Charles Chiang

Wright State University, Dayton, Ohio, United States

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Publications (3)5.01 Total impact

  • Ethan Levin · Rishu Gupta · Daniel Butler · Charles Chiang · John Y M Koo
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    ABSTRACT: Background: Topical corticosteroids are a mainstay of therapy for inflammatory skin disorders. Hypothalamic-pituitary-adrenal (HPA) axis suppression is a potential systemic risk of topical steroid use. Our aim was to review available data on the risk of HPA axis suppression associated with long-term topical steroid use and to distinguish between pathologic and physiologic adrenal suppression. Methods: We performed a PubMed search for literature that evaluated the risk of HPA axis suppression associated with topical steroid use. Results: Fifteen of sixteen clinical trials reviewed did not report any pathologic adrenal suppression. In the single clinical trial that reported pathologic adrenal suppression, the patients used twice the maximum recommended amount of clobetasol propionate continuously for as long as 18 months. Physiologic adrenal suppression was seen as early as 1-2 weeks after treatment with class I-IV topical corticosteroids. In about half of these patients, cortisol levels spontaneously returned to normal within a few weeks, despite continuous therapy. Conclusion: Even when adrenal suppression occurs, topical corticosteroids are unlikely to be associated with clinical signs or symptoms of HPA axis suppression and are extremely safe as long as they are used within the current safety guidelines.
    No preview · Article · Oct 2013 · Journal of Dermatological Treatment
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    ABSTRACT: Background: Alefacept (AmeviveĀ®) was the first biologic agent to be approved by the FDA for use in moderate to severe chronic plaque psoriasis and remains one of the safest systemic agents. However, alefacept is the least utilized of all the biologic agents due to the finding that it is only effective in a small proportion of patients and its maximal efficacy is not seen until approximately 6 weeks after treatment completion. Objective: To determine whether intralesional injections with a biologic agent can predict who will be a responder or a non-responder to the medication. Methods: This was a single-center 22-week study consisting of three phases: i) intralesional injection to a target plaque, ii) intramuscular alefacept injections for 12 weeks (standard dose) and iii) post-treatment follow-up. Results: There appears to be a perfect correlation between patients who show a response to an intralesional injection of alefacept to a small, target plaque and those who eventually respond to a full 12-week systemic course of the medication (achieve at least 70% improvement in their PASI scores from baseline) (p = 0.0003). Limitations: This study had a small sample size and was limited by the fact that it was open-label without a control arm. Conclusion: The results from this pilot study demonstrated that alefacept appears to work intralesionally and this may be usable to predict systemic response. More importantly, these results strongly suggest that a biologic agent can work locally - a novel concept that contradicts the common notion that biologic agents must work "systemically".
    No preview · Article · Apr 2012 · Journal of Dermatological Treatment
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    ABSTRACT: Alefacept is a remittive treatment for generalized psoriasis but is rarely used due to its erratic efficacy. To determine if psoriasis plaques will respond to intralesional alefacept and if this predicts a systemic response to intramuscular (IM) alefacept. We describe a 25-week, single-center, open-label study. Patients received weekly intralesional alefacept of increasing concentrations into target plaques for 3 weeks followed by IM injections for 12 weeks and concluded with an observation period of 9 weeks. The psoriasis area and severity index (PASI) was used to assess the efficacy of IM alefacept. Interim results are reported for the first seven patients enrolled. Two patients responded intralesionally to the most dilute 1:100 concentration of alefacept to sterile water and achieved a 59% and 100% improvement in PASI. Five patients did not respond intralesionally to the most dilute form of alefacept and none achieved PASI 75. Two of these five patients did not respond to any concentration and achieved a 26% and 38% improvement in PASI. Limitations to this study include a small sample size and being non-placebo-controlled. Alefacept is effective intralesionally and may predict a systemic response - challenging the concept that biologics must work systemically.
    No preview · Article · Jan 2011 · Journal of Dermatological Treatment

Publication Stats

6 Citations
5.01 Total Impact Points


  • 2012-2013
    • Wright State University
      • Department of Dermatology
      Dayton, Ohio, United States
  • 2011
    • University of California, San Francisco
      • Department of Dermatology
      San Francisco, California, United States