Comparison of topical capsaicin and betamethasone in the treatment of chronic skin lesions due to sulfur mustard exposure

Chronic pruritic skin lesions are considered to be one of the late complications of sulfur mustard exposure. The purpose of this study was to compare the efficacy of topical capsaicin with that of betamethasone in the treatment of these lesions. In this investigator-blinded, randomized clinical trial, patients applied capsaicin cream 0.025% (n=32) or betamethasone cream 0.1% (n=32) 2 times a day for 6 weeks. Efficacy was based on a dermatologist assessment. The severity of the pruritus was assessed by pruritic score questionnaire and a visual analog scale before and after treatment. All patients complained of pruritus. Both groups showed a significant decrease in pruritus, scaling, and skin dryness (p<0.05), but burning sensation was not improved significantly in the capsaicin group. The mean (+/- standard deviation [SD]) baseline pruritic scores in the capsaicin and betamethasone groups were 29.4 (13.1) and 33.6 (7.2), respectively (p=0.1). The mean (SD) pruritus score change from baseline to after the treatment was significantly higher (p<0.001) in the betamethasone group than in the capsaicin group, 12.7 (6.4) vs. 6.9 (5.6). Fourteen (35%) patients in the capsaicin group reported a burning sensation and intolerable odor, but these effects were not serious enough to necessitate discontinuing the treatment. Topical capsaicin cream 0.025% was much less well tolerated than betamethasone and inferior to betamethasone in reducing chronic skin lesions and symptoms from sulfur mustard exposure.     

Comparison of Clinical Efficacy of Topical Pimecrolimus with Betamethasone in Chronic Skin Lesions Due to Sulfur Mustard Exposure: A Randomized,Investigator‐Blind Study

Abstract: This study compared topical pimecrolimus with betamethasone in the treatment of pruritus and chronic skin lesions due to sulfur mustard exposure. Seventy male chemical‐injured war veterans participated in this investigator‐blinded clinical trial. They were randomized to receive pimecrolimus cream 1% (n = 35) or betamethasone cream 0.1% (n = 35) two times a day for 6 weeks. Dermatological examination and assessment of pruritus severity by a pruritic score questionnaire and visual analogue scale were done before and after the treatment course. A significant decrease (P < 0.05) in pruritus, burning sensation, and skin dryness was shown in both groups after the treatment. However, the severity of hyper‐ and hypopigmentation, vesicle, erythema, fissure, lichenification and excoriation did not decrease significantly in either group (P > 0.05). Mean (± standard deviation) pruritic scores at baseline for the pimecrolimus and betamethasone groups were 30.4 (± 8.0) and 33.6 (± 7.2), respectively (P = 0.103). These scores decreased to 18.8 (± 4.8) in the pimecrolimus and 20.8 (± 4.0) in the betamethasone groups after treatment; both showed a statistically significant decrease (P < 0.001). Change of pruritus score from baseline to after the treatment course was not statistically different between the two groups (P = 0.502). No serious side‐effects were reported during the course of the treatment. Topical pimecrolimus 1% was as effective as betamethasone cream 0.1% in controlling pruritus, burning sensation and skin dryness of sulfur mustard‐exposed patients.     

Pimecrolimus 1% cream for the treatment of seborrheic dermatitis: a systematic review of randomized controlled trials

Seborrheic dermatitis is a common, chronic, relapsing inflammatory skin disorder that manifests as erythema, scaling and pruritus in sebum gland-rich areas of the skin. The objective of this article is to evaluate the clinical efficacy of pimecrolimus 1% cream in the treatment of seborrheic dermatitis compared with corticosteroids, antimycotics, placebo or no intervention. Pimecrolimus 1% cream appears to be a well-tolerated and effective treatment for seborrheic dermatitis. It has comparable efficacy, in terms of decreasing severity of erythema, scaling and pruritus, to the standard treatments: topical corticosteroids and antimycotics. However, future studies with more standardized measures of treatment outcome are recommended. More studies may also be conducted to further evaluate pimecrolimus 1% cream as a long-term maintenance therapy for seborrheic dermatitis.     

Efficacy of Aloe vera/olive oil cream versus betamethasone cream for chronic skin lesions following sulfur mustard exposure: a randomized double-blind clinical trial

Background: Chronic pruritic skin lesions are among the common late complications of sulfur mustard intoxication. In the present randomized double-blind clinical trial, therapeutic efficacy of Aloe vera/olive oil combination cream in the alleviation of these lesions was evaluated and compared to that of betamethasone 0.1% cream.

Methods: Sixty-seven Iranian chemical warfare-injured veterans were randomized to apply A. vera/olive oil (n?=?34, completers?=?31) or betamethasone 0.1% (n?=?33, completers?=?32) cream twice daily for 6 weeks. Evaluation of pruritus severity was performed using a pruritic score questionnaire and visual analogue scale (VAS).

Results: Both treatments were associated with significant reductions in the frequency of pruritus (p?<?0.05), burning sensation (p?<?0.01 and p?<?0.001 in A. vera/olive oil and betamethasone group, respectively), scaling (p?<?0.01 and p?<?0.05) and dry skin (p?<?0.001) at the end of trial. Fissure and excoriation were only reduced in the A. vera group (p?<?0.05). The change in the frequency of hyper- and hypopigmentation lesions, blisters, erythema and lichenification did not reach statistical significance in any of the groups (p?>?0.05). Mean pruritus (p?<?0.05) and VAS scores (p?<?0.01 and p?<?0.05) were significantly decreased by the end of trial in both groups. The rate of improvement in the pruritus severity [defined as being classified in a less severe category (mild, moderate and severe)] was found to be comparable between the groups (p?>?0.05).

Conclusion: A. vera/olive oil cream was at least as effective as betamethasone 0.1% in the treatment of sulfur mustard-induced chronic skin complications and might serve as a promising therapeutic option for the alleviation of symptoms in mustard gas-exposed patients.     

Efficacy of bufexamac cream versus betamethasone valerate cream in contact dermatitis: a double-blind trial.

A double-blind controlled study was carried out in 72 patients with atopic or contact dermatitis, who were randomly allocated to receive treatment with either 5% bufexamac, 0.1% betamethasone valerate or placebo creams. Patients applied the cream twice daily for 2 weeks. Assessments of the degree of severity of inflammation, induration, lichenification, crusts, scaling, and pruritus were made before and after treatment. The results showed that both active preparations were equally effective in improving the skin condition in the majority of the patients. In younger patients, however, the improvement with betamethasone valerate appeared to be somewhat better than that with bufexamac, particularly in relation to pruritus.     

Efficacy of bufexamac cream versus betamethasone valerate cream in contact dermatitis: a double-blind trial

Summary

A double-blind controlled study was carried out in 72 patients with atopic or contact dermatitis, who were randomly allocated to receive treatment with either 5% bufexamac, 0.1% betamethasone valerate or placebo creams. Patients applied the cream twice daily for 2 weeks. Assessments of the degree of severity of inflammation, induration, lichenification, crusts, scaling, and pruritus were made before and after treatment. The results showed that both active preparations were equally effective in improving the skin condition in the majority of the patients. In younger patients, however, the improvement with betamethasone valerate appeared to be somewhat better than that with bufexamac, particularly in relation to pruritus.     

Treatment of Opioid-Induced Pruritus with Ondansetron: Report of Four Patients

Pruritus is a common side effect after neuraxial administration of the opioids; particularly morphine sulfate. Ondansetron has been used to treat the pruritus in patients with cholestatic diseases or renal insufficiency, suggesting that pruritus may be mediated by serotonin. We administered ondansetron to four patients suffering from pruritus due to the perioperative administration of opioids. Pruritus disappeared within few minutes in three of these patients. Future studies are necessary to evaluate the efficacy of ondansetron for the treatment as well as the prevention of this opioid-induced effect.     

倍他米松乳膏的稳定性及有效期预测

目的:研究及预测倍他米松乳膏的稳定性与有效期。方法:以高效液相色谱法测定倍他米松的含量,分别用初均速法和强光照射法对倍他米松乳膏进行稳定性试验。结果:倍他米松检测浓度线性范围为0·25~8μg/ml(r=0·9991),平均回收率为98·56%(RSD=0·78%);其含量与温度相关性较大,光照的影响不明显。结论:倍他米松乳膏宜于常温阴凉处保存,预测有效期为1y。     

复方倍他米松注射液局部注射治疗142例神经性皮炎临床疗效观察

目的观察复方倍他米松注射液局部注射治疗神经性皮炎的临床疗效及安全性,探索简单有效的治疗方法。方法应用复方倍他米松注射液与2%利多卡因按1:1比例混合皮损内注射治疗神经性皮炎,每隔3周注射1次,每人注射不超过6次,注射浓度为0.1ml/cm2。自身其他皮损同时外用澳能作为对照。结果治疗组在缓解皮损硬度、瘙痒方面疗效明显优于对照组(总有效率为98.6%)。两者在皮肤瘙痒及硬度等指标的改善率上存在显著差异,P<0.01。结论复方倍他米松注射液为一种疗效高、作用持久、副作用少、使用方便的强效激素制剂,有较高的临床应用价值。     

Relationship between in vivo skin blanching and in vitro release rate for betamethasone valerate creams.

Betamethasone valerate creams from two firms were evaluated using the skin blanching procedure. In both studies, the same cream formulation exhibited significantly higher blanching compared to the other product. An in vitro release rate was determined for these betamethasone valerate cream products using a diffusion cell system, with a cellulose acetate membrane and a 60% ethanol:water receptor medium. The release rate (flux) of betamethasone valerate was higher for the higher blanching formulation and was statistically different from the other product. The integrity of the cellulose acetate membrane in 60% ethanol:water mixture was ascertained using hydrocortisone cream product. The in vitro drug release method, using a diffusion cell system and a synthetic membrane, can serve as a good quality control test method for topical creams.     

Topical pimecrolimus: a review of its clinical potential in the management of atopic dermatitis

Pimecrolimus (SDZ ASM 981), an ascomycin derivative, is a nonsteroid, has anti-inflammatory activity, and has demonstrated efficacy in reducing symptoms of atopic dermatitis in adult and paediatric patients when applied topically. Compared with vehicle, topical pimecrolimus 1.0% cream was significantly more effective at reducing symptoms of atopic dermatitis, as measured by the Eczema Area and Severity Index (EASI), in infants aged 3 to 23 months, children aged 2 to 17 years and adults. The median reductions from baseline in the total EASI score in adults after treatment with pimecrolimus 1.0% or corresponding vehicle twice daily for 3 weeks were 47 and 0%, respectively. In infants and children, treatment with pimecrolimus 1.0% twice daily for 6 weeks resulted in significant decreases in mean EASI scores compared with vehicle. The severity of pruritus was significantly reduced in patients of all age groups after topical treatment with pimecrolimus 1.0% cream. Compared with vehicle, the incidence of eczematous flares was also reduced by intermittent long-term use of topical pimecrolimus 1.0% in adults, children and infants. Sixty percent of children treated with pimecrolimus for 1 year completed the first 6 months of treatment without experiencing a flare, compared with 35% of patients who received vehicle. Furthermore, the use of topical corticosteroids for the treatment of uncontrolled flares in adults, children and infants was lower in the pimecrolimus groups than in the vehicle groups. Topical pimecrolimus 1.0% cream is well tolerated in atopic dermatitis patients of all age groups. There were no clinically relevant systemic adverse events reported from any of the studies in patients with atopic dermatitis. The most frequently reported adverse events pertained to application site reactions, such as burning and a feeling of warmth. In conclusion, topical pimecrolimus 1.0% cream has shown efficacy in the treatment of mild to moderate atopic dermatitis in infants, children and adults. Although tolerability data concerning infants and children have not yet been published in full, the drug appears to be well tolerated in all age groups, and there have been no reports of clinically relevant systemic adverse events. Furthermore, pimecrolimus 1.0% cream has shown no potential for skin atrophy, a problem commonly associated with treatment with topical corticosteroids. Pimecrolimus 1.0% cream provides a promising and well tolerated treatment option in the management of infants, children and adults with mild to moderate atopic dermatitis.     

Efficacy of topical oxatomide in women with pruritus vulvae

Pruritus vulvae is a very common condition. The patient's scratching often worsens the situation and makes diagnosis by the clinician difficult. A clinical trial to assess the safety and efficacy of a topical antihistaminic drug (oxatomide) was carried out. The first stage aimed to determine the best formulation and concentration: eleven patients were admitted in the study, conducted openly. Two preparations (cream and gel) and two concentrations (2.5% and 5%) were tested. A second stage was performed to assess the efficacy of oxatomide gel 5% versus placebo: thirty patients entered a double-blind, cross-over, placebo-controlled study. Results of the first stage demonstrated good local tolerability of the medication, good patient acceptance and no side effects. During the second stage better anti-itching action of topical oxatomide than placebo was obtained. Safety and acceptability were confirmed. In general topical oxatomide showed good tolerability and efficacy in women with vulvar itching of various natures.     

Local treatment of psoriasis with desoxymethasone and betamethasone 17,21-dipropionate: a double-blind comparison.

A double-blind comparison of the effectiveness of 0.25% desoxymethasone and 0.05% betamethasone 17,21-dipropionate creams was carried out in 40 patients with symmetrical, chronic psoriatic lesions. The lesions were pre-treated for 1 week with an inactive cream base and then the trial preparations were applied, without occlusion, to one or other side at random twice daily for 21 days. Overall response to treatment and the effect of the two topical steroids on scaling, induration, erythema, and pruritus were assessed at the start of and 4, 7, 14, and 21 days after the start of active treatment. The results indicated a better but not statistically significant response to desoxy-methasone. By the end of the trial period, the desoxymethasone-treated side was better in 22.5% of cases compared with 10% of cases in the betamethasone dipropionate-treated side. No side-effects of treatment were observed.     

加巴喷丁治疗维持性血液透析患者皮肤瘙痒症的临床研究

目的 评价加巴喷丁治疗维持性血液透析(MHD)患者皮肤瘙痒症的疗效及安全性.方法 采用随机对照研究,选择顽固性皮肤瘙痒的MHD患者,随机分为试验组20例和对照组20例.试验组患者每周3次透析后晚间服加巴喷丁100~300 mg,对照组服用安慰剂.4周后根据视觉模拟评分(VAS)进行疗效评价,同时观察不良反应.结果 治疗组得分平均下降(6.0±2.6)分,安慰剂组平均下降(1.3±1.9)分.两组VAS得分下降程度有明显差异(P<0.01).没有患者因药物副作用而中断治疗.结论 加巴喷丁治疗顽固性尿毒症皮肤瘙痒症是安全和有效的.     

Comparative efficacy of once a day diflorasone diacetate and twice a day betamethasone valerate ointment applications in eczematous dermatitis

The efficacy of once a day applications of 0.05% diflorasone diacetate ointment and twice a day applications of 0.1% betamethasone valerate ointment was compared in 70 patients with eczematous dermatitis. Altogether 32 patients completed the 3-week study. Fourteen patients in the diflorasone group and 6 on betamethasone left the study earlier because of total (100%) improvement of lesions. Eight patients left because of unsatisfactory progress and 6 because of personal reasons. There were only two noticeable differences observed between treatment groups. At Week 2, the diflorasone diacetate group improved significantly more than the betamethasone valerate group with respect to pruritus. At Week 3, this difference in the improvement of pruritus was marginally significant in favour of diflorasone diacetate. Excluding the complications due to a secondary infection, no adverse reactions were recorded in the diflorasone diacetate-treated patients; 1 betamethasone valerate-treated patient developed telangiectasia. The once a day applications of diflorasone diacetate not only proved to be slightly more efficacious than the twice a day applications of betamethasone valerate, but also provided the advantages of patient convenience and compliance.     

Treatment of head and neck dermatitis with ciclopiroxolamine cream--results of a double-blind, placebo-controlled study

In atopic dermatitis, microbial allergens may be pathogenetically significant. Apart from Staphylococcus aureus, these are primarily lipophilic Malassezia yeasts. They are particularly involved in the pathogenesis of head and neck dermatitis (HND), a special form of atopic dermatitis, which is often difficult to treat. Fifty patients (21 men, 29 women) with moderate to severe HND of at least 6 months' duration were included in a prospective double-blind study. All of them showed at least 10% involvement of the head-neck region. The severity of disease was evaluated by Investigator Global Assessment (IGA), Eczema Area and Severity Index (EASI) for the head-neck region and a pruritus score. IgE antibodies to Malassezia sympodialis and/or Malassezia furfur (at least CAP class 1) were a prerequisite for study enrollment. Either 1% ciclopiroxolamine cream (Batrafen; Aventis Pharma, Bad Soden, Germany) or the corresponding base cream were thinly applied to the affected areas twice daily for 28 days. Sixteen patients in the ciclopiroxolamine group and 13 patients in the placebo group completed the study. To assess the change in severity of atopic eczema, IGA differences between the individual measuring points were determined for all patients. There were significant differences in the IGA score change between the ciclopiroxolamine group and the placebo group, from t3 to t4, and over the total period. Similar, but not significant, changes were observed with the EASI score, in terms of affected skin area and itching. The present study is the first to examine the effect of antifungal single-drug therapy with a cream containing ciclopiroxolamine on the course of HND. The study medication was found to be significantly effective. To optimize this effect, suitable patients selected in terms of fungal load, specific IgE, prick test and particularly atopy patch test for Malassezia antigens could receive combined treatment with antimycotic-containing shampoos and/or short-term systemic antimycotic therapy in severe cases.     

Local treatment of psoriasis with desoxymethasone and betamethasone 17,21-dipropionate: a double-blind comparison

Summary

A double-blind comparison of the effectiveness of 0.25 % desoxymethasone and 0.05 % betamethasone 17, 21-dipropionate creams was carried out in 40 patients with symmetrical, chronic psoriatic lesions. The lesions were pre-treated for 1 week with an inactive cream base and then the trial preparations were applied, without occlusion, to one or other side at random twice daily for 21 days. Overall response to treatment and the effect of the two topical steroids on scaling, induration, erythema, and pruritus were assessed at the start of and 4, 7,14, and 21 days after the start of active treatment. The results indicated a better but not statistically significant response to desoxymethasone. By the end of the trial period, the desoxymethasone-treated side was better in 22.5% of cases compared with 10% of cases in the betamethasone dipropionate-treatedside. No side-effects of treatment were observed.     

Plasma concentrations of betamethasone after topical application of betamethasone 17-valerate: comparison with oral administration.

Plasma concentrations of betamethasone were measured by r.i.a. after oral administration of 0.6 mg betamethasone and topical application of betamethasone 17-valerate in the same five healthy subjects. Betamethasone 17-valerate was prepared as a suspension in medical grade pressure sensitive adhesive and applied to a 100 cm2 area on the back for 28 h. Mean maximum plasma concentrations were 5.0 and 0.24 ng ml-1 and mean AUC values were 75.4 and 7.74 ng ml-1 h after oral and topical administrations, respectively. The mean plasma elimination half-life of betamethasone after the removal of topical betamethasone 17-valerate was 16.6 h which was twice that after oral administration, 8.1 h. Betamethasone 17-valerate may require application to the skin more than twice daily.     

他克莫司软膏治疗光敏性皮肤病的临床观察

目的 研究并探讨他克莫司软膏治疗光敏性皮肤病的临床疗效.方法 选取2014年1月至2016年6月期间本院收治的90例光敏性皮肤病患者作为研究对象,采取计算机数字随机序列法将患者分为两组,每组45例.对照组患者采用喜辽妥软膏外涂,观察组患者采用他克莫司软膏外涂,比较两组患者的临床总有效率、皮肤瘙痒评分、皮损评分、生活质量评分、不良反应发生情况.结果 观察组患者治疗2周后、治疗4周后的临床总有效率分别为82.22％、95.56％,对照组分别为60.00％、80.00％,两组比较差异均有统计学意义(均P＜ 0.05).治疗4周后,两组患者的皮肤瘙痒评分、皮损评分、生活质量评分均较治疗前明显降低(P＜0.05);观察组患者治疗4周后的皮肤瘙痒评分、皮损评分、生活质量评分较对照组更低(P＜0.05).在治疗过程中,观察组患者的不良反应发生率为8.89％,对照组为6.67％,两组比较差异无统计学意义(P＞0.05).结论 采用他克莫司软膏外涂治疗光敏性皮肤病具有显著的临床疗效,可有效缓解患者的皮肤瘙痒、皮损等症状,改善患者的生活质量,且不良反应较少.     

Doxepin cream for eczema?

One of the more disruptive symptoms of eczema is itching. Traditionally, it is treated with emollients, topical corticosteroids or oral antihistamines. A topical form of the antidepressant doxepin (doxepin 5% cream; Xepin-Bioglan) is now marketed for "the relief of pruritus associated with eczema" in adults and children aged over 12 years. Here, we review the efficacy and safety of this product and assess its role in the management of eczema.