Long-term continuous therapy with topical corticosteroids should be avoided, irrespective of age. Adrenal suppression can occur, even without occlusion. In view of the high efficacy and potency of Nerisone Forte it is suggested that treatment for one or two weeks should generally be sufficient to obtain control of even the most refractory lesion, after which a change to Nerisone can usually be made if further therapy is necessary.
Since prolonged therapy with potent topical corticosteroids may cause local atrophic changes such as striae, thinning, hypertrichosis and telangiectasia, particularly in skin folds and where occlusive dressings are used, it is recommended that the progress of patients under treatment for more than one week with Nerisone Forte be reviewed weekly, and that repeat prescriptions be written only when the prescribing physician has seen the patient again.
Topical corticosteroids may be hazardous in psoriasis for a number of reasons including rebound relapses following development of tolerance, risk of generalised pustular psoriasis, and local and systemic toxicity due to impaired barrier function of the skin.
Careful patient supervision is important in psoriasis. Since absorption is increased with the use of occlusive dressings, these should not be left on for more than 24 hours. If secondary infection occurs during treatment, the use of occlusive dressings should be stopped until the infection has been eliminated, and appropriate treatment of the infection should be instituted if it persists.
Exacerbation of skin infections may occur. Infections or secondarily infected dermatoses require additional therapy with antibiotics or chemotherapeutic agents. This treatment can often be topical, but for heavy infections systemic antibacterial therapy may be necessary.
If fungal infections are present, a topically active antimycotic should be applied. If aggravation of skin irritation develops with the use of Nerisone, treatment should be withdrawn and appropriate therapy installed. Allergic contact dermatitis due to topical corticosteroids and excipients can occur.
In these cases eczema fails to improve or deteriorates with treatment. Corticosteroid hypersensitivity occurs most frequently among patients with stasis dermatitis and leg ulceration. Such an observation should be corroborated with appropriate diagnostic patch testing.
The appropriate corticosteroid concentration and the choice of the vehicle is crucial in detecting corticosteroid hypersensitivity in patch tests. Patients with an allergy to corticosteroids may cross-react to several corticosteroids to which they have not previously been exposed.
After topical application, allergies to cross-reacting systemically applied corticosteroids may occur. g. after large dosed or extensive application over a prolonged period, occlusive dressing technique or application to the skin around the eyes).