Level of Awareness and Attitude towards Topical Steroids among Medical Interns.

Topical steroids are the most commonly prescribed drugs in dermatological setting, and they are also one of the most abused ones, as these drugs are very cheap, easily available over the counter, and provide quick relief in symptoms. This study aims to find the level of awareness and attitude regarding topical steroids among medical interns. MethodsThis was a cross sectional questionnaire-based study conducted among medical interns of 2014 batch of Rohilkhand Medical College in the Department of Dermatology, Venereology and Leprosy. The study was conducted with the help of a questionnaire that was modified from the study, Verma P, et al. This was followed by a presentation on topical steroids use, misuse and what steps can be taken to prevent their rampant misuse. Finally, a feedback was taken on importance of the study. ResultsTotal 69 medical interns were included in the study. Fifty-two interns had previously prescribed or used topical corticosteroids. Steroids (clobetasol, betamethasone, mometasone) in combination with either tretinoin & hydroquinone or antimicrobials were commonly abused. The commonest indication for which they were used were infections of which tinea was the most common followed by dark spots or as a fairness cream, acne, eczema, and other conditions such as pruritus, insect bite, burn, etc. ConclusionsThis study shows significant knowledge gap among medical interns regarding topical steroids. Thus, knowledge regarding topical corticosteroids is very essential and should be emphasized more during the MBBS period. More studies are required to study regarding their awareness and misuse.

Assessment of prescribing pattern and cost analysis of topical steroids for skin disorders in dermatological outpatient department of a tertiary care hospital

Background: Topical steroid is most commonly prescribed in non-infective dermatological conditions. Periodical Prescription audit is mandatory for the effective management. Hence the present study is designed to assess the prescribing pattern and cost analysis of topical steroids for various skin disorders in the dermatology OPD of a teaching hospital.Methods: This is a prospective observational study conducted in dermatology OPD of a teaching hospital from Jan-Mar 2019 in patients prescribed with topical steroids in all age groups after obtaining IEC approval. Data was analyzed for prescription pattern and cost analysis using descriptive statistics and expressed in percentage.Results: A total of 90 prescriptions were analyzed among which males were 45% and females were 55%, the common indications were eczema-27.7%, atopic dermatitis-25.5%, psoriasis-16.6%, dermatoses-13.3%, lichen planus-7.77% etc. Topical steroids commonly prescribed were super potent (Clobetasol 34.4% and Halobetasol 22.2%). Cream and ointment formulation were commonly used. Common adverse reactions were skin atrophy, hypopigmentation, acne. In prescribing pattern, specification of strength and quantity were lacking whereas instructions regarding area of application-44.4%, route of administration-83.3%, frequency and duration-91% were noted. In cost analysis, comparison is made between similar potency and clinical outcome. Of which, Clobetasol 0.05% and Betamethasone 0.01% is found to be cost effective compared to Halobetasol 0.05% and Mometasone 0.1% respectively.Conclusions: This study provides a limelight on prescribing pattern of topical steroids and emphasize periodic audit to rationalize the prescription with cost effectiveness.

Comparative Study of Quality of Life in Patients with Scalp Psoriasis Treated Using Topical Steroid Alone vs. Topical Steroid Combined with Cyclosporine / 대한피부과학회지

BACKGROUND: Scalp psoriasis severely affects patients' quality of life, and patients may occasionally be refractory to topical steroid application. Although systemic therapy combined with topical steroid application is recommended for treatment-resistant scalp psoriasis, previous research has not reported whether such combination treatment improves patients' quality of life.OBJECTIVE: This study investigated whether combination therapy using oral cyclosporine and topical steroid reduces the severity of scalp psoriasis and improves patients' quality of life compared with the use of topical steroid alone.METHODS: The study included 23 patients with scalp psoriasis who were categorized as patients who received topical steroid therapy alone vs. those who received combination therapy with topical steroid and oral cyclosporine for 12 weeks. The severity of psoriasis and quality of life were evaluated at 4, 8, and 12 weeks of treatment.RESULTS: No significant improvement was observed in the severity of psoriasis or in patients' quality of life during the treatment period in patients receiving topical steroid alone. Patients treated with a combination of topical steroid and oral cyclosporine showed a reduction in the severity of psoriasis from the 4th week of treatment and their quality of life improved from the 12th week of treatment.CONCLUSION: Combination therapy with oral cyclosporine and topical steroid may reduce the severity of scalp psoriasis and improve patients' quality of life.

A potential side effect of oral topical steroids: Central serous chorioretinopathy

Topical corticosteroids are some of the most common drugs used in oral medicine for treating atrophic and erosive lesions that affect the mucosa. Adverse effects of these drugs include oral candidiasis with associated burning mouth and hypogeusia, hypersensitive reactions to the drug, and inhibition of the hypothalamic–pituitary–adrenal axis and secondary adrenal insufficiency. The ocular side effects of oral topical steroids are less documented. This short communication describes a case of central serous retinopathy that developed following administration of oral topical steroid.

Annular pustular psoriasis in a 6-year-old child: Case report

@#Annular pustular psoriasis (APP) is a rare variant of pustular psoriasis occurring only in about 1-5.4% of children with psoriasis. Pustular psoriasis is triggered by endogenous and exogenous factors. Exogenous factors include stress, upper respiratory tract infection and withdrawal of systemic corticosteroids. This condition usually requires systemic treatment. However, there are still no randomized controlled trials or standardized guidelines proving the advantage of any specific treatment modality over the other. We report a case of a 6-year-old male who presented with diarrhea followed by appearance of erythematous annular plaques with pustules and nail changes. Punch biopsy showed pustular psoriasis. Patient was treated with topical betamethasone valerate and calcipotriol, and there was noted to have no recurrence of skin lesions for 4 months.

A Potent Regimen For Oral Lichen Planus: A Review

Background:Oral lichen planus (OLP) is a chronic inflammatory disease that affects oral mucosa. Substantial fluctuation is seen between the patients in response to various treatments posing difficulty for the physician in management of the disease. Aim: To assess efficacy of any form of intervention used to manage oral lichen planus. Materials and methods: All the published randomised control trials from 2000 to 2016 in the management of OLP, comparing active interventions with or without placebo irrespective of age, gender were selected from Cochrane central register of controlled trials, CENTRAL, EMBASE and MEDLINE were included in the study, and SWOT analysis was performed. Results and conclusion: Thirty two randomised control trials using different drug interventions were included in this systematic review. The superiority of corticosteroids in remission of clinical signs of OLP is evident, though with few side effects. Future research with consistent parameters and newer formulations, directed towards personalised medicine are required in a quest of the potent regime to treat this condition.

Comparison between topical tacrolimus and potent topical steroids in treatment of childhood vitiligo / 重庆医学

Objective To assess which of topical tacrolimus and topical highly potent steroids,is more effective and safer in the treatment of pediatric vitiligo.Methods The PubMed,Cochrane library,Scopus and CINAHL plus databases were retrieved.The search was confined to English language articles.The randomized controlled trial(RCT) articles were included in our study.The quality of the identified articles was examined by using the CASP Randomised Controlled Trials Checklist.Results As a result,there were only a few studies related to the comparison.However,there were only two RCTs regarding a comparison of topical tacrolimus 0.1％ and clobetasol propionate 0.05 ％ in childhood vitiligo.Conclusion When the body surface area (BSA) involved in the child is ＜20 ％,and the disease is not rapidly spreading,topical therapy is the first choice.Topical tacrolimus may be considered as an alternative therapy for childhood vitiligo,especially for acrofacial and segmental types,before considering other modalities,but still need to observe long-term side effects.

Systemic absorption of 0.1% triamcinolone acetonide as topical application in management of oral lichen planus.

Context: Topical corticosteroids are the treatment of choice for oral lichen planus (OLP) due to its potential anti‑inflammatory effect. However, chronic nature of OLP often requires long‑term and frequent applications, exposing patients to local and systemic side effects. Aim: To detect the systemic absorption of 0.1% triamcinolone acetonide (TAC) through the oral mucosa of patients with OLP. Subjects and Methods: This was a pilot pharmacokinetic study carried out in the Department of Oral Medicine and Radiology in collaboration with the Department of Toxicology, over 10 months. A total of twenty patients with OLP were included and advised to apply 0.1% TAC 3 times/day for 2 weeks and 2 times/day for next 2 weeks. Blood samples were obtained on the first and second visits and analyzed for triamcinolone using High pressure liquid chromatography (HPLC). Statistical Analysis Used: Paired t‑test was done to compare visual analog scale (VAS) score for burning sensation at the first and second visits, statistically significant if P < 0.05. The baseline demographic data were analyzed using descriptive statistics. Results: Paired t‑test was done to compare VAS score for burning sensation at the first and second visits, which turned to being statistically significant (P = 0.001). Although HPLC is an established method for the detection of TAC, none of the study populations showed evidence of steroid (TAC) in the blood sample during 4 weeks of treatment duration. Conclusions: 0.1% triamcinolone is a relatively safe drug to be used with no systemic absorption in the standard dose regimen for oral lichen palnus.

Erosive Lichen Planus of the Oral Cavity: A Case Report.

Erosive lichen planus (LP) is a clinical form of oral LP characterized by the bilateral presentation of erosive and erythematous areas in the oral cavity usually the buccal mucosa with predominance in middle aged females with undue stress factors. In this article, we are giving a case report of a 56-year-old female patient who came to our Department of Oral Medicine and Radiology with a chief complaint of burning sensation of the mouth to hot and spicy food. The diagnosis was given as erosive LP. We also aim to review the literature and management of the lesion with reference to the same.

Prurito neuropático / Neuropathic pruritus

El prurito neuropático es una forma patológica de prurito, donde la curva estímulo-respuesta que rige la sensación normal se ha distorsionado y la sensación de prurito está fuera de proporción o incluso completamente independiente de los estímulos pruritogénicos. Al igual que el dolor neuropático, el prurito neuropático aún es poco conocido, a pesar de los avances en la comprensión de los mecanismos de éste. La causa del prurito neuropático puede ser extremadamente difícil de precisar. El tratamiento eficaz requiere de la identificación anatómica y etiológica del problema neurológico y la instauración de un tratamiento modificador de la enfermedad. En algunos casos, esto puede ser neuroquirúrgico. El prurito neuropático no suele responder a antihistamínicos, esteroides tópicos u otros medicamentos eficaces para tratar el prurito convencional. Por otra parte, al igual que otros síntomas neurológicos, el prurito puede indicar un problema neurológico potencialmente grave que puede necesitar tratamiento rehabilitador.

Neuropathic Pruritus is a pathological form of itching, where stimulus-response curve governing normal sensation, has been distorted and itching sensation is out of proportion or even completely independent pruritogenic stimuli. As neuropathic pain, neuropathic pruritus is still poorly understood, despite advances in understanding the mechanisms thereof. The cause of neuropathic itch can be extremely difficult to pinpoint. Effective treatment requires identification of anatomical and etiological neurological problem, and the establishment of a disease-modifying treatment. In some cases, this may be neurosurgical. The neuropathic pruritus not usually respond to antihistamines, topical steroids or other effective drugs to treat itching conventional. Moreover, like other neurological symptoms, pruritus may indicate a potentially serious neurological problem that may need rehabilitation treatment.

Current status of atopic dermatitis in Japan

Atopic dermatitis (AD) is a common, chronic or chronically relapsing, severely pruritic, eczematous skin disease. AD is the second most frequently observed skin disease in dermatology clinics in Japan. Prevalence of childhood AD is 12-13% in mainland Japan; however, it is only half that (about 6%) in children from Ishigaki Island, Okinawa. Topical steroids and tacrolimus are the mainstay of treatment. However, the adverse effects and emotional fear of long-term use of topical steroids have induced a "topical steroid phobia" in patients throughout the world. Undertreatment can exacerbate facial/periocular lesions and lead to the development of atopic cataract and retinal detachment due to repeated scratching/rubbing/patting. Overcoming topical steroid phobia is a key issue for the successful treatment of AD through education, understanding and cooperation of patients and their guardians.

Management of mucous membrane pemphigoid with dapsone plus weekly steroid injections in a young patient: a case report / Tratamento de penfigóide membranoso mucoso com dapsona e injeções semanais de esteróide em um paciente jovem: relato de caso

Purpose: Mucous Membrane Pemphigoid (MMP) is an autoimmune subepithelial blistering disorder usually affecting older individuals. This paper describes the pharmacological management of MMP in a young patient. Case description: A 23 year-old woman showed erythematous ulcerative gingiva in the maxillary palatal region and around the retromolar region. A perilesional excisional biopsy was done, and the histologic and immunohistochemical analysis confirmed the clinical diagnosis of MMP as the cause of desquamative gingivitis in this patient. The patient was treated with topical steroids plus daily Dapsone 100 mg and weekly steroid injections (40 mg). The lesions began to resolve after 12 weeks of therapy. Conclusion: This case of MMP in a young female patient was effectively managed with a combination therapy of topical steroids, Dapsone and steroid injections.

Objetivo: O penfigóide membranoso mucoso (PMM) é uma desordem autoimume subeptelial bolhosa que geralmente afeta indivíduos mais velhos. Este relato de caso descreve a abordagem farmacológica do PMM em uma paciente jovem. Descrição do caso: Uma paciente do sexo feminino, com 23 anos de idade, apresentava a gengiva eritematosa e ulcerada na região palatina e na região retromolar. A biópsia excisional total foi realizada e as análises histológica e de imuno-histoquímica confirmaram o diagnóstico clínico de PMM como causa da gengivite descamativa nesta paciente. A paciente foi tratada com esteróides tópicos, Dapsona 100 mg diariamente e injeções de esteróides mensais (40 mg). A resolução das lesões se iniciou após 12 semanas de terapia medicamentosa. Conclusão: Este caso de PMM em uma paciente jovem foi efetivamente tratado com uma terapia combinada de esteróides tópicos, Dapsona e injeções de esteróides.