Topical steroid application can induce branched/reticular vessels in Bowen disease on the upper trunk

Hiroyo Hashimoto; Yaei Togawa; Naoki Aoyagi; Ryoji Kurita; Rena Oguma; Mari Iwasawa; Keisuke Suehiro; Hiroyuki Matsue

doi:10.4081/dr.2020.8835

Topical steroid application can induce branched/reticular vessels in Bowen disease on the upper trunk

Dermatology Reports ◽

10.4081/dr.2020.8835 ◽

2020 ◽

Vol 12 (2) ◽

Author(s):

Hiroyo Hashimoto ◽

Yaei Togawa ◽

Naoki Aoyagi ◽

Ryoji Kurita ◽

Rena Oguma ◽

...

Keyword(s):

Medical Records ◽

Topical Steroid ◽

Topical Steroids ◽

Steroid Use ◽

Keratinocyte Proliferation ◽

History Of ◽

Superficial Dermis ◽

Bowen Disease ◽

Epidermal Atrophy ◽

Chronic Eczema

We aimed to elucidate the dermoscopic vasculature of patients with Bowen Disease (BD) that was misdiagnosed as chronic eczema and had branched and/or reticular vessels after topical steroid application. The medical records of 19 patients with BD on the upper trunk were retrospectively reviewed for steroid use history, vascular structure observed in dermoscopy, and corresponding histological findings. Four patients treated with strong topical steroids showed remarkable branched and/or reticular vessels on dermoscopy. Histopathology showed partial epidermal atrophy with irregular thin elongation of the rete ridges, atypical keratinocyte proliferation in the epidermis, and vasodilation in the superficial dermis. We considered that vasodilation and partial epidermal atrophy may be induced by topical steroid application in BD-affected areas. In cases of suspected BD with reddish-brown plaque showing branched and/or reticulated vessels in dermoscopy, confirming a history of topical steroid use is helpful.

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Topical Corticosteroids and Fungal Keratitis: A Review of the Literature and Case Series

Journal of Clinical Medicine ◽

10.3390/jcm10061178 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1178

Author(s):

Karl Anders Knutsson ◽

Alfonso Iovieno ◽

Stanislav Matuska ◽

Luigi Fontana ◽

Paolo Rama

Keyword(s):

Rebound Effect ◽

Clinical Signs ◽

Topical Steroid ◽

Case Series ◽

Signs And Symptoms ◽

Fungal Keratitis ◽

Principal Factor ◽

Topical Steroids ◽

Review Of The Literature ◽

Steroid Use

The management of fungal keratitis is complex since signs and symptoms are subtle and ocular inflammation is minimal in the preliminary stages of infection. Initial misdiagnosis of the condition and consequent management of inflammation with corticosteroids is a frequent occurrence. Topical steroid use is considered to be a principal factor for development of fungal keratitis. In this review, we assess the studies that have reported outcomes of fungal keratitis in patients receiving steroids prior to diagnosis. We also assess the possible rebound effect present when steroids are abruptly discontinued and the clinical characteristics of three patients in this particular clinical scenario. Previous reports and the three clinical descriptions presented suggest that in fungal keratitis, discontinuing topical steroids can induce worsening of clinical signs. In these cases, we recommend to slowly taper steroids and continue or commence appropriate antifungal therapy.

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Steroid Dermatitis Resembling Rosacea: A Clinical Evaluation of 75 Patients

ISRN Dermatology ◽

10.1155/2013/491376 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Ammar F. Hameed

Keyword(s):

Prospective Observational Study ◽

Clinical Manifestations ◽

Topical Steroid ◽

Topical Steroids ◽

Clinical Presentations ◽

Common Causes ◽

The Face ◽

History Of ◽

Rebound Phenomenon ◽

Papulopustular Eruption

Background. The use of topical steroids on the skin of the face should be carefully evaluated by the dermatologist; however, its misuse still occurs producing dermatological problem resembling rosacea. Objectives. To report the different clinical manifestations of steroid dermatitis resembling rosacea and to discover causes behind abusing topical steroids on the face. Methods. In this prospective observational study, 75 patients with steroid dermatitis resembling rosacea who had history of topical steroid use on their faces for at least 1–3 months were evaluated at the Department of Dermatology, Baghdad Teaching Hospital, between August 2010 and December 2012. Results. The majority of patients were young women who used a combinations of potent and very potent topical steroid for average period of 0.25–10 years. Facial redness and hotness, telangiectasia, and rebound phenomenon with papulopustular eruption were the main clinical presentations. The most common causes of using topical steroid on the face were pigmentary problems and acne through recommendations from nonmedical personnel. Conclusion. Topical steroid should not be used on the face unless it is under strict dermatological supervision.

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Misuse of topical corticosteroids and attitude towards self-medication: a rising alarm

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20175370 ◽

2017 ◽

Vol 3 (4) ◽

pp. 485

Author(s):

Savita Chaudhary

Keyword(s):

Indian Population ◽

Topical Steroid ◽

Medical Practitioner ◽

Topical Steroids ◽

Self Medication ◽

Topical Medication ◽

Inappropriate Use ◽

Topical Corticosteroids ◽

Number Of Patients ◽

History Of

Background:Topical corticosteroids (TC) are among the most commonly used medications for treatment of skin disorders. They give immediate relief from symptoms in many inflammatory dermatoses. Even inappropriate use in infectious dermatoses relieves the symptoms. This study was done to analyze the misuse of topical corticosteroids in Indian population and to analyze the attitude of patients towards self-medication.Methods:All patients presenting with various dermatoses to the investigator were asked about history of usage of any topical medication on the lesion. In case of a positive answer, the investigator ascertained whether the topical medication in question contained a corticosteroid. The total number of patients seen during the recruitment period (January 2012 – December 2012) was noted on a separate list. Full questionnaires were only filled for patients with history of using topical corticosteroids.Results:5256 patients were screened out of which 4100 (78%) were already using topical medications. 3154 (60%) patients were using topical steroid in various forms. About 80% of the patients using topical steroids confessed that they have not consulted qualified medical practitioner. They were advised these medications by chemists, friends or quacks, neighbours, barbers, beauticians etc.Conclusions:Misuse of topical corticosteroids is common in Indian population and results in various complications. Educating public, chemists, general practitioners along with strict vigil by law enforcing agencies is needed for optimal and safe use of corticosteroids.

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Topical steroids - fairness fervour to fallout

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20172203 ◽

2017 ◽

Vol 3 (2) ◽

pp. 234

Author(s):

Ashok S. Hogade ◽

Ismat Fatima

Keyword(s):

Symptomatic Relief ◽

Topical Steroid ◽

Pharmaceutical Companies ◽

Topical Steroids ◽

Short Term ◽

Inappropriate Use ◽

Inflammatory Dermatoses ◽

Household Workers ◽

History Of ◽

Almost All

Background: Topical Steroids (TS) are one of the most widely used therapeutic formulations in practice. Treatment was revolutionized with the advent of these anti-inflammatory corticosteroids .They provide rapid symptomatic relief in almost all inflammatory dermatoses , in short term. In India topical steroids are marketed by many pharmaceutical companies and few of these formulations are available at every medical store even without a prescription.Methods: Patients with relevant facial dermatoses (clinical features suggestive of TS abuse) with history of current TS inappropriate use were included. Diagnosis was established on clinical basis and consent was sought. Proper skin examination was performed to detect the condition related to abuse of TS.Results: Out of 100 patients studied 54 were females and 46 males. Majority were of 15-35 years age group and unmarried. 72% patients belonged to lower and 25% to middle socioeconomic class. Majority of the patients were students (42%) followed by household workers (38%). Conclusions: Unnecessary cosmetic use of TCs with or without fairness creams is quite common in facial dermatoses resulting in steroidal dermatitis resembling rosacea. Topical steroid misuse is increasing because of easy availability, Lack of awareness, Obsession for fair skin.

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The use of a Domain Ontology for the Management of Essential Hypertension (Preprint)

10.2196/preprints.25427 ◽

2020 ◽

Author(s):

Emma Chavez ◽

Vanessa Perez ◽

Angélica Urrutia

Keyword(s):

Decision Making ◽

Essential Hypertension ◽

Medical History ◽

Medical Records ◽

Medical Training ◽

Relevant Information ◽

Domain Ontology ◽

Free Text ◽

Snomed Ct ◽

History Of

BACKGROUND : Currently, hypertension is one of the diseases with greater risk of mortality in the world. Particularly in Chile, 90% of the population with this disease has idiopathic or essential hypertension. Essential hypertension is characterized by high blood pressure rates and it´s cause is unknown, which means that every patient might requires a different treatment, depending on their history and symptoms. Different data, such as history, symptoms, exams, etc., are generated for each patient suffering from the disease. This data is presented in the patient’s medical record, in no order, making it difficult to search for relevant information. Therefore, there is a need for a common, unified vocabulary of the terms that adequately represent the diseased, making searching within the domain more effective. OBJECTIVE The objective of this study is to develop a domain ontology for essential hypertension , therefore arranging the more significant data within the domain as tool for medical training or to support physicians’ decision making will be provided. METHODS The terms used for the ontology were extracted from the medical history of de-identified medical records, of patients with essential hypertension. The Snomed-CT’ collection of medical terms, and clinical guidelines to control the disease were also used. Methontology was used for the design, classes definition and their hierarchy, as well as relationships between concepts and instances. Three criteria were used to validate the ontology, which also helped to measure its quality. Tests were run with a dataset to verify that the tool was created according to the requirements. RESULTS An ontology of 310 instances classified into 37 classes was developed. From these, 4 super classes and 30 relationships were obtained. In the dataset tests, 100% correct and coherent answers were obtained for quality tests (3). CONCLUSIONS The development of this ontology provides a tool for physicians, specialists, and students, among others, that can be incorporated into clinical systems to support decision making regarding essential hypertension. Nevertheless, more instances should be incorporated into the ontology by carrying out further searched in the medical history or free text sections of the medical records of patients with this disease.

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The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

Lipids in Health and Disease ◽

10.1186/s12944-021-01488-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Robert J. Sanchez ◽

Wenzhen Ge ◽

Wenhui Wei ◽

Manish P. Ponda ◽

Robert S. Rosenson

Keyword(s):

Acute Pancreatitis ◽

Medical Records ◽

Adult Population ◽

Baseline Period ◽

Prior History ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Recurrent Acute Pancreatitis ◽

History Of ◽

Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

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Chronic Endophthalmitis Caused by Pseudomonas stutzeri

Case Reports in Ophthalmology ◽

10.1159/000510129 ◽

2020 ◽

Vol 11 (3) ◽

pp. 595-599

Author(s):

Saeed T. Alshahrani ◽

J. Fernando Arevalo

Keyword(s):

Pseudomonas Stutzeri ◽

Posterior Chamber ◽

Topical Steroids ◽

Sensitivity Testing ◽

Corneal Incision ◽

Presumptive Diagnosis ◽

Lens Extraction ◽

History Of ◽

Sudden Decrease ◽

The Right

A patient presented with complaints of a sudden decrease in vision, ocular redness, and pain in the right eye. The patient had a history of clear lens extraction with intraocular lens (IOL) implantation for myopia 2 years previously. He had been prescribed topical steroids for episodes of inflammation that occurred repeatedly every 1–2 months. With a presumptive diagnosis of chronic endophthalmitis, a 23-G transconjunctival sutureless pars plana vitrectomy (PPV) with delivery of intravitreal antibiotics was performed the next day. Culture sensitivity testing of the vitreous sample indicated Pseudomonas stutzeri that was sensitive to ceftazidime and gentamicin. Two weeks later, the patient presented with sudden loss of vision and all the signs of recurrent endophthalmitis. 23-G transconjunctival sutureless PPV was performed along with removal of the posterior chamber IOL through a corneal incision. Complete resolution was only achieved after removal of the IOL, resulting in excellent visual recovery. Due to its chronic and fulminating nature, P. stutzeri can induce endophthalmitis and should be considered in the differential diagnosis. Aseptic measures are the best prevention.

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Status Epilepticus in Children With Epilepsy: The Role of Antiepileptic Drug Levels in Prevention

PEDIATRICS ◽

10.1542/peds.98.6.1119 ◽

1996 ◽

Vol 98 (6) ◽

pp. 1119-1121

Author(s):

Joseph Maytal ◽

Gerald Novak ◽

Catherine Ascher ◽

Robert Bienkowski

Keyword(s):

Status Epilepticus ◽

Antiepileptic Drug ◽

Medical Records ◽

Clinic Visit ◽

Drug Levels ◽

Progressive Encephalopathy ◽

History Of ◽

The Mean ◽

Subtherapeutic Level

Objectives. To determine the association between subtherapeutic antiepileptic drug (AED) levels or AED withdrawal and status epilepticus (SE) in children with epilepsy. Methods. We studied the AED levels at the time of SE in 51 consecutive children with epilepsy. Information about prior AED levels, possible etiology of seizures, and acute precipitants was extracted from medical records. Results. The mean age at the time of SE was 5.7 years (range, 3 months through 18 years). Forty-three patients had history of remote insult, five had history of progressive encephalopathy, and three patients were classified as idiopathic. At the time of SE all AED levels were therapeutic in 34 (66%) patients and at least one level was therapeutic in 42 (82%) patients. All levels were subtherapeutic in 9 (18%) patients. Four patients had their AED reduced or discontinued less than 1 week before SE. Twelve patients with therapeutic AED levels on their most recent clinic visit had at least one subtherapeutic level at the time of SE. Eight (16%) patients were febrile and one was hyponatremic. Of the 51 patients, 31 (61%) had no obvious explanation for the development of SE, as all known AEDs were therapeutic and there were no known acute insults. Conclusions. Neurologically abnormal children with preexisting epilepsy are at high risk for development of SE despite having therapeutic AED levels at that time. Acute precipitants of SE, such as fever or AED withdrawal, may play a role in inducing SE only in a minority of patients.

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A STUDY OF ETIOPATHOGENESIS OF MIDDLE EAR GRANULATIONS IN CHRONIC OTITIS MEDIAAND THEIR MANAGEMENT

10.36106/ijsr/0121686 ◽

2021 ◽

pp. 33-35

Author(s):

Shambhu Sharan Gupta ◽

Satish Kumar ◽

Debarshi Jana

Keyword(s):

Middle Ear ◽

Laboratory Data ◽

Topical Steroid ◽

Chronic Otitis Media ◽

Urban Background ◽

Male Preponderance ◽

History Of ◽

Chemical Cautery ◽

Rural Patients ◽

Complete History

Objective: The purpose of this study was to evaluate the etiopathogenesis of middle ear granulations in cases of Chronic Otitis Media (COM) and their management. Materials and Methods:Aprospective study was conducted on 100 patients over a period of 12 months. Patients clinically diagnosed as COM and operated, with the ndings of granulations in middle ear were included in this study. Each of these patients was subjected to complete history and thorough ENT examination after taking proper written informed consent. Clinical and laboratory data from the study was recorded as per the proforma. Results:Analysis of data revealed that maximum cases were found in the second or third decade of life with a male preponderance. Rural patients were 75% as compared to those from urban background 25%. Mucosal type of COM was found in 69% patients and squamous type in 31% patients. Maximum patients presented with history of discharge since 5-10 years, mostly mucopurulent type of discharge. Granulations were found to be present at more that one site in middle ear in most of the patients. Incus was the most commonly involved ossicle. Conservative management included chemical cautery and aural toilet followed with antibiotics with topical steroid.

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A case of nodular episcleritis mimicking a solitary giant episcleral mass

European Journal of Ophthalmology ◽

10.1177/11206721211052879 ◽

2021 ◽

pp. 112067212110528

Author(s):

Lan Zhou ◽

Juanjuan Wang ◽

Guihua Xu ◽

Dingding Wang ◽

Xiaoyi Wang ◽

...

Keyword(s):

Topical Steroid ◽

Inflammatory Cells ◽

Systemic Hypertension ◽

Eye Drops ◽

Definite Diagnosis ◽

Imaging Studies ◽

Immunohistochemical Examination ◽

History Of ◽

Inflammatory Drugs

Purpose To describe an atypical nodular episcleritis mimicking a solitary giant episcleral mass, which is not attributed to any systemic diseases and identified only after immunohistochemical examination. Case report A sixty-year-old Chinese woman with systemic hypertension presented with 6-month history of giant, solitary and redness epibulbar mass arising from the superior aspect of her left eye. The lesion gradually enlarged, even with 6-month history of irregular topical steroid eye drops treatment. Imaging studies and laboratory test revealed a 10 mm × 8 mm episcleral mass absence of any infection indicator and autoimmune antibody changes. The mass was completely removed before its extension through the deep scleral, histopathologic examination revealed a nodular episcleritis composed of various chronic inflammatory cells infiltration. Topical steroid eye drops treatment combined with oral steroidal anti-inflammatory drugs was then administrated regularly for 1 month, and no recurrence occurred after 1-year follow-up. Conclusion Nodular anterior episcleritis is characterized by underlying chronic inflammation of the anterior episclera and can be presented as asymptomatic episcleral mass. Besides a thorough investigation systemically, tissue biopsy is required for definite diagnosis.

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