RESUMO
BACKGROUND: Facial seborrheic dermatitis (SD), a chronic inflammatory skin condition, can impact quality of life, and relapses can be frequent. Three broad categories of agents are used to treat SD: antifungal agents, keratolytics, and corticosteroids. Topical therapies are the first line of defense in treating this condition. OBJECTIVE: Our objective was to critically review the published literature on topical treatments for facial SD. METHODS: We searched PubMed, Scopus, Clinicaltrials.gov, MEDLINE, Embase, and Cochrane library databases for original clinical studies evaluating topical treatments for SD. We then conducted both a critical analysis of the selected studies by grading the evidence and a qualitative comparison of results among and within studies. RESULTS: A total of 32 studies were eligible for inclusion, encompassing 18 topical treatments for facial SD. Pimecrolimus, the focus of seven of the 32 eligible studies, was the most commonly studied topical treatment. CONCLUSION: Promiseb®, desonide, mometasone furoate, and pimecrolimus were found to be effective topical treatments for facial SD, as they had the lowest recurrence rate, highest clearance rate, and the lowest severity scores (e.g., erythema, scaling, and pruritus), respectively. Ciclopirox olamine, ketoconazole, lithium (gluconate and succinate), and tacrolimus are also strongly recommended (level A recommendations) topical treatments for facial SD, as they are consistently effective across high-quality trials (randomized controlled trials).
Assuntos
Anti-Inflamatórios/uso terapêutico , Antifúngicos/uso terapêutico , Dermatite Seborreica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Dermatoses Faciais/tratamento farmacológico , Administração Cutânea , Anti-Inflamatórios/efeitos adversos , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Inibidores de Calcineurina/administração & dosagem , Inibidores de Calcineurina/efeitos adversos , Inibidores de Calcineurina/uso terapêutico , Ciclopirox , Dermatite Seborreica/microbiologia , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversos , Desonida/administração & dosagem , Desonida/efeitos adversos , Desonida/uso terapêutico , Dermatoses Faciais/microbiologia , Humanos , Cetoconazol/administração & dosagem , Cetoconazol/efeitos adversos , Cetoconazol/uso terapêutico , Malassezia/efeitos dos fármacos , Furoato de Mometasona/administração & dosagem , Furoato de Mometasona/efeitos adversos , Furoato de Mometasona/uso terapêutico , Preparações de Plantas/administração & dosagem , Preparações de Plantas/efeitos adversos , Preparações de Plantas/uso terapêutico , Guias de Prática Clínica como Assunto , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Piridonas/uso terapêutico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Tacrolimo/administração & dosagem , Tacrolimo/efeitos adversos , Tacrolimo/análogos & derivados , Tacrolimo/uso terapêutico , Resultado do Tratamento , Vitaminas/administração & dosagem , Vitaminas/efeitos adversos , Vitaminas/uso terapêuticoRESUMO
Topical steroids are used for the treatment of primary atopic dermatitis (AD); however, their associated risk of serious complications is great due to the presence of vulnerable lesions in young children with AD. Topical calcineurin inhibitors (TCIs) are steroid-free, anti-inflammatory agents used for topical AD therapy. However, their use is prohibited in infants <2 years of age because of their carcinogenic potential. We conducted a randomized, double-blind trial to evaluate the efficacy of TCIs as a secondary AD treatment for children <2 years of age by comparing 1% pimecrolimus cream with 0.05% desonide cream. We performed urinary metabolomics to predict long-term side effects. The 1% pimecrolimus cream displayed similar efficacy and exceptional safety compared with the 0.05% desonide cream. Metabolomics-based long-term toxicity tests effectively predicted long-term side effects using short-term clinical models. This applicable method for the functional interpretation of metabolomics data sets the foundation for future studies involving the prediction of the toxicity and systemic reactions caused by long-term medication administration.
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Dermatite Atópica , Desonida/administração & dosagem , Metabolômica , Creme para a Pele/administração & dosagem , Tacrolimo/análogos & derivados , Anti-Inflamatórios não Esteroides/efeitos adversos , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/urina , Desonida/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Creme para a Pele/efeitos adversos , Tacrolimo/administração & dosagem , Tacrolimo/efeitos adversos , Fatores de TempoAssuntos
Anti-Inflamatórios/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Desonida/uso terapêutico , Administração Cutânea , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Dermatite Atópica/epidemiologia , Dermatite Atópica/patologia , Desonida/administração & dosagem , Desonida/efeitos adversos , Humanos , Hidrogéis , Adesão à Medicação , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Desonide 0.05% was recently developed in an emulsion foam formulation. OBJECTIVE: The safety of desonide foam 0.05% in children aged 3 months to 17 years was evaluated in two phase II studies and one phase III study. METHODS: A phase II open-label study of the effect of desonide foam 0.05% on the hypothalamic-pituitary-adrenal axis was evaluated in pediatric and adolescent participants with mild-to-moderate atopic dermatitis. The phase II and III clinical efficacy studies evaluated adverse events. RESULTS: At the end of the 4-week treatment in the phase II study, 4% (3 of 75) of participants experienced mild, reversible hypothalamic-pituitary-adrenal-axis suppression. The combined safety data from the phase II and III studies revealed 6% of participants in the desonide foam group and 14% in the vehicle foam group reported adverse events (P = .0002), with application site burning as the most commonly reported adverse event (3% in the desonide foam group vs 7% in the vehicle foam group; P = .004). LIMITATIONS: The studies evaluated short-term use only. CONCLUSION: Desonide foam was safe and well tolerated in participants as young as 3 months.
Assuntos
Anti-Inflamatórios/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Desonida/administração & dosagem , Administração Cutânea , Adolescente , Anti-Inflamatórios/efeitos adversos , Criança , Pré-Escolar , Dermatite Atópica/patologia , Desonida/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Lactente , Masculino , Sistema Hipófise-Suprarrenal/efeitos dos fármacos , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: Desonide is a low-potency topical corticosteroid that has been used for decades in the treatment of steroid-responsive dermatoses. The favorable safety profile of this topical agent makes it ideal for patients of all ages. OBJECTIVE: This article provides a review of desonide's history, pharmacodynamic properties, vehicle technology, efficacy and safety. METHODS: Randomized controlled trials, as well as open-label and non-comparative studies, case series and reports, experimental models, and data from the Galderma pharmacovigiliance program were reviewed in order to address the clinical efficacy and safety of desonide. RESULTS/CONCLUSION: Clinical efficacy and safety have been proven in multiple clinical trials. In addition to cream, lotion and ointment formulations, the recently developed hydrogel and foam preparations have increased desonide's versatility and patient tolerability.
Assuntos
Desonida/administração & dosagem , Desonida/uso terapêutico , Química Farmacêutica , Desonida/efeitos adversos , Desonida/farmacocinética , Formas de Dosagem , HumanosRESUMO
Desonide foam is a newly approved topical corticosteroid preparation of 0.05% desonide. It has been shown effective compared with vehicle placebo in the treatment of mild-to-moderate atopic dermatitis in both pediatric and adult populations. Given the favorable safety profile of all other desonide preparations and their utility as a low potency corticosteroid, desonide foam promises to be a useful addition to the armamentarium, when other desonide vehicles might be less acceptable.
Assuntos
Corticosteroides , Anti-Inflamatórios , Dermatite Atópica/tratamento farmacológico , Desonida , Administração Tópica , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Corticosteroides/farmacologia , Corticosteroides/uso terapêutico , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Criança , Desonida/administração & dosagem , Desonida/efeitos adversos , Desonida/farmacologia , Desonida/uso terapêutico , Humanos , Veículos FarmacêuticosAssuntos
Dermatite Atópica/tratamento farmacológico , Desonida/administração & dosagem , Glucocorticoides/administração & dosagem , Adolescente , Insuficiência Adrenal/induzido quimicamente , Criança , Pré-Escolar , Desonida/efeitos adversos , Géis , Glucocorticoides/efeitos adversos , Humanos , LactenteRESUMO
Desonide (as a cream, ointment, or lotion formulation) is widely used for the treatment of steroid-responsive dermatoses. This paper provides information on its safety record, as determined from adverse event reports and published trial results. A pharmacovigilance program, initiated in 1992 for all countries where desonide is available, collected reports of adverse events associated with topical desonide over nine years. Published accounts of randomized, controlled trials of desonide in comparison with hydrocortisone were reviewed. Sixty-two reports have been collected; most were from consumers and were not medically substantiated. There were no serious reactions directly attributable to desonide treatment and the majority of events reported were classified as expected local reactions, generally mild in nature. This level of reporting is against a background of extensive prescribing of desonide; almost one million packs are dispensed per annum in the US alone. The excellent safety profile of desonide revealed by this pharmacovigilance program is supported by a review of published clinical trial results.
Assuntos
Anti-Inflamatórios/efeitos adversos , Dermatite/tratamento farmacológico , Desonida/efeitos adversos , Administração Cutânea , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Criança , Ensaios Clínicos como Assunto , Dermatite Seborreica/tratamento farmacológico , Desonida/administração & dosagem , Desonida/uso terapêutico , Hipersensibilidade a Drogas/etiologia , Eritema/induzido quimicamente , Oftalmopatias/induzido quimicamente , Humanos , Pomadas , Vigilância de Produtos Comercializados , Ensaios Clínicos Controlados Aleatórios como Assunto , Pele/efeitos dos fármacosAssuntos
Budesonida/efeitos adversos , Reações Cruzadas/imunologia , Dermatite Alérgica de Contato/diagnóstico , Desonida/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Administração Tópica , Adulto , Idoso , Budesonida/farmacologia , Estudos de Coortes , Dermatite Alérgica de Contato/etiologia , Desonida/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes do Emplastro/métodos , Sensibilidade e EspecificidadeRESUMO
The differences between topical corticosteroids are based mainly on their potency, safety and patient acceptability. The aim of this study was to evaluate a mild- to mid-potent topical corticosteroid, desonide 0.05%, on these three parameters in an Australian cohort of patients with facial seborrhoeic or atopic dermatitis. Eighty-one adult patients were randomized to receive desonide 0.05% lotion or its vehicle, applied twice daily for 3 weeks under double-blind conditions. In the active treatment group, 88% of patients had their skin condition cleared or almost cleared and only two patients experienced cutaneous adverse events (rash and pruritus). The acceptability of the lotion was high; 95% of patients stated they would use this topical corticosteroid again. These data support the short-term use of desonide 0.05% lotion as a suitable agent for the short-term treatment of facial dermatitis.
Assuntos
Anti-Inflamatórios/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Dermatite Seborreica/tratamento farmacológico , Desonida/uso terapêutico , Administração Tópica , Adolescente , Adulto , Anti-Inflamatórios/efeitos adversos , Austrália , Dermatite Atópica/diagnóstico , Dermatite Seborreica/diagnóstico , Desonida/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Emulsões , Estética , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/tratamento farmacológico , Feminino , Seguimentos , Glucocorticoides , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade , Valores de Referência , Resultado do TratamentoRESUMO
OBJECTIVE: Systemic side effects of local corticosteroid therapy may occur when treating chronic inflammatory dermatoses in children. We compared the effect of micronized desonide cream 0.1 p.100 versus betamethasone dipropionate cream 0.5 p.100. PATIENTS AND METHODS: A randomized double-blind trial was conducted to assess the efficacy of micronized desonide cream 0.1 p.100 (group 1) versus bethamethasone cream dipropionate 0.05 p.100 (group 2) in children treated for atopic dermatitis and to compare their effects on serum cortisol levels 8 hours after administration. Twenty-nine patients, mean age 13.8 months were included (15 in group 1 and 14 in group 2). The creams were applied twice a day from day 1 to 5 then once a day from day 6 to 7 and finally once every two days to day 15. RESULTS: The two treatments were effective with a decrease in body surface area involved and an improvement in lesion score from day 5 to day 20. Cortisolemia fell off significantly for both treatments between day 0 and day 5 (group 1: Deltad5=-4.74 mg/ml, p=0.01; group 2: Deltad5=-13.06 mg/ml, p<0.0001), only for group 2 between day 0 and day 20 (Deltad20=-7.38 mg/ml, p=0.02) and to a lesser degree between day 0 and day 30 (Deltad30=-3.18 mg/ml, p=0.06). The decrease was greater in group 2 than in group 1 on day 5 (p=0.01) and to a lesser degree at day 20 (p=0.06). CONCLUSIONS: Micronized desonide cream 0.1 p.100 has less potential for suppressing the adrenal cortisol axis than betamethasone dipropionate cream 0.05 p.100 while the therapeutic effect on childhood atopic dermatitis is the same.
Assuntos
Anti-Inflamatórios/administração & dosagem , Betametasona/análogos & derivados , Dermatite Atópica/tratamento farmacológico , Desonida/administração & dosagem , Hidrocortisona/sangue , Administração Tópica , Anti-Inflamatórios/efeitos adversos , Betametasona/administração & dosagem , Betametasona/efeitos adversos , Pré-Escolar , Dermatite Atópica/sangue , Desonida/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Lactente , Masculino , Pomadas , Resultado do TratamentoAssuntos
Acne Vulgar/induzido quimicamente , Anti-Inflamatórios/efeitos adversos , Dermatoses Faciais/induzido quimicamente , Administração Cutânea , Administração Oral , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Infecciosos Locais/efeitos adversos , Betametasona/efeitos adversos , Pré-Escolar , Clindamicina/administração & dosagem , Clindamicina/uso terapêutico , Clotrimazol/efeitos adversos , Desonida/efeitos adversos , Eritema/induzido quimicamente , Etilsuccinato de Eritromicina/administração & dosagem , Etilsuccinato de Eritromicina/uso terapêutico , Feminino , Glucocorticoides , HumanosAssuntos
Anti-Inflamatórios/efeitos adversos , Anticolesterolemiantes/efeitos adversos , Desonida/efeitos adversos , Toxidermias/diagnóstico , Dermatoses Faciais/induzido quimicamente , Lovastatina/efeitos adversos , Administração Tópica , Anti-Inflamatórios/administração & dosagem , Anticolesterolemiantes/uso terapêutico , Desonida/administração & dosagem , Diagnóstico Diferencial , Progressão da Doença , Toxidermias/etiologia , Quimioterapia Combinada , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/tratamento farmacológico , Feminino , Glucocorticoides , Humanos , Lovastatina/uso terapêutico , Pessoa de Meia-Idade , Testes do Emplastro , RecidivaAssuntos
Anti-Inflamatórios/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Desonida/efeitos adversos , Toxidermias/etiologia , Conservantes Farmacêuticos/efeitos adversos , Galato de Propila/efeitos adversos , Administração Tópica , Glucocorticoides , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
22 cases of allergic contact dermatitis from topical corticosteroids were observed in Strasbourg and previously published. 7 further cases are reported here and the vehicle and concentration of corticosteroids for patch tests are discussed. A 0.1% concentration in petrolatum seemed adequate for testing the 4 molecules (triamcinolone acetonide, dexamethasone, desonide and amcinonide) responsible for the 7 new cases. In 1 case, several cross-reactions were seen. A corticosteroid screening series permits patch testing of the suspected molecule(s) in a selective way. Without this series, long delays are required to make the correct diagnosis by patch testing. We have reviewed more than 60 papers on corticosteroid allergy published up to now.