6 - Derm - Eczema - Topical steroids

Question 1

how do topical steroids work

Answer 1

reduce infl by causing vasoconstriction and inactivation of infl mediators

Question 2

different potencies and examples

Answer 2

mild - 1% hydrocortisone
med - clobetasone
potent - betamethasone
v potent - clobetasol

Question 3

for face flexures and groin….

Answer 3

use hydrocortisone (may use clobetasone on face for 1 wk if needed)

Question 4

when use clobetasol?

mgmt of eczema first step?

Answer 4

only briefly on thick skin

control with betamethasone for 1week

Question 5

SE of top steroids - more common where? and in who?

Answer 5

face, axillae, upper thighs

young and elderly

Question 6

commoner side effects - 6

Answer 6

striae
skin atrophy
infection
tachyphylaxis
steroid acne
steroid allergy

Question 7

skin atrophy - what? appearance? possible prognosis?

Answer 7

thinning epidermis
wrinkled and shiny skin, telangiectasia, hypopigmented

can be reversible over months

Question 8

Striae - what? prog?

Answer 8

stretch marks

permanent and irreversible

Question 9

Infection examples

Answer 9

impetigo, fungal (tinea incognito), cellulitis

Question 10

steroid acne - appearance? what may happen?

Answer 10

red areas with papules/pustules

may have rebound flare - worse when steroids stopped

Question 11

two more rarer SE

Answer 11

glaucoma

adrenal suppresion/cushings - if long term high doses

Question 12

3 principles of steroids use

Answer 12

ointments > creams - better hydration
once/twice a day - in bursts of a few days
active areas only

Question 13

how to know how much to put on?

Answer 13

use finger tip units - single line along distal phalange of index finger