Whole body application of a potent topical corticosteroid for bullous pemphigoid

Terra, Jorrit B.; Potze, Wilma; Jonkman, Marcel F.

doi:10.1111/jdv.12153

Cited by 22 publications

(11 citation statements)

References 14 publications

(25 reference statements)

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“…Another finding of our study is the significant suppression of autoreactive T cells in patients with BP on topical immunosuppressive treatment ( Figure 4 ). Topical super potent glucocorticoids (GC) as monotherapy are currently considered the first line treatment in moderate and severe BP ( 52 , 53 ) although other therapeutic options are also discussed ( 54 ). In our study, clobetasol propionate ointment was topically applied in 16 BP patients at an initial dose of approximately 40 g daily for 1 month, and then was slowly tapered over the following 12 months.…”

Section: Discussionmentioning

confidence: 99%

Autoreactive Peripheral Blood T Helper Cell Responses in Bullous Pemphigoid and Elderly Patients With Pruritic Disorders

et al. 2021

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Bullous pemphigoid (BP) is a prototypic autoimmune disorder of the elderly, characterized by serum IgG autoantibodies, namely anti-BP180 and anti-BP230, directed against components of the basal membrane zone that lead to sub-epidermal loss of adhesion. Pruritus may be indicative of a pre-clinical stage of BP, since a subset of these patients shows serum IgG autoantibodies against BP230 and/or BP180 while chronic pruritus is increasingly common in the elderly population and is associated with a variety of dermatoses. Clinical and experimental evidence further suggests that pruritus of the elderly may be linked to autoimmunity with loss of self-tolerance against cutaneous autoantigens. Thus, the objective of this study was to determine autoreactive T cell responses against BP180 in elderly patients in comparison to patients with BP. A total of 22 elderly patients with pruritic disorders, 34 patients with bullous or non-bullous BP and 34 age-matched healthy controls were included in this study. The level of anti-BP180 and anti-BP230 IgG serum autoantibodies, Bullous Pemphigoid Disease Area Index (BPDAI), and pruritus severity were assessed for all patients and controls. For characterization of the autoreactive T cell response, peripheral blood mononuclear cells were stimulated ex vivo with recombinant BP180 proteins (NH2- and COOH-terminal domains) and the frequencies of BP180-specific T cells producing interferon-γ, interleukin (IL)-5 or IL-17 were subsequently determined by ELISpot assay. Patients with BP showed a mixed Th1/Th2 response against BP180 while autoreactive Th1 cells were identified in a minor subset of elderly patients with pruritic disorders. Furthermore, our T cell characterization revealed that therapeutic application of topical clobetasol propionate ointment in BP patients significantly reduced peripheral blood BP180-specific T cells, along with clinically improved symptoms, strongly suggesting a systemic immunosuppressive effect of this treatment.

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Section: Discussionmentioning

confidence: 99%

Autoreactive Peripheral Blood T Helper Cell Responses in Bullous Pemphigoid and Elderly Patients With Pruritic Disorders

et al. 2021

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“…Thus, one FTU per time for twice daily is equal to 1 g daily. The topical GC dosage used to treat bullous pemphigoid has been calculated according to lesion area and severity, and daily dose of topical propionic acid chloride betamethasone cream for mild, moderate, and severe bullous pemphigoid is 20 g, 30 g, and 40 g, respectively [ 13 , 14 ]. Based on these previous reports [ 12 – 14 ], we determined the daily dosages for the three patient groups as 15 g for a lesion area of 30%–40%, 20 g for 41%–50%, and 30 g for 51%–60% in the current study.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Halometasone Cream to Treat Chronic Generalized Eczema and the Effects of Halometasone Cream on Serum Cortisol Levels

2017

BioMed Research International

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The aim of the study was to investigate the efficacy and safety of halometasone cream to treat chronic generalized eczema and the effects of halometasone cream on serum cortisol (COR) levels. Sixty consecutive outpatients diagnosed with chronic generalized eczema between January and April 2017 were included and divided into groups A, B, and C with a lesion area of 30%-40%, 41%-50%, and 51%-60%, respectively. Groups A, B, and C were treated with halometasone cream with a daily dose of 15 g, 20 g, and 30 g for 7-14 days, respectively. Ten patients were randomly selected from each group for serum COR measurement at days 0, 7, and 14. On day 14, group B had significantly higher cure rate (47.1%) than groups A (17.9%) and C (13.3%) and significantly higher effectiveness rate (82.4%) than group C (40.0%) (all < 0.05). Serum COR levels were not affected in group A but were reduced significantly in groups B and C on days 7 and 14 (all < 0.05). No adverse reaction was observed. Halometasone cream appeared to relieve chronic generalized eczema effectively and safely. High dosage (≥20 g daily for 14 days) may temporarily reduce endogenous COR production substantially, although it may be more effective.

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“…Previously, 1-year mortality was consistently reported at between 35% and 40% Europe-wide with treatment involving high doses of oral corticosteroids, 1,[8][9][10] compared with 20% in the present study and other recent studies with most patients treated by TCS. 3,4,11 The present study demonstrates that TCS can be successfully proposed when the healthcare system allows close management of patients with BP, alongside the active involvement of nurses and patients' relatives. When these conditions are not met and given the high risk of relapse in poorly adherent patients, other therapeutic options should be considered, even if their safety and efficacy are not yet proven.…”

mentioning

confidence: 88%

“…1,2 Indeed, in four studies that included a total of more than 1000 patients with BP, more than 95% of patients achieved disease control after a mean delay of 7-15 days. [1][2][3][4] TCS have been proposed as the first-line treatment for BP in the Cochrane review and in the guidelines of the European Dermatology Forum and the European Academy of Dermatology and Venereology. 5,6 However, adherence to treatment might be impaired by practical considerations.…”

mentioning

confidence: 99%

Assessment of adherence to topical corticosteroids in patients with bullous pemphigoid

et al. 2016

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Whole body application of a potent topical corticosteroid for bullous pemphigoid

Cited by 22 publications

References 14 publications

Autoreactive Peripheral Blood T Helper Cell Responses in Bullous Pemphigoid and Elderly Patients With Pruritic Disorders

Autoreactive Peripheral Blood T Helper Cell Responses in Bullous Pemphigoid and Elderly Patients With Pruritic Disorders

Efficacy and Safety of Halometasone Cream to Treat Chronic Generalized Eczema and the Effects of Halometasone Cream on Serum Cortisol Levels

Assessment of adherence to topical corticosteroids in patients with bullous pemphigoid

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