W24 Topical corticosteroids (SM) Flashcards
What are the therapeutic uses of topical corticosteroids? (3)
(which conditions?)
Atopic eczema= Skin becomes itchy, dry, cracked and sore
Contact dermatitis= Triggered by contact with particular substances, such as soaps and detergents. Skin becomes red,
inflamed (irritated), blistered, dry, thickened and cracked
Psoriasis= Skin becomes red, inflamed (irritated), blistered, dry, thickened epidermal and flaky, crusty patches with silver scales
Topical steroids are used to treat infection.
True or False?
False. For Skin inflammation and not skin infection
What are the pharmacological actions of topical corticosteroids? (4)
Anti-inflammatory
Immunosuppressive
Antiproliferative
Vasoconstrictive
Steroid molecules can act on nuclear receptor which is called a … effect?
Called a genomic effect as it can affect transcription/translation of genes
non-genomic= activates cytoplasmic receptor
What is the moA of the Anti-inflammatory effect of TCS?
Phospholipids converted to Arachidonic acid (by phospholipase A2) usually
- The anti-inflammatory effect of TCS occurs from the synthesis of lipocortin, which inhibits phospholipase A2, * ultimately decreasing the production of prostaglandins and leukotrienes.
- TCS represses inducible COX-2, which also inhibits the production of prostaglandins & leukotrienes
- inhibiting the synthesis of phospholipids into arachidonic acid and then synthesis of prostaglandins, thromboxanes and leukotrienes
- lipocortin- directly inhibits phospholipase A2 from doing this conversion
Mechanism of action-
What is the Anti-proliferative effect of TCS?
TCS act on multiple pathways
* TCS- mediated increase in Lipocortin 1 reduces the keratinocytes proliferation and collagen synthesis in the epidermis and dermis
Mechanism of action- Immunosuppressive effect of TCS?
TCS inhibits the humoral factors involved in the inflammatory response as well as suppression of the maturation, differentiation, and proliferation of all immune cell
Mechanism of action- Vasoconstrictive effect of TCS
- MOA is unknown (Thought to be related to inhibiting vasodilators, histamine,bradykinins and prostaglandin. Also, regarded as part of the anti-inflammatory effect)
- Vasoconstriction of the blood vessels within the upper dermis decreases the inflammatory mediators delivered to the region.
TCS preparation potencies
- TCS are combined with antifungals, antimicrobials, if inflammation is associated with infection
- Urea or salicylic acid is included in some TCS formulations to facilitate the absorption of TCS
- Salicylic acid is a keratolytic drug. Thus, it is beneficial in the treatment of scaly skin diseases where the skin has become thickened
- Urea aid skin integrity and hydration and have keratolytic, anti-fungal, anti-bacterial, and anti-priuritic effects
What are the Cutaneous TCS adverse effects?
atrophy, striae, rosacea, purpura and others
- Persistent use of TCS in the same region leads to epidermal thinning (inhibited keratinocyte proliferation, collagen, and loss of extracellular matrix).
- Losing connective tissue leads to erythema (skin reactions), telangiectasias (spider vein; small, widened blood vessel), and purpura (purple-coloured spots).
- Atrophy is reversible with cessation of steroid use (but takes longer time)
Striae develop due to injury to the
dermis and mechanical stress. Striae appear as scars and are permanent.
- TCS increase the proliferation of
Propionibacterium acnes and Demodex
folliculorum, acne rosacea-like conditions. - Steroid-induced rosacea has been commonly associated with topical fluorinated steroids
- Less common
- Hypertrichosis (excessive hair growth), pigment alteration (purpura), and delayed wound healing.
Systemic TCS adverse effects
- Hypothalamic-pituitary axis suppression
- Cushing syndrome
- Hypertension
- Hyperglycaemia
- Glaucoma
Paediatric use: Avoid moderate and potent TCS (children’s skin is thin and vulnerable to cutaneous and systemic ADRs)
Geriatric use: Thin skin and ageing-related skin atrophy
Use in Pregnancy: No clinical data.
TCS withdrawal:
What is Tachyphylaxis?
When is it more likely to occur?
Tachyphylaxis — Repeated administration of TCS leads to desensitisation/ tachyphylaxis and reductions in corticosteroid-induced vasoconstriction, antiproliferative effects, and inhibition of histamine release.
* Long-term continuous or inappropriate use of topical steroids can result in rebound flares after stopping treatment (topical steroid withdrawal syndrome), which takes the form of dermatitis with intense redness, stinging and burning that can spread beyond the initial treatment area.
* It is more likely to occur when delicate skin sites such as the face and flexures are treated.
TCS contraindications?
- TCS is contraindicated for bacterial infections as their anti-inflammatory and vasoconstrictive effect will mask the infection, ultimately delaying diagnosis and treatment.
- TCS should also be avoided in impetigo, furuncles and carbuncles, cellulitis, erysipelas, lymphangitis, and erythrasma.
- Relative contraindications include candida and dermatophytes infections
- The immunosuppressive effects may result in persistent fungal infections that can be identified as tinea incognito, significant for increased spread and inflammation with pustule formation
furuncle-boils
carbuncle- cluster of boils
Anabolic Steroids are not topical corticosteroids
- Anabolic steroids are manufactured drugs that copy the effects of the male hormone testosterone.
- They have limited medical uses and are not the same as corticosteroids, a different type of steroid drug that’s more commonly prescribed.
- They are sometimes taken without medical advice to increase muscle mass and improve athletic performance.
- Regular use can lead to physical and psychological changes in both men and women and potentially dangerous medical conditions.
- Anabolic steroids are addictive.
- People who have body dysmorphic disorder may abuse anabolic steroids.
