Makindo Medical Notes

Related Subjects: |Cellulitis |Pyoderma gangrenosum |Pemphigus Vulgaris |Toxic Epidermal Necrolysis |Stevens-Johnson Syndrome |Necrotising fasciitis |Gas Gangrene (Clostridium perfringens) |Purpura Fulminans |Severe burns |Anatomy of Skin |Skin Pathology and lesions |Skin and soft tissue and bone infections

Emollients

• Emollients are oil based ingredients in skin creams, lotions, moisturizers or ointments that form a film on your skin. These ingredients can relieve dryness, itching and scaling. Emollients can help the skin feel more comfortable with eczema, psoriasis, dry or sensitive skin.
• Skin care creams, lotions and ointments that contain emollients can: Attract moisture (water) to your skin. Prevent the loss of moisture in skin, soften scaling or peeling skin, soothe irritated or dry skin.
• Emollients absorb better when skin is damp. To get the most out of your emollient:
  • Take a warm (not hot) bath or shower and use a gentle cleanser.
  • Rinse your skin well and gently pat dry.
  • Take a handful of emollient and warm it between your hands.
  • Apply the emollient to the areas of dry, scaling or irritated skin, ideally within three minutes of getting out of your shower or bath.
  • Rub the emollient into your skin gently in a downward circular motion.

Steroid Creams and Potency

• The potency of the steroid you are given will be based on several factors:
  • Babies and children are more susceptible systemic effects of topical steroids as thinner skin and surface to volume ratio. Caution is needed,
  • Skin thickness: Faces, flexures, genitals are thin skin, thick skin is the soles, palms and scalp. For thinner skin mild and moderate preparations are commonly prescribed.
  • Size of the affected area: A weaker steroid might be prescribed when a large area of skin requires treatment.

Using topical steroids

• Very Potent
  • Dermovate (clobetasol proprionate 0.05%)
  • Dermovate scalp lotion (clobetasol propionate 0.05%)
  • Etrivex shampoo (clobetasol propionate 500 micrograms/g)
  • DO NOT USE ON Eyelids, Face, Groin, Armpits, Genitals, Children, Psoriasis
• Potent
  • Betnovate (betamethasone valerate 0.1% in a water miscible base)
  • Betacap (betamethasone valerate 0.1% containing coconut oil derivative)
  • Locoid (hydrocortisone butyrate 0.1%)
  • Synalar (fluocinolone acetonide 0.025%)
  • Elocon (mometasone furoate 0.1%)
  • DO NOT USE ON Eyelids, Face, Groin, Armpits, Genitals, Children, Psoriasis WITHOUT SENIOR ADVICE
• Potent steroids With antibacterial
  • Fucibet (betamethasone valerate 0.1%, fusidic acid 2%)
  • Synalar C (fluocinolone acetonide 0.025%, clioquinol 3%)
  • Synalar N (fluocinolone acetonide 0.025%, neomycin sulfate 0.5%)
  • DO NOT USE ON Eyelids, Face, Groin, Armpits, Genitals, Children, Psoriasis WITHOUT SENIOR ADVICE
• Potent steroids With salicylic acid
  • Diprosalic betamethasone diproprionate 0.05%,salicylic acid 3%)
  • With vitamin D (for use in psoriasis only) Dovobet (betamethasone diproprionate 0.05%, calcipotriol 50micrograms/g)
  • Enstilar (betamethasone diproprionate 0.05%, calcipotriol 50micrograms/g
  • DO NOT USE ON Eyelids, Face, Groin, Armpits, Genitals, Children, Psoriasis WITHOUT SENIOR ADVICE
• Moderate
  • Betnovate RD (betamethasone valerate 0.25%)
  • Eumovate (clobetasone butyrate 0.05%)
  • Fludroxycortide Tape (4 micrograms/cm2)
  • Modrasone (Alclometsone dipropionate 0.05%)
  • DO NOT USE ON Eyelids

Using Steroids

• Apply topical steroids after an emollient by accurately ‘colouring in’ any red sore areas highlighted by the application of the emollient. Steroid can be applied as soon as the emollient can no longer be seen on the skin, which can be a few minutes.
• Apply the correct potency topical steroid to the correct body area (see ladder). Never use very potent steroids on the face, genitals, armpits and groin, and only use mild steroids on the eyelids and under a nappy for a maximum of 5‐7 days.
• Always use the mildest strength steroid that clears eczema but ensure that regular ‘steroid free’ days can be achieved. If not it may be better to increase the strength of steroid if the body area being treated allows this.
• Apply the topical steroid every morning and night (except Elocon which is once daily) until the skin is completely clear.
• Apply the topical steroid immediately as soon as the eczema returns.
• If the eczema is not clearing after seven days of using a topical steroid patients should continue to use it but make an appointment to see their GP to review therapy.
• If skin becomes broken, develops blisters or yellow heads, is weepy or suddenly worse all over (signs of infection) patients should continue treatment but make an urgent appointment to see their GP.
• If the topical steroid stings on application or the eczema patches just aren't clearing then the GP may consider changing the treatment to an ointment as these don’t tend to contain preservatives and are more hydrating than creams
• Products containing antibacterials should be applied twice daily for 7‐14 days maximum per infective flare (check individual product details). Patients should then revert to a steroid that does not contain antimicrobials to control flares unless the skin is infected.

References

• Steroid Poster