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Fig 2.21 Key Message

With topical steroids ... Side-effects come from inappropriate use Good effects come from appropriate use

other local side-effects, and central systemic effects effects are not often considered. Evidently in clinical studies the relative absence of the particular side-effects being studied must in part be related to the presence of the disease process, and the behavioural complications associated with it. Thus, as skin is thinned by a topical steroid, it is thickened by the characteristic rubbing and scratching associated with atopic skin disease.The latter phenomenon needs to be allowed for when considering experimental studies using healthy skin. What we can conclude at present is that local sideeffects are associated with injudicious and inappropriate use of topical steroids. The risk of skin atrophy from topical steroid use cannot be ignored. However, when used correctly only benefits accrue (Fig 2.21). The Combined Approach described in this manual both sets out the protocol for the best use of topical steroids, and depends on their good effects for good results.

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Systemic side-effects Not only is it convenient and otherwise rational to treat skin disease with steroids by topical application, this route clearly helps avoid systemic side-effects. Even so, a particularly important hazard of topical steroid use is the possibility of absorbed glucocorticosteroids in the circulation leading to a depression of the hypothalamopituitary-adrenocortical axis. This leads to a reduction in naturally circulating corticosteroids, demonstrable by estimating the 9 a.m. blood cortisol level. In extreme and fortunately rare cases it is possible with topical steroids to induce iatrogenic Cushing's syndrome, followed by Addison's disease on withdrawal. Although regular small amounts of prescribed systemic steroids can induce other systemic side-effects in adults (p. 33) these are not reported systemic side-effects of topical steroids. In children any possible systemic effects need to be distinguished from effects on development caused by eczema and asthma themselves (p. 32).

Topical steroids in clinical practice Attitudes to topical steroids Our clinical experience using the programme described in this manual is that problems with topical steroids can be expected when they are used inappropriately and without due regard to all aspects of the condition being treated.

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Profile for Christopher Bridgett

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients