"Steroid fatigue" as reason for derm treatment failure?

RE: "Steroid fatigue" as reason for derm treatment failure?

David Scarff — Wed, 04 Nov 2020 11:16:37 GMT

I have heard of this as a concept, and seems particularly popular in the US. However I would agree with Judith that most cases of steroid failure represent other causes, and in my caseload usually represents secondary skin fold infection (ears, lips, feet, anal sacs) involving either bacterial or yeast overgrowth / infection.

RE: "Steroid fatigue" as reason for derm treatment failure?

Judith Joyce — Mon, 19 Oct 2020 17:24:17 GMT

I have only heard of this in a list of putative causes of steroid ineffectiveness in lectures. Agree with Clive that, far more likely there is another complicating factor, either subsequent to use of steroids as he lists (also calcinosis cutis in iatrogenic HAC sometimes presents as pruritus before grossly visible lesions) or separately, in my experience most commonly flea bite dermatitis.

RE: "Steroid fatigue" as reason for derm treatment failure?

Sarah Keir — Fri, 16 Oct 2020 11:45:22 GMT

Never heard of steroid fatigue. Being a medic, I have patients that have been on considerable doses for months or even years in some rare cases.

RE: "Steroid fatigue" as reason for derm treatment failure?

Clive Ansell — Fri, 16 Oct 2020 10:09:31 GMT

Not heard of it before.

I think if corticosteroids are working less well than they were, I would reevaluate the diagnosis and look for secondary or coexisting disease before rushing to change to another c/s. In dermatology I would want to exclude bacterial or malassezia infection, and ectoparasites. Demodex for example.

I've seen many cases now where dogs have been on preds for ages, with varying degrees of waxing and waning success, usually without a diagnosis because of cost constrains. Many of these have improved dramatically since Bravecto came on to the block.