Erythema corticosteroids

Perioral dermatitis is characterized by erythema, scaling and small papules and pustules symmetrically distributed around the mouth, sometimes extending to the nasolabial folds and the cheeks. This condition typically occurs in females 20-40 years of age. Topical corticosteroids can exacerbate the disease and should be avoided. 

Gentian violet solution is used to delineate the areas to be treated. Refrigerant topical anesthesia is used to freeze the skin prior to the procedure. Holding the skin taut, the dermabrader treats one anatomic unit at a time. Post-operatively, patients may have an open or closed dressing system, use antiviral agents, antibacterials and corticosteroids. The re-epithelialization is complete in 5-7 days and residual erythema is common for up to 4 weeks. 

Erythema, inflammation, pain, and itching caused by contact dermatitis can be effectively treated with topically applied corticosteroids. With such a wide range of products and potencies available, an appropriate steroid selection is based on severity and location of the lesions. Table 62-6 shows a list of topical steroids and their potencies. Higher-potency preparations are used in areas where penetration is poor, such as on the elbows and knees. Lower-potency products should be reserved for areas of higher penetration, such as on the face, axillae, and groin. Low-potency steroids are also recommended for the treatment of infants and children.32,33... 

Eye Contact Wash eyes immediately with copious amounts of water for at least 15 min apply an ophthalmic corticosteroid ointment after decontamination treat delayed erythema with a bland shake lotion (such as calamine lotion) or a topical corticosteroid depending on severity do not wear contact lenses when working with this chemical seek medical attention immediately. 

Topical corticosteroids (Table 16-1) may halt synthesis and mitosis of DNA in epidermal cells and appear to inhibit phospholipase A, lowering the amounts of arachidonic acid, prostaglandins, and leukotrienes in the skin. These effects, coupled with local vasoconstriction, reduce erythema, pruritus, and scaling. As antipsoriatic agents, they are best used adjunc-tively with a product that specifically functions to normalize epidermal hyperproliferation. 

Tazarotene (Tazorac) is a synthetic retinoid that is hydrolyzed to its active metabolite, tazarotenic acid, which modulates keratinocyte proliferation and differentiation. It is available as a 0.05% or 0.1% gel and cream and is applied once daily (usually in the evening) for mild to moderate plaque psoriasis. Adverse effects are dose- and frequency related and include mild to moderate pruritus, burning, stinging, and erythema. Application of the gel to eczematous skin or to more than 20% of body surface area is not recommended because this may lead to extensive systemic absorption. Tazarotene is often used with topical corticosteroids to decrease local adverse effects and increase efficacy. 

Giant cell arteritis (cranial or temporal arteritis) is an inflammatory condition that may affect any of the large arteries, especially the temporal and occipital arteries. The thickened temporal arteries may be tender and non-pulsatile, with erythema and oedema of the overlying skin. Early treatment with high-dose corticosteroids such as prednisolone is essential and should be continued for a minimum of 2-3 years at a reduced dose. 

Fluorouracil (Efudex, Fluoroplex) is an antimetabolite used for the topical treatment of actinic keratoses. It is also useful for the treatment of superficial basal cell carcinomas when conventional surgical modalities are impractical. Local inflammatory reactions characterized by erythema, edema, crusting, burning, and pain are common (and, some would argue, desirable) but may be minimized by reduced frequency of application or use in combination with a topical corticosteroid. 

Mechanism of Action Topical corticosteroids exhibit anti-inflammatory, antipruritic, and vasoconstrictive properties. Clinically, these actions correspond to decreased edema, erythema, pruritus, plaque formation, and scaling of the affected skin. Pharmacokinetics Approximately 3% is absorbed during an 8-hr period. Metabolized in the liver. Excreted in the urine. 

A 60-year-old man underwent coronary angiography with iopamidol 200 ml. One day later he developed infiltrated erythema of the face with a generalized maculopapular rash. The skin symptoms receded within 1 week after treatment with a corticosteroid ointment. Coronary angiography with iopamidol was repeated 3 years later and again within 1 day a maculopapular rash developed and regressed within a few days with intravenous dimethindene and prednisolone-21-hydrogen succinate. 

Erythema multiforme has been reported in a 19-year-old man 8 days after he started to take meloxicam for tendonitis withdrawal and therapy with corticosteroids resulted in complete recovery (13). 

Facial edema also has been observed. Reactions are often accompanied by fever, lymphadenopathy, elevated transaminases, leukocytosis, and eosinophilia. These rashes can progress to more severe, potentially fatal reactions, such as erythema multiforme, exfoliative dermatitis, or toxic epidermal necrolysis. Thus, if phenytoin is suspected as the etiology of the reaction, it should be discontinued immediately and an alternative anticonvulsant started if necessary. Corticosteroid therapy may mask some of the signs and symptoms of a hypersensitivity reaction, and patients on concomitant corticosteroids should be evaluated carefully for any symptoms resembling a hypersensitivity reaction. 

Scabs should not be pulled off in the post-peel period. Aggressive use of OT can cause scarring and/or pigmentation problems. Intense application of OT can cause patches of erythema that can persist for up to 3 months. This prolonged erythema can be treated by the application of topical corticosteroids and total sunblock. 

Erythema is inevitable after a phenol peel (Figure 37.18). ft can sometimes be less severe and of a shorter duration if a corticosteroid is injected intravenously at the beginning of the peel. Its intensity varies from patient to patient, from light and imperceptible to severe and deep. Resorcinol is a potentially allergenic phenol derivative persistent, pruritic erythema after a resorcinol peel might be a sign of contact dermatitis. 

Corticosteroids by the systemic route will only be needed very rarely to treat erythema. They can be administered in a single and preventive injection at the start of a phenol peel. Promethazine can be recommended, at a maximum dose of six times 25 mg/day, when the erythema causes pruritus and reflex scratching that could lead to unsightly scars, infections or dyschromia. 

When a peel causes localized inflammation that visibly develops into hyperpigmentation, even with sun protection and avoidance, a corticosteroid (preferably a fluoro-corticosteroid) should be applied. It should be applied twice a day locally to the erythema before it develops into hyperpigmentation and should not be used long term (1 week at the most), to avoid the side-effects associated with corticosteroids. This treatment should of course be combined with sun protection/avoidance measures and a topical depigmenting agent. 

Topical corticosteroids are the most widely used agents in the treatment of psoriasis in the United States. They are often used to decrease erythema, scaling, and pruritus. Topical vasoconstricting potencies of corticosteroids are ranked by the Stoughton-Cornell classification in seven classes (Table 96-4). Class I steroids are very high-potency products such as clobetasolpropionate 0.05%, halobetasolpropionate, and betamethasone dipropionate. ... 

Predominant treatment-related adverse effects are mild to moderate pruritus, burning, stinging, or erythema. These local reactions have been shown to be dose- and frequency-related." " Tazarotene is often used in combination with topical corticosteroids to decrease... 

The most common patient complaints with topical tacrolimus therapy are transient itching and burning at the site of application. Although no data support the practice, many clinicians recommend pretreatment with topical corticosteroids to prevent or reduce tacrolimus-induced burning and erythema. Systemic adverse effects of tacrolimus, while well documented with oral therapy, have not been observed in patients using the topical ointment for AD. Patients who receive long-term systemic immunosuppressants are prone to devel-... 

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