Monday 27 November, 2006Articles in the December issue discuss various australiaa issues affecting school-aged children, including acne, eczema and growth disorders. Topical corticosteroid TCS withdrawal addiction is a potential complication of TCS treatment, particularly where there has been an inappropriate long-term use of steroid cream potency australia TCS on the face or genital area. TCS addiction tseroid withdrawal is increasingly being discussed clenbuterol side effects on men social and mainstream media; however, it has received little attention steroid cream potency australia medical publications. Australian general practitioners GPs may come into contact with patients who have read material or watched videos about this condition. The objective of this article is to provide a succinct, evidence-based overview of TCS dbal a3 and withdrawal for GPs. TCSs are indicated in the stwroid of many patients with eczema. By being aware of TCS addiction and withdrawal, practitioners may be better able to help prevent this adverse effect and offer supportive care to patients in TCS withdrawal.
Topical corticosteroids | The Medicine Box
Articles in the December issue discuss various health issues affecting school-aged children, including acne, eczema and growth disorders. Topical corticosteroid TCS withdrawal addiction is a potential complication of TCS treatment, particularly where there has been an inappropriate long-term use of moderate-to-potent TCS on the face or genital area. TCS addiction and withdrawal is increasingly being discussed in social and mainstream media; however, it has received little attention in medical publications.
Australian general practitioners GPs may come into contact with patients who have read material or watched videos about this condition. The objective of this article is to provide a succinct, evidence-based overview of TCS addiction and withdrawal for GPs. TCSs are indicated in the management of many patients with eczema. By being aware of TCS addiction and withdrawal, practitioners may be better able to help prevent this adverse effect and offer supportive care to patients in TCS withdrawal.
It would also be useful for GPs to be able to discuss TCS addiction and withdrawal with patients who seek to clarify information they glean from non-medical sources. Case M, aged 27 years, has chronic eczema. Frustrated with her deteriorating condition, M turned to the internet for advice. She read about red skin syndrome, diagnosed herself with topical steroid addiction and is now three months into TCS withdrawal. M comes to you for advice about a possible skin infection to her areola areas, which have been red and oozing for the past four weeks.
Independently published international guidelines recommend TCS as the first-line anti-inflammatory therapy for eczema, 1,2 and its efficacy is well established. It was first described in by Kligman and Frosch, 3 and there have been limited articles on the topic in the medical literature since then. However, the US National Eczema Association received sufficient patient enquiries about the condition to justify the formation of a Scientific Advisory Committee Task Force to conduct a systematic review, which was published in When patients with TCS addiction cease TCS, they may develop widespread redness Figures 1 and 2 , burning pain, peeling skin, oozing areas Figure 3 and severe itch.
Erythema typically spreads from the original eczematous areas locally — for example, from the face to the neck and then the upper limbs. The severity and pattern of symptoms seen can vary significantly between patients. While an affected patient is still using TCS, their skin can look normal or well controlled, 5 or it may appear atrophic or demonstrate telangiectasia.
Several different names have been used to describe this condition in the literature. The incidence and prevalence of TCS addiction and withdrawal are unknown.
The widespread red skin seen in this condition is thought to be the result of prolonged fixed vasodilatation. TCSs have a suppressive effect on nitric oxide in the endothelium and the release of accumulated endothelial nitric oxide stores results in hyperdilatation of vessels. The three main differentials are allergic contact dermatitis, 1,4 infection 5 and an eczematous flare.
Supportive measures are indicated for physical and psychological symptoms. Patients can trial oral antihistamines for their itch. Burning pain may be alleviated with ice or cool water compresses or possibly gabapentin.
Multiple telephone calls and visits for reassurance have been recommended. Patients may want to cease TCS for a combination of concerns about continuing to use often potent TCS regularly and indefinitely with diminishing clinical benefit, and the anticipation of improved skin following completion of the TCS withdrawal process. Steroid phobia is a separate issue and is not applicable in these patients: After complete withdrawal, a patient with TCS addiction can expect normal skin 4 or the original eczema symptoms.
Concern about the possibility of TCS addiction should not prevent adequate and appropriate treatment with TCS when indicated. While research is very limited to date, avoiding prolonged use of moderate-to-potent TCS on the face may be prudent as this is a highly significant risk factor for the development of TCS addiction and withdrawal. Do not use TCS continuously for more than two to four weeks — then frequency should be tapered to twice weekly use. Your provider should strive to help create a safe and effective long term treatment plan that does not include daily use of TCS, especially on more sensitive areas.
M monitored herself for signs of infection — fever, tenderness or pain and expanding areas of redness to surrounding skin. She washed the area daily with a Chinese herbal tea, and applied vaseline under non-stick dressings before putting on clothing.
Her symptoms remained stable until spontaneous clearing of areola skin five months later. At this point, her face, neck and arms were still exhibiting TCS withdrawal symptoms. M had negotiated with her employer to work from home and reduce her hours.
In addition, she was now seeing a psychologist. TCS can cause TCS addiction and withdrawal in some eczema patients with a history of moderate to high potency TCS use, especially to the face or genital area. Appropriate treatment of eczema is essential and general practitioners GPs might counsel patients at risk of developing TCS addiction by being mindful of this condition. GPs can play a key role in supporting diagnosed patients through the challenging withdrawal period.
Consultations about this issue may become a more frequent scenario for GPs as increasing numbers of patients research their symptoms online. Rational and informed discussions about TCS addiction and withdrawal would be very helpful for patients searching for answers from a trusted source.
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Submit article to AFP. Ear, nose and throat June Article Download article Download Citations. Belinda Sheary Background Topical corticosteroid TCS withdrawal addiction is a potential complication of TCS treatment, particularly where there has been an inappropriate long-term use of moderate-to-potent TCS on the face or genital area. Discussion TCSs are indicated in the management of many patients with eczema.
Widespread redness to lower limbs, oedema to ankles and some exfoliation Figure 2. Case continued — six months later M monitored herself for signs of infection — fever, tenderness or pain and expanding areas of redness to surrounding skin. Downloads Help with downloads. Opening or saving files Files on the website can be opened or downloaded and saved to your computer or device.
MP3 Most web browsers will play the MP3 audio within the browser. I declare the following competing interests: Additional Author remove First Name: Comparison of reference management software. Diagnosis and management of hearing loss in elderly patients.
Implantable hearing devices — An update. Medical taxonomy meets the upper respiratory tract. An approach for the general practitioner. More than meets the painful red eye. Type 2 diabetes mellitus in children and adolescents. Safe and effective cultural mentorship in general practice. Widespread redness to lower limbs, oedema to ankles and some exfoliation. Psychological support for these patients is essential and may be required for many months.