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Topical steroids (2008)

Topical steroids (2008). Dr. Amal Kokandi MB,BCh, MSc, MD. Mode of action. Anti-inflamatory Immunosuppression Vasoconstriction Antimtotic Glucocorticoid activity Cushing’s syndrome Mineralocorticoid activity Antimetabolic effect striae, dermal atrophy, and ecchymosis). Uses.

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Topical steroids (2008)

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  1. Topical steroids (2008) Dr. Amal Kokandi MB,BCh, MSc, MD

  2. Mode of action • Anti-inflamatory • Immunosuppression • Vasoconstriction • Antimtotic • Glucocorticoid activity • Cushing’s syndrome • Mineralocorticoid activity • Antimetabolic effect • striae, dermal atrophy, and ecchymosis)

  3. Uses • Common indications for topical steroids: • Eczema • Pityriasis rosea • Lichen planus • Alopecia areata • Psoriasis (some forms) • vitiligo

  4. Special considerations • Face • Intertriginous areas • Children • Effect of occlusion • infections and combination formulas (with antibiotics and antifungals)

  5. Finger tip unit

  6. Finger tip unit • 2 FTU = nearly 1 gram • Enough for twice size of adult hand • A hand and fingers (front and back) = 1FTU • A foot (all over) + 2FTU • Front of chest and abdomen = 7FTU • Back and buttocks = 7FTU • Face and neck = 2.5 FTU • An entire arm and hand = 4 FTU • An entire leg and foot = 8 FTU

  7. Potencies (European) • Weak • Moderate • Potent • Very potent

  8. Potencies (American) • Class1 (superpotent) • Class2 (potent) • Class3 (potent) • Class4 (midstrength) • Class5 (midstrength) • Class6 (mild) • Class7 (least potent)

  9. Examples • Weak • Hydrocrtisone 0.5-2.5% (Alfacort, Mycoheal with miconazole, Fucidin H with fucidic acid) • Moderate • Clobetasone butyrate 0.05% (Eumovate) • Hydrocrtisone with urea (Carmol HC)

  10. Examples • Potent • Mometasone dipropionate 0.025% or furoate 0.1% (Elica, Elica M with miconazole, Momenta with miconazol & gentamycin) • Betamethasone esters as valerate 0.1% or diproprionate 0.05% (Betnovate, Betaderm, Fucibact B with Fucidic acid, Betazol with miconazole, Diprosalic with salicylic acid)

  11. Examples • Potent (cont.) • Hydrocortisone 17 butyrate 0.1% (Locoid) • Trimcinolone acetonide 0.1% (Panderm with gentamycin, nystatin & neomycin)

  12. Examples • Very potent • Clobetasol propionate 0.05% (Dermovate, Gamavate) • Diflucortolone valerate (Nerisone)

  13. Side effects • Perioral dermatitis and rosacea • Tachyphylaxis & steroid addiction • Infections (tinea incognito, herpes simplex, pityriasis versicolor, scabies……) • Adrenal suppression • Glucoma and cataract • Angina bullosa purpura (hard palate)

  14. Side effects • Local side effects • Telangiectasia, purpura, epidermal, dermal and subcutaneous atrophy, striae, psuedoscars…… • Folliculitis • Allergic reactions • Hypopigmentation • Hypertrichosis • Delayed wound healing • Alteration in skin elasticity & mechanical properties

  15. Dermatitis due to topical steroid

  16. Tinea incognito

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