Misuse Of Topical Corticosteroids Research Articles

Moderate to severe psoriasis: from topical to biological treatment

The simple use of topical corticosteroids in the treatment of severe psoriasis is often inefficient and harmful. The first line of treatment in these cases is based on systemic therapies such as methotrexate, cyclosporin and phototherapy. Later on, biological treatments can be used. We present three cases of severe psoriasis that have been treated by topical corticosteroids for a long time and with large doses without success and many side-effects. For each one of them, we have introduced either a systemic or a biological treatment with a good efficacy and tolerance. Psoriasis has a strong impact on the quality of life and is comparable to patients with major diseases like cancer or depression. Patients who have severe psoriasis are for the most part disappointed and dissatisfied from their treatment. In fact, the misuse of topical corticosteroids for prolonged periods of time may induce local or systemic side-effects without any improvement. Although patients are more pleased with systemic treatments, their use is often limited because physicians are anxious from the systemic side-effects that may occur. Systemic treatments are often used too late. Patients are not pleased from the way they are treated. Accordingly, using these treatments earlier may improve patients' quality of life.

Cushing's syndrome induced by misuse of topical corticosteroids in a child with psoriasis vulgaris

Prolonged exc)genous corticosteroid aclministration may cause Cushingi syndrome. However the development of Cushing's syndrome from topical corlico,sleroid therapy is rare. A 7½-year-old boy has suffered from psoriasis vulgaris since the age of nvo. He was treated by a dermatologist with a mixlure of 3% salicylic acid, 50% liquor carbonis delergens, 10 grams of 0.1% mometasonefuroate ointment, ancl 5 grams combination cream consisting of 0.1% gentamycin sulphate and 0.0250 Àfiuocinolone acetonide. The parents continued the treatment without the doctorb supervision. They applied it lo all over the patient's body three times dailyfor 3½ years. The patient showed milcl hypertension, moonface, btffilo hump, obesity, multiple striae, and suppression of hypothalamus-pituitary-adrenal axis. The bone minerttl density and bone age examinations revealed normal results. Children are more prone to develop systemic side fficts of topical medicalion beccntse o/'their higher ratio of btal body surface area to body weight. Corticosteroid must be used with great care, especially in children. It is very important to inform the parents abott polential side effects of corticosteroid. (Med J Indones 2008; 17: 281-6)