Looking for:
Top prednisone alternatives and how to switch your Rx.Whether or not to use systemic corticosteroids to treat a skin disease - This Changed My Practice |
Alternative to prednisone for itching
For Hives, A New Study Suggests Many Can Skip The Steroids | WBUR News - Topical calcineurin inhibitors
Topical corticosteroids have been used to treat inflammatory skin conditions such as eczema and atopic dermatitis for more than 50 years. As anti-inflammatories, they reduce redness and swelling, suppress the immune system and constrict blood vessels in the skin. Topical steroids are divided into seven groups based on their potency levels, ranging from Group I most potent to Group VII least potent. A common Group VII corticosteroid is hydrocortisone. It is chemically similar to cortisol, which is a hormone produced by your body.
The chance and severity of side effects of topical steroids depend on the dose, type of steroid and length of treatment. Long-term use of topical steroids may result in unwanted side effects such as. Steroid-free topical treatments such as TriCalm deliver effective itch relief without the unwanted side effects of steroids and they are safe to use as often as needed. In fact, TriCalm hydrogel is clinically shown to significantly reduce itch intensity and duration, without the use of steroids.
Learn more about steroid use. Enter your email address below and we'll send you a personalized coupon code. Home Steroid Free. Steroid Free What are topical steroids? Risks with topical steroid use The chance and severity of side effects of topical steroids depend on the dose, type of steroid and length of treatment.
Benefits of going steroid free Steroid-free topical treatments such as TriCalm deliver effective itch relief without the unwanted side effects of steroids and they are safe to use as often as needed. Before you go Email Address: field is required. Email Address is Required.
❾-50%}Alternative to prednisone for itching
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? Enter your email address below and we'll send you a personalized coupon code.
Home Steroid Free. Steroid Free What are topical steroids? Risks with topical steroid use The chance and severity of side effects of topical steroids depend on the dose, type of steroid and length of treatment. Benefits of going steroid free Steroid-free topical treatments such as TriCalm deliver effective itch relief without the unwanted side effects of steroids and they are safe to use as often as needed. Before you go These side effects may be particularly problematic for patients who have pre-existing risks or health conditions such as osteoporosis, heart failure, hypertension, diabetes, glaucoma, or cataracts.
Despite its side effects, prednisone is an effective treatment for many diseases and might not always have a suitable replacement. In many cases, however, an adjunct agent can be used with prednisone to reduce the strength and duration of prednisone therapy. This article will discuss prednisone alternatives and steroid-sparing treatments that can reduce the dose of prednisone for patients with specific conditions.
The table below lists common therapies that can replace prednisone or can be used as an adjunct therapy to reduce the cumulative dose of prednisone. Some common uses, side effects, and dosing regimens are listed for each agent.
Other corticosteroid-responsive conditions: 0. Transplant rejection: 0. Rheumatic disorders: 0. Heart or liver transplant: 1.
SLE: Loading dose of mg by mouth daily x 3 days. Juvenile idiopathic arthritis: mg by mouth once daily based on weight Leflunomide coupons Other alternatives to prednisone Remicade infliximab Enbrel etanercept Humira adalimumab Tocilizumab Dupixent dupilumab for severe asthma Fasenra benralizumab Cinqair reslizumab Xolair omalizumab Lupkynis voclosporin NSAIDs Patients with arthritis may be able to use NSAIDs instead of prednisone if their disease activity is not too severe.
NSAIDs are not as effective as steroids for the treatment of arthritis, but if symptoms are adequately controlled with NSAIDs, patients may not need to take oral corticosteroids. Common over-the-counter anti-inflammatory drugs for arthritis include ibuprofen , naproxen , and diclofenac gel.
It is important to seek advice from your pharmacist or healthcare provider when using over-the-counter treatments in conjunction with prescriptions as certain drug interactions may occur. Dexamethasone is a suitable alternative to prednisone for the treatment of acute asthma. In general, dexamethasone is better tolerated and requires a shorter course of therapy five days of prednisone versus one to five days of dexamethasone.
Dexamethasone is approximately six times as potent as prednisone, and a single dose is longer acting. Therefore, fewer doses are required compared with prednisone. A study in showed that two days of dexamethasone had similar efficacy to five days of prednisone and patients on dexamethasone had better compliance and fewer side effects. A study in also demonstrated that two doses of dexamethasone are as effective as five days of prednisone in children with asthma exacerbation admitted to the emergency department.
A meta-analysis in concludes that dexamethasone is associated with less vomiting compared to prednisone when used for asthma exacerbations. Finally, dexamethasone is available in more dosage forms than prednisone.
While prednisone is only available as an oral tablet, dexamethasone is available as a tablet or solution, and can be injected via the intravenous, subcutaneous, or intramuscular route. Methotrexate is used as a steroid-sparing agent for many diseases. It is common to use DMARDs like methotrexate to reduce prednisone doses and allow for earlier discontinuation of prednisone.
Methotrexate is considered a steroid-sparing treatment for many forms of arthritis such as giant cell arteritis, juvenile idiopathic arthritis , rheumatoid arthritis, systemic lupus erythematosus, polymyalgia rheumatica, etc. Methotrexate is also commonly used as a steroid-sparing agent in the treatment of uveitis. Methotrexate may be a viable steroid-sparing agent for myasthenia gravis , although azathioprine is better studied and more commonly used for this purpose.
A study demonstrated that patients with myasthenia gravis who are treated with methotrexate had significant improvement in disease activity and reduced prednisone dosages.
Two studies demonstrated that lupus patients taking mycophenolate and voclosporin could achieve clinical response while using much lower doses of oral prednisone. In fact, these two trials had the lowest peak steroid doses and faster steroid tapering than any other lupus nephritis trial. In patients with lupus without renal involvement, mycophenolate was shown to be superior to azathioprine when combined with steroids, and thus may be a better option than azathioprine for reducing prednisone doses.
Mycophenolate can be used to reduce steroid use in many different inflammatory and immune diseases other than lupus. Mycophenolate has similar steroid-sparing effects as methotrexate when used for uveitis. In a head-to-head study comparing mycophenolate and azathioprine for the treatment of pemphigus, patients taking mycophenolate required significantly lower steroid dose to achieve clinical remission compared to patients taking azathioprine.
Mercaptopurine may be a great option to reduce prednisone doses in patients with inflammatory bowel disease. The brand name of mercaptopurine is Purinethol. Azathioprine is another DMARD that can reduce steroid doses in patients with inflammatory bowel disease.
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 ACDatopic dermatitis ADdrug 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 ACDatopic dermatitis ADdrug 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.
localhost › blog › prednisone-alternatives. About Topical Steroids: TriCalm Anti-Itch is a safe, steroid-free alternative to corticosteroids, like hydrocortisone cream. Several years back, I found a homeopathic cream manufactured by Boericke and Tafel called Florasone that helps ease the discomfort of rashes and. Dexamethasone is a corticosteroid indicated for allergic states, dermatologic diseases, endocrine disorders, gastrointestinal diseases, hematologic disorders. "Prednisone is a strong and great drug for certain problems, but it is no better than antihistamine treatment for patients who are itching. Mary V. Dexamethasone, methotrexate, mycophenolate, mercaptopurine, azathioprine, and leflunomide are some prednisone alternatives. A healthy lifestyle should include eight hours of regular sleep each night. Shirley Sze Dr. Share this article. Paul Thiessen Dr. Keep in mind that every eczema treatment comes with potential risks and benefits.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! You can try subscribing here or try again later. Play Listen Live.
No comments:
Post a Comment