The Australasian College of Dermatologists
Recommendations from the Australasian College of Dermatologists on leg cellulitis, epidermal cysts, urticaria, distorted toenails & acne, advice on systemic non-sedating antihistamines and topical corticosteroids for skin conditions. The Australasian College of Dermatologists (ACD) is the sole medical college accredited by the Australian Medical Council for the training and continuing professional development of medical practitioners in the specialty of dermatology. As the national peak membership organisation, we represent over 550 dermatologist Fellows (FACD) and 100 trainees. We are the leading authority in Australia for dermatology, providing information, advocacy and advice to patients, communities, government and other stakeholders on skin health and dermatological practice.
7.
Do not routinely prescribe or recommend topical steroids Class II and above on the face including periorbital areas, or flexural areas of skin (axilla/groin and natal cleft).
Topical steroids Class II and above (see classes and potency rankings) should not be used on the on the face including periorbital areas, or flexural areas of skin (axilla/groin and natal cleft) except under Dermatologist supervision. Such treatment should be brief and intermittent as topical treatments can cause striae, telangiectasia, pigmentary changes, permanent facial erythema, steroid acne, perioral dermatitis, hypertrichosis and superinfection.
Systemic treatments usually under the care of a Dermatologist are suggested for treating patients with side effects from chronic or repeated use of potent topical steroids. Patients using such treatments should cease application immediately and avoid triggering factors. In cases where it is difficult to stop topical steroids abruptly, it is suggested that patients begin a chosen systemic treatment and to taper off the concentration and strength of the topical steroids used.
Supporting evidence
- Hameed AF 2013. Steroid Dermatitis Resembling Rosacae: A Clinical Evaluation of 75 Patients. ISRN Dermatol. 2013 Apr 21;2013:491376
- Coondoo A, Phiske M, Verma S and Lahiri K. 2014. Side-effects of Topical Steroids: A Long Overdue Revisit. Indian Dermatol Online J. 2014 Oct;5(4):416-25
- Daniel BS and Orchard D. 2015. Ocular Side-Effects of Topical Corticosteroids: What a Dermatologist Needs to Know. Australas J Dermatol. 2015 Aug;56(3):164-9
- Sharma R, Abrol S and Wani M. 2017. Misuse of Topical Corticosteroids on Facial Skin. A Study of 200 Patients. J Dermatol Case Rep 2017 Mar 31;11(1):5-8
- Australasian College of Dermatologists. 2020. Consensus statement: Topical corticosteroids in paediatric eczema. 2020 Jun. Available at https://www.dermcoll.edu.au/about/position-statements/
How this list was made
College’s Expert Advisory Committee, comprising seven longstanding Fellows considered four potential recommendations, together with supporting evidence, and agreed to proceed with three of them. The Committee then refined and finalised the recommendations. These were reviewed by the NPS Representatives Committee and finalised in response to the feedback received.
- 1 Do not assume that bilateral redness and swelling of both lower legs is due to infection unless there is clinical evidence of sepsis such as malaise, fever and neutrophilia, plus an expanding area of redness or swelling over a period of hours to days.
- 2 Do not routinely prescribe antibiotics for inflamed epidermoid cysts (formerly called sebaceous cysts) of the skin.
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3
Acute urticaria (i.e. of less than 6 weeks duration) does not routinely require investigation for an underlying cause. Where clinical history and examination suggest the possibility of a bacterial infection or food as a likely trigger, further testing may be warranted. If individual lesions (weals) persist for longer than 24 hours an alternative diagnosis may need to be considered.
- 4 Do not prescribe topical or systemic anti-fungal medication for patients with thickened, distorted toenails unless mycological confirmation of a dermatophyte infection has been obtained.
- 5 Monotherapy for acne with either topical or systemic antibiotics should be avoided.
- 6 Do not recommend that patients take systemic non-sedating antihistamine for itchy rashes, i.e. eczema, psoriasis. Non-sedating antihistamines can be prescribed for urticaria according to the ASCIA guidelines.
- 7 Do not routinely prescribe or recommend topical steroids Class II and above on the face including periorbital areas, or flexural areas of skin (axilla/groin and natal cleft).
- 8 Review your diagnosis and/or treatment/adherence if patient has not responded to adequate prescribed topical steroids after two weeks.