Use Of Potent Topical Steroids Research Articles

Vulvar inflammatory disorders: A review

Vulvar inflammatory disorders (VID) are a miscellaneous group of non-infectious conditions of the vulvar area, which can be broadly classified based on etiology and pathology. Here, we discuss a few pertinent VID including vulvar dermatitis, psoriasis, lichen planus, and lichen sclerosus. This review will focus only on common VID, and a few rare conditions with characteristic features such as Crohn’s disease, plasma cell vulvitis, acantholytic disorder of genitocrural area, desquamative vulvitis, and atrophic vulvovaginitis. A thorough history taking and relevant investigations including dermoscopy and biopsy are relevant to proper diagnosis and management of VID. Early management of VID is essential since these conditions are prone to interfere with psychosexual functioning of the patient. Potent topical steroids are the first line management in most cases, followed by topical calcineurin inhibitors, emollients, and antihistamines. Vulvar area is resistant to steroid induced atrophy; hence, use of potent topical steroids does not pose a problem. Oral steroids or steroid sparing agents are used in resistant cases.

The importance of topical steroids after adhesiolysis in erosive lichen planus and graft versus host disease

The aim of this study was to assess the efficacy of a postoperative steroid regimen in maintaining vulvovaginal architecture and vaginal patency following surgical adhesiolysis in severe erosive lichen planus (ELP) and genital graft versus host disease (GVHD). Sixteen women applied potent topical steroids to the vulva and vagina from 48 hours after surgery. Sexual and urinary function and vulvovaginal anatomy were assessed at 6 weeks, 6, 12 and 24 months. All of the patients had failed sexual function due to vaginal stenosis. Eleven patients were unable to have cervical smears and three had associated haematocolpos. Vaginal adhesiolysis achieving complete patency occurred in all patients with stenosis. Fifteen (93.7%) patients were compliant with the regimen. After two years, 12 (75%) patients had maintained complete vaginal patency. Four patients (25%) developed vaginal restenosis. This study demonstrates that the potent topical steroids used post-operatively are very effective in maintaining vaginal patency and function.Impact statementWhat is already known on this subject? Potent topical steroids are the first line treatment for ELP and GVHD and have been reported to be helpful after surgery to release adhesions.What do the results of this study add? Topical steroids used immediately after surgical adhesiolysis in patients with vulvo-vaginal lichen planus and graft-versus-host disease improves the outcomes and maintains function, which can give a prolonged benefit.What are the implications of these findings for clinical practice and/or further research? The use of potent topical steroids should be considered as routine practice after surgery in erosive inflammatory disease to control inflammation and improve the long term outcomes for these patients.

High‐Potency Topical Steroids: An Effective Therapy for Chronic Scalp Inflammation in Rapp–Hodgkin Ectodermal Dysplasia

Chronic erosive pustular dermatitis with a predilection for the scalp is a hallmark of ectodermal dysplasias (EDs) caused by mutations in TP63, including Rapp-Hodgkin and Hay-Wells EDs. It is among the most troublesome and symptomatic complications and is typically refractory to classic wound care approaches. We report two cases of Rapp-Hodgkin ED with refractory scalp erosions that markedly improved with the use of potent topical steroids. We also note marked similarities between this scalp inflammation and "erosive pustular dermatosis of the scalp," a condition more typically found in elderly individuals with severe scalp sun damage, and speculate about possible shared pathogenetic mechanisms.

Norwegian scabies: Rare cause of erythroderma.

Sir, Erythroderma is the condition where more than 90% body surface area develops erythema and scaling. Common causes are eczemas (40%), psoriasis (15%), drugs and malignancy, while crusted scabies, lichen planus, dermatomyositis, etc. account for only 0.5% cases.[12] Scabies is an infestation by ectoparasite of female gravid mite of Sarcoptes scabiei var. hominis. Burrow is the pathognomonic feature of scabies infestation. The average number of adult female mites on an individual suffering from the common form of scabies is about 12. Approximately 40-50 eggs are laid by each female during its lifespan of 4-6 weeks, during which time she doesn’t leave the burrow. Scabies affects all races and social classes worldwide, but accurate figures of its prevalence are difficult to obtain.[1] The appellation “Norwegian” derives from the description in Norway by Danielssen and Boeck of a type of scabies in which a huge number of mites were present in lepers may be the number of mites was in millions. It is seen in patients with sensory anesthesia, mental impairment, physical incapacity, and immunosuppression.[1] A 62-year-old patient presented with large, warty crusts with irregular thickening and fissuring of the scalp, neck, trunk, arms, forearms, thighs, genitalia, gluteal region, dorsum of hands and webs of fingers [Figures 1-3]. Scaling was generalized and there was sparing of palms, soles, and nails. There was no itching at the time of presentation. He developed mild itching on some occasions during the course of illness and over one a period of year, he had been treated in multiple hospitals for eczema and psoriasis and applied topical corticosteroid for his hyperkeratotic lesions [Figure 4]. On general examination, he had pallor and generalized lymphadenopathy. On dermatological examination, large thickened crusts were evident from the scalp to mid-thigh, sparing some areas of the chest, palms, soles and nails. More than 90% of skin surface was involved with erythema and scaling. Crusts could be separated with a forceps without bleeding. On mental state examination, patient had dementia and denied sensation of itching. Microscopic examination of crusts dissolved in 10% KOH revealed fields teeming with mites and eggs [Figures 5 and 6]. He was treated with ivermectin 12 mg weekly for four weeks and application of topical permethrin 5% cream every day for two weeks and then once weekly for the next two weeks. After one month of treatment the patient's erythroderma and skin lesions regressed completely.Figure 1: Generalized scaling all over the bodyFigure 2: Scaling over back and buttocksFigure 3: Affection of web of fingers and dorsum of hand and forearmsFigure 4: Scaling over the neckFigure 5: Scabies mite in KOH mount of scales (×10)Figure 6: Eggs of scabies mite in 10% KOH mountIn common scabies, there are few mites, probably because scratching destroys the burrows. A good standard of hygiene may also help to control the mite population. In crusted scabies, the host's response to the mites is modified, allowing them to multiply.[13] Patients who are mentally retarded or suffer from dementia may develop crusted scabies.[2] The reason for this association with mental abnormality is not completely understood, but lack of appreciation of pruritus may be important. Crusted scabies has also resulted from inappropriate use of potent topical steroids.[3456] Suppression of sensitivity to the mites reduces itching, so there is less scratching and destruction of burrows. Moreover, diagnosis of the cause of erythroderma is sometimes difficult and repeated biopsy is needed. Our clinical differential diagnoses were hyperkeratotic eczema, psoriasis, contact dermatitis, but after application of topical corticosteroid the lesions didn’t resolve but rather they were exacerbated. There were crusts; and no micaceous scales or the Auspitz's sign of were absent. Thus the patient's dementia likely contributed to scabies evolving into the crusted variant while the use of topical potent corticosteroid exacerbated the erythroderma.

Infantile Exogenous Cushing Syndrome due to Misuse of Topical Corticosteroid

Background: Topical Corticosteroids have been ordered in Medical practice by many doctors for Various Skin diseases but prolong use of these Medication causes Systemic adverse effects including Cushing Syndrome. Iatrogenic Cushing Syndrome may occur with over use of potent topical steroids mostly due to Diaper dermatitis. Case report: We report a 3 month old female infant who developed Cushing Syndrome after diaper dermatitis treatment through misuse of Clobetasol without doctor’s Prescription. After diagnosis, the application of this topical corticosteroid was stopped and physiologic dose of prednisolon was prescribed to prevent an adrenal crisis for 2 months. Conclusions: Continuous use of moderate to high potency topical corticosteroids over several months can contribute to cushing’s syndrome. So parents must be informed by physicians about the adverse effect of steroids and they should be avoided in very young infant.

Skin diseases affecting the vulva

Skin diseases of the vulva are associated with considerable morbidity and often reluctance on the part of patients to seek medical attention. The most common conditions seen in a dermatology vulval clinic are the vulval dermatoses (inflammatory disorders), which comprise lichen sclerosus, lichen planus, vulval eczema and psoriasis. Other conditions such as vulval pain syndromes, vulval disorders associated with systemic diseases and blistering diseases are also seen. Treatment of many of these conditions involves the use of potent topical steroids, which are safe to use under supervision and in the short term.

The management of polymorphic light eruption

Many cases of polymorphic light eruption are mild and effectively prevented by the use of broad spectrum topical sunscreens combined with careful sun exposure. For a minority of severely affected individuals, a short prophylactic springtime course of PUVA or UVB is often helpful. Other treatments such as hydroxychloroquine are rarely indicated but may be assessed in resistant cases. For established PLE, short-term use of potent topical steroids may give symptomatic relief. (J Dermatol Treat (1992)3: 99–101)

Cushing's syndrome secondary to topical steroid application to the scalp: A cautionary tale

We report a case of Cushing's syndrome following obsessional abuse of a potent topical steroid lotion applied exclusively to the scalp, and which resolved after the lotion was withdrawn. This case exemplifies the danger of prolonged undersupervised use of potent topical steroids and caution is necessary with all long-term prescriptions.