Topical Corticosteroid Withdrawal Research Articles

Treatment of Topical Corticosteroid Withdrawal: A Case Series.

Treatment of Topical Corticosteroid Withdrawal: A Case Series.

777 Treatment of topical corticosteroid withdrawal

777 Treatment of topical corticosteroid withdrawal

Topical corticosteroid withdrawal syndrome: the patient community call for high-quality research, clear definitions and diagnostic criteria.

Topical corticosteroid withdrawal syndrome: the patient community call for high-quality research, clear definitions and diagnostic criteria.

Severe Topical Corticosteroid Withdrawal Syndrome from Over-the-Counter Steroids

A 34-year-old man suddenly developed an erythematous and exfoliative facial rash. Within days, his skin became intensely pruritic and painful, and the rash spread to his entire body. He also acquired malaise with fever of 39.7°C, necessitating hospitalization. Examination revealed thickened and oozing plaques covering his face; in addition, multiple erythematous papules erupted on his torso and bilateral extremities, but no mucosal erosions (Figure 1). His history was notable for lifelong atopic dermatitis self-treated with hydrocortisone ointment/cream 1% (up to 2.5%) multiple times daily, with use of class III potency topical corticosteroids (TCS) intermittently for flares.

A study on abuse of topical corticosteroids in patients who attended dermatology venerology leprosy outpatient department

Background: Topical corticosteroids (TCs) are widely used in the patients affected with dermatoses. Abuse of these agents may cause severe adverse effects. Aim of the study was to study the abuse of TCs in patient who attend Dermatology, Venereology, and Leprosy (DVL) outpatient department. Methods: This prospective observational study was conducted in department of DVL at Rajah Muthiah Medical college, Tamil Nadu during the period of six months from November 2018 to April 2019. The patients were enrolled for the study based on inclusion and exclusion criteria.Results: Totally 50 patients with adverse drug reactions (ADRs) by the abuse of TCs were enrolled for the study. It was found that TCs were abused in all ages and equally in both genders. Nearly 72% of the people used TCs for Tinea infection and 20% of the people used TCs for acne vulgaris. Very high potent TCs such as betamethasone and beclomethasone were abused by 55% of the patient. Tinea incognito (TI) was found as common ADRs by the abuse of TCs (74%). Nearly 88% of the people bought TCs from pharmacies without prescription. Sixteen brands were found as easily accessible and affordable for the patients. Medication adherence were increased by 60% after the patient counselling.Conclusion: This study concludes, TI was found as a common ADR in patients who abused TCs such as betamethasone, beclomethasone and clobetasol. High potent TCs should not be allowed to dispense without prescription. Withdrawal of TCs will reduce the risk of ADRs.

The role of topical tacrolimus in adherence to antifungal therapy in recalcitrant tinea incognito: a preliminary non randomised controlled study

<p class="abstract"><strong>Background:</strong> The dropout of outpatients on antifungal therapy for recalcitrant tinea incognito is attributable to the flare on withdrawal of topical corticosteroids and the virulence of pathogens. The objective of the study was to evaluate the role of topical tacrolimus in adherence to antifungal therapy in recalcitrant tinea incognito.</p><p class="abstract"><strong>Methods:</strong> 28 cases of topical corticosteroid induced tinea incognito of more than 6 months duration were enrolled and topical and systemic antifungal therapy instituted for 8 weeks. Topical tacrolimus was also instituted in the test cohort. The end point for resolution was the absence of raised margins, erythema, induration and scaling.<strong></strong></p><p class="abstract"><strong>Results:</strong> 17 patients were male while 11 were female and their age ranged from 16-45 years (mean 26.5). Two patients were from upper-middle; 5 from lower-middle and 21 from upper-lower socioeconomic class. Their occupations included shop assistants, security guards, drivers and labourers and the duration of illness ranged from 7-36 months. Topical corticosteroids were obtained on prescription by 5 and over the counter by 23 patients. Out of the test cohort of 14, all lesions had resolved in 10 patients who had adhered to therapy and were reviewed at the end of 8 and 10 weeks. While 5 reported burning on application of tacrolimus 1 developed folliculitis. Out of the control cohort of 14, though 5 had adhered to therapy all lesions had resolved only in 3 patients at the end of 8 and 10 weeks.</p><p class="abstract"><strong>Conclusions:</strong> Topical tacrolimus facilitates adherence to antifungal therapy in recalcitrant tinea incognito.</p>

What's new in atopic eczema? An analysis of systematic reviews published in 2015. Part 2: prevention and treatment.

This review forms part of a series of annual updates that summarize the evidence base for atopic eczema (AE), providing a succinct guide for clinicians and patients. It provides a summary of key findings from 26 systematic reviews that were published during 2015, and focuses on the treatment and prevention of AE. For systematic reviews on the epidemiology and methodological issues, see Part 1 of this update. Topical corticosteroid withdrawal syndrome, 'steroid addiction', has been evaluated in a high-quality systematic review, which helps better define this entity and the risk factors for it. A Cochrane Review has not demonstrated any association between topical corticosteroid use in pregnancy and adverse outcomes, although very large quantities of potent/very potent topical corticosteroids may be associated with reduced birth weight. House dust mite avoidance strategies do not appear to prevent AE. Exposure to probiotics prenatally and in early infancy may help prevent AE, but there is no evidence that maternal diet or supplementation has a preventative effect.

Pathological Role of Regulatory T Cells in the Initiation and Maintenance of Eczema Herpeticum Lesions

It remains unknown why the occurrence of eczema herpeticum (EH) caused by an extensive disseminated cutaneous infection with HSV-1 or HSV-2 is associated with the exacerbation of atopic dermatitis lesions after withdrawal of treatment. Although regulatory T cells (Tregs) limit the magnitude of HSV-specific T cell responses in mice, their role in the induction and resolution of EH has not been defined. We initially investigated the frequencies, phenotype, and function of Tregs in the peripheral blood of atopic dermatitis with EH (ADEH) patients at onset and after clinical resolution, atopic dermatitis patients without EH, and healthy controls. Tregs with the skin-homing phenotype and the activated/induced phenotype were expanded at onset and contracted upon resolution. Treg-suppressive capacity was retained in ADEH patients and, the expanded Tregs suppressed IFN-γ production from HSV-1-specific CD8(+) and CD4(+) T cells. The increased frequency of CD14(dim)CD16(+) proinflammatory monocytes (pMOs) was also observed in the blood and EH skin lesions. Thus, pMOs detected in ADEH patients at onset were characterized by an increased ability to produce IL-10 and a decreased ability to produce proinflammatory cytokines, unlike their normal counterparts. Our coculture study using Tregs and pMOs showed that the pMOs can promote the expansion of inducible Tregs. Tregs were detected frequently in the vicinity of HSV-expressing and varicella zoster virus-expressing CD16(+) monocytes in the EH lesions. Expansions of functional Tregs, together with pMOs, initially required for ameliorating excessive inflammation occurring after withdrawal of topical corticosteroids could, in turn, contribute to the initiation and progression of HSV reactivation, resulting in the onset of EH.