The Dermatology Practice.

#topicalsteroids #eczema #psoriasis

Topical steroids, also known as topical corticosteroids, are a class of medications widely used to treat various skin conditions. They are available in different potencies and formulations, including creams, ointments, lotions, and gels. In this article, we will discuss the indications, potency, and side effects of topical steroids, as well as alternative treatments like topical calcineurin inhibitors and PDE4 inhibitors.

Indications for Topical Steroids

Topical steroids are commonly used to treat a range of skin conditions, including:

  1. Atopic dermatitis (eczema): Topical steroids are often used to reduce inflammation and itching associated with eczema
  2. Psoriasis: Topical steroids can help reduce inflammation and slow down skin cell growth in psoriasis
  3. Contact dermatitis: Topical steroids can help reduce inflammation and itching caused by skin allergies or irritants
  4. Seborrheic dermatitis: Topical steroids can help reduce inflammation and flaking associated with seborrheic dermatitis. Sometimes, having an added anti fungal coverage may have a synergistic effect
  5. Skin allergies: Topical steroids can help reduce inflammation and itching caused by skin allergies

Potency of Topical Steroids

Topical steroids are classified into seven potency categories, ranging from Class I (superpotent) to Class VII (least potent). The potency of a topical steroid is determined by its ability to suppress inflammation and immune responses. Superpotent and potent steroids should be used under clear direction from healthcare professionals. Do note that the consistency e.g. lotions, ointments do have an effect on the potency of the steroids.

  1. Class I (superpotent): Examples include clobetasol propionate
  2. Class II (potent)
  3. Class III (upper mid-strength)
  4. Class IV (mid-strength): Examples include betamethasone valerate and triamcinolone acetonide
  5. Class V (lower mid-strength)
  6. Class VI (mild): Examples include hydrocortisone acetate and desonide
  7. Class VII (least potent): Examples include hydrocortisone

Side Effects of Topical Steroids

While topical steroids are generally safe and effective, they can cause side effects, especially with prolonged use or high-potency formulations. Common side effects include:

  1. Skin thinning (atrophy)
  2. Stretch marks (striae)
  3. Rosacea-like symptoms
  4. Acne-like symptoms
  5. Folliculitis
  6. Hypopigmentation
  7. Hypertrichosis

Topical Calcineurin Inhibitors

Topical calcineurin inhibitors are a class of medications that can be used as an alternative to topical steroids. They work by inhibiting the activity of calcineurin, a protein that plays a key role in the immune response. Examples of topical calcineurin inhibitors include:

  1. Tacrolimus
  2. Pimecrolimus

Topical calcineurin inhibitors are commonly used to treat atopic dermatitis, psoriasis, and vitiligo. They are generally well-tolerated and can be used for prolonged periods without the risk of skin thinning or other side effects associated with topical steroids.
Nonetheless, they may cause skin irritation on initial use, where patients report a ‘burning’ sensation.

Topical PDE4 Inhibitors

Topical PDE4 inhibitors are a new class of medications that have been approved for the treatment of atopic dermatitis. They work by inhibiting the activity of phosphodiesterase 4 (PDE4), an enzyme that plays a key role in the inflammatory response. Examples of topical PDE4 inhibitors include:

  1. Crisaborole

Topical PDE4 inhibitors have been shown to be effective in reducing inflammation and itching associated with atopic dermatitis. Similar to topical calcineurin inhibitors, they may elicit a skin reaction or sensation on initial use.

Conclusion

Topical steroids are a widely used treatment for various skin conditions, including atopic dermatitis, psoriasis, and contact dermatitis. However, there needs to be a balance in its duration of use and strict monitoring. Other topical anti inflammatories can be useful adjuncts in the appropriate context. Always speak to your healthcare provider and be judicious in their use!

References

  1. National Eczema Association. (2020). Topical Corticosteroids.
  2. British Journal of Dermatology. (2018). Topical corticosteroids: A systematic review.

    3. #skincare #lighttreatment #medicallighttherapy #eczema #psoriasis

    What is Phototherapy?

    Phototherapy involves the use of specific wavelengths of light to target various skin conditions. The light emitted by phototherapy devices can be ultraviolet (UV) A or B, visible, or infrared, depending on the condition being treated. Phototherapy can be administered in various forms, including both targeted (hand held devices focussing on problem areas) or systemic (Full body).
    They are a form of skin directed therapies that can be used for large areas of skin with no internal derangements.


    What is Excimer Laser?

    The excimer laser is a type of phototherapy that uses a specific wavelength of UV light to target various skin conditions. The excimer laser emits a high-intensity beam of UV light that is precisely calibrated to target specific skin cells. This laser is commonly used to treat conditions such as:

    1. Psoriasis: The excimer laser can help reduce psoriatic plaques and inflammation
    2. Vitiligo: The excimer laser can help repigment vitiligo patches
    3. Atopic Dermatitis: The excimer laser can help reduce inflammation and itching associated with atopic dermatitis

      4. How does phototherapy differ from sunlight?

      1. Spectrum/ Specificity:

        Phototherapy typically uses narrowband light (specifically ultraviolet B). This range is more effective in treating skin conditions like psoriasis and vitiligo.

        In contrast, sunlight contains a broader spectrum of UV light, including shorter wavelengths that may cause skin damage or pigmentation

      2. Intensity: Controlled emission of UV light, which can be adjusted to meet individual patient’s needs. This is not seen in sunlight, which varies in intensity throughout the day, season and location
      3. Duration: Phototherapy typically involves short treatment sessions, ranging from a few minutes to 30 minutes. In contrast, sunlight exposure can be prolonged, leading to increased risks of skin damage

    Conditions Treated with Phototherapy and Excimer Laser

    1. Psoriasis: Phototherapy, including excimer laser, can help reduce psoriatic plaques and inflammation
    2. Vitiligo: Phototherapy, including excimer laser, can help repigment vitiligo patches
    3. Atopic Dermatitis: Phototherapy, including excimer laser, can help reduce inflammation and itching associated with atopic dermatitis
    4. Acne: Blue light phototherapy can help reduce acne-causing bacteria and inflammation
    5. Pain and Inflammation: Infrared phototherapy can help reduce pain and inflammation in conditions such as arthritis and fibromyalgia

    Benefits of Phototherapy and Excimer Laser

    1. Non-Invasive: Phototherapy and excimer laser are non-invasive treatments that do not require surgery or injections
    2. Targeted Treatment: Phototherapy and excimer laser can target specific skin cells and conditions, reducing the risk of side effects
    3. Minimally Painful: Phototherapy and excimer laser treatments are generally minimally painful and well-tolerated
    4. Quick Recovery: Phototherapy and excimer laser treatments typically require minimal downtime, allowing patients to resume their daily activities quickly

    Conclusion

    Phototherapy and excimer laser are highly effective treatments for various skin conditions. By understanding the mechanisms and benefits of these treatments, patients can make informed decisions about their skincare options. Whether you’re struggling with psoriasis, vitiligo, or acne, phototherapy and excimer laser can provide a safe and effective solution. Consult with a healthcare professional or dermatologist to determine if phototherapy or excimer laser is right for you.

    References

    1. National Psoriasis Foundation. (2020). Light Therapy.
    2. Mayo Clinic. (2020). Excimer laser for psoriasis.

      3. #skincare #radiantskin #skinglow #skinrejuvenation #exosomes #peptides

      The quest for radiant youthful skin has led to the discovery of innovative skincare ingredients. Among these, exosomes, stem cell factors, and peptides have garnered significant attention for their potential to revolutionize skin regeneration. In this comprehensive guide, we’ll delve into the world of these three skincare powerhouses, exploring their benefits, mechanisms, and applications in skincare.

      Exosomes: The Cellular Messengers

      Exosomes are tiny, membrane-bound vesicles (30-150 nm) released by cells, including stem cells, to communicate with neighboring cells. They are akin to messenger molecules. These nanocarriers contain a cargo of biomolecules, such as proteins, lipids, and nucleic acids, which are essential for intercellular signaling.

      Benefits of Exosomes in Skincare:

      1. Cellular Communication: Exosomes facilitate communication between skin cells, promoting a harmonious and balanced skin environment
      2. Wound Healing: Exosomes have been shown to accelerate wound healing by promoting cell migration, proliferation, and differentiation
      3. Anti-Aging: Exosomes can help reduce fine lines, wrinkles, and age-related skin damage by stimulating collagen production and improving skin elasticity
      4. Skin Barrier Repair: Exosomes can help repair the skin’s natural barrier function, reducing inflammation and improving skin hydration


      Exosome Derivatives

      While exosomes can be derived from stem cells, such as mesenchymal stem cells (MSCs) or adipose-derived stem cells (ADSCs), there are other sources of derived exosomes. These include plant-based, synthetic/ engineered exosomes which are biomimetic in nature, hybrid exosomes. These products can be found in various forms, including serums, creams, and masks.

      Stem Cell Factors: Unlocking Cellular Potential

      Stem cell factors are signaling molecules produced by stem cells to regulate cellular behavior, including proliferation, differentiation, and survival. These factors can be used to stimulate skin cells, promoting regeneration and rejuvenation.

      Benefits of Stem Cell Factors in Skincare:

      1. Cellular Regeneration: Stem cell factors can stimulate skin cells to regenerate and repair damaged tissue
      2. Collagen Production: Stem cell factors can increase collagen production, improving skin elasticity and reducing fine lines and wrinkles
      3. Skin Brightening: Stem cell factors can help reduce melanin production, resulting in a brighter, more even-toned complexion
      4. Wound Healing: Stem cell factors can accelerate wound healing by promoting cell migration, proliferation, and differentiation

      Stem Cell Factor-Based Skincare Products

      Stem cell factor-based skincare products typically contain a combination of growth factors that help in regulation of stem cell behaviour, such as epidermal growth factor (EGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF). These products can be found in various forms, including serums, creams, and masks.

      Peptides: The Building Blocks of Skin

      Peptides are short chains of amino acids that play a crucial role in skin health. They can stimulate collagen production, improve skin elasticity, and reduce inflammation.
      Peptides take on different roles in the skin. They can help to regulate certain skin functions by their actions on skin

      1. Neurotransmitter: To reduce wrinkle formation and muscle contraction
      2. Signalling: Stimulate production of collagen, elastin and skin structural proteins
      3. Carrier: Delivering trace elements e.g. copper to the skin

      Benefits of Peptides in Skincare

      1. Collagen Production: Peptides can stimulate collagen production, improving skin elasticity and reducing fine lines and wrinkles
      2. Skin Firming: Peptides can help firm and tighten the skin, reducing the appearance of sagging skin
      3. Inflammation Reduction: Peptides can reduce inflammation, which can contribute to skin conditions like acne, rosacea, and eczema
      4. Wound Healing: Peptides can accelerate wound healing by promoting cell migration, proliferation, and differentiation

      Peptide-Based Skincare Products

      Peptide-based skincare products typically contain a combination of short-chain peptides, such as acetyl hexapeptide-8, palmitoyl pentapeptide-4, and dipeptide diaminobutyroyl benzylamide diacetate. These products can be found in various forms, including serums, creams, and masks.

      Conclusion

      Exosomes, stem cell factors, and peptides are revolutionizing the skincare industry with their potential to promote skin regeneration, rejuvenation, and repair. By understanding the benefits and mechanisms of these ingredients, skincare professionals and enthusiasts can harness their power to achieve healthier, more radiant skin. As research continues to uncover the secrets of these skincare powerhouses, we can expect to see even more innovative products and treatments emerge in the future.

      References

      1. Sreeraj et al. Exosomes for skin treatment: Therapeutic and cosmetic applications. NanoTransMed Dec 2024 .
      2. Shin et al. The use of epidermal growth factor in dermatological practice. Int Wound J. Dec 2022.