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7/25/2019 Topical Steroid Addiction in Atopic
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op ca eroAddiction in Atopic
Dermatitis
MeiriaSari
03011186
Coach : dr. Eko KrisnantoSp.KK
Journal28th Nove!er" 201#
7/25/2019 Topical Steroid Addiction in Atopic
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Author : Mototsugu Fukaya, Kenji Sato,
Mitsuko Sato, Hajime Kimata,Shigeki Fujisawa, Haruhiko Dozono,
Jun Yoshizawa, Satoko Minaguchi
Published :Date : 14 October 2014
Topical Steroid Addictionin Atopic Dermatitis
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Abstract The American Acaemy o! Dermato"ogy
new guie"ine May #$%&
To'ica" steroi aiction or re burning skin
synrome #$$( Journa" o! the American
Acaemy o! Dermato"ogy
contro)ersies *ur'ose+
etter unerstan the i""ness
To s'ur iscussion regaring to'ica" steroi
aiction or re burning skin synrome-
Keywords: topical steroid addiction, atopic
dermatitis, red burning sin syndrome, rebound,
corticosteroid, ec!ema
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.ntrouction
/ationa" 0czema Association 1/0A2 assemb"ea task !orce to e"uciate the rea"ities o! the i""ness
simplefear,
patientignorance
(TSA)or
(RBSS).
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1. How do ou de!ne steroid addiction"
TSA not referred to steroid addiction
topicalcorticosteroid addiction.
#topical steroid$ topical corticosteroids (T%S)dermatological
#steroid$
topical and sstemic steroid #addiction$ fre&uentl and uni&uel wit' t'e
topical form, T%S was !rst used Burrin Australia in 1*+.
atients ecome unale to do wit'out t'e T%S ec-ema
Burrs directed more toward e/pressingpatients e'a0ior.
ligman and 2rosc' dermatological ormorp'ological
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6. 7'at are t'e clinical !ndings ofsteroid addiction"
Before
wit'drawal
normal orwell8
controlled
9tc'ingmore
T%S do notwor5 as
well
rurigo8li5eeruptions(2ig 1A)
After
wit'drawal
ert'ema
ec-ema t'ic5ened
(:prurigo )
(2ig 1B).
reounderuption
;us'ing orert'ema wit' or
wit'oute/udati0eedema
2)
Se0erereou
nd
ac$tephase
thickenedand
des%$aat
ive skin
depressedand
pessiistic
skin&rad$a''(iproves
)ver(
sensitive*)Fi&3*
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+.+ t(pica' appearanceo, -S+" ith pr$ri&o/
'ike er$ption !e,oreithdraa'.
.+ppearance $st a,tertria' o, decreasin& theao$nt o, potent
topica' steroids. -heseverit( o, addictionis so intense that thepatient cannot sa,e'(ithdra !( a
&rad$a'/decreaseethod.
C.-he re!o$nder(thea is
spreadin& a,tercop'ete cessation o,
Fi&$re1
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+. e,ore ithdraa'. 2 eeks a,ter
ithdraa'
C.3 onths a,terithdraa
.13 onths a,terithdraa'.
-he
proced$res o,ithdraa' ina severe caseo, -S+.
Fi&$re2
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-he skin here a !and/aid as p'aced and detached
)(e''o arros* shos an irritated appearance in the 'e,t
Fi&$re3A case presenting 'persensiti0it after topical steroidwit'drawal.
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+. 7'at do t'e s5in lesions loo5 li5e,and 'ow are t'e di3erent to ec-ema"
?riginal s5in disease Distriution
Atopicdermatit
isnec5,
5nees, orelows(;e/or
parts oft'e od)
TSA
not limited (not in
palms and soles)
Reound eruptioncentral to
e/tremities (2ig@)
t'in and pale
after wit'drawal,t'ic5ened
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Fi&$re+n e4ap'e o, t(pica' dearcation aro$ndthe rists seen in the re!o$nd er$ption.
)+* at the peak o,re!o$nd
)* 1 onth 'ater )C* 2 onths 'ater
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@. 7'ere on t'e od doesit usuall occur"
Face (special ,rosacea ) Armpit, genital(thin )
Other areas
(latently,difficult)
No original
lesion, no TCSwere everapplied
Soles and palms
(rarely, andec!ema"housewi
ves ec!ema)
#hole$%ody(potent TCS,senile &erosis)
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. 7'at strengt' of steroid and usagepattern leads to steroid addiction"
longer periods of application
potent strengt' of t'e T%S
not have arecord o,
the app'ied-CS
istologically atrophy
after ' wees(within wees) (Fig*)
After the
interruption
sin mayrecover
TCS can %e
resumed
noevidence reallyprevents
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Fi&$re#
2 eeks5 app'ication o, 0.0# c'o!etaso' propionate tice a da(" ona hea'th( ad$'t ,orear.Note: -he epideris !ecae o!vio$s'( thinner" and 7CN+/positiven$c'ei )!ron* decreased.
T'e result of immuno'istoc'emical staining, using an antiodagainst %A
!e,ore
a,ter
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*.How common is steroid addiction
sndrome"
JAA 6===
+E
6FE
1E
7oor'( Contro''ed isease
Au"ts
3hi"ren
.n!ants
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+ rolems 2rom t'e Giewpoint of re0entingTSA or RBSS in t'e new AAD guidelines
potent T%S proacti0e approac' reacti0e approac'
T'e proacti0eapproac' 'as
co0ert meanings
7it' repeated use sameagent
Tac'p'la/is andTSA are di3erent
prolems
steroid8p'oic patients s'ort8term oser0ation
e3ecti0e
ndertreatments'ould not alwas
e regarded asinade&uac
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9s it also e3ecti0e from a more long8term 0iewpoint"
Did t'e numer of patients wit'adult'ood atopic dermatitis increaseafter dermatologists egan to
prescrie T%S se0eral decades ago" 7' do patients wit' atopic
dermatitis onl complain or worr
regarding T%S use"
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