Corticosteroid responsive dermatoses treatment

Initial dose based on previous asthma drug therapy and disease severity; 100 mcg via oral inhalation once daily is the usual recommended starting dose for patients not on an inhaled corticosteroid. After 2 weeks of therapy, if asthma symptoms are uncontrolled, increase dose to 200 mcg via oral inhalation once daily. Max: 200 mcg once daily. Administer at the same time each day. The maximum beneficial effect may not be achieved for up to 2 weeks or longer after starting treatment. Titrate to the lowest effective dose once asthma stability is achieved.

References: 1. Bikowski J, Pillai R, Shroot B. The position not the presence of the halogen in corticosteroids influences potency and side effects. J Drugs Dermatol . 2006;5(2):125-130. 2. Del Rosso J, Friedlander SF. Corticosteroids: options in the era of steroid-sparing therapy. J Am Acad Dermatol . 2005; 53(1 Suppl 1):s50-s58. 3. US Food and Drug Administration NDA 017765. Promius Pharma, LLC, Princeton, NJ: Aug 1977. 4. Rosenthal AL. Clocortolone pivalate: a paired comparison clinical trial of a new topical steroid in eczema/atopic dermatitis. Cutis . 1980;25(1):96-98. 5. Kircik LH. A study to assess the occlusivity and moisturization potential of three topical corticosteroid products using the skin trauma after razor shaving (STARS) bioassay. J Drugs Dermatol . 2014;13(5):582-585. 6. Cloderm [package insert]. Princeton, NJ: Promius Pharma, LLC; 2017.

Intralesional fluorouracil (50 mg per mL, two to three times per week) appears to shrink keloids safely while avoiding the tissue atrophy and telangiectasia that may occur with repeated corticosteroid injections. 30 Combining fluorouracil with corticosteroid injections and pulsed dye laser produced superior results more rapidly than corticosteroid injections alone or corticosteroids with fluorouracil. 13 Good to excellent responses at 12 weeks as rated by a blinded observer were 15 percent for triamcinolone acetonide, 40 percent for triamcinolone plus fluorouracil, and 70 percent for all three modalities (all significant). Combining corticosteroids and fluorouracil diminished the adverse effects of corticosteroids. Rare skin complications of fluorouracil may include hyperpigmentation and wound ulceration. No systemic adverse effects (., anemia, leucopenia, thrombocytopenia) occurred in this study.

In a systematic review and meta-analysis, Tsikopoulos and associates (2016) compared the effectiveness of autologous whole blood with that of corticosteroid injections (CSIs) on epicondylopathy and plantar fasciopathy. The databases of PubMed, Web of Science, CENTRAL, and Scopus were searched up to May 6, 2015.  Randomized trials comparing the effects of autologous whole blood and CSIs on epicondylopathy or plantar fasciopathy were included.  Trials exploring the effectiveness of PRP were excluded.  The primary outcome was pain relief.  The secondary outcome included the assessment of composite outcomes.  All outcomes were assessed at 2 to 6 (short-term) weeks, 8 to 13 (intermediate-term) weeks and 24 to 26 (medium-term) weeks.  Quality assessment was performed with the Cochrane risk of bias tool.  A total of 9 trials were included.  For pain relief, there was a statistically significant difference in favor of corticosteroids in the short-term (standardized mean difference [SMD] ; 95 % confidence interval (CI): to ; I2 = 53 %; p < ).  A statistically significant difference in favor of autologous whole blood was indicated in the medium-term assessment of pain relief on epicondylopathy.  The authors concluded that corticosteroids were marginally superior to autologous whole blood in relieving pain on plantar fasciopathy at 2 to 6 weeks.  They stated that autologous whole blood provided significant clinical relief on epicondylopathy at 8 to 24 weeks.  Moreover, they stated that conclusions were limited by the risk of bias.

Treat infection if present; discontinue if infection persists or worsens. Do not use near eyes, or on diaper dermatitis or pre-existing skin atrophy. Do not use fluorinated steroids longer than 1 week on the face. Avoid abrupt cessation in chronic use. Systemic absorption increased by broken or inflamed skin, prolonged use, application to large surface area, or use of occlusive dressings. Occlude only if necessary; do not occlude higher potency products. Monitor adrenal function in children if a high potency product or occlusion is used, and in adults if more than 50g weekly of a high potency product is used. Discontinue or reduce dose or potency if HPA axis suppression, Cushing's syndrome, hyperglycemia, glucosuria, or irritation occurs. Use lowest effective dose and potency (esp. in children). Use caution if applying to face or body folds. Do not use continuously or for prophylaxis. Foams are flammable. Reevaluate periodically. Pregnancy (). Nursing mothers.

Corticosteroid responsive dermatoses treatment

corticosteroid responsive dermatoses treatment

In a systematic review and meta-analysis, Tsikopoulos and associates (2016) compared the effectiveness of autologous whole blood with that of corticosteroid injections (CSIs) on epicondylopathy and plantar fasciopathy. The databases of PubMed, Web of Science, CENTRAL, and Scopus were searched up to May 6, 2015.  Randomized trials comparing the effects of autologous whole blood and CSIs on epicondylopathy or plantar fasciopathy were included.  Trials exploring the effectiveness of PRP were excluded.  The primary outcome was pain relief.  The secondary outcome included the assessment of composite outcomes.  All outcomes were assessed at 2 to 6 (short-term) weeks, 8 to 13 (intermediate-term) weeks and 24 to 26 (medium-term) weeks.  Quality assessment was performed with the Cochrane risk of bias tool.  A total of 9 trials were included.  For pain relief, there was a statistically significant difference in favor of corticosteroids in the short-term (standardized mean difference [SMD] ; 95 % confidence interval (CI): to ; I2 = 53 %; p < ).  A statistically significant difference in favor of autologous whole blood was indicated in the medium-term assessment of pain relief on epicondylopathy.  The authors concluded that corticosteroids were marginally superior to autologous whole blood in relieving pain on plantar fasciopathy at 2 to 6 weeks.  They stated that autologous whole blood provided significant clinical relief on epicondylopathy at 8 to 24 weeks.  Moreover, they stated that conclusions were limited by the risk of bias.

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