The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Maria C Garzon - One of the best experts on this subject based on the ideXlab platform.
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ultrapotent Topical Corticosteroid treatment of hemangiomas of infancy
Journal of The American Academy of Dermatology, 2005Co-Authors: Maria C Garzon, Anne W Lucky, Aimee Hawrot, Ilona J FriedenAbstract:Background Superficial cutaneous hemangiomas of infancy represent a therapeutic challenge. Two small case series using ultrapotent Topical Corticosteroids for periocular hemangiomas were reported in the ophthalmologic literature. The use of this therapy for hemangiomas of infancy at other sites on the body has not been reported. Objective We sought to assess the clinical effects of short-term application of ultrapotent Topical Corticosteroids for the treatment of hemangiomas of infancy. Methods The records of 34 infants with proliferating hemangiomas of infancy that were treated with ultrapotent Topical steroids were reviewed retrospectively. Treatment response was based on: (1) cessation of growth; (2) shrinkage or flattening of the lesion; and (3) lightening of the surface color. Lesions demonstrating responses of two of the three criteria were judged to have good response; one criterion, partial response; and no improvement, no response. Results Of the patients, 35% demonstrated good response, 38% partial response, and 27% no response. Conclusions Hemangiomas in 74% of the infants demonstrated either good or partial response to treatment with ultrapotent Topical Corticosteroids. Of the responders, the majority reported cessation of growth before what would have been expected for their age. Improvement varied, with thinner superficial hemangiomas demonstrating better cosmetic improvement than thicker lesions.
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ultrapotent Topical Corticosteroid treatment of childhood genital lichen sclerosus
Archives of Dermatology, 1999Co-Authors: Maria C Garzon, Amy S PallerAbstract:Objective To observe the clinical effects of short-term application of ultrapotent Topical Corticosteroid on symptomatic genital lesions of lichen sclerosus in pediatric patients. Design Case series of 10 prepubertal girls with genital lichen sclerosus. Ultrapotent Topical Corticosteroids were applied twice daily for 6 to 8 weeks and patients were reexamined at completion of treatment. Long-term follow-up over 6 months to 3 years. Setting Pediatric dermatology clinic (referral center). Patients Ten prepubertal girls with typical clinical features of genital and/or perianal lichen sclerosus. Intervention Topical ultrapotent Corticosteroid ointment was applied sparingly to affected areas for 6 to 8 weeks. Main Outcome Measure Improvement of erythema, whitening erosions, and atrophy. Subjective improvement of symptoms. Results All patients showed partial or total subsistence of signs and symptoms of lichen sclerosus. Frequency and severity of recurrences varied, but patients responded within a few days to reapplication of ultrapotent Topical Corticosteroid. No significant adverse effects were noted after the initial 6- to 8-week course of therapy or during the 6-month to 3-year follow-up period. Conclusion A 6- to 8-week course of ultrapotent Topical Corticosteroid is a safe and effective treatment for genital lichen sclerosus in pediatric patients.
Amy S Paller - One of the best experts on this subject based on the ideXlab platform.
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ultrapotent Topical Corticosteroid treatment of childhood genital lichen sclerosus
Archives of Dermatology, 1999Co-Authors: Maria C Garzon, Amy S PallerAbstract:Objective To observe the clinical effects of short-term application of ultrapotent Topical Corticosteroid on symptomatic genital lesions of lichen sclerosus in pediatric patients. Design Case series of 10 prepubertal girls with genital lichen sclerosus. Ultrapotent Topical Corticosteroids were applied twice daily for 6 to 8 weeks and patients were reexamined at completion of treatment. Long-term follow-up over 6 months to 3 years. Setting Pediatric dermatology clinic (referral center). Patients Ten prepubertal girls with typical clinical features of genital and/or perianal lichen sclerosus. Intervention Topical ultrapotent Corticosteroid ointment was applied sparingly to affected areas for 6 to 8 weeks. Main Outcome Measure Improvement of erythema, whitening erosions, and atrophy. Subjective improvement of symptoms. Results All patients showed partial or total subsistence of signs and symptoms of lichen sclerosus. Frequency and severity of recurrences varied, but patients responded within a few days to reapplication of ultrapotent Topical Corticosteroid. No significant adverse effects were noted after the initial 6- to 8-week course of therapy or during the 6-month to 3-year follow-up period. Conclusion A 6- to 8-week course of ultrapotent Topical Corticosteroid is a safe and effective treatment for genital lichen sclerosus in pediatric patients.
Tracey Sach - One of the best experts on this subject based on the ideXlab platform.
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an economic evaluation of the randomized controlled trial of Topical Corticosteroid and home based narrowband ultraviolet b for active and limited vitiligo the hi light vitiligo trial
British Journal of Dermatology, 2021Co-Authors: Tracey Sach, Kim S Thomas, Jonathan M Batchelor, A Perways, Joanne R Chalmers, Rachel H Haines, Garry Meakin, Lelia Duley, J Ravenscroft, Andy RogersAbstract:BACKGROUND Economic evidence for vitiligo treatments is absent. OBJECTIVES To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of Topical Corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo. METHODS Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months' treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost-utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015. RESULTS The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188-235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151-196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment. CONCLUSIONS Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success.
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randomized controlled trial of Topical Corticosteroid and home based narrowband ultraviolet b for active and limited vitiligo results of the hi light vitiligo trial
British Journal of Dermatology, 2021Co-Authors: Kim S Thomas, Jonathan M Batchelor, Joanne R Chalmers, Rachel H Haines, Garry Meakin, Lelia Duley, J Ravenscroft, Andy Rogers, Perways Akram, Tracey SachAbstract:BACKGROUND Evidence for the effectiveness of vitiligo treatments is limited. OBJECTIVES To determine the effectiveness of (i) handheld narrowband UVB (NB-UVB) and (ii) a combination of potent Topical Corticosteroid (TCS) and NB-UVB, compared with TCS alone, for localized vitiligo. METHODS A pragmatic, three-arm, placebo-controlled randomized controlled trial (9-month treatment, 12-month follow-up). Adults and children, recruited from secondary care and the community, aged ≥ 5 years and with active vitiligo affecting < 10% of skin, were randomized 1 : 1 : 1 to receive TCS (mometasone furoate 0·1% ointment + dummy NB-UVB), NB-UVB (NB-UVB + placebo TCS) or a combination (TCS + NB-UVB). TCS was applied once daily on alternating weeks; NB-UVB was administered on alternate days in escalating doses, adjusted for erythema. The primary outcome was treatment success at 9 months at a target patch assessed using the participant-reported Vitiligo Noticeability Scale, with multiple imputation for missing data. The trial was registered with number ISRCTN17160087 on 8 January 2015. RESULTS In total 517 participants were randomized to TCS (n = 173), NB-UVB (n = 169) and combination (n = 175). Primary outcome data were available for 370 (72%) participants. The proportions with target patch treatment success were 17% (TCS), 22% (NB-UVB) and 27% (combination). Combination treatment was superior to TCS: adjusted between-group difference 10·9% (95% confidence interval 1·0%-20·9%; P = 0·032; number needed to treat = 10). NB-UVB alone was not superior to TCS: adjusted between-group difference 5·2% (95% CI - 4·4% to 14·9%; P = 0·29; number needed to treat = 19). Participants using interventions with ≥ 75% expected adherence were more likely to achieve treatment success, but the effects were lost once treatment stopped. Localized grade 3 or 4 erythema was reported in 62 (12%) participants (including three with dummy light). Skin thinning was reported in 13 (2·5%) participants (including one with placebo ointment). CONCLUSIONS Combination treatment with home-based handheld NB-UVB plus TCS is likely to be superior to TCS alone for treatment of localized vitiligo. Combination treatment was relatively safe and well tolerated but was successful in only around one-quarter of participants.
Sasima Eimpunth - One of the best experts on this subject based on the ideXlab platform.
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a randomized double blind placebo controlled study of the effect of a high potency Topical Corticosteroid after sclerotherapy for reticular and telangiectatic veins of the lower extremities
Dermatologic Surgery, 2015Co-Authors: Daniel P Friedmann, Ana Marie Liolios, Mitchel P Goldman, Sasima EimpunthAbstract:Background Although typically mild, transient, and expected, most adverse events (AEs) postsclerotherapy are inflammatory in nature. Objective To evaluate the effects of a high-potency Topical Corticosteroid (TC) applied immediately postsclerotherapy. Materials and methods Subjects undergoing bilateral lower extremity sclerotherapy with polidocanol had extremities randomized to a single application of betamethasone dipropionate and placebo saline solutions immediately post-treatment in a double-blind manner. Adverse events were assessed for each extremity by subjects at t = 0 (preapplication) and t = 15 (15 minutes postapplication) and by an investigator at t = 0 and t = 15, and at Days 14 and 60. Subjects and investigator evaluated efficacy with a quartile improvement scale. Results Sixteen female subjects completed the study. Subjects reported no statistically significant differences in AEs between TC and placebo at either t = 0 or t = 15. Investigator scores for erythema and swelling/urtication were not significantly different between groups at the same time points. Although most subjects demonstrated 26% to 75% improvement at Day 60, results were not significantly different between extremities on subject and investigator evaluation. Conclusion High-potency TC application immediately postsclerotherapy produced no statistically significant differences in subject- and investigator-assessed AEs and clearance rates compared with placebo. Foam sclerotherapy with polidocanol is safe and effective for the treatment of lower extremity reticular veins.
Mark Lebwohl - One of the best experts on this subject based on the ideXlab platform.
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an investigator initiated double blind vehicle controlled pilot study assessment for tachyphylaxis to Topically occluded halobetasol 0 05 ointment in the treatment of psoriasis
Journal of The American Academy of Dermatology, 2014Co-Authors: Tali Czarnowicki, Rita V Linkner, Mayte Suarezfarinas, Arie Ingber, Mark LebwohlAbstract:Background Topical Corticosteroids are the most common first-line treatment for psoriasis. Tachyphylaxis, a decreased response to treatment with repetitive application of the drug, is a controversial phenomenon associated with Topical Corticosteroid treatment. Objective We sought to prove or disprove tachyphylaxis to occluded halobetasol 0.05% versus vehicle. Methods Patients with plaque psoriasis were recruited to this study. The study involved 3 phases (1, 2A, and 2B) with each phase being separated by a treatment vacation period. In phases 1 and 2A, 2 plaques were randomized to either halobetasol 0.05% or vehicle ointment application. In phase 2B, halobetasol 0.05% was applied to both. Target Lesion Severity Scale was used for clinical assessment. Results Twenty patients were enrolled. No difference in time to clearance ( P = .88) or time to recurrence ( P = .92) of the treated plaques was found between phases 1 and 2A. Percentage of improvement was higher in phase 2A compared with phase 1 (89.4%, P P Limitations Limitations are small sample size and 1 Corticosteroid tested. Conclusion No evidence of tachyphylaxis to the Topical Corticosteroid halobetasol 0.05% ointment treatment in patients with plaque psoriasis was found.
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factors impacting the combination of Topical Corticosteroid therapies for psoriasis perspectives from the international psoriasis council
Journal of The European Academy of Dermatology and Venereology, 2011Co-Authors: P C M Van De Kerkhof, K Kragballe, Siegfried Segaert, Mark LebwohlAbstract:Corticosteroids are the mainstay of Topical therapies for the treatment of mild to moderate psoriasis. Selection of vehicle, concentrations of Corticosteroid and coadministered medications, and frequency of administration are critical factors that enhance bioavailability of Topical Corticosteroids. Topical Corticosteroids are commonly used as polytherapy and combination therapy with other agents, such as salicylic acid, vitamin D analogues and tazarotene. Combinations are selected for the ability to enhance efficacy while minimizing Corticosteroid-related side-effects, such as cutaneous atrophy. New, innovative products such as sprays, foams and nail lacquers provide opportunities to tailor treatment for individuals, which promotes patient adherence to medications. This review covers features of Topical Corticosteroid formulations that affect bioavailability, efficacy and safety when used as monotherapy and in combination with other agents for the treatment of mild to moderate psoriasis.
