Glikokortykosteroid donosowy

Zusammenfassung Fragestellung: In der vorliegenden Arbeit wurde untersucht, welchen Einfluss eine mehrwöchige Therapie mit Budesonidspray (Rhinocortol ® -Spray) auf die mittlere Zilienschlagfrequenz und den rhinoskopischen Befund hat. Patienten und Methoden: Die Zilienschlagfrequenz wurde photometrisch bei Patienten mit chronischer Sinusitis an von der Nasenschleimhaut entnommenen Biopsien vor und nach Therapie bestimmt. Ergebnisse: Es resultierte keine signifikante Zilienschlagfrequenzänderung. Der Rangsummentest nach Wilcoxon ergab einen p-Wert von 0,856. Der rhinoskopische Befund besserte sich nach lokaler Kortikosteroidtherapie bei 9 Patienten (57%), während er bei 6 Patienten (37%) unverändert blieb. Zilienschlagfrequenz und rhinoskopischer Befund korrelierten nicht (r s = 0,06). Schlussfolgerungen: Die vorliegende Untersuchung deutet darauf hin, dass Rhinocortolspray nicht schädigend auf das Flimmerepithel wirkt und dass das Präparat zur Therapie der chronischen Sinusitis geeignet ist.

Examplifying the case of a 24-year-old female patient, who developed a severe dyshidrotic dermatophytid of the hands in addition to a pronounced inflammatory mycosis of the feet, the main differential diagnoses of this probably underdiagnosed disease pattern are discussed. Besides dyshidrosis these mainly include dyshidrotic variants of atopic dermatitis and dyshidrosiform contact dermatitis. The strong delayed-type hypersensitivity reaction to dermatophyte antigens often leads to agonizing itch. Therefore, in the present case a topical antifungal-corticosteroid combination was used in addition to systemic antifungal therapy.

For the symptomatic treatment of allergic rhinitis the following groups of drugs are available (Fig 1): decongestants (sympathicomimetics), stabilisers of the mast cell membrane (DNCG, Nedocromil), corticosteroids (Aerosols), antihistamines, ketotifen, anticholinergica. The world wide use (and abuse) of decongestants (sympathicomimetics) is limited by the so-called rhinopathia medicamentosa, when the necessary treatment exceeds 3 or 4 weeks. The antiallergic preparations like sodiumcromoglycat and nedocromil prevent sneezing, rhinorrhea and eye irritations. Their reported effect is „stabilisation” of the mast cell membrane. They have practical no side effects, but the patients compliance is limited by the short, prophylactic effect, necessitating frequent topical applications up to 6 times daily. As the overall symptom scores are only reduced between 30% to 50%, they are not suited for severe cases of allergic rhinitis. Nedocromil should have a significantly better efficiency than DNCG. The development of efficient topical glucocorticosteroid aerosols was a great progress in the treatment of allergic rhinitis. With daily doses of 100 µg to 800 µg they are very effective against hypersecretion, sneezing, itching and also blocking of the nose. Because of the so-called “first pass” effect after resorption through the nasal mucosa they have minimal general side effects, especially on the balance of the endocrine system. Their rare local side effects on the nasal respiratory mucosa include local irritations, crusting, dryness and seldom nose bleeding. They may be overcome by concomitant use of ointment or change to aqueous glucocorticoid preparations without any propellant. The therapeutic significance of antihistaminic drugs has changed in the last years, since new preparations with H 1 -receptor speeifity and without undesired any sedative or anticholinergic side effects. They are very effective in reliving symptoms of rhinorrhea and itching, but have less effects on blocking of the nose. Anticholinergic drugs, like ipratropriumbromid exhibit only control of hypersecretion and are therefore very limited for clinical use. Summarizing we have today some symptomatic very effective drugs for the treatment of allergic rhinitis, which have - to our opinion - limited the indications for other antiallergic therapy modalities with more risks like hyposensitation (immuno therapy).

Glikokortykosteroid donosowy

glikokortykosteroid donosowy


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