Topical corticosteroids withdrawal (sometimes called “topical steroid addiction” or “Red Skin Syndrome”) appears to be a clinical adverse effect that can occur when topical corticosteroids are inappropriately used or overused, then stopped. It can result from prolonged, frequent, and inappropriate use of moderate to high potency topical corticosteroids, especially on the face and genital area, but is not limited to these criteria. In reviewing the studies that were used for the systematic review, it is thought that adult women who blush easily are a population particularly at risk. Very few cases have been reported in children, but no large-scale studies have attempted to quantify the incidence. Thus, continued vigilance and adherence to a safe, long-term treatment plan developed in conjunction with your dermatology provider is advised.
It is important to note that fluoridated water may be consumed from sources other than the home water supply, such as the workplace, school and/or day care, bottled water, filtered water and from processed beverages and foods prepared with fluoridated water. For this reason, dietary fluoride supplements should be prescribed by carefully following the recommended dosage schedule. Dietary fluoride supplements are not recommended for children residing in a community with adequate levels of fluoride in the water supply.
The ADA’s dietary fluoride supplement recommendations remain unchanged in light of the new guidelines for community water fluoridation in the . released in April 2015 by the . Public Health Service. 19 The recommendation for fluoride levels in drinking water was reconsidered in 2015 when it was determined that milligrams of fluoride per liter of water ( ppm) was optimal. The new recommendation, which was supported by the ADA, does not change the ADA Council on Scientific Affairs’ systematic review and clinical recommendation for the use of dietary fluoride supplements that was released in 2010.
Formulations of topical diclofenac, ibuprofen, ketoprofen, piroxicam, and indomethacin demonstrated significantly higher rates of clinical success (more participants with at least 50% pain relief) than matching topical placebo (moderate or high quality data ). Benzydamine did not. Three drug and formulation combinations had NNTs for clinical success below 4. For diclofenac, the Emulgel® formulation had the lowest NNT of (95% CI to ) in two studies using at least 50% pain intensity reduction as the outcome . Diclofenac plasters other than Flector® also had a low NNT of ( to ) based on good or excellent responses in some studies. Ketoprofen gel had an NNT of ( to ), from five studies in the 1980s, some with less well defined outcomes. Ibuprofen gel had an NNT of ( to ) from two studies with outcomes of marked improvement or complete remission. All other drug and formulation combinations had NNT values above 4, indicating lesser efficacy .