Dermatitis local corticosteroids

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Topical corticosteroids exert localized anti-inflamma-toiy activity. When applied to inflamed skin, they reduce itching, redness, and swelling. These drugs are useful in treating skin disorders, such as psoriasis, dermatitis, rashes, eczema, insect bite reactions, and first-and second-degree burns, including sunburns. 

Pruritus Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses Contact dermatitis, atopic dermatitis, nummular eczema, stasis eczema, asteatotic eczema, lichen planus, lichen simplex chronicus, insect and arthropod bite reactions, first- and second-degree localized burns, and sunburns. 

Irritant or allergic contact dermatitis is eczematous and is often caused by antimicrobials, local anaesthetics, topical antihistamines, and increasingly commonly by topical corticosteroids. It is often due to the vehicle in which the active drug is applied, particularly a cream. 

Eczematous skin lesions are characterized by their chronic evolution and their frequent spread, despite the topical administration of corticosteroids. They are caused, as was shown by Hjorth and Trolle-Lassen (1963), by parabens contained in corticosteroid ointments. Patch tests done with different types of parabens yielded positive responses. Local application of pure corticosteroids, without preservatives, brought about rapid healing. This type of allergy, falsely related to corticosteroids, was particularly studied by Shorr (1968) 1 % of his patients treated for chronic dermatitis suffered from this allergy. 

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