A few examples of how I might prescribe these: - Mild seborrheic dermatitis on the face: (class 6-7) - Psoriasis in the scalp: (class 1-2) - Full body rash, super symptomatic (class 1-2, avoiding the thin areas). - Full body rash, annoying, but pt doing ok (class 3-4). 9/
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In general, you can use all these steroids BID for 2 weeks max. After that, we advise a 2 week break. Another way to think about it is that you should NOT use it as much as you're using it. One area I might be more conservative are areas w/ thinner skin (eg: 1 week instead). 10/
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We limit steroid use because with excessive use, side effects occur, like skin thinning, purpura, & stretch marks. It's really important to counsel carefully, otherwise patients will use them forever! Steroids can also cause other skin disease, like perioral derm (photo3)! 11/pic.twitter.com/HbsQipjRkD
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So how do you realistically do this? My tip is to pick your favorite class 1-2, class 3-4, & class 6-7 steroid. That way, based on the exam, you always have one to use. My go to steroids: Class 1-2: betamethasone dipropionate Class 3-4: triamcinolone Class 6-7: hydrocortisone 12/
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These choices change depending on a variety of factors. If insurance covers one versus another, I'll choose the cheaper option. Also, if it's for a hair-bearing area, I'll use a lotion or a liquid/foam instead. If the patient needs A LOT, triamcinolone comes in a 1lb jar! 13/pic.twitter.com/7lXmGgggNM
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A few other points: - Try desoximetasone for patients that get allergies to other steroids. That one is in its own class (allergen wise), so it doesn't cross react. - Don't get it in the eyes! - There are steroids sparing agents that can be tried too. Ask a
#derm for help! 14/1 reply 2 retweets 18 likesShow this thread -
One more tip. Make sure you prescribe enough! If the rash is extensive, and you prescribe "1 tube," the pharmacy will dispense 15 g usually. That's less than a travel sized toothpaste! For full body, I'll use the 1lb jar (454 g), or at least 2 of the largest sized tubes! 15/pic.twitter.com/loeSeHnltD
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And don't forget - even infectious things may get better with topical steroids at first (because you're treating that inflammation). So be careful, and perhaps if it scales, always consider evaluating for a fungal process. 16/pic.twitter.com/o72mtmQ4Fe
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To recap: - Topical steroids are a great option for inflammatory skin disease. - Avoid with suspected infections and if the process is too deep. - Pick your favorite from each category (strong, medium, mild) of potency. - Limit to BID x 2 weeks max. You need to take breaks! 17/
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One last thing. I made a topical steroids cheat sheet, which I've shared with medicine residents. I've added it here in case you find it helpful! Remember - these are generic tips for steroid use; every patient is different!
#dermatologists are here to help! 18/18pic.twitter.com/T0hjbM4SDO
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This is terrific- do you have a higher resolution version of this we could share? "topical steroid cheatsheet" ->https://www.grepmed.com/images/5152
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Replying to @grepmeded
I’ll try to find one. It’d be on my work computer.
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