A lack of insulin in the bloodstream allows unregulated fatty acid release from adipose tissue which increases fatty acid oxidation to acetyl CoA, some of which is diverted to ketogenesis. This raises ketone levels significantly above what is seen in normal physiology. Alcohol
Alcoholic ketoacidosis is caused by complex physiology that is usually the result of prolonged and heavy alcohol intake in the setting of poor nutrition. Chronic alcohol use can cause depleted hepatic glycogen stores and ethanol metabolism further impairs gluconeogenesis. This can reduce glucose availability and lead to hypoglycemia and increased reliance on fatty acid and ketone metabolism. An additional stressor such as vomiting or dehydration can cause an increase in counterregulatory hormones such as glucagon, cortisol and growth hormone which may further increase free fatty acid release and  ketone production. Ethanol metabolism can also increase blood lactic acid levels which may also contribute to a metabolic acidosis. Starvation
Starvation is a rare cause of ketoacidosis, usually instead causing physiologic ketosis without ketoacidosis. Ketoacidosis from starvation most commonly occurs in the setting of an additional metabolic stressor such as pregnancy, lactation, or acute illness. Medications
Certain medications can also cause elevated ketones, such as SGLT2 inhibitors causing euglycemic ketoacidosis. Overdose of salicylates or isoniazid can also cause ketoacidosis. Toxins
Ketoacidosis can be the result of ingestion of methanol, ethylene glycol, isopropyl alcohol, and acetone. Pathophysiology
Ketones are primarily produced from free fatty acids in the mitochondria of liver cells.
Alclometasone is a synthetic corticosteroid for topical dermatologic use, possessing anti-inflammatory, antipruritic, and vasoconstrictive properties.The prodrug alclometasone dipropionate was originally marketed under the brand name Aclovate by GlaxoSmithKline as a topical cream and ointment. However, generic versions of the drug are available. Medical uses
Alclometasone cream and ointment are indicated for the relief of corticosteroid-responsive dermatoses, including:

atopic dermatitis
eczema
psoriasis
allergic dermatitis
contact dermatitis
actinic dermatitis
kiss-type allergy
skin itchAlclometasone may be used on sensitive skin sites (face, skinfolds); in pediatric patients 1 year or older and in geriatric patients. Contraindications
hypersensitivity to alclometasone or any of ingredients in pharmaceutical forms
cutaneous tuberculosis
chicken pox
perioral dermatitis
acne
rosacea
open wounds
trophic ulcers
viral infection of skin
skin manifestations of syphilis

Side effects
Adverse reactions (sometimes, less than 1-2% cases) include:

burning
itching
erythema
skin reddening
xerodermia
skin irritation
acne
hypopigmentation
prickly heat
folliculitis
white atrophy
hypertrichosis
reinfection of skin

Pharmacology
Alclometasone induces the production of lipocortins, formally known as annexins, which inhibit phospholipase A2 – the enzyme responsible for the synthesis of arachidonic acid. Without the oxidation of arachidonic acid, eicosanoids, such as prostaglandins, thromboxanes, and leukotrienes, cant be produced. Alclometasone also inhibits the release of pro-inflammatory mediators from leukocytes (e.g., cytokines, histamine, leukotrienes, serotonin). Formulations
Alclometasone as Aclovate is supplied in:

Cream; Topical; 0.05%
Ointment; Topical; 0.05%


== References ==