corticosteroids
corticosteroids
also known as glucocorticosteroids
see also:
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
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:
-
adult atopic dermatitis
nummular eczema
low potency
corticosteroids.txt · Last modified: 2019/06/01 14:50 (external edit)