INTRODUCTION: Norwegian or crusted scabies is a rare and highly contagious form of skin parasitosis caused by Sarcoptes scabiei var. hominis. Individuals maffffinly affected are considered to be immunocompromised such as those on prolonged glucocorticosteroid therapy, with AIDS or organ transplant patients. This disease presents as a hyperkeratotic dermatosis with an acral distribution. CASE REPORT: This is a case of a 2-month-old healthy Filipino male, who was previously managed as a case of miliaria rubra and treated with clobetasol 0.05% – ketoconazole 2% cream for 1 week. The papules and plaques became widespread. Consult with a pediatrician revealed widespread scabies and for which patient was prescribed topical permethrin with no improvement. On examination, patient presented with multiple erythematous papules and plaques with crusts on the face, trunk, extremities, palms and soles. Thickened yellowish plaques were observed on the palms and soles. Both parents also presented with widespread papules most prominent on the flexural areas accompanied by nocturnal pruritus. On dermoscopy, numerous mites and burrows were seen in a “jet with contrail pattern.” Prominent yellowish scales were also noted. Patient was admitted due to fever and superimposed bacterial infection and was given IV oxacillin, paracetamol, 8% precipitated sulfur in a hypoallergenic lotion applied twice daily and sodium fusidate ointment. On the 4th hospital day, the patient was afebrile and the lesions were noted to decrease in both erythema and crusting. Follow-up dermoscopy revealed absence scales, burrows and mites. CONCLUSION: Prolonged, unsupervised use of topical corticosteroids in our case most likely induced an immunocompromised state thus predisposing the patient to develop Norwegian scabies. In countries were cases of Norwegian scabies have been unresponsive to permethrin and when ivermectin is not available, the use of precipitated sulfur may still be the best therapeutic and safest option for infants.
Infant ; Scabies ; Mometasone Furoate ; Anti-Allergic Agents ; Adrenal Cortex Hormones

OBJECTIVETo explore the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS).

METHODSA total of 386 children with OSAHS were enrolled from June 2008 to April 2011.Ninety children with adenoid and tonsil ≤ degree III (group A) were randomly divided into A1 subgroup and A2 subgroup, while 22 of 296 (group B) children aged less than 3 years old with degree IV adenoid and(or) tonsil were divided into B1 subgroup, and the other 274 of 296 children with degree IV adenoid and (or) tonsil were divided into B1 subgroup, B2 subgroup and B3 subgroup. The adenoid, tonsil size examination and nasal endoscopic examination scores were performed before treatment, 3 months and 6 months after treatment. Drug therapy included oral antibiotics, mometasone furoate as a nasal spray, leukotriene receptor antagonist (LTRAs), mucoactive medications. Conservative treatment meant drug therapy plus negative pressure of sputum aspiration.Surgical treatment meant coblation adenotonsillectomy. A1 subgroup received drug therapy for 3 months; A2 and B1 subgroup received conservative treatment for 3 months; B2 subgroup received coblation adenotonsillectomy after 3 days conservative treatment and postoperative drug therapy for 2 weeks; B3 subgroup received coblation adenotonsillectomy after 2 weeks conservative treatment and postoperative drug therapy for 3 months.

RESULTSThe adenoid and tonsil size of A2 subgroup decreased at 3 months after treatment (Wald χ² were 10.584 and 8.366, respectively, P < 0.05), no significant re-increase was found at 6 months, and no decrease was found in the A1 subgroup (P > 0.05). The nasal endoscopic examination scores decreased in both A1 and A2 subgroup at 3 months after the treatment (F = 403.420, P < 0.05), but it was found re-increase in A1 subgroup at the 6 months (P < 0.05), no significant re-increase was found in the A2 subgroup. The polysomnography (PSG) monitor of A2 subgroup was 100.0% normal at 3 months after treatment, while the A1 subgroup was only 43.2% (χ² = 36.189, P < 0.05). B2 and B3 subgroups cured after coblation adenotonsillectomy, but no decrease of the adenoid and tonsil size was found in B1 subgroup (P > 0.05). The nasal endoscopic examination scores of B1, B2 and B3 subgroups showed significant decrease after the treatment, but re-increase was found in both B1 and B2 subgroups at the 6 months (F = 1 614.244, P < 0.05), no significant re-increase was found in the B3 subgroup. The PSG monitor of B3 subgroup was 100.0% normal at 3 months after treatment, B2 subgroup 73.4%, and B1 subgroup only 57.4% (χ² = 90.846, P < 0.05).

CONCLUSIONSThe treatment method of children with OSAHS should be selected according to the age, condition of disease, and size of the adenoid and tonsil. Adenoid and tonsil ≤ degree III should select conservative treatment; while for degree IV adenoid and (or) tonsil, surgical treatment should be primary choice. Conservative treatment can reduce the risk of perioperative and adequate postoperative drug therapy can help prevent recurrence after surgery.

Adenoidectomy ; Adenoids ; Child ; Humans ; Mometasone Furoate ; Palatine Tonsil ; Polysomnography ; Pregnadienediols ; Recurrence ; Sleep Apnea, Obstructive ; therapy ; Tonsillectomy

BACKGROUND: It is unclear how the usage of topical steroid agents affects skin barrier function. OBJECTIVE: In order to follow up on previous research into this topic, we sought to investigate the effects of a 3-week application of topical mometasone cream on the alteration of skin barrier function. METHODS: Twenty-six patients who had been clinically diagnosed with allergic contact dermatitis were enrolled. Topical mometasone cream was applied to the skin lesions. Clinical symptoms, transepidermal water loss (TEWL), corneometer unit, and pH value were measured on the initial visit, 1 week after treatment, and 3 weeks after treatment, and their values were compared. RESULTS: Clinical symptoms showed improvement after topical mometasone cream was applied (p<0.05), but changes in TEWL, corneometer units, and pH values failed to show statistical significance (p>0.05). CONCLUSION: This study found that treatment with topical mometasone cream for 3 weeks has no effect on skin barrier function. We believe that this research will help determine the optimal duration and dosage of topical steroid agents used for treating allergic contact dermatitis.
Dermatitis, Allergic Contact* ; Dermatitis, Contact ; Follow-Up Studies ; Humans ; Hydrogen-Ion Concentration ; Skin* ; Mometasone Furoate

BACKGROUND: Topical application of corticosteroids also has an influence on skin barrier impairment. Physiological lipid mixtures, such as multi-lamellar emulsion (MLE) containing a natural lipid component leads to effective recovery of the barrier function. OBJECTIVE: The purpose of this study was to conduct an evaluation of the therapeutic efficacy and skin barrier protection of topical mometasone furoate in MLE. METHODS: A multi-center randomized, double-blind, controlled study was performed to assess the efficacy and safety of mometasone furoate cream in MLE for Korean patients with eczema. The study group included 175 patients with eczema, who applied either mometasone furoate in MLE cream or methylprednisolone aceponate cream for 2 weeks. Treatment efficacy was evaluated using the physician's global assessment of clinical response (PGA), trans-epidermal water loss (TEWL), and visual analogue scale (VAS) for pruritus. Patients were evaluated using these indices at days 4, 8, and 15. RESULTS: Comparison of PGA score, TEWL, and VAS score at baseline with those at days 4, 8, and 15 of treatment showed a significant improvement in both groups. Patients who applied mometasone furoate in MLE (74.8%) showed better results (p<0.05) than those who applied methylprednisolone aceponate (47.8%). The TEWL improvement ratio was higher in the mometasone furoate in MLE group than that in the methylprednisolone aceponate group, and VAS improvement was also better in the mometasone furoate in MLE group. CONCLUSION: Mometasone furoate in MLE has a better therapeutic efficacy as well as less skin barrier impairment than methylprednisolone aceponate.
Adrenal Cortex Hormones ; Cross-Over Studies ; Eczema ; Humans ; Methylprednisolone ; Pregnadienediols ; Prostaglandins A ; Pruritus ; Skin ; Treatment Outcome ; Water Loss, Insensible ; Mometasone Furoate

PURPOSE: Nasal cytology is important in the diagnosis and treatment of nasal inflammatory diseases. Treatment of allergic rhinitis (AR) according to nasal cytology has not been fully studied. We plan to explore the individualized treatment of AR according to nasal cytology. METHODS: Nasal cytology from 468 AR patients was examined for inflammatory cell quantity (grade 0–5) and the percentage of neutrophils and eosinophils. Results were subdivided into the following categories: AR(Eos), eosinophil ≥50% of the whole inflammatory cells; AR(Neu), neutrophils ≥90%; AR(Eos/Neu), 10%≤ eosinophil <50%; AR(Low), grade 0/1 inflammatory cell quantity. Nasal cytology-guided treatment was implemented: all AR(Eos) patients (n=22) and half of the AR(Neu) patients (AR[Neu1], n=22) were treated with mometasone furoate spray and oral loratadine. Another half of the AR(Neu) patients (AR[Neu2], n=22) were treated with oral clarithromycin. Visual analog scale (VAS), symptom scores, and nasal cytology were evaluated 2 weeks before and after treatment. RESULTS: There were 224/468 (47.86%) AR(Eos), 67/468 (14.32%) AR(Neu), 112/468 (23.93%) AR(Eos/Neu), and 65/468 (13.89%) AR(Low) of the AR patients studied. There were no significant differences in clinical characteristics among these subgroups, except that the nasal blockage score was higher in AR(Eos) patients than in AR(Neu) patients (1.99 vs. 1.50, P=0.02). Comparing AR(Eos) patients with AR(Neu1) patients 2 weeks after treatment, nasal symptoms and VAS were significantly lower in AR(Eos) patients, except for nasal blockage symptoms (P<0.05 of nasal itching and sneezing; P<0.01 for nasal secretion, total scores, and VAS). Comparing AR(Neu1) with AR(Neu2) patients, nasal symptoms, and VAS were significantly lower in AR(Neu2), except for nasal blockage and nasal itching symptoms (P<0.05 for nasal secretions, sneezing, total score, and VAS). CONCLUSIONS: Nasal cytology may have important value in subtyping AR and optimizing AR treatment. Treating neutrophils is very important in AR patients with locally predominant neutrophils.
Clarithromycin ; Diagnosis ; Eosinophils ; Humans ; Loratadine ; Mometasone Furoate ; Nasal Obstruction ; Neutrophils ; Pruritus ; Rhinitis, Allergic* ; Sneezing ; Visual Analog Scale

BACKGROUND AND OBJECTIVES: The epithelial rupture theory for the polyp formation has been well approved. According to Norlander et al., the polyp formation initiated by multifactorial pathophysiological events (infection/inflammation) appears to be a series of the consecutive events involving the rupture of epithelium, prolapse of lamina propria, epithelial ingrowth, microcavity formation, and finally the polyp formation. The purpose of this study is to determine the effects of steroid and steroid receptor blocker at the early stage of the polyp formation in a rabbit model. MATERIALS AND METHODS: In 20 New Zealand white rabbits, polyps were induced by epithelial damage with ostial occlusion. The mometasone and RU 486, given by the biodegradable film (polylactic acid), were used to investigate the possible effects of steroid and steroid receptor blockers. After one and three weeks, macroscopic polyps were counted postmortem and on histological slides after serial sectioning. RESULT: The polyp formation was significantly increased in the RU 486-treated group, whereas it was reduced in the mometasone-treated group. According to the alpha-actin immunohistochemistry, neovascularization at the margin of the initial polyp in the RU 486-treated group markedly increased compared with the mometasone-treated group. CONCLUSION: Steroid is thought to inhibit the initial polyp formation by reducing neovascularization particularly at the margin of initial polyp.
Actins ; Epithelium ; Immunohistochemistry ; Mifepristone ; Mucous Membrane ; Nasal Polyps ; Polyps* ; Prolapse ; Rabbits ; Receptors, Steroid* ; Rupture ; Steroids ; Mometasone Furoate

OBJECTIVES: To investigate the effect of rhinophototherapy with medical therapy on quality of life in persistent allergic rhinitis. METHODS: A prospective, randomized study was being performed between December 2009 and March 2010. The study included 65 patients with persistent allergic rhinitis. The diagnosis was confirmed with positive skin tests. All of the patients had house dust mite allergies. We divided the patients into two groups. First group (n=33) was given topical mometasone furoate 200 mcg/day and levocetirizine 5 mg/day for a month. Rhinophototherapy was applied with the same medical therapy to the second group (n=32), twice a week for three weeks continuously. Rhinophototherapy included visible light, ultraviolet A and ultraviolet B. We evaluated patients before the treatment, at the first month and at the third month after treatment with rhinoconjunctivitis quality of life questionnaire, nasal symptom scores and visual analogue scale (VAS) scores. RESULTS: Improvements of all variables of the quality of life questionnaire, nasal symptom scores and VAS were statistically significant in the second group both on the first and the third months when compared with the first group. CONCLUSION: Allergic rhinitis is a social problem and impairs quality of life. Rhinophototherapy with medical therapy improves the quality of life in allergic rhinitis.
Cetirizine ; Humans ; Hypersensitivity ; Light ; Pregnadienediols ; Prospective Studies ; Pyroglyphidae ; Quality of Life ; Rhinitis ; Rhinitis, Allergic, Perennial ; Skin Tests ; Social Problems ; Mometasone Furoate ; Surveys and Questionnaires

OBJECTIVES: To evaluate efficacy of short term intranasal corticosteroid (mometasone furoate) treatment in pediatric sleep-disordered breathing (SDB) patients. METHODS: A prospective, observational study was done. A total of 41 children (2-11 years old) were enrolled into this study. All patients received 4-weeks course of mometasone furoate 100 microg/day treatment. They were evaluated at pretreatment and immediately after treatment with obstructive sleep apnea (OSA)-18 quality of life survey and lateral neck X-ray. Also, the assessment of each patients included history, skin prick test or CAP test, and sinus radiography. We compared the OSA-18 survey score and adenoidal-nasopharyngeal (AN) ratio between before and after treatment. RESULTS: Total OSA-18 score and AN ratio decreased significantly after treatment regardless of allergy, sinusitis, and obesity (P=0.003, P=0.006). There was no complication after treatment of mometasone furoate. CONCLUSION: Pediatric SDB patients with adenoid hypertrophy could be effectively treated with 4-weeks course of mometasone furoate. Allergy, obesity, and sinusitis did not affect on the result of treatment.
Adenoids ; Administration, Topical ; Child ; Humans ; Hypersensitivity ; Hypertrophy ; Neck ; Obesity ; Pediatrics ; Pregnadienediols ; Prospective Studies ; Quality of Life ; Sinusitis ; Skin ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Treatment Outcome ; Mometasone Furoate

OBJECTIVES: To evaluate efficacy of short term intranasal corticosteroid (mometasone furoate) treatment in pediatric sleep-disordered breathing (SDB) patients. METHODS: A prospective, observational study was done. A total of 41 children (2-11 years old) were enrolled into this study. All patients received 4-weeks course of mometasone furoate 100 microg/day treatment. They were evaluated at pretreatment and immediately after treatment with obstructive sleep apnea (OSA)-18 quality of life survey and lateral neck X-ray. Also, the assessment of each patients included history, skin prick test or CAP test, and sinus radiography. We compared the OSA-18 survey score and adenoidal-nasopharyngeal (AN) ratio between before and after treatment. RESULTS: Total OSA-18 score and AN ratio decreased significantly after treatment regardless of allergy, sinusitis, and obesity (P=0.003, P=0.006). There was no complication after treatment of mometasone furoate. CONCLUSION: Pediatric SDB patients with adenoid hypertrophy could be effectively treated with 4-weeks course of mometasone furoate. Allergy, obesity, and sinusitis did not affect on the result of treatment.
Adenoids ; Administration, Topical ; Child ; Humans ; Hypersensitivity ; Hypertrophy ; Neck ; Obesity ; Pediatrics ; Pregnadienediols ; Prospective Studies ; Quality of Life ; Sinusitis ; Skin ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Treatment Outcome ; Mometasone Furoate

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the effect of intranasal Mometasone furoate instillation into the nasal cavity of mice which had peripherally induced anosmia. SUBJECTS AND METHOD: Three groups of mice were studied: normal control group (nasal instillation of normal saline, n=6), Mometasone furoate non-instillation group (no treatment after nasal instillation of zinc sulfate, n=12), and Mometasone furoate instillation group (daily mometasone furoate instillation after nasal instillation of zinc sulfate, n=12). Tissues of olfactory mucosa were obtained on 1, 2, 3, 4 weeks after the instillation of zinc sulfate, and processed for immunohistochemistry using antisera to olfactory marker protein (OMP) for evaluation of olfactory regeneration. RESULTS: No OMP-positive cells were observed in the first week after the instillation of zinc sulfate in both groups. However, OMP-positive cells began appearing in the second week in both groups and gradually increased as time goes by. In the Mometasone furoate instillation group, the increase of OMP-positive cells was significantly greater than that of Mometasone furoate non-instillation group. CONCLUSION: Mometasone furoate instillation enhances regeneration of olfactory receptor cells after injury. Mometasone furoate instillation can be suggested as an effective treatment modality for olfactory dysfunction.
Animals ; Immune Sera ; Immunohistochemistry ; Mice* ; Nasal Cavity ; Olfaction Disorders ; Olfactory Marker Protein ; Olfactory Mucosa ; Olfactory Receptor Neurons ; Regeneration ; Smell ; Zinc Sulfate ; Mometasone Furoate