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Alternative to prednisone for itching. Whether or not to use systemic corticosteroids to treat a skin disease |
- 5 Alternatives to Steroids for Eczema
Alternative to prednisone for itching -
The baffling, itchy red welts began in early fall, cropping up in odd places: on my torso why would a mosquito bite a spot that wasn't exposed? Every day or two, a new one would appear; some in clusters and others alone; some as small as pimples, but one swelling almost to the size of a ping pong ball. Finally, I went to urgent care. It took a seasoned doctor about 10 seconds to diagnose me with hives: the often-mysterious allergic reaction that affects about one-fifth of us at some time in our lives.
He prescribed an over-the-counter antihistamine, Benadryl, and a steroid, prednisone. I knew vaguely that steroids were not-to-be-taken-lightly drugs. They carry the potential for significant side effects: 'roid rage, blood sugar spikes, long-term risk of infection and bone loss. But this was a "Make it stop! The treatment worked beautifully, ending the itch and beating down the swelling within a day or two.
I never did figure out what triggered the hives. Hold The Steroids. The press release about the Annals Of Emergency Medicine study included this:. With the addition of prednisone, the relief scores were actually worse. Levocetirizine — better known by the brand name Xyzal — is a non-sedating antihistamine that lasts 24 hours.
It got federal approval earlier this year to be sold over the counter. So maybe, I wondered, I didn't need to take those slightly scary steroids after all? The French study was small -- just patients with basic hives, no puffiness of face or feet — but high quality: patients were randomly assigned to steroids or placebo, and "blind" to which they got.
On the other hand, hives can be a little scary too: They can — rarely — progress to a potentially life-threatening anaphylactic reaction. So couldn't steroids help prevent that? What does this study mean for the next time you or I see those nasty itchy red bumps breaking out? First, as always, ask your doctor if you're in any doubt: Is this hives? Should I be seen? Editorializing here, but if you can't send a smartphone photo to your primary care office, something's wrong.
Rade Vukmir. Both say the study is unlikely to shift the current standard practice of offering both an antihistamine and a steroid — and often a Pepcid or Zantac as well, which block an additional kind of histamine, Vukmir said, for a " punch.
But each found value in it nonetheless. Hsu Blatman says that for patients with relatively mild cases of hives, the study underscores the option of simply taking antihistamines at home. But if you continue to have symptoms or it doesn't seem like it's turning around, then you should be seeking medical advice. She called the study "nicely done," and further evidence that histamine is a key element in the hives allergic reaction, "so it makes sense that if you take an antihistamine, that that would help with blocking the histamine, which is what's really driving that itch.
But, I asked her, doesn't it make sense that if an allergic reaction like hives is an overreaction of the immune system, and steroids ratchet down the immune system, they should be helpful against hives? The steroid "is trying to help decrease that inflammation kind of slowly," she said.
So for patients who may have a bigger presentation, the steroids can be helpful in that way. Vukmir said the study offers more fodder for a discussion between doctors and patients as they consider the options. In the wake of the study, he said, his script might sound like this:.
You know, normally we would prescribe steroids in this situation. It's been done for years. There's a good track record. Some people get a little concerned about steroids. So there is this other alternative: There's a new study that said maybe we don't need to give steroids, in that you don't get better that much more quickly.
And we can try that approach, and I might use a higher dose of the antihistamine. He might also suggest that the patient call him if there's a problem, and that he could still phone the steroid prescription in to the pharmacy. And medicine is always trying to improve, in part by reexamining current medical dogma, as this French study did.
I'm leaning toward skipping the steroid, at least at first, if I get another hives attack. But one lingering concern: The study did find that in one patient among the 50 who got a placebo rather than a steroid, the hives progressed to an anaphylactic allergic reaction.
Vukmir said he wasn't sure the report was a full-fledged anaphylactic reaction, and in any case, there's usually good warning: The classic anaphylactic reaction, he said, typically occurs within 20 minutes, and involves a blood pressure drop or significant breathing problems. So if you're prone to hives, would you try skipping the steroid yourself? The good news is that hives usually pass on their own anyway — they're "self-limiting," in medical parlance.
The better news is that whether you take steroids or not, the risks they'll turn life-threatening are exceedingly low. And maybe the best news is that in current medical culture, you're likely to have a choice. Skip to main content. Listen Live. It's Boston local news in one concise, fun and informative email Thank you!
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❾-50%}For Hives, A New Study Suggests Many Can Skip The Steroids | WBUR News
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Ric Arseneau Dr. In a small study, lower steroid doses were required in patients with polymyalgia rheumatica and giant cell arteritis after taking leflunomide. Leflunomide is also an effective steroid-sparing option for patients with pulmonary sarcoidosis.
Another lung disease, chronic hypersensitivity pneumonitis cHP , may be treated with leflunomide in some cases. A study showed that leflunomide had a significant steroid-sparing effect—half of the patients discontinued prednisone entirely.
In patients with inflammatory diseases related to IgG4 antibodies collectively known as IgG4-related disease , leflunomide can lower the cumulative dose of steroids needed to achieve and maintain remission.
Adding leflunomide to steroid therapy can also shorten the time to complete response and maintain a longer duration of remission compared to steroids alone.
Natural remedies are not a replacement for prednisone, but they may work alongside prednisone to help fight inflammation. Antioxidants such as flavonoids and carotenoids protect tissue from damage by reactive oxygen species and other free radicals. They may have an even stronger effect when taken together.
By preventing tissue damage, these antioxidants prevent unwanted inflammatory responses from occurring. Other anti-inflammatory supplements such as omega-3 fatty acids , zinc , and turmeric curcumin fight inflammation that is already present. They provide the building blocks of natural molecules our body needs to resolve inflammation.
Avoid inflammatory foods such as margarine, corn oil, deep-fried foods, and processed food products to reduce inflammation. It is well known that refined sugar and simple carbohydrates like white four, white rice, and high fructose corn syrup contribute to chronic inflammation.
Replace these processed items with plant-based foods that are high in fiber, like fruits, vegetables, and whole grains. Staying hydrated helps our bodies clear out toxins.
When metabolic waste products and toxins accumulate in the body, they contribute significantly to inflammation. Perhaps the most obvious example of this effect is when dehydration leads to higher concentrations of uric acid, triggering a gout flare. Water also has a lubricating effect on joints. Synovial fluid provides a cushion at the joints to prevent bones from coming into contact. When we become dehydrated our synovial fluid does not provide as much lubrication.
A deficiency of synovial fluid can lead to damage and inflammation of the joints. According to a recent study , patients aiming to reduce inflammation should avoid long endurance exercise as it can contribute to chronic inflammation.
Instead, opt for moderately intense exercise with frequent resting periods. Another study in concluded that 20 minutes of moderate exercise is sufficient to produce an anti-inflammatory response. It is no secret that stress leads to many health problems. That is why rest and relaxation are key to lowering inflammation. Not sleeping enough has immediate pro-inflammatory effects. A healthy lifestyle should include eight hours of regular sleep each night. See our guide to improving sleep.
Chronic stress contributes to chronic diseases by contributing to inflammation. During this state, the body releases stress hormones cortisol and adrenaline.
It also releases pro-inflammatory molecules called cytokines. These molecules plan an important role in fighting off different forms of danger, but when they are chronically released into the body, they can wreak havoc. To combat chronic stress , practice yoga or some form of meditation. This could be as simple as writing your thoughts down in a journal, discussing your concerns with a friend, or taking a nature walk. The first step to replacing prednisone is discussing alternatives with a healthcare provider.
Prednisone should not be stopped abruptly or without medical advice. This is called a dose taper. Patients who have been on high doses or long courses of prednisone will need more gradual tapers. They carry the potential for significant side effects: 'roid rage, blood sugar spikes, long-term risk of infection and bone loss. But this was a "Make it stop! The treatment worked beautifully, ending the itch and beating down the swelling within a day or two.
I never did figure out what triggered the hives. Hold The Steroids. The press release about the Annals Of Emergency Medicine study included this:.
With the addition of prednisone, the relief scores were actually worse. Levocetirizine — better known by the brand name Xyzal — is a non-sedating antihistamine that lasts 24 hours.
It got federal approval earlier this year to be sold over the counter. So maybe, I wondered, I didn't need to take those slightly scary steroids after all? The French study was small -- just patients with basic hives, no puffiness of face or feet — but high quality: patients were randomly assigned to steroids or placebo, and "blind" to which they got. On the other hand, hives can be a little scary too: They can — rarely — progress to a potentially life-threatening anaphylactic reaction.
So couldn't steroids help prevent that? What does this study mean for the next time you or I see those nasty itchy red bumps breaking out? First, as always, ask your doctor if you're in any doubt: Is this hives? Should I be seen? Editorializing here, but if you can't send a smartphone photo to your primary care office, something's wrong. Rade Vukmir.
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How Well Do You Sleep? Corticosteroids or steroids for short are one of the most common treatments for eczema. They work by reducing inflammation and itching from eczema, which gives the skin a chance to heal. This treatment is typically recommended for short-term use only. When used longer than directed and then stopped abruptly, high potency steroid creams can cause a condition called topical steroid withdrawal syndrome.
Symptoms include: burning, stinging, and bright red skin swelling skin sensitivity pimple-like bumps papules nodules deeper bumps pustules As a result, many people seek alternatives to steroid creams for the treatment of their eczema. But there are a variety of options to consider.
Keep reading to learn about steroid-free ways to treat eczema, along with potential risks to discuss with a doctor. This steroid-free eczema treatment is applied directly to the skin. TCIs for eczema come in two forms: tacrolimus ointment Protopicused for moderate to severe eczema pimecrolimus cream Elidelused for mild to moderate eczema TCIs work by stopping the activity of certain cells in the immune system.
That helps reduce inflammation and relieve certain eczema symptoms, including itchy, discolored skin. They can also be used long term to prevent flares. TCIs are safe and well-tolerated over the short term. The most common side effect is a mild burning or stinging after applying the medication to the skin. This type of medication is relatively new, so the long-term risks are still unknown. Talk with your dermatologist or a healthcare professional about whether the benefits of this medication outweigh the risks for you.
Crisaborole Crisaborole Eucrisa is another alternative to steroids for eczema. It works by blocking the production of an enzyme that helps regulate inflammation in the skin, which can provide relief from mild to moderate eczema symptoms. This eczema treatment comes as an ointment that you apply to the skin, typically twice per day.
It can be used by both adults and children as young as 3 months old. The most common side effect of crisaborole is burning or stinging at the application site. This sensation typically goes away after you use the medication for a while.
The medication can be used continuously over the long term, or intermittently when you experience an eczema flare. Your doctor can recommend how long you should use this medication. They work by preventing a type of protein called cytokines from attaching to certain receptors in the body that cause overactivity in the immune system.
That helps reduce inflammation and reduce the severity of eczema symptoms. JAK inhibitors can be taken orally or applied as a cream directly to the skin, depending on which type your doctor prescribes.
While abrocitinib is only available to adults, updacitinib and ruxolitinib can be used in adolescents 12 years of age or older. JAK inhibitors can be very effective at reducing eczema symptoms, according to a research review.
However, there are some potential side effectsincluding: nausea swelling of the nasal passages swelling in the back of the throat headache upper respiratory tract infection Side effects with JAK inhibitors tend to be mild and get less intense over time, but you should still let a healthcare professional know if you experience any side effects. JAK inhibitors also present additional risks when used long term.
This is especially true with the oral versions of the medication. Rare but serious complications may include: heart attack and stroke blood clots certain types of cancer Because these medications suppress the immune system, you may be more likely to develop infections when using them.
Talk with a doctor about whether JAK inhibitors are the right alternative to steroids for your eczema, and discuss ways to reduce your risk of infections and other side effects. Injectable medications Eczema can now be treated with two injectable medications: dupilumab Dupixentavailable for adults and children ages 6 and up tralokinumab Adbryavailable for adults only Injectable treatments for eczema do not contain steroids.
They work by blocking overactivity in the immune system, which helps reduce inflammation. These medications come in pre-filled syringes that can be injected by your doctor or on your own at home. Redness and soreness at the injection site are common side effects, but these symptoms are usually mild.
Mild infections, including pink eye and upper respiratory tract infections, can also happen. Phototherapy In addition to oral and topical medications, light therapy phototherapy can be used to treat eczema flares without steroids. Sessions can be a few seconds to a few minutes long.
Most people with eczema will need to receive two or three phototherapy treatments every week for a few weeks or months until symptoms improve, according to the American Academy of Dermatology AAD. Phototherapy helps eczema symptoms by reducing inflammation in the skin.
It may also reduce the need to use other medications, such as steroids for eczema. The most common side effects of phototherapy are: sunburn skin tenderness premature skin aging As with any UV exposure, phototherapy may increase the likelihood of developing skin cancer with repeated exposure.
If sunlight triggers your eczema symptoms, you should avoid phototherapy. Frequently asked questions about alternatives to steroids for eczema What can I use instead of topical steroids for eczema? If you want an alternative to topical steroids for eczema, there are many options to choose from, including: nonsteroidal ointments and creams oral and topical JAK inhibitors injectable biologics phototherapy While topical steroids for eczema can cause side effects, other medications come with their own risks, as well.
Talk with your doctor about what to expect when switching eczema treatments and the pros and cons of various medications. Can eczema be treated without steroids? You may also be able to manage mild eczema symptoms without medications. What can be used instead of cortisone cream?
Nonsteroidal skin creams and ointments can be used in place of cortisone cream to treat symptoms of eczema. Crisaborole or TCIs can be used by both adults and children to help reduce inflammation and relieve itch. The takeaway Topical steroids are one of the first-line treatment options for eczema, but they can cause side effects and should only be used as directed by a healthcare professional. Fortunately, there are a variety of alternatives to steroids that can be used to treat eczema, including: TCIs crisaborole JAK inhibitors biologics phototherapy A doctor can make a specific treatment recommendation for you based on your age, treatment history, and the severity of your symptoms.
Keep in mind that every eczema treatment comes with potential risks and benefits. Talk with a healthcare professional about which eczema treatment might be right for you. How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations.
We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Share this article. Read this next.
Medically reviewed by Debra Sullivan, Ph. Here's How to Know Itchy feet?
localhost › blog › prednisone-alternatives. About Topical Steroids: TriCalm Anti-Itch is a safe, steroid-free alternative to corticosteroids, like hydrocortisone cream. "Prednisone is a strong and great drug for certain problems, but it is no better than antihistamine treatment for patients who are itching. are some prednisone alternatives. Topical calcineurin inhibitors such as tacrolimus and pimecrolimus are frequently used as alternatives to topical corticosteroids for the. Methotrexate coupons. Azathioprine is another DMARD that can reduce steroid doses in patients with inflammatory bowel disease. Tailoring therapy for type 2 diabetes: the role of incretins This app changed my practice: CCS lipid guidelines Letter from the editor What is the correct dosing for Vitamin D? Alisa Lipson Dr.By Dr. Eileen Murray on October 3, Eileen Murray MD FRCPC biography and disclosures Disclosures: Served as a consultant for the pharmaceutical industry and participated in clinical research evaluating new therapies for psoriasis and atopic dermatitis.
When I started out in dermatology, corticosteroids were the only systemic drug available to treat patients with severe allergic contact dermatitis ACD , atopic dermatitis AD , drug reactions and those with bullous diseases. Corticosteroids are potent and excellent immunosuppressive agents.
The main problem with systemic use is the high risk of drug interactions, as well as multiple serious acute and long-term side effects.
It was the belief at the time that patients treated oral corticosteroids for short periods, two weeks or less for instance were not adversely affected by treatment.
Severe ACD caused by poison ivy was the disease I treated most frequently with systemic corticosteroids. Patients were given a two-week course of oral Prednisone, 50mg daily for seven days and 25mg daily for another seven total dose of mg. Two weeks of treatment was necessary to prevent recrudescence and completely clear the eruption. The following article made me change the way I treated ACD and stimulated me to try to avoid using systemic corticosteroids when at all possible.
McKee et al 1 reported a group of male patients who had developed osteonecrosis six to thirty-three months after a single short-course of oral corticosteroids within three years of presentation.
The mean steroid dose in equivalent milligrams of prednisone was range — mg. The mean duration of drug therapy was Osteonecrosis is a known complication of systemic corticosteroid use and was initially believed to occur only in patients who received high doses equivalent to more than mg of prednisone for extended periods 3 months or longer. Each patient with ACD is instructed to apply a wet dressing 3,4 see Patient handout three times daily for 15 to 20minutes followed by the application of clobetasol propionate cream — the most potent topical corticosteroid.
The patient continues the wet dressings daily until they are no longer itchy. Soon after changing my practice, I had a series of patients with severe, generalized ACD appearing two days post surgery.
Systemic treatment would have interfered with post operative healing. All of them were treated with the topical regime and had quick relief of itching. Their ACD cleared just as quickly as those patients I had previously treated with systemic corticosteroids. Psoriasis and chronic urticaria: do not treat either of these diseases with systemic corticosteroids!
Do not treat undiagnosed skin disease or itching with systemic corticosteroids:. A young man in the middle of the night presented to the emergency with a generalized rash and severe itching; so severe he was begging for relief.
Three weeks previously he had been seen in a walk-in clinic and prescribed a one-week course of oral prednisone. A week later, no better, he saw his family physician and was given an antifungal cream. Within the week, he was seen at another walk-in clinic and given a topical corticosteroid. The rash continued to get worse culminating in his visit to emergency where he was being treated with IV Solu-Medrol and antihistamines.
He had the most severe case of pityriasis rosea PR I have ever seen. I discontinued his corticosteroids, prescribed a day course of erythromycin and a compounded cooling lotion containing 0. By then his itch had subsided. His rash cleared within five days. In this case, the initial treatment with oral corticosteroids had increased the severity of the disease so much that none of the physicians he saw subsequently were able to make a clinical diagnosis.
The etiology of PR is still not known. It may be a reaction to unknown triggers. Most cases are mild and resolve spontaneously without treatment. Recent studies have suggested an infectious etiology might be responsible. Both oral erythromycin and acyclovir have been reported to clear patients with severe disease 5. An older male patient, within hours of inadvertently ingesting one cloxacillin capsule, presented with fever, facial swelling, diffuse erythema and numerous pin-sized non-follicular pustules.
He was otherwise well. I suggested that he be admitted and observed overnight. That evening, I found an article describing a series of patients with the same presentation — an unusual and rare drug reaction designated as acute generalized exanthematous pustulosis. The good news, it resolves spontaneously within a few days. I stopped at the hospital early the next morning. I was too late; his physician had treated him with overnight with IV solu-medrol.
Treating with topical corticosteroid is sometimes as effective for skin disease as the systemic drug:. There is evidence to show that treating severe bullous diseases with potent topical corticosteroids can be as effective as treating with systemic.
Topical treatment is very much safer as very little of the drug is absorbed even with open lesions. Also, as the skin heals even less corticosteroid is absorbed. Bullous pemphigoid most common in elderly patients is now often treated with topical corticosteroids alone or in combination with high doses of tetracycline and niacinamide 6,7.
Patients who may require systemic corticosteroids include patients with severe or unresponsive disease or those intolerant to other treatment. Diseases most frequently treated include drug reactions, AD, nummular dermatitis, ACD, bullous pemphigoid and lichen planus. From: Murray Eileen, Diagnosing Skin Diseases: A diagnostic tool and educational resource for pediatricians and primary care givers. Note: Wet dressings are cool and soothing, antipruritic, and antiseptic.
They also enhance absorption of topical medications. They are the epitome of a treatment that always helps and never harms. For skin diseases with weeping or crusting a wet dressing open to the air dries the lesions.
If the skin is dry an occluded wet dressing increases moisture retention. Physicians began using wet dressings several hundred years ago. Solutions were compounded by surgeons treating wounded soldiers. Many lives were saved because the wet dressings greatly reduced the risk of infection. Karl August Burow, -a German surgeon, an inventor of both plastic surgery and wound healing techniques. Whether or not to use systemic corticosteroids to treat a skin disease.
View Results. Read More 2 Comments. The information presented here is interesting, but anecdotal. If I am to weigh the risk and benefit of offering oral steroids to my patients I need to get a sense of how likely such adverse events are.
I agree with Dr. Murray that it is important to know that this complication happens in the 50mg per day dosing range, and I thank her for her contribution — but a decision to abandon a traditional and highly effective treatment requires a better sense of absolute risk. The orthopaedic surgeon who put together the osteonecrosis case series discussed in this article sees a highly select population of those who suffer such complications.
What was the denominator? Having written perhaps prescriptions for oral steroids I have never seen this complication — although clearly that is too small a sample size to be meaningful. The next time your local Division of Family Practice gets together count heads, and years of practice, and ask how many cases of osteonecrosis secondary to oral steroids the group has seen.
I thank Dr. Scott Garrison for his thoughtful comments. Statistics are not my thing so am not able to provide a sense of absolute risk. I do think that the large cohort study by Dr. Feng-Chen Kao provides compelling evidence for the association of systemic corticosteroid use with both fracture-related arthroplasty and fracture-unrelated surgery. In a group of 21, users matched with non-users followed over 12 years, the hazard ratio HR was double for steroid users over non-users.
The HR increased with increased steroid dosage, particularly in those with fracture-unrelated arthropathy. The adjusted HR increased from 3. I think the most important point is that systemic corticosteroids are not a substitute for topical corticosteroids. They are a potent, broad-spectrum immunosuppressive agent and need to be prescribed with the same cautions you would use with any other immunosuppressive agent.
Topical corticosteroids are potent immunosuppressants but with normal use, rarely cause systemic symptoms. Our skin is an excellent barrier. I remember seeing a sixteen-year-old girl who had been prescribed clobetasol cream to treat her atopic dermatitis. It cleared her disease. However, she continued to apply it to her skin every morning after her shower to prevent the eczema from coming back.
She continued the daily treatment for a year. By that time, she had developed severe striae over her arms and legs. She was assessed by an endocrinologist and had no evidence of adrenal suppression. Notify me of followup comments via e-mail.
You can also subscribe without commenting. Whether or not to use systemic corticosteroids to treat a skin disease By Dr. Eileen Murray on October 3, Dr. What I did before When I started out in dermatology, corticosteroids were the only systemic drug available to treat patients with severe allergic contact dermatitis ACD , atopic dermatitis AD , drug reactions and those with bullous diseases.
What changed my practice The following article made me change the way I treated ACD and stimulated me to try to avoid using systemic corticosteroids when at all possible. What I do now 1. Allergic contact dermatitis: Each patient with ACD is instructed to apply a wet dressing 3,4 see Patient handout three times daily for 15 to 20minutes followed by the application of clobetasol propionate cream — the most potent topical corticosteroid.
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