Growth retardation corticosteroids

Adverse reactions of corticosteroids are frequent with the long-term immunosuppressive regimens which are often needed and include an increased risk of infections, Cushing-like symptoms, hypertension, hyperglycemia, osteoporosis, growth retardation in children and mental reactions such as dysphoria, psychosis and depression. 

Increasing the concentration increases the penetration, but not to the same degree. Solubility of the corticosteroid in the vehicle is an other determinant of absorption and efficacy. So different formulations of the same corticosteroid can end up in a different efficacy classification. Efficacy can be further augmented by using the corticosteroid under occlusion. Occlusion with plastic enhances penetration and also absorption. However, with increased absorption also the risk of systemic side-effects increases. Systemic absorption will suppress the pituitary-adrenal axis and may cause Cushing s syndrome and a plethora of other adverse events (see Chapter 24, Section Il.b). Even small amounts absorbed may already cause growth retardation in children. 

Mygind H, Thulstrup AM, Pedersen L, Larsen H. Risk of intrauterine growth retardation, malformations and other birth outcomes in children after topical use of corticosteroid in pregnancy. Acta Obstet Gynecol Scand 2002 81(3) 234-9. 

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. 

Quantities of steroid cream or ointment to use for a child will still be expressed as adult fingertip units (see Table 9.1). In general, the lowest strength of topical corticosteroid should be prescribed to young children as systemic side-effects such as growth retardation are more commonly seen in children. For this reason it is common for children to have steroid holidays when only emollients are used to control the... 

Concerns about adverse effects from topical steroids have resulted in restrictions of its use on certain anatomic areas and its use in children. Both health care providers and patients lack of confidence in the safety of topical corticosteroid use has resulted in undertreatment and nonadherence. The potential for adverse effects with these products depends a variety of factors. The concentration applied, the amount applied, how often it is applied, and for how long it is applied can be important factors to consider. Long-term topical corticosteroid use primarily results in cutaneous abnormalities such as skin atrophy, striae, hypopigmentation, and steroid-induced acne. Systemic effects, namely hypothalamic-pituitary-adrenal axis suppression, growth retardation, and other adrenal abnormalities have been reported and thus have resulted in limiting topical steroid use in children (Table 97-2). - ... 

Zinc Dermatitis, hypogeusia, alopecia, diarrhea, apathy, depression, growth retardation, impaired wound healing, immunosuppression Acute gastric distress, nausea, dizziness, death with large intravenous doses Chronic immunosuppression, decreased HDL, copper deficiency Decreased infection, hypoalbuminemia, corticosteroids, pregnancy, burns, stress, inflammation Increased tissue injury, hemolysis, contaminated collection tube... 

Another major breakthrough in lead design is the steroid-eluting electrode (Figure 11.12). About 1 mg of a corticosteroid (dexamethasone sodium phosphate) is contained in a silicone core that is surrounded by the electrode material. The leaking of the steroid into the myocardium occurs slowly over several years and reduces the inflammation that results from the lead placement. It also retards the growth of the fibrous sack that forms around the electrode, which separates it from viable myocardium. As a result, the dramatic rise in acute thresholds that is seen with nonsteroid leads during the 8-16 weeks postimplant is nearly ehminated. 

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