The goals of pharmacotherapy are to alleviate morbidity and prevent complications. Midpotency corticosteroids, such as triamcinolone 0.1% ointment, room generally reliable in to reduce the inflammation and also itching of acute flares that stasis dermatitis. <37, 38> However, the clinician have to be wary of utilizing high-potency subject corticosteroids in stasis dermatitis; the chronically inflamed skin can increase the threat of systemic absorption and steroid-induced cutaneous atrophy can predispose the patience to ulceration. <39, 40>

Infection is a certain concern in stasis dermatitis, since topical corticosteroids make the patient more susceptible to infection. Open excoriations and also erosions need to be treated through a topical antibiotic.

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Corticosteroids


Class Summary

These agents elicit anti-inflammatory and immunosuppressive properties.


Triamcinolone topical (Oralone, Triderm, Zytopic, Kenalog)


Triamcinolone subject is a moderate-potency steroid through anti-inflammatory properties. It treats inflammation dermatosis that is responsive to steroids. It decreases inflammation through suppressing the migrate of polymorphonuclear leukocytes and also reversing capillary permeability.



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Antibiotics, Other


Class Summary

These are provided to treat open excoriations and erosions. Apparent superficial impetiginization should be treated with topical mupirocin or a systemic antibiotic with task against Staphylococcus and also Streptococcus varieties (eg, dicloxacillin, cephalexin, cefadroxil, levofloxacin).


Bacitracin (Baci-IM, Baciguent)


Bacitracin prevents the transport of mucopeptides into the farming cell wall, which causes inhibition of bacter cell wall surface synthesis.


Bacitracin and polymyxin B (Polysporin, Polycin, AK-Poly-Bac)


Bacitracin stays clear of transfer the mucopeptides into the farming cell wall, which reasons inhibition of bacter cell wall surface synthesis. Polymyxin B damages the bacter cytoplasmic membrane and also alters permeability, resulting in intracellular ingredient to leak. This agent is offered to treat open up excoriations and erosions.


Mupirocin (Bactroban, Centany)


Mupirocin inhibits bacterial protein synthetic by binding to isoleucyl transfer-RNA synthetase.


Dicloxacillin


Dicloxacillin is offered in the treatment of infections resulted in by penicillinase-producing staphylococci. It may be used as early therapy as soon as staphylococcal epidemic is suspected.


Cephalexin (Keflex)


Cephalexin is a first-generation cephalosporin the arrests bacterial expansion by inhibiting bacter cell wall synthesis. It has actually bactericidal activity against rapidly growing organisms. It has actually primary activity against skin flora and is provided for skin epidemic or prophylaxis in boy procedures.


Levofloxacin (Levaquin)


Levofloxacin inhibits DNA gyrase and topoisomerase IV, resulting in bactericidal activity. It is provided as an alternative agent because that MRSA infection.


Cefadroxil


Cefadroxil is a first-generation semisynthetic cephalosporin the arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly cultivation organisms, including S aureus, S pneumoniae, S pyogenes, Moraxella catarrhalis, E coli, Klebsiella species, and also Proteus mirabilis.



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Topical Immunomodulators


Class Summary

These agents modify immune processes that encourage inflammation.


Pimecrolimus (Elidel cream)


Pimecrolimus is shown for eczema and atopic dermatitis. It to be the very first nonsteroid cream authorized in the United claims for mild-to-moderate atopic dermatitis. Pimecrolimus is obtained from ascomycin, a organic substance developed by fungus Streptomyces hygroscopicus var ascomyceticus.


This certified dealer selectively inhibits production and also release of inflammation cytokines from caused T cell by binding come cytosolic immunophilin receptor macrophilin-12. The resulting complex inhibits phosphatase calcineurin, thus blocking T-cell activation and also cytokine release.


Cutaneous atrophy was no observed in clinical trials, a potential advantage over object corticosteroids.


Tacrolimus ointment (Protopic) 0.1% or 0.03%


Tacrolimus reduces itching and inflammation through suppressing release of cytokines indigenous T cells. It also inhibits transcription for genes that encode interleukin (IL)–3, IL-4, IL-5, granulocyte-macrophage colony-stimulating factor (GM-CSF), and also tumor necrosis factor–alpha (TNF-alpha), all of which are involved in the beforehand stages of T-cell activation.


Additionally, tacrolimus may inhibit relax of preformed mediators from skin mast cells and also basophils and may down-regulate expression of the high-affinity IgE receptor (FCeRI) top top Langerhans cells.


Tacrolimus have the right to be provided in patients as young together 2 years. It is an ext expensive than topical corticosteroids. This agent is available as ointment in concentrations of 0.03% and also 0.1%.



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This patient exhibits the standard hyperpigmentation and varicosities that stasis dermatitis. Over there is inflammation eczematous readjust overlying the medial ankle, with healed scar from recent ulceration.
This patient v chronic stasis dermatitis exhibits classic features, such together erythema, hyperpigmentation, and dilated superficial veins mirroring poor function of the deep venous system. The problem is commonly confined to the lower leg, particularly the medial portion of the leg.
Patient with stasis dermatitis. The huge scar on the calf resulted from armed forces shrapnel. Injuries to the venous system because of trauma or surgical procedure are common factors in the advance of stasis dermatitis.
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Contributor Information and also Disclosures
author

Scott l Flugman, MDConsulting Staff, skin science Associates the Huntington, PC Scott l Flugman, MD is a member the the following medical societies: Alpha Omega Alpha, American Academy the Dermatology, American clinical Association, Phi Beta KappaDisclosure: Nothing come disclose.


Coauthor(s)

Richard A Clark, MDProfessor that Biomedical Engineering, Dermatology and also Medicine, Stony Brook University; manager of Burn, Nonscar Healing program RCCC, equipped Forces institute of Regenerative medication Richard A Clark, MD is a member the the complying with medical societies: American Association for the advancement of Science, American culture for Clinical Investigation, Alpha Omega Alpha, Wound heal Society, American Academy of Allergy Asthma and also Immunology, American Academy that Dermatology, association of Clinical Scientists, brand-new York Academy that Medicine, culture for Investigative DermatologyDisclosure: Nothing come disclose.

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Dirk M Elston, MDProfessor and also Chairman, department of Dermatology and also Dermatologic Surgery, medical University of south Carolina college of medicine Dirk M Elston, MD is a member that the complying with medical societies: American Academy of DermatologyDisclosure: Nothing come disclose.


Acknowledgements

Jeffrey Meffert, MD Assistant Clinical Professor that Dermatology, college of Texas school of medication at san Antonio

Jeffrey Meffert, MD is a member of the complying with medical societies: American Academy the Dermatology, American clinical Association, combination of military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing come disclose.

Jean-Hilaire Saurat, MD Chair, Professor, room of Dermatology, college of Geneva, Switzerland

Jean-Hilaire Saurat, MD is a member the the following medical societies: American Academy that Dermatology, American Dermatological Association, and culture for Investigative Dermatology

Disclosure: Nothing come disclose.

Richard ns Vinson, MD Assistant Clinical Professor, room of Dermatology, Texas tech University health Sciences Center, Paul l Foster school of Medicine; Consulting Staff, mountain View Dermatology, PA

Richard p Vinson, MD is a member the the following medical societies: American Academy of Dermatology, combination of army Dermatologists, Texas Dermatological Society, and also Texas clinical Association