Systemic corticosteroids can reactivate tuberculosis and should not be used in patients with a history of active tuberculosis, except when chemoprophylaxis is instituted concomitantly. The incidence or course of acute bacterial infection are probably minimally affected by inhaled triamcinolone. Application of topical corticosteroids to areas of infection, including tuberculosis of the skin, should be initiated or continued only if the appropriate antiinfective treatment is instituted. If the infection does not respond to the antimicrobial therapy, the concurrent use of the topical corticosteroid should be discontinued until the infection is controlled.
Complications arise when pruritus is accompanied by intense scratching. Lichen simplex chronicus is a localized skin thickening, often appearing over the posterior neck, extremities, scrotum, vulva, anus, and buttocks. In prurigo nodularis, a variant of lichen simplex chronicus, 10- to 20-mm nodules develop over areas within easy scratching reach, such as the extensor arms and legs. 11 Prurigo nodularis has been successfully treated with a cream containing percent capsaicin (Zostrix) applied topically four to six times per day for two to eight weeks). 39 [Evidence level B, nonrandomized clinical studies] Impetigo may result from superinfected excoriations, as commonly occur in patients with atopic dermatitis. 7 , 9