Local side effects

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). 

Aerosol spray cans were invented in 1929, and perfection of a reliable valve and development of disposable cans took place in the 1940s. Shortly thereafter, aerosol became a household word. Like many other modem conveniences, however, the aerosol spray can has drawbacks as well as advantages. Because the particles in an aerosol are extremely tiny, they are quite mobile. They last for a long time in the atmosphere and can affect the climate, as already described. They can penetrate deep into our lungs and cause adverse health effects. Thus, anthropogenic aerosols have both global and local side effects. Despite increasing scientific studies, these effects are not yet fttlly understood. 

Local side effects are usually tolerable and may be caused by preservatives, therefore switching from one product to another may alleviate the local side effects. Stinging of the eyes upon instillation is the most common adverse effect. Other local adverse effects include conjunctivitis, keratitis, dry eyes, and uveitis.10,13... 

Local side effects include burning, stinging, itching, foreign body sensation, dry eyes, and conjunctivitis. Brinzolamide may have a lower incidence of these side effects since the drug is in a neutral pH solution. Dorzolamide has been reported to cause irreversible corneal decompensation. Taste abnormalities have been reported with each agent. Both topical carbonic anhydrase inhibitors are sulfonamides and are contraindicated in patients with history of sulfonamide hypersensitivity.10,13... 

The emetines include emetine and dehydroemetine. These drugs act only against trophozoites. Their mechanism of action is based on eukaryote protein synthesis. They are parenterally administered because oral preparations are absorbed erratically and may induce severe vomiting. They are widely distributed and accumulate in liver, lungs and other tissues. The emetines are slowly elimination via the kidneys. Local side-effects in the area of the intramuscular injection are pain, tenderness and muscle weakness. Serious toxicity is common if the drugs are given for more than 10 days. Side effects include nausea, vomiting, diarrhoea but also cardiotoxicity. 

Topical azole derivatives include the imidazoles bifonazole, clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, lanoconazole, flutrima-zole and sertaconazole. These drugs show activity against the dermatophytes Epidermophyton, Mi-crosporum and Trichophyton. They are also effective against the yeasts Candida albicans and Pityrospo-rum orbiculare. Local side effects include pruritus, erythema and local irritation. Allergic dermatitis is rare. 

Topical preparations usually contain relatively insoluble steroids, such as clobetasol propionate, triamcinolone acetonide, or triamcinolone diacetate. Side effects of this mode of drug application are usually milder and more transient than those seen after systemically administered steroids. However, potent topical corticosteroids, such as clobetasol propionate (Temovate), can suppress adrenal function when used in large amounts for a long time, especially when the skin surface is denuded or when occlusive dressings are employed. Since the high potency topical preparations carry a higher risk of local side effects, their use should be held in reserve. 

N, N -Diallyl-pynmidine-2,4,6-triamine, U-7720 (23) was initially, developed as a potent antihypertensive agent. Later, its metabolite minoxidil (3) was found to be efficacious as both an antihypertensive orally and for hair growth topically. The systemic and local side effects of topical minoxidil (3) are essentially non-existent. 

The function of Kollidon 12 PF or Kollidon 17 PF is to reduce strongly the local side effects (e.g. formation of oedemas) and to increase the retention time in the tissue. 

Dubus JC, Marguet C, Deschildre A, Mely L, Le Roux P, Brouard J, Huiart L. Reseau de Recherche Clinique en Pneumonologie Pediatrique. Local side-effects of inhaled corticosteroids in asthmatic children influence of drug, dose, age, and device. Allergy 2001 56(10) 944-8. 

The indications for LNIT do not differ from those for the subcutaneous route of administration LNIT should obviously be used in patients suffering from rhinitis, and its effectiveness seems to depend on the preseasonal administration. The possible local side effects do not, at present, represent a real problem. 

Although the incidence of adverse reactions to mupirocin is typically low (occurring in less than 1.5% of patients), several local side effects such as burning, stinging, pain, erythema, and contact dermatitis have been reported. Resistance to mupirocin has been reported but is not common. Some strains of bacteria have a low level of resistance but succumb to high-dose of mupirocin.14 Due to this fact, it should be handled with extreme care, especially as prophylactic use, in order to prevent further resistance. 

Ind also explained that, since cidesonide is activated in the lung, it has an improved systemic safety profile compared with other corticosteroids, and patients should be less likely to suffer from local side effects. 

Diqnafosol is highly water-solnble dinucleatide, stable at room temperatnre. It does not appear to be systemi-cally absorbed and is rapidly metabolized on the surface of the eye to naturally occurring compounds. It is well tolerated with localized side effects (burning/stinging). ft is administered four times a day as an unpreserved, sterile, aqueous drop. 

To ensure optimal drug delivery, it is necessary to coordinate activation of the inhaler with inspiration and a final hold of breath. Many patients, especially the young and the elderly, find this very difficult and spacer devices are often used between the inhaler and lips these act as an aerosol reservoir and also reduce impaction of aerosol in the oropharynx. Topical deposition can cause local side effects in the mouth, particularly Candida with inhaled glucocorticoids a spacer abolishes this problem. 

Prodrugs can be used to increase or decrease the aqueous solubility, mask bitterness, increase lipophili-city, improve absorption, decrease local side effects, and alter membrane permeability of the parent molecule. For example, chloramphenicol has an aqueous solubility of 2.5mg/ml, but chloramphenicol sodium succinate, a prodrug, has an aqueous solubility of lOOmg/ml. Hydantoins also possess low aqueous solu-bilites that result in low and variable availability and precipitation following injection. In an effort to increase the aqueous solubility of phenytoin, Stella et prepared the ethyl and triethylamine esters... 

When a drug is mainly absorbed in the upper part of the GI tract and the unabsorbed fraction, which arrives to the colon, may cause serious local side effects, the GRDF is an excellent solution to reduce the appearance of such drugs in the colon. A good example for such compounds is antibiotics. 

Flotra L. Different modes of chlorhexidine application and related local side effects. J Periodontal Res Suppl 1973 12 41-4. 

E Due to her concomitant disease states, AK should avoid beta-blockers, adrenergic agents, and sulfa medications. Pilocarpine is not a good choice for AK due to its bothersome local side effects. Latanoprost is a good initial choice for AK due to its convenient once daily dosing and mild local and systemic side effects. 

Lip Eyelid is one of the safest phenol peels on the market, but incorrect application can lead to the usual local side effects of chemical peels. 

Local adverse effects from ICSs include oropharyngeal candidiasis and dysphonia that are dose-dependent. The dysphonia appears to be due to a local corticosteroid-induced myopathy of the vocal cords. The use of a spacer device can decrease oropharyngeal deposition and thus decrease the incidence and severity of local side effects. In infants who require delivery through a facemask, the parent should clean the nasal-perioral area with a damp cloth following each treatment to prevent topical candidal infections. 

Although topical GCs usually have less side-effects than systemic GCs, and are successfully used to treat several inflammatory dermatological diseases, their major limitation remains the local side-effects they can cause. Furthermore, severe disease exacerbations often cannot be treated efficiently with compounds that work locally only. In such situations, systemic treatment is mandatory (e.g. in bullous skin diseases). In dermatological indications especially the main drawback of topical GCs is the development of skin atrophy after long-term use [11, 12],... 

A second advantage of spacers is that the large particles are deposited on the walls before finer particles, hence the dose inhaled consists of a higher percentage of fine inhalable particles. Conversely, a lower amount of non-respirable particles are deposited in the mouth and throat, where local side-effects can occur, especially for steroids. 

In the treatment of diabetes mellitus, insulin is generally administered by injection. However, the injections may cause local side effects and allergic reactions, and may also result in the patients physical and mental pain. Thus, alternative routes of administration such as nasal [2], buccal [3], pulmonary [4], rectal [5], and ocular [7] have... 

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