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Steroid phobia

Parents are reluctant to use topical steroids on their child's eczema because of unfounded fears about their side effects based on evidence from the 1960s, according to a consensus statement by 20 Australasian paediatric dermatologists issued this month.

Steroid phobia was based on old research that involved prolonged application of topical steroids under dressings applied to flexural areas. More recent data showed no evidence of skin atrophy with routine long-term use of topical steroids in children with eczema, the statement said.

However, according to the dermatologists, pharmacists were still issuing warnings about skin atrophy, with a recent study by one of the authors showing two-thirds (67%) of pharmacists told patients not to use topical steroids for more than two weeks at a time.

The misinformation meant children were commonly having to live with unnecessary and prolonged exacerbations of eczema, despite there being a highly effective treatment that had minimal adverse effects, they said.

"The advice given by dermatologists to parents of children with eczema regarding the use of topical steroids is unfortunately frequently undermined by other health professionals," they wrote in the Australasian Journal of Dermatology.

24 March, 2015
Michael Woodhead

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General Information

Monkeypox (MPXV)
Monkeypox is a viral infection that causes a rash. It is spread by skin-to-skin contact with someone who has monkeypox. Most people recover within a few weeks.

Since May 2022, there has been a global increase in monkeypox cases reported from multiple countries where monkeypox is not usually seen. Most of the cases are in men who have sex with men.

The situation with monkeypox in NSW is changing rapidly. While most cases have been acquired overseas, a small number may have acquired their infections in Australia.

What are the symptoms?
Symptoms usually begin 7-14 days after exposure. This can be as short as a few days or as long as 21 days.

Monkeypox symptoms may include:

rashes, pimple-like lesions or sores, particularly in areas that are hard to see such as the genitals, anus or buttocks. and on the face, arms and legs.
ulcers, lesions or sores in the mouth
People can experience fever, headache, muscle aches, backache, swollen lymph nodes, chills and/or exhaustion prior to the rash or lesions developing
The lesions start as a flat red rash that develops into pustules, which then form crusts or scabs and fall off.

How does monkeypox spread?
Monkeypox mainly spreads from one person to another by direct skin-to-skin contact. It may be spread by breathing in droplets breathed out by someone who has monkeypox during prolonged close contact, but this is rare. It can also be spread through contact with infected bodily fluids or contaminated objects, such as bedding or clothes.

Monkeypox may be passed on during sex. It is not known how long the monkeypox virus remains present in semen and other genital excretions. People who have monkeypox should abstain from sex for the duration of their infection. People who have recovered from monkeypox should use condoms when engaging in sexual activity for 8 weeks after recovery.

People with monkeypox are infectious from the time they first get symptoms until all the lesions have crusted, the scabs have fallen off and a fresh layer of skin has formed underneath.

Who is at risk of monkeypox?
Most people are not at risk of monkeypox.

People at highest risk are men who have sex with men, particularly those who are travelling to outbreak areas, have multiple sexual partners or attend large parties or sex on premises venues.

To date most people with monkeypox in Australia have been infected while overseas. However, some people have been infected in Australia following contact with people who have recently travelled overseas.

How is monkeypox prevented?
Stay alert for symptoms and take steps to prevent infection
Vaccination is only one way to prevent monkeypox infection.

As there is still a risk of infection following vaccination, it's still important to take steps to reduce the chance of catching or spreading monkeypox.

Prevent the spread of monkeypox
Avoid close contact with people who have monkeypox.
Events such as parties or clubs where there is less clothing worn, and therefore a higher likelihood of direct skin-to-skin contact, carry risk of monkeypox exposure. Avoid any rashes or sores you see on others and minimise skin-to-skin contact.
Exchange contact information with your sexual partners to assist with contact tracing if needed.
Avoid contact with any materials, such as bedding or towels, that may have been in contact with an infected person.
Practise good hand hygiene. Wash your hands with soap and water or use an alcohol-based hand sanitiser.
Monitor for symptoms
Men who have sex with men who are returning from known outbreak hotspots such as Europe and North America should monitor for signs or symptoms of monkeypox, particularly those who have attended dance parties, sex parties, saunas, or sex on premises venues.
Check yourself for symptoms before you leave home. If you feel unwell or sick, or have any rashes or sores, do not attend events or venues.
If signs or symptoms develop, self-isolate immediately and seek care by calling ahead to make an appointment with your local GP or sexual health clinic.
Limit sexual partners for three weeks following your return from overseas.

Take action if you are exposed
If you are advised that you are a close contact of someone with confirmed monkeypox, self-isolate immediately and call your GP or sexual health clinic. If you have questions about monkeypox, contact the NSW Sexual Health Infolink on 1800 451 624.
If you are caring for someone with monkeypox, use personal protective equipment (PPE), including gloves and a N95 mask.
Use a condom during sex for at least 8 weeks after you recover from monkeypox.

Smallpox vaccines can provide protection against monkeypox because the two viruses are closely related. NSW Health has secured limited supplies of a new vaccine against smallpox (JYNNEOS) which has fewer side effects than previous smallpox vaccines and can be safely used by all groups of people, including those who are immunocompromised.

NSW Health have begun vaccinating people at highest risk from monkeypox.

Doctors and other community partners are identifying people who are most at risk from monkeypox to receive a vaccine as supplies of vaccine become available. Many people will not be eligible during the initial rollout. NSW Health is working to ensure the most vulnerable people access the vaccine first.

NSW Health expects to receive a further 30,000 doses at the end of September and 70,000 doses in early 2023.

NSW Health will provide more information about eligibility and access to the vaccine at that time.

How is monkeypox diagnosed?
Diagnosis depends on the doctor suspecting monkeypox in someone who has monkeypox symptoms. Infection can be confirmed by testing the blister fluid or scabs from the skin rash.

How is monkeypox treated?
The illness typically lasts for 2−4 weeks and is mild. Most people with monkeypox only need regular over-the-counter pain medicines and oral fluids and can be monitored by their GP or treating clinician. A few people may need supportive management such as intravenous fluids and treatment to control fever or pain.

There are antiviral medications available that may help to treat people with severe illness.

What is the public health response?
Doctors, hospitals and laboratories must notify any suspected cases to the local public health unit immediately. Public health unit staff will initiate a public health investigation, contact tracing and control measures.

Further information
If you think you might have symptoms of monkeypox, please call ahead to your GP or local sexual health clinic. Wear a mask when attending the clinic.

If you have questions about monkeypox, contact the NSW Sexual Health Infolink on 1800 451 624.

Source: www.health.nsw.gov.au

The information in the above were collected from the internet,
either from government websites or from reasonably reliable health information sources.
They are for general information only and should not replace the need of seeking medical care during illnesses.

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