The human skin blanching assay for in vivo topical corticosteroid assessment

Haigh, J.; Meyer, Eric; Smith, Eric W.; Kanfer, Isadore

doi:10.1016/s0378-5173(97)00078-1

Cited by 14 publications

(7 citation statements)

References 10 publications

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“…The skin blanching response has been shown to be regulated by vascular smooth muscle glucocorticoid receptors (GR) [22]–[24], leading to local vasoconstriction [25]. Studies investigating the association between GR single nucleotide polymorphisms (SNPs) and corticosteroid sensitivity have shown that individuals with a BclI SNP express a lower skin blanching response [24], [26].…”

Section: Discussionmentioning

confidence: 99%

Lower Corticosteroid Skin Blanching Response Is Associated with Severe COPD

et al. 2014

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BackgroundChronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation caused by ongoing inflammatory and remodeling processes of the airways and lung tissue. Inflammation can be targeted by corticosteroids. However, airway inflammation is generally less responsive to steroids in COPD than in asthma. The underlying mechanisms are yet unclear. This study aimed to assess whether skin corticosteroid insensitivity is associated with COPD and COPD severity using the corticosteroid skin blanching test.MethodsCOPD patients GOLD stage I–IV (n = 27, 24, 22, and 16 respectively) and healthy never-smokers and smokers (n = 28 and 56 respectively) were included. Corticosteroid sensitivity was assessed by the corticosteroid skin blanching test. Budesonide was applied in 8 logarithmically increasing concentrations (0–100 μg/ml) on subject's forearm. Assessment of blanching was performed after 7 hours using a 7-point scale (normal skin to intense blanching). All subjects performed spirometry and body plethysmography.ResultsBoth GOLD III and GOLD IV COPD patients showed significantly lower skin blanching responses than healthy never-smokers and smokers, GOLD I, and GOLD II patients. Their area under the dose-response curve values of the skin blanching response were 586 and 243 vs. 1560, 1154, 1380, and 1309 respectively, p<0.05. Lower FEV1 levels and higher RV/TLC ratios were significantly associated with lower skin blanching responses (p = 0.001 and p = 0.004 respectively). GOLD stage I, II, III and IV patients had similar age and packyears.ConclusionsIn this study, severe and very severe COPD patients had lower skin corticosteroid sensitivity than mild and moderate COPD patients and non-COPD controls with comparable age and packyears. Our findings together suggest that the reduced skin blanching response fits with a subgroup of COPD patients that has an early-onset COPD phenotype.

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Section: Discussionmentioning

confidence: 99%

Lower Corticosteroid Skin Blanching Response Is Associated with Severe COPD

et al. 2014

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“…As it also requires considerable training of the observers, it is not a robust methodology for general laboratory adoption 56 . Even more, in most studies, male and female volunteers are included in the experiment, both arms are used as application sites, and invariably more than one observer is used to estimate the degree of induced blanching 24 . However, the number of observers required to ensure accuracy of readings seems to be undecided and ranges in studies from one to five 31,57 …”

Section: Methods For Determination Of Skin‐blanching Intensitymentioning

confidence: 99%

“…38 The blanching response results can be calculated as a percentage of the total possible score (percentage TPS), and the area under the blanching curve (AUBC) can be calculated from these results. 24 The method of visual scoring has been criticized, as these results were reported to lack reproducibility due to the subjectivity of the investigators. 55 As it also requires considerable training of the observers, it is not a robust methodology for general laboratory adoption.…”

Section: Methods For Determination Of Skin-blanching Intensitymentioning

confidence: 99%

“…The exact mechanism of the production of blanching in the skin‐blanching test is not fully understood, but it is thought that local vasoconstriction of the skin microvasculature and the consequent blood‐flow reduction cause this phenomenon 24 . This is followed by a phase of rebound vasodilatation 25 .…”

Section: The Skin‐blanching Assaymentioning

confidence: 99%

“…[19][20][21][22][23] The exact mechanism of the production of blanching in the skin-blanching test is not fully understood, but it is thought that local vasoconstriction of the skin microvasculature and the consequent blood-flow reduction cause this phenomenon. 24 This is followed by a phase of rebound vasodilatation. 25 The skin-blanching property of GCs presumably relates to the rate and extent to which GCs diffuse from the formulation and passes through the stratum corneum to the vasculature.…”

Section: Introductionmentioning

confidence: 99%

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The skin‐blanching assay

Smit¹,

Neumann

Thio

2012

Acad Dermatol Venereol

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The skin-blanching assay is used for the determination and bioequivalence of dermatologic glucocorticoids (GCs). The exact mechanism of the production of blanching is not fully understood, but it is considered that local vasoconstriction of the skin microvasculature and the consequent blood-flow reduction cause this phenomenon. Several factors influence skin blanching, including drug concentration, duration of application, nature of vehicle, occlusion, posture and location. The intensity of vasoconstriction can be measured in several ways: visual or quantitative methods, such as reflectance spectroscopy, thermography, laser Doppler velocimetry and chromametry. In literature, contradicting results in the correlation of the skin-blanching assay with different tests to determine GC sensitivity have been reported, limiting its clinical usefulness.

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The Vasoconstrictor Assay ( VCA ): Then and Now

Kanfer

Maibach

2021

Drug Delivery Approaches

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The human skin blanching assay for in vivo topical corticosteroid assessment

Cited by 14 publications

References 10 publications

Lower Corticosteroid Skin Blanching Response Is Associated with Severe COPD

Lower Corticosteroid Skin Blanching Response Is Associated with Severe COPD

The skin‐blanching assay

The Vasoconstrictor Assay ( VCA ): Then and Now

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