Topical steroid systemic side effects

Pathologic phimosis is a common problem throughout the world. In Europe, Asia, South America, and Central America neonatal circumcision is not routinely performed, thus childhood phimosis is not rare. In addition, in the United States and Canada the rates of neonatal circumcision, estimated to be 60% to 90%, 5 are declining. 9 Thus, even in the United States and Canada, phimosis is a commonly faced problem. Obviously, one of the difficulties that arises when studying phimosis is the lack of a clear definition and differentiation between a pathologic phimosis and a physiologic nonretractile foreskin. 10 In our study, nonretractable and pinpoint prepuces correspond to type II and type I of the classification by Kayaba et al. 11 The cases classified as ''retractable'' phimosis might not be considered pathologic by others because of a potential for spontaneous resolution with increasing age. However, all patients included in our study were originally referred for circumcision, they all had a constrictive ring for which they had sought medical attention, and they would have been considered candidates for circumcision if topical therapy had not been offered. [CIRP note: These doctors show the common inability to distinguish between normal in childhood developmentally narrow foreskin and a pathological condition called phimosis.]

This study was undertaken to determine whether the commonly used treatment of psoriasis with potent topical glucocorticoids results in hypercortisolism and whether metabolic changes might provide a means for monitoring pharmacologic effects of excessive systemic absorption of glucocorticoids. Plasma cortisol, glucose, and insulin and circulating polymorphonuclear leukocytes were assessed under controlled conditions in five otherwise healthy patients with psoriasis (40% to 85% involvement) treated with topical desoximetasone, without occlusion. In all patients, there were rapid and sustained suppression of endogenous cortisol production, twofold to threefold increases in fasting insulin levels indicating insulin resistance, and elevated levels of polymorphonuclear leukocytes. Two patients also experienced reduced glucose tolerance. These findings suggest that application of potent corticosteroids to large areas of diseased skin results in sufficient systemic absorption to cause not only adrenal suppression but some degree of hypercortisolism with greater frequency and rapidity than has been suggested. Prospective monitoring of insulin-glucose relationships as a sensitive index of the metabolic effects of glucocorticoids may provide a means of assessing excess systemic absorption that is not predictable on the basis of adrenal suppression or circulating levels of the drug. Such prediction could have particular relevance in anticipating adverse clinical effects in the treatment of chronic skin disorders with potent topical glucocorticoids.

Occlusive Dressing Technique

Occlusive dressings may be used for the management of psoriasis or other recalcitrant rub a small amount of cream into the lesion until it disappears. Reapply the preparation leaving a thin coating on the lesion, cover with pliable nonporous film, and seal the edges. If needed, additional moisture may be provided by covering the lesion with a dampened clean cotton cloth before the nonporous film is applied or by briefly wetting the affected area with water immediately prior to applying the medication. The frequency of changing dressings is best determined on an individual basis. It may be convenient to apply Triamcinolone acetonide cream under an occlusive dressing in the evening and to remove the dressing in the morning (., 12-hour occlusion). When utilizing the12-hour occlusion regimen, additional cream should be applied, without occlusion, during the day. Reapplication is essential at each dressing change. If an infection develops, the use of occlusive dressings should be discontinued and appropriate antimicrobial therapy instituted.

The rationale for the use of vitamin D derivatives in the treatment of psoriasis is based on the observation that patients with hypocalcemia often develop various forms of psoriasis, most notably the pustular form. In one case, a patient who had undergone thyroidectomy developed repeated flares of pustular psoriasis after decreases were made in her dosage of ergocalciferol (Vitamin D 2 ); each episode was related to severe hypocalcemia and resolved after her serum calcium levels normalized. 14 Another patient with osteoporosis experienced dramatic improvement in severe psoriasis after receiving an oral form of vitamin D. 15 This finding, along with the discovery that the bioactive form of 1,25-dihydroxycholecalciferol has been shown to inhibit keratinocyte proliferation and promote keratinocyte differentiation, 16 has led to the development of vitamin D analogs for the treatment of psoriasis.

Topical steroid systemic side effects

topical steroid systemic side effects

The rationale for the use of vitamin D derivatives in the treatment of psoriasis is based on the observation that patients with hypocalcemia often develop various forms of psoriasis, most notably the pustular form. In one case, a patient who had undergone thyroidectomy developed repeated flares of pustular psoriasis after decreases were made in her dosage of ergocalciferol (Vitamin D 2 ); each episode was related to severe hypocalcemia and resolved after her serum calcium levels normalized. 14 Another patient with osteoporosis experienced dramatic improvement in severe psoriasis after receiving an oral form of vitamin D. 15 This finding, along with the discovery that the bioactive form of 1,25-dihydroxycholecalciferol has been shown to inhibit keratinocyte proliferation and promote keratinocyte differentiation, 16 has led to the development of vitamin D analogs for the treatment of psoriasis.

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