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This chapter reviews important agents for treatment of skin disorders: topical corticosteroids, antihistamines, antimicrobials, and topical agent medical bases or vehicles.

Systemic Corticosteroids

Urticaria, angioedema, Toxicodendron dermatitis (rhus, poison ivy, or poison oak), and other contact or allergic disorders are potential indications for systemic corticosteroids. Other dermatologic syndromes, such as erythema multiforme, toxic epidermal necrolysis, and vasculitis, are best treated with systemic steroids only after consultation with a dermatologist. In one study, small bursts of prednisone (40 milligrams daily for 4 days) markedly reduced the pruritus and hastened the clinical improvement of urticaria.1 Patients with poison ivy or oak eruptions who require systemic steroids should be treated with oral prednisone (1 milligram/kg body weight) with a slow 2- to 3-week taper. Other contact or allergic dermatitides may benefit from an abbreviated course (4 days) of oral prednisone. However, oral corticosteroids are relatively contraindicated, or must be used with great care, in those with diabetes, hypertension, active peptic ulcer disease, psychiatric disease, and immunodeficiency. Follow-up within 2 to 3 days with the primary care physician or a dermatologist is needed if oral corticosteroids are prescribed to patients with these comorbidities.

Topical Corticosteroids

Topical corticosteroids are powerful and useful tools in the management of dermatologic disease. Numerous agents are available for use. They differ in concentration, base components, and cost. Familiarity with a single agent in each potency class is sufficient to treat any steroid-responsive skin ailment safely and effectively. Corticosteroid potency or strength (i.e., the anti-inflammatory property) is measured by the agent’s ability to induce vasoconstriction. Agents’ strengths are rated by vasoconstricting ability on a scale of 1 to 7, with lower scale numbers correlating with more potent corticosteroids: group 1 agents are the most powerful corticosteroids, and group 7 medications are the least potent (Table 244-1).

Table 244-1 Listing of Topical Corticosteroid Agents by Potency Group*

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