In patients with the adrenogenital syndrome, a single intramuscular injection of 40 mg every two weeks may be adequate. For maintenance of patients with rheumatoid arthritis , the weekly intramuscular dose will vary from 40 to 120 mg. The usual dosage for patients with dermatologic lesions benefited by systemic corticoid therapy is 40 to 120 mg of methylprednisolone acetate administered intramuscularly at weekly intervals for one to four weeks. In acute severe dermatitis due to poison ivy, relief may result within 8 to 12 hours following intramuscular administration of a single dose of 80 to 120 mg. In chronic contact dermatitis, repeated injections at 5 to 10 day intervals may be necessary. In seborrheic dermatitis, a weekly dose of 80 mg may be adequate to control the condition.
Treatment is difficult. Due to the intensity of the itch patients often go from doctor to doctor looking for relief. No one treatment is always effective and several treatments may need to be tried. Initial treatment is often potent prescription steroid creams . If these help, a milder cream can be used for longer-term control. Antihistamine creams (Zonalon, Pramoxine) or pills (Atarax, Periactin) are often added for additional relief. Intralesional steroid injections , anti-depressant pills, and non-prescription capsaicin cream helps many of those not improved with the usual treatment.
As previously indicated, it is imperative for the head and neck surgeon to properly identify the type of scar as a wound contracture, hypertrophic scar, or keloid as this information will dictate the most effective form of treatment. A scar contracture can be identified by its restrictive nature as well as its confinement to the area of trauma and its lack of fibrous tissue outgrowths. Keloids and HTSs, on the otherhand, all have some degree of fibrous outgrowth. HTSs remain with the confines of the wound and typically decrease in size over time as op-posed to keloids, which may have phases of quiescence followed by reactivation and enlargement.