Keywords

Corticosteroids

  1. A.

    Topical Steroids [1, 2] (Tables 8.1 and 8.2)

Table 8.1 Indications for topical steroids [3]
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Table 8.2 Classes and formulations of topical steroids
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Most Common Adverse Effects of Topical Steroids (Table 8.3)

  • Atrophic changes (easy bruising, purpura, striae, telangiectasias)

  • Infection (e.g. tinea incognito)

  • Contact dermatitis

  • Acneiform eruption

  • Delayed wound healing

  • Perirorificial dermatitis

  • Systemic effects rare

Table 8.3 Adverse effects of long-term use of oral corticosteroids
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Topical Steroids in Pregnancy (pregnancy category c)

  • Appear to be safe in pregnancy, though some studies suggest increased risk of fetal growth restriction with potent/super potent topical corticosteroids

  • Mild- to moderate-potency topical corticosteroids preferred over higher potency

  • Avoid high- and super-potency topical corticosteroids if possible

  1. B.

    Oral Corticosteroids

Clinical Indications

  • Eczema/dermatitis

  • Vesiculobullous disorders

  • Cutaneous lupus

  • Sarcoidosis

  • Vasculitis

General Guidelines for Steroid Treatment

  • Generally, higher dose prescribed initially (0.5–1 .5 mg/kg) with decrease after 2–4 weeks

  • Risk of adverse effects increases with longer length of use and higher dosage

  • Best if taken as single dose in AM to reduce suppression of HPA axis

  • Short-term steroid treatment

    • Generally safe for acute dermatitis

    • No need for tapering if used for <1–2 weeks

  • Long-term steroid treatment (See Table 8.3 for Adverse Effects of Oral Steroids)

    • Monitor blood pressure, weight and blood sugar

    • Consider bone density scan to evaluate for osteoporosis and/or bisphosphonate therapy

    • Taper slowly to avoid risk of acute adrenal insufficiency

    • Consider stress dose steroids if illness, trauma or surgical procedure

Oral Steroids in Pregnancy/Lactation (pregnancy category c)

  • Not preferred for initial therapy

  • Avoid in first trimester

  • Use at lowest effective dose in second and third trimester

  • Present in breastmilk

  • Generally acceptable in usual doses, however monitoring of infant should be performed

Antibiotics

  1. 1.

    Topical Antibiotics (Table 8.4)

Table 8.4 Commonly used topical antibiotics
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Clinical Indications

  • Acne vulgaris

  • Treatment/prophylaxis of wound infections

  • Impetigo

  • MRSA nasal carriers

  1. 2.

    Oral Antibiotics

Clinical Indications

  • Acne Vulgaris (Table 8.5) [4, 5,5,7]

    • Moderate-severe inflammatory acne, resistant to topical treatments

    • Limit use to 3 months and re-evaluate

    • Avoid monotherapy – use with topical products including benzoyl peroxide and retinoid during and after antibiotic therapy

  • Skin and Soft Tissue Infections [8] (Table 8.6)

    • Includes impetigo, ecthyma, erysipelas and mild cellulitis

    • Recommend culture and gram stain if possible

    • If no culture performed, treat with Dicloxacillin 500 mg QID PO for presumed MSSA unless MRSA suspected

Table 8.5 Commonly used antibiotics for acne vulgaris
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Table 8.6 Commonly used topical/oral antibiotics for skin and soft tissue infection (SSTI)
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Antivirals [9] (Table 8.7)

Table 8.7 Commonly used antiviral medications
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Antifungals (Tables 8.8 and 8.9)

Table 8.8 Commonly used oral anti-fungal medications
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Table 8.9 Commonly used topical antifungal medications
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Antihistamines [10] (Table 8.10)

Table 8.10 Commonly used anti-histamines
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Acne Medications [12] (Table 8.11)

Table 8.11 Commonly used acne medications
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Biologic Therapy (Table 8.12)

Table 8.12 Commonly used biologic medications
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Miscellaneous medications (Table 8.13)

Table 8.13 Commonly used miscellaneous medications
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