Topical steroids mechanism of action

The doctor may suggest hospitalization simply because it may be necessary to break the cycle of chronic inflammation, or other problems that are exacerbating the illness. Frequently, five or six days of vigorous in-hospital treatment care can result in a dramatic clearing of the eczema. Food tests, allergy skin testing, and the development of an outpatient therapy plan can all be done during the hospitalization. Unfortunately, getting approval from insurers is often difficult. During an acute flare the number of 15-20 minute baths must be increased to three or four per day. Besides hydrating the skin, baths also increase the penetration of topical medication up to ten-fold if the medicine is applied immediately after the bath. Wet wraps after baths may also help hydration and medicinal penetration. Bedtime wet wraps are most practical, and can be done with elasticized gauze followed by ace bandages or double pajamas. (The first pair of pajamas is worn damp but not soaking wet, and a second pair of dry pajamas is worn over them. For a tighter fit, sometimes a plastic sauna suit is used instead of the dry pajamas.) For feet and hands, socks can be used. Additional blankets or increased room heat may be necessary during this three to seven days to prevent chilling.

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The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.

-Solution, ointment, gel, foam, cream formulations: Apply a thin layer to affected areas twice a day and rub in gently and completely. Not recommended for use in children under 12 years of age.
-Shampoo, spray, and lotion formulations: Not recommended for use in children under 18 years of age.

Maximum dose: The total dosage should not exceed 50 g (50 mL or fl. oz.) per week.

Duration of therapy: Treatment should be limited to 2 consecutive weeks for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses and up to 2 additional weeks in localized lesions (less than 10% body surface area) of moderate to severe plaque psoriasis that
have not improved after the initial 2 weeks of treatment.

Comments: Unless directed by a healthcare professional, this drug should not be used with occlusive dressings.

Uses:
-Corticosteroid-responsive inflammatory and pruritic dermatoses; psoriasis; recalcitrant eczemas, lichen planus, discoid lupus erythematosus, and other conditions which do not respond satisfactorily to less active steroids.

An Alternative Treatment

Decreased tear meniscus in dry eye.
As an alternative to steroids—or as an adjunctive therapy—topical cyclosporine can also be used to control inflammation in dry eye disease. While cyclosporine does not demonstrate the rapid anti-inflammatory effect of steroids, it carries fewer risks and is safe for long-term use.
Because of their complementary efficacy and safety profiles, many practitioners often begin dry eye treatment by prescribing both topical steroids and cyclosporine. Following the recommendation of the Asclepius Panel, the use of combination therapy is instituted with the topical corticosteroid, Lotemax (loteprednol etabonate ophthalmic suspension %, Bausch + Lomb) and Restasis (cyclosporine ophthalmic emulsion %, Allergan). 24 The Asclepius Panel recommends practitioners begin early treatment with an anti-inflammatory agent (such as Lotemax) four times a day to improve symptoms and to prevent disease progression. After two weeks, the frequency of the corticosteroid is reduced to twice daily and supplemented with Restasis twice a day. Treatment with loteprednol was stopped after day 60, while cyclosporine treatment is continued.

Topical steroids mechanism of action

topical steroids mechanism of action

-Solution, ointment, gel, foam, cream formulations: Apply a thin layer to affected areas twice a day and rub in gently and completely. Not recommended for use in children under 12 years of age.
-Shampoo, spray, and lotion formulations: Not recommended for use in children under 18 years of age.

Maximum dose: The total dosage should not exceed 50 g (50 mL or fl. oz.) per week.

Duration of therapy: Treatment should be limited to 2 consecutive weeks for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses and up to 2 additional weeks in localized lesions (less than 10% body surface area) of moderate to severe plaque psoriasis that
have not improved after the initial 2 weeks of treatment.

Comments: Unless directed by a healthcare professional, this drug should not be used with occlusive dressings.

Uses:
-Corticosteroid-responsive inflammatory and pruritic dermatoses; psoriasis; recalcitrant eczemas, lichen planus, discoid lupus erythematosus, and other conditions which do not respond satisfactorily to less active steroids.

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