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The Prevention Of Recurrent Recalcitrant Dermatoses Treated By Systemic Corticosteroid

The Prevention Of Recurrent Recalcitrant Dermatoses Treated By Systemic Corticosteroid. Sunarso Suyoso Faculty of Medicine – Airlangga University/ Dr. Soetomo General Hospital - Surabaya. Recalcitrant Dermatoses e.g. Treated by systemic corticosteroid. Prevention Of The Recurrence.

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The Prevention Of Recurrent Recalcitrant Dermatoses Treated By Systemic Corticosteroid

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  1. The Prevention Of Recurrent Recalcitrant Dermatoses Treated By Systemic Corticosteroid SunarsoSuyoso Faculty of Medicine – Airlangga University/ Dr. Soetomo General Hospital - Surabaya

  2. Recalcitrant Dermatoses e.g. Treated by systemic corticosteroid

  3. Prevention Of The Recurrence

  4. Hypothalamic – Pituitary – Adrenal axis

  5. Months (> 4 weeks) years • minimized by using • Single morning dose • Intermediate acting agent on • alternate morning

  6. Be Careful with

  7. Impaired basal HPA axis function

  8. Preparation Intermediate acting CS :

  9. Other Immunosuppressive agents used in dermatology as steroid – sparing agents

  10. 1. Corticosteroid 2-4 x/ day Severe acute dermatoses

  11. Tapering Regiment Very short term treatment < 1 week  tapering Ө

  12. Alternate dose 30/25/35/20/40/15/45

  13. + Azathioprine/ others < 1 week + Corticosteroid topical + Azathioprine / others lesion > / fail 4 weeks

  14. STOP Physiologic basal HPA Axis function • 10 ug/100 dl or • >276 nmol/dl STOP or 5 mg /1-0-0/3x/ week + Azathioprine/ others 2x/ week stop 1x/ week Still impaired Basal HPA Axis Function

  15. 2nd way of treatment Check cortisol serum 4 weeks for adrenal recovery

  16. Special Treatment Erythema Nodosom Leprosum

  17. Special treatment

  18. Contraindications to CS : • Systemic fungal infection • Ocular herpes simplex • Untreated active TBC Relative contraindications : - Prior to age 2 years and at puberty - Active peptic ulcer - Treated active TBC - Severe depression/ psychosis - Extensive reactive dermatosis (e.g. psoriasis)  used only if absolutely necessary

  19. Risk factors for toxicity from corticosteroid therapy

  20. Side effects of short-term Corticosteroid therapy (< 3 weeks) Hypertensive patient, no problem for 2 weeks

  21. Side effects of long-term Corticosteroid therapy (> 4 weeks)

  22. Summary of preventive measures for long-term CS therapy

  23. Immunosuppressive Agents

  24. Antibiotic dosage adjustments in the setting of renal and hepatic disease

  25. Antibiotic dosage adjustments in the setting of renal and hepatic desease

  26. Antibiotic dosage adjustments in the setting of renal and hepatic desease

  27. Antibiotic dosing adjustment in the setting of renal and hepatic desease

  28. General treatment Diet : - Low in saturated fat & calories • Prebiotic  Quality of live

  29. We can see this in www.rsudrsoetomo.jatimprov.go.id Menu : PromosiKesehatan Submenu : Lain-lain Thank You

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