Corticosteroids, preparation

Keratolytic agents such as salicylic acid are often added to bath oil or shampoos (typically 3% to 4%) for scalp psoriasis.10 Salicylic acid can also be added to topical corticosteroid preparations to enhance steroid penetration (salicylic acid breaks down keratin). 

Table 61-1 groups topical corticosteroid formulations according to approximate relative efficacy. Table 61-2 lists major dermatologic diseases in order of their responsiveness to these drugs. In the first group of diseases, low- to medium-efficacy corticosteroid preparations often produce clinical remission. In the second group, it is often necessary to use high-efficacy preparations, occlusion therapy, or both. Once a remission has been achieved, every effort should be made to maintain the improvement with a low-efficacy corticosteroid. 

O Byrne PM, Pedersen S. Measuring efficacy and safety of different inhaled corticosteroid preparations. J Allergy Clin Immunol 1998 102(6 Pt l) 879-86. 

Martin RJ, Szefler SJ, Chinchilh VM, Kraft M, Dolovich M, Boushey HA, Cherniack RM, Craig TJ, Drazen JM, Fagan JK, Fahy JV, Fish JE, Ford JG, Israel E, Kunselman SJ, Lazarus SC, Lemanske RF Jr, Peters SP, Sorkness CA. Systemic effect comparisons of six inhaled corticosteroid preparations. Am J Respir Crit Care Med 2002 165(10) 1377-83. 

Intralesional injection of steroid can lead to adrenal suppression. Infents and small children are especially susceptible, because a given amoimt of steroid is distributed in a smaller volume of fluid and tissue compartments. Infents injected with mixtiu es of triamcinolone acetonide and betamethasone or dexamethasone fiar periocular hemangiomas exhibited depressed serum cortisol and adrenocorticotropic hormone levels. The adrenal suppression can last up to 5 months and can result in weight loss and growth retardation. It is not known whether other corticosteroid preparations would produce similar effects or which other fectors might influence these results. In general, topical and periocular use of steroids produces minimal systemic effects. Withdrawal of topical or periocular steroids does not generally cause adrenal crisis. 

Topical corticosteroid preparations are used to treat the underlying inflammatory cause of pruritus, e.g. in eczema. 

Bigliardi PL, Izakovic J, Weber JM, Bircher AJ. Anaphylaxis to the carbohydrate carboxymethylcellulose in parenteral corticosteroid preparations. Dermatology 2003 207(1) 100-103. 

Injection of hydrophilic drugs under the bulbar conjunctiva results in direct diffusion of relatively high levels of the drug into the anterior chamber, comeal stroma, posterior chamber and anterior vitreous. In the horse, the route is used most frequently to manage acute anterior segment disease or, using depot corticosteroid preparations, in the management of anterior uveitis uncomplicated by comeal ulceration. 

Use repository corticosteroid preparations with great care. They are irrecoverable once injected and cause protracted local immunosuppression. They are potentially disastrous if comeal ulceration supervenes. 

Fluticasone propionate is an androstane, carboth-ioate corticosteroid. Of the available aerosolized corticosteroid preparations commercially, fluticasone propionate is the most potent, most lipophilic and most expensive. It has the longest pulmonary... 

Formulations containing an absorption promoting substance, such as propylene glycol or sodium lauryl sulphate, may increase the permeability of the stratum comeum to water-soluble drugs. Propylene glycol is a commonly used vehicle in topical corticosteroid preparations for veterinary use. Various aprotic solvents, which include dimethylacetamide, dimethylformamide, dimethylsulphoxide, tetrahydrofurfuryl alcohol, and 2-pyrrolidone, serve as penetration enhancers of polar drugs (Barry, 1983). Dimethylsulphoxide... 

Martin R, Szefler SJ, Chinchilli V, Kraft M, Dolovich M, Boushey HCR, et al. Systemic effect comparisons of six inhaled corticosteroid preparations. Am J Respir Crit Care Med 2002 165 1377-1383. 

Many topical agents are used to manage seborrheic dermatitis. Depending on what area of the body is affected, the pharmacist or other health professional can assist in selection of proper vehicles (i.e., solutions or shampoos for the scalp). Ingredients such as selenium sulfide, salicylic acid, and coal tar can help soften and remove the scales. Seborrheic dermatitis responds very quickly to low-potency topical corticosteroid preparations, but judicious use is important to avoid long-term adverse effects. Topical ketoconazole 2% can also be used to help control the yeast colonization. ... 

Duration of therapy for extrapulmonary tuberculosis caused by drug-resistant organisms is not known. Corticosteroid preparations vary among studies. 

Hida T, Chandler D, Arena JE, Machemer R. Experimental and clinical observations of the intraocular toxicity of commercial corticosteroid preparations. Am J Ophthalmol 1986 101(2) 190 195. 

RE Collard. Formulation and manufacture of corticosteroid preparations. Pharm J 186 11.1-117, 1961. 

Several cases of allergic hypersensitivity reactions including anaphylactic reactions, urticaria, and contact dermatitis to various corticosteroid preparations have been reported (Alani and Alani 1972 Gutzwiller 1974 Kounis 1976 Tegner 1976 and references cited therein), but the immunochemical mechanisms involved have apparently not been studied as yet. 

Ramstrom, O. Ye, L. Mosbach, K. Artificial antibodies to corticosteroids prepared by molecular imprinting. Chem. Biol. 1996, 3, 471-477. 

Generally, an antibacterial cream should be given to chemical skin burns to protect the surface and to prevent secondary infection. If there is a significant element of inflammation in non-necrotic areas, a mild topical corticosteroid preparation can be used. Frequent examinations of primarily superficial and limited burns are also advisable, as they can become deeper in a few days. 

Marks et al. (71) described a method of assaying the potency of topical corticosteroid preparations by studying the antimitotic activity on the skin of hairless mice. Briggs and Briggs (72) report on the induction of skin enzymes metabolizing carcinogenic hydrocarbons by topical corticosteroids. They consider that an increase occurs in epidermal aryl hydrocarbon hydroxylase (AHH) activity in human subjects who use topical corticosteroid therapy. This enzyme... 

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