Principles of safe use of local glucocorticosteroids
Effective treatment of patients with dermatosis is largely connected with the proper conduct of external therapy, adequate disease genesis, morphology, rash and localization of the pathological process.
Glucorticosteroid drugs are used in medical practice as external agents since 1952, when Sulzberger first showed the effectiveness of external use of steroids. To date, about 50 glucocorticosteroid preparations for external use have been registered on the US pharmaceutical market. Among the variety of means for external therapy, corticosteroids are the most popular today because of the speed of development and activity of anti-inflammatory action.
They are preferred by general practitioners (general practitioners and pediatricians) in the initial detection of pathological lesions on the skin of their patients, and dermatologists. It is safe to say that local (topical) glucocorticosteroids are the most commonly prescribed drugs for patients with dermatoses, due to the prevalence in the structure of the predominant number of skin diseases uncontrolled (lost protective), high-intensity inflammatory reaction, which acts as one of of the most serious damaging factors and which gives the patient additional painful suffering, aggravating neurotic and immune disorders. The need to suppress the inflammatory response in such cases led to the creation of tools with high anti-inflammatory activity, which became the topical glucocorticoids .
To date, the arsenal of glucocorticoids for external use is extremely large and diverse. External corticosteroids are different both in their main active ingredient and in the dosage form.
The effect of the anti-inflammatory action of corticosteroids is largely due to their ability to suppress tissue respiration and metabolic processes in the foci of inflammation ( including blockade of proinflammatory cytokines and inflammatory mediators).
An essential role here is played by their vasoconstrictor action, the ability to inhibit the functional, including mitotic, activity of cells, humoral and cellular immune responses. It is important that the same mechanisms determine the development of the main local complications of local corticosteroid therapy: infectious processes, corticosteroid acne, perioral dermatitis, and skin atrophy, which is most rapidly developing when using local GCS on the skin of the face and folds.
With prolonged, often uncontrolled by the doctor, use on large surfaces may develop systemic complications, the main of which is the suppression of adrenal function. Therefore, the physician should have a clear understanding of the points of application of various drugs and the principles (rules) of their safe use in patients of different ages, sexes and with different localization of lesions.
Compliance with the following principles of local corticosteroid therapy allows you to achieve the maximum effect, avoiding the development of complications:
1 – indication for use of local corticosteroids – inflammatory process of non-infectious nature;
2 – the use of external corticosteroids is contraindicated in infectious skin diseases (bacterial, viral, fungal), with the exception of combined processes in which combination preparations containing, along with the corticosteroid component, an anti-infection component can be used for a short course ;
3 – it is unacceptable to use any external corticosteroid drugs for wounds and ulcers due to the inhibitory effect on epithelialization processes and a high risk of attaching a secondary infection;
4 – the period of continuous use of external glucocorticoids must comply with the instructions to the drug; in the absence of such data, the duration of use should not exceed 2 weeks;
5 – It is recommended to avoid the use of corticosteroid preparations on the skin of the face; however, if necessary, you should use a non-halogenated drug and try to limit yourself to a non-productivecourse (no more than 7–14 days), and apply the drug with superficial stroking movements; advantage should be given to light emulsion or cream forms; glucocorticoids is absolutely contraindicated in acne and perioraldermatitis;
6 – It is not recommended to use local corticosteroid funds over large areas and in folds to exclude resorptive action; the maximum allowable area of application of local corticosteroid preparations should not exceed 20% of the body surface, unless the instructions for use indicate a different (larger or smaller) area; with a large lesion area, it is recommended to apply local glucocorticoids to individual lesion areas in turn; the use of folds greatly increases the risk of developing infectious complications, so non-halogenated cream or emulsion forms are better to be used in these areas ;
7 – when conducting local corticosteroid therapy, it is recommended to avoid occlusive dressings due to the risk of increased absorption and the development of systemic complications; in the presence of severe lichenisation, in order to achieve the best effect, it is recommended to apply ointment forms with a minimum amount or lack of water;
8 – it is advisable to observe the principle of stepwise treatment: to begin therapy with the use of a strong drug, going as far as achieving a clinical effect on dry sensitive skin care products;
9 – the frequency of applications during the day should not exceed that specified in the instructions for the preparation, it is necessary to observe certain intervals between applications;
10 – the use of external glucocorticoids for children requires a more rigorous approach: apply glucocorticoids no more than 1–1.5 weeks continuously (in the absence of indications for a longer period in the instruction) with surface strokes; the use of non-halogenated corticosteroid preparations not earlier than the age specified in the instructions is encouraged ; in the absence of data in the instructions on the age limit of the drug to children is better not to use; the list of external corticosteroid drugs approved for use in children is limited; it should be noted that widely used diapers, and even diapers can play the role of occlusivedressings and contribute to the development of side effects and complications.