Posted by ed_uk on April 5, 2006, at 14:08:41
In reply to Re: Steroid Psychosis Again! » ed_uk, posted by john berk on April 4, 2006, at 20:25:33
Hi John
Clobetasol cream can be more effective than prednisone........
The role of topical corticosteroids in bullous pemphigoid in the elderly.
Joly P, Fontaine J, Roujeau JC.
Department of Dermatology, Hopital Charles Nicolle, and Inserm U 519, Universite de Rouen, Rouen, France. Pascal.Joly@chu-rouen.fr
Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease. Until recently the condition was treated with oral corticosteroids (eg. prednisone). However, high-dose corticosteroids are poorly tolerated (severe side effects) in the elderly and their use has probably contributed to the high mortality rates observed in several cohorts. Accordingly, considerable effort has been directed at identifying corticosteroid-sparing agents, such as immunosuppressant drugs, plasma exchange techniques, intravenous immunoglobulins and tetracycline, that can be used in this clinical setting. Many of these options have appeared to be useful in open series, but they have been found to be ineffective or only marginally effective when tested in randomised, controlled trials. An important breakthrough occurred with the demonstration in a large, randomised trial that a 'super-potent' topical corticosteroid (clobetasol propionate) was not only associated with a significant ***decrease in severe complications and mortality*** of BP patients, but was also *more effective* than oral prednisone. New strategies for BP should include topical clobetasol propionate as first-line therapy in the elderly and consider adjuvant therapy only in the very rare cases that are either resistant or intolerant to this treatment.
Regards
Ed
poster:ed_uk
thread:628200
URL: http://www.dr-bob.org/babble/20060403/msgs/629273.html