Adverse effects from topical steroids.

The introduction of topical corticosteroids greatly expanded the practitioner's dermatologic armamentarium and at the same time augmented the list of local and systemic iatrogenic diseases with which he must deal. A recent review of the literature was undertaken to determine the adverse effects seen with topically administered corticosteroids. These were found to be arbitrarily assignable to eight categories: pilosebaceous, atrophic, therapeutic, immunologic, cosmetic, endocrinologic, oculonasal, and allergic. A brief discussion of the individual entities seen in each category as well as the etiology, when known, and treatment, if any, are included in this discussion.

Steroid myopathy. Insidious cause of muscle weakness.

Steroids are so commonly prescribed for so many conditions that physicians tend to become somewhat cavalier in their use. With drug therapy of any type, however, this tendency can lead to trouble. Steroid myopathy, as occurs in Cushing's syndrome. Can develop with steroid therapy and can cause irreversible atrophy if not detected and treated early.

The topical administration of steroids in the treatment of typical vulvar dystrophies.

Sixty-eight patients with histologically diagnosed typical vulvar dystrophies were treated with local administration of steroids. Twenty-three patients with hyperplastic dystrophies received topical fluorinated corticosteroids twice a day for 4 weeks and once a day for another 2 weeks. Thirty-five patients with lichen sclerosus were given local 2% testosterone propionate in vaseline twice a day for 8 weeks, once a day for another 8 weeks and then 3 times a week for another 8 weeks. Ten patients with mixed dystrophy first received topical fluorinated corticosteroids twice a day for 4 weeks and once a day for another 2 weeks, and then local 2% testosterone propionate in vaseline twice a day for 4 weeks and once a day for another 4 weeks. A relief of symptomatology and a regression of gross appearance were obtained in 82.6% and 69.6% of patients respectively with hyperplastic dystrophy, in 82.9% and 65.7% of those with lichen sclerosus and in 80% and 40% of those with mixed dystrophy. A recurrence of symptomatology often occurred at various times after the end of therapy.

Steroid-induced rosacea.

The excessive, regular use of topical fluorinated corticosteroids on the face often produces an array of skin complications, including an eruption clinically indistinguishable from rosacea ("iatrosacea"). Treatment involves discontinuation of the steroid and administration of oral tetracycline and nonsteroidal topical preparations. Once therapy is begun, clearing of the lesions may take several months.

Questions about dexamethasone use for the prevention of anti-SSA related congenital heart block.

BACKGROUND: Mothers with anti-SSA/Ro antibodies who have had a previous fetus with congenital heart block (CHB) have a risk of recurrence estimated to be up to 16%. OBJECTIVE: To improve the management of these "high risk patients" by determining (a) whether or not prophylactic treatment is efficient; (b) whether or not fluorinated steroids (betametasone and dexamethasone) that do cross the placenta in an active form are safe for the fetus; and (c) which prophylactic treatment should be used. METHODS: Retrospective study performed on seven mothers sent to a university hospital owing to a past history of one (six mothers) or two children (one mother) with CHB. RESULTS: 13 subsequent pregnancies occurred. No CHB was observed. All four pregnancies in women treated with 10 mg/day prednisone were uneventful. Three pregnancies in women receiving no steroids resulted in two early spontaneous abortions and one live birth. The six pregnancies in women treated with dexamethasone (4-5 mg/day) ended in one early and one late spontaneous abortion, two stillbirths, and two live births with intrauterine growth restriction and mild adrenal insufficiency. A histological study of one stillbirth disclosed intrauterine growth restriction and marked adrenal hypoplasia. CONCLUSION: Adverse obstetric outcomes were often seen here and major concerns have been raised by paediatricians about the safety of fluorinated steroids, owing to the results of animals studies, retrospective data, and randomised trials. Because fluorinated steroids have not been shown to improve prophylactic treatment of CHB in pregnant women at high risk, their use is questionable.

Periocular dermatitis akin to the perioral variety.

A persistent periocular dermatitis resulting from the prolonged use of topical fluorinated corticosteroids that resembled the perioral variety was observed in three patients. All topical therapy was ineffective until systemic tetracycline was administered.

[Gluteal granuloma in an infant]. / Granuloma glutaeale infantum.

This report deals with a 5-month-old infant who at the age of 2 months was treated with topical fluorinated steroids for dermatitis in the diaper area. The treatment was continued for about 2 months. Some weeks later, multiple oval and round dark brown nodules developed in the inguinogenital areas. Histologic examination of these lesions revealed intense granulomatous infiltration in the upper dermis that consisted of lymphocytes, neutrophilic and eosinophilic granulocytes, and histiocytes. After steroid therapy was discontinued, the nodules slowly disappeared.

Perioral dermatitis.

Forty-three patients with perioral dermatitis are described. In seven patients, this eruption was associated with the use of hydrocortisone butyrate (Locoid) alone, and this topical steroid can no longer be recommended unreservedly for use on the face. In fifteen other patients, medication was undertaken without medical advice. The time may have come to print on tubes of potent local steroids warnings about the hazards of long-term use on the face without medical advice. Drug companies and pharmacists could also help by asking patients to discard any partially-used tubes of ointment and an expiry date stamped prominently on the tubes rather than on the cardboard container may help. Continuing medical education is obviously still required to prevent a minority of family doctors prescribing wrongly for their patients.

Treatment of ragweed hay fever with an intranasal spray containing fluinsolide, a new synthetic corticosteroid.

Flunisolide, a new synthetic fluorinated corticosteroid, was administered as a nasal spray via a squeeze bottle to patients with ragweed hay fever for 4 wk during the hay fever season. Fifty-one patients, paired on the basis of similar skin sensitivity to intradermal ragweed (greater than or equal to 10-1 PNU/ml), were randomly assigned in a double-blind manner either an aerosol-containing flunisolide dissolved in vehicle (a mixture of polyethylene glycol and propylene glycol) or vehicle alone. Flunisolide was sprayed as a 0.025% solution two times in each nostril twice a day. Forty-eight patients completed the study. Three patients dropped out for reasons unrelated to flunisolide usage. On the basis of physician interviews and daily symptom dairy scores, patients receiving flunisolide showed significant improvement of hay fever symptoms when compared to their counterparts receiving vehicle. No systemic steroid side effects were observed. Morning plasma cortisol levels measured prio to and after 3 wk of flunisolide therapy showed no significant difference between the treatment groups. Adverse local effects were minor and were noted less frequently with flunisolide than with vehicle. Flunisolide's topical efficacy and lack of adrenal suppression provide distinct advantages over other steroid preparations available in the United States for treatment of seasonal allergic rhinitis.