Management of a skin
problem is an art. It is not wise to rush in writing a prescription
covering the front and back of the page. You can usually evaluate the
physician skill from his prescription. The competent physician is the one
who can treat his patient thoroughly with minimal curative medications,
having no side effects, and with reasonable expenses. This can be summarized
in few words "if you can‘t help to cure, don‘t do more harm."
The prescription should
be written without hesitation, with confidence, efficiency and in a manner
conveying to the patient that the writer knows what he is doing and is
writing this prescription specially for this patient. This small piece of
paper represents the culmination of the physician‘s skill, experience,
diagnostic, therapeutic acumen as applied to the patient and having the
great hope that it will be curative.
prescribed should be recorded in the patient‘s file and not later in the
day where it may be forgotten.
The physician should not
misuse or abuse his position and should always be loyal and faithful
to his patient. This can be considered when he has a demarcation
line and philosophy that he gives the same attention and care to
any patient as if he is his kid, or his sister , father or mother.
do not need any prescription , just only re-assurance and general
advice concerning their skin problem. If his condition can
be solved without a prescription no need for that at all .
This may build up a great confidence towards the physician
and may be very helpful from the social and psychological
point of view.
Fig. 12. Keloid lesion due to
repeated Skin biting (psychosis)
A patient with dry skin
may need only emollients . An advice to minimize bathing, to use oily soap where that
may be all what is needed to relieve his skin problem.
should not hunt a small bird with a rocket; this means that mild lesions
are treated with the less potent medications even if treatment will take
The patient should be
carefully instructed on how to use the prescribed medications. It is more easy with
oral medications but for topical ones as ointments, strict instructions
should be emphasized - how to apply, the amount which he should use, duration of
treatment and where he has to be careful in using such medications.
prescribed should be clear. It is of prime importance to explain to the
family of young patients on how to use it and the exact doses whether it
comes in the form of drops, syrup or tablets.
Household measures are
almost always used to measure the medications:
One Drop is
equivalent to 0.05 cc.
One Teaspoon is
equivalent to 5 cc.
One Desert Spoon is
equivalent to 8 cc.
One tablespoon is
equivalent to 15 cc.
One Ordinary Glass is
equivalent to 250 cc.
I will not forget the
case of a patient to whom I prescribed anesthetic and antiphlogestic
suppositories to relieve his congested piles. He came next morning in a
very bad condition carried by his relatives reporting that the medications
were about to kill the patient. I was really embarrassed, how come such
side effects can occur from such suppositories. Immediately I asked the
patient how he used the medications. The patient replied, according to the
instructions, I used these suppositories three times daily in spite of
their bitter taste. The problem, I couldn‘t swallow these big capsules ,
but I could solve that by mixing these with hot tea and drank them
The physician should be
very careful also in prescribing topical steroids especially for infants
and young children and when this is strongly indicated. He has to use
mometasone furoate 0.1% or mild hydrocortisone in the suitable base
according to the skin problem.
Ointments are used
for dry intact skin; creams are used for subacute cases where there is
minimal oozing, while lotions are used to dry skin lesions as in wet
The area involved also
determines the type and the state of topical medications used. Hairy areas
need lotions, intertriginous areas need very mild types as in the axilla
or the napkin area. The face also should have special care when using
sulfides should not be used for newborn infants due to the possibility of
It is not uncommon to
have patients used potent steroids and even mild ones presenting with
severe erythema, telangiectasia, acniform eruption and moon face. The
delicate thin facial
skin as a result of that becomes very sensitive that may be affected by
very mild stimuli even by the wind blow.
The skin of such patients
becomes addicted to the topical steroid applied to the face. The patient
sometimes continues and insists to use this medication by himself
believing that this is the proper medication that can cure his skin
problem, in spite of warnings of its side effects. This will lead to
deterioration and to more complications and instead of having one problem,
there will be another.
When I have any doubt
with diagnosing a skin lesion, or when the patient has a sensitive,
eczematous lesion, e.g., the diaper area or the face, I usually prescribe
mild non-harmful preparation such as Pufexamac (Droxaryl cream or Flogocid
ointment) until a diagnosis can be reached. This is much better than
rushing to give the patient different vague medications of suspicious
value. These may cause the patient a lot of psychic and financial burden
besides it may distort the morphology of the original disease and make
diagnosis more difficult. This preparation is safe and gives good results
and worth wise to be used especially for skin problems in infants and
The patient should know
more about his skin problem. So we should give them a brief idea about the
nature of his condition, how long his problem is expected to resolve, and
measures to be taken to prevent recurrence and to avoid triggering
factors. These instructions may be more important than the prescription in
especially when the condition is related to different external or internal
stimuli will save time and are easy to the patient to refer to when
Some patients should be
instructed to come back for follow up. If such patient is told "call
this office if your skin problem will not improve within five days."
The patient may not call back, and won‘t be grateful. He will complain
that you couldn‘t cure his skin problem. The well followed-up patient
usually will be cured and will be grateful.
Hygiene is very important
and considered as a part of treatment. It is a learning experience and the
physician should instruct the mother about the ideal way on how to clean
her baby. This may appear so easy for others, but it is very important to
give instructions on how to take care of the skin of infants and children.
It should be noted that
nothing should be applied to the skin of any baby without taking into
careful consideration of the potential hazards of percutaneous absorption.
The best-documented hazards are related to aniline dyes, hexachlorophene,
boric acid, antiseptics, alcohol, and corticosteroids.
A number of other
substances should never be used in neonates. These include neomycin, boric
acid, resorcinol (e.g. in Castellan‘s solution), and gamma benzene
hexachlorid, Benzyl benzoate and Salicylic acid.
Antiseptics such as
chlorhexidine and iodine should be used with the greatest caution. Care
should also be taken with agents used to launder, sterilize or mark
napkins and bed linen. Fatal cases were recorded among infants due to
phenol absorbed from the skin surface as a result of phenol in mothballs
used for storage of clothes and sheets.
MEDICATIONS USED IN DERMATOLOGY
, antihistamines are the mostly frequently prescribed medications. These may be
specific, empirical or placebo. It is very important that the physician
should have a wide knowledge concerning the pharmacology of the drugs
prescribed, the efficiancy of the drug, drug interactions, unwanted side
effects, as over dose, under dose and the idiosyncrasy.
antihistamines cross the brain barrier causing sometimes-unwanted side
effects such as sedation and drowsiness.
The new generation
antihistamines are better tolerated and most are non-sedating. The
practitioner should have a wide scope of knowledge also on the other
characteristic of antihistamines, such as the long acting, short acting,
dosage and the indications in different age groups.
are given as a placebo in certain dermatoses. In these cases we use the
less expensive and those with minimal side effects.
Antihistamines are the
first line of treatment in pruritic skin diseases antagonizes histamine at
the H1 receptor site. There are different antihistamines either working as
antihistamine or on other mediators.
Antihistamines have a
CH2CH2N = grouping resembling the histamine molecule and thus allowing
them to block histamine receptors.
There are different
Their main therapeutic effect is a peripheral one antagonizing the
action of histamine. These have an important role in treatment of skin
disorders mediated by the effect of histamine as vasodilatation,
increased permeability of small blood vessels, smooth-muscle
contraction and itching.
Mediate their effects on gastric acid production. However, they also
play a role in skin blood vessels, as well as having an effect on the
Found in the brain and are responsible for autoregulation of histamine
production and release.
The dosage of systemic
drugs are calculated roughly on the basis of body weight or better
according to the body surface especially in children. The old generation
antihistamines are better given in three or four divided daily doses. The
second-generation antihistamines are given usually as one daily dose at
bedtime to prevent scratching at night and may help irritable children and
his family in having undisturbed sleeps.
It should be noted that
two antihistamines from different groups or generations or different
families may be sometimes required to relieve certain reluctant pruritic
skin diseases not responding to the traditional treatment such as in some
cases of chronic urticaria.
antihistamines cross the brain barrier and should be given with great care
to young children or to those who need concentration in their work as
drivers and others.
non-sedating antihistamines such as Loratidin, Cetrizine and terfenadine
block the release of histamine and other inflammatory mediators from mast
cells and basophils.
Some H1 antagonists can
be given safely to children as young as one year as Trimeperazine which
can be given to small infants 6 month of age.
Children less than 12
years should not be given antihistamines like azatadine, pyrilamine and
maleate - available in the market with different trade names
(Chlortimeton, Polaramine) and in different forms. (Chlortrimeton) is
available as tablets 4 mg, repetabs 8-mg., 12 mg, and syrup 2 mg/tsp.
and injections 10 mg /cc per ampoule.
Pediatric dose is 0.35
Adult dose 2-4 mg three
or four times daily or 8-12 mg. /12-24 hour at bedtime.
maleate - Available as tablets (Dimetapp) 4 mg., extentabs 8 mg. and 12
mg., elixir 2 mg/tsp. It is available also as injections 10 mg/cc. or
100 mg /cc.
Dexachloropheneramine maleate - (Polaramine) repetabs 6 mg, tablets 2 mg
and syrup 2 mg/tsp.:
The pediatric daily
dose depends on the age of the child. Children from 2-5 years, the dose
is 0. 5 mg three times daily.
The adult dose is 2 mg
three times daily.
A single daily dose 4-6
mgm can be given to adults at bedtime.
Children from 6-11 year,
the dose is one mg three times daily.
Diphenhidramine HCL (Benadryl capsules), 10, 25, 50 mg, elixir 12.5 mg
/tsp. and also is available as injections 50 mg /vial.
Children dose is 5
mg./kg. /day divided into four daily doses or two-teaspoon at bedtime
may be very helpful to control itching in children.
The adult dose is 25-50
mg. three times daily.
(Phenergan) is promethazine HCL. The drug is available either in tablet
forms of 12.5 mg, 25, and 50 mg or in syrup form of 6.25 mg/tsp.
The drug is
photosensitizer and sometimes causes vague muscle spasm.
Doses of promethazine:
Children - 0. 5
mg./kg/day three times daily.
Adult - 25 mg daily
Cyproheptadine HCL (Periactin) tablets 4 mg. or syrup 2mg/tsp.:
Children can be given
Syrup of Periactin, 2
mg per teaspoon can be given at bedtime for older children. If drug is
taken during the daytime it may keep the child drowsy.
I give half teaspoon
when the child comes from the school and one-teaspoon at bedtime. That
usually gives good results.
The drug is available in tablet form of different strengths: 10
mg, 25 mg,
50 mg or 100 mg. and syrup 10mg/tsp.
Atarax is an
antihistamine, anticholinergic and sedative.
Dose of Atarax:
Children can be given 2
Adult dose is 10-25 mg.
Atarax is my favorite
drug especially in atopic patients and those having urticaria. It gives
very good results alone or in severe chronic cases can be combined with
another antihistamine such as Benadryl syrup. I usually give one teaspoon
of Atarax at night and a teaspoon of Benadryl (10 mg) at bedtime.
Such combination is very
helpful to control itching at night, enabling the patient to deep sleep and
that inturn helps the exhausted parents to have undisturbed sleep too. These
medications are usually curative for chronic cases where other medications
failed to control the skin lesion.
pamoate): this drug is available as an oral suspension 25 mg/tsp.,
capsules 25, 50, 100 mg and intramuscular vials 25 mg/cc or 50 mg/cc.
antihistamines such as Cyproheptadine, Chloropheneramine, promethazine
should not be given to children under two years of age.
Children less than 6
years should not be given antihistamines like Bromopheneramine
(sustained release), Chloropheneramine, Tripolidine, and Phenindamine.
tablets 10mg) contains starch and Tartrazinein its coating which
may cause dermatitis and exacerbation of the pre-existing skin lesion,
while the 25 mg. & 100mg are free from Tartrazine in the coating).
The main side
effects of the old generation antihistamines are: drowsiness, dry mouth,
lack of concentration and dizziness.
include pharmacologically different compounds where most of these groups
are non-sedating in the ordinary daily doses.
antihistamines include: Terfenadine, Loratidine, Cetrizine, Mequitizine
Action & Dosage:
The new generation
antihistamines are characterized by decreased sedation and less
anticholinergic side effects.
loratidine are new antihistamines and all have a similar effect, while
loratidene, terfenadine and cetrizine are superior to astemazole in their
speed of action in relieving symptoms.
Terfenadene is considered
as the first non-sedating antihistamine and the most widely used
non-sedating antihistamine. It is a potent and specific antagonist of
H1-receptors. It has effective symptom relief, without unwanted side
effects and has no effect on judgment or performance. The pharmacokinetics
of terfenadine is not significantly affected by food.
The onset of action of
the drug is from 1-2 hours and the peak effect is from 3-4 hours. The
daily dose of 60mg is given twice daily. Each dose has an effect for 12
hours only. It has been reported that the two tablets can be given and
have the same effect as that of a twice daily dose.
Terfenadene was believed
to be devoid of the side effects if the recommended dose is not exceeded.
In the recommended daily dose, this drug is free of sedation. Exceeding
the recommended dose may increase the risk of cardiac arrhythmia that may
lead to syncope, ventricular fibrillation and sudden death.
Recently different side
effects such as arrythmia and cardiac fibrillations were recorded, that is
why the drug was drawn from certain markets. Meanwhile, the whole story is
not clear, hence some still believes that the drug has its indication and
is effective, if it is given according to the recommended instructions.
Avoid combination of the
drug with ketoconazole, H2 antagonists, macrolides and erythrocin.
The pediatric dose is
15-mgm/12 hour for children from 3-6 years. and 30mg. /12 hours for
children around 12 years of age .
The adult daily dose is
60 mg twice daily. This dose may be doubled to 120 mg daily in severe
Cetrizine is rapidly
absorbed with little metabolism and is mostly excreted unchanged in urine
and this is why the dose should be reduced if given to a patient with
The onset of action is
within one hour and the peak effect is from 4-8 hours. The drug has long
acting effect where a single dose may have its action for about 24 hours.
Cetrizine has been
demonstrated to cause sedation and functional impairment compared to
placebo. This effect appears to be dose related.
The drug is not
recommended for use in pregnancy.
The adult dose is 5-10 mg
Loratidine is well
absorbed and extensively metabolized. Time of onset is delayed, usually
after 5 days.
Loratidine may produce
impairment of performance at high doses , should be given with care to
old patients,and to those who have renal and liver impairment.
The onset of action is
rapid, (within one hour) and the peak of its effect is 4-6hours. The drug
has long acting effect, where a single dose of one tablet 10-mg can work
for 24 hours.
The drug has no sedation,
anticholinergic side effect or dose limitation warnings.
Pregnancy: FDA Category B
The drug is available in
syrup and tablet form of 10mg that is given in once-daily dose. The adult
dose is 10 mg. daily.
Astemazole is a potent H1
receptor antagonist. Its activity is at 5-HT receptors. Astemazole
absorption is delayed and reduced in the presence of food. This may
explain the weight gain in some patients using astemazole
Peak plasma level of
astemazole is reached within one hour and the terminal half-life is around
11 days following a single 10mg daily dose. The relief of symptoms is
slow, it usually begins after two days.
Astemazole has a delayed
onset of action usually from 1-3 days. It has the longest peak of action
with prolonged duration compared with the new generation antihistamines,
which is from 9-12 days.
Astemazole has also been
shown to be free of sedative side effects like terfenadine, but exceeding
the recommended daily dose, both may increase the risk of cardiac
arrhythmia, syncope, ventricular fibrillation and even sudden death.
Astemazole has been
approved by the FDA with the Category C in pregnancy.
Interaction of Astemazole
Plasma levels of
astemazole may be increased as a result of interaction with various drugs
such as ketoconazole, H2 -antagonists, erythrocin and macrolides.
The pediatric dose (above
40 kg) is 0.2 mg/kg. /day. Astemizole has a very high affinity for H1
receptor and its effects are not reversible after discontinuation of the
The adult dose is 10 mg
daily. This antihistamine is safe, very long acting, effective and has
minimal side effects).
The adult daily dose is 8
mg three times daily (rapid-acting antihistamine).
Since the year of 1952
when topical steroids first became commercially available, many
preparations that are different in their potency and structure have been
used to treat different skin lesions.
anti-inflammatory, anti-allergic and anti-proliferative preparations. In
pediatric patients, the topical application of a steroid should be limited
to the least amount and for the shortest period to cause the therapeutic
Children and infants are
more susceptible to the different topical steroids especially the
fluorinated types. This is because they have larger skin surface area in
relation to body weight.
The effectiveness of
topical corticosteroids depends on the pharmacological structure, potency,
state of the skin surface, age, duration of application and the degree of
penetration into the skin.
Fig.13. Seborrheic Dermatitls
Fig.14. The same patient
with non-steroid topical preperation;Flogocid ointment)
The above patient
was treated with non-steroid preparation (Pufexamac, Flogocid
ointment for five days with the result of dramatic relief
of the skin lesion. The other patient was seen after receiving
topical steroids in other centers for a long time with remission
and relapse resulting in more complications, more expensive,
more suffering and waste of time.
Fig. 15. Infantile Eczema
treated by potent corticosteroid
hydrocortisone preparations have minimal anti-inflammatory reaction and
very few side effects while fluorinated groups have high anti-inflammatory
reactions and many side effects such as striae, telengectasia, skin
atrophy and even systemic unwanted side effects.
(Elocom) is the only topical steroid approved for use for children in USA.
Even 0.5% and 1% hydrocortisone formulations that are available without
prescription are not approved for use in children.
steroids are now available with different bases and strengths.
OF TOPICAL CORTICOSTEROIDS
effects: mainly the fluorinated types.
Pruritic skin lesions:
such as eczema.
plastic lesions as lichen planus and psoriasis.
discoid lupus erythematosus.
diseases: pemphigus and dermatitis herpetiformis.
such as sarcoid and granuloma annulare.
Methods of Use:
Direct application to
the skin lesions.
Apply the medication to
moist skin after bathing or soaking the area in water, if possible. Rub
the medication thoroughly to the skin surface.
Ointments are more
effective than creams and gels.
medications (Betamethasone valerate 0.1%, flucinolone acetonide 0.025 %,
Triamcinolone acetonide0.1%) are about thousand times potent than 0.1%
This method is
done by covering the area by
cellophane tape after application of the medication or using special tapes
contains the active corticosteroid (Cordran tape). The area to be treated
is washed first then the ointment is rubbed to the area and occluded.
It was found that the
potency of the corticosteroid by the occlusion method increases to about
hundred times than the free application on the skin surface. This is
mainly related to the hydration of the occluded area, increase penetration
of the preparation and at the same time the entire applied amounts are
kept all over the time in contact with the skin surface and not removed by
Occlusion method is used
mainly for solitary or few lesions as hypertrophic lichen planus, solitary
psoriasis patches and is not used for wide areas in order not to produce
unwanted local and systemic side effects.
TYPES OF TOPICAL
Mild steroid :
(Elocom): Very mild and has a good effect. It is more safe steroid than
other available topical steroid. This type of topical corticosteroid can
be used in young ages.
Weak steroids :
hydrocortisone, Colbetasone (Eumovate)
Moderately potent :
valerate: (Celestoderm), Flucinolone (Synalar).
Very potent: Colbetasol
CORTICOSTEROIDS AVAILABLE IN THE MARKET
(Elocom): safe and "FDA" approved for use in children.
Eumovate ointment , cream and lotion .
steroids: more potent but more expensive than hydrocortisone.
Different types of
fluorinated steroids available are:
fluoromethasone) ointment , cream and lotion or in combination with
salicylic acid, tar or vioform.
valerate (Betnovate ointment , cream and scalp lotion). Celestoderm
ointment and cream. These preparations may be available in combination
with antibiotic; Gentamycin; Celestoderm with Garamycin for infected
dipropionate (Diprosone, ointment, cream and lotion)
is available as (Decodron cream) or in combination with antibiotic
(Decoderm compound) or with antibacterial antifungal (Decoderm
trivalent), spray, ophthalmic), or combined with salicylic acid
(Arsticort ointment and cream).
cream, lotion, orabase for mouth lesions)
ointment, cream and lotion. This is one of the most potent topical
steroid. Dermovate should not in any way be applied to the skin of
infants, young children, to the face or delicate skin of the crural areas.
NONSTEROIDAL TOPICAL PREPERATIONS
1- Pufexamac : This an effective and safe
topical nonsteroidal preperation especially in the pediatric age.
* Atopic dermatitis
* insect bites and papular urticaria
* All types of irritant skin conditions.
* photo-toxic and photo-allergic reactions.
*Burns and sun burn .
* Drug reactions.
* After laser surgery especially skin resurfacing which
minimizes erythema and enhances rappid healing.
This drug can replace corticosteroid topical medication
in most of skin problem but with safer ,cheaper and almost without any
side effects wether locally or systemic.
Pufexamac is available in the market as " Droxaryl
cream or Parfenac cream. The cream is available also in combination with
antifungal preperation and available in the market
as"Flogocid".This is very effective in diaper dermatitis and
other irritant skin problems mainly in infants.
There is a continual search in dermatology for more
selective anti-inflammatory drugs to replace broad spectrum steroids.
Tacrolimus (FK506), which is related to cyclosporin, is a powerful
immune suppressor that was introduced to reduce organ transplant
rejection. Like cyclosporin, it has been used systemically to treat
psoriasis, atopic dermatitis, and pyoderma gangrenosum.
Unlike cyclosporin, tacrolimus seems to be effective
when applied topically. Initial open trials suggest that over 90% of
children and adults rapidly achieve at least good improvement of
atopic dermatitis. There is no systemic accumulation. Adverse effects
occur in about half but are transient and are predominantly burning
and erythema at the application site
Tacrolimus (Protopic cream): is a non-steroid
topical preperation .This is safe and effective in eczematous skin
condition mainly atopic dermatitis.The drug prooved recently to be
effective in vitilligo.Tacrolimus ointment is a steroid-free topical
immunomodulator developed for the treatment of atopic dermatitis, a
common, chronic inflammatory skin disease. By inhibiting T-cell activation
and cytokine production, topically applied tacrolimus modulates
inflammatory responses in the skin. Numerous clinical trials have shown
that it is effective and well tolerated for the treatment of atopic
dermatitis, its licensed indication. In addition, numerous publications
suggest that tacrolimus ointment may provide effective treatment for a
variety of other inflammatory skin disorders, many of which are very
difficult to manage with standard therapy.
PREPARATIONS FOR SCALP
AND HAIRY AREAS
Hairy areas such as the
scalp should be treated by lotion preparations, which are easily washed,
non-sticky and cosmetically more acceptable.
SOME TOPICAL STEROIDS
Locoid scalp application
(Diprosone & Salicylic acid)
Dermovate for scalp
These preparations can be
easily washed by normal shampoos. In certain lesions such as psoriasis and
seborrheic dermatitis we use tar shampoos, which are more effective and
can act as an additional remedy to the scalp lesion.
Steroid lotions can be
used twice weekly or once daily according to the strength of the steroid
in the lotion, age of the patient and the type of the lesion to be
Steroid lotions should be
also used cautiously and should not reach the eyes. The same precautions for
other steroid preparations should be considered.
SIDE EFFECTS OF STEROIDS
bacterial or fungal skin infections.
Potent steroids may
cause exacerbation of the skin lesion, or exacerbates existing systemic
diseases such as diabetes and hypertension.
Thinning of the skin
especially that of the face and intertriginous areas due to skin
Adrenal failure due
to systemic or local absorption of the potent topical steroid.
These side effects depend
on the type of steroid used, the site, the duration of treatment, the
surface area and the amount of steroid applied. It was found that 75 g. of
a potent steroid used for more than two weeks produces some of such side
effects. This is why it is crucial to discuss to the patient or his
family, the side effects of steroids.
When topical steroids are
prescribed to the newborn and children, there are many hazards,
which may result from abuse or misuse of these topical preparations.
Fig. 18.Acniform eruptian
Depigmentation (Topical Cortisone)
Fig. 16. Moon Face &
(Misuse of Corticosteroids)
It is not uncommon to see
some healthy persons especially, females without any skin lesion, using
Colbetasol (Dermovate ointment) for a very long time on belief that this
steroid can cause whitening of their dark complexions.
Fig.19. Misuse of
atrophy due to prolonged use of topical potent steroid
responsible for such side effects ||: The family , the
pharmacist or the physician?
Topical steroids are better
used twice daily for a short period. It is wise to explain to the
patient how many tubes he has to use, amount for each application
and for how long.
Fig.20. Acniform eruption
Fig. 21. Striae
stimulates the production of adrenocortical hormones. Hydrocortisone,
corticosterone and androgenic hormones are secreted in response of ACTH
adrenocortical steroids are either glucocorticoids or androgenic
corticoids.The glucocorticoids, such as cortisone, are ant-inflammatory,
influence carbohydrate metabolism and protein catabolism.
include deoxycorticosterone and aldosterone, have an effect on controlling
electrolyte balance and sodium retention.
ACTH and corticotrophin
effect: increase in these products leads to:
Increase in the excretion
retention, edema and potassium loss.
Reduction of cholesterol.
Oral preparations are
well absorbed from the gastrointestinal tract.
Some physicians prefer
steroid injections due to the following:
It is easy to
They have control of
It has fewer side
effects than oral preparations.
SOME TYPES OF ORAL
Steroids vary in their
Cortisone 25mg =
prednisone 5mg= Dexamethasone
0.75mg. = triamcinolone
4mg.= betametasone0.5 mg.
Fluorinated steroids are
potent anti-inflammatory and have less electrolyte disturbance.
tablets(Medrol 2 and 4mg.).
Prednisolone tablets 1and
Prednisone 1 and 5mg.
Triamcinolone tablets 1,2
Some types of injectable
(kenacort 40mg/ml given deeply intramuscularly weekly or every two weeks.
medrol 40mg/ml) can be given weekly, safer and has fewer side effects than
Certain skin lesions
either single or few in number can be treated by local infiltration with
(Leddercort 25mg/4ml is the most commonly used preparation.
The solution can be
infiltrated with the same concentration available as that in the supplied
vial or sometimes diluted by normal saline depending on the type of lesion
infiltrated, site of infiltration (delicate skin of the face and
intertriginous areas need lower concentrations).
preparations may cause local atrophy and skin depigmentation.
During infiltration the
needle that is used for infiltration should not be too superficial or
injected very deep in the tissues.
Aspirate the solution
from the vial where the amount aspirated depends on the size and number of
lesions to be treated.
In children or very
sensitive persons rarely local topical anesthetic (Emla cream, Astra) can
be applied forty minuets before infiltration.
Infiltrate the sides of
the lesion from the periphery and each time try to go gently deeper under
Solitary lesions of
hypertrophic lichen planus
Solitary lesions of
Solitary lesion of
discoid lupus erythematosus.
Solitary lesions of