Chapter 1 Alert by Dr. Kligman
Steroid Addiction
By AM. Kligman, PJ. Frosch published in the International Journal of Dermatology, Volume 18(1979) Issue 1, Pages 23 - 31
Steroid addiction was introduced for the first time in 1979 in the paper Dr. Kligman wrote for the International Journal of Dermatology. Dr. Kligman is a renowned authority in the dermatological field and it might be surprising for dermatologists to know that he was the first person who wrote about the addiction observed when topical corticosteroids are applied for patients with atopic dermatitis (AD).
The paper begins with the description of side effects of topical corticosteroids already known in those days, such as epidermal/dermal atrophy, striae, telangiectasia and depigmentation in black people. Then comes “steroid addiction” in the following context.
----- Excerpt -----
Steroid addiction is a more subtle and more insidious type of side reaction. It is common but is not high in medical consciousness because it frequently goes unrecognized. Hence, it is underreported and not well characterized.
----- End of excerpt -----
Dr. Kligman then listed actual examples of steroid addiction including steroid rosacea, perioral dermatitis, steroid acne, and pruritus/intertrigo at the anal areas, vulva or genitals.
----- Excerpt -----
Rebound can occur in any chronic dermatosis which has been under long term treatment with topical steroids, seborrheic dermatitis and atopic eczema are the most frequent examples in our experience. All too commonly the rebound flare is taken nonchalantly as part of the up and down course of the disease, almost an expected event. If the rebound is severe, a more potent steroid will often be prescribed, regrettably initiating the phase of steroid escalation. Close inspection will most often show that the flare has different characteristics than the basic dermatosis—cracking, pustulation, intense redness are clues. Atrophy may suggest overuse, but the patient is generally addicted by that time.
----- End of excerpt -----
Topical corticosteroids were found to be effective drugs for AD treatment by Dr. Sultzburger in 1952, and it was 22 years later that Dr. Kligman wrote the present paper. Though another 36 years have passed since then, the problem of steroid addiction or flare rebound is still considered a negative phase of AD treatment as of 2010 in Japan, and is not even referred to in the JDA guideline as if mentioning it was a taboo. Therefore, there appeared a young.
Japanese dermatologist who declared on his clinic website as follows: ”Topical steroid application will never cause steroid addiction and rebound flare. It’s a flat lie originated by folk medicine practitioners who try to cash in on what is called “atopic business.”
Steroid addiction or rebound as a result of long-term use of topical corticosteroids is the word proposed to give warning by dermatologists who noticed such a phenomenon in the 1970s. It is not the word conveniently created by folk medicine practitioners or those who are engaged in “atopic business.”
Steroid Addiction
By AM. Kligman, PJ. Frosch published in the International Journal of Dermatology, Volume 18(1979) Issue 1, Pages 23 - 31
Steroid addiction was introduced for the first time in 1979 in the paper Dr. Kligman wrote for the International Journal of Dermatology. Dr. Kligman is a renowned authority in the dermatological field and it might be surprising for dermatologists to know that he was the first person who wrote about the addiction observed when topical corticosteroids are applied for patients with atopic dermatitis (AD).
The paper begins with the description of side effects of topical corticosteroids already known in those days, such as epidermal/dermal atrophy, striae, telangiectasia and depigmentation in black people. Then comes “steroid addiction” in the following context.
----- Excerpt -----
Steroid addiction is a more subtle and more insidious type of side reaction. It is common but is not high in medical consciousness because it frequently goes unrecognized. Hence, it is underreported and not well characterized.
----- End of excerpt -----
Dr. Kligman then listed actual examples of steroid addiction including steroid rosacea, perioral dermatitis, steroid acne, and pruritus/intertrigo at the anal areas, vulva or genitals.
----- Excerpt -----
Rebound can occur in any chronic dermatosis which has been under long term treatment with topical steroids, seborrheic dermatitis and atopic eczema are the most frequent examples in our experience. All too commonly the rebound flare is taken nonchalantly as part of the up and down course of the disease, almost an expected event. If the rebound is severe, a more potent steroid will often be prescribed, regrettably initiating the phase of steroid escalation. Close inspection will most often show that the flare has different characteristics than the basic dermatosis—cracking, pustulation, intense redness are clues. Atrophy may suggest overuse, but the patient is generally addicted by that time.
----- End of excerpt -----
Topical corticosteroids were found to be effective drugs for AD treatment by Dr. Sultzburger in 1952, and it was 22 years later that Dr. Kligman wrote the present paper. Though another 36 years have passed since then, the problem of steroid addiction or flare rebound is still considered a negative phase of AD treatment as of 2010 in Japan, and is not even referred to in the JDA guideline as if mentioning it was a taboo. Therefore, there appeared a young.
Japanese dermatologist who declared on his clinic website as follows: ”Topical steroid application will never cause steroid addiction and rebound flare. It’s a flat lie originated by folk medicine practitioners who try to cash in on what is called “atopic business.”
Steroid addiction or rebound as a result of long-term use of topical corticosteroids is the word proposed to give warning by dermatologists who noticed such a phenomenon in the 1970s. It is not the word conveniently created by folk medicine practitioners or those who are engaged in “atopic business.”
Dr. Albert M. Kligman (Picture from the on-line New York Times)
Dr.Kligman acquired the medical license in 1947 and was engaged in research for many years as a professor of Department of Dermatology, University Pennsylvania (90 years or so at present)
Dr.Kligman acquired the medical license in 1947 and was engaged in research for many years as a professor of Department of Dermatology, University Pennsylvania (90 years or so at present)