Topical Steroids 1-2

Question 1

What are topical corticosteroids effective against? what is a key councelling point?

Answer 1

conditions characterised by Hyperproliferation, Inflammation and Immmunologic involvement. They’re not curative - relapse can occur when discontinued.

Question 2

When do you use a Corticosteroid in the treatment ladder?

Answer 2

After emolients have proven to be ineffective

Question 3

what are the advantages of topical delivery of steroids?

Answer 3

1. non invasive so acceptable
2. targets condition directly on the skin
3. can be added into daily routine as it can comply with other moisturisers
4. can be used in combination with antifungals and antivirals
5. steroids may be delivered at controlled rates over long periods (days)

Question 4

what is Eczema?

Answer 4

– a chronic skin condition where the skin becomes itchy, reddened, dry and cracked (and sometimes infected).

Question 5

what is dermatitis?

Answer 5

an acute type of eczema that can cause red, itchy and scaly skin, and sometimes burning and stinging. It can lead to blistered, dry and cracked skin (and sometimes infections). Normally caused by a local irritant (e.g., “Contact” or “Allergic”) or radiation.

Question 6

what is Psoriasis

Answer 6

a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales (e.g., elbows and flexures typically affected).

Question 7

What is impetigo

Answer 7

– a highly contagious skin infection often around the mouth that causes sores and blisters (often with yellow tinge). It is very common and affects mainly children (usually Staphylococcus)

Question 8

Do not use corticosteroids for

Answer 8

Hives or Sunburn or Acne

Question 9

what are topical corticosteroids? Why are they applied?

Answer 9

drugs related to natural hormones produced by the body. They are applied directly to skin to reduce inflammation (body response to a percieved injury - associated by pain, heat, rednesss and swelling as a protective response)

they can vary from mild to very potent

Question 10

Mechanism of Inflammation

Answer 10

Normal function: Prepare the body for healing and repair

Inflammation comes about when there is an accumulation of serval types of white blood cells and biochemical signalling factors at the sites of infection.

The WBC releases enzymes that destroy pathogens and remodel tissues to repair injury.

In inflammatory diseases excessive levels of white blood cells accumulate and their (now uncontrolled) destrucive action targets the body’s own tissues.

can be triggered by microbial infections or phyiscal agents

Question 11

Biochemical effects of Corticosteroid therapy:

Answer 11

Corticosteroids regulate the expression of genes with a net anti-inflammatory effect

1. reduce the production of inflammatory mediators e.g cytokines and prostaglandins
2. inhibit inflammatory cell migration to sites of inflammation by inhibiting expression of adhesion molecules
3. Promote the death by apoptosis of white blood cells recruited to sites of inflammation
4. Effects realised by two main mechnamisms: genomic and non genomic

Question 12

caustions and contraindications when using topical corticosteroids

Answer 12

• Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes).
• Cautions applicable to systemic corticosteroid treatment may also apply if absorption occurs due to topical or local use.
• In children avoid prolonged use, and use potent or very potent corticosteroids under specialist supervision.
• Extreme caution is required in dermatoses of infancy including nappy rash - treatment should be limited to 5–7 days in infants and children.
• Potent or very potent topical corticosteroids must be used under specialist supervision in children.

contraindications:

acne - sunburn - untreated bacteral/fungal/viral skin lesions

Question 13

councelling points on steroid application:

Answer 13

1. Topical corticosteroid preparations should be applied no more frequently than twice daily; once daily is often sufficient.
2. Topical corticosteroids should be spread thinly on the skin but in sufficient quantity to cover the affected areas.
3. This length can be measured in terms of a fingertip unit (the distance from the tip of the adult index finger to the first crease)

Question 14

what indications and patient groups can you not give hydrocortisone preparations to?

Answer 14

Children under 10 years,

Pregnant women,

For application to the face

For application to the anogenital region,

For application to broken or infected skin including: cold sores, acne, athlete’s foot.