Topical steroids have been both extensively used and found to be very effective for the treatment of eczema. Concerns about side effects both on the skin and systemically has increased acceptance of the new steroid free alternative. Worries about long term use of a cortisone cream making the skin less responsive to treatment is a potential risk and is occasionally a concern. This may not occur with the topical immunomodulators but longer term studies will be needed to confirm this.
The new topical immunomodulators (TIMS) provide a significant new choice in the treatment of atopic eczema. They are used as a steroid-sparing medications. There is a discussion whether the immunomodulators should be used alone as monotherapy. Good evidence is available to show that using a potent topical cortisone twice a week only will reduce and may prevent eczema flares. If this was combined with intermittent use the immunomodulators this might further reduce flares. However some TIMs may reduce flares on their own.
For locations such as the face, folds and anterior upper chest the topical immunomodulators seem to be effective, well tolerated and free of significant side effects other than initial and minimal burning.
The following charts simplify some of the anti-inflammatory options:
Thyroid storm is a life-threatening condition of the hyperthyroid state. 26 It most commonly occurs in patients with Graves' disease but may also occur in those with multinodular goiter or toxic adenoma. 27 It is treated by correcting the hyperthyroidism and treating the precipitating events. 26 Correction of the hyperthyroid state involves using drugs such as propylthiouracil or methimazole (Tapazole), beta blockers or corticosteroids, which decrease the peripheral effects of thyroid hormone and the conversion of thyroxine (T 4 ) to the more potent triiodothyronine (T 3 ). 22 , 26 Dexamethasone can be used for that purpose, at a dosage of 2 mg intravenously every six hours, and can eventually can be switched to an oral dosage of 2 mg every six hours. 28