Use Of Steroid Creams Research Articles

Topical steroid menace: A case series of severe debilitating infections during the COVID-19 pandemic

ABSTRACT Background: Topical corticosteroids is a boon and also a bane in treating chronic skin conditions. The risk of cutaneous infections due to topical steroids increases with their potency, dose, and duration of treatment. Herein, we present a case series of severe debilitating infections secondary to topical steroid abuse. Materials and Methods: We came across five cases of severe skin infection following the prolonged application of topical steroids. These cases gave a history of the use of steroid creams for persistent skin conditions and the inability to visit the hospital due to the prevailing COVID-19 pandemic. Observations: We came across two cases of crusted scabies, two cases of Fournier’s gangrene, and a case of erosio interdigitalis blastomycetica. These cases had been using topical steroids for a prolonged period for other dermatological conditions. Conclusion: We propose that, as crusted scabies and erosio interdigitalis blastomycetica mimic various other papulosquamous disorders, a KOH examination is a diagnostic tool. Topical steroid abuse is one of the predisposing factors for Fournier’s gangrene. Key words: Topical Steroids; Crusted Scabies; Fournier’s Gangrene; COVID-19

Clinicomycological Profile of Pediatric Dermatophytoses: An Observational Study.

Background/Objectives:There has been a recent explosion in the incidence of dermatophytic infections globally, especially in tropical countries including India. This increase is associated with a change in the clinical pattern and mycological profile with poor response to treatment, in adults and children. Limited studies in India have focused on pediatric dermatophytoses. Our study’s primary objective was to assess the clinicomycological profile of pediatric dermatophytosis in our region and secondarily to understand the association of lifestyle factors with poor response to treatment.Methods:This was an observational study including children ≤16 years of age, clinically diagnosed with tinea. Clinical and lifestyle data regarding site, affected surface area, duration of infection, previous treatment, possible sources of infection, overcrowding, and bathing practices were collected. Samples were collected for potassium hydroxide mount and fungal culture.Results:A total of 183 children participated in our study. The most common diagnosis was tinea corporis. Tinea cruris was more frequent in preadolescents, where males were more affected. Positive associations were seen between increased duration of infection, increased household infection, infection among playmates, irregular bathing, and use of steroid creams. The most common organism isolated was Trichophyton mentagrophytes/interdigitale (55.19%) followed by Trichophyton rubrum (14.75%).Conclusions:There is a change in the mycological profile of pediatric dermatophytosis with an increase in Trichophyton mentagrophytes/interdigitale infection. Important sources of infection in children must be identified in chronic and recurrent cases. Misinformed and ignorant use of steroid creams is an important reason for recurrent infection.

Duration of topical therapy in the maintenance of atopic dermatitis remission in paediatric age.

BACKGROUND Topical corticosteroids (TCS) are the first-choice treatment for atopic dermatitis (AD) flares. In literature there are clear advice about the potency, dosage and frequency of application of TCS, but there are no shared indications about duration of the treatment during a flare. The aim of the study is to demonstrate if the use of a steroid cream for less than or 5 days, could be equal or more effective than the application for more than 5 days during a flare episode, in keeping a remission state of AD. METHODS The study population (N.=122) was selected according to the following inclusion criteria: at least one specialist allergological and dermatological examination in the period November 2015 to February 2017, age between 1 and 11 years; mild to moderate atopic dermatitis. All patients were given a standardized telephone questionnaire, which concerns on multiple aspects: parents' self-reported perceptions of the severity of their child's condition; actual use of emollients, moisturizers and steroid creams; number of consecutive days of using of topical steroid cream during an exacerbation of AD; average number of AD exacerbations per month in the last year; total number of AD exacerbations in the last year. RESULTS Data from 96 patients was examined. We classified three groups of patients from data collected: group 1 (N.=40): use of TCS for ≤5 consecutive days during an exacerbation event of AD; group 2 (N.=12): use of TCS for >5 consecutive days during an exacerbation event of AD; group 3 (N.=44): nonuse of TCS or use of TCS with a different posology. We found a further subgroup in group 3 (3a, N.=27) with patients using only emollient creme in AD management. In group 1, 27 patients (67.5%) did not show a good AD control; on the contrary, 13 patients (27.5%) reported a good AD control. In group 2, 4 patients (25%) did not show a good AD control; on the contrary, 8 patients (75%) reported a good AD control. By comparing the data obtained in the presence of good AD control, the difference between the percentages obtained was found to be statistically significant (P=0.034). CONCLUSIONS The results obtained show that a therapeutic pattern based on the use of TCS for a duration of more than 5 consecutive days during an episode of AD exacerbation is more efficient than the proposed alternative therapeutic scheme in the maintenance of AD remission.

The use of steroid cream for physiologic phimosis in male infants with a history of UTI and normal renal ultrasound is associated with decreased risk of recurrent UTI

An uncircumcised male infant with a history of urinary tract infection (UTI), physiologic phimosis, and a normal renal ultrasound is a common patient referred to pediatric urology clinics. Topical steroid creams have been shown to effectively release physiologic phimosis. The objective of this study was to test the hypothesis that use of steroid cream for physiologic phimosis is associated with a lower UTI recurrence in uncircumcised male infants with normal renal ultrasounds. Uncircumcised males younger than 12 months referred for a UTI with a normal renal ultrasound were included. A longitudinal data set was created, and recurrent UTIs were identified. The proportion with a recurrent UTI was compared between those who received a prescription for a steroid cream for phimosis and those who did not. The morbidity of the initial and recurrent UTIs was also described. The association of recurrent UTI with vesicoureteral reflux (VUR) was also evaluated. A total of 192 uncircumcised males with a median age of 5.8 months (interquartile range [IQR]: 3.5-7.9 months) were included. Twenty-seven patients were treated with a course of betamethasone valerate 0.1% cream, and 165 were not (Summary Table). There were no significant differences between groups in the frequency of voiding cystourethrogram (VCUG), diagnosis of VUR, or use of continuous prophylactic antibiotics (CAP). During a median follow-up of 8.7 months (IQR: 3.1-17.5 months), none of the patients treated with steroid cream had a recurrent UTI compared with 27 of 165 (16%) patients not treated (P=0.02). Among the 173 patients whose initial UTI was febrile, recurrent febrile UTIs occurred in no treated patients and 23 of 150 (15%) untreated patients (P=0.047). The results of this study are consistent with those of a previous randomized trial of steroid cream for physiologic phimosis which found lower recurrent UTI in those whose foreskins became retractable. In addition, the results are consistent with the declining incidence of UTIs in uncircumcised males mirroring the natural history of physiologic phimosis resolving. This study is limited by its retrospective nature and non-standardized follow-up. The use of steroid cream for physiologic phimosis is associated with a decreased risk of recurrent UTIs in uncircumcised male infants with a normal renal ultrasound. In this group, steroid cream for physiologic phimosis is a well-tolerated and simple alternative to circumcision to potentially decrease risk of recurrent UTI.

MELADERM-trial: Melatonin cream against acute radiation dermatitis in patients with early breast cancer

Radiation
 dermatitis following radiation therapy in the treatment of early breast cancer
 can lead to discontinuation or prolongation of treatment and an impaired
 quality of life. Melatonin has been demonstrated to protect against radiation
 injury. The aim of this study is to investigate whether melatonin can protect
 against radiation dermatitis when applied topically in women receiving
 radiation therapy for early breast cancer. This study will be a randomized,
 placebo-controlled, double-blind controlled trial. Patients will apply the
 melatonin or placebo preparation topically twice daily for the duration of
 their radiation therapy. Our objective outcomes will be the Radiation Therapy
 Oncology Group’s acute radiation morbidity scoring criteria for skin, image
 analysis of clinical photographs, and use of steroid cream for radiation
 dermatitis. Subjective outcomes will be quality of life questionnaires
 developed by the European Organisation for Research and Treatment of Cancer.
 Outcomes will be measured throughout the five weeks of radiation treatment and
 be followed up for another three weeks. According to sample-size calculations
 and inclusion schedule, we intend to include a total of 80 evaluable patients. We
 will analyze the primary outcomes using parametric and non-parametric tests
 where applicable. Secondary outcomes will be analyzed by a mixed linear model. Most
 patients with breast cancer who undergo radiation therapy will develop
 radiation dermatitis as a result of the therapy. Should our intervention
 provide better outcomes, many patients could obtain a better quality of life.
 We expect topical melatonin treatment to have little or no adverse effects, to
 be easy to apply, and not to interfere with the anti-tumor efficacy of the
 radiation therapy.

Duration of topical therapy in the maintenance of atopic dermatitis remission in pediatric age.

Topical corticosteroids (TCS) are the first-choice treatment for atopic dermatitis (AD) flares. In literature there are clear advice about the potency, dosage and frequency of application of TCS, but there are no shared indications about duration of the treatment during a flare. The aim of the study is to demonstrate if the use of a steroid cream for less than or 5 days, could be equal or more effective than the application for more than 5 days during a flare episode, in keeping a remission state of AD. The study population (N.=122) was selected according to the following inclusion criteria: at least one specialist allergological and dermatological examination in the period November 2015 to February 2017, age between 1 and 11 years; mild to moderate atopic dermatitis. All patients were given a standardized telephone questionnaire, which concerns on multiple aspects: parents' self-reported perceptions of the severity of their child's condition; actual use of emollients, moisturizers and steroid creams; number of consecutive days of using of topical steroid cream during an exacerbation of AD; average number of AD exacerbations per month in the last year; total number of AD exacerbations in the last year. Data from 96 patients was examined. We classified three groups of patients from data collected: group 1 (N.=40): use of TCS for ≤5 consecutive days during an exacerbation event of AD; group 2 (N.=12): use of TCS for >5 consecutive days during an exacerbation event of AD; group 3 (N.=44): nonuse of TCS or use of TCS with a different posology. We found a further subgroup in group 3 (3a, N.=27) with patients using only emollient crème in AD management. In group 1, 27 patients (67.5%) did not show a good AD control; on the contrary, 13 patients (27.5%) reported a good AD control. In group 2, 4 patients (25%) did not show a good AD control; on the contrary, 8 patients (75%) reported a good AD control. By comparing the data obtained in the presence of good AD control, the difference between the percentages obtained was found to be statistically significant (P=0.034). The results obtained show that a therapeutic pattern based on the use of TCS for a duration of more than 5 consecutive days during an episode of AD exacerbation is more efficient than the proposed alternative therapeutic scheme in the maintenance of AD remission.

Seborrheic dermatitis of the eyelid

Seborrheic (say: seb-uh-ree-uh) dermatitis is a chronic inflammatory skin condition presenting as dry whitish scales or greasy scales. Can involve the scalp, eyebrows, forehead, face, trunk, or skin folds. Dandruff and cradle cap are both forms of seborrheic dermatitis. The severity of seborrheic dermatitis can be lessened by controlling the risk factors and by paying careful attention to skin care. Seborrheic dermatitis of the eyelid margin usually responds to gentle cleaning of the lid margins nightly as needed, with undiluted Johnson and Johnson baby shampoo using a cotton swab. Remove thick scales by applying warm olive or mineral oil and then wash off several hours later with Dawn washing detergent and a soft bristle tooth-brush. For dense scalp scaling, 10% Liquor Carbonic Detergents (LCD) in nivea oil may be used at bedtime, covering the head with a shower cap. This should be done nightly for 1-3 weeks. Once controlled, washing with zinc soaps or selenium lotion with periodic use of steroid cream will help maintain remission. Recently, creams classified as topical immune modulators are being used which suppresses the immune system to treat inflammation. Further, it is thought that sunlight improves seborrheic dermatitis. In some persons, the condition gets better in the summer, especially after outdoor activities.

Use of Steroid Creams as a Possible Cause of Immunosuppression in Homosexuals

Use of Steroid Creams as a Possible Cause of Immunosuppression in Homosexuals

Relieving Itching in the Geriatric Patient

Itching is a common condition in elderly patients and probablpy is caused by a combination of factors, low humidity being one of the most important. After determining that the patient does not have systemic pruritus, the physician should give advice about trying to increase the ambient humidity and about bathing, eg, to decrease the number of baths or showers, use warm water rather than very hot water, and soap only the axillary, anal, and pubic areas. In some instances the use of steroid creams or lotions may be helpful.