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Consider using the oral steroid Prednisone for severe contact dermatitis. It can also be used to treat temporal arteritis patients and Bell's palsy patients.
Herpes simplex is a common cause cause of Bell's palsy in young people (cultured from 7th nerve). The diagnosis of Bell's palsy is typically thought of as a diagnosis of exclusion.1,2 Recent studies show compelling evidence that the herpes simplex virus may be a common cause of this "idiopathic" facial palsy. As early as the 1970s, Adour suggested a link between Bell's palsy and the herpes simplex virus.3 Since that time, there have been a plethora of studies attempting to link herpes simplex virus to Bell's palsy.4,5,6,7 The evidence seems to weigh heavily that many so-called idiopathic cases may be caused by reactivation of the herpes virus. A study by Murakami has further enhanced the belief that herpes simplex plays a critical role. Murakami was able to utilize senstive polymerase chain reaction techniques to isolate hepres virus DNA from the facial nerve during the acute phase of the palsy. His research found that HSV-1 genomes were detected in 11 of 14 (79%) patients with Bell's palsy but not in patients with herpes zoster oticus or in controls.5 If you have a Bell's palsy patient who is not an older person with diabetes or hypertension, then consider treatment with a combination prednisone and acyclovir.
Predisone has so many potential side effects--making it a "necessary evil drug." It does a lot of good for patients, but can have many side effects. Dr. Grogg recalls a thyroid eye disease patient she treated with steroids for 3-4 weeks. The woman's "moon" face (a part of Cushing's syndrome) happened within that timeframe. Patients get better on steroids, but may feel lousy.
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Contact dermatitis with allergic conjunctivitis |
Oral Steroid Use
Precautions are advised in patients with peptic ulcer disease, TB, active infection, psychosis, or pregnancy. Oral steroids can be used cautiously with patients who have peptic ulcer disease but who don't have an active peptic ulcer. Do this in conjunction with the patient's physician. Do not, however, prescribe oral steroids for patients with active peptic ulcers.
Side effects of oral steroid use include (among others): Hyperglycemia, hypokalemia, hypertension, peptic ulcer, increased IOP, cataract, pseudotumor cerebri (PTC), mental status changes, osteoporosis, decreased wound healing, and fluid retention.
Dosage varies widely; the main concern is not using enough. For allergic responses, pulse therapy works well (60-80 mg x 3-4 days). Available in 1, 2.5, 5, 10, 20, 50mg.
For a normal-sized person, Dr. Grogg typically prescribes 60 mg for 3-4 days. Pulse dosing works well for contact dermatitis. You don't need to taper if only using for 3-4 days. For a very large patient, she might go up to 80 mg, but that's unusual.
When doing a taper such as in treating thyroid eye disease patients, give 10 mg tabs out and calculate taper. The doctors at the IU Health Center don't use the Metero dose packs because the only therapeutic dose is given the first day; the rest are subtherapeutic dosages.
References:
- Skorin L: How to Tell Bell's from the Masqueraders. Review of Optometry 2003 May;140:05;www.revoptom.com.
- Ahmed A: When is facial paralysis Bell palsy? Current diagnosis and treatment. Cleveland Clinic Journal of Medicine 2005 May;72(5):398-405.
- Adour KK, Bell DN, Hilsinger Jr RL: Herpes simplex virus in idiopathic facial paralysis (Bell Palsy). JAMA 1975;233(6):527-530.
- Adour KK, Ruboyianes JM, et al: Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a dobule-blind, randomized, controlled trial. Ann Otol Rhinol Laryngol 1996 May;105(5):371-378.
- Murakami S, Mutsuhiko M, et al: Bell Palsy and Herpes Simplex Virus. Annals of Internal Medicine 1996 January;124(1):27-39.
- Hadar T, Tovi F, Sidi J, et al: Specific IgG and IgA antibodies to herpes simplex virus and varicella zoster virus in acute peripheral facial palsy patients. J Med Virol. 1983;12(4):237-245.
- Kaygusuz, et al: The role of viruses in idiopathic peripheral facial palsy and cellular immune response. American Journal of Otolaryngology 2004 November-December;25(6):401-406.
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