Topical steroids for chronic rhinosinusitis without nasal polyps: A systematic review and meta-analysis.

BACKGROUND: Evidence supporting topical steroids for the treatment of chronic rhinosinusitis without nasal polyposis (CRSsNP) is unclear. Recent trials describe alternative topical steroid delivery modalities, including rinses and exhalation delivery system (EDS), necessitating a re-examination of the current literature. METHODS: Cochrane Library, CINAHL, PubMed, and Scopus databases were searched from inception to February 13, 2024 for placebo-controlled randomized control trials on topical steroids used to treat CRSsNP, including topical spray, nasal irrigation, sinonasal catheter, and EDS modalities. Primary outcome measures included total symptom scores (TSS) (Δ) and response rates (odds ratio). RESULTS: Ten trials (N = 751) were included for meta-analysis, with a mean age of 47.5 years (range: 18-80 years; 95% confidence interval [CI]: 43.9-51.2 years). Topical steroids delivered by any method significantly improved TSS in CRSsNP patients (Δ0.4; 95% CI: 0.3-0.6; p < 0.0001). When stratified by allergy status, CRSsNP patients without allergy had significantly improved TSS when treated with EDS (Δ0.4; 95% CI: 0.1-0.7; p = 0.01), but not with topical spray (Δ0.04; 95% CI: -0.9 to 1.0; p = 0.94). Patients treated with EDS or sinonasal catheter responded significantly better compared to placebo (odds ratio [OR]: 3.4; 95% CI: 1.9-6.0; p < 0.0001; OR: 12.4; 95% CI: 1.8-83.8; p < 0.01), whereas patients treated with topical spray had no significant difference (OR: 1.8; 95% CI: 0.9-4.0; p = 0.12). CONCLUSIONS: Topical steroids are effective in treating CRSsNP, especially when delivered via EDS or sinonasal catheter. Future trials comparing steroid delivery mechanisms using validated outcome measures in CRSsNP populations are needed.

Clinical Outcomes of Topical Bevacizumab for the Treatment of Corneal Neovascularization.

Background and objective In corneal neovascularization, the peri-corneal vascular structure grows into a normally avascular cornea. This is due to an imbalance between the angiogenic and anti-angiogenic factors that sustain corneal transparency. There are various etiologies of this condition, and they can be divided into infective or non-infective causes, such as inflammation, trauma, or surgical causes. Corneal neovascularization has been shown to improve with the current treatments using steroids and anti-vascular endothelial growth factors. This study aimed to evaluate the effectiveness of topical bevacizumab as an anti-angiogenic agent in patients with corneal neovascularization. Methods This retrospective study included patients who suffered corneal neovascularization of various etiologies and completed six months of topical bevacizumab therapy between 2020 and 2022 at the Universiti Kebangsaan Malaysia Medical Centre. Results A total of 16 patients received treatment with topical bevacizumab over the three-year study period. Based on specified inclusion and exclusion criteria, 12 patients were eligible for inclusion in this study. Eight patients (66%) showed improvement in terms of either 'clock hours' of improvement, morphology, or regression of corneal neovascularization. All infective causes of corneal neovascularization showed improvement on completion of bevacizumab compared to other causes. Conclusion Topical bevacizumab can be one of the treatment choices for corneal neovascularization. As the outcome varies depending on the severity and chronicity of the condition, the attending ophthalmologist should treat each case differently. Although topical bevacizumab is more effective in mild and moderate cases, the indications for its use in chronic cases remain debatable as the results are unfavorable in such cases.

The Efficacy and Safety of Standard versus Soft Topical Steroids after Cataract Surgery: A Systematic Review and Meta-analysis.

TOPIC: Review of the efficacy and safety of standard versus soft topical steroid application after cataract surgery. CLINICAL RELEVANCE: The control of postoperative inflammation is the mainstay of treatment after cataract surgery. However, no consensus exists regarding the postoperative steroid of choice. Basing the choice of topical postoperative steroidal treatment on high-quality data regarding both risks and benefits of various drugs would be advantageous for both patients and clinicians. METHODS: A systematic search of the PubMed, Scopus, and Embase electronic databases for all peer-reviewed published randomized control trials that included clinical outcomes of topical steroidal treatment after uneventful cataract surgery was performed. Individual study data were extracted and evaluated in a weighted pooled analysis including grading of total anterior chamber (AC) inflammation, AC cells, AC flare, postoperative visual acuity (VA), intraocular pressure (IOP), and rate of adverse events (AEs). RESULTS: Overall, 508 studies were found, of which 7 were eligible for the systematic review and ultimately were included for analysis, reporting on 593 patients from 5 countries. Age of included patients, when available, ranged between 3.7 and 73.4 years. Follow-up data were available for analysis at 1, 7, and 28 days after surgery. Except for a significantly lower grade of AC flare in the standard steroid group at day 7 (standardized mean difference, 0.26; 95% confidence interval, 0.05-0.47; I2 = 0%), inflammatory activity measurements displayed insignificant differences at every other follow-up (days 1 and 28 after surgery). Pooled analysis of IOP at each follow-up demonstrated a higher IOP at the 7-day visit in the standard steroid group, whereas IOP at other time points was comparable among the groups. Qualitative analysis of ocular AEs showed similarities among the groups. DISCUSSION: The findings of this study suggest that for the average patient, both groups produce a comparable effect on both AC inflammation and postoperative IOP and VA. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

[Genital lichen sclerosus and lichen planus]. / Genitaler Lichen sclerosus und Lichen planus.

Lichen sclerosus (LS) and lichen planus (LP) are chronic inflammatory dermatoses of unknown aetiology. They pose the most important differential diagnoses of inflammatory dermatoses in the genital area. There is often a delay in diagnosing LS and LP and subsequently treatment is initiated late in the course of the disease, which will lead to scarring and a decreased quality of life. There is an increased risk of the development of malignancies in the genital area in both diseases; however, early and continuous treatment with potent topical steroids will decrease this risk.

Awareness and Knowledge of Adverse Effects of Topical Corticosteroids Among the General Population in Jeddah, Saudi Arabia.

Purpose: Corticosteroids are naturally produced in the adrenal cortex and regulate a variety of physiological processes, including but not limited to, stress homeostasis, metabolism, and inflammation. As synthetic steroids exert the same effects as natural steroids, they are used in the treatment of various skin conditions. Synthetic steroids are delivered in a variety of forms, such as topical preparations, oral preparations, and injections. Topical steroids are one of the most commonly prescribed medications in dermatology clinics. Although topical steroids were thought to provide maximum benefit with no side effects, many side effects have been reported by topical corticosteroid users. Therefore, this study examined awareness and knowledge regarding topical steroids among the general population in Jeddah, Saudi Arabia. Methodology: This was a cross-sectional study involving 426 subjects in Jeddah, Saudi Arabia. Subjects completed a self-administered questionnaire, and data were collected from February to April 2023. The questionnaire assessed age, sex, education level, occupation, and general knowledge regarding the side effects of topical steroids. Results: The study cohort was predominantly female (77%). Half of the participants were aged 21-39 years. Most of the subjects (70%) were steroid users, and the most common reported indication for steroid use was undetermined (37.6%). Nearly half of the participants did not know whether steroids were dangerous, and 59.4% did not know that topical steroids can cause systemic effects. Conclusion: This study assesses knowledge regarding topical steroids among the general population in the western region of Saudi Arabia. The results revealed a lack of knowledge regarding the side effects of topical steroids. Awareness of potential topical steroid side effects should be increased among the general population to minimize the occurrence of serious side effects.

A Practical Update on Pediatric Eosinophilic Esophagitis.

Eosinophilic esophagitis (EoE) is an emerging atopic disease of unknown etiology limited to the esophagus. The pathogenesis is still understood and is likely characterized by type 2 inflammation. Food allergens are the primary triggers of EoE that stimulate inflammatory cells through an impaired esophageal barrier. In children and adolescents, clinical presentation varies with age and mainly includes food refusal, recurrent vomiting, failure to thrive, abdominal/epigastric pain, dysphagia, and food impaction. Upper-gastrointestinal endoscopy is the gold standard for diagnosing and monitoring EoE. EoE therapy aims to achieve clinical, endoscopic, and histological ("deep") remission; prevent esophageal fibrosis; and improve quality of life. In pediatrics, the cornerstones of therapy are proton pump inhibitors, topical steroids (swallowed fluticasone and viscous budesonide), and food elimination diets. In recent years, much progress has been made in understanding EoE pathogenesis, characterizing the clinical and molecular heterogeneity, and identifying new therapeutic approaches. Notably, clinical, molecular, endoscopic, and histological features reflect and influence the evolution of inflammation over time and the response to currently available treatments. Therefore, different EoE phenotypes and endotypes have recently been recognized. Dupilumab recently was approved by FDA and EMA as the first biological therapy for adolescents (≥12 years) and adults with active EoE, but other biologics are still under consideration. Due to its chronic course, EoE management requires long-term therapy, a multidisciplinary approach, and regular follow-ups.

Comparing the Effectiveness of Low-Level Laser Therapy and Topical Steroid Therapy Combination Regimen With Routine Topical Steroid Therapy in the Management of Oral Lichen Planus Symptomatic Patients.

BACKGROUND: For symptomatic oral lichen planus (OLP), a wide range of therapeutic approaches have been suggested. To minimize discomfort and symptoms among individuals with symptomatic OLP, extensive therapy is frequently needed. Therefore, finding a new therapeutic approach that may effectively manage OLP's symptoms and signs while having few adverse effects continues to be a difficult task. Recently, low-level laser therapy (LLLT) has become a popular alternative therapy option for OLP with no serious side effects. AIM: The present research was designed to compare the effectiveness of a combination regimen of LLLT in addition to topical steroids with routine topical steroid therapy separately in order to manage patients with bothersome OLP with an extended period of follow-up. MATERIALS AND METHODS: In our trial, 60 patients were chosen and given sequential numbers as they signed up to take part. The participants were divided randomly into two categories: category A (LLLT plus topical steroids) and category B (only topical steroids). The data were entered into the aforementioned prepared case template after receiving informed consent. The aforementioned prepared case template included the following criteria for evaluating the result of the treatment: pain, recurrence, burning sensation, clinical remission, and size of the lesion. Applying the visual analog scale (VAS), pain, as well as burning sensations, were assessed in both categories. With the aid of the Electronic Digital Vernier Caliper (Mitutoyo, China), these individuals were assessed for the dimension of the lesion. RESULTS: The pain score on day 21 of intervention in category A was 2.5, while it was 4.63 in category B. The difference in findings was significant statistically at day 21 (p = 0.0032). The pain score on day 28 of intervention in category A was 1.3, while it was 3.0 in category B. The difference in findings was significant statistically at day 28 (p = 0.003). The pain score was greater in the control category as compared to the intervention category. The burning sensation score on day 21 of intervention in category A was 2.5, while it was 4.5 in category B. The difference in findings was significant statistically (p = 0.0024). The burning sensation score at the follow-up phase on day 45 of intervention in category A was 1.1, while it was 3.4 in category B. The difference in findings was significant statistically (p = 0.002). CONCLUSION: Newer therapeutic techniques are becoming accessible to oral specialists for controlling oral mucosal disorders as a result of evolving dental trends. The gold standard for treating people with symptomatic OLP continues to be topical corticosteroids. The therapeutic advantages of topical corticosteroids, however, are considerably outweighed by their complementary effect when paired with newer treatment methods like LLLT.

A Single-Center Retrospective Study of Pediatric Vitiligo in a Tertiary Hospital.

Vitiligo is a common disorder; however, its management is unknown by many primary-care doctors and pediatricians. Most articles focus on adults; we analyze the characteristics and impact on children. A single-center retrospective study was conducted over 10 years on 254 children diagnosed with vitiligo. About 50.4% were male with a mean age of 8.24 years. There was a slight predominance of nonsegmented vitiligo. About 12.59% had family history of vitiligo and 11.4% of autoimmune diseases. Around 15.7% patients presented other dermatological diseases and 9.05%, autoimmune diseases. No significant statistical differences were found when comparing age, sex, and type of vitiligo with other variables. Almost 96.06% received treatment with calcineurin inhibitors and 66.53% topical steroids. Around 77% obtained repigmentation, and out of the initial nonresponders, 16% responded to phototherapy. In general, our results concur with the scarce literature. A long-term follow-up of children with vitiligo is needed to identify treatment side effects and diseases associated.

Assessment of Visual Acuity Outcomes in Ocular Syphilis Treated With Adjunctive Topical or Oral Steroids.

PURPOSE: There is no consensus surrounding adjunctive steroid use in the treatment of ocular syphilis. We evaluated clinical outcomes of patients with ocular syphilis who were treated with penicillin plus either topical or oral steroids. METHODS: Nine male patients aged 26 to 72 years with a diagnosis of ocular syphilis were retrospectively identified (18 eyes). All patients were treated with penicillin and adjunctive topical or oral steroids. Visual acuity reported as the logarithm of the minimum angle of resolution (logMAR) and slit lamp findings were documented at presentation, short-term follow-up (<7 days after initiating therapy), and long-term follow-up (day 7+). Visual acuity outcomes were compared between eyes treated with topical versus oral steroids as well as eyes treated simultaneously with adjunctive steroids and penicillin versus patients treated with steroids after penicillin. RESULTS: At short-term follow-up, the mean logMAR (SD, Snellen fraction) visual acuity for eyes treated with topical steroids 0.93 (0.53, 20/170) was significantly lower than that for the oral steroid group 0.23 (0.09, 20/110; p=0.0075). Similarly, at long-term follow-up, the topical steroid group had a significantly lower visual acuity of 0.75 (20/112) compared to a visual acuity of 0.07 (20/25) for the oral steroid group (p=0.0022). Moreover, the oral steroid group displayed significant improvement in visual acuity at long-term follow-up compared to baseline while the topical steroid group did not demonstrate the same effect (p=0.0406 and p=0.5945, respectively). Initiation of steroid treatment simultaneously with penicillin did not result in better visual acuity than delayed steroid treatment (p>0.05). CONCLUSIONS: Steroids are an effective adjunctive treatment for patients with ocular syphilis. Oral steroids may be superior to topical steroids for improving visual function, especially in patients with a severe inflammatory component. Patients treated with oral or topical steroids and penicillin simultaneously did not demonstrate better visual acuity outcomes than patients treated with oral or topical steroids after penicillin was initiated.

A very early steroid responder after cataract surgery: a case report.

BACKGROUND: Increased intraocular pressure (IOP), a side effect of corticosteroid eye drops, typically develops during the first few weeks of administration, and steroid response is not generally considered a cause of increased IOP immediately after cataract surgery. CASE PRESENTATION: Here, I report a rare case of increased IOP due to steroid eye drops immediately after surgery. A man in his 80s presented with vision loss. Bilateral cataracts and pseudoexfoliation syndrome were confirmed. Postoperative eye drops including steroid eye drops were started immediately after cataract surgery in the right eye. High IOP was observed at the next and subsequent morning visits, but IOP normalized when steroid eye drops were discontinued. After surgery on the left eye, steroids were not administered postoperatively, and no increase in IOP was observed. CONCLUSION: This case report highlights that a very early steroid response may be potential cause of elevated IOP immediately after cataract surgery.

Scleritis and Episcleritis following Coronavirus Disease (COVID-19) Vaccination.

INTRODUCTION: Coronavirus disease (COVID-19) vaccines have been reported to have ocular side effects including scleritis and episcleritis. PURPOSE: To report scleritis and episcleritis within a month following administration of COVID-19 vaccine. METHODS: Retrospective case series. RESULTS: 15 eyes of 12 consecutive patients with scleritis and episcleritis from March 2021 to September 2021 were included. The mean time of onset of symptoms in patients with scleritis was 15.7 days (range, 4-30) and for episcleritis it was 13.2 days (range 2-30). Patients received COVISHIELD™ (10 patients) and COVAXIN™ (2 patients). Five patients had denovo inflammation and seven had recurrent inflammation. Episcleritis patients were treated with topical steroids and systemic COX2 inhibitors while patients with scleritis were treated with topical steroids/oral steroids/antiviral medications depending on the aetiology. CONCLUSION: Scleritis and episcleritis following COVID-19 vaccination are milder and do not require intensive immunosuppression except in rare cases.

Efficacy and safety of topical 0.1% cannabidiol for managing recurrent aphthous ulcers: a randomized controlled trial.

BACKGROUND: Although topical steroids constitute the first-line therapy for recurrent aphthous ulcers (RAUs), their long-term use often leads to candidiasis. Although cannabidiol (CBD) can be an alternative for pharmacologically managing RAUs due to its analgesic and anti-inflammatory in vivo effects, there is a lack of clinical and safety trials concerning its use. The aim of this study was to evaluate the clinical safety and efficacy of topical 0.1% CBD for managing RAU. METHODS: A CBD patch test was performed on 100 healthy subjects. CBD was applied on the normal oral mucosa of 50 healthy subjects 3 times/day for 7 days. Oral examination, vital signs, and blood tests were performed pre- and post-CBD use. Another 69 RAU subjects randomly received one of three topical interventions: 0.1% CBD, 0.1% triamcinolone acetonide (TA), or placebo. These were applied on the ulcers 3 times/day for 7 days. The ulcer and erythematous size were measured on day 0, 2, 5, and 7. Pain ratings were recorded daily. The subjects rated their satisfaction with the intervention and completed a quality-of-life questionnaire (OHIP-14). RESULTS: None of the subjects exhibited allergic reactions or side effects. Their vital signs and blood parameters were stable before and after the 7-day CBD intervention. CBD and TA significantly reduced ulcer size more than placebo at all time points. The erythematous size reduction was higher in the CBD intervention than the placebo on day 2, while TA reduced the erythematous size at all time points. The pain score in the CBD group was lower compared with placebo on day 5, whereas TA reduced pain more than placebo on day 4, 5, and 7. The subjects receiving CBD reported higher satisfaction than placebo. However, the OHIP-14 scores were comparable among the interventions. CONCLUSIONS: Topical 0.1% CBD reduced ulcer size and accelerated ulcer healing without side effects. CBD exerted anti-inflammatory effects in the early stage and an analgesic effect in the late RAU stage. Thus, topical 0.1% CBD might be more appropriate for RAU patients who decline to take topical steroids, except for cases where CBD is contraindicated. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR) Number TCTR20220802004. Retrospectively registered on 02/08/2022.

Extensive severe intraorbital arteriovenous malformations: report of a rare laser complication and successful management.

Arteriovenous malformations (AVMs) are rare congenital errors of vascular morphogenesis, characterised by abnormal direct communications between arteries and veins, bypassing the normal capillary bed. Apart from the central nervous system, typical locations include the head and neck, and less frequently limbs, trunk or internal organs. AVMs of the head and neck often become clinically evident and symptomatic only in later childhood and are characterised by a history of variable growth, sometimes leading to large, deforming, pulsating masses with a propensity to massive haemorrhage. Therapeutic strategy is based on selective embolisation, surgical excision, or a combination of both. Radical surgical excision of local AVMs is the only effective treatment but it may be mutilating, especially for AVMs of the head and neck. Laser therapy represents a good option to treat the cutaneous aspects of AVMs nevertheless, its efficacy is limited. To the date, pharmacological therapy for AVMs is still on debate due to its controversial outcomes as it seems not as effective as other treatments and usually requires a longer course of application. However, pharmacological therapy could be useful in selected patients and for AVMs nonresponsive to traditional treatment, allowing them to obtain acceptable results without serious complications. This paper reports the case of a serious laser complication of extensive intraorbital AVM successfully treated by local reconstruction and topical pharmacological treatment.

The effect of topical steroids and non-steroidal anti inflammatory drugs on epiphora of unknown cause: Optical coherence tomography study.

PURPOSE: The aim of this study is to evaluate using topical non-steroidal antiinflammatory and low-potency steroid drugs for the treatment of epiphora without an underlying cause using anterior segment-optical coherence tomography (AS-OCT) and Munk epiphora grading system. METHODS: Thirty patients with epiphora who had no underlying cause were evaluated prospectively.A detailed ophthalmological examination, tear meniscus height on slit-lamp, fluorescein tear break-up time, schirmer test, lisamin green conjonctival staining, lacrimal syringing of the upper and lower canaliculus were done in all patients. The patients with contact lens wear,punctal stenosis, lacrimal system disorders, dry eye disease, eyelid malpositions, pterygium, conjunctivochalasis, conjunctivitis, blepharitis, ocular infection, and corneal disease, used topical anti-glaucomatous drugs were excluded. All patients were treated with a combination of topical low-potency drug (loteprednol etabonate 0.5%) twice daily for ten days and topical non-steroidal anti-inflammatory drug (nepafenac 0.3%)once a day for 1 month. Before and after the medical treatment protocol, tear meniscus area (TMA) and tear meniscus height (TMH) were measured by AS-OCT and patients were asked to subjectively rate their epiphora according to the Munk epiphora grading system. The effectiveness of treatment were evaluated by AS-OCT measurements and the Munk epiphora grading system. RESULTS: Fourteen males and sixteen females were included. The mean age at presentation was 60.1 ± 7.35 years and duration of symptoms was 10.03 ± 5.08 months. The mean duration of follow-up was 8.7 ± 3.2 months. Munk epiphora grading system was significantly decreased from 2.5 to 1.6 after treatment (p: 0.004). TMH and TMA were significantly decreased on AS-OCT (TMH:402 vs 309 µm, p:0.001, TMA:0.797 vs 0.347 mm2, p = 0.006).Six of thirty patients subjectively reported that their symptoms had not improved but TMH and TMA were significantly decreased on AS-OCT. CONCLUSIONS: The combined use of topical non-steroidal anti-inflammatory and low-potency steroid drops may be a good option in patients with epiphora who does not have an underlying cause.

Higher Body Mass Index Is Associated With Decreased Treatment Response to Topical Steroids in Eosinophilic Esophagitis.

BACKGROUND & AIMS: Understanding which eosinophilic esophagitis (EoE) patients will respond to treatment with topical corticosteroids (tCS) remains challenging, and it is unknown whether obesity impacts treatment response. This study aimed to determine whether treatment outcomes to tCS in EoE patients vary by body mass index (BMI). METHODS: This retrospective cohort study of the University of North Carolina EoE Clinicopathologic database assessed subjects age 14 years or older with a new diagnosis of EoE. Their BMI was calculated and histologic, symptom, and endoscopic responses were recorded after tCS treatment. The treatment response of obese (BMI, ≥30 kg/m2) and nonobese EoE status was compared using bivariate and multivariate analyses. RESULTS: We identified 296 EoE patients treated with tCS. Baseline characteristics were similar, although obese EoE patients had more heartburn and hiatal hernias. Histologic response was higher for those who were nonobese compared with obese at fewer than 15 (61% vs 47%; P = .049) and 6 or fewer (54% vs 38%; P = .02) eosinophils per high-power field, respectively. In addition, nonobese patients had significantly greater endoscopic and symptomatic responses. On multivariate analysis, increasing BMI was associated independently with decreased histologic response after accounting for age, heartburn, dilation, and hiatal hernia whether BMI was assessed as a continuous variable (adjusted odds ratio [aOR], 0.93; 95% CI, 0.89-0.98), as nonobese vs obese (aOR, 0.38; 95% CI, 0.21-0.68), or in 4 categories (overweight vs normal [aOR, 0.46; 95% CI, 0.26-0.84] or obese vs normal [aOR, 0.26; 95% CI, 0.13-0.51]). CONCLUSIONS: As BMI increases in EoE patients, the odds of histologic, symptomatic, and endoscopic responses to tCS decreases, with obese patients having an approximately 40% decrease in odds of response.

Which first-line treatment for cutaneous sarcoidosis? A retrospective study of 120 patients.

Sarcoidosis is a systemic disease that affects the skin in about 25% of patients. The treatment of cutaneous sarcoidosis is guided by the extent of lesions, associated symptoms and organ involvement. To evaluate rates of response to various potential first-line treatments for cutaneous sarcoidosis during the year following treatment initiation. This retrospective multicentre study included 120 patients with cutaneous sarcoidosis. Treatment response was assessed retrospectively from the patients' medical records. Univariate logistic regression analysis, with an estimation of unadjusted odds ratios (OR) and their 95% CI ,was performed to identify factors associated with complete cutaneous remission (CR), followed by multivariate logistic regression analysis. At one year, 43 of the 120 (36%) included patients had CR. The best response rates were obtained with oral corticosteroids (12/21, 57%), followed by a combination of hydroxychloroquine and topical steroids (6/13, 46%). In multivariate analysis, lupus pernio was the only predictor of a poor cutaneous response. We suggest the use of a combination of hydroxychloroquine and topical steroids as an optimal first-line treatment for cutaneous sarcoidosis, given the known adverse effects of systemic corticosteroids.