisone, giving a 17% absolute benefit in favour of fluocinonide (95% CI 4.5 to 29.5% and NNT 6). In the second trial, hydroxychloroquine was compared with acitretin in 58 people. There was marked improvement or clearing in 46% of people using acitretin and in 50% of those on hydroxychloroquine, a nonsignificant 4% absolute gain with hydroxychloroquine (95%CI -23% to 30%). The adverse effects were more frequent and more severe in the acitretin group. REVIEWER'S CONCLUSIONS: Fluocinonide cream may be more effective than hydrocortisone in treating people with discoid lupus erythematosus. Hydroxychloroquine and acitretin appear to be of equal efficacy, although adverse effects are more frequent and more severe with acitretin. There is not enough reliable evidence about other drugs used to treat discoid lupus erythematosus.

Dermatologic Agents↗
PubMed1982

Applications of glucocorticosteroids. The effects of twice-daily vs once-every-other-day applications on mouse epidermal cell DNA synthesis.

To determine a schedule for continuous suppression of epidermal cell DNA synthesis, 0.05% fluocinonide ointment was applied either twice daily or once on alternate days to hairless mouse skin for 174 hours. Suppression occurred similarly for both regimens for 78 hours followed by an increase in DNA synthesis despite continued application of fluocinonide. The systemic effect was less marked with the alternate-day schedule. The effect of a single application of the fluocinonide ointment was also studied over 174 hours. Substantial inhibition of DNA synthesis occurred but for a shorter period followed by an increase and then return to normal values. Experiments were performed where second applications were made at various time intervals after the first. These did not appear to affect events until 192 hours had elapsed, when a second application caused profound inhibition of DNA synthesis once more.

Administration, Topical↗
PubMed1990

Absorption of a topical steroid and evaluation of adrenal suppression in patients with erosive lichen planus.

This study was designed to investigate the absorption of a topical steroid applied to the gingiva and buccal mucosa of patients with erosive lichen planus and to healthy control patients. In addition, adrenal suppression was assessed by measurements of serum and urine cortisol levels. Ten patients with erosive lichen planus and eight control patients provided urine and blood samples at baseline, day 3, and day 21. After establishment of baseline laboratory values, patients were instructed to apply 500 mg of a 0.05% fluocinonide gel to the gingiva and buccal mucosa three times a day for 3 weeks. Measurements of cortisol levels revealed no significant changes in either the disease or the control group. Although procedures were developed to detect fluocinonide, none of the patients showed evidence of the steroid during the study. It was concluded that the topical application of a fluocinonide gel to the gingiva and buccal mucosa over a 3-week period in patients with erosive lichen planus produced no adrenal suppression.

Absorption↗
PubMed2005

Transient band-like keratopathy after treatment for seborrheic dermatitis.

PURPOSE: To describe a case of transient band-like keratopathy after ocular exposure to fluocinonide cream and ketoconazole shampoo. DESIGN: Observational case report. RESULTS: A 40-year-old patient presented with acute pain, photophobia, lacrimation, and redness in 1 eye. The symptoms began while using fluocinonide cream and ketoconazole shampoo as treatment of seborrheic dermatitis of the scalp. Examination revealed white clumpy deposits in a horizontal band across the inferocentral corneal epithelium and conjunctival hyperemia. Corneal scrapings revealed no cells or organisms, and culture was negative. The lipophilic deposits dissolved during slide fixation and processing. With conservative treatment the deposits resolved in 3 days. CONCLUSION: We present a case of transient band-like corneal deposit, a novel complication of fluocinonide and ketoconazole exposure.

Administration, Topical↗
PubMed1997

Glucocorticoids decrease tissue mast cell number by reducing the production of the c-kit ligand, stem cell factor, by resident cells: in vitro and in vivo evidence in murine systems.

The local delivery of glucocorticoids to tissues significantly decreases mast cell number. This pharmacologic effect of glucocorticoids is believed to be one of the mechanisms by which glucocorticoids regulate allergic inflammation. To determine the mechanism by which glucocorticoids are able to exert this effect, we first applied the glucocorticoid fluocinonide to mouse dermis and observed that the decrease in mast cell number was associated with an increase in mast cell apoptosis. This did not appear to be due to a direct effect of the glucocorticoid on mast cells, as the addition of 0.01-1.0 microM of the glucocorticoid dexamethasone into stem cell factor (SCF)-dependent mast cell cultures did not enhance mast cell death. However, addition of dexamethasone to cultured fibroblasts did result in a downregulation of SCF mRNA and a significant decrease in SCF protein production. Similarly, immunohistochemistry performed on fluocinonide-treated mouse dermis revealed a decrease in immunoreactive SCF. Administration of SCF at sites of fluocinonide administration to the dermis abolished the mast cell-depleting effect of this glucocorticoid. Thus, glucocorticoids decrease tissue mast cell number by downregulating tissue SCF production required for the survival of local mast cells. This observation may be applicable to the design of improved strategies to treat mast cell-mediated disorders.

3T3 Cells↗