Skin burn local corticosteroids

Topical aciclovir is not well tolerated by patients after a deep peel because of the burning sensation it triggers. If pain is very local, EMLA cream can be used cautiously, as it is absorbed more readily through skin that has no stratum corneum and is damaged by herpes. Local corticosteroids should not be used. 

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. 

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. 

The main adverse effect of pimecrolimus is local skin irritation, with a stinging or burning sensation, which occurs in 30% of patients. Typically, children have less skin irritation than adults. Adverse effects such as local immunosuppression and an increased risk of local bacterial and viral infections (notably eczema herpeticum) are less common than with topical glucocorticoids (5). In addition, there is a lack of skin atrophy (6,7). However, topical corticosteroids have the advantage of better skin penetration than pimecrolimus and will therefore continue to be used for more heavily keratinized skin such as in psoriasis (8). 

Tazarotene gel, applied once daily to dry skin, may be used as monotherapy or in combination with other medications, such as topical corticosteroids, for the treatment of localized plaque psoriasis. This is the first topical retinoid approved by the Food and Drug Administration (FDA) for the treatment of psoriasis. Side effects of burning, itching, and skin irritation are relatively common, and patients should avoid sun exposure. 

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