- Reducing unwanted systemic effects of glucocorticoids in dermatology achieved by their local application in the lesion. Dermatology introduction acting locally with glucocorticoids which may assume revolution in the treatment of inflammatory skin diseases, including such severe as eczema, neurodermatitis, psoriasis (in this case, a steroid and anti-proliferative effects on cells of the epidermis) and others.
With high activity, the modern local corticosteroid agents with adequate use have practically no systemic action. Local influence not only used its anti-inflammatory and anti-allergic effects, but hyperplastic processes in the epidermis (psoriasis and others.) And local-anesthetic effect (decrease itching and pain at the site of application).
It is found that the therapeutic effect is due not to corticosteroids outer resorption but by its action directly on the skin tissue at the site of application. However, even in these cases after discontinuation of treatment in the plasma levels of corticosteroids, according to most authors, are normalizing.
Significantly increases the absorption of local corticosteroids at the imposition of occlusive dressings and application of drugs on the damaged skin. In case of removal of the stratum corneum resorption increases about 100 times compared with the intact skin.
The permeability of the skin for local corticosteroid is enhanced with an increase in body temperature and environment humidity.
The degree of resorption affected by the presence of alcohol, propylene glycol, Dimexidum (DMSO) and other activators suction. DMSO, for example, greatly improves skin corticosteroids resorption and increases their activity (proposed methods of combined use). The nature of absorption of drugs is determined by their chemical characteristics and properties of the substrate. Easier absorbed acetonides corticosteroids worse – acetates, even worse – alcohol.
Prolonged uncontrolled use of local corticosteroid agents can occur and local side effects that contribute to the development of local complications:
- 1. Infectious Complications arise as a result of weakening the resistance of the skin against infectious agents. Against the background of weakening the protective properties of the skin easier to develop bacterial, viral and fungal processes or exacerbated existing ones. 2. Skin atrophy can develop long-term use of drugs due to inhibition of proliferation of epidermal cells, vasoconstriction, the impact on immune mechanisms, effects on the connective tissue (the mechanism described above). Particularly rapidly develop atrophic changes in the skin. On other areas of the skin may occur changes in the form of striae.
- 3. The use of corticosteroid agents on the skin are often entails a violation of the sebaceous glands and the development of corticosteroid acne and perioral dermatitis. In some cases, the use of local corticosteroids is the sole cause of perioral dermatitis. More severe complications are those using fluorinated corticosteroids. Mechanisms of these complications is very difficult and ambiguous.
- 4. Addiction. Prolonged and uncontrolled use of external funds corticosteroid (months) their effectiveness can be reduced, and the cancellation will inevitably lead to severe exacerbations of the disease (manifestation of so-called withdrawal), which are difficult to remove by other means. In this regard, many authors recommended for clinical effect through local corticosteroid therapy move to a less active drugs in order to maintain this result.
- 5. Prolonged use of corticosteroids may develop local complications such as telangiectasia, hirsutism, hypopigmentation, milia formation. Especially quickly these complications develop on the skin.
- 6. For some people the opportunity to poor tolerance of steroids that can be expressed in the appearance of pruritus, rash different – until petechial.
Please note that under the influence of external funds corticosteroid may occur pathomorphosis pathological process, which is expressed in a significant change in the clinical picture of the disease, making it difficult to diagnose the most banal processes.
This analysis of side effects and complications of the outer corticosteroid therapy leads to an understanding of the limitations and contraindications of this therapy:
- 1. The use of external corticosteroids are contraindicated for any infectious diseases (bacterial, viral, mycotic inflammation) with the exception of combined processes in which at some point may be used combination of drugs, including in its membership, along with corticosteroid anti-infective component. 2. Do not apply external corticosteroid agents to wounds and ulcers due to their inhibitory effect on the process enitelizatsii and scarring and the risk of joining a secondary infection.
- 3. We do not recommend the use of corticosteroids on the face (except when the damage caused by the disease outweighs the risk of these complications). In the case of local corticosteroids on the skin must be limited to a very short course (no more than 7-14 days), cause the drug dotted surface movements, to give preference to non-halogenated agents. Corticosteroid drugs are absolutely contraindicated in acne, pink acne, perioral dermatitis.
- 4. We do not recommend prolonged use of large amounts of external corticosteroid agents over large areas, in the folds to avoid resorptive action and addictive. In the case of a fold and significantly increases the risk of infectious complications. It is believed that the optimal period of continuous use of corticosteroid external funds is 14 days. Prolonged use is recommended only with Clobetasol cream.
- 5. The use of external funds corticosteroid children allowed only if strict indications for limited areas, no more than 1-1.5 weeks continuously. The drug is applied to the surface dashed movements. There is evidence of suppression of adrenocortical function in infants with very long-term use of corticosteroid local funds, often using fluorinated products. However, it notes that the function of the adrenal cortex is restored after cessation of treatment.
Please note that widely used diapers and diaper can play the usual role of occlusive dressings, and promote the development of the previously mentioned complications.
Pregnancy and lactation are a relative contraindication to the use of external funds corticosteroid. In each case, the risk of complications should not exceed the effects of the negative impact of the disease. In the appointment of local corticosteroid pregnant should strictly take into account all the restrictions listed above.