Topical Corticosteroids

Vehicles

  • Ointment - water suspended in oil for dry,thick,hyperkeratotic affected areas like feet, palms,eczema

  • Cream - oil suspended in water for moist intertriginous areas

  • Lotion - powder in water for exudative lesions, hairy areas, large surface areas, pruritic areas

  • Solution - water bases for exudative lesions, hairy areas

  • Gel - oil in water emulsion with alcohol for exudative lesions, hairy areas, scalp

  • Foam - aerosolized matrix of liquid film for inflamed skin,scalp,rectum

Diseases

  • atopic dermatitis -multifactorial skin condition characterized by pruritus and scratching, exacerbations and remissions, family history, clinical 6+ weeks, skin lichenification and presence of dry skin

  • contact dermatitis - skin inflammation from a exogenous agent directly or indirectly characterized by wet edematous lesions in acute phase or dry, thickened, scaly lesions in chronic phase

  • seborrheic dermatitis - chronic skin disease characterized by yellowish, greasy scales over erythematous patches or plaques commonly in scalp, face, external auditory canal

  • psoriasis - chronic systemic skin disorder characterized by bumpy red patches, covered with white scales commonly on scalp, knees, and lower back

  • Hemorrhoids - groups of large inflamed hemorrhoidal vessels that project into lumen during defecation

  • Vitiligo - loss of skin color appearing in blotches due to melanocytes cell death or loss of function

  • Lichen planus - purple pruritic, flat-topped bumps

  • Lichen sclerosis - thin white patches of skin usually in genital area

Classifications

very high class 1

scalp psoriasis, moderate to severe plaque psoriasis

high class 2

eczema flares, scalp psoriasis, moderate to severe plaque psoriasis

Augmented betamethasone dipropionate 0.05% gel/lotion/ointment

Clobetasol propionate 0.05% foam/solution/lotion/cream/ointment/shampoo/spray

Fluocinonide 0.1% cream

Augmented betamethasone dipropionate 0.05% cream

Betamethasone dipropionate 0.05% ointment

Clobetasol propionate 0.025% cream

Fluocinonide 0.05% gel/solution/cream/ointment

Mometasone furoate 0.1% ointment

Triamcinolone acetonide 0.5% cream/ointment

Medium Class 3-5

moderate eczema, trunk or scalp seborrheic dermatitis

low class 6-7

mild eczema or at face/skin folds, mild plaque psoriasis, psoriasis on face or intertriginous areas, face or intertriginous or trunk seborrheic dermatitis

Betamethasone dipropionate 0.05% spray/lotion/cream

Mometasone furoate 0.1% lotion/cream

Fluocinolone acetonide 0.25% cream/ointment and 0.01% shampoo

Fluocinonide 0.05% cream

Triamcinolone acetonide 0.1%, 0.025% lotion/cream/ointment and 0.147 mg/gm spray

Desonide 0.05% foam/gel/lotion/cream/ointment

Fluocinonides acetonide 0.01% cream/solution

Hydrocortisone 0.5%, 1%, 2%, 2.5% spray/lotion/cream/ointment

  • Class 1 - very high potency, used as alternative to systemic for small areas for < 2-3 continuous weeks

  • Class 2 - high potency, used for conditions with severe inflammation for < 8 continuous weeks

  • Class 3 -5 - medium potency, used for moderate inflammation for < 8 continuous weeks

  • Class 6-7 - low potency, used for mild inflammation and can be used chronically and for thin-skinned areas/patients

    • face, intertriginous areas (underarms, breast folds, urogenital area, folds of knees & elbows, between fingers & toes)

    • Babies, Children, Elderly >65

Dosing

  • Frequency 1-2 times/day or week or alternate day

  • contraindications - bacterial infections , impetigo, furuncles/carbuncles, cellulitis

  • Cutaneous ADRs - steroid acne, skin atrophy, hypopigmentation, telangiectasis, striae-stretch marks, purpura, hypertrichosis, rosacea-appearing eruption

  • Counseling Points

    • Administer by washing affected area and pat dry, then squeeze small amount of cream or ointment to apply a thin layer of medication to the area, massage until it disappears, apply after bathing when skin moist

    • Dispensing - include location of application, frequency, duration, apply with or without occlusive dressing. discuss potential cutaneous and systemic side effects

      • Occlusive dressing - designed to enhance penetration and prevent scratching of skin, but may cause maceration and bacterial or fungal infections. Limit to 12 hours per day