Appendix D Topical corticosteroids for the treatment of atopic eczema, grouped by potency Frequency of application of topical corticosteroids for atopic eczema Guidance

If there is a worsening of your condition during use consult your prescriber – you may be experiencing an allergic reaction, have an infection or your condition requires a different treatment. No treatment is likely to reverse the changes of lichen sclerosus completely, but the symptoms and signs of the disease can usually be well controlled with the application of a steroid. Disclaimer – the author PCDS cannot accept responsibility for any misleading or incorrect statements, and the management of individual patients remains the direct responsibility of the individual doctor.

• Fusidic acid/betamethasone should be used with care in children as paediatric patients may demonstrate greater susceptibility to topical corticosteroids induced HPA axis suppression and Cushing’s syndrome than adult patients.
• Times at maximum concentration c(tmax) orally are reached around 90 min.
• A severe form of rebound flare can develop which takes the form of a dermatitis with intense redness, stinging and burning that can spread beyond the initial treatment area.
• This paper by Sheary highlighted that concerns about topical steroid withdrawal reactions are leading some patients to cease long-term topical corticosteroid therapy and that diagnostic criteria for this condition do not exist.
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All Yellow Card reports received are entered onto the MHRA’s adverse drug reaction database so that they are available for signal detection. For topically applied fusidic acid, no information concerning potential symptoms and signs due to overdose administration is available. Cushing’s syndrome and adrenocortical insufficiency may develop following topical application of corticosteroids in large amounts and for more than 3 weeks.

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The authors described that in the initial phases, the corticosteroids were usually effective, and patients felt relief for weeks to months. However, as time passed many patients required systemic corticosteroids at increasingly frequent intervals, some every 6 to 10 weeks. Daily topical treatment only maintained tolerance of symptoms and mild diminution of the rash. The authors stated that by this point, the initial limited areas of dermatitis had expanded significantly.

• For topically applied fusidic acid, no information concerning potential symptoms and signs due to overdose administration is available.
• We also sought advice on the review from our experts and from dermatologists and skin charities.
• Doxepin cream can cause drowsiness that may affect skilled tasks and there may be a risk of sensitisation.

Studies show that, when combined with Minoxidil, it can be an effective treatment for alopecia areata [7]. The Yellow Card scheme run by the MHRA is the UK system for collecting and monitoring information buy underground steroids on safety concerns such as suspected side effects involving medicines. Suspected side effects are reported by health professionals and the public, including patients, carers and parents.

Treatment

The degree of penetration depends on factors such as the duration of exposure to fusidic acid and the condition of the skin. Fusidic acid is excreted mainly in the bile with little excreted in the urine. Undesirable effects are listed by MedDRA SOC and the individual undesirable effects are listed starting with the most frequently reported.

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The MHRA use specialised software to subject Yellow Card data to statistical analysis to detect signals. A type of eczema triggered by contact with particular substances, such as soaps and detergents. Contact dermatitis causes the skin to become itchy, blistered, dry and cracked.

13.1 Topical treatments for scar reduction

In 2000 based on skin patch test results obtained from a large cohort of corticosteroid allergic patients [20]. Try to avoid washing your hair within an hour of using the steroid cream, and don’t apply other creams like moisturisers or serums at the same time. If a steroid cream has been prescribed to you for another condition, check with your GP if it’s suitable for scalp use before you apply it. Patients with alopecia areata typically have follicular inflammation caused by white blood cells attacking the hair follicles.

It should be noted that this does not refer to whether the reactions were directly caused by the medicine. There may be more cases within the MHRA Yellow Card database that are potentially topical steroid withdrawal reactions, but due to a lack of information we cannot determine them as such at this time. Generally, you should only use it for short periods if using it for eczema or a fungal infection.

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Women were 56% of the 55 patients seen, and ages ranged from 20 to 66 years (with a mean age of 32 years; and median age of 30 years). 60% had used potent topical corticosteroids on the face, and 42% had a history of oral corticosteroid use for skin symptoms. Burning pain was reported in 65%; all had widespread areas of red skin; and so-called “elephant wrinkles” or “red sleeve”. This paper by Sheary reviews some individual cases and the literature, including the review by Hajar above.

Due to the content of corticosteroid, fusidic acid/betamethasone should be used with care near the eyes. Avoid getting fusidic acid/betamethasone into the eyes (see section 4.8). If a steroid cream has been prescribed to you for a scalp condition, it should be safe. However, you may experience side effects; always check the label so you know what to expect.

Rebound reactions may still benefit from treatment with a topical corticosteroid. This paper by Sheary highlighted that concerns about topical steroid withdrawal reactions are leading some patients to cease long-term topical corticosteroid therapy and that diagnostic criteria for this condition do not exist. The author therefore examined the demographics and outcomes in adult patients who believe they are experiencing topical steroid withdrawal reactions following discontinuation of chronic overuse of topical corticosteroids.

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They reported that the papulopustular withdrawal subtype is more likely in patients who develop steroid rosacea, but this is not a prerequisite condition for this subtype. The papulopustular variant can be differentiated from the erythematoedematous subtype by the prominent features of pustules and papules, along with erythema, but less frequently swelling, oedema, burning, and stinging. Following an increasing number of patient enquiries to the US National Eczema Association, Hajar and colleagues sought to review the current evidence regarding addiction and withdrawal of topical steroid withdrawal. Cases without a clear temporal association were excluded, as were case series without a definitive number of cases and reviews of expert opinion.