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topical corticosteroids

  • AVOID high potency or super-potent preparations on areas of thin skin such as the face, flexures, scrotum and eyelids
  • Take great care when using in occlusive dressings, in children (do not use on nappy region as occluded dressing) and, in the elderly
  • Should NOT be used on denuded skin
  • AVOID long periods of Rx - no longer than 2 wks on the face and 3-4 wks elsewhere - longer treatments should have steroid-free breaks of a few days to a week to reduce tachphylaxis.
  • Should NOT be used for infected skin, acne rosacea, acne vulgaris or perioral dermatitis
  • AVOID more than 45g/week of potent or more than 100g/wk of moderately potent steroid to minimise systemic effects in adults.
  • AVOID potent steroids in pregnancy as systemic absorption may cause fetal abnormality in animal studies
  • Most applications can be daily or bd, but where it is wiped off, may require more frequent applications

general usage guidelines

  • lotions are preferred for children (as more permeable skin), on hairy skin and for extensive areas but require shaking
  • creams are less greasy than ointments, easy to spread and washable in water
  • ointments provide the highest drug penetration and increase the potency
  • whole body application requires 30-40g per application!
  • one hand application requires 0.3g per application

adverse effects

  • skin atrophy with possible scarring and ulceration
  • increased skin transparency and brightness
  • telangectasia
  • striae
  • easy bruising
  • delayed wound healing
  • faster spread of skin infections
  • hypopigmentation
  • glaucoma if used near the eye
  • contact hypersensitivity to preservatives
  • tachyphylaxis
  • systemic effects if extensive skin areas

classification based upon potency

super-potent - class 1 USA / UK

  • 0.05% betamethasone dipropionate as ointment in optimised vehicle
  • 0.05% clobetasol propionate

high potency - class 2/3 USA, class II UK

  • 0.05% betamethasone dipropionate ointment
  • 0.1% betamethasone valerate ointment
  • 0.1% mometasone furoate ointment or cream
  • the best option for chronic, hyperkeratotic, lichenified or indurated lesions such as:
    • palmo-plantar psoriasis
    • lichen planus
    • lichen simplex chronicus

moderate potency - class 4/5 USA, class III UK

  • 0.05% betamethasone dipropionate cream or lotion
  • 0.05% betamethasone valerate ointment or cream
  • 0.1% triamcinolone acetonide cream
  • 0.1% methylprednisolone aceponate ointment, cream or lotion
  • 0.05% clobetasone cream
  • the best option for:
    • psoriasis other than intertriginous
    • adult atopic dermatitis
    • nummular eczema

low potency

  • 0.5% or 1% hydrocortisone or hydrocortisone acetate
  • 0.05% desonide
  • the best option for areas of thin skin such as:
    • children's atopic dermatitis
    • seborrheic dermatitis
    • intertriginous psoriasis
    • other intertrigos
corticosteroids.txt · Last modified: 2019/06/01 14:50 (external edit)