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Glucocorticoids are prescribed frequently for their immunosuppressive and anti-inflammatory properties. They are administered locally, through topical and intralesional routes, and systemically, through intramuscular, intravenous, and oral routes.

Mechanisms of glucocorticoid action are numerous, as discussed in Chapter 59. These include apoptosis of lymphocytes, inhibitory effects on the arachidonic acid cascade, depression of production of many cytokines, and myriad effects on inflammatory cells.

Topical glucocorticoids (see Chapter 59, Table 59-4) can be grouped based on potency and many of the more potent drugs have a fluorinated hydrocortisone backbone.

therapeutic uses Many inflammatory skin diseases respond to topical or intralesional administration of glucocorticoids. Absorption varies among body areas; the steroid is selected on the basis of its potency, the site of involvement, and the severity of the skin disease. Often, a more potent steroid is used initially, followed by a less potent agent. Twice-daily application is sufficient, and more frequent application does not improve response. In general, only nonfluorinated glucocorticoids should be used on the face or in occluded areas such as the axillae or groin.

Intralesional preparations of glucocorticoids include insoluble preparations of triamcinolone acetonide (kenalog-10, others) and triamcinolone hexacetonide (kenolog-40 and aristospan), which solubilize gradually and therefore have a prolonged duration of action.

toxicity and monitoring Chronic use of potent topical glucocorticoids (e.g., diflo-rasone diacetate 0.05%, betamethasone dipropionate 0.05%) can cause skin atrophy, striae, telangiectasias, purpura, and acneiform eruptions. Because perioral dermatitis and rosacea can develop after the use of fluorinated compounds on the face, they should not be used in this site.

Systemic Glucocorticoids therapeutic uses systemic glucocorticoid therapy is used for severe dermatological illnesses. In general, it is best to reserve this method for allergic contact dermatitis to plants (e.g., poison ivy) and for life-threatening vesiculobullous dermatoses such as pemphigus vulgaris and bullous pemphigoid. Chronic administration of oral glucocorticoids is problematic, given the side effects associated with their long-term use (see Chapter 59).

Daily morning dosing with prednisone generally is preferred, although divided doses are used occasionally to enhance efficacy. Fewer side effects are seen with alternate-day dosing, and if required for chronic therapy, prednisone is tapered to every other day as soon as it is practical. pulse therapy using large intravenous doses of methylprednisolone sodium succinate (solu-medrol) is an option for severe resistant pyoderma gangrenosum, pemphigus vulgaris, systemic lupus erythe-matosus with multisystem disease, and dermatomyositis. The dose usually is 0.5-1 g given over 2-3 hours. More rapid infusion has been associated with increased rates of hypotension, electrolyte shifts, and cardiac arrhythmias.

toxicity and monitoring Most side effects are dose-dependent. Long-term use is associated with a number of complications, including psychiatric problems, cataracts, myopathy, osteoporosis, avascular bone necrosis, glucose intolerance or overt diabetes mellitus, and hypertension. In addition, psoriatic patients treated with parenteral or topical glucocorticoids may have a pustular flare, particularly if the steroid is tapered rapidly.

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How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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