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Patrick J Potter, MD, FRCSC  Associate Professor, Department of Physical Medicine and Rehabilitation, University of Western Ontario School of Medicine; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre

Patrick J Potter, MD, FRCSC is a member of the following medical societies: Academy of Spinal Cord Injury Professionals , College of Physicians and Surgeons of Ontario , Canadian Association of Physical Medicine and Rehabilitation , Canadian Medical Association , Ontario Medical Association , Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Weaker topical steroids are utilized for thin- skinned and sensitive areas, especially areas under occlusion, such as the armpit, groin, buttock crease, breast folds. Weaker steroids are used on the face, eyelids, diaper area, perianal skin, and intertrigo of the groin or body folds. Moderate steroids are used for atopic dermatitis , nummular eczema , xerotic eczema , lichen sclerosis et atrophicus of the vulva , scabies (after scabiecide) and severe dermatitis . Strong steroids are used for psoriasis , lichen planus , discoid lupus , chapped feet, lichen simplex chronicus , severe poison ivy exposure, alopecia areata , nummular eczema, and severe atopic dermatitis in adults. [1]

Lewis Sarett of Merck & Co. was the first to synthesize cortisone, using a 36-step process that started with deoxycholic acid, which was extracted from ox bile . [43] The low efficiency of converting deoxycholic acid into cortisone led to a cost of US $200 per gram. Russell Marker , at Syntex , discovered a much cheaper and more convenient starting material, diosgenin from wild Mexican yams . His conversion of diosgenin into progesterone by a four-step process now known as Marker degradation was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception . [44] In 1952, . Peterson and . Murray of Upjohn developed a process that used Rhizopus mold to oxidize progesterone into a compound that was readily converted to cortisone. [45] The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US $6 per gram, falling to $ per gram by 1980. Percy Julian's research also aided progress in the field. [46] The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the leukocyte adhesion cascade and the role of phospholipase A2 in the production of prostaglandins and leukotrienes was fully understood in the early 1980s.

Corticosteroid agents are beneficial in the management of tuberculosis in children when the host inflammatory reaction contributes significantly to tissue damage or impaired function. 208 Corticosteroids decrease mortality rates and long-term neurologic sequelae in patients with tuberculous meningitis by reducing vasculitis, inflammation, and increased intracranial pressure. 209 A CNS inflammatory mass that arises during therapy of tuberculous meningitis usually responds to corticosteroid therapy. Children with enlarged hilar lymph nodes that compress the tracheobronchial tree, causing respiratory distress, localized emphysema, or collapse-consolidation lesions, frequently benefit from corticosteroid therapy. 210 Corticosteroids may benefit the course of miliary disease associated with alveolar-capillary block, pleural effusion, or pericardial effusion. Prednisone is used most commonly at the dose of 1 to 2 mg/kg per day for 4 to 6 weeks.

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Corticosteroid agents are beneficial in the management of tuberculosis in children when the host inflammatory reaction contributes significantly to tissue damage or impaired function. 208 Corticosteroids decrease mortality rates and long-term neurologic sequelae in patients with tuberculous meningitis by reducing vasculitis, inflammation, and increased intracranial pressure. 209 A CNS inflammatory mass that arises during therapy of tuberculous meningitis usually responds to corticosteroid therapy. Children with enlarged hilar lymph nodes that compress the tracheobronchial tree, causing respiratory distress, localized emphysema, or collapse-consolidation lesions, frequently benefit from corticosteroid therapy. 210 Corticosteroids may benefit the course of miliary disease associated with alveolar-capillary block, pleural effusion, or pericardial effusion. Prednisone is used most commonly at the dose of 1 to 2 mg/kg per day for 4 to 6 weeks.

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