Efficacy of levamisole for the treatment of slow spreading vitiligo.

Levamisole can be used as an immunomodifier for an effective treatment of vitiligo. A clinical trial was done to assess the efficacy of levamisole in patients of vitiligo. The study was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to July 2011. A total number of sixty patients were assigned purposively. Among them thirty patients were belonged to Group A, treated with levamisole alone and another thirty patients belonged to Group B, treated with levamisole 160 mg weekly with topical 0.1% fluocinolone acetonide acetate on the lesions once a day for a duration of 6 months. Patients were followed up every 2 weeks interval and were continued up to 6 weeks. Out of all patients from group A, the mean sizes of the lesions were 8.17cm before treatment but 5.90cm, 4.32cm, and 3.57cm at 1st visit, 2nd visit and 3rd visit respectively after treatment. In Group B, the mean sizes of the lesions were 7.50cm before treatment but 4.92cm, 3.00cm, and 4.75cm at 1st visit, 2nd visit and 3rd visit respectively after treatment. Among the respondents of Group A & B, 25(83.3%) and 27(90%) were cured respectively. This study observed that Levamisol with topical 0.1% fluocinolone was more responsive in percentage but the difference was not statistically significant.

Outcomes of birdshot chorioretinopathy treated with an intravitreal sustained-release fluocinolone acetonide-containing device.

PURPOSE: To evaluate outcomes in birdshot chorioretinopathy following intravitreal implantation of a fluocinolone acetonide-containing drug delivery device. DESIGN: Retrospective, multicenter, interventional case study. METHODS: University- and community-based tertiary care. Twenty-two HLA-A29+ birdshot patients (36 eyes) were implanted with a sustained-release corticosteroid device and followed for up to 3 years. Main outcome measures were Snellen acuity, intraocular inflammation, adjunctive therapy, cataract, ocular hypertension, or glaucoma. Paired Wilcoxon statistics were used to analyze visual acuities; paired McNemar statistics were used to analyze presence or absence of other outcomes. RESULTS: Nineteen of 22 patients (32 eyes) completed 12 months of follow-up with improvement in median visual acuity (P=.015). Prior to implantation, 18 of 22 patients (82%) received immunosuppressive therapy versus 1 of 19 (5%) by 12 months (P<.001). Eyes with zero vitreous haze increased from 7 of 27 scored eyes (26%) at baseline to 30 of 30 eyes (100%) by 12 months (P<.001). Cystoid macular edema decreased from 13 of 36 eyes (36%) at baseline to 2 of 32 eyes (6%) at 12 months (P=.006). Five of 24 phakic eyes at baseline exited the study before surgery; all other eyes received cataract surgery. One hundred percent of study eyes had ocular hypertension, required intraocular pressure-lowering therapy, or had glaucoma surgery by 12 months. CONCLUSIONS: Implantation of a fluocinolone acetonide-containing intraocular device in birdshot chorioretinopathy can improve vision, control inflammation, and eliminate systemic therapy. There is a high incidence of cataract progression and intraocular hypertension or glaucoma.

Dermal absorption of fluprednidene-21-acetate and miconazole from a new topical preparation in pigs.

The dermal absorption of fluprednidene-21-acetate (CAS 1255-35-2) and miconazole nitrate (CAS 22832-87-7) of a new combination cream (Decoderm tri) was studied in pigs after application of 0.5 g cream/kg body weight under occlusive dressing for 5 h. 3H-labelled fluprednidene-21-acetate and 14C-labelled miconazole nitrate were introduced into the base cream as single components or in combination. The three resulting creams were tested in groups of 3 pigs each. To obtain a basis for the assessment of the data after dermal application the two labelled drugs were also examined after intravenous injection. Based on the comparison of the AUC of the radioactive labels an absorption of 4.4% for fluprednidene-21-acetate was calculated when administered alone and 2.4% when administered in the combination cream. For miconazole a smaller absorbed fraction of the dermal dose of 0.5 and 0.8%, resp., was found. Since the differences between single and combined administration were not significant, it follows that there is no relevant reciprocal influence of the two compounds on their dermal absorption.

[Optimized interval treatment of eczema with fluprednidene. A multicenter double-blind study]. / Die optimierte Intervallbehandlung des Ekzems mit Flupredniden. Eine Multizenter-Doppelblind-Studie.

In a multicenter double-blind study, 44 patients suffering from eczema were bilaterally treated with 0.1% fluprednidene-21-acetate over 21 days. Continuous application twice a day was compared with intermittent therapy, i.e. 1 day intermission (15 patients), 2 days intermission (16 patients) and 3 days intermission (13 patients) using the cream base. Final evaluation was based on 11 criteria. All regimens, continuous and intermittent, proved effective (at least 90% reduction of the lesions). Treatment with 3 days intermission showed the same favorable results as continuous application, although the amount of glucocorticoids applied was 75% less. Measurements of the skin fold thickness (SFT) in healthy controls did not indicate any atrophy after treatment with fluprednidene under the same conditions as the eczema patients or under occlusion for up to 21 days. Clobetasol-17-propionate, in contrast, significantly reduced the SFT already after application of only 1 week.

[Diurnal dependence of skin reactions in the administration of external substances]. / Zur tageszeitlichen Abhängigkeit von Hautreaktionen bei externer Wirkstoffapplikation.

In order to investigate the influence of the application time of the day on skin reactions, test persons were treated with various substances inducing experimental inflammation in human skin. Additional tests provided us with data regarding the antiinflammatory activity of topical glucocorticoids on the experimental inflammation as well as the vasoconstrictive activity dependent on the application time of the day. Although all tests showed great individual scattering ranges, statistical evaluation did not reveal any clear evidence for the supposition that pharmacological responses of the skin may be influenced by the hour of the topical application. Thus, it seems not likely that the success of topical treatment of toxic dermatitis by means of glucocorticoids depends on the hour of application.

[Testing the loss of efficacy (tachyphylaxis) during external steroid application]. / Testungen auf Wirkverlust (Tachyphylaxie) bei der externen Steroidanwendung.

The steroids fluprednylidene-21-acetate (FA) and betamethasone-17-valerate (BV) were tested in comparison to their inactive bases for loss of activity (tachyphylaxis) after 2 weeks of application. In the croton oil test, both steroids produced equal inhibition of the pustular inflammatory reaction. The vasoconstriction test after 14 days of use revealed a clear decrease in the blanching reaction - which was, however, not statistically significant in the case of BV.

Intermittent maintenance therapy in chronic hand eczema with clobetasol propionate and flupredniden acetate.

The clinical effect of two topical corticosteroids, one of very strong potency (clobetasol propionate), and one of medium potency (flupredniden acetate), was studied in the maintenance therapy of 55 patients with chronic hand eczema. Initially, 61 patients were treated on both hands continuously for 1 to 3 weeks with clobetasol only which brought about healing in 90% of cases (mean time to healing: 11 days). In a subsequent double-blind left/right study, the capacity of the two corticosteroids for keeping the dermatitis in remission was compared using an intermittent schedule of 2 applications a week. The protocol was followed by 46 patients and the mean observation period was 138 days. Treatment with clobetasol kept patients free from relapses during the entire observation period in 70%, with flupredniden in 30%. Relapses occurred with clobetasol after a mean of 66 days, with flupredniden after 36 days. Side-effects, occurring with similar frequency with both drugs, were few and mild. It is suggested that an intermittent schedule is advantageous when using a corticosteroid of high potency.

Evaluation of topical anti-inflammatory steroid formulations in an Arthus model of inflammation.

Formulations of a number of steroids were evaluated after topical application in a reversed passive Arthus test (RPA) in rabbits. Four 21-chlorosteroids in the same cream base were investigated. The preparations of SQ 18,566 (halcinonide) and SQ 20,811 showed anti-edema activity, but those of SQ 15,361 and SQ 20,589 were less active. Ointment formulations of halcinonide also reduced edema in the RPA. These results, coupled with previously reported clinical data, suggest that the RPA might be utilized to distinguish good from poor formulations of anti-inflammatory steroids prior to screening tests or clinical trials in humans.