Corticosteroids in dermatology

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Editor, – I refer to the article 'The role of corticosteroids in dermatology'(Aust Prescr1998;21:9-11). I am particularly interested in:

- the role of corticosteroids in chloasma

- the use of high-dose corticosteroids in acute allergic contact dermatitis- benefit-risk analysis.

L.I. Mokhothu
Maseru, Lesotho

Professor R. Marks, one of the authors of the article, comments:
There is no role for corticosteroids in the treatment of chloasma.

There is no formal benefit-risk analysis on the use of high-dose corticosteroids in acute allergic contact dermatitis. I am presuming that Mr Mokhothu is referring to high-dose corticosteroids given orally. However, there are plenty of data showing that high-dose corticosteroids, whether used topically or systemically, will reduce the inflammatory response of an acute allergic contact dermatitis. There are also data showing that short-term use of systemic corticosteroids is not normally associated with any major risk unless there are some other underlying conditions in which systemic corticosteroid use is contra indicated e.g. tuberculosis. In the absence of any contraindications, when the allergen is known and is able to be avoided, some people believe that the use of high-dose corticosteroids systemically is warranted to assist in rapid resolution of the acute inflammatory response.