Tachyphylaxis to topically applied steroids

Vivier, Anthony du

doi:10.1001/archderm.112.9.1245

Cited by 51 publications

(16 citation statements)

References 14 publications

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“…In the experimental setting, tachyphylaxis can be quantified by means of the vasoconstrictor assay and inhibition of fibroblast proliferation. 19,20 Due to the tissue becoming less sensitive (tachyphylaxis), preparations that are more potent are frequently being used to achieve comparable effects, 36 yielding more severe undesired effects.…”

Section: Adverse Effects Of Topical Corticosteroidsmentioning

confidence: 99%

Adverse effects of topical glucocorticosteroids

Hengge

Ruzicka

Schwartz

et al. 2006

Journal of the American Academy of Dermatology

895

682

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Section: Adverse Effects Of Topical Corticosteroidsmentioning

confidence: 99%

Adverse effects of topical glucocorticosteroids

Hengge

Ruzicka

Schwartz

et al. 2006

Journal of the American Academy of Dermatology

895

682

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“…The advantage of this strategy is 2-fold; first, the exposure to topical steroids is limited, markedly reducing the risk of side effects, and second, when topical steroids are used, they are applied on steroid naive skin, maximizing their efficacy and avoiding tachyphylaxis. 121,122 Since the first long-term studies combining a topical calcineurin inhibitor (pimecrolimus) and topical steroids sequentially, 98,99,101 additional concomitant usage of the 2 classes of drugs have been attempted. Initial studies with a mid potency steroid plus pimecrolimus concomitantly showed no additional risk of adding pimecrolimus versus placebo to the steroid therapy.…”

Section: New Directions In the Management Of Admentioning

confidence: 99%

Current management of atopic dermatitis and interruption of the atopic march

Boguniewicz

Eichenfield

Hultsch

2003

Journal of Allergy and Clinical Immunology

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“…Use of topical corticosteroids spans various fields of medicine, particularly in dermatology where they remain the most frequently used drug [16,17]. They are also indicated in diseases of the eyes, ear, nose and throat.…”

Section: Indications For the Use Of Topical Steroidsmentioning

confidence: 99%

“…The adverse effects/complications can be local, systemic or both. Systemic effects of topical steroids are observed more often in infants and children who are more prone to the systemic effects of steroid when treated inappropriately, owing to their large body-surface area [17]. A reversible suppression of the hypothalamic-pituitary-adrenal (HPA) axis, which lasted 4 months, has been reported in patients after discontinuation of moderated doses of clobetasol propionate [24].…”

Section: Adverse Effects Of Topical Steroidsmentioning

confidence: 99%

Misuse and abuse of topical steroids: implications

Nnoruka¹,

Daramola²,

Ike³

2007

Expert Review of Dermatology

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Topical steroids, having revolutionized dermatotherapy over several decades, remain the mainstay of treatment for steroid-responsive inflammatory dermatoses worldwide. Challenges, nevertheless, abound on the usage of topical steroids, particularly with their inappropriate application. Several steps and improved formulations are constantly evolving in the scientific world, aimed at addressing most of the associated adverse events. However, until the dawn of the 'ideal topical steroid', the implications of application misuse will remain significant. This review discusses the concept of 'misuse and abuse' of topical steroids, gives an overview of topical steroids, differentiates 'misuse' as opposed to 'abuse' of application of topical steroids as they occur in different settings and provides a schematic algorithm for the appropriate and optimal application of topical steroids. Consequently, this separation will allow a more accurate estimation of the burdens of these two aspects that require different solutions. 31-40 (2007) Topical glucocorticoids are the foundation of dermatotherapeutics [1], particularly for the noninfected inflammatory dermatoses, such as the eczemas and dermatitis. Their availability since 1952 has marked the most important milestone in dermatology to date [2,3]. Although the 'ideal' topical steroids have not yet been synthesized, topical administration of steroids still remains the safest mode of administration for glucocorticoids.Topical steroids are derivatives of the prototype hydrocortisone, a natural glucocortico steriod of the adrenal cortex. Chemical substitutions at certain key positions of the cyclopentanophenathrene nucleus, altering both its glucocorticoid and mineralocorticoid properties, affects the potency of these drugs. For example, halogenation at the 9-α position enhances the potency by improving activity within the target cell and decreasing breakdown into inactive metabolites [4], while masking or removing the hydrophilic 17-dihydroxyacetone side chain or the 16 α-hydroxy group increases the lipophilicity of the molecule, thereby enhancing penetration through the stratum corneum [1,5].The existence of a reservoir within the stratum corneum for most topical xenobiotics, particularly topical steroids [6,7], affects the choice of application frequency and the dose, while percutaneous absorption is dependent on the intrinsic property of the steroid, the vehicle used, the anatomical site, age of patient and method of application (i.e., under occlusion or hydration). However, individual variation in percutaneous absorption can also be quite pronounced. All of these factors must be taken into account when considering the potential for undesirable effects of topical steroids.Abuse of steroids could be regarded as the use of steroids to achieve purposes other than a therapeutic one, while misuse of steroids can be regarded as the inappropriate use of steroids for therapeutic purposes. These terms are introduced in this article for the purpose of describing the inapt use of prescr...

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Tachyphylaxis to topically applied steroids

Cited by 51 publications

References 14 publications

Adverse effects of topical glucocorticosteroids

Adverse effects of topical glucocorticosteroids

Current management of atopic dermatitis and interruption of the atopic march

Misuse and abuse of topical steroids: implications

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