CORTICOSTEROID TABLETS TREATING

Some doctors use short courses of corticosteroid tablets for patients with chronic urticaria, to allow the irritation to settle down before other treatments are tried. In very severe cases of rheumatoid arthritis, corticosteroid tablets are sometimes used (see Section 5). A corticosteroid injection into an affected joint can reduce inflammation for some time.

In eczema, corticosteroid creams or ointments are used when other forms of treatment (see Section 6) have failed. The creams, ointments and other preparations are classified into four groups: mildly potent, moderately potent, potent and very potent. In general, only preparations in the first two groups are prescribed for children, since there is a risk of stunting and other side-effects when corticosteroids are absorbed into the bloodstream (see p319). Even in adults, the potent and very potent preparations are generally only used for a few weeks, to control an acute outbreak of skin irritation; a less potent preparation is then substituted.

The amount absorbed depends on certain other factors, besides the potency of the cream or ointment. More will be absorbed from the face and genitals, and creams should be used sparingly in these areas. Damaged skin will also absorb more.

If corticosteroids have been applied to the skin for more than a few weeks, treatment should not end abruptly, or there may be a flare-up of the eczema. The cream should be withdrawn gradually, a little less being applied each day. The corticosteroid cream can be used alternately with an emollient (see Section 6) to ease withdrawal.

In general, treatment with mildly potent corticosteroid preparations can be continued for as long as necessary. Provided there is good medical supervision, such treatment can safely continue for several years if needed.

The corticosteroids most commonly used in creams and ointments for eczema is hydrocortisone.

Creams and ointments used for eczema often contain other drugs, besides the corticosteroid. Some include antibiotics and/or anti-fungal drugs, to treat secondary infections. Others contain substances that help to reduce itching, soothe the skin, or restore its water content. Preparations containing a mixture of coal-tar (which reduces itching! and hydrocortisone (eg Carbo-Cort) are often very effective, the coal tar helping to make the hydrocortisone effective, even at a low dosage.

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