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adverse effects’ from TCS.
news about skin atrophy is that the
thickness of skin tends to return to
normal within 2 weeks of stopping a
Yet, there are significant
gaps in evidence-based guidelines
for using TCS for older people.
The majority of research investigating
TC-induced skin atrophy were trials
lasting 2–4 weeks.8 There is a paucity of
trials conducted among older people,
with multiple morbidities, using TCS
intermittently over an extended period.
Nevertheless, dermatologists seem
less concerned than they were about
TC-induced atrophy in older patients.5
Accredited pharmacists need to be
confident in their recommendations to
use TCS, while remaining focused on
minimizing exposure where possible.
Accredited pharmacists may come
across patients who have used TCSs
continuously over a long period of time.
While steroid withdrawal can induce
serious rebound adverse effects, this is
mostly seen among women when used
on the face for cosmetic purposes.9
Patients who have been using TCS for
extended periods should probably
be referred to specialist care in order
to manage any steroid withdrawal,
given the lack of evidence-based
1. Long CC, Finlay AY. The finger-tip unit—a new practical
measure. Clin Exp Dermatol. 1991;16(6):444–7 .
2. Rigby D. Pharmacy myth busters. Aust Pharm. 2016;35(7):20.
3. Haggan M. End topical corticosteroid phobia: expert. AJP
Online,15/6/2016. At: https://ajp.com.au/news/end-topical-
4. Farrugia LL, Lee A, Fischer G, Blaszcz ynski A, Carter SR, Smith
SD. Evaluation of the influence of pharmacists and GPs on
patient perceptions of long-term topical corticosteroid
use [Accepted for publication]. Journal of Dermatological
5. Dermatology Expert Group. Therapeutic Guidelines:
Dermatology Version 4 Melbourne: Therapeutic Guidelines.
6. Carlos G, Uribe P, Fernández-Peñas P. Rational use of topical
corticosteroids. Australian Prescriber 2013;36:159–61.
7. de Almeida Neto AC, Chen TF. When pharmacotherapeutic
recommendations may lead to the reverse effect
on physician decision-making. Pharm World Sci.
8. Barnes L, Kaya G, Rollason V. Topical corticosteroid-
induced skin atrophy: A comprehensive review. Drug Saf.
9. Hajar T, Leshem YA, Hanifin JM, Nedorost ST, Lio PA, Paller
AS, et al. A systematic review of topical corticosteroid
withdrawal (“steroid addiction”) in patients with atopic
dermatitis and other dermatoses. J Am Acad Dermatol.
Please review Product Information before recommending.
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Minimum Product Information: Chlorsig (chloramphenicol) eye drops (0.5%) and ointment
(1%) Indications: For the treatment of bacterial conjunctivitis. Other superficial ocular infections
caused by chloramphenicol-sensitive organisms under medical supervision only. Contraindications:
Hypersensitivity to any excipients and or/toxic reaction to the drug. Precautions: Bone marrow
hypoplasia, including aplastic anaemia and death, has been rarely reported following local application of
chloramphenicol. Chloramphenicol should not be used when less potentially dangerous agents would be
expected to provide effective treatment. Ophthalmic agents may retard corneal wound healing. Eye pain/
injury, reduced or blurred vision, severe ocular infections, contact lenses, dry eye syndrome, glaucoma,
concomitant use of other ocular medications, eye surgery or laser within the last 6 months, pregnancy
(Cat A), lactation. See full PI. Adverse Reactions: Blood dyscrasias; local irritation (itching/burning),
angioneurotic oedema; anaphylaxis, urticaria, fever, vesicular, maculopapular dermatitis. Dosage and
Administration: Eye Drops: Adults and children (2 years and over): Instil 1 or 2 drops in the affected eye(s)
every two to six hours for up to 5 days. Eye Ointment: Adults and children (2 years and over): Apply 1.5 cm
into lower eye lid of the affected eye every three hours for up to 5 days. Chlorsig is not recommended for
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