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Crispian Scully - One of the best experts on this subject based on the ideXlab platform.
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topical corticosteroids in association with miconazole and chlorhexidine in the long term management of atrophic erosive oral lichen planus a placebo controlled and comparative study between clobetasol and Fluocinonide
Oral Diseases, 2008Co-Authors: M Carbone, D Conrotto, Roberto Broccoletti, Saviana Gandolfo, Marina Carrozzo, Crispian ScullyAbstract:OBJECTIVE: To evaluate the efficacy of a combination of topical corticosteroids with topical antimycotic drugs in the therapy of atrophic-erosive forms of oral lichen planus (OLP). PATIENTS AND METHODS: The study population consisted of 60 patients with OLP subdivided into three groups matched for sex and age. The first group (25 patients) and the second group (24 patients) received respectively 0.05% clobetasol propionate ointment or 0.05% Fluocinonide ointment in an adhesive medium (4% hydroxyethyl cellulose gel) plus in each case antimycotic treatment consisting of miconazole gel and 0.12% chlorhexidine mouthwashes. The third group (11 1 patients), placebo group, received only hydroxyethyl cellulose gel and antimycotic treatment as above. All the treatment regimens were carried out for 6 months. Each patient was examined every 2 months during the 6-month period of active treatment and for a further 6 months of follow-up. Objective and subjective clinical progress was scored and compared between the three groups. Plasma cortisol levels were monitored in half the patients using the topical corticosteroids. RESULTS: All patients treated with clobetasol and 90% of the patients treated with Fluocinonide witnessed some improvement, whereas in the placebo group only 20% of patients improved (P < 0.0001 and P = 0.00029, respectively). However, when considering complete responses, only clobetasol gave significantly better results than placebo. Clobetasol resolved 75% of the lesions whereas Fluocinonide was effective in 25% of cases and placebo in none. Clobetasol achieved better results statistically than did Fluocinonide (P=0.00442) and placebo (P = 0.00049) whereas there was no statistical difference among Fluocinonide and placebo (P = 0.140). Similar results were obtained for symptoms. Both drugs were shown to be effective in the treatment of erosive lesions, but clobetasol was considerably more efficacious than Fluocinonide in the atrophic areas (75% vs 25% of total response, respectively) (P = 0.00442). None of the treated patients contracted oropharyngeal candidiasis. After 6 months of follow-up, 65% of the clobetasol-treated group and 55% of the Fluocinonide group were stable. Estimation of plasma cortisol levels showed no significant systemic adverse effects of clobetasol or Fluocinonide. CONCLUSIONS: Our results suggest that a very potent topical corticosteroid such as clobetasol may control OLP in most cases, with no significant adrenal suppression or adverse effects. Moreover, a concomitant antimycotic treatment with miconazole gel and chlorhexidine mouthwashes is a useful and safe prophylaxis against oropharyngeal candidiasis.
M Carbone - One of the best experts on this subject based on the ideXlab platform.
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topical corticosteroids in association with miconazole and chlorhexidine in the long term management of atrophic erosive oral lichen planus a placebo controlled and comparative study between clobetasol and Fluocinonide
Oral Diseases, 2008Co-Authors: M Carbone, D Conrotto, Roberto Broccoletti, Saviana Gandolfo, Marina Carrozzo, Crispian ScullyAbstract:OBJECTIVE: To evaluate the efficacy of a combination of topical corticosteroids with topical antimycotic drugs in the therapy of atrophic-erosive forms of oral lichen planus (OLP). PATIENTS AND METHODS: The study population consisted of 60 patients with OLP subdivided into three groups matched for sex and age. The first group (25 patients) and the second group (24 patients) received respectively 0.05% clobetasol propionate ointment or 0.05% Fluocinonide ointment in an adhesive medium (4% hydroxyethyl cellulose gel) plus in each case antimycotic treatment consisting of miconazole gel and 0.12% chlorhexidine mouthwashes. The third group (11 1 patients), placebo group, received only hydroxyethyl cellulose gel and antimycotic treatment as above. All the treatment regimens were carried out for 6 months. Each patient was examined every 2 months during the 6-month period of active treatment and for a further 6 months of follow-up. Objective and subjective clinical progress was scored and compared between the three groups. Plasma cortisol levels were monitored in half the patients using the topical corticosteroids. RESULTS: All patients treated with clobetasol and 90% of the patients treated with Fluocinonide witnessed some improvement, whereas in the placebo group only 20% of patients improved (P < 0.0001 and P = 0.00029, respectively). However, when considering complete responses, only clobetasol gave significantly better results than placebo. Clobetasol resolved 75% of the lesions whereas Fluocinonide was effective in 25% of cases and placebo in none. Clobetasol achieved better results statistically than did Fluocinonide (P=0.00442) and placebo (P = 0.00049) whereas there was no statistical difference among Fluocinonide and placebo (P = 0.140). Similar results were obtained for symptoms. Both drugs were shown to be effective in the treatment of erosive lesions, but clobetasol was considerably more efficacious than Fluocinonide in the atrophic areas (75% vs 25% of total response, respectively) (P = 0.00442). None of the treated patients contracted oropharyngeal candidiasis. After 6 months of follow-up, 65% of the clobetasol-treated group and 55% of the Fluocinonide group were stable. Estimation of plasma cortisol levels showed no significant systemic adverse effects of clobetasol or Fluocinonide. CONCLUSIONS: Our results suggest that a very potent topical corticosteroid such as clobetasol may control OLP in most cases, with no significant adrenal suppression or adverse effects. Moreover, a concomitant antimycotic treatment with miconazole gel and chlorhexidine mouthwashes is a useful and safe prophylaxis against oropharyngeal candidiasis.
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the topical treatment of atrophic erosive oral lichen planus with Fluocinonide in a bioadhesive gel chlorhexidine and miconazole gel a totally open trial
Minerva stomatologica, 1996Co-Authors: M Carbone, Roberto Broccoletti, Marina Carrozzo, A Mattea, Saviana GandolfoAbstract:To evaluate the efficacy and long-term course of topical steroids treatment in oral lichen planus (OLP), an open trial has been carried out in 30 patients with atrophic-erosive or symptomatic varieties of OLP confirmed histologically with relative contraindications for systemic steroid treatment (namely, liver disease, peptic ulcer, diabetes, blood hypertension or osteoporosis). The treatment was the following: Fluocinonide (Topsyn) 0.025% in 4% idrossiethylcellulose gel applied 3 times/daily for two months, 2 times/daily for the next 2 months and 1 times/daily for other 2 months. Moreover, chlorhexidine (Plakout) 0.12%, 3 mouthwashes/daily and miconazole gel (Micotef) applied 1 times/daily were used for the entire period of the steroid therapy as antimycotics. The clinical evaluation of signs and symptoms was assessed on a scale of 0 to 5 and of 0 to 3, respectively. Twenty patients concluded the entire therapeutical scheme, whereas 5 (17%) interrupted the treatment for the appearance of side-effects (namely, gastroesophageal disturbances, mucosal bleeding and pruritus), 1 interrupted voluntarily the treatment and 4 cases did not present at the controls. No cases of oral candidiasis were seen. Eighteen patients (90%) had improvements of oral lesions with significant statically reductions in the scores of signs (p < 0.002) and of symptoms (p < 0.02) (Wilcoxon test). We emphasize also that in 61% of the responders the oral conditions were stable after 6 months of follow-up. In conclusion our results suggest the following: a) Fluocinonide is an effective and safe drug for the treatment of OLP, especially in addition with chlorehixidine and miconazole; b) the stability of our results demonstrates that probably an adequate steroid therapeutical scheme is more useful than continuous steroid administration in the treatment of OLP.
S Bhambri - One of the best experts on this subject based on the ideXlab platform.
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daily application of Fluocinonide 0 1 cream for the treatment of atopic dermatitis
The Journal of clinical and aesthetic dermatology, 2009Co-Authors: James Q Del Rosso, S BhambriAbstract:Objective: To assess the efficacy and safety of topical Fluocinonide 0.1% cream for the treatment of atopic dermatitis. Design: In this double-blind, vehicle-controlled study, patients were randomized to receive treatment with Fluocinonide 0.1% cream applied once (n=109) or twice daily (n=102) or vehicle applied once (n=50) or twice daily (n=52) for two weeks. Setting: Multicenter, outpatient. Participants: Patients aged 18 years or older with atopic dermatitis affecting at least two percent but less than 10 percent of body surface area. Measurements: Efficacy and safety measures included lesion severity, pruritus, hypothalamic-pituitary-adrenal axis suppression, and adverse events. Results: Fluocinonide 0.1% cream applied once or twice daily was more effective than cream vehicle. Both regimens were similarly efficacious after two weeks of treatment. At the end of treatment, lesions were cleared or almost cleared in 59 percent of subjects treated once daily and 57 percent of subjects treated twice daily with Fluocinonide 0.1% cream. Further, considerable residual benefit remained after cessation of twice-daily versus once-daily treatment. Skin safety evaluations showed no significant adverse effects of treatment on signs or symptoms of skin atrophy. Fluocinonide 0.1% cream and vehicle treatments did not differ significantly in their suppression of the hypothalamic-pituitary-adrenal axis, nor did hypothalamic-pituitary-adrenal axis suppression differ significantly following once- or twice-daily treatment with Fluocinonide 0.1% cream. Fluocinonide 0.1% cream was well tolerated. Conclusion: Once- or twice-daily topical application of Fluocinonide 0.1% cream for 14 days was safe and effective for treating atopic dermatitis in this adult patient population. The efficacy of once-daily application was comparable to twice-daily application.
Daniel J Tanner - One of the best experts on this subject based on the ideXlab platform.
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mometasone furoate 0 1 salicylic acid 5 ointment twice daily versus Fluocinonide 0 05 ointment twice daily in the management of patients with psoriasis
Clinical Therapeutics, 1997Co-Authors: Roland S Medansky, Cynthia A Cuffie, Daniel J TannerAbstract:This study compared the clinical efficacy and safety of the combination agent mometasone furoate 0.1%-salicylic acid 5% ointment with those of the single agent Fluocinonide 0.05% ointment, each applied twice daily for 21 days, in the treatment of patients with moderate to severe plaque psoriasis. Forty adult patients were included in this single-center, randomized, double-masked, intraindividual, bilateral-paired comparative trial. Two similar, bilaterally symmetrical target lesions on the trunk, arms, or legs of each patient were selected for treatment and evaluation. One lesion was treated with mometasone furoate 0.1%-salicylic acid 5% ointment, and the other was treated with Fluocinonide 0.05% ointment, both twice daily for 21 days. Treatment was randomly assigned to the right or left side of the body. Signs of psoriasis (ie, erythema, induration, and scaling) and overall clinical response were evaluated and scored on days 4, 8, 15, and 22 and compared against baseline. Patients were asked to evaluate the treatments for efficacy and acceptability at each visit. The primary efficacy parameter was the mean percentage of improvement in total sign scores for the target lesions. Safety was evaluated based on clinical observation and patients' reports. Beginning with day 15, statistically significant differences favoring mometasone furoate 0.1%-salicylic acid 5% ointment over Fluocinonide 0.05% ointment were seen in individual and total sign scores, as well as in overall global clinical response. On day 15, 20 patients expressed a preference for one treatment over the other, and 20 patients made no distinction between the two. Of those who expressed a preference, significantly more patients believed mometasone furoate 0.1%-salicylic acid 5% ointment to be better than Fluocinonide 0.05% ointment. On day 22, of 25 patients who expressed a preference, significantly more patients thought mometasone furoate 0.1%-salicylic acid 5% ointment was better than Fluocinonide 0.05% ointment. No adverse events were recorded for either treatment group. The combination mometasone furoate 0.1%-salicylic acid 5% ointment was significantly more efficacious than and equally as safe as Fluocinonide 0.05% ointment in the management of patients with plaque psoriasis and was preferred by a greater number of patients.
Karljiković-rajić Katarina - One of the best experts on this subject based on the ideXlab platform.
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HPLC evaluation of solvolysis of a novel ester fluocinolone acetonide 21-(2'-phenoxypropionate) in comparison with Fluocinonide
'Informa UK Limited', 2011Co-Authors: Marković Bojan, Vladimirov Sote, Čudina Olivera, Savić Vladimir, Karljiković-rajić KatarinaAbstract:In this study the solvolysis of novel fluocinolone acetonide 21-(2'-phenoxypropionate) in comparison with Fluocinonide was analyzed in order to evaluate this process as an in vitro model for prodrug activation. The solvolysis was performed in ethanol: water (90: 10 v/v) mixture using the excess of NaHCO3. The solvolytic mixtures of those esters with different lipophilicity were assayed by proposed RP-HPLC method using isocratic elution with methanol: water (75: 25 v/v); flow rate 1 mL min(-1), and detection at 238 nm. Solvolytic rate constants (at 25 degrees C) for novel prodrug fluocinolone acetonide 21-(2'-phenoxypropionate) (0.0434 h(-1)) and Fluocinonide (0.0593 h(-1)) have been compared. This in vitro model of solvolysis and corresponding rate constants are in good correlation with our preliminary data of anti-inflammatory potencies of those prodrugs. Limits of detection, important for the initial stage of solvolysis, were experimentally determined with values of 4.10 mu M and 0.24 mu M for fluocinolone acetonide 21-(2'-phenoxypropionate) and Fluocinonide, respectively
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Investigation of Solvolysis Kinetics of New Synthesized Fluocinolone Acetonide C-21 Esters-An In Vitro Model for Prodrug Activation
'MDPI AG', 2011Co-Authors: Marković Bojan, Vladimirov Sote, Čudina Olivera, Savić Vladimir, Dobričić Vladimir, Karljiković-rajić KatarinaAbstract:In this study the solvolysis of newly synthesized fluocinolone acetonide C-21 esters was analysed in comparison with Fluocinonide during a 24-hour period of time. The solvolysis was performed in an ethanol-water (90:10 v/v) mixture using the excess of NaHCO(3). The solvolytic mixtures of each investigated ester have been assayed by a RP-HPLC method using isocratic elution with methanol-water (75:25 v/v); flow rate 1 mL/min; detection at 238 nm; temperature 25 degrees C. Solvolytic rate constants were calculated from the obtained data. Geometry optimizations and charges calculations were carried out by Gaussian W03 software. A good correlation (R = 0.9924) was obtained between solvolytic rate constants and the polarity of the C-O2 bond of those esters. The established relation between solvolytic rate constant (K) and lipophilicity (cLogP) with experimental anti-inflammatory activity could be indicative for topical corticosteroid prodrug activation