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Introduction High-volume corticosteroid nasal irrigation is a treatment option in patients with chronic rhinosinusitis. In Brazil, alternatives are used to optimize its cost and popularize its use, such as 1% compounded budesonide drops or betamethasone cream, and it is necessary to study these treatment modalities. Objective To evaluate the clinical response of nasal irrigation with 1% compounded budesonide drops or betamethasone cream compared to nasal sprays utilized in patients with chronic rhinosinusitis. Methods This was a retrospective observational study with 257 patients. One hundred and eight patients using corticosteroid nasal irrigation (292 treatment cycles) and 149 using corticosteroid nasal spray (300 treatment cycles) were included. Evaluation of subjective improvement, adverse events, exacerbations, and objective assessments with SNOT-22 and Lund–Kennedy endoscopic score were performed, in addition to sub-analyses related to nasal polyps and previous surgery. Results Corticosteroid nasal irrigation and corticosteroid nasal spray improved the Lund–Kennedy endoscopic score, with more adverse events in the corticosteroid nasal irrigation group. Previous surgery increased corticosteroid nasal irrigation improvement, with greater subjective improvement and fewer exacerbations. 1% compounded budesonide drops were better than betamethasone cream in the Lund–Kennedy endoscopic score, with fewer adverse events. A 1,000 µg dose of 1% compounded budesonide drops was more effective than 500 µg. Conclusion Corticosteroid nasal irrigation was effective in improving the Lund–Kennedy endoscopic score in chronic rhinosinusitis, especially in patients with nasal polyps and previous surgery, in addition to promoting a higher rate of subjective improvement and fewer exacerbations than corticosteroid nasal spray, but with more adverse events. 1% compounded budesonide drops improved the Lund–Kennedy endoscopic score with fewer adverse events than betamethasone cream, particularly at higher doses (1000 µg).

Most patients with psoriasis present with localized mild-to-moderate disease. In this case, the application of topical treatments in the first-line setting is recommended in most cases. Among different topical options, the fixed-dose combination of betamethasone dipropionate (BD) and vitamin D analogue (Cal) aerosol foam (Enstilar®, Leo Pharma) is approved as first-line topical therapy for the treatment of psoriasis in USA and the EU, due to its high efficacy and its favorable administration scheme. The PSO-LONG was the first trial to report on the long-term efficacy and safety of the Cal/DB foam treatment for the proactive management of psoriasis and now, the indications of Cal/BD foam included its use in the psoriasis maintenance treatment. However, the precise role of this treatment and the potential therapeutic schemes in the long-term management of psoriasis need further clarification. This Position Paper, authored by a group of Italian Expert Dermatologists, critically discusses the long-term management of psoriasis with Cal/BD foam in clinical practice. In particular, the biological rationale in the proactive treatment with Cal/BD foam and current evidence regarding this therapeutic approach are presented, along with its application also in patients with moderate-to-severe disease, difficult-to-treat lesions, or within combination regimens. In addition, strategies to improve adherence to long-term treatment of psoriasis are discussed,.

BACKGROUND: Low back pain affects 80% of people worldwide at least once in a lifetime and reduces the quality of life and causes absence from work. OBJECTIVE: To evaluate the pain and functional status of patients with lumbar disc disease who received blind caudal epidural injections (CEI) for pain relief. METHODS: The records of 107 patients who had been given CEI between September 2017 and January 2018 were retrospectively analyzed. The inclusion criteria were age > 18 years, > 3-month history of low back pain, and diagnosis of lumbar disc disease by magnetic resonance imaging. The epidural injection solution consisted of 2 mL of betamethasone sodium and 8 mL saline. Follow-up examinations were conducted 3 and 6 months post-injection and the patients were evaluated using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: The most common disc pathology was at the L4–L5 level. The VAS and ODI scores indicated significantly reduced pain at 3 and 6 months compared with the pre-injection baseline. Two patients experienced total anesthesia and paresis of the lower limbs, but recovered fully after 2 weeks. Blood was aspirated during the injection in two patients, but second-attempt injections were successful in both cases. No other complications were observed. CONCLUSION: Our results suggest that the blind method is safe for administering CEI to patients with chronic low back pain in the absence of radiological screening and results in significant pain relief with improved functional capacity.

Objective: To evaluate the effects of antenatal steroid administration on neonatal outcomes in late preterm births. Methods: Demographic and neonatal data from women who gave birth between May 2018 and March 2021 at 34+0–36+6 weeks of gestation were screened from the information system of the hospital. The patients were assigned to two groups: those who were and those who were not given steroids. All parameters were compared between the two groups. Results: The 1-minute (9 versus 8) and 5-minute (10 versus 9) Apgar scores, need for a neonatal intensive care unit (NICU) stay (23.7% versus 27.8%), length of stay (Day) in the NICU (1.97 ± 0.24 versus 2.45 ± 0.16), rate of transient tachypnea of the newborn (3.3% versus 7.8%), respiratory distress syndrome (2.5% versus 5.2%), need for mechanical ventilation (1.2% versus 3.8%), and neonatal sepsis (1% versus 2.6%) were lower in the group that received betamethasone compared with the group that did not; the differences between the two groups were statistically significant. Conclusion: Based on the results of the present study, we believe that antenatal steroid administration would be beneficial before late preterm births occurring between 34+0 and 36+6 weeks of pregnancy, considering the significant reduction in various respiratory complications, especially in respiratory distress syndrome and the need for an NICU stay.

Aims: No study has evaluated the BET pharmacokinetics in twin pregnancies separated by chorionicity. The aim this study is to describe and compare the BET pharmacokinetic parameters in singleton, dichorionic (DC) and monochorionic (MC) twin pregnancies in the third trimester of pregnancy. Methods: Twenty-six pregnant women received an intramuscular dose of 6 mg of BET sodium phosphate plus 6 mg BET acetate. Serial blood samples were collected for 24 hours after the first intramuscular BET esters dose. BET plasma concentrations were quantified using a validated HPLC analytical method. BET pharmacokinetic parameters were obtained employing a non-compartment model, and were compared using ANOVA’s test with Tukey’s multiple comparisons test. Correlations between clinical features and pharmacokinetic parameters were analyzed using Pearson’s correlation. Preliminary data on the BET placental transfer were also presented. Results: The geometric mean (IC 95%) of AUC0-∞ 670.0 (504.3-805.2) vs 434.9 (311.2-539.6) ng.h/mL and the CL/F 18.38 (13.84-22.65) vs 29.40 (21.17-36.69) were significantly lower and higher, respectively, in DC twin pregnancies compared to singleton. Others pharmacokinetic parameters did not differ among the groups. Conclusions: Data from this study suggest that the presence of two fetoplacental units may increase the BET metabolism by CYP3A4 enzyme and increase its elimination. Pharmacokinetic-pharmacodynamic clinical studies are needed to investigate whether this BET pharmacokinetic changes have clinical repercussions for the newborns and require dose adjustment in DC twin pregnancies.

Plaque psoriasis is a common, chronic and relapsing inflammatory skin disease clinically characterized by erythema and scaling desquamation. As over 90% of psoriasis patients benefit from topical therapies, local treatments continue to play an eminent role in management strategies. One such topical treatment is the fixed dose combination of calcipotriol (CAL) and betamethasone dipropionate (BDP).Pooled analysis of two different phase 3 clinical trails to compare superiority regarding efficacy, safety and quality of life (QoL) between CAL/BDP PAD-cream and CAL/BDP TS.The data from two phase 3, multicentre, randomized, investigator-blind, active and vehicle-controlled trials enrolling patients with psoriasis were pooled and analysed. Investigational products included a CAL/BDP cream based on PAD™ Technology (PAD-cream) designed for high skin penetration and increased patient preference, an active control (marketed CAL/BDP topical suspension/gel, in the following abbreviated as CAL/BDP TS) and cream vehicle, which were applied once daily for 8 weeks.Efficacy and safety of the novel CAL/BDP PAD-cream formulation for the topical treatment of psoriasis demonstrated superiority for all efficacy end points after 8 weeks of treatment. PGA treatment success for CAL/BDP PAD-cream (43.2%) was greater than CAL/BDP TS (31.9%; P 0.0001), the mean per cent reduction in mPASI for CAL/BDP PAD-cream was 64.6% compared to 56.4% for CAL/BDP TS (P 0.0001) and DLQI 0/1 was obtained by 43.8% in the CAL/BDP PAD-cream group versus 34.2% in the CAL/BDP TS group (P = 0.0005). There was no adverse drug reaction reported with a frequency of1%, associated with the CAL/BDP PAD-cream.The novel fixed dose combination CAL/BDP PAD-cream offers greater efficacy, superior patient QoL and equivalent favourable safety for the topical treatment of psoriasis, in comparison to the currently available topical suspension/gel.

The administration of antenatal corticosteroids has been widely adopted as the standard of care in the management of pregnancies at risk for preterm delivery before 37 weeks of gestation, with the primary goal of reducing neonatal morbidity. However, the long-term risks associated with antenatal corticosteroid use remain uncertain. The purpose of this Consult is to review the current literature on the benefits and risks of antenatal corticosteroid use in the late preterm period and to provide recommendations based on the available evidence. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we recommend offering a single course of antenatal corticosteroids (2 doses of 12 mg of intramuscular betamethasone 24 hours apart) to patients who meet the inclusion criteria of the Antenatal Late Preterm Steroids trial, ie, those with a singleton pregnancy between 34 0/7 and 36 6/7 weeks of gestation who are at high risk of preterm birth within the next 7 days and before 37 weeks of gestation (GRADE 1A); (2) we suggest consideration for the use of antenatal corticosteroids in select populations not included in the original Antenatal Late Preterm Steroids trial, such as patients with multiple gestations reduced to a singleton gestation on or after 14 0/7 weeks of gestation, patients with fetal anomalies, or those who are expected to deliver in

Objective While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not a standard practice in the United States. We aim to determine if the administration of antenatal corticosteroids for fetal lung maturation within 1 week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity. Study Design Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within 1 week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn, and neonatal intensive care unit admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using t-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher's exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression. Results History of preterm birth was significantly higher in those who received antenatal corticosteroids compared with those who did not (24.0 vs. 10.9%, p = 0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared with those who were exposed (RR 4.1, 95% CI 1.2–13.7; p = 0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5–89.0, p Conclusion Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared with routine management. Key Points

Oral sub mucous fibrosis (OSF) is commonly seen in the Indian subcontinent affecting individuals of all age groups. It is a potentially malignant disorder caused almost exclusively by the use of smokeless form of tobacco products. The malignant transformation rates vary from 3 to 19%. The standard of care (SOC) in managing OSF includes habit cessation, intralesional steroid and hyaluronidase injections, and mouth opening exercises. To evaluate the efficacy of rebamipide to reduce the oral burning sensation associated with OSMF as compared to coventional Betamethasone intralesional injection.After providing information about the study and obtaining consent, these individuals were divided into two groups of 15 each using random sampling method. Patients in the rebamipide group (group I) were prescribed 100 mg tablets of rebamipide thrice a day for 21 days. The other 15 patients (group II) were given SOC, intralesional betamethasone injection 4 mg/mL once a week for 4 weeks. Visual analog scale (VAS) with 11 points (0–10) was used to assess burning sensation in the first visit, and change in the burning sensation was assessed after every 7th day on VAS in both the groups.: The improvement in the VAS score in each visit was significant (p < 0.05) in the 1st, 2nd, 3rd, and 4th visit. The VAS score between the 4th and 5th visit failed to reach a statistically significant level (p > 0.05). The VAS score was significantly different between the rebamipide and betamethasone group (p > 0.05) in third & fourth visit. Our results showed that rebamipide was equally efficacious if not better than the betamethasone intralesional injections.

Preterm delivery represents the major cause of neonatal morbidity and mortality. Respiratory morbidity is the primary cause of early neonatal mortality and disability. The administration of antenatal corticosteroids, in cases of imminent preterm delivery, can enhance fetal lung maturation and reduce the incidence of respiratory distress syndrome, leading to improved neonatal outcomes. The scope of this narrative review was to synthesize available evidence on the efficacy and safety of corticosteroids' administration during antenatal period, in cases of anticipated preterm delivery. Hence, for those cases, a single course of antenatal corticosteroids from 24 up to 34 gestational weeks should be offered. Betamethasone and dexamethasone are the most widely used drugs, with similar effectiveness and a recommended dosage of 24mg in divided doses, over a 24- hour period. However, there is an ongoing debate regarding the gestational age of administration. Some obstetric societies recommend their administration even at 22 weeks of gestation. Conflicting is also their usefulness in late preterm cases (between 34 and 37 weeks) or in cases of elective cesarean delivery at term. The use of repeated courses of corticosteroids may be considered in specific cases, however, concerns on the long-term outcomes of repeated courses beyond 34 gestational weeks have been raised.

A descriptive observational and cross-sectional study was carried out. The clinical characteristics, etiologic agents, treatments and outcome of 33 cases of tinea capitis in the Mycology Unit at Francisco J. Muniz Hospital of Buenos Aires City between January 2015 and December 2019 were analyzed. The median age of the patients was 7 years, 21 of whom were male, 3 were HIV-positive and 22 had pets. The isolated etiologic agents were the following: Microsporum canis in 22 cases, Trichophyton tonsurans in 8, Nannizzia gypsea in 2 and Trichophyton mentagrophytes in one patient. Suppurative tinea capitis (krion Celsi) was detected in 10 cases and the same number of patients presented other skin locations of their dermatophytosis in addition to those in the scalp. Twenty-one cases were orally treated with griseofulvin and 12 with terbinafine. Those patients with suppurative tinea capitis received drops of betamethasone by mouth besides the antifungal drugs. All patients had good clinical and mycological response to the treatments, all lesions disappeared, and mycological studies turned negative by the end of the treatments. We conclude that both drugs were effective for the treatment of tinea capitis; however, lesions in those cases receiving terbinafine involuted more slowly.

For women with a singleton or a multiple pregnancy in situations where active neonatal care is appropriate, and for whom preterm birth is anticipated between 24 and 34 weeks of gestation, one course of prenatal corticosteroids should ideally be offered 18 to 72 h before preterm birth is expected to improve outcomes for the baby. However, if preterm birth is expected within 18 h, prenatal corticosteroids should still be administered. One course of corticosteroids includes two doses of betamethasone acetate/phosphate 12 mg IM 24 h apart, or two doses of dexamethasone phosphate 12 mg IM 24 h apart. In women in whom preterm birth is expected within 72 h and who have had one course of corticosteroids more than a week previously, one single additional course of prenatal corticosteroids could be given at risk of imminent delivery. Prenatal corticosteroids should not be offered routinely to women in whom late preterm birth between 34 and 36 weeks is anticipated. In addition, prenatal corticosteroids should not be given routinely before cesarean delivery at term. Neither should prenatal corticosteroids be given "just in case". Instead, prenatal steroid administration should be reserved for women for whom preterm birth is expected within no more than 7 days, based on the woman's symptoms or an accurate predictive test.

Wenyun Ting,1,&ast; Yuming Chong,1,2,&ast; Jing Xu,2 Jiuzuo Huang,1 Nanze Yu,1 Zhifei Liu1 1Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China; 2Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhifei LiuDepartment of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of ChinaEmail liuzfpumch@163.comPurpose: Keloids are caused by uncontrolled excessive proliferation of fibrous tissue. Multiple treatment strategies including steroid injection, surgical excision, laser therapy and radiation therapy have been reported. Few studies have evaluated the performance of plasma skin regeneration (PSR) in the treatment of keloid. This study aimed to evaluate the effectiveness of PSR combined with radiation therapy for keloids on different body parts.Patients and Methods: A total of 71 patients with 98 keloids were enrolled in this study. Keloids < 4 mm thick underwent single-dose PSR, while keloids ≥ 4 mm thick were administered compound betamethasone injection beforehand. Radiation therapy was administered after 24 hours and again 7 days later after PSR. The outcome was evaluated using the patient and observer scar assessment scale at 12 months post-treatment.Results: Patient-reported average scores for all keloids significantly decreased from 35.05± 9.94 to 21.84± 7.04 (p < 0.05). Keloids on face and neck, chest, and back responded better than those on shoulders and limbs. The recurrence rate was observed to be 15.3% (15 out of 98). Adverse effects were mild.Conclusion: PSR combined with radiation therapy is an effective and safe strategy to treat keloids. Location could be a factor that affects curative effects.Keywords: keloid, plasma skin regeneration, radiation therapy, POSAS, recurrence rate

We have previously developed a maternal‐fetal physiologically‐based pharmacokinetic (m‐f PBPK) model to dynamically predict (and verify) fetal‐maternal exposure to drugs that passively diffuse across the placenta. Here, we extended the application of this model to dynamically predict fetal exposure to drugs which are effluxed by placental P‐glycoprotein, namely the antenatal corticosteroids (ACS; dexamethasone [DEX], and betamethasone [BET]). To do so, we estimated both the placental P‐gp mediated efflux clearance (CL) and the passive diffusion CL of the ACS. The efficacy and toxicity of the currently used maternal ACS dosing regimens to prevent neonatal respiratory distress syndrome could be improved by altering their dosing regimens. Therefore, to illustrate the utility of our m‐f PBPK model, we used it to design alternative dosing regimens of DEX and BET that could potentially improve their efficacy and reduce their toxicity. The redesigned dosing regimens are convenient to administer, maintain maternal‐fetal exposure (area under the concentration‐time curve [AUC]) or maximum plasma concentration (Cmax) or both (DEX and BET) or minimize maternal exposure while maintaining fetal drug plasma concentrations above the minimum therapeutic threshold of 1 ng/ml for 48 h (BET only; based on efficacy data in sheep). To our knowledge, this is the first study to dynamically predict fetal plasma concentrations of placental P‐gp effluxed drugs. Our approach and our m‐f PBPK model could be used in the future to predict maternal‐fetal exposure to any drug and to design alternative dosing regimens of the drug.

Objective To study the clinical efficacy, recurrence rate and safety of 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) combined with microneedle or CO2 lattice laser (CO2FL), in comparison with intrascar betamethasone injection in the treatment of hypertrophic acne scar. Methods Fifty-two patients with hypertrophic acne scars at the mandibular angle were enrolled and assigned to different therapy groups. Sixteen patients were treated with microneedle-assisted incorporation of ALA. Twenty-eight patients underwent CO2FL-assisted incorporation of ALA. Eight patients received standard therapy with intrascar injection of glucocorticoid. Two dermatologists, blinded to the therapy groups, independently evaluated the scars in all patients using the average value of the Vancouver Scar Scale score, which was treated as an integer variable. Results After three rounds of treatment, there was no significant difference in therapeutic effective rate among the microneedle, laser and topical glucocorticoid groups (93.75% vs 100% vs 100%, P = .855). One out of 16 patients (6.25%) in the microneedle group, no patient (0%) in the laser group and two out of eight patients (25%) in the topical glucocorticoid group had recurrence. The laser group showed a higher rate of adverse effects, which were usually mild and reversible, except for pigmentation. Adverse reactions could be completely subsided within 3 weeks. Conclusions Either CO2FL or microneedle combined ALA-PDT for hypertrophic scar, as to topical glucocorticoid therapy, showed equivalent clinical effects but lower recurrence rate within 6 months of follow-up period.

Background: Psoriasis is a chronic inflammatory immune-mediated disease characterized by an increased rate of keratinocyte division. The results of recent studies have made it possible to establish that the cytokines of the IL-36 family occupy a significant place in the initiation and regulation of the inflammatory process in psoriasis. IL-36 is in an inactive form and proteolytic processing is required for its activation in the skin, which is possible with the participation of neutrophilic serine proteases. Localization of these enzymes in the upper layers of the epidermis suggests the clinical efficacy of a topical targeted drug that inhibits serine proteases, sivelestat. On the basis of this active substance, we have created a drug in an external dosage form and conducted an experimental study of its effectiveness on a laboratory model of psoriasis. Aims: to evaluate the therapeutic efficacy of sivelestat in a laboratory model of imiquimod-induced psoriasis. Materials and methods: In the experiment, 40 inbred BALB/c mice were used, which were randomized into 4 groups of 10 each. An imiquimod-induced model of psoriasis was used. Mice of group No. I - without therapy (control), No. II - ointment (vaseline) containing 1% sivelestat, No. III - cream (lanolin + olive oil + water in equal proportions) containing 1% sivelestat, No. IV - betamethasone cream dipropionate 0.05%. Clinical assessment of skin rashes was performed using the PASI-modified method (mPASI), as well as histological and immunohistochemical examination of the skin. Results: When evaluating clinical manifestations, it was found that the total mPASI index when using sivelestat cream decreased by 50%, and sivelestat ointment - by 36%. The histological examination showed that the thickness of the epidermis in the groups where the therapy was applied was 2.4-3.6 times less than in the control group. An immunohistochemical study of the skin found that after treatment with sivelestat, the number of CD3 + cells in the skin was 1.8-2.2 times less, and the level of proliferative activity (Ki-67 + cells) was 2.3-2.9 times less. lower than in the group without therapy Conclusions: On a laboratory model of imiquimod-induced psoriasis, it was found that a serine protease inhibitor (sivelestat) has a therapeutic efficacy comparable to a strong topical glucocorticosteroid drug (betamethasone dipropionate 0.05%). A pronounced resolution of the elements of the skin rash, a reduction in the thickness of the epidermis, a decrease in skin infiltration with T-lymphocytes and a normalization of the rate of cell division of the epidermis and dermis are shown. Suppression of the activity of IL-36-mediated inflammation in the skin by means of topical inhibitors of serine proteases is a promising new direction in the treatment of patients with psoriasis.

Background and aim Psoriasis is a skin disorder that leads to chronic inflammation and keratinocyte hyperproliferation. Sericin extracted from Bombyx mori cocoon has been demonstrated to possess anti-inflammatory and antiproliferative properties, which makes it a viable candidate for psoriasis treatment. This study aimed to investigate the therapeutic effect of sericin on skin psoriasis at the cellular level. Experimental procedure Imiquimod-induced skin psoriasis was established in Sprague-Dawley rats. The rats with psoriasis were divided into 6 groups (n = 5), namely, one nontreatment control group and five groups that received different treatments: sericin (2.5%, 5%, and 10%), 0.1% betamethasone, 3 μg/ml calcitriol. The treatments were administered twice daily for 7 days, followed by skin sample collection. Epidermal improvement and protein expression were evaluated using histopathological and label-free proteomic approaches and immunohistochemistry. Results and conclusion Compared with other concentrations, 10% sericin had the desired effect of improving skin psoriasis as shown by reduced epidermal thickness, similar to the effects of betamethasone and calcitriol treatments. Anti-inflammatory activity was shown by decreased C–C motif chemokine 20 (CCL20) expression posttreatment. Proteomic observation revealed that sericin reduced cytokine production by Th17 cells by interfering with the JAK-STAT signaling pathway. Sericin treatment also resulted in a modulated immune response via upregulation of Galectin-3 (Lgals3) and downregulation of Sphingosine-1-phosphate lyase1 (Sgpl1). Sericin improved epithelial cell proliferation by upregulating Nucleoside diphosphate kinase B (Nme2). Therefore, the therapeutic effect of sericin on psoriasis correlated with a reduced immune response and attenuated epidermal proliferation, making sericin a promising approach for skin psoriasis treatment., Graphical abstract Image 1, Highlights • Sericin extracted from Bombyx mori cocoon ameliorates skin psoriasis. • Sericin modulated immune response and epithelial cell proliferation in skin-psoriasis rat model. • Sericin upregulated Lgals3 and downregulated Sgpl1 in immune system. • Downregulated Nme2 of skin psoriasis by sericin treatment reduces epithelial cell proliferation.

Background Psoriasis vulgaris is not easy to manage, even when mild. Knowledge of the efficacy of most topical therapies in this population is limited. Objective To assess the efficacy of calcipotriene 0.005% plus betamethasone dipropionate 0.064% (Cal/BD) foam in patients with mild psoriasis. Methods Post hoc analysis was performed on pooled data for subjects with mild psoriasis at baseline from 2 Phase 3 and 1 Phase 2 clinical trials. All subjects applied Cal/BD foam or vehicle foam once daily for at least 4 weeks. Efficacy assessments included treatment success (defined as IGA=0), mPASI, BSA, and the composite IGAeBSA score. Results Of the 848 subjects, 164 had mild psoriasis at baseline. Within this subpopulation of mild subjects, Cal/BD foam demonstrated significant efficacy over vehicle at week 4 in terms of the proportion of subjects achieving complete clearance of visible lesions (IGA=0). Significant improvements were also observed for mPASI, BSA, and IGAeBSA score. Limitations These post hoc analyses need to be confirmed with prospective studies. Conclusion Once-daily Cal/BD foam for 4 weeks demonstrated effectiveness in treating subjects with mild psoriasis, a population in which demonstration of treatment success can be difficult, because of the requirement for complete clearance of visible disease. Clinicaltrials.gov: NCT02132936, NCT01866163, and NCT01536938 J Drugs Dermatol. 2021;20(8):822-828. doi:10.36849/JDD.5743.

One of the most frequent causes of neonatal mortality or NICU admission of neonates especially in premature infants is Neonatal Respiratory Distress Syndrome (NRDS). Antenatal steroids are the most important and widely utilized interventions for improvement of neonatal outcomes like reducing incidence of respiratory distress syndrome (RDS), reducing neonatal NICU (neonatal intensive care unit) admission rates and also improve outcomes of pre-term infants. Antenatal steroids (ANS) like betamethasone 12 mg are given at 24 hourly IM at 28-34 weeks of gestation to mother. For administration of corticosteroids at less than 24 weeks of gestational age decision should be made at a senior level by taking all clinical aspects into consideration.To observe the effect of Betamethasone administration IM in pregnant women at risk of pre-term delivery and fetal outcomes in terms of development of Respiratory Distress Syndrome (RDS) and Neonatal Intensive Care Unit (NICU) admission rate by giving it between 28 to 34 weeks of gestation.Antenatal corticosteroids (betamethasone) play an important role for prevention of respiratory distress syndrome and reducing NICU admission rate of new borns and also reduce neonatal mortality and morbidity but benefits related to the time between administration of corticosteroid and delivery needed to be explored. Benefits of the injection betamethasone administration IM 12 mg between 24 hours and seven days on pre-term delivery has been established.,This was prospective study conducted in private setup from November 2020 to March 2021 in Scientific Research Institute, Surendranagar, Gujarat, India. Study comprised of 100 women with single tone pregnancies (28 – 36 weeks gestational age) in age group of 19 – 33 years not in labour, but at risk for pre-term delivery based on fetal or maternal indications. These pregnant women were treated with two doses of 12 mg Betamethasone Intramuscularly apart of 24 hourly for maturation of fetal lungs.Antenatal corticosteroids like betamethasone have a significant benefit on neonatal outcome even if used after 34 weeks of pregnancy. This was given prophylactically to those who are known to have increased risk of pre-term labour. Antenatal steroid like betamethasone 12 mg IM is also of benefit to reduce neonatal respiratory distress syndrome (NRDS) and NICU admission rates by giving it at 28-34 weeks of gestational age.

BackgroundBetamethasone (BMZ) is used to accelerate fetal lung maturation in women with threatened preterm birth, but its efficacy is variable and limited by the lack of patient individualization in its dosing and administration. To determine sources of variability and potential opportunities for individualization of therapy, the objective of this study was to evaluate maternal factors associated with development of neonatal respiratory distress syndrome (RDS) in a cohort of women who received betamethasone.MethodsThis study prospectively enrolled women, gestational ages 23–34 weeks, who received betamethasone for threatened preterm birth. Maternal demographics, prenatal history, and neonatal outcomes were abstracted from hospital records. RDS was the primary outcome. Associations between RDS diagnosis and maternal demographics, prenatal history, and betamethasone dosing were evaluated in a case-control analysis and multivariable regression adjusted for gestational age at delivery. Secondary analyses limited the cohort to women who delivered within 1 or 2 weeks of betamethasone dosing.ResultsOf 209 deliveries, 90 (43 %) resulted in neonatal RDS. Within the overall cohort and controlling for gestational age at birth, RDS was only associated with cesarean births compared to vaginal births (adjusted OR 1.17 [1.06–1.29]). Route of delivery was also the only significant factor related to RDS in the 83 neonates delivered within 7 days of BMZ dosing. However, among 101 deliveries within 14 days of betamethasone dosing and controlling for gestational age at birth, women who experienced preterm premature rupture of membranes (PPROM) had lower RDS rates than those without PPROM (57.9 % vs. 80.2 %, adjusted OR 0.81 [0.67–0.99]). Maternal age, BMI, race, and ethnicity were not associated with RDS in the regression models.ConclusionsOf maternal characteristics analyzed, only delivery by cesarean was associated with neonatal RDS after antenatal betamethasone use.

Objective In the antenatal late preterm steroids (ALPS) trial betamethasone significantly decreased short-term neonatal respiratory morbidity but increased the risk of neonatal hypoglycemia, diagnosed only categorically ( Study Design Secondary analysis of infants from ALPS, a multicenter trial randomizing women at risk for late preterm delivery to betamethasone or placebo. This study was a reabstraction of all available charts from the parent trial, all of which were requested. Unreviewed charts included those lost to follow-up or from sites not participating in the reabstraction. Duration of hypoglycemia ( Results Of 2,831 randomized, 2,609 (92.2%) were included. There were 387 (29.3%) and 223 (17.3%) with hypoglycemia in the betamethasone and placebo groups, respectively (relative risk [RR]: 1.69, 95% confidence interval [CI]: 1.46–1.96). Hypoglycemia generally occurred in the first 24 hours in both groups: 374/385 (97.1%) in the betamethasone group and 214/222 (96.4%) in the placebo group (p = 0.63). Of 387 neonates with hypoglycemia in the betamethasone group, 132 (34.1%) received treatment, while 73/223 (32.7%) received treatment in placebo group (p = 0.73). The lowest recorded blood sugar was similar between groups. Most hypoglycemia resolved by 24 hours in both (93.0 vs. 89.3% in the betamethasone and placebo groups, respectively, p = 0.18). Among infants with hypoglycemia in the first 24 hours, the time to resolution was shorter in the betamethasone group (2.80 [interquartile range: 2.03–7.03) vs. 3.74 (interquartile range: 2.15–15.08) hours; p = 0.002]. Persistence for >72 hours was rare and similar in both groups, nine (2.4%, betamethasone) and four (1.9%, placebo, p = 0.18). Conclusion In this cohort, hypoglycemia was transient and most received no treatment, with a quicker resolution in the betamethasone group. Prolonged hypoglycemia was uncommon irrespective of steroid exposure. Key Points

While many patients with psoriasis are candidates for topical agents, long-term treatment effects are unclear. This systematic review evaluated global findings from clinical trials and real-world studies of topical calcipotriol and the two-compound formulation of calcipotriol and betamethasone dipropionate for mild-to-moderate plaque psoriasis (including scalp psoriasis). PubMed, Embase and MEDLINE were searched for relevant English-language publications along with Chinese, Japanese, Korean and Latin American publication databases. Identified articles were screened by title and abstract against predefined inclusion/exclusion criteria. A narrative synthesis of key efficacy and safety findings from the full papers of selected publications was developed. Thirty-seven relevant papers were identified (25 English, 11 Chinese and one Japanese-language study) including 28 randomized controlled trials. While there was significant heterogeneity in study length, treatment intensity and clinical measures, following a critical review of the published data combined with expert opinion, the following clinical practice recommendations were agreed in order to assist healthcare providers: in adults, long-term treatment with calcipotriol/betamethasone dipropionate is well tolerated and efficacious for up to 1 year on an 'as needed' basis, and for up to 16 weeks on a fixed-treatment regimen. Calcipotriol is also well tolerated and efficacious when used long term (up to 52 weeks) 'as needed' and for up to 20 weeks on a fixed-treatment regimen. Used on an 'as needed' basis for up to 1 year, the safety and efficacy profile of fixed-dose combination calcipotriol/betamethasone dipropionate is more favorable than calcipotriol alone; regular consultation between patients and their dermatologist/primary care physician is required to review psoriasis symptoms and adjust treatment accordingly; a specific treatment goal should be agreed on initiation of topical agent(s) to determine when long-term treatment can begin or if a regimen change is warranted; and application frequency during the continued treatment phase should consider the patients' treatment expectations and goals.

Patient 1: Clinical Course Patient 1 was delivered via cesarean delivery at 25 5/7 weeks’ gestation in the setting of fetal bradycardia. The prenatal course was complicated by preterm premature rupture of membranes 16 days before delivery. The neonate’s mother had received 2 doses of betamethasone and adequate antibiotic treatment for positive group B Streptococcus status. The neonate had poor respiratory effort after birth and required intubation; his Apgar scores were 4 and 8 at 1 and 5 minutes of age, respectively. Soon after birth, he was critically ill with severe hypotension, which was attributed to possible sepsis requiring multiple inotropes; hydrocortisone was not needed. Ampicillin and gentamicin were initiated. He was initially given volume-control conventional ventilation at a rate of 30 breaths/min, positive end-expiratory pressure (PEEP) of 5 cm H20, tidal volume of 6 mL/kg, pressure support of 8 cm H2O, and fraction of inspired oxygen (Fio2) of 0.5. Because of worsening respiratory acidosis, he was transitioned to high-frequency oscillatory ventilation (requiring Fio2 1.0) and was started on inhaled nitric oxide within the first day after birth. In the setting of persistent hypotension, ceftazidime and azithromycin were also added to the antibiotic regimen. After the hypotension resolved, feedings were initiated 5 days after birth. The inhaled nitric oxide was weaned off on the sixth day after birth. Gentamicin was discontinued at 5 days of age, azithromycin was discontinued at 7 days of age, and ampicillin and ceftazidime were discontinued at 8 days of age. On the eighth day after birth when the neonate was taking 20 mL/kg of gastric feedings per day, his abdominal girth increased and he had an episode of nonbilious emesis. His abdomen was soft but tender to palpation. Abdominal radiography showed isolated gastric pneumatosis along the superior portion of the stomach …

Background The term temporomandibular joint disorders covers a broad spectrum of clinical issues related to joints and muscles in the orofacial area. Curcumin is a major bioactive component of turmeric and can be used as an oral medication to treat a wide variety of ailments including pain, rheumatoid arthritis, and cancer. This study intended to investigate the ameliorating effect of curcumin on tempromandibular joint experimentally induced arthritis. Methods Forty male Sprague-Dawley rats were randomly divided into four groups. Group 1 act as control negative, group 2, 3 and 4 were subjected to induction of arthritis by bilaterally local injection of 50 μL Freund’s complete adjuvant into TMJ. Group 2: rats were left untreated. Group 3: rats were daily treated with betamethasone (0.5 mg/ml/kg body weight) orally. Group 4: rats were daily treated with curcumin (200 mg/ml/kg body weight) orally. Histological preparation for H&E, immunohistochemistry stain for TGF-β and Interleukin-6 were measured in the sera of rats by enzyme linked immunosorbant assay using IL-6 ELISA kit. Results Group I revealed normal TMJ features. Group II showed thickening of disc, thinning of cartilage, disordered bone trabeculae. Group III and IV showed nearly normal thickness of disc and condylar cartilage, nearly normal arrangement of bone trabeculae. Conclusion Treatment with curcumin showed reduction of inflammatory cell infiltration, repair of bone and cartilage erosion as well as the betamethasone treated group. Conclusion the supplementation of curcumin has a promising protective effect on the degenerative changes in the experimental induced TMJ arthritis.

Psoriasis is one of the prototypic papulosquamous skin diseases characterized by erythematous papules or plaques. This disease is chronic in nature with a tendency to relapse. Betamethasone dipropionate binds to specific intracellular glucocorticoid receptors and subsequently binds to DNA to modify gene expression. The study duration was 6 weeks. A total of 60 study participants of both sexes diagnosed with mild to moderate psoriasis were included in the study. They were randomized into two groups. Group A – topical calcipotriol plus betamethasone treatment group consisting of 30 patients and Group B – topical betamethasone alone also consisting of 30 patients and a total of 28 patients in topical calcipotriol plus betamethasone treatment group and 28 patients in topical betamethasone group completed the study. A total of 98 patients were screened for this study, out of which 38 patients were excluded where 11 patients refused to participate and 27 patients didn’t meet the inclusion criteria of our study. These results shows that there is statistically significant percentage reduction in PASI score after 2 weeks (p=0.01) and 4weeks (p

Pyoderma gangrenosum (PG) is a rare skin disease of chronic course and a tendency for recurrence. Pathergy phenomenon, which is characterized by the rapid development of skin lesions at the site of a mechanical trauma, affects about 30% of patients with PG. However, this symptom is not pathognomonic for PG and may develop in other conditions including Behcet’s disease, Sweet syndrome and Crohn’s disease. In the current paper, we present a 25-year-old woman with an infiltrative lesion with a tendency for ulceration located in the interscapular region. Excision of the skin lesion led to the development of infiltration with small ulcerations at the site of surgical intervention. Clinical presentation corresponded to the classical pathergic reaction, which in turn raised the suspicion of PG. Therapy consisted of cyclosporin 5 mg/kg/day and topical ointment with 0.05% of betamethasone and 0.1% of gentamicin. Complete healing was observed after three weeks of treatment. We present the case in order to draw attention to the diagnostic significance of pathergy phenomenon in dermatology.

Introduction: Psoriasis is an inflammatory skin disease affecting approximately 3.2% of adults in the United States. The mainstay treatment for mild-to-moderate plaque psoriasis (the most common subtype and severity) is topical therapy. Areas covered:The fixed combination calcipotriol plus betamethasone dipropionate (BD) is an effective topical treatment for plaque psoriasis. Two therapies with separate actions–a Vitamin D analog and a high-potency topical corticosteroid–combined into a single medication allows for better efficacy and patient adherence. The treatment is available in ointment, gel, suspension, foam, and cream formulations. The authors elaborate on this and provide their expert perspectives. Expert opinion: Combination calcipotriol/BD offers several advantages over its separate product monotherapies, including better efficacy, safety, and ease of use. Newer calcipotriol/BD formulations include less messy vehicles, thus promoting improved adherence. Further data are needed on whether combination calcipotriol/BD will be cost-effective and whether insurers will place it in the treatment coverage algorithm. Due to its higher price, calcipotriol/BD will likely remain a second-line treatment option after generic topical corticosteroids.

BACKGROUND There is limited evidence supporting the use of alternative treatments for patients with nonstable vitiligo. OBJECTIVE This study aimed to review the effects of oral mini-pulse (OMP) therapy in the management of nonsegmental vitiligo. METHODS The following databases were searched between inception and May 2020 for relevant studies: Scopus, Web of Science, MEDLINE, and Embase. All randomized controlled trials that compared OMP therapy with any other active treatment or placebo for nonstable vitiligo were included. The Cochrane's risk of bias tool was used to evaluate the risk of bias (ROB) in selected studies, and the overall quality of evidence of each outcome was assessed using the Grading Recommendations, Assessment, Development, and Evaluations (GRADE) system. RESULTS Four studies met our selection criteria. All of them were conducted in India and included 246 patients. OMP therapy included betamethasone or dexamethasone. The duration of treatment was 6 months in all studies. Up to 32% of patients achieved a repigmentation rate of >75% when OMP therapy was administered as monotherapy. No difference was observed between OMP therapy and other treatments in arresting the disease, and weight gain was the most frequent adverse effect. The overall ROB in all included studies was relatively high because of the randomization process, outcome measurement and informed selection of outcomes. CONCLUSION Based on the findings of these studies, OMP therapy did not demonstrate additional value compared with other treatments. Hence, there is an urgent need to conduct high-quality clinical trials to evaluate this therapy.

To evaluate correlations between preoperative pain sensitivity and postoperative analgesic consumption together with pain perception shortly after arthroscopic partial meniscectomy in non-arthritic knees. Ninety-nine patients who underwent primary arthroscopic meniscectomy were prospectively divided into three postoperative treatment groups that were prescribed with betamethasone injection (at the end of surgery), oral celecoxib or rescue analgesia (control). Preoperative pain sensitivity was evaluated by pain sensitivity questionnaires (PSQ). Patients were followed for the first three postoperative weeks to evaluate knee injury and osteoarthritis outcome score (KOOS) pain scores and analgesics consumption. Statistical analysis included correlations among preoperative pain sensitivity, postoperative pain levels and analgesics consumption. A receiver operating characteristic curve was plotted to investigate the cutoff values of the PSQ score to predict insufficient postoperative pain reduction. There were no differences at baseline among all study groups in age, sex, BMI, level of activity, comorbidities and surgical findings. At the final follow-up, KOOS pain scores improved in all groups (p

Background and Objective: Psoriasis is an autoimmune skin disease involving cascading release of cytokines activated by the innate and acquired immune system. The increasing prevalence rate of psoriasis demands for more appropriate therapy. The existing chemical moiety is promising for better therapeutic outcome, but the selection of a proper channel for administration has to be reviewed. Hence there is a need to select the most appropriate dosage form and route of administration for improving the curative rate of psoriasis. Results: A total of 108 systematic reviews of research and review articles were conducted to make the manuscript comprehensible. The role of inflammatory mediators in the pathogenesis of the disease is discussed for a better understanding of the selection of pharmacotherapy. The older and newer therapeutic moiety with its mode of administration for psoriasis treatment has been discussed. With a comparative review on topical and oral administration of first-line drugs such as methotrexate (MTX), cyclosporine (CsA), and betamethasone, its benefits-liabilities in the selected routes were accounted for. Emphasis has also been paid on advanced nanocarriers for dermatologic applications. Conclusion: For a better therapeutic outcome, proper selection of drug moiety with its appropriate administration is the major requisite. With the advent of nanotechnology, the development of nanocarrier for dermatologic application has been successfully demonstrated in positioning the systemically administrated drug into topical targeted delivery. In a nutshell, to achieve successful treatment strategies towards psoriasis, there is a need to focus on the development of stable, non-toxic nanocarrier for topical delivery. Inclusion of the existing orally administered drug moiety into nanocarriers for topical delivery is proposed in order to enhance therapeutics payload with reduced side effects which serves as a better treatment approach for relief of the psoriasis condition.

Background Knee osteoarthritis nonoperative management options remain limited. Our aim is to define the current American Association of Hip and Knee Surgeons (AAHKS) members’ practices and perceptions in terms of the frequency, formulation, use of concomitant aspiration, maximum lifetime number of injections, efficacy, interval between injection and surgery and complication rates. Methods A 22-question survey based on Likert scale response anchors was approved and distributed by the AAHKS Research Committee to its membership by email during the Spring 2019 meeting. Data were managed with REDCap software. Results Membership response totaled 537 of 2365 (22.7%) members. Highlights include every respondent using intra-articular corticosteroid injections (ICIs) in their practice, and most use a three-month minimum interval, although the preferred interval is longer. Near consensus was found waiting three months before surgery. There was a great variability in the number of injections allowed, and injections before surgery were very common. Nearly all responders use a local anesthetic mixture with the cortisone injection, but there was great variation in corticosteroid type: methylprednisolone (42%), triamcinolone (41%), betamethasone (13.3%), and dexamethasone (3.7%). Conclusion The results of our survey indicate the majority of the AAHKS members who completed the survey use ICIs routinely for treatment of knee osteoarthritis. There was near consensus in ICIs, which is effective with decreasing efficacy over serial injections, and an absolute minimum interval between injections was believed by most to be three months with no clearly defined lifetime limit and strong consensus for a three-month preoperative interval. The formulation of steroid, local anesthetic, and skin preparation technique varied greatly.

Background We report a case of pulmonary edema induced by tocolytic agents that was successfully managed with noninvasive positive-pressure ventilation (NPPV) and resulted in extended gestation. Case presentation A 36-year-old Japanese pregnant woman received tocolytic therapy with ritodrine hydrochloride, magnesium sulfate, nifedipine, and betamethasone from 28 weeks of gestation. She developed respiratory failure. and her chest X-ray showed enlarged pulmonary vascular shadows. At 29 weeks and 1 day of gestation, she was diagnosed with pulmonary edema induced by tocolytic agents. Because respiratory failure worsened 2 days after ritodrine hydrochloride and magnesium sulfate were stopped, NPPV was initiated. Her respiratory status improved and she was weaned off of NPPV after 3 days. She underwent cesarean section because of breech presentation at 30 weeks and 0 days of gestation due to initiation of labor pains. Conclusions NPPV can be safely administered in cases of tocolytic agent-induced pulmonary edema during pregnancy.

The fixed-dose combination calcipotriol (Cal; 50 µg/g) plus betamethasone dipropionate (BD; 0.5 mg/g) ointment and gel formulations have well-established efficacy profiles in the treatment of psoriasis vulgaris (chronic plaque psoriasis); this combination has been shown to produce favourable outcomes versus either monotherapy. To improve upon the efficacy and cosmetic acceptability of these treatments Cal/BD foam was developed, demonstrating superior efficacy in Phase II/III studies compared with either of its monocomponents, Cal/BD ointment, Cal/BD gel and various other therapies for the treatment of psoriasis. Multiple outcome measures were evaluated in the clinical studies, including physician's global assessment of disease severity and modified psoriasis area and severity index. Of note, 38-55% of patients across studies achieved a physician's global assessment of 'clear' or 'almost clear' after 4 weeks of Cal/BD treatment. This superior efficacy was not associated with an increased frequency or severity of adverse events, and there was no evidence for dysregulation of the hypothalamic-pituitary-adrenal axis or calcium homeostasis. Overall, Cal/BD foam was efficacious, with a good tolerability profile consistent with established Cal/BD formulations.

The physical symptoms of psoriasis vulgaris (chronic plaque psoriasis), such as itch and itch‐related sleep loss, and the psychological impact of visible plaques on the body, all contribute to significantly reduced health‐related quality of life (HRQoL) in patients with psoriasis. In fact, the deterioration of HRQoL in patients with psoriasis is similar to patients with other chronic conditions, such as cancer and cardiovascular diseases. Rapid and effective improvements in HRQoL and itch‐related outcomes would therefore be highly valued by patients and may even improve adherence to treatment. In this article, we summarise previously published data assessing the impact of fixed‐dose combination calcipotriol 50 µg/g plus betamethasone dipropionate 0.5 mg/g cutaneous foam (Cal/BD foam) on itch relief, quality of sleep, onset of action and HRQoL. Findings across multiple analyses indicate that Cal/BD foam provides significant improvements in itch, itch‐related sleep loss and HRQoL compared with vehicle foam or Cal/BD gel comparators. Additionally, the benefits of Cal/BD foam were recorded earlier than these comparators, often within 1 week of treatment, indicating a rapid onset of action. With the published data to hand, it is clear that Cal/BD foam provides significant improvements in the outcomes that matter most to patients and should be considered an effective topical treatment for psoriasis., Video abstract

Erythema annulare centrifugum (EAC) is a rare erythema characterized by erythematous and urticarial papules or annular plaques that enlarges centrifugally. The lesions usually involve the thighs and the legs. Several disorders are occasionally associated with EAC, infections, including mycoses, bacteria, or viruses and drugs have also been regarded as possible causes of this eruption. We present a 42-year-old dark-skinned woman affected by recurrent EAC that appeared secondary to influenza type A (H1N1). Histopathology showed a superficial form of EAC. In our case, a previous cytomegalovirus and Epstein-Barr virus (EBV) infection were identified and no underlying other diseases were found. Clarithromycin with calcipotriol betamethasone treatment was temporarily efficacious. In the last 3 years, the lesions started to appear every 2 weeks and tended to regress with local treatment after a variable period. We believe that the latent cytomegalovirus and the reactivity induced by EBV combined with influenza can determine, in our case, a cell mediate cutaneous immune response, which leads to the peculiar inflammatory disease known as EAC.

BACKGROUND AND OBJECTIVES Wheezing is one of the most common reasons for the presentation of children to primary care or the emergency ward, before 7 years of age. Current guidelines recommend a short course of oral corticosteroids (OCS) for those children with a wheezing attack severe enough to require hospitalization. However, the optimal choice of therapy is controversial. We aimed to compare the efficacy of betamethasone to that of dexamethasone in achieving clinical response in preschool children requiring hospitalization for an acute wheezing attack. METHODS This was a retrospective study. Medical records of healthy children without significant comorbidities between 1 and 7 years of age (n = 234) admitted with a moderate-severity acute wheezing attack to two pediatric wards between 2014 and 2018 were included. All children were treated with either betamethasone or dexamethasone exclusively during the hospitalization. The primary outcome of interest was the length of hospital stay (LOS). RESULTS The demographic parameters and the clinical severity of wheezing episodes were similar in the two study groups, as was the LOS. However, the dexamethasone cumulative dose used during hospitalization was significantly larger than the betamethasone cumulative dose (3.76 (1.88-5.64) vs. 1.86 (1.24-3.1) mg/kg of prednisone-equivalent dose, p

BACKGROUND Nail psoriasis is a common and potentially debilitating condition for which no effective and safe nonsystemic therapy is currently available. Recently, laser-assisted drug delivery (LADD) is being increasingly used to facilitate transcutaneous penetration of topical treatments. OBJECTIVES We set to assess the efficacy and safety of combined pulse-dye laser and fractional CO2 laser-assisted betamethasonecalcipotriol gel delivery for the treatment of nail psoriasis. MATERIAL AND METHODS We conducted a prospective, intrapatient comparative study in a series of 22 patients with bilateral fingernail psoriasis. Nails on the randomized hand were treated with 3 monthly sessions of pulse-dye laser to the proximal and lateral nail folds followed by fractional ablative CO2 laser to the nail plate. Between treatments and one month following the last treatment, the participants applied betamethasone propionate-calcipotriol gel once daily to the nail plate. Clinical outcome was ascertained using nails photography, the Nail Psoriasis Severity Index (NAPSI) and patient satisfaction. RESULTS Seventeen completed the study. Three participants withdrew from the study because of treatment-associated pain. Treatment was associated with a statistically significant improvement of the NAPSI scale (p < .002). Patient satisfaction was high. CONCLUSION Combined PDL and fractional ablative CO2-LADD of betamethasone-calcipotriol gel should be considered for the treatment of nail psoriasis.

Glaucoma is a leading cause of irreversible blindness worldwide. This study evaluates the reduction of intraocular pressure (IOP) induced by C. cicadae mycelia extract in a steroid-induced rat model of glaucoma. Cordyceps cicadae mycelia is a well-known and valued traditional Chinese herbal medicine. C. cicadae mycelia were cultured using a liquid fermentation technique. The harvested C. cicadae mycelia were then lyophilized and extracted with two solvents, water and ethanol. The aqueous extract (CCM-DW) and ethanolic extract (CCM-EtOH) of the mycelia were obtained through lyophilization. Sprague Dawley rats were randomly divided into four groups (n = 6 in each group): a normal group, a control group, and experimental groups treated with CCM-DW, or CCM-EtOH (both at 50 mg/kg/body weight). Except for those in the normal group, all rats received a subconjunctival injection of betamethasone to induce high IOP. The rats in the experimental groups received a daily administration of CCM by oral gavage for four consecutive weeks. IOP reduction is the known treatment for glaucoma. The results revealed that steroid treatment caused a significant increase in the animals' IOP (control group). Elevated IOP decreased significantly after treatment with CCM-DW and CCM-EtOH (p < 0.01), and CCM-DW was more effective than CCM-EtOH. CCM-DW and CCM-EtOH were capable of causing significant decreases in high IOP-induced lesions in pathological studies in which it was shown that the efficacy of CCM-DW surpassed that of CCM-EtOH. After CCM-DW administration for 28 days, there were significant decreases in malondialdehyde and lactate dehydrogenase levels and significant increases in catalase, superoxide dismutase, and glutathione peroxidase levels. In summary, C. cicadae mycelia may be beneficial for preventing or treating glaucoma due to its significant IOP-lowering and antioxidant activities.

OBJECTIVE The aim: The study was aimed to compare the efficiency of intrathyroid steroid injection to oral steroid intake in patients with subacute thyroiditis. PATIENTS AND METHODS Materials and methods: 32 patients with subacute thyroiditis with insufficient result from NSAIDs treatment were randomly divided into two groups. The 1st group received two intrathyroid steroid injections, the 2nd group received oral prednisone. The results of the treatment were evaluated via ultrasound and evaluation of ESR and CRP at 0, 2, 4, 8 and 16 weeks of treatment. RESULTS Results: Patients of the 1st group showed much faster result at the ultrasound compared to the 2nd group: mean decrease in hypoechogenity area 44,42% vs 16,35% at week 2, p < 0,001; 93,29% vs 75,98% at week 4, p < 0,001; 97,8% vs 95,24% at week 8, p = 0,4; mean decrease in ESR 66,34% vs 51,92% at week 2, p = 0,023; 84,43% vs 74,94% at week 4, p = 0,023; mean decrease in CRP 26,53% vs 20,77% at week 2, p = 0,024, 33,77% vs 29,98%, at week 4, p = 0,026. No side effects were noted during the treatment of patients of the 1st group. CONCLUSION Conclusions: Compared to oral steroid intake intrathyroid steroid injection is faster, safer and generally better tolerated by patients.

Curcumin is a traditionally used spice with a potential to treat various inflammatory diseases including arthritis. This study was aimed at observing curcumin’s effects on the histopathological progression and interleukin-1β (IL-1β) levels in collagen�induced arthritis (CIA). Thirty male Sprague-Dawley rats (150+50 g) were divided into five random groups. A group was assigned as the normal control (CTRL), while the remaining were subcutaneously immunised with 150 µg of collagen emulsion on day 0. CTRL and CIA-Curcumin-d0 groups were supplemented daily with olive oil (1 ml/kg) and curcumin (110 mg/ml/kg) from day 0, respectively. The CIA-OV (negative control), CIA-Beta and CIA-Curcumin-d14 groups were given daily supplementation of olive oil (1 ml/kg), Betamethasone (0.5 mg/ml/kg), and curcumin (110 mg/ml/kg) from day 14, respectively. The daily oral supplementations continued until day 42. The study showed that CIA-Beta (**P

In the era of evidence-based medicine, confirming a disease by using various instrumental methods is one of the important tasks. This enables to reduce the number of diagnostic errors and to prescribe the appropriate treatment in accordance with the current views on the problem of alopecia areata in each case. Moreover, monitoring the course of the disease, data recording and their statistical processing opens up the prospect for obtaining evidence-based treatment methods. Studying the effectiveness of various treatment options and approaches including the registration of results obtained and their statistical processing is of great clinical significance. The aim of this study is to compare the efficiency of monotherapy with betamethasone injections, with platelet-rich plasma, and their combination. The venous blood of 104 patients aged (35.7 ± 8.9 years with alopecia areata was used in the study. All patients were randomly divided to three groups. The group І received intradermal injections of betamethasone (4 sessions per month). The group ІІ received intradermal injections of platelet-rich plasma once every 2 weeks for 16 weeks. The group ІІІ received 4 sessions of betamethasone which were alternated with 4 sessions of platelet-rich plasma treatment at interval of 2 weeks. The patients were examined before the treatment and in 3, 6 and 17 months. The following factors as the age, sex, smoking habit, the presence of alopecia in relatives, the duration, shape and stage of the disease, the index of the severity of alopecia and hair growth, the presence of "yellow and black dots", "conical" and terminal hair were considered in the study. Statistical analysis was performed using SPSS (version 22.0.). The results have shown the combination therapy allows us to obtain the best result, especially in long follow-up period.

Background: Topical agents are still the mainstay for the treatment of mild-to-moderate plaque psoriasis, in which fixed combinations play an important role. Tazarotene/betamethasone dipropionate (Taz/BD) cream is a novel fixed combination approved for treating plaque psoriasis in China, but its efficacy and safety have not been verified in a real-world environment. Objectives: The primary objective was to investigate the efficacy and safety of Taz/BD cream in treating plaque psoriasis. The secondary objectives were to assess its relapse after discontinuation and the efficacy and safety profiles during retreatment. Methods: A prospective, multicenter, large-scale observational study was conducted. Adult patients with chronic plaque psoriasis involving Results: In total, 2,299 eligible patients were enrolled, and 2,095 patients (91.1%) completed the 4-week study. The mean PASI improvement at week 4 was 53.7%, and the PASI 50/75 response rates were 62.5 and 26.8%, respectively. The mean PASI reduction in plaque induration, desquamation and erythema were 58.3, 61.0 and 40.0%, respectively (p < 0.001). Adverse reactions occurred in 445 patients (20.8%) at week 4. The most frequently reported adverse reactions were local skin irritation, including pruritus (10%), pain (6.7%), erythema (6.1%) and desquamation (1.8%). During the post-treatment period, 47 patients (24.0%) relapsed within 8 weeks after drug discontinuation. Forty-five patients were retreated for another 4 weeks, and the PASI 50/75 response rates were 72.7 and 40.9%, respectively. There were no unexpected safety signals during retreatment. Conclusion: Taz/BD cream is effective and well tolerated in treating mild-to-moderate plaque psoriasis under near real-world conditions and demonstrates efficacy and safety during retreatment.

Exclusive local therapy is a sufficient treatment option for most mild cases of psoriasis. It is estimated that even 70–80% of patients do not require systemic treatment or light therapy, and topical medications effectively control the symptoms of the disease. Moreover, topical medications are also an essential treatment option in addition to systemic therapy for moderate to severe psoriasis. The most common medications used in local therapy are glucocorticosteroids and vitamin D analogues. These substances show the highest efficiency among all drugs available on the market, while maintaining a favorable toxicity profile. A significant advantage of these medications is also the ease of use, which significantly affects the compliance with medical recommendations and regular use of the preparation by patients. The different mechanism of action of the two drugs makes this unique combination of calcipotriol and betamethasone dipropionate particularly effective at any stage of the pathogenesis of psoriasis. Due to their strong antiproliferative, immunomodulating and immunostatic effects, this duo is currently recommended by the Polish Dermatological Society as a first-line preparation in the local treatment of smooth skin, hands and feet. The ointment ensures rapid penetration of active substances, strongly moisturizing, reducing skin atrophy, which is an additional benefit for patients with psoriasis. The study analyzes the effectiveness, safety and mechanism of action of medications containing calcipotriol with betamethasone dipropionate in the local therapy of psoriasis in the light of current literature data, with particular emphasis on the form of ointment.

therapy for their reliable removal. Standard methods of treatment often give unpredictable results, are accompanied by various complications, and require the use of expensive equipment. AIM: To investigate the efficacy and safety of intralesional injection of a combination of 5-fluorouracil (5-FU) and betamethasone for the treatment of keloids and hypertrophic scars. MATERIALS AND METHODS: The study involved 26 patients who were divided into two equal groups. Patients in group A received intralesional injections of betamethasone, and those in group B received 5-FU and betamethasone. Three injections were performed with an interval of 3 weeks. The scars were assessed at the beginning of the treatment, on the 3rd and 6th week during the treatment, and 4 and 16 weeks after the end of the treatment. The dynamics of scar condition was evaluated by the average decrease in the scar height and density, changes in subjective sensations, and the presence or absence of complications. RESULTS: At 4 weeks after the end of the therapy, the total effectiveness of reducing the initial scar height was significantly higher in group B (10 patients; 76.9%) than in group A (6; 46.1%). In the comparison of long-term results at 16 weeks after treatment, 92.3% of the patients from group B and 53.8% of the patients from group A showed cessation of scar growth, flattening and softening, diminished itching and pain, smoothing of the scar contour, and a decrease in the color of the border between the scar and surrounding tissues. CONCLUSIONS: The combination of betamethasone with 5-FU is safer and more effective than monotherapy with betamethasone or 5-FU in the treatment of keloid and hypertrophic scars, with a faster and more pronounced decrease in the height and density of the scar, erythema, and subjective sensations. This mode of therapy is characterized by a low relapse rate with prolonged follow-up. The article is of interest to practicing cosmetologists, dermatologists, and plastic surgeons.

BACKGROUND: Lichen plane (LP) occurs in 0.5%1% of the population. The exact epidemiology of genital LP is unknown. According to various data, LP occurs in 49% of all cases of vulvar lesions. The LP of the oral cavity and the vulva occurs in 1957% of cases. The clinical forms of LP that occur in the anogenital region in women include the erosive, papulosquamous, and less often hypertrophic forms. No distinct guidelines are available for the treatment of vulvar LP. Except for the use of photodynamic therapy (PDT), no randomized controlled trials have been conducted for the treatment of erosive vulvar LP. The research results have shown that PDT can be effective in lichen plane of the oral cavity. AIM: To evaluate the effectiveness of PDT in women with genital LP compared to topical glucocorticosteroids. MATERIALS AND METODS: The study group included 15 patients with a diagnosis of vulvar LP. The patients were divided into two groups depending on the treatment method. Group 1 patients were treated with PDT. Group 2 patients with topical 0.05% betamethasone cream once daily for 1.5 months. RESULTS: Six months after the last procedure, the regression on the genital LP rating scale was 32% in group 1 patients and 25% in group 2 patients. The severity of pain, according to the visual analog scale, was 29% in group 1 and 22% in group 2. As for adverse events, in group 1, four patients experienced a burning sensation and dryness for 23 days after the procedure, and one patient, after two procedures, had blood discharge, which ceased after 1 day. In group 2, five patients complained of burning and dryness during treatment, two patients had acute candidiasis during treatment, and one patient had bacterial vaginosis. CONCLUSION: The use of PDT can reduce the frequency of use of corticosteroid drugs in the genital area and accordingly reduce the frequency of steroid adverse events, such as atrophy and secondary infection.

Background Ocular graft-versus-host disease (GVHD) is one of the most severe complications of hematopoietic stem cell transplantation. It manifests as an impairment of the ocular surface, such as severe dry eye disease, and deteriorates the recipient's visual function and quality of life. We encountered an "overlap syndrome" of ocular GVHD, which is characterized by the presence of both acute and chronic GVHD symptoms. In this report, we present the treatment progress of the overlap syndrome in a case with ocular GVHD. Case presentation A 57-year-old man with acute myeloblastic leukemia underwent hematopoietic stem cell transplantation. Six weeks after the treatment, the recipient complained of eye pain and discharge. He was diagnosed with the overlap syndrome due to low tear volume, severe corneal epithelitis, hyperemia, and a pseudomembrane on the conjunctiva. Immune cells infiltration, fibrinoid degeneration, fibroblastic and spindle-shaped cells, and fibrosis were observed in the pathology of the pseudomembrane. The recipient was treated with topical immunosuppression and pseudomembrane removal. One week after the initial treatment, ocular GVHD improved. Twelve weeks after the treatment, the topical steroid was discontinued due to the elevation of intraocular pressure. Conclusions The assessment of conjunctival pseudomembrane in ocular GVHD is important to determine the stage of the case and to assess systemic GVHD. Furthermore, prompt removal of the pseudomembrane after diagnosis is an appropriate management to reduce the symptoms of ocular GVHD. The combination of topical steroids and immunosuppressive agents is suggested to be an effective treatment in management of overlap syndrome.