Corticosteroids mechanism of action immunosuppression

Parameters No. treated 40 Females 23 Males 17 No. with Atopic Dermatitis 15 No. with Psoriasis vulgaris 25 Mean age (years) 43 (range 22-57) Mean duration of treatment with Group III or IV topical steroids (years) 16 (range 6-25) Localization of skin atrophy:   Extremities 40 Face 28 Trunk 12 Concomitant Diseases:   Arthritis 7 Hypertonia 6 Rhinitis allergica 4 Concomitant medication:   Antiflogistica 6 Antihistamines 2 Antihypertensive drugs 5 Table 2.
Clinical evaluation of severity of symptoms and signs of skin atrophy at baseline and at end of treatment.

Clinical parameters Mean severity at baseline Mean severity at end of treatment Decreased thickness of skin (range 2-3) Laxity (range 2-3) Purpura/Echymoses (range 1-3) Dryness Teleangiectasia (range 2-3) (range 1-2) Table 3.
Mean epidermal and dermal thickness, skin elasticity, erythemal and moisture indexes at baseline and after 8 months of treatment with Vivida of 40 patients with corticosteroid induced skin atrophy.
Parameters Baseline 8 months Epidermal thickness (mm) (-) (-) Dermal thickness (mm) (-) (-) Elasticity Index 44 (39-53) 74 (65-78) Erythemal Index (-) (-) Moisture Index (11-37) (75-97)

However, a randomized, placebo-controlled, double-blind study by McAlindon et al found that in patients with knee osteoarthritis, intra-articular corticosteroid injections (40 mg of triamcinolone acetonide, administered quarterly over 2 years) led to an increase in cartilage loss and was associated with less pain reduction than placebo injections. The study determined that the mean change in index compartment cartilage thickness in the corticosteroid patients was about twice that of the placebo subjects. (The investigators stated, though, that due to the timing of pain measurements, the study could have missed transient pain reductions in the corticosteroid group.) [ 18 , 19 ]

Lewis Sarett of Merck & Co. was the first to synthesize cortisone, using a 36-step process that started with deoxycholic acid, which was extracted from ox bile . [43] The low efficiency of converting deoxycholic acid into cortisone led to a cost of US $200 per gram. Russell Marker , at Syntex , discovered a much cheaper and more convenient starting material, diosgenin from wild Mexican yams . His conversion of diosgenin into progesterone by a four-step process now known as Marker degradation was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception . [44] In 1952, . Peterson and . Murray of Upjohn developed a process that used Rhizopus mold to oxidize progesterone into a compound that was readily converted to cortisone. [45] The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US $6 per gram, falling to $ per gram by 1980. Percy Julian's research also aided progress in the field. [46] The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the leukocyte adhesion cascade and the role of phospholipase A2 in the production of prostaglandins and leukotrienes was fully understood in the early 1980s.

Betamethasone dipropionate was patented by Merck in 1987 as an augmented cream/lotion, Diprolene in the ., and Disprosone in Europe. [7] These patents expired in 2003 and 2007 respectively leading to generic production of betamethasone dipropionate. During this time other topical corticosteroids such as triamcinolone acetonide and clobetasol propionate also became available as generic creams. Merck filed for "pediatric exclusivity" in 2001 launching a clinical trial to prove betamethasone dipropionate's safety and efficacy for use in pediatrics. [8]

Corticosteroids mechanism of action immunosuppression

corticosteroids mechanism of action immunosuppression

Betamethasone dipropionate was patented by Merck in 1987 as an augmented cream/lotion, Diprolene in the ., and Disprosone in Europe. [7] These patents expired in 2003 and 2007 respectively leading to generic production of betamethasone dipropionate. During this time other topical corticosteroids such as triamcinolone acetonide and clobetasol propionate also became available as generic creams. Merck filed for "pediatric exclusivity" in 2001 launching a clinical trial to prove betamethasone dipropionate's safety and efficacy for use in pediatrics. [8]

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