For Health Professionals

References:

Topical steroids side-effects and withdrawal

1. Topical corticosteroid addiction and withdrawal – An overview for GPs.

Australian Family Physician Volume 45, No.6, June 2016 Pages 386-388.

2. Steroid withdrawal effects following long-term topical corticosteroid use. Dermatitis: 7/8 2018 - Volume 29 - Issue 4 - p 213-218

"Patients with a history of long-term TCS overuse may experience symptoms and signs described in TSW on stopping TCSs. Diagnostic criteria, reflecting the histories and examination findings of the patients studied, are suggested in this article with the aim to advance discussion and research into TSW."

3. Side-effects of Topical Steroids: A Long Overdue Revisit. Indian Dermatology Online Journal. 2014 Oct;5(4):416-25. Arijit Coondoo 1Meghana Phiske 2Shyam Verma 3Koushik Lahiri 4

"The introduction of topical steroids (TS) of varying potency have rendered the therapy of inflammatory cutaneous disorders more effective and less time-consuming. However the usefulness of these has become a double edged sword with constantly rising instances of abuse and misuse leading to serious local, systemic and psychological side effects. These side effects occur more with TS of higher potency and on particular areas of the body like face and genitalia. The article reviews the side effects of TS with special mention about peadiatric age group, also includes the measures for preventing the side effects."

4. The Challenges of Topical Steroid Withdrawal  Peter A. Lio M.D. Practical Dermatology Clinical Focus. September 2015. 

5. The role of corticosteroids in dermatology Michael Lee, Robin Marks. Experimental and Clinical Pharmacology Aust Prescr 1998;21:9-11.

"Corticosteroids are extremely useful in the treatment of skin disorders. Topical applications are mainly used as the drug is delivered directly to the target organ. The dose can easily be titrated according to response. Intralesional and systemic corticosteroids are warranted in certain circumstances. The newer generation of corticosteroids have improved efficacy, but are not entirely free of adverse reactions. For maximum benefit and minimal adverse effects, various factors have to be taken into account, including the nature of the disease, age of the patient, site affected, and the pharmacology of the corticosteroids and the vehicle."

6. For more information on Topical Steroid Withdrawal Syndrome Support and it's symptoms visit ITSAN.org 

Skin Barrier, Staph infection and Eczema.

1. The role of Staphylococcus aureus in atopic eczema: treatment strategies

Journal of the European Academy of Dermatology and Venereology.

Volume 7, Supplement 1, July 1996, Pages S31-S37.
" Atopic eczema arises as a result of the interaction of environmental factors with an abnormal immune system in a genetically predisposed individual. Also the skin of patients with atopic eczema carries high levels of Staphylococcus aureus, which correlate with the severity of the eczema. Staphylococcus aureus releases a toxin with superantigenic actions which initiates a vicious circle in atopic eczema. Therapy of atopic eczema will be more effective if it breaks the vicious circle at two points. Topical steroids inhibit the action and production of pro-inflammatory mediators breaking the circle at one point. Intensive emollient therapy and antibiotic/steroid combinations reduce the number of Staphylococcus aureus and the penetratioin of the toxins through the skin, thereby breaking the circle at a second point.

Conclusion Using the approach of reducing both the effects of cytokines and of superantigens, it is possible to reduce the potency and quantity of topical steroids applied and therefore their cutaneous adverse effects."

2. Exploring the Role of Staphylococcus AureusToxins in Atopic Dermatitis

Seiti Yamada Yoshikawa F, Feitosa de Lima J, Notomi Sato M, Álefe Leuzzi Ramos Y, Aoki V, Leao Orfali R. Toxins (Basel). 2019;11(6):321. Published 2019 Jun 5. doi:10.3390/toxins11060321

"Atopic dermatitis (AD) is a chronic and inflammatory skin disease with intense pruritus and xerosis. AD pathogenesis is multifactorial, involving genetic, environmental, and immunological factors, including the participation of Staphylococcus aureus. This bacterium colonizes up to 30–100% of AD skin and its virulence factors are responsible for its pathogenicity and antimicrobial survival. This is a concise review of S. aureus superantigen-activated signaling pathways, highlighting their involvement in AD pathogenesis, with an emphasis on skin barrier disruption, innate and adaptive immunity dysfunction, and microbiome alterations."

Studies on Essential oils 

1. Investigations of kanuka and manuka essential oils for in vitro treatment of disease and cellular inflammation caused by infectious microorganisms. 

Journal of Microbiology, Immunology and Infection. Vol 48, Issue 1, February 2016, pages 104-111.

Results

"Multiple analyses of microorganism growth confirmed that both essential oils significantly inhibited four fungi and the four bacteria. The potent fungicidal properties of the oils were confirmed by minimum inhibitory concentrations ranging from 0.78% to 3.13%. The oils also showed excellent bactericidal qualities with 100% inhibition of the examined bacteria. In THP-1 cells, both oils lowered tumor necrosis factor-α released after lipopolysaccharide stimulation. Finally, the antimicrobial and anti-inflammatory effects of the oils were obtained without adversely affecting the immune system."

2. Commercial Essential Oils as Potential Antimicrobials to Treat Skin Diseases.

Orchard A, van Vuuren S. Commercial Essential Oils as Potential Antimicrobials to Treat Skin Diseases. Evid Based Complement Alternat Med. 2017;2017:4517971. doi:10.1155/2017/4517971

3. Antimicrobial Activity of Some Essential Oils—Present Status and Future Perspectives Sonam ChouhanKanika Sharma, and Sanjay Guleria

. 2017 Sep; 4(3): 58.

"Moreover, the development of resistance to different antimicrobial agents by bacteria, fungi, viruses, parasites, etc. is a great challenge to the medical field for treating the infections caused by them, and hence, there is a pressing need to look for new and novel antimicrobials. "

Studies on Propolis

1. Propolis: A new frontier for wound healing? 

Martinotti S, Ranzato E. Propolis: a new frontier for wound healing?. Burns Trauma. 2015;3:9. Published 2015 Jul 22. doi:10.1186/s41038-015-0010-z

"Propolis is a resin produced by honeybees by mixing wax, pollen, salivary secretions, and collected natural resins.

The precise composition of propolis varies with the source, and over 300 chemical components belonging to the flavonoids, terpenes, and phenolic acids have been identified in propolis. Moreover, its chemical composition is subjected to the geographical location, botanical origin, and bee species.

Propolis and its compounds have been the focus of many works due to their antimicrobial and anti-inflammatory activity; however, it is now recognized that propolis also possesses regenerative properties."

2. Comparison of Propolis Skin Cream to Silver Sulfadiazine: A Naturopathic Alternative to Antibiotics in Treatment of Minor Burns.

Gregory, Scott & Piccolo, Nelson & Piccolo, Maria & Piccolo, Monica & Heggers, John. (2002). Comparison of Propolis Skin Cream to Silver Sulfadiazine: A Naturopathic Alternative to Antibiotics in Treatment of Minor Burns. Journal of alternative and complementary medicine (New York, N.Y.). 8. 77-83. 10.1089/107555302753507203.

3. Antioxidant Potential of Propolis, Bee Pollen, and Royal Jelly: Possible Medical Application

"Honeybees products comprise of numerous substances, including propolis, bee pollen, and royal jelly, which have long been known for their medicinal and health-promoting properties. Their wide biological effects have been known and used since antiquity. Bee products are considered to be a potential source of natural antioxidants such as flavonoids, phenolic acids, or terpenoids."

Compounded items that may help with Atopic Dermatitis and TSW: PEA capsules 300mg and/or topical cream containing PEA 1.5% 

1.N-palmitoylethanolamine and N-acetylethanolamine are effective in asteatotic eczema: results of a randomized, double-blind, controlled study in 60 patients.

Chao Yuan, Xue-Min Wang, [...], and Philippe Humbert. Journal Clinical Interventions in Aging. 17 July 2014 Volume 2014:9 Pages 1163—1169.

"In a model of passive immunoglobulin E-induced cutaneous anaphylaxis, researchers found that PEA and AEA are both bioactive signaling lipids capable of downregulating inflammation in the skin. In the immune system, PEA could downmodulate activation of skin mast cells and inhibit release of histamine, prostaglandin D2, and tumor necrosis factor alpha."

2. Efficacy of ultra‐micronized palmitoylethanolamide in canine atopic dermatitis: an open‐label multi‐centre study

Chiara Noli et al.Vet Dermatol 2015; 26: 432–e101

"The micronised-PEA effect on pruritus was the primary outcome in this study and was statistically significant. Nearly 80% of dogs improved in the first month. This is similar to previous findings for ciclosporin and better than results reported with tepoxalin and misoprostol, the latter achieving reductions of pruritus in 46% and 64% of dogs, respectively. In the present study we observed a 36% reduction in the mean pruritus score, lower than that of prednisolone and higher than antihistamines.

The success rate of the study was around 60% (i.e. 71 out of 122 dogs showed a >2 cm reduction of their pruritus score from baseline, this representing a shift to a lower severity class).

This study concluded that micronised-PEA decreased pruritus to normal levels in almost one third of atopic dogs."

The individual daily dose for analysed dogs was 10.9 mg/kg (range 6.4–25.0, median 10.7).

3. Adjuvant treatment of atopic eczema: assessment of an emollient containing N‐palmitoylethanolamine (ATOPA study) B. Eberlein et al. JEADV 20 December 2007

"This study showed substantial relief of objective and subjective symptoms of atopic eczema after regular skin care with the study cream containing PEA. The patient‐related effectiveness (decline of pruritus and loss of sleep) indicated a gain in quality of life in these patients. The reduced use of topical corticosteroids is important in view of safety and pharmacoeconomic implications in the treatment of atopic eczema."