Because steroids are lipophilic, they diffuse easily through the cell membranes, and therefore have a very large distribution volume. In their target tissues, steroids are concentrated by an uptake mechanism which relies on their binding to intracellular proteins (or " receptors ", see below). High concentration of steroids are also found in adipose tissue, although this is not a target for hormone action. In the human male, adipose tissue contains aromatase activity, and seems to be the main source of androgen-derived estrogens found in the circulation. But most of the peripheral metabolism occurs in the liver and to some extent in the kidneys, which are the major sites of hormone inactivation and elimination, or catabolism (see below).
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.
Radiofrequency Ablation is an outpatient procedure, a small area of nerve tissue is heated to decrease pain signals from that procedure is conducted under guided imaging. A needle is inserted at the offending nerve site, then an electrical current produced by a radio wave is used for the heat-and-destroy mission. The chronic pain relief lasts for a relatively long period, from six to nine months. This is a big advance because it is very localized, very specific, pain treatment. It’s not a cure-all, but it can really make a difference in specific cases. Facet joints of the spine are particularly responsive to this technique.