RESUMEN
Topical clobetasol propionate is widely used for the treatment of psoriasis. One formulation of clobetasol propionate, Skin Cap, was thought by some practitioners and patients to be more effective than other formulations. Differences in corticosteroid bioavailability could account for differences in efficacy. The purpose of this study is to compare the relative bioavailability of clobetasol propionate from Skin Cap to two FDA-approved formulations of clobetasol propionate (Olux foam and Temovate scalp application). The bioavailability was assessed by measuring the percutaneous absorption of clobetasol propionate in vitro on scalp skin, using the human cadaver skin model. There was no significant difference in the percutaneous absorption of clobetasol propionate between Olux foam and Skin Cap (2.09 and 1.93% at 48 h, respectively) or between Olux foam and Temovate scalp application (3.70 and 3.46%, respectively) when applied under unoccluded conditions. Under occluded conditions, there was greater absorption of clobetasol propionate from the Olux foam as compared with Skin Cap (4.94 and 1.57%, respectively; p < 0.05). The Skin Cap vehicle does not provide more bioavailable clobetasol propionate than currently available, FDA-approved products. Other differences, including those in patient compliance, could account for the perceived efficacy of the product.
Asunto(s)
Antiinflamatorios/farmacología , Clobetasol/análogos & derivados , Clobetasol/farmacocinética , Vehículos Farmacéuticos/química , Piel/efectos de los fármacos , Administración Cutánea , Antiinflamatorios/administración & dosificación , Disponibilidad Biológica , Clobetasol/administración & dosificación , Excipientes/química , Glucocorticoides , Humanos , Técnicas In Vitro , Cuero Cabelludo , Piel/metabolismo , Absorción Cutánea/efectos de los fármacosRESUMEN
We conducted a 12-week, multicenter, randomized, double-masked, parallel-group study of the efficacy, safety, and tolerability of azelaic acid 20% cream and glycolic acid lotion compared with tretinoin 0.025% cream and a vehicle lotion to treat mild-to-moderate facial acne vulgaris. Patients treated with azelaic/glycolic acid experienced a significantly greater reduction in the number of papules, as well as a greater reduction in the number of inflammatory lesions, than those treated with tretinoin. Overall global improvement was approximately 25% in both groups. In the physician evaluations, treatment with azelaic/glycolic acid was found to cause significantly less dryness, scaling, and erythema than tretinoin. Patients also reported significantly less dryness, redness, and peeling with azelaic/glycolic acid. Significantly more patients in the azelaic/glycolic acid group than the tretinoin group reported that they felt attractive. The combination of azelaic acid and glycolic acid is a useful alternative to tretinoin, being at least as efficacious as the latter, while offering a superior tolerability and patient approval profile.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Fármacos Dermatológicos/uso terapéutico , Ácidos Dicarboxílicos/uso terapéutico , Glicolatos/uso terapéutico , Queratolíticos/uso terapéutico , Tretinoina/uso terapéutico , Administración Tópica , Adulto , Fármacos Dermatológicos/efectos adversos , Ácidos Dicarboxílicos/efectos adversos , Método Doble Ciego , Femenino , Glicolatos/efectos adversos , Humanos , Queratolíticos/efectos adversos , Masculino , Pomadas , Resultado del Tratamiento , Tretinoina/efectos adversosRESUMEN
The potential for a variety of local and systemic side effects from the use of potent topical corticosteroids has long been recognized. However, adrenal suppression has only rarely been documented. We describe two patients with profound hypothalamic-pituitary-adrenal axis suppression resulting from the unregulated use of super potent topical corticosteroids.
Asunto(s)
Glándulas Suprarrenales/efectos de los fármacos , Antiinflamatorios/efectos adversos , Betametasona/análogos & derivados , Clobetasol/análogos & derivados , Administración Tópica , Adulto , Antiinflamatorios/administración & dosificación , Betametasona/administración & dosificación , Betametasona/efectos adversos , Enfermedad Crónica , Clobetasol/administración & dosificación , Clobetasol/efectos adversos , Depresión Química , Femenino , Glucocorticoides , Humanos , Masculino , Pomadas , Psoriasis/complicaciones , Psoriasis/tratamiento farmacológico , Automedicación/efectos adversosRESUMEN
Cutaneous T-cell lymphoma (CTCL) is significantly less common than B-cell lymphoma in patients with acquired immunodeficiency syndrome (AIDS). Periocular involvement by CTCL usually occurs in the setting of more widespread plaque or tumor-stage disease; therefore, CTCL localized solely to the periocular region is rare. We report the case of a 38-year-old Hispanic woman with AIDS and an enlarging tumor of the left upper eyelid. The clinical differential diagnosis included various infections and neoplasms. Examination of an incisional biopsy specimen revealed a dense infiltrate of atypical lymphocytes that labeled as T cells with use of the immunoperoxidase technique. The tumor subsequently regressed with local radiotherapy. Eyelid CTCL is reviewed and the differential diagnosis of eyelid lesions is reviewed.
Asunto(s)
Neoplasias de los Párpados/patología , Linfoma Relacionado con SIDA/patología , Linfoma Cutáneo de Células T/patología , Infecciones Oportunistas Relacionadas con el SIDA/patología , Síndrome de Inmunodeficiencia Adquirida/patología , Adulto , Diagnóstico Diferencial , Neoplasias de los Párpados/radioterapia , Femenino , Humanos , Linfoma Relacionado con SIDA/radioterapia , Linfoma Cutáneo de Células T/radioterapiaRESUMEN
Lymph node biopsies were positive in 20% (7/35) of stage T1 and T2 (stage B) tumors and 64% (21/33) of stage T3 (stage C) tumors in 69 previously untreated and unselected patients with apparently localized carcinoma of the prostate. One patient with a To (stage A) tumor had no evidence of lymph node metastasis. Prospective analysis demonstrated an overall lymphographic accuracy of 78%, sensitivity of 57% and specificity of 92%. The detection of lymph node metastases in the lymphogram is limited by the frequency of microscopic metastasis and the frequency of benign changes within pelvic lymph nodes in this older patient population. Diagnostic criteria for metastatic disease which gives a low incidence of false-positive interpretations should be maintained, since relaxing the criteria will not necessarily improve the detection rate of metastases and would decrease specificity.
Asunto(s)
Carcinoma/diagnóstico por imagen , Linfografía , Neoplasias de la Próstata/diagnóstico por imagen , Anciano , Carcinoma/patología , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/patologíaRESUMEN
Ipsilateral elevation and contralateral suppression of renin secretion have been established in a patient with a post-traumatic renal arteriovenous fistula associated with diastolic hypertension. This finding is rare because of the dilutional effect of arterial blood shunted in the renal vein. Increased renin secretion in this instance supports the proposed mechanism of diastolic hypertension with renal arteriovenous fistula.