Presentation is loading. Please wait.

Presentation is loading. Please wait.

Topical Steroid Therapy Val Anderson Dermatology Specialist Nurse South Gloucestershire Community Health Services.

Similar presentations


Presentation on theme: "Topical Steroid Therapy Val Anderson Dermatology Specialist Nurse South Gloucestershire Community Health Services."— Presentation transcript:

1 Topical Steroid Therapy Val Anderson Dermatology Specialist Nurse South Gloucestershire Community Health Services

2 What are steroids? Essentially hormones Essentially hormones Glucocorticoids/ mineralcorticoids Glucocorticoids/ mineralcorticoids Naturally formed in the adrenal cortex Naturally formed in the adrenal cortex Natural glucocorticoids maintain normal blood sugar and assist the body to recover in times of stress. Natural glucocorticoids maintain normal blood sugar and assist the body to recover in times of stress.

3 Why Topical Steroids ? To gain control of signs and symptoms of inflammatory skin disease To gain control of signs and symptoms of inflammatory skin disease Achieve maximum efficacy with minimal side effects. Achieve maximum efficacy with minimal side effects.

4 Action of Topical Steroids Anti-inflammatory Anti-inflammatory Immunosuppressive Immunosuppressive Vasoconstrictive Vasoconstrictive Anti-mitotic – decrease proliferation Anti-mitotic – decrease proliferation Readily penetrate the dermis Readily penetrate the dermis “ Reduce inflammation and make the skin less sore and itchy ” “ Reduce inflammation and make the skin less sore and itchy ”

5 Steroid Phobia Present in health care professionals, patients and carers. Present in health care professionals, patients and carers. A reluctance to use prescribed topical steroids due to perceived side effects A reluctance to use prescribed topical steroids due to perceived side effects Reassurance is essential to gain full concordance with treatment. Reassurance is essential to gain full concordance with treatment. REMEMBER: Appropriate topical steroid use limits potential side effects almost entirely.

6 Potential side effects Cutaneous Thinning / Atrophy HypopigmentationStriaeTelangietasiaTachyphylaxis,Infections, Perioral dermatitis, Contact dermatitis, Hirsutism, Monomorphic acne or rosacea N.B Epidermal thinning does occur within 1-3 weeks of tx with potent or very potent steroids normal skin but reverses within 4 weeks of stopping

7 Potential Side Effects : systemic These are RARE and ALWAYS AVOIDABLE These are RARE and ALWAYS AVOIDABLE Due to systemic absorption of the steroid Due to systemic absorption of the steroid

8 Adverse effects : systemically Osteoporosis Osteoporosis Muscle atrophy Muscle atrophy Cushings Syndrome Cushings Syndrome Inhibition of growth (children) Inhibition of growth (children) Cataracts Cataracts Masking of infection Masking of infection Hypoglycaemia Hypoglycaemia

9 Which steroid?- factors to consider Age /potency – adult, adolescent or child Age /potency – adult, adolescent or child Site – absorption increased at certain sites Site – absorption increased at certain sites Extent- localised or generalised Extent- localised or generalised Base- creams or ointments? Base- creams or ointments? Method- frequency of application / occlusion Method- frequency of application / occlusion Experience of use - dexterity Experience of use - dexterity

10 Steroid potencies Group I. Mild e.g. Hydrocortisone 1% OTC (over the counter) Group I. Mild e.g. Hydrocortisone 1% OTC (over the counter) Group II. Mod (1 X OTC) Group II. Mod (1 X OTC) Group III. Potent  prescription only Group III. Potent  prescription only Group IV. Very potent  prescription only Group IV. Very potent  prescription only Relative potencies compared to Hydrocortisone 1% (Grp I) Group x stronger Group x stronger Group x stronger Group x stronger Group x stronger Group x stronger

11 Steroid ladder VERY POTENT  Dermovate  Nerisone Forte POTENT  Synalar  Fucibet  Diprosalic  Betnovate  Elocon  Locoid MODERATELY POTENT  Eumovate  Haelan  Trimovate  Calmurid HC  Betnovate RD  Synalar 1 in 4 MILD  Hydrocortisone 0.5%,1.0% & 2.5%  Fucidin H  Alphosyl HC  Synalar 1 in 10

12 Steroid application Reassure - explain rationale for use and benefits Reassure - explain rationale for use and benefits Early use - to control exacerbations Early use - to control exacerbations Therapeutic dose - < prolongs flare and subsequent control Therapeutic dose - < prolongs flare and subsequent control Demonstrate - light smear, F.T.U (finger tip unit) Demonstrate - light smear, F.T.U (finger tip unit)

13 Weekly Quantities of steroid Adult using b.d applications Creams and Ointments face & neck…………………… g face & neck…………………… g both hands…………………… g both hands…………………… g scalp………………………… g scalp………………………… g both arms…………………… g both arms…………………… g both legs……………………… 100g both legs……………………… 100g trunk………………………… g trunk………………………… g groins & genitalia…………… g groins & genitalia…………… g BNF March 2006

14 Summary of NICE Guidelines No statistical difference between once and twice daily steroid applicaton frequency on efficacy. No statistical difference between once and twice daily steroid applicaton frequency on efficacy. Application days and consider steroid holiday Application days and consider steroid holiday Improve patient and carer education Improve patient and carer education

15 Steroid Workshop Practice finger tip unit measurements Practice finger tip unit measurements Discuss photos and case studies Discuss photos and case studies

16 Case Study 1 6 month old baby with history of eczema since 4 months old. 6 month old baby with history of eczema since 4 months old. Tried emollients and has been given topical steroids by GP 2 weeks ago. Tried emollients and has been given topical steroids by GP 2 weeks ago. O/E moderate eczema present on facial cheeks. Excoriations present and baby waking at night. O/E moderate eczema present on facial cheeks. Excoriations present and baby waking at night. Not improved since prescription for topical steroid given. Not improved since prescription for topical steroid given.

17 What issues related to topical steroid use would you consider during assessment and treatment decisions for this child ?

18 Case Study 2 14 year old boy 14 year old boy History of eczema since 2 years old. History of eczema since 2 years old. O/E has moderate levels of eczema in arm flexures with some weeping. O/E has moderate levels of eczema in arm flexures with some weeping. Prescribed hydrocortisone 1% ointment by GP 3 weeks ago- nil improvement. Prescribed hydrocortisone 1% ointment by GP 3 weeks ago- nil improvement. Arms now becoming sore. Arms now becoming sore.

19 What issues related to topical steroid use would you consider during assessment and treatment decisions for this child ?

20 Any Questions ?

21 I have one for you

22 What will you do differently tomorrow?


Download ppt "Topical Steroid Therapy Val Anderson Dermatology Specialist Nurse South Gloucestershire Community Health Services."

Similar presentations


Ads by Google