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Topical Steroids

»	When were corticosteroids discovered? When were they first used therapeutically?
»	Describe the basic steroid nucleus.
»	How is the potency of topical steroid medications determined?
»	How do topical steroids inhibit cutaneous inflammation?
»	How are topical corticosteroids classified as to potency?
»	How many topical steroid medications are available in the United States?
»	What are the differences between brand name and generic topical steroid products?
»	With so many products available, how do you decide which product to prescribe for your patient?
»	What specific directions should be provided when prescribing super-, high-, and midpotency topical steroids?
»	Why is the vehicle important when recommending a topical corticosteroid?
»	Are certain vehicles preferred for particular types of lesions or anatomic sites?
»	A patient has 5% total body surface area (TBSA) involvement. How much topical steroid should be prescribed for twice daily application for a 1-week-on and 1-week-off treatment cycle? The patient will return in 4 weeks for follow-up.
»	How should the FTU application technique be applied to children?
»	When are combination topical steroid and antiinfective products indicated?
»	What is tachyphylaxis and how can it be prevented?
»	What are the local cutaneous side effects of topical steroids?
»	What are the effects of topical steroids on the epidermis?
»	What are the effects of topical steroids on the dermis?
»	What are the systemic side effects of topical steroid therapy?
»	Are there topical steroid addicts?
»	What is periorificial dermatitis?
»	What is tinea incognito?
»	Can topical steroid medications cause contact dermatitis?
»	Mrs. Jones brings her 9-month-old infant with moderate atopic dermatitis to your office. What topical steroid do you prescribe?
»	A 40-year-old woman presents with a 5-year history of chronic dermatitis on her palms. Lesions are plaques with abundant scale. What topical steroid do you prescribe?
»	A 35-year-old woman with moderate psoriasis presents with scalp, facial, and body plaque lesions. What topical steroid do you prescribe?
»	Mrs. Smith brings her 6-month-old infant with a 2-week history of diaper dermatitis to your office. What topical steroid do you prescribe? Would you recommend any other topical therapy?
»	List some common mistakes that are made when prescribing a topical steroid.

What are the effects of topical steroids on the dermis?

Cutaneous atrophy and slight hypopigmentation from
intralesional corticosteroids. (Courtesy of the Fitzsimons Army Medical
Center teaching files.)

Fig. 50.3 Cutaneous atrophy and slight hypopigmentation from intralesional corticosteroids. (Courtesy of the Fitzsimons Army Medical Center teaching files.)

Fig. 50.4 Striae associated with midpotency topical steroid use.

Within 1 to 3 weeks of using superpotent topical steroids, the dermal volume is measurably reduced. This is due to decreased fibroblast production of dermal ground substance, primarily hyaluronic acid, and decreased dermal water content. Abnormal synthesis of collagen and elastin results in dermal atrophy (Fig. 50-3), skin fragility, striae (Fig. 50-4), telangiectasias, poor vascular support with skin purpura, and decreased wound healing.