topical steroids dermatology
TRANSCRIPT
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Topical Steroids
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ANTIINFLAMMATORY
ACTIONInhibition of
enzymephospholipase A2
by induction ofinhibitory proteins
IMMUNOSUPRESSIVE ACTIONinhibit
proinammatorygenes , inhibitsphagocytosis andstabilises lysosomalmembranes
VASOCONSTRICTION
ANTI PROLIFERATIVEACTION
on broblasts, inhibitsynthesis of both
mucopolysaccharidesand collagen
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Basic structure of
corticosteroid
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Classication :
Class 1 Superpotent
Class 2
Class 3
Class 4Class
Class ! M"l#
Class $ Least potent
ased on !asoconstrictor assay, the e"tent to #hichthe agent causes cutaneous !asoconstriction$%blanching e&ect'( in normal, healthy persons)
Potent
M"#stren%t&
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Some commonly used drugs :
Class 1'Superpotent(
)eta*et&asone #"prop"onateo"nt*ent+ ,rea*+ -.-/Clo0etasol prop"onate o"nt*ent+,rea*+ -.-/
alo0etasol prop"onate o"nt*ent+,rea*+ -.-/
Class 2 'Potent( eso"*etasone o"nt*ent+ ,rea*+-.2/%el -.-/
Class 3 'Potent( Tr"a*,"lonone a,eton"#e o"nt*ent+-.1/Tr"a*,"lonone a,eton"#e ,rea*+-./
Class 4 'M"#stren%t&( Fluo,"nolone a,eton"#e ,rea*+ -.2/
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Sensible topical drug therapy in!ol!es not only theselection of an appropriate agent, but also a
thoughtful consideration of the areas of the bodya&ected)
)as", pr"n,"ples
*) State of the diseased s+in
$athologic changes(
2) Area of the body
-) Concentration of the drug
.) Type of !ehicle $e)g),ointment, cream, lotion(
/) 0ethod of application1) A dened duration of usethat both ma"imizes
ecacy and minimizesad!erse side e&ects)
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Indications
3czematous disorders: Atopic dermatitis,contact dermatitis, seborrheic dermatitis,nummular dermatitis, lichen simple",
prurigo, house#i!es4s eczema, diaperdermatitis
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Indications
apulos5uamous disorders: soriasis,lichen planus, pityriasis rosea
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Indications Connecti!e tissue disorder: 6upus
erythematosus, dermatomyositis
7eutrophilic dermatoses: ehcet4sdisease, pyoderma gangrenosum
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Indications ullous dermatoses: emphigus foliaceus,
bullous pemphigoid, pemphigoidgestationis
8thers: acne +eloidalis nuchae, alopeciaareata, aphthous ulcer, !itiligo, lichensclerosus et atrophicus
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Contraindications: A0solute: prior
h9o hypersensiti!ity
to topicalcorticosteroid or acomponent of the!ehicle
Relat"6e:untreated localbacterial, fungal,
!iral orm cobacterial
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Na"ls0id strength to mildpotent $digital
atrophy(
Pal*s an# Solesotent ;Super potent
class
Fa,e an#ano%en"tal
6east potent; mildclass
Trun7 an#Etre*"t"es
0id strength; otentclass
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LESION RECOMMENE AVOIE
Acute erythema 6otion, cream 8intment, paste
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Side 3&ects of
Topical Steroids
>a!inder Singh Au?la>oll no) **@2@*@@
Serial B2.-
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Lo,al S"#e E8e,ts
8ccur #ith prolonged treatment
epend on:
The potency of the topicalcorticosteroid,
The !ehicle $ointments, creams orlotions(
The site of application
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Atrophy is the most common ad!ersee&ect
articularly seen on intertriginous areas
Striae tend to beirre!ersible
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A,ne"9or* Erupt"ons
Caused by degradation of follicularepithelium, resulting in e"trusion offollicular content)
>osacea
erioralermatitis
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Purpura ; rash of purplespots on the s+in due tointernal bleeding ofsmall blood !essels$8n use of strongsteroids, caused by
atrophy of the collagen
Telan%"e,tas"a;
dilatation of thecapillaries causingthem to appear assmall red or purple
clusters, often spidery
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Less Fre:uent Lo,al
S"#e E8e,ts Dypertrichosis $abnormal amount of hair
gro#th o!er the body(
igmentation alterations
elayed #ound healing
3"acerbation of s+in infections
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;"tra
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Top",al Stero"#
epen#ent Fa,e >ebound erythema, burning and scalingof the face on attempted stoppage of thesteroid)
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S5ste*", S"#e E8e,ts >are, but may occur #hen highly potent steroids
are used for prolonged periods of time on areas ofthin s+in li+e the face or inamed surfaces)
Suppression of hypothalamic;pituitary;adrenal
a"is Cushing4s syndrome
Dyperglycemia
Ero#th retardation in children $suppressi!e e&ect
on osteoblastogenesis in the bone marro# andpromote apoptosis of osteoblasts and osteocytes,thus leading to decreased bone formation(
Cataract formationor glaucoma$application toeyelids(