Topical Steroid Addiction in Atopic

7/25/2019 Topical Steroid Addiction in Atopic

1/19

op ca eroAddiction in Atopic

Dermatitis

MeiriaSari

03011186

Coach : dr. Eko KrisnantoSp.KK

Journal28th Nove!er" 201#


2/19

Author : Mototsugu Fukaya, Kenji Sato,

Mitsuko Sato, Hajime Kimata,Shigeki Fujisawa, Haruhiko Dozono,

Jun Yoshizawa, Satoko Minaguchi

Published :Date : 14 October 2014

Topical Steroid Addictionin Atopic Dermatitis


3/19

Abstract The American Acaemy o! Dermato"ogy

new guie"ine May #$%&

To'ica" steroi aiction or re burning skin

synrome #$$( Journa" o! the American

Acaemy o! Dermato"ogy

contro)ersies *ur'ose+

etter unerstan the i""ness

To s'ur iscussion regaring to'ica" steroi

aiction or re burning skin synrome-

Keywords: topical steroid addiction, atopic

dermatitis, red burning sin syndrome, rebound,

corticosteroid, ec!ema


4/19

.ntrouction

/ationa" 0czema Association 1/0A2 assemb"ea task !orce to e"uciate the rea"ities o! the i""ness

simplefear,

patientignorance

(TSA)or

(RBSS).


5/19

1. How do ou de!ne steroid addiction"

TSA not referred to steroid addiction

topicalcorticosteroid addiction.

#topical steroid$ topical corticosteroids (T%S)dermatological

#steroid$

topical and sstemic steroid #addiction$ fre&uentl and uni&uel wit' t'e

topical form, T%S was !rst used Burrin Australia in 1*+.

atients ecome unale to do wit'out t'e T%S ec-ema

Burrs directed more toward e/pressingpatients e'a0ior.

ligman and 2rosc' dermatological ormorp'ological


6/19

6. 7'at are t'e clinical !ndings ofsteroid addiction"

Before

wit'drawal

normal orwell8

controlled

9tc'ingmore

T%S do notwor5 as

well

rurigo8li5eeruptions(2ig 1A)

After

wit'drawal

ert'ema

ec-ema t'ic5ened

(:prurigo )

(2ig 1B).

reounderuption

;us'ing orert'ema wit' or

wit'oute/udati0eedema

2)

Se0erereou

nd

ac$tephase

thickenedand

des%$aat

ive skin

depressedand

pessiistic

skin&rad$a''(iproves

)ver(

sensitive*)Fi&3*


7/19

+.+ t(pica' appearanceo, -S+" ith pr$ri&o/

'ike er$ption !e,oreithdraa'.

.+ppearance $st a,tertria' o, decreasin& theao$nt o, potent

topica' steroids. -heseverit( o, addictionis so intense that thepatient cannot sa,e'(ithdra !( a

&rad$a'/decreaseethod.

C.-he re!o$nder(thea is

spreadin& a,tercop'ete cessation o,

Fi&$re1


8/19

+. e,ore ithdraa'. 2 eeks a,ter

ithdraa'

C.3 onths a,terithdraa

.13 onths a,terithdraa'.

-he

proced$res o,ithdraa' ina severe caseo, -S+.

Fi&$re2


9/19

-he skin here a !and/aid as p'aced and detached

)(e''o arros* shos an irritated appearance in the 'e,t

Fi&$re3A case presenting 'persensiti0it after topical steroidwit'drawal.


10/19

+. 7'at do t'e s5in lesions loo5 li5e,and 'ow are t'e di3erent to ec-ema"

?riginal s5in disease Distriution

Atopicdermatit

isnec5,

5nees, orelows(;e/or

parts oft'e od)

TSA

not limited (not in

palms and soles)

Reound eruptioncentral to

e/tremities (2ig@)

t'in and pale

after wit'drawal,t'ic5ened


11/19

Fi&$re+n e4ap'e o, t(pica' dearcation aro$ndthe rists seen in the re!o$nd er$ption.

)+* at the peak o,re!o$nd

)* 1 onth 'ater )C* 2 onths 'ater


12/19

@. 7'ere on t'e od doesit usuall occur"

Face (special ,rosacea ) Armpit, genital(thin )

Other areas

(latently,difficult)

No original

lesion, no TCSwere everapplied

Soles and palms

(rarely, andec!ema"housewi

ves ec!ema)

#hole$%ody(potent TCS,senile &erosis)


13/19

. 7'at strengt' of steroid and usagepattern leads to steroid addiction"

longer periods of application

potent strengt' of t'e T%S

not have arecord o,

the app'ied-CS

istologically atrophy

after ' wees(within wees) (Fig*)

After the

interruption

sin mayrecover

TCS can %e

resumed

noevidence reallyprevents


14/19

Fi&$re#

2 eeks5 app'ication o, 0.0# c'o!etaso' propionate tice a da(" ona hea'th( ad$'t ,orear.Note: -he epideris !ecae o!vio$s'( thinner" and 7CN+/positiven$c'ei )!ron* decreased.

T'e result of immuno'istoc'emical staining, using an antiodagainst %A

!e,ore

a,ter


15/19


16/19

*.How common is steroid addiction

sndrome"

JAA 6===

+E

6FE

1E

7oor'( Contro''ed isease

Au"ts

3hi"ren

.n!ants


17/19

+ rolems 2rom t'e Giewpoint of re0entingTSA or RBSS in t'e new AAD guidelines

potent T%S proacti0e approac' reacti0e approac'

T'e proacti0eapproac' 'as

co0ert meanings

7it' repeated use sameagent

Tac'p'la/is andTSA are di3erent

prolems

steroid8p'oic patients s'ort8term oser0ation

e3ecti0e

ndertreatments'ould not alwas

e regarded asinade&uac


18/19

9s it also e3ecti0e from a more long8term 0iewpoint"

Did t'e numer of patients wit'adult'ood atopic dermatitis increaseafter dermatologists egan to

prescrie T%S se0eral decades ago" 7' do patients wit' atopic

dermatitis onl complain or worr

regarding T%S use"


19/19

Documents

Topical Steroid Addiction in Atopic