Derm Corticosteroids Flashcards
where are corticosteroids produced
adrenal cortex
includes androgens, glucocorticoids, and mineralocorticoids
what are synthetic corticosteroids used to treat
inflammation, lymphocytes, immune function
binds cytoplasmic steroid receptors that go to DNA to induce or repress the expression of target genes
low vs high dose effects of corticosteroids
low: anti inflammatory
high: immunosuppressive
what are the anti inflammatory effects of corticosteroids
- suppress genes for inflammatory cytokines
- decrease neutrophil migration to target tissues (remains in circulation)
- decreases eosinophil, lymphocyte, and basophils in circulation
- increases lipocortin to inhibit PLA to decrease production of prostaglandins and leukotrienes
immunosuppressive effects of corticosteroids
- affect cell mediated immunity
- decrease circulating lymphocytes by inducing apoptosis
- decrease cytokines
- interfere with antigen presentation by APCs
what are dermatologic indications for corticosteroid use
- pruritus
- inflammation of skin/ear canals
- acute allergic/hypersensitivity reactions
- immune mediated or autoimmune diseases
what type of administrations are used
systemic and topical
cannot achieve therapeutic dose without inducing side effects
what are general side effects of corticosteroids
- PU, PD, PP
- muscle atrophy/weakness
- infections (skin, UTI)
- GI ulceration
- adrenal suppression
what are the skin side effects of corticosteroids
- thin skin
- comedones
- hyperpigmentation
- alopecia from telogen follicles
- decreased elasticity
- bruising
- infection (pyoderma, fungal, demodex)
corticosteroid side effects: dogs
- PU, PD, PP
- “pot belly” - hepatopathy + fat redistribution
- “pred head” - muscle/collagen atrophy
- UTI, incontinence
- calcinosis cutis
- hypertension
calcinosis cutis
dystrophic calcification of the skin
erythematous papules coalesce and form gritty plaques, ulcerations, and crusts
corticosteroid side effects: cats
- PU, PD, PP
- diabetes mellitus
- congestive heart failure
- ear tipping
- skin fragility
when are corticosteroids contraindicated in horses
horses with laminitis
short acting corticosteroids
hydrocortisone, cortisone
less useful clinically
intermediate acting corticosteroids
prednisone, prednisolone, methylprednisolone
most common; admin q24-48
long acting corticosteroids
triamcinolone, dexamethasone, betamethasone
similar to intermediate but administered less frequently
oral vs parenteral administration of corticosteroids
oral: safest, can control dose
- begin with induction dose (high) then taper to lowest therapeutic dose until admin q48
parenteral: cannot regulate or remove once administered (less controlled)
corticosteroid dosage: anti inflammatory in dogs
induction: 1-2 mg/kg/day
maintenance: 0.5-1 mg/kg EOD
corticosteroid dosage: immunosuppressive in dogs
induction: 2-4 mg/kg/day
maintenance: 1-2 mg/kg EOD
corticosteroid dosage: anti inflammatory in cats
induction: 2-3 mg/kg/day
maintenance: 1-2 mg/kg EOD
corticosteroid dosage: immunosuppressive in cats
induction: 4-6 mg/kg/day
maintenance: 2-4 mg/kg EOD
corticosteroid dosage: prednisolone anti-inflammatory in horses
induction: 1-2 mg/kg/day
maintenance: 0.5-1 mg/kg EOD
corticosteroid dosage: prednisolone immunosuppressive in horses
induction: 2-4 mg/kg/day
maintenance: 1-2 mg/kg EOD
corticosteroid dosage: dexamethasone anti-inflammatory in horses
induction: 0.02-0.04 mg/kg/day
maintenance: 0.01-0.02 mg/kg EOD
corticosteroid dosage: dexamethasone immunosuppressive in horses
induction: 0.04-0.08 mg/kg/day
maintenance: 0.02-0.04 mg/kg EOD
side effects of topical corticosteroids
- skin atrophy
- comedones
- phlebectasia
increased risk of side effects with increased potency
percutaneous absorption in small pets can cause systemic side effects
what species require prednisone vs prednisolone
prednisone: dogs only
prednisolone: cats and horses
