Dermatoses that are steroid sensitive respond best if treated continuously with low dose daily therapy.
a) True _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ b) False _ _ _ _ _ _ _ _ _ _ Correct ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ Answer and Commentary _ _ _ _ _ _ _ _ _ _ Continuous use of topical steroids results in resistance and even acute tolerance or tachyphylaxis. The mechanism of resistance to steroids is poorly understood but is thought to be partially due to the loss of vasoconstriction ability after repeated use. It is thought that the steroids may cause release of endogenous norepinephrine from storage sites which then cause vasoconstriction. Repeated steroid use depletes these stores so that vasoconstriction is no longer effected. There may be other mechanisms as well, but what is certain is that the shorter the use, the better. Once a dermatitis is cleared with a moderately potent steroid, it should be weaned to a milder form as soon as possible and then discontinued. Try not to use more than 45 grams per week of mid-strength steroid in an adult, and over 15 grams per week in a child. ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯
