Topical Corticosteroids

Application of topical corticosteroids (CSs) is part of the standard external therapy in CLE. Alone or in combination with systemic anti-inflammatory agents, CSs are very effective in reducing the main symptoms of the skin lesions of LE, namely, redness and squamae. To be effective in LE, intermediate (e. g., triamcinolone acetonide) to potent or superpotent CS preparations (betamethasone dipropionate, halobetasol propionate, fluocinonide, and clobetasol propionate) have to be used to achieve significant amelioration of the skin lesions. Usually, potent CS preparations should not be used on the face since the well-known side effects (atrophy, telangiectasias, steroid dermatitis, and folliculitis) tend to be especially severe in facial skin. However, in view of the risk-benefit ratio, CLE represents an exception to that rule, since the facial skin lesions of LE are often exceedingly disfiguring so that the CS side effects are less troublesome. Twice-daily application for a few weeks followed by a rest period of a few weeks may help minimize the risk of local side effects.

The choice of the vehicle for the CS treatment is important, for example, ointment-based products have a greater effectiveness since they induce stronger hydration of the skin with greater delivery of the CS through the horny layer into the skin. At the same time, these preparations are especially suitable for hypertrophic lesions, as they effectively ameliorate the stubborn hyperkeratosis of LE.

Creams may be cosmetically more acceptable for some patients, but they also may be more irritating owing to the emulsifiers, preservatives, and fragrances that most of them contain. For scalp lesions, CS solutions and gels are best applied since they can also be easily washed off with standard shampoos. For scalp lesions, the CS side effects are less harmful since the skin in this area seems to be less sensitive, especially regarding atrophy and telangiectasias. Potent CS preparations, therefore, may be applied here deliberately.

To enhance the efficacy of CSs, occlusive therapy may be chosen, especially for scalp lesions (e. g., shower cap). Different occlusive techniques exist for the various skin areas, which all can be applied overnight for maximum efficacy. Plastic food wrap (saran wrap) or adhesive gas-permeable surgical dressings (TegaDerm) can be used for larger areas on the trunk and extremities. For the hands, vinyl-over-cotton gloves (two-layered glove technique) can be recommended. If only the fingers are affected, rubber finger cots are available for occlusion.

To further increase CS efficacy and to achieve maximal drug concentrations in the active lesion, intralesional therapy may be chosen. Especially in hyperkeratotic discoid LE (DLE) and other refractory lesions, intralesional CS application may lead to better treatment responses. The concentration of the CS has to be adjusted to the site of injection, that is, 2.5-5 mg/mL triamcinolone acetonide suspension for the face and up to 10 mg/mL for other sites like the scalp or extremities. Intralesional CS application has long-lasting effects and may not be repeated until 4-6 weeks after the previous injections. To avoid subcutaneous atrophy, the injections should be placed in the dermis and not in the subcutaneous fat.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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