Corticosteroid responsive dermatoses treatment

Cryptogenic chronic hepatitis (CCH) is diagnosed in patients with persistently elevated aminotransferase levels of unknown etiology. The workup of CCH patients must include a liver biopsy in order to exclude the largely unrecognized diagnosis of seronegative autoimmune hepatitis (SAIH). Patients with SAIH have demographic, biochemical, and histologic features of autoimmune hepatitis (AIH) and may be treated effectively with corticosteroids. Recognition and treatment of SAIH are necessary to prevent progression to end-stage liver disease. We performed a retrospective review of a database of 3507 patients seen at our institution over a 5-year period. Thirty patients with conventional AIH and an additional six patients with SAIH were identified. The two groups were similar with respect to mean age, gender, and baseline biochemistries. Of the 20 AIH patients who had pretreatment liver biopsies, 85% had moderate to severe interface hepatitis, compared to % of patients with SAIH. In the SAIH group, % had advanced fibrosis (stage 3 or 4), versus 40% in the conventional AIH group ( P = ). All patients were treated with corticosteroids followed by azathioprine. The mean time to remission (normal ALT) was similar in both groups, vs. months. Within 3 months, % of AIH patients and % of SAIH patients were in remission. We conclude that a trial of corticosteroids is a reasonable therapeutic measure in patients with chronic hepatitis that has features of AIH despite negative autoantibody markers. In most patients, clinical remission will be seen within 3 months, possibly avoiding progression to end-stage liver disease.

The most common immunosuppression regimen used in patients after liver transplant is the combination of calcineurin inhibitor, usually tacrolimus, with prednisone. Recurrence of AIH in the transplanted liver can occur in 25% to 30% of the cases and seems to be more common when prednisone is discontinued. 41,42 Thus prednisone is usually continued at low doses after transplant. Autoimmune hepatitis recurrence in the liver transplant can often be successfully treated by reintroducing prednisone and optimizing calcineurin inhibitors. A combination of prednisone and azathioprine has also been used to treat recurrent AIH. These patients have a similar prognosis as transplanted patients who do not have recurrent AIH. 41

The growth of children and adolescents receiving orally inhaled corticosteroids, including QVAR, should be monitored routinely (., via stadiometry). If a child or adolescent on any corticosteroid appears to have growth suppression, the possibility that he/she is particularly sensitive to this effect should be considered. The potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the risks associated with alternative therapies. To minimize the systemic effects of orally inhaled corticosteroids, including QVAR, each patient should be titrated to his/her lowest effective dose [see Dosage and Administration ( )] .

There are no adequate and well-controlled studies with QVAR in pregnant women. Animal studies were conducted with beclomethasone dipropionate in rats, mice, and rabbits. Systemic exposure data were not determined in the animal studies. In rats exposed to beclomethasone dipropionate by inhalation at doses greater than 180 times the maximum recommended adult human daily inhalation dose (MRHDID), doserelated gross injury to the fetal adrenal glands was observed. However, there was no evidence of external or skeletal malformations or embryolethality in rats at inhalation doses up to 440 times the MRHDID. Beclomethasone dipropionate was teratogenic (mice and rabbits) and embryolethal (rabbits) at subcutaneous doses equal to or greater than approximately times the MRHDID. Beclomethasone dipropionate treatment was embryolethal and caused decreased pup survival in mice at subcutaneous doses equal to or greater than times the MRHDID. Beclomethasone dipropionate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Corticosteroid responsive dermatoses treatment

corticosteroid responsive dermatoses treatment

There are no adequate and well-controlled studies with QVAR in pregnant women. Animal studies were conducted with beclomethasone dipropionate in rats, mice, and rabbits. Systemic exposure data were not determined in the animal studies. In rats exposed to beclomethasone dipropionate by inhalation at doses greater than 180 times the maximum recommended adult human daily inhalation dose (MRHDID), doserelated gross injury to the fetal adrenal glands was observed. However, there was no evidence of external or skeletal malformations or embryolethality in rats at inhalation doses up to 440 times the MRHDID. Beclomethasone dipropionate was teratogenic (mice and rabbits) and embryolethal (rabbits) at subcutaneous doses equal to or greater than approximately times the MRHDID. Beclomethasone dipropionate treatment was embryolethal and caused decreased pup survival in mice at subcutaneous doses equal to or greater than times the MRHDID. Beclomethasone dipropionate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

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