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      Systemic Side-Effects of Topical Corticosteroids

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          Abstract

          With the introduction of topical corticosteroids, a milestone has been achieved in dermatologic therapy; owing to its potent anti-inflammatory and ant proliferative effects, it became possible to treat some hitherto resistant dermatoses. But this magic drug can cause enough mischief if used inappropriately. Children are more susceptible to the systemic adverse effects because of enhanced percutaneous absorption through their tender skin. So, systemic side effects should be kept in mind while prescribing this therapeutically valuable topical medicament.

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          Adverse effects of topical glucocorticosteroids.

          Ulrich Hengge, Thomas Ruzicka, Robert A. Schwartz … (2006)
          Topical corticosteroids were introduced into medicine about 50 years ago. They represent a significant milestone in dermatologic therapy. Despite encouragement to report observed adverse drug reactions, the clinical practice of reporting is poor and incomplete. Likewise, adverse effects and safety of topical corticosteroids are neglected in the medical literature. The authors provide an updated review of their adverse-effect profile. Children are more prone to the development of systemic reactions to topically applied medication because of their higher ratio of total body surface area to body weight. Cutaneous adverse effects occur regularly with prolonged treatment and are dependent on the chemical nature of the drug, the vehicle, and the location of its application. The most frequent adverse effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura. Those that occur with lower frequency include hypertrichosis, pigmentation alterations, delayed wound healing, and exacerbation of skin infections. Of particular interest is the rate of contact sensitization against corticosteroids, which is considerably higher than generally believed. Systemic reactions such as hyperglycemia, glaucoma, and adrenal insufficiency have also been reported to follow topical application. The authors provide an updated review of local and systemic adverse effects upon administration of topical corticosteroids, including the latest FDA report on the safety of such steroids in children. At the completion of this learning activity, participants should be familiar with topical corticosteroids and their proper use.
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            Overcoming the Stratum Corneum: The Modulation of Skin Penetration

            H Trommer, R.H.H. Neubert (2006)
            It is preferred that topically administered drugs act either dermally or transdermally. For that reason they have to penetrate into the deeper skin layers or permeate the skin. The outermost layer of the human skin, the stratum corneum, is responsible for its barrier function. Most topically administered drugs do not have the ability to penetrate the stratum corneum. In these cases modulations of the skin penetration profiles of these drugs and skin barrier manipulations are necessary. A skin penetration enhancement can be achieved either chemically, physically or by use of appropriate formulations. Numerous chemical compounds have been evaluated for penetration-enhancing activity, and different modes of action have been identified for skin penetration enhancement. In addition to chemical methods, skin penetration of drugs can be improved by physical options such as iontophoresis and phonophoresis, as well as by combinations of both chemical and physical methods or by combinations of several physical methods. There are cases where skin penetration of the drug used in the formulation is not the aim of the topical administration. Penetration reducers can be used to prevent chemicals entering the systemic circulation. This article concentrates on the progress made mainly over the last decade by use of chemical penetration enhancers. The different action modes of these substances are explained, including the basic principles of the physical skin penetration enhancement techniques and examples for their application.
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              The effect of topically applied compound F in selected dermatoses.

              K H Witten, Marion Sulzberger (1952)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Dermatol
                Journal ID (iso-abbrev): Indian J Dermatol
                Journal ID (publisher-id): IJD
                Title: Indian Journal of Dermatology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0019-5154
                ISSN (Electronic): 1998-3611
                Publication date (Print): Sep-Oct 2014
                Volume: 59
                Issue: 5
                Pages: 460-464
                Affiliations
                [1] From the Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
                [1 ] Department of Dermatology, Burdwan Medical College, Burdwan, West Bengal, India
                [2 ] Department of Pediatric Dermatology, BJ Wadia Hospital for Children, Mumbai, Maharashtra, India
                Author notes
                Address for correspondence: Dr. Sandipan Dhar, Flat 9 C, Palazzo 35, Panditia Road, Kolkata - 700 029, West Bengal, India. E-mail: drsandipan@ 123456gmail.com
                Article
                Publisher ID: IJD-59-460
                DOI: 10.4103/0019-5154.139874
                PMC ID: 4171913
                PubMed ID: 25284850
                SO-VID: a4fa97af-8e1b-4ca6-b44d-ad897c99eb45
                Copyright © Copyright: © Indian Journal of Dermatology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : May 2014
                Date accepted : May 2014
                Categories
                Subject: IJD Symposium

                ScienceOpen disciplines: Dermatology
                Keywords: adverse effects,hypothalamus-pituitary-adrenal axis,infants and children,percutaneous absorption,topical corticosteroids
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: adverse effects, hypothalamus-pituitary-adrenal axis, infants and children, percutaneous absorption, topical corticosteroids

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