4. Introduction
Sulzberger and witten treated
eczematous dermatosis with topical
hydrocortisone in 1952
This success made a new cornerstone in
the history of dermatology
5. CS have a basic structure of cyclopentanoperhydrophenanthrene
ring(17c)formed by fusion of 3 six membered ring and 1 five membered
ring
6.
7.
8.
9.
10.
11.
12.
13.
14.
15. Absorbtion at different sites
Forearm 1%
Armpits 4%
Face 7%
Eyelids and genitals 30%
Palm .1%
Sole .05%
16.
17. Effects of TCS
Figure 2: Anti-inflammatory, immunosuppressive, and vasoconstrictive effects of topical
corticosteroids
33. Factors affecting choice of TCS
Anatomic area of application
Disease responsiveness
Severity of the disease
Extent of BSA involvement
Age of the patient
Suitability of the vehicle
Potency of steroid molecule
65. Topical steroid withdrawl(TCW)
TSW is a skin condition that may be associated with the use of topical
steroids which are medications used to treat various skin condition such as
eczema and psoriasis
Exact cause and mechanism are not clear because not everyone who uses
TCS will develop TSW
Also known as red skin syndrome or topical steroid addiction
TSW is a relatively rare and under recognized condition
66. Clinical presentation
There is a range of clinical presentations and symptoms
In general there is red,itchy,dry and burning skin that affect small area to
nearly the whole body
Recurrent scratching for severe itching may breaks the skin barrier that
may lead to skin infection
There may be oozing,bleeding and cracking
67. TSW cont
Extreme tiredness
Insomnia
Rapid weight loss
Hair loss
Excessive flaking of skin
Lymph node swelling
Swelling of legs and arms
Feeling cold
Anxious
68. TSW treatment
There is no agreed treatment of TSW
Cessation of TCS
A tapering course of oral steroid may be helpful
Oral tetracycline and low dose isotretenoin have been used in steroid
rosacea perioral dermatitis
Cold compression
Psychological support
Oral antibiotis in case of infection
69. prevention
Avoid prolonged and frequent use of high potency TCS
Risk of TSW should not prevent appropriate management of atopic
dermatitis
70. Myths vs reality of TSW
TCS should not be used for treatment of eczema due to
of local and systemic side effect
TCS have been proven to be safe treatment even in children
when used carefully and continue to be important therapies
for calming inflamed skin
TSW is a worse version of normal TCS side effects TSW is a unique adverse event that is separate from other TCS
side effects.it typically affects face,neck and genital areas upon
stopping TCS therapy
Once affected with TSW the condition is irreversible TSW can be treated by discontinuing the TCS and providing
supportive care
Regular use of TCS will result in TSW A recent study reviewed that TSW results from frequent,
inappropriate and prolonged use of moderate to high potency TCS
primarily on the face and genital area.appropriate use of TCS as
prescribed is unlikely to predispose patients to TSW
Physicians can accurately predict the frequency/duration of TCS
usage needed to prevent TSW
Although TCS can be safely prescribed to avoid predisposing patients
to TSW there is still much that remains unknown about the
condition.The exact rate of how common TSW is and minimum
frequency and duration of TCS usage can lead to it are still a
mystery,making close follow up and frequent re evaluation important
for all receivingTCS
71. Myth vs Reality
Physicians can accurately predict
individual Predisposed to develop TSW
Greatest predisposing factor is chronic
misuse of TCS especially those of mid to
higher potency beyond the regimen
was originally prescribed
Physical symptoms of TSW are very easy
to diagnose and are uniform among all
patients
Physicians have yet to pinpoint the set of
symptoms that are definitely associated
with TSW and there is variability in how
different patients present.some TSW
symptoms also overlap with other
condition such as allergic contact
dermatitisfurther complicating the
diagnosis.however patients who
experience any of the most common
symptoms of burning/stinging,worsening
with heat or sun,itching,facial hot flushes
within 3 weeks of stopping TCS usage
should consult
73. Take care
No steroid should be used without a
doctor’s prescription
How much is to be used has to be
told by your dermatologist
Never reuse your older prescription
for a recurrent or new rash
Do not self treat
Do not apply creams to skin that is
infected or has open wounds
Do not share prescription with
relatives and friends for their
treatment
Wash your hand before and after use
Take care of your skin by judicious use