Steroid responsive encephalopathy review

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  • Citation tools Download this article to citation manager Cohen Steven P , Hanling Steven , Bicket Mark C , White Ronald L , Veizi Elias , Kurihara Connie et al. Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study BMJ 2015; 350 :h1748
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    The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.

    Because steroids are lipophilic, they diffuse easily through the cell membranes, and therefore have a very large distribution volume. In their target tissues, steroids are concentrated by an uptake mechanism which relies on their binding to intracellular proteins (or " receptors ", see below). High concentration of steroids are also found in adipose tissue, although this is not a target for hormone action. In the human male, adipose tissue contains aromatase activity, and seems to be the main source of androgen-derived estrogens found in the circulation. But most of the peripheral metabolism occurs in the liver and to some extent in the kidneys, which are the major sites of hormone inactivation and elimination, or catabolism (see below).

    Treatment
    Treatment is centered around immunosuppression.  Most dogs respond quickly to corticosteroids.  I typically start with prednisone at 1-2 mg/kg BID depending on severity.  Most dogs are significantly improved within 1-2 weeks and can be slowly weaned off the steroids over the course of 8-10 months.  In rare cases, other immunosuppressive medications (., azathioprine, cytarabine, cyclosporine) are needed to achieve remission or to help alleviate the annoying adverse effects of prednisone. Pain medications, GI protectants and general supportive care (., using a harness instead of a collar, elevated food/water bowls) may be needed.

    Steroid responsive encephalopathy review

    steroid responsive encephalopathy review

    Treatment
    Treatment is centered around immunosuppression.  Most dogs respond quickly to corticosteroids.  I typically start with prednisone at 1-2 mg/kg BID depending on severity.  Most dogs are significantly improved within 1-2 weeks and can be slowly weaned off the steroids over the course of 8-10 months.  In rare cases, other immunosuppressive medications (., azathioprine, cytarabine, cyclosporine) are needed to achieve remission or to help alleviate the annoying adverse effects of prednisone. Pain medications, GI protectants and general supportive care (., using a harness instead of a collar, elevated food/water bowls) may be needed.

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