Corticosteroids (Topical)

Uses

Corticosteroids (topical) are effective anti-inflammatory preparations used to control eczema/dermatitis and many other skin conditions.

Corticosteroids (topical), or topical steroids, are effective anti-inflammatory medications prescribed to treat rashes, eczema, and dermatitis, as well as other skin conditions. They are classified into seven different groups, and whenever possible, the weakest topical steroid that is still effective should be the one that is used.

Group I (Very potent. The strongest class of topical steroids, up to 600 times stronger than hydrocortisone)

Clobetasol propionate 0.05% (Dermovate)
Betamethasone dipropionate 0.25% (Diprolene)
Halobetasol proprionate 0.05% (Ultravate, Halox)
Diflorasone diacetate 0.05% (Psorcon)

Group II

Fluocinonide 0.05% (Lidex)
Halcinonide 0.05% (Halog)
Amcinonide 0.05% (Cyclocort)
Desoximetasone 0.25% (Topicort)

Group III

Triamcinolone acetonide 0.5% (Kenalog, Aristocort cream)
Mometasone furoate 0.1% (Elocon ointment)
Fluticasone propionate 0.005% (Cutivate)
Betamethasone dipropionate 0.05% (Diprosone)

Group IV

Fluocinolone acetonide 0.01-0.2% (Synalar, Synemol, Fluonid)
Hydrocortisone valerate 0.2% (Westcort)
Hydrocortisone butyrate 0.1% (Locoid)
Flurandrenolide 0.05% (Cordran)
Triamcinolone acetonide 0.1% (Kenalog, Aristocort A ointment)
Mometasone furoate 0.1% (Elocon cream, lotion)

Group V

Triamcinolone acetonide 0.1% (Kenalog, Aristocort cream, lotion)
Fluticasone propionate 0.05% (Cutivate cream)
Desonide 0.05% (Tridesilon, DesOwen ointment)
Fluocinolone acetonide 0.025% (Synalar, Synemol cream)
Hydrocortisone valerate 0.2% (Westcort cream)

Group VI

Prednicarbate 0.05% (Aclovate cream, ointment)
Triamcinolone acetonide 0.025% (Aristocort A cream, Kenalog lotion)
Fluocinolone acetonide 0.01% (Capex shampoo, Dermasmooth)
Desonide 0.05% (DesOwen cream, lotion)

Group VII (The weakest class of topical steroids)

Hydrocortisone 2.5% (Hytone cream, lotion, ointment)
Hydrocortisone 1% (Many over-the-counter brands)

The type of topical steroid used is based on the diagnosis and body location. In general, weaker topical steroids are used on thin-skinned and sensitive areas, especially areas like the armpit, groin, buttock crease, breast folds. Weaker steroids are also used on the face, eyelids, diaper area, perianal skin,the groin or body folds. Moderate steroids are used for atopic dermatitis, nummular eczema, asteatotic dermatitis, lichen sclerosis, scabies, severe dermatitis. Stronger steroids are used for psoriasis, lichen planus, discoid lupus, chapped feet, lichen simplex chronicus, severe poison ivy, alopecia areata, nummular eczema, and severe atopic dermatitis in adults.

Dosing

A topical steroid is often prescribed to be used on a week on, week off routine. Some recommend using the topical steroid for 3 consecutive days on, followed by 4 consecutive days off. Weak topical steroid are reserved for the eyelids, facial skin, body folds, axillae, groin, genitals, and perineal region. Moderate topical steroids are used in wider unoccluded parts of the body like the trunk, arms, and legs. Strong topical steroids are used in limited skin areas to minimize systemic side effects. They are indicated for thick-skinned areas like the palms, soles of feet, and certain dermatitis such as lichen planus and psoriasis of the limbs.

Topical steroids should only be applied to the areas affected by the skin disease, and generally only once or twice daily, or as otherwise as sparing as possible. The fingertip unit -- a standard way to measure the amount of steroid you should be using to treat skin inflammation -- is useful in determining how much lotion, cream, or other dosage should be used.

Side Effects

If used correctly, topical steroids are safe and rarely cause side effects. However, the use of Corticosteroids (topical) may cause some side effects, which can include raised blood pressure, fluid retention, diabetes and suppression of the adrenal gland, which may result in the patient becoming ill when trying to come off the steroid treatment. Other side effects may include atrophy (irreversible thinning of the skin), tearing, bruising, stretch marks, rash around the mouth, glaucoma, and telangiectasia (enlarged blood vessels in the skin).

Abrupt withdrawal of these medications can lead to aggressive recurrence of the condition. Moreover, overuse may cause dermatitis.

Notes of Precaution

Use the least potent steroid possible to control the inflammation.

Only apply the steroid to areas of skin affected by the skin disease.

Only use the steroid as often as prescribed by your doctor – no more than once or twice a day.

Apply the steroid sparingly.

Wherever possible, avoid using steroids for long periods of time and on large areas of skin.

Once the inflammation is under control, reduce or stop using the steroid. Use moisturisers to help prevent flare-ups.

Never use a topical steroid as a moisturiser.

Women who are pregnant or breastfeeding should not use topical steroids unless advised to do so by their physician.

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Corticosteroid medications — including cortisone, hydrocortisone and prednisone — are used to treat a variety of conditions, from rashes to lupus to asthma.

Corticosteroids are drugs that closely resemble cortisol, a hormone that your adrenal glands produce naturally. Corticosteroids are also referred to as \"steroids,\" but should not be confused with the male hormone-related steroid compounds that some athletes abuse. Corticosteroids include medications such as cortisone, methylprednisolone, and the most commonly used prednisone, which is used to treat certain rheumatologic diseases.

Steroids work by decreasing inflammation and reducing the activity of the immune system, reducing skin damage. Low doses of steroids might provide significant relief from pain and stiffness for people with rheumatoid arthritis. Other skin conditions treated with steroids include pemphigus and pemphigoid, and severe forms of dermatitis.

Dosage

Corticosteroids can be taken by mouth, by inhaler and intranasal spray, by injection, or topically (see Corticosteroids (topical)). You can receive low, medium, or high doses, depending upon the condition being treated.

Side Effects

Corticosteroids carry a risk of side effects. Some side effects can cause serious health problems. However, side effects are minimal with short-term use of Corticosteroids (less than a month). Long-term use for more serious conditions, however, runs a higher risk of side effects, which may include increased appetite, weight gain, sudden mood swings, muscle weakness, blurred vision, increased growth of body hair, easy bruising, lower resistance to infection, swollen face, acne, Osteoporosis, high blood pressure, stomach irritation, nervousness, restlessness, difficulty sleeping, cataracts or glaucom, and water retention.

Additionally, injected corticosteroids can cause side effects near the site of the injection, which may include pain, infection, shrinking of soft tissue and loss of color in the skin.

Notes of Precaution

There are a number of precautions that can be taken to reduce the risk of side effects, including:

- The use steroids only when necessary.
- The use of local steroids for local problems.
- Use the smallest amount to gain control of the disease.
- Reduce the dose gradually as long as the disease remains under control.
- Monitor blood pressure, weight, and blood sugar.
- Prescribe calcium supplements to help maintain bone density.