Information on level of drugs into breastmilk
Wendy Jones in Breastfeeding and Medication, 2013
Bath preparations provide hydration to the skin during soaking. Many of these preparations are used for babies suffering from dry skin. No ingredient which can affect breastmilk will be absorbed during use. Compatible with use during breastfeeding due to poor absorption through skin. Topical corticosteroids Application of topical corticosteroids is recommended to treat inflammatory conditions of the skin in particular eczema and dermatitis. Used in normal quantities (i.e. a maximum of 30g or less per week) application is unlikely to lead to systemic absorption. Potent topical corticosteroids such as Dermovate should be used sparingly for as short a time as possible. Use of less-potent corticosteroid applications to large areas of the body should be kept to a minimum accompanied by frequent application of emollient preparations. Drug choice in a mother during breastfeeding based on evidence of benefit and safety for the baby: According to maternal need, lower potency corticosteroids preferable, but no reason to stop breastfeeding if mother needs more potent products in normal amounts, but avoid skin-to-skin contact Mild corticosteroids: hydrocortisone 0.1 to 2.5% Moderate-strength corticosteroids: Betnovate RD, Eumovate Potent corticosteroids: Betamethasone 0.1%, Betnovate, Locoid, Metosyn Very potent products: Dermovate, Nerisone Forte
Topical Therapies for Psoriasis
Siba P. Raychaudhuri, Smriti K. Raychaudhuri, Debasis Bagchi in Psoriasis and Psoriatic Arthritis, 2017
Long-term data on efficacy and safety are missing; however, depending on their potency, topical corticosteroids may be used continuously for up to 8 weeks. To reduce the incidence and impact of classical corticosteroid side effects, for example, skin atrophy, vascular fragility, and localized infections, they should be used discontinuously beyond that time and be combined with other agents, like UV light. A major drawback is tachyphylaxis [60] and relapse or even rebound after (rapidly) stopping the therapy, which may be overcome by slowly tapering the application frequency, as well as steroid potency. After complete cessation of clinical symptoms, topical corticosteroids may be used over weeks or several months twice a week at the sites that were originally involved [12–15]. The steroid-sparing effect, as well as reduction of number and intensity of flares, with this so-called proactive treatment has been documented for atopic eczema in controlled clinical studies, but may work equally well in psoriasis.
United Airways
Jonathan A. Bernstein, Mark L. Levy in Clinical Asthma, 2014
The BSACI guideline4 emphasizes the importance of education, particularly with regard to the negative effect that rhinitis may have on quality of life. Relevant allergen avoidance should be discussed. The patient should be provided with information about the potential complications of rhinitis, such as asthma, sinusitis, and eustachian tube dysfunction. Information about therapy should be given, including a demonstration of the nasal spray technique where prescribed. Occupational rhinitis is considered a risk factor for occupational asthma and usually predates the onset of asthma. Of particular relevance to the workplace is primary prevention, particularly through the use of non-powdered or nonlatex gloves, and the avoidance of other occupational allergens known to cause sensitization (see Chapter 24). The superior efficacy and safety of the new-generation topical corticosteroids should be highlighted for those patients who are reluctant to use these drugs. Patients may be reluctant to use corticosteroids at more than one site, the nose as well as the lungs, but the contribution to the total corticosteroid load from INCS is minute compared with that from bronchial inhalers. Conversely, the contribution from untreated rhinitis to the overall disease burden can be considerable. In some asthmatic patients, the addition of nasal therapy allows a reduction in the inhaled dose.
Inverse pityriasis rosea secondary to COVID-19 vaccination
Published in Baylor University Medical Center Proceedings, 2022
Blayne Fenner, Jessica L. Marquez, Meredith Pham, Michelle Tarbox
Physical examination revealed erythematous papules and plaques with a trailing scale distributed predominantly in the axilla, inframammary, and groin area, with a total body surface area of around 5% (Figure 1). Dermoscopy revealed a collarette of scale as well as central yellow hue with a peripheral reddish background (Figure 2a). Two 4-mm punch biopsies were performed, one on the first reported lesion under her left breast and the other on a lesion in the groin. Pathology revealed areas of confluent parakeratosis as well as mounds of parakeratosis. Moderate psoriasiform hyperplasia of the epidermis with moderate spongiosis, moderate inflammatory infiltrate of lymphocytes with eosinophils in the dermis, extravasation of red blood cells, and moderate exocytosis of lymphocytes into the epidermis were also observed on histopathology (Figures 2b–2d). A periodic acid-Schiff stain was negative for fungus or yeast. The histologic differential at this point included psoriasis, PR, subacute to chronic eczema, and contact dermatitis. The patient was given topical corticosteroids. Two weeks later, she reported improvement in her symptoms with almost complete resolution of the rash and pruritus.
Reply: Anterior Uveitis Due to Intracameral Moxifloxacin: A Case Report
Published in Ocular Immunology and Inflammation, 2022
Juliana Muñoz-Ortiz, Juliana Reyes-Guanes, Alejandra de-la-Torre
We also agree that in pure BAIT cases, circulating anterior chamber particles might be misinterpreted as inflammatory cells present in uveitis cases. These patients usually do not respond to corticosteroids. We understand the concern about the description of BAIT as a pathology with limited inflammation. However, our diagnosis was not a pure BAIT syndrome, but a BAIT-like syndrome presented with unilateral involvement. The patient was referred to us with severe inflammation so topical corticosteroids were initiated. He arrived at our consultation with a moderate level of inflammation, which indicated a favorable response; and subsequently, steroids tapering, and antihypertensive treatment was indicated. If the inflammation had not been treated, we cannot be sure if the perpetuation of inflammation and an IOP increase may have occurred.
Steroid phobia among general users of topical steroids: a cross-sectional nationwide survey
Published in Journal of Dermatological Treatment, 2019
Seung Yeon Song, Sun-Young Jung, EunYoung Kim
In regards to factors associated with steroid phobia, our study found that female respondents were more likely to have steroid phobia than male respondents. This is in contrast to previous studies, which found no association with patient demographics (7,11). As one would expect, respondents who answered that they had experienced side effects of TCs were more likely to have steroid phobia. In terms of the side effects of concern to the respondents, skin thinning, and growth stunt were the main reasons for the development of steroid phobia, which were also the areas of concern identified in atopic dermatitis patients and parents of pediatric patients with eczema (10,15). In a recent study on skin thinning and TC use in eczema, no evidence of skin atrophy after 20 weeks of treatment with a once-daily potent topical TC preparation was found, suggesting that the ‘fear’ of skin thinning expressed by parents and patients might be irrational (22). Additionally, there is no clear evidence of growth retardation. A study conducted in 1992 reported growth impairment in an infant; however, this was due to the use of a potent topical steroid with a dose of 30 g/week for 3 years (23). The likelihood of experiencing systemic side effects is low and topical corticosteroids are overall considered safe (24). However, a fear of potential or imagined side effects is the main reason behind poor compliance and can lead to failure of response (10,25). Thus, health professionals should be mindful of such concerns held by patients when providing counseling on TC use.
Related Knowledge Centers
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