Combination of 1,064-nm Neodymium-doped Yttrium Aluminum Garnet Laser and Steroid Tape Decreases the Total Treatment Time of Hypertrophic Scars: An Analysis of 40 Cases of Cesarean-Section Scars.

BACKGROUND: The 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (Cutera, Inc., Brisbane, CA) and steroid tape (fludroxycortide tape) have been used to treat keloids and hypertrophic scars. OBJECTIVE: To evaluate the efficacy of contact-mode 1,064-nm Nd:YAG laser therapy and steroid tape for hypertrophic cesarean-section scars versus conservative therapy (steroid tape only). MATERIALS AND METHODS: A medical record review identified 40 consecutive Japanese patients who had hypertrophic scars (total Japan Scar Workshop Scar Scale [JSS] 2015 evaluation scores of 9 to 12) for more than 1 year after a vertical cesarean section and who were treated at our scar-specialist clinic from July 2015 to December 2017. All 40 patients continued treatment until the total JSS score dropped below 3. Recurrence was defined as a ≥1-point increase in the total JSW score 6 months after achieving a total JSS score <3. RESULTS: The patients had a mean age of 34.2 years. The test (n = 25) and control (n = 15) groups took on average 16.9 and 24.3 months to achieve a total JSS score <3, respectively (p < .01). In the following 6 months, none of the scars recurred. CONCLUSION: Nd:YAG laser treatment effectively decreased the total treatment time of hypertrophic cesarean-section scars. An algorithm for treating mild and severe hypertrophic cesarean-section scars is proposed.

Fludroxycortide cream as an alternative therapy for actinic cheilitis.

OBJECTIVES: The objective of the study is to assess, by clinical follow-up, the efficacy of the dermatological cream Fludroxycortide 0.125 mg/g (Drenison®) in the treatment of actinic cheilitis (AC). MATERIAL AND METHODS: Twenty-three patients diagnosed with AC participated in the study. Fifteen were submitted to corticotherapy with Fludroxycortide, applied three times a day for up to 6 weeks, associated with lip sunscreen (LS) before sun exposure. In the control group of eight patients, only the use of LS was established. At each weekly return, a photographic record was made of the lesion. After treatment, images were evaluated and scores were assigned to verify clinical evolution. Also, patients treated with Fludroxycortide responded to a questionnaire, to assess drug tolerability and treatment satisfaction. RESULTS: In the group treated with Fludroxycortide (n = 15), five patients showed total improvement, seven presented partial improvement, and three showed no clinical change. Concerning the patients treated with LS (n = 8), one presented total remission of the clinical lesion characteristics, four exhibited partial improvement, and three exhibited no clinical lip alteration. No case presented symptom worsening. Of the 15 patients undergoing corticotherapy, 12 were satisfied and reported that the product was not irritating and contributed to lesion improvement. CONCLUSIONS: Conventional treatment with LS was effective in the remission of some AC lesions, but treatment responses were improved when associated with Fludroxycortide, especially in the more severe cases. CLINICAL RELEVANCE: As it is a non-invasive therapy leading, in most cases, to adequate clinical results, safety, and tolerability, Fludroxycortide can be considered an effective alternative treatment for AC.

In vitro penetration through the skin layers of topically applied glucocorticoids.

Corticoids are actives widely used in the treatment of skin diseases. This work aims to study the penetration of 3 corticoids (betamethasone, clobetasol, and flurandrenolide), their relationship with their Log D values and the effects of the vehicles. The 3 compounds were applied on a Franz-type diffusion cell in propylene glycol solution and their respective commercial creams and ointments. The active amounts found in the stratum corneum, epidermal, and dermal layers of the skin were investigated. Their diffusions were greatly affected by the formulation; moreover higher amounts of substance in the epidermis and dermis were detected in ointments than in creams. The enhancement effect of propylene glycol was also observed. The differences between the 3 substances could be related to their lipophilicity, molecular structure, and molecular weight. The more hydrophobic compounds (clobetasol and betamethasone) are present in higher amounts in the epidermis and dermis, while the hydrophilic compound (flurandrenolide) is mostly present in the receptor fluid.

A high-content biosensor-based screen identifies cell-permeable activators and inhibitors of EGFR function: implications in drug discovery.

Early success of kinase inhibitors has validated their use as drugs. However, discovery efforts have also suffered from high attrition rates due to lack of cellular activity. We reasoned that screening for such candidates in live cells would identify novel cell-permeable modulators for development. For this purpose, we have used our recently optimized epidermal growth factor receptor (EGFR) biosensor assay to screen for modulators of EGFR activity. Here, we report on its validation under high-throughput screening (HTS) conditions displaying a signal-to-noise ratio of 21 and a Z' value of 0.56-attributes of a robust cell-based assay. We performed a pilot screen against a library of 6912 compounds demonstrating good reproducibility and identifying 82 inhibitors and 66 activators with initial hit rates of 1.2% and 0.95%, respectively. Follow-up dose-response studies revealed that 12 of the 13 known EGFR inhibitors in the library were confirmed as hits. ZM-306416, a vascular endothelial growth factor receptor (VEGFR) antagonist, was identified as a potent inhibitor of EGFR function. Flurandrenolide, beclomethasone, and ebastine were confirmed as activators of EGFR function. Taken together, our results validate this novel approach and demonstrate its utility in the discovery of novel kinase modulators with potential use in the clinic.

Novel chemical suppressors of long QT syndrome identified by an in vivo functional screen.

BACKGROUND: Genetic long QT (LQT) syndrome is a life-threatening disorder caused by mutations that result in prolongation of cardiac repolarization. Recent work has demonstrated that a zebrafish model of LQT syndrome faithfully recapitulates several features of human disease, including prolongation of ventricular action potential duration, spontaneous early afterdepolarizations, and 2:1 atrioventricular block in early stages of development. Because of their transparency, small size, and absorption of small molecules from their environment, zebrafish are amenable to high-throughput chemical screens. We describe a small-molecule screen using the zebrafish KCNH2 mutant breakdance to identify compounds that can rescue the LQT type 2 phenotype. METHODS AND RESULTS: Zebrafish breakdance embryos were exposed to test compounds at 48 hours of development and scored for rescue of 2:1 atrioventricular block at 72 hours in a 96-well format. Only compounds that suppressed the LQT phenotype in 3 of 3 fish were considered hits. Screen compounds were obtained from commercially available small-molecule libraries (Prestwick and Chembridge). Initial hits were confirmed with dose-response testing and time-course studies. Optical mapping with the voltage-sensitive dye di-4 ANEPPS was performed to measure compound effects on cardiac action potential durations. Screening of 1200 small molecules resulted in the identification of flurandrenolide and 2-methoxy-N-(4-methylphenyl) benzamide (2-MMB) as compounds that reproducibly suppressed the LQT phenotype. Optical mapping confirmed that treatment with each compound caused shortening of ventricular action potential durations. Structure activity studies and steroid receptor knockdown suggest that flurandrenolide functions via the glucocorticoid signaling pathway. CONCLUSIONS: Using a zebrafish model of LQT type 2 syndrome in a high-throughput chemical screen, we have identified 2 compounds, flurandrenolide and the novel compound 2-MMB, as small molecules that rescue the zebrafish LQT type 2 syndrome by shortening the ventricular action potential duration. We provide evidence that flurandrenolide functions via the glucocorticoid receptor-mediated pathway. These 2 molecules and future discoveries from this screen should yield novel tools for the study of cardiac electrophysiology and may lead to novel therapeutics for human LQT patients.

Extensive keloid formation and progression after each vaccination.

Keloids are scars that extend beyond the original wound boundaries. They typically occur in darker skinned individuals with a familial tendency. Keloid formation has occurred after vaccination with bacilli Calmette-Guerin (BCG), small pox and hepatitis B vaccinations. We report the case of a 45-year-old female patient who developed extensive keloidal scars on her bilateral upper arms beginning in childhood after routine vaccinations. These keloids progressed with additional vaccines given at the same sites. Keloidal scars develop in anatomic areas exposed to increased skin tension as was seen in this patient. Treatment of these keloids is difficult but typically involves surgical excision, cryotherapy, radiation and intralesional and topical corticosteroids.

Linear cutaneous lupus erythematosus in the lines of Blaschko.

Eleven patients with linear cutaneous lupus erythematosus following the lines of Blaschko have been previously reported in the literature. We describe a child with this entity following Blaschko lines on the trunk. The patient responded to oral hydroxychloroquine therapy combined with topical flurandrenolide tape resulting in resolution with atrophic scarring. The clinical and histological features of linear cutaneous lupus erythematosus are discussed and a review of the literature is presented.

Transmittance properties of flurandrenolide tape for psoriasis: helpful adjunct to phototherapy.

BACKGROUND: Flurandrenolide tape is a valuable agent in the treatment of lichen simplex chronicus and in psoriasis. The corticosteroid is helpful for reducing the symptoms and induration of the lichen simplex chronicus lesion, and occlusion of the lesion with the tape reduces the patient's opportunity to rub and scratch the affected area. OBJECTIVES: The purpose of this study was to determine to what extent flurandrenolide tape may block ultraviolet (UV) light and interfere with phototherapy of psoriasis. METHODS: Flurandrenolide tape was applied to quartz spectroscopy cuvettes, and the absorption spectrum was determined using a Beckman DU-600 spectrophotometer. The effect of the tape on UV light transmission was also determined using our UVA-UVB office phototherapy unit. RESULTS: Flurandrenolide tape has considerable UV absorption in the UVC range with less absorption in the UVB and UVA range. The transmittance is greater (less absorption) with longer wavelengths. There was greater UV absorption in the UVB range than in the UVA range. CONCLUSION: Although flurandrenolide tape may be left in place during PUVA therapy, adjustment of UV dose or removal of the tape is probably needed during UVB phototherapy.

Lichen planus associated with milia.

The formation of milia is well recognized in both bullous and inflammatory dermatoses. There are several reports of milia developing in a rare variant of lichen planus pilaris known as lichen planus follicularis tumidus (LPFT), but the association of milia with other types of lichen planus (LP) has not been documented in the literature. We report five patients who developed milia during the course of either drug-induced or idiopathic LP and one in whom milia developed in a lichenoid tattoo reaction. Milia were noted to occur transiently during the resolving phase of LP. Most cases were severe enough to warrant treatment with systemic steroids. The association of milia with LP is not restricted to the rare clinical variant LPFT. We speculate that a severe lichenoid reaction with basal layer degeneration may precipitate the formation of milia in some cases of LP.

Comparative efficacy of once-daily flurandrenolide tape versus twice-daily diflorasone diacetate ointment in the treatment of psoriasis.

BACKGROUND: Flurandrenolide tape has recently been listed as a group I topical corticosteroid. There are no studies that compare this product to group I ointments in the treatment of steroid-responsive dermatoses. OBJECTIVE: Our purpose was to determine the relative efficacy of flurandrenolide (4 microg/cm2) tape versus 0.05% diflorasone diacetate ointment in plaque psoriasis. METHODS: Thirty patients participated in an investigator-blinded, randomized, bilateral paired-comparison study of flurandrenolide tape applied to lesions of one side of the body once daily for up to 16 hours versus diflorasone diacetate ointment applied contralaterally twice daily. Lesions were assessed at baseline, then reevaluated at 2 and 4 weeks. RESULTS: Flurandrenolide tape-treated plaques showed consistently greater clearing in terms of erythema, scaling, induration, and treatment success for all plaques, as well as the subset of knee and elbow plaques, when compared with the lesions receiving diflorasone diacetate ointment. CONCLUSION: The efficacy of flurandrenolide tape in the treatment of psoriatic plaques surpasses that of diflorasone diacetate ointment.

Treatment of recurrent earlobe keloids.

The use of complete surgical excision and postoperative pressure with steroid-impregnated tape has been evaluated in fifty-seven patients with recurrent earlobe keloids. All patients underwent conventional treatment previously, which was not curative. In a four-year follow-up of the method described here, four recurrences occurred. Patients' failure to use the recommended pressure earring and alteration in endocrine balance were noted in three of the four patients with recurrent keloids.

Estudo clínico com fluorandrenolida tópica oclusiva no tratamento de dermatoses que respondem a corticoterapia / Clinical study with topical occlusive flurandrenolide in the treatment of dermatosis responsive to corticotherapy

Um total de 30 pacientes, adultos e crianças de ambos os sexos, portadores de diversas dermatoses, foi tratado com corticoterapia oclusiva, usando-se uma fita plástica impregnada com fluorandrenolida. Os resultados finais constituíram-se em excelente e bom, num total de 30 casos (100%), näo havendo aparecimento de intolerância no uso do medicamento em qualquer dos pacientes. A segurança e comodidade da preparaçäo, evidenciadas pela ausência de reaçöes adversas e praticidade no uso, demonstradas pela boa aceitaçäo de todos os pacientes estudados, leva-nos a concluir que a fluorandrenolida em fita plástica adesiva constitui excelente e prático recurso terapêutico em dermatoses que respondem ao uso dos corticóides tópicos

Tratamento de dermatoses com o uso da fita plástica impregnada com fluorandrenolida / Treatment of dermatoses with the use of adhesive plastic tape impregnated with flurandrenolide

Um total de 30 pacientes adultos e crianças de ambos os sexos, portadores de variadas dermatoses, foram submetidos a terapêutica tópica com uma nova forma medicamentosa, constituída de fita plástica adesiva impregnada com fluorandrenolida na concentraçäo de 4 mcg/cm2. A aplicaçäo foi por períodos de 24 ou 48 horas, e os resultados obtidos foram considerados excelentes em 22 pacientes, bons em 5, melhora parcial em 2, havendo reaçäo discreta de hipersensibilidade em apenas um paciente, considerado como piora

[Contact allergy to fludroxycortid and cetyl alcohol]. / Kontaktallergie auf Fludroxycortid und Cetylalkohol.

A 66-year-old female developed increasing eczematous reactions after treatment of her leg ulcer with a corticoid ointment. When patch tested with the constituents she reacted positive to fludroxycortide (flurandrenolone) and cetyl alcohol. Contact allergy to this fluorinated corticosteroid has not been described before.