Topical glucocorticosteroids: efficacy and safety in gynecology


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Topical glucocorticosteroids (GCS) are one of the most commonly prescribed groups of drugs in dermatology. Due to the high anti-inflammatory efficacy of GCS, this group of drugs is capable of rapid elimination of skin and mucosal symptoms, such as itching and burning. These symptoms represent a significant decrease in the quality of life in patients with both non-infectious and infectious diseases affecting the vulva. The range of available topical GCS includes drugs characterized by varying degrees of activity. Unlike dermatological practice, the use of topical GCS with enhanced activity in gynecology can lead to a remarkable increase in systemic absorption and, therefore, the risk of side effects. This review includes the most relevant issues of the efficacy and safety of topical GCS in gynecology. Conclusion. The analysis of international clinical guidelines and published results of clinical studies indicate the necessity to limit the duration of the use of highly active topical GCS in gynecological practice and to choose drugs of moderate or low activity, including hydrocortisone, as a long-term therapy. The low level of systemic absorption in the vulvovaginal area and the low risk of adverse drug reactions, along with the high level of delivery of hydrocortisone to the cells of the mucous membrane, suggest that the drug has therapeutic potential for safe and effective use in gynecology.

Full Text

Restricted Access

About the authors

S. K Zyryanov

Peoples' Friendship University of Russia; City Clinical Hospital No. 24, Moscow City Health Department

Email: zyryanovsk@rudn.university
M.D, professor, the Head of the Department of General and Clinical Pharmacology of the Medical Institute, Peoples' Friendship University of Russia; Deputy Chief Medical Officer, City Clinical Hospital No. 24, Moscow City Health Department. 117198, Russia, Moscow, Miklukho-Maklaya str., 6; 127015, Russia, Miscow, Pistzovaya str., 10

O. I Butranova

Peoples' Friendship University of Russia

Email: butranova-oi@rudn.ru
Ph.D, Associated Professor of the Department of General and Clinical Pharmacology of the Medical Institute 117198, Russia, Moscow, Miklukho-Maklaya str., 6

References

  1. Das A., Panda S. Use of topical corticosteroids in dermatology: An evidence-based approach. Indian J. Dermatol. 2017; 62(3): 237-50. https://dx.doi. org/10.4103/ijd.IJD_169_17.
  2. Goldstein A. T., Marinoff S. C., Christopher K., Srodon M. Prevalence of vulvar lichen sclerosus in a general gynecology practice. J. Reprod. Med. 2005; 50(7): 477-80.
  3. Egan M.E., Lipsky M.S. Diagnosis of vaginitis. Am. Fam. Physician. 2000; 62(5): 1095-104.
  4. Paladine H.L., Desai U.A. Vaginitis: diagnosis and treatment. Am. Fam. Physician. 2018; 97(5): 321-9.
  5. Brander E.P.A., McQuillan S.K. Prepubertal vulvovaginitis. CMAJ. 2018; 190(26): E800. https://dx.doi.org/10.1503/cmaj.180004.
  6. Aballea S., Guelfucci F., Wagner J., Khemiri A., Dietz J.P., Sobel J., Toumi M. Subjective health status and health-related quality of life among women with Recurrent Vulvovaginal Candidosis (RVVC) in Europe and the USA. Health Qual. Life Outcomes. 2013; 11: 169. https://dx.doi.org/10.1186/1477-7525-11-169.
  7. Oakley R.H., Cidlowski J.A. The biology of the glucocorticoid receptor: new signaling mechanisms in health and disease. J. Allergy Clin. Immunol. 2013; 132(5): 1033-44. https://dx.doi.org/10.1016/j.jaci.2013.09.007.
  8. Ramamoorthy S., Cidlowski J.A. Corticosteroids: mechanisms of action in health and disease. Rheum. Dis. Clin. North Am. 2016; 42(1): 15-vii. https:// dx.doi.org/10.1016/j.rdc.2015.08.002.
  9. Samarasinghe R.A., Witchell S.F., DeFranco D.B. Cooperativity and complementarity: synergies in non-classical and classical glucocorticoid signaling. Cell Cycle. 2012; 11(15): 2819-27. https://dx.doi.org/10.4161/ cc.21018.
  10. Vandewalle J., Luypaert A., De Bosscher K., Libert C. Therapeutic mechanisms of glucocorticoids. Trends Endocrinol. Metab. 2018; 29(1): 42-54. https://dx.doi. org/10.1016/j.tem.2017.10.010.
  11. Panettieri R.A., Schaafsma D., Amrani Y., Koziol-White C., Ostrom R., Tliba O. Non-genomic effects of glucocorticoids: An updated view. Trends Pharmacol. Sci. 2019; 40(1): 38-49. https://dx.doi.org/10.1016/j.tips.2018.11.002.
  12. Chung Y.S., Jin H.L., Jeong K.W. Cell-specific expression of ENACa gene by FOXA1 in the glucocorticoid receptor pathway. Int. J. Immunopathol. Pharmacol. 2020; 34: 2058738420946192. https://dx.doi.org/10.1177/2058738420946192.
  13. Vitellius G., Trabado S., Bouligand J., Delemer B., Lombes M. Pathophysiology of glucocorticoid signaling. Ann. Endocrinol. (Paris). 2018; 79(3): 98-106. https:// dx.doi.org/10.1016/j.ando.2018.03.001.
  14. Sainte Marie Y., Toulon A., Paus R., Maubec E., Cherfa A., Grossin M. et al. Targeted skin overexpression of the mineralocorticoid receptor in mice causes epidermal atrophy, premature skin barrier formation, eye abnormalities, and alopecia. Am. J. Pathol. 2007; 171(3): 846-60. https://dx.doi.org/10.2353/ ajpath.2007.060991.
  15. Uva L., Miguel D., Pinheiro C., Antunes J., Cruz D., Ferreira J., Filipe P. Mechanisms of action of topical corticosteroids in psoriasis. Int. J. Endocrinol. 2012; 2012: 561018. https://dx.doi.org/10.1155/2012/561018.
  16. Niculet E., Bobeica C., Tatu A.L. Glucocorticoid-induced skin atrophy: The old and the new. Clin. Cosmet. Investig. Dermatol. 2020; 13: 1041-50. https:// dx.doi.org/10.2147/CCID.S224211.
  17. Galon J., Franchimont D., Hiroi N., Frey G., Boettner A., Ehrhart-Bornstein M. et al. Gene profiling reveals unknown enhancing and suppressive actions of glucocorticoids on immune cells. FASEB J. 2002; 16(1): 61-71. https:// dx.doi.org/10.1096/fj.01-0245com.
  18. Radoja N, Komine M., Jho S.H., Blumenberg M., Tomic-Canic M. Novel mechanism of steroid action in skin through glucocorticoid receptor monomers. Mol. Cell. Biol. 2000; 20(12): 4328-39. https://dx.doi.org/10.1128/ mcb.20.12.4328-4339.2000.
  19. Kosztyu P, Hill M., Jemelkova J., Czernekova L., Kafkova L.R., Hruby M. et al. Glucocorticoids reduce aberrant O-glycosylation of IgA1 in IgA nephropathy patients. Kidney Blood Press. Res. 2018; 43(2): 350-9. https://dx.doi. org/10.1159/000487903.
  20. Johnson E., Groben P, Eanes A., Iyer P, Ugoeke J., Zolnoun D. Vulvar skin atrophy induced by topical glucocorticoids. J. Midwifery Womens Health. 2012; 57(3): 296-9. https://dx.doi.org/10.1111/j.1542-2011.2012.00189.x.
  21. Renaud-Vilmer C., Cavelier-Balloy B., Porcher R., Dubertret L. Vulvar lichen sclerosus: effect of long-term topical application of a potent steroid on the course of the disease. Arch. Dermatol. 2004; 140(6): 709-12. https:// dx.doi.org/10.1001/archderm.140.6.709.
  22. Coondoo A., Phiske M., Verma S., Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol. Online J. 2014; 5(4): 416-25. https:// dx.doi.org/10.4103/2229-5178.142483.
  23. Gual A., Pau-Charles I., Abeck D. Topical corticosteroids in dermatology: From chemical development to galenic innovation and therapeutic trends. J. Clin. Exp. Dermatol. Res. 2015; 6: 269. https://dx.doi.org/10.4172/2155-9554.1000269.
  24. Cross S.E., Magnusson B.M., Winckle G., Anissimov Y., Roberts M.S. Determination of the effect of lipophilicity on the in vitro permeability and tissue reservoir characteristics of topically applied solutes in human skin layers. J. Invest. Dermatol. 2003; 120(5): 759-64. https://dx.doi.org/10.1046/ j.1523-1747.2003.12131.x.
  25. Pellanda C., Strub C., Figueiredo V., Rufli T., Imanidis G., Surber C. Topical bioavailability of triamcinolone acetonide: effect of occlusion. Skin Pharmacol. Physiol. 2007; 20(1): 50-6. https://dx.doi.org/10.1159/000096172.
  26. Haque T., Talukder M.M.U. Chemical enhancer: A simplistic way to modulate barrier function of the stratum corneum. Adv. Pharm. Bull. 2018; 8(2): 169-79. https://dx.doi.org/10.15171/apb.2018.021.
  27. Kapoor M.S., Guha Sarkar S., Banerjee R. Stratum corneum modulation by chemical enhancers and lipid nanostructures: implications for transdermal drug delivery. Ther. Deliv. 2017; 8(8): 701-18. https://dx.doi.org/10.4155/ tde-2017-0045.
  28. Farage M., Maibach H.I. The vulvar epithelium differs from the skin: implications for cutaneous testing to address topical vulvar exposures. Contact Dermatitis. 2004; 51(4): 201-9. https://dx.doi.org/10.1111/j.0105-1873.2004.00444.x.
  29. Connor C.J., Eppsteiner E.E. Vulvar contact dermatitis. Proc. Obstet. Gynecol. 2014; 4(2): Article 1. https://dx.doi.org/10.17077/ 2154-4751.1255.
  30. Rathi S.K., D'Souza P. Rational and ethical use of topical corticosteroids based on safety and efficacy. Indian J. Dermatol. 2012; 57(4): 251-9. https:// dx.doi.org/10.4103/0019-5154.97655.
  31. Nicolaides N.C., Pavlaki A.N., Maria Alexandra M.A., Chrousos G.P. Glucocorticoid therapy and adrenal suppression. Updated 2018 Oct 19. In: Feingold K.R., Anawalt B., Boyce A., Chrousos G., de Herder W.W., Dhatariya K., eds. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279156/
  32. Burger-Stritt S., Bachmann L., Kurlbaum M., Hahner S. Emergency treatment of adrenal crisis with prednisone suppositories: a bioequivalence study in female patients with Addison's disease. Endocr. Connect. 2019; 8(4): 425-34. https:// dx.doi.org/10.1530/EC-19-0024.
  33. Tromm A., Mollmann H., Barth J., Hochhaus G., Krieg M., Bigalke C., Mollmann A, Derendorf H. Pharmacokinetics and rectal bioavailability of hydrocortisone acetate after single and multiple administration in healthy subjects and patients. J. Clin. Pharmacol. 2001; 41(5): 536-41. https://dx.doi. org/10.1177/00912700122010410.
  34. Mollmann H., Barth J., Mollmann C., Tunn S., Krieg M., Derendorf H. Pharmacokinetics and rectal bioavailability of hydrocortisone acetate. J. Pharm. Sci. 1991; 80(9): 835-6. https://dx.doi.ois/10.1002/jps.2600800906.
  35. Van der Meijden W.I., Boffa M.J., Ter Harmsel W.A., Kirtschig G., Lewis F.M., Moyal-Barracco M., Tiplica G.S., Sherrard J. 2016 European guideline for the management of vulval conditions. J. Eur. Acad. Dermatol. Venereol. 2017; 31(6): 925-41. https://dx.doi.org/10.1111/jdv.14096.
  36. Anderson M., Kutzner S., Kaufman R.H. Treatment of vulvovaginal lichen planus with vaginal hydrocortisone suppositories. Obstet. Gynecol. 2002; 100(2): 35962. https://dx.doi.org/10.1016/s0029-7844(02)02117-8.
  37. Fischer G. Treatment of vaginitis and vulvitis. Aust. Prescr. 2001; 24(3): 59-61. https:/dx./doi.org/10.18773/austprescr.2001.067.
  38. Woelber L., Prieske K., Mendling W., Schmalfeldt B., Tietz H.J., Jaeger A. Vulvar pruritus-causes, diagnosis and therapeutic approach. Dtsch. Arztebl. Int. 2020; 116(8): 126-33. https://dx.doi.org/10.3238/arztebl.2020.0126.
  39. Sheppard C. Treatment of vulvovaginitis. Aust. Prescr. 2020; 43(6): 195-9. https://dx.doi.org/10.18773/austprescr.2020.055.
  40. Lambert J. Pruritus in female patients. Biomed. Res. Int. 2014; 2014: 541867. https://dx.doi.org/10.1155/2014/541867.
  41. Chi C.C., Wang S.H., Wojnarowska F., Kirtschig G., Davies E., Bennett C. Safety of topical corticosteroids in pregnancy. Cochrane Database Syst. Rev. 2015; (10): CD007346. https://dx.doi.org/10.1002/14651858.CD007346.pub3
  42. Аполихина И.А., Саидова А.С., Куликов И.А., Баранов И.И. Применение нового комбинированного препарата для местного применения (метронидазол + хлорамфеникол + натамицин + гидрокортизона ацетат) для лечения вагинитов различной этиологии. Акушерство и гинекология. 2020; 7: 143-50.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies