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A bluffer’s guide to topical steroids & antihistamines

A bluffer’s guide to topical steroids & antihistamines. Dr Tony Downs. Dermovate Ointment. Betnovate Ointment. Elocon Ointment. Betnovate RD Ointment. Eumovate Ointment. Topical Steroids. I Very Potent . II Potent. III Moderately potent . Hydrocortisone Oint. IV Mild.

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A bluffer’s guide to topical steroids & antihistamines

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  1. A bluffer’s guide to topical steroids & antihistamines Dr Tony Downs

  2. Dermovate Ointment Betnovate Ointment Elocon Ointment Betnovate RD Ointment Eumovate Ointment Topical Steroids I Very Potent II Potent III Moderately potent Hydrocortisone Oint IV Mild

  3. ECZEMA TREATMENTTopical steroids Explanation & reassurance Two tier regime Use until symptoms controlled Wean down gently High risk sites (face, nappy area medial thighs, adolescents) Review patients using potent steroids Try and keep it simple

  4. Steroid potency by location and age

  5. Age 9/12 Betnovate 6/12

  6. AD high potency steroid > 2yrs

  7. Treating steroid induced rosacea • Oral tetracycline (eglymecycline) for 8 weeks • Step down to 1% Hydrocortisone • Tell patient to expect a flare before it gets better

  8. Anti-histaminesnon-sedating • Non-sedating for hayfever & urticaria/angioedema • Last almost 24hrs • Certirizine 10mg→40mg → levocertirizine 5mg • Loratidine 10mg→40mg → desloratidine 5mg • Fexofenidine 180mg • Mizolastine 10mg (QT interval prolongation) • Rupatadine 10mg

  9. Sedating anti-histamines • For reduced scratching at night & to help with sleep • Potential hangover effect in the morning • Tolerance of sedation with regular use • Vallergan • Phenergan • Atarax (shorter acting) • Piriton (shortest acting)

  10. Anti-histamines with additional activity • Anti-PAF – Rupatadine • Anti-leukotriene - Ketotifen (mast cell stabilizer) • Anti-serotonin – Cyproheptadine • Anti H2 receptor - Ranitidine, Cimetidine

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