Side Effects Of Topical Steroids Research Articles

Awareness and Knowledge of Adverse Effects of Topical Corticosteroids Among the General Population in Jeddah, Saudi Arabia.

Corticosteroids are naturally produced in the adrenal cortex and regulate a variety of physiological processes, including but not limited to, stress homeostasis, metabolism, and inflammation. As synthetic steroids exert the same effects as natural steroids, they are used in the treatment of various skin conditions. Synthetic steroids are delivered in a variety of forms, such as topical preparations, oral preparations, and injections. Topical steroids are one of the most commonly prescribed medications in dermatology clinics. Although topical steroids were thought to provide maximum benefit with no side effects, many side effects have been reported by topical corticosteroid users. Therefore, this study examined awareness and knowledge regarding topical steroids among the general population in Jeddah, Saudi Arabia. This was a cross-sectional study involving 426 subjects in Jeddah, Saudi Arabia. Subjects completed a self-administered questionnaire, and data were collected from February to April 2023. The questionnaire assessed age, sex, education level, occupation, and general knowledge regarding the side effects of topical steroids. The study cohort was predominantly female (77%). Half of the participants were aged 21-39 years. Most of the subjects (70%) were steroid users, and the most common reported indication for steroid use was undetermined (37.6%). Nearly half of the participants did not know whether steroids were dangerous, and 59.4% did not know that topical steroids can cause systemic effects. This study assesses knowledge regarding topical steroids among the general population in the western region of Saudi Arabia. The results revealed a lack of knowledge regarding the side effects of topical steroids. Awareness of potential topical steroid side effects should be increased among the general population to minimize the occurrence of serious side effects.

13266 Targeting steroid phobia: A health services research and randomized controlled trial

Fear of side effects of topical steroids is common and results in non-compliance and poor control. This was a prospective, double blinded, randomized controlled trial. Participants in the intervention arm were shown an educational video targeting common misconceptions highlighted from our pilot data. Control patients received standard medical care. Steroid phobia was assessed with the TOPICOP score. Adherence was assessed using the ECOB score, and quality of life with the DLQI. 270 patients were randomised in a 1:1 ratio.

Sexual dimorphism in atrophic effects of topical glucocorticoids is driven by differential regulation of atrophogene REDD1 in male and female skin.

Topical glucocorticoids, well-known anti-inflammatory drugs, induce multiple adverse effects, including skin atrophy. The sex-specific effects of systemic glucocorticoids are known, but sexual dimorphism of therapeutic and side effects of topical steroids has not been studied. We report here that female and male mice were equally sensitive to the anti-inflammatory effect of glucocorticoid fluocinolone acetonide (FA) in ear edema test. At the same time, females were more sensitive to FA-induced skin atrophy. We recently reported that REDD1 (regulated in development and DNA damage 1) plays central role in steroid atrophy. We found that REDD1 was more efficiently activated by FA in females, and that REDD1 knockout significantly protected female but not male mice from skin atrophy. Studies using human keratinocytes revealed that both estradiol and FA induced REDD1 mRNA/protein expression, and cooperated when they were combined at low doses. Chromatin immunoprecipitation analysis confirmed that REDD1 is an estrogen receptor (ER) target gene with multiple estrogen response elements in its promoter. Moreover, experiments with GR and ER inhibitors suggested that REDD1 induction by these hormones was interdependent on functional activity of both receptors. Overall, our results are important for the development of safer GR-targeted therapies suited for female and male dermatological patients.

Topical steroids: Awareness and misuse among patients, pharmacists and general medical practitioner.

(1) To determine the level of awareness among patients, pharmacists and general practitioners about commonly available topical steroids and its combinations.(2) To determine the source of recommendation/prescription of topical steroids and its combination creams.(3) To know and create awareness about the side effects of topical steroids in all the study groups. This was a prospective questionnaire-based study where three study groups, namely patients, pharmacists and general practitioners, were included. This study was approved by the institutional ethics committee. after ethical clearance. The patients who used topical steroids for dermatoses where it is an absolute contraindication, as well as those who developed side effects, were included in the study. ThoroughComplete cutaneous examination was done specifically to detect the side effects of steroids. Seminars were conducted and questionnaires were given to both the pharmacists and general practitioners of nearby areas. The questionnaire consisted of questions regarding their prescription and dispensing practices of topical steroids and its combinations. Out of 95 patients seen, the most commonly used steroid molecule was clobetasol propionate 0.05% in 44 (46.3%) patients, the common source of recommendation was general practitioners in 36 (37.8%), the common indication was superficial dermatophytosis in 85 (89%) and the most common adverse effect was recurrence/increase in the extent of the infection in 72 (75.78%) patients. Out of total 44 general practitioners enrolled in the study, 22 (50%) were qualified allopathic medical practitioners and22 (50%) were homeopathic/ayurvedic doctors. Superficial dermatophytosis [19 (43.18%)] was the common dermatosis seen by them. While 29 (65.90%) preferred prescribing topical steroids or its combination, rest of them preferred plain steroid creams. Out of 179 pharmacists, 74 (41.34%) did not have appropriate knowledge of topical steroids, 35 (19.55%) were not aware that steroids are isschedule "H" drugs. Commonest molecule sold over the counterwas clobetasol propionate 0.05% by 74 (41.89%). The limitations of our study were small study group and short duration. As dermatologists, it is our responsibility, to correctly educate the society, particularly the non-dermatologist medical fraternity, about ethical and rational use of topical steroids.

Steroid phobia among general users of topical steroids: a cross-sectional nationwide survey

Objective: The aim of this study was to assess steroid phobia among general users of topical corticosteroids and to analyze factors associated with steroid phobia.Methods: A cross-sectional nationwide survey was conducted using an online panel with participants stratified by age, sex, and region. Those aged 18–65 years with experience of topical steroid use within the past 1 year were included.Results: Of the 3000 respondents included, 929 (31%) had steroid phobia. Among those with steroid phobia, 322 (35%) reported that their fear developed after obtaining information from the media. Weight gain, asthma, skin thinning, growth stunting, and skin aging were the side effects cited as the main reasons behind development of steroid phobia. Female respondents and those with experience of the side effects of topical steroids were more likely to have steroid phobia, while those who obtained information on topical steroid use from a healthcare professional were less likely to have steroid phobia.Conclusions: Steroid phobia among general users of topical steroids appears to be relatively high despite most of them being non-chronic topical steroid users. Healthcare professionals should not refrain from counseling patients, but instead actively address the issues leading to fears in patients.

Awareness of and phobias about topical corticosteroids in parents of infants with eczema in Hangzhou, China.

Knowledge of and phobias about topical corticosteroids in parents of infants with eczema affect efficacy of eczema treatment. We surveyed 300 parents of children with eczema using a questionnaire to investigate knowledge of and phobias about topical corticosteroids. Overall, 85.7% (n = 257) of children had used topical corticosteroids, with 12.8% (n = 33) of children having steroids applied for only 1-3 days per episode; 79.4% (n = 204) of patients discontinued topical steroid therapy immediately after improvement. Twenty-five percent (n = 75) of parents refused a prescription of steroid ointment, and 32.3% (n = 97) did not use the steroid ointment on their children despite having received a prescription. During steroid treatment, 95.7% (246) of parents were very concerned about the side effects of topical steroids. One hundred eight parents (42%) did not use a topical steroid ointment for recurrence of eczema because of concerns about using topical corticosteroids. Most parents of infants with eczema had excessive concerns about topical corticosteroids, leading to inadequate treatment of atopic dermatitis. In clinical practice, physicians should reinforce parents' understanding of steroid treatment for eczema and guide rational use of topical steroids for infantile eczema.

Bilateral Periorbital Involvement Localized to Eyelids in Lichen Planus Pigmentosus.

Sir, Lichen planus pigmentosus (LPP) usually affects the face and neck of dark-skin phototype individuals having overexposure to sunlight. There are also a few known atypical clinical variants. Here, we document a unique case of LPP affecting both upper and lower eyelids bilaterally presenting as “raccoon eyes.” A 35-year-old male presented with asymptomatic dark slate-gray hyperpigmentation over both eyelids on both sides for the past 1 year. There was no history of trauma, pre-existing dermatosis, or topical and/or systemic medications before the onset of pigmentation. Local cutaneous examination revealed well-defined dark slate-gray hyperpigmented patches chiefly involving both the right and left upper eyelids and medial aspect of both lower eyelids extending to the infraorbital area [Figure 1a and b]. Few brownish-black hyperpigmented patches with atrophic centre were also present on the right side of forehead. Nails and mucosa were normal on examination.Figure 1: (a) Dark slate-gray hyperpigmented patches on both upper eyelids and hyperpigmented patches with atrophic centre on right side of forehead. (b) Slate-gray hyperpigmentation of medial aspect of both lower eyelidsHistopathologic examination of the punch biopsy specimen taken from lower eyelid lesion demonstrated moderately dense superficial perivascular lichenoid lymphocytic infiltrate along with melanophages in papillary dermis with wedge-shaped hypergranulosis and compact orthohyperkeratosis. The dermoepidermal junction showed focal basal cell vacuolization, and scattered necrotic keratinocytes and colloid bodies were seen at the interface [Figure 2]. Based on the clinicopathologic correlation, bilateral eyelid pigmentation was diagnosed as LPP and the atrophic hyperpigmented patches on forehead were considered as lichen planus too (atrophic variant) because LPP is well known to coexist with other cutaneous lesions of LP.Figure 2: Compact orthohyperkeratosis, wedge-shaped hypergranulosis, perivascular lichenoid lymphocytic infiltrate along with focal basal cell vacuolization, and scattered colloid bodies at the interface (H and E, ×400)LPP is a relatively common pigmentary disorder seen in individuals of Fitzpatrick skin type III–V living in tropical countries such as India, middle-east, and Latin America.[1] It chiefly affects the face, neck, and upper limbs with ill-defined slate-gray to brownish-black hyperpigmentated homogenous patches.[1] There are certain rare clinical forms of LPP such as LPP inversus (flexural involvement), blaschkoid, zosteriform, segmental, and mucosal forms reported in literature.[2] In this article, a unique presentation of LPP has been noted which involved both upper and lower eyelids bilaterally, masquerading as “raccoon eyes.” Previously, only 19 cases of LP were reportedly seen to involve eyelid regions, summarized in a recently published article, and none of those cases were the LPP variant of LP.[3] Of note, we could find a single case having ill-defined patches of LPP with periocular distribution in a female.[4] Considering the peculiar involvement of eyelid area, its differential diagnosis includes only a few conditions such as dermal melanocytosis, post-inflammatory hyperpigmentation secondary to atopic dermatitis, allergic contact dermatitis, Riehl's melnosis or pigmented cosmetic dermatitis (PCD), fixed drug eruption (FDE), and tear trough associated with ageing.[5] Among these, PCD is the most important differential diagnosis occurring secondary to application of cosmetics containing allergens such as balsam of Peru, cinnamates and lanolin, or some pigments.[1] Considering that patch testing is not a very useful method to differentiate these two conditions, detailed history, morphology and color of the lesions, and histopathologic demonstration of classical findings of LPP confirm the diagnosis. Treatment modalities for LPP include topical application of mild or potent steroids, tacrolimus, oral administration of dapsone, retinoic acid derivatives, cyclosporine, and phototherapy.[3] For cases of LPP of eyelids, tacrolimus should be used for topical application to avoid ocular side effects of topical steroids. Description of such a unique case further expands the dimension of clinical variants of LPP, warranting its consideration as an important differential diagnosis in all doubtful cases. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Topical steroid addiction in atopic dermatitis.

The American Academy of Dermatology published a new guideline regarding topical therapy in atopic dermatitis in May 2014. Although topical steroid addiction or red burning skin syndrome had been mentioned as possible side effects of topical steroids in a 2006 review article in the Journal of the American Academy of Dermatology, no statement was made regarding this illness in the new guidelines. This suggests that there are still controversies regarding this illness. Here, we describe the clinical features of topical steroid addiction or red burning skin syndrome, based on the treatment of many cases of the illness. Because there have been few articles in the medical literature regarding this illness, the description in this article will be of some benefit to better understand the illness and to spur discussion regarding topical steroid addiction or red burning skin syndrome.

Topical steroid addiction in atopic dermatitis

Topical steroid addiction in atopic dermatitis Mototsugu Fukaya,1 Kenji Sato,2 Mitsuko Sato,3 Hajime Kimata,4 Shigeki Fujisawa,5 Haruhiko Dozono,6 Jun Yoshizawa,7 Satoko Minaguchi8 1Tsurumai Kouen Clinic, Nagoya, 2Department of Dermatology, Hannan Chuo Hospital, Osaka, 3Sato Pediatric Clinic, Osaka, 4Kimata Hajime Clinic, Osaka, 5Fujisawa Dermatology Clinic, Tokyo, 6Dozono Medical House, Kagoshima, 7Yoshizawa Dermatology Clinic, Yokohama, 8Department of Dermatology, Kounosu Kyousei Hospital, Saitama, Japan Abstract: The American Academy of Dermatology published a new guideline regarding topical therapy in atopic dermatitis in May 2014. Although topical steroid addiction or red burning skin syndrome had been mentioned as possible side effects of topical steroids in a 2006 review article in the Journal of the American Academy of Dermatology, no statement was made regarding this illness in the new guidelines. This suggests that there are still controversies regarding this illness. Here, we describe the clinical features of topical steroid addiction or red burning skin syndrome, based on the treatment of many cases of the illness. Because there have been few articles in the medical literature regarding this illness, the description in this article will be of some benefit to better understand the illness and to spur discussion regarding topical steroid addiction or red burning skin syndrome. Keywords: topical steroid addiction, atopic dermatitis, red burning skin syndrome, rebound, corticosteroid, eczema

Topical corticosteroid abuse on the face: a prospective, study on outpatients of dermatology

Introduction: Topical corticosteroids (TCS) are widely misused. Uncontrolled use of steroids can cause undesirable adverse effects especially on face. Aim: The aim of this study was to assess the skin manifestations of TCS misuse over the face in the patients attending dermatology outpatient and to analyze various factors contributing to such misuse. Methods and Methods: A total of 200 patients with facial dermatoses using topical steroids over face for minimum period of 1 month, reported between June 2010 and May 2011 were enrolled in the study. Details about the usage of topical corticosteroids and their side effects were recorded. The patients were educated about the misuse. Results: Majority of the patients were females (71%). The most common reason for misuse was acne (61%) followed by use as a fairness cream (23%). The average duration of usage was 6 months to 1 year, longest being 8 years. The drug most commonly misused was Betamethaone Valerate (71%). The commonest side effect noted was acne form eruptions (52%) followed by steroid dependent face (SDF) (36%). There were no cases of allergic contact dermatitis or perioral dermatitis. The exacerbation of the lesions on stoppage of steroid cream (90%) fairness effect (10%) were the reasons for continued use. (100%) were unaware of side effects of topical steroids. Conclusions: Steroids have been misused by patients on their own or by doctors for various reasons. Hence the awareness about their correct usage is essential.

Steroid Phobia in the Ward

Topical steroid phobia is a recognised phenomenon and may be exhibited by patients, parents of patients, relatives, GPs, dermatologists, pharmacists, Internet sites and patient blogs [1-3]. Unhelpful and overvalued beliefs about side effects of topical steroids exist, resulting in a reluctance to use topical steroids as recommended. Adherence to the suggested treatment regimen is reduced which can result in suboptimum outcomes. The reasons for steroid phobia are complex and have been explored recently [4].

Side-effects of topical steroids: A long overdue revisit.

The introduction of topical steroids (TS) of varying potency have rendered the therapy of inflammatory cutaneous disorders more effective and less time-consuming. However the usefulness of these has become a double edged sword with constantly rising instances of abuse and misuse leading to serious local, systemic and psychological side effects. These side effects occur more with TS of higher potency and on particular areas of the body like face and genitalia. The article reviews the side effects of TS with special mention about peadiatric age group, also includes the measures for preventing the side effects.

Nonpharmacologic Treatment of Chronic Graft-versus-Host Disease in Children and Adolescents

Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for many children with life-threatening diseases. One of the most significant long-term complications of transplantation is chronic graft-versus-host disease (cGVHD). Although the rates of cGVHD after HSCT are lower in the pediatric population than in adults, cGVHD remains a significant cause of morbidity and mortality. Medicines used to prevent and treat cGVHD remain unsatisfactory, with protracted use of immune suppression necessary and high rates of first-line treatment failure. Efforts to improve salvage treatment are urgently required. Nonpharmacologic strategies attempt to modulate the cellular inflammation response and possibly allow reduction or cessation of immunosuppressive drugs. Mesenchymal stromal cells (MSC) have been shown invitro to mediate a wide variety of immune responses. MSC have been used in the prophylaxis of acute GVHD (aGVHD) and for the treatment of established steroid refractory aGVHD and, more recently, in the management of cGVHD. Extracorporeal photochemotherapy (ECP) has shown promising efficacy in graft-versus-host disease, and may allow a significant reduction in the use of systemic steroids and other immunosuppressants, reducing long-term morbidity and mortality. The accumulated experience shows ECP to be well tolerated, with no clinically significant side effects.

Predictors of topical steroid misuse among patrons of pharmacies in Pretoria

AbstractBackground:The misuse of topical steroids, i.e. the usage of these products for skin lightening, is a widespread phenomenon among African men and women. Studies have reported prevalence rates of 18.5% to 70% among participants. Though women constitute the majority of users, people of various age groups, socioeconomic status, employment and marital status practise skin lightening. Besides topical steroid products, other commonly used products include preparations containing hydroquinone or mercury derivatives.The misuse of these products is associated with skin problems such as cellulitis, contact eczema, bacterial and fungal infections, Cushing's syndrome, acne, skin atrophy and pigmentation disorders. Although these effects are well documented, it seems that there is little awareness of them among the general public. Other less commonly reported problems include delaying the diagnosis of leprosy, and erythrodermic psoriasis.Data on the misuse and side effects of topical steroids have been gathere...