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      Topical steroid addiction in atopic dermatitis

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          Abstract

          The American Academy of Dermatology published a new guideline regarding topical therapy in atopic dermatitis in May 2014. Although topical steroid addiction or red burning skin syndrome had been mentioned as possible side effects of topical steroids in a 2006 review article in the Journal of the American Academy of Dermatology, no statement was made regarding this illness in the new guidelines. This suggests that there are still controversies regarding this illness. Here, we describe the clinical features of topical steroid addiction or red burning skin syndrome, based on the treatment of many cases of the illness. Because there have been few articles in the medical literature regarding this illness, the description in this article will be of some benefit to better understand the illness and to spur discussion regarding topical steroid addiction or red burning skin syndrome.

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          Most cited references16

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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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            Twice weekly fluticasone propionate added to emollient maintenance treatment to reduce risk of relapse in atopic dermatitis: randomised, double blind, parallel group study.

            Oliver Van Hecke, J Berth, John Livden … (2003)
            To explore the efficacy and safety of fluticasone propionate, cream and ointment, applied twice weekly in addition to maintenance treatment with emollients, in reducing the risk of relapse of chronic recurrent atopic dermatitis. Randomised, double blind, parallel group study of 20 weeks' duration. Dermatology outpatient clinics (6 countries, 39 centres). Adult (aged 12-65) patients with moderate to severe atopic dermatitis who were experiencing a flare. Participants applied fluticasone propionate (0.05% cream or 0.005% ointment; once or twice daily) regularly for four weeks to stabilise their condition. The patients whose disease was brought under control then continued into a 16 week maintenance phase, applying emollient on a daily basis with a bath oil as needed and either the same formulation of fluticasone propionate or its placebo base (emollient alone) twice weekly to the areas that were usually affected. Time to relapse of atopic dermatitis during maintenance phase. 376 patients entered the stabilisation phase, and 295 continued into the maintenance phase. After 16 weeks in the maintenance phase, the disease remained under control in 133 patients (87 using fluticasone propionate twice weekly, 46 using emollient alone), 135 (40 fluticasone propionate, 95 emollient) had experienced a relapse, and 27 had discontinued. Median time to relapse was six weeks for emollient alone compared with more than 16 weeks for additional fluticasone propionate. Patients who applied fluticasone propionate cream twice weekly were 5.8 times less likely (95% confidence interval 3.1 to 10.8, P < 0.001) and patients using fluticasone propionate ointment 1.9 times less likely (1.2 to 3.2, P=0.010) to have a relapse than patients applying emollient alone. The groups showed no differences in adverse events. After atopic dermatitis had been stabilised the addition of fluticasone propionate twice weekly to maintenance treatment with emollients significantly reduced the risk of relapse.
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              Clinical dose and adverse effects of topical steroids in daily management of atopic dermatitis.

              Y Nose, N Kinukawa, H Terao … (2002)
              Topical steroids are used as the first-line therapy for atopic dermatitis. To determine the clinical doses of topical steroids for the daily treatment of atopic dermatitis in clinics and to elucidate their adverse effects. A multicentre retrospective analysis of a series of 1271 patients (210 infants, 546 children, and 515 adolescents and adults) with atopic dermatitis. Less than 89.5 g, 135 g and 304 g of topical steroid were applied in 90% of the patients in the infant, childhood, and adolescent and adult AD groups, respectively, on the entire body during the 6-month treatment period. The majority of patients were controlled well; however, 7% of infant, 10% of childhood and 19% of adolescent and adult patients remained in a very severe or severe state or experienced exacerbation even though they applied larger amounts of topical steroids. With regard to adverse effects, the incidence of telangiectasia on cheeks tended to increase in patients who had a longer duration of disease and who applied more than 20 g to the face during the 6-month treatment period. The steroid-induced atrophy of the antecubital and popliteal fossae was more frequently observed in males than in females. Topical steroids are useful for treating atopic dermatitis, but a substantial percentage of patients cannot be satisfactorily treated with topical steroids. For such patients, adjustments of dose and rank of topical steroids and other therapeutic adjuncts are necessary.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Drug Healthc Patient Saf
                Journal ID (iso-abbrev): Drug Healthc Patient Saf
                Journal ID (publisher-id): Drug, Healthcare and Patient Safety
                Title: Drug, Healthcare and Patient Safety
                Publisher: Dove Medical Press
                ISSN (Electronic): 1179-1365
                Publication date Collection: 2014
                Publication date (Electronic): 14 October 2014
                Volume: 6
                Pages: 131-138
                Affiliations
                [1 ]Tsurumai Kouen Clinic, Nagoya, Japan
                [2 ]Department of Dermatology, Hannan Chuo Hospital, Osaka, Japan
                [3 ]Sato Pediatric Clinic, Osaka, Japan
                [4 ]Kimata Hajime Clinic, Osaka, Japan
                [5 ]Fujisawa Dermatology Clinic, Tokyo, Japan
                [6 ]Dozono Medical House, Kagoshima, Japan
                [7 ]Yoshizawa Dermatology Clinic, Yokohama, Japan
                [8 ]Department of Dermatology, Kounosu Kyousei Hospital, Saitama, Japan
                Author notes
                Correspondence: Mototsugu Fukaya, Tsurumai Kouen Clinic, 5-20-6, Chiyoda, Naka-ku, Nagoya-City, Aichi Prefecture, 460-0012 Japan, Email moto@ 123456earth.ocn.ne.jp
                Article
                Publisher ID: dhps-6-131
                DOI: 10.2147/DHPS.S6920
                PMC ID: 4207549
                PubMed ID: 25378953
                SO-VID: 0ad95fc7-ec9c-421f-b690-e39cf29a1e48
                Copyright © © 2014 Fukaya et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License
                License:

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Review

                ScienceOpen disciplines: Public health
                Keywords: topical steroid addiction,atopic dermatitis,red burning skin syndrome,rebound,corticosteroid,eczema
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: topical steroid addiction, atopic dermatitis, red burning skin syndrome, rebound, corticosteroid, eczema

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