topical steroid

Weaker topical steroids are utilized for thin-skinned and sensitive areas, especially areas under occlusion, such as the armpit, groin, buttock crease, and breast folds. Weaker steroids are used on the face, eyelids, diaper area, perianal skin, and intertrigo of the groin or body folds. Moderate steroids are used for atopic dermatitis, nummular eczema, xerotic eczema, lichen sclerosis et atrophicus of the vulva, scabies (after scabiecide) and severe dermatitis. Strong steroids are used for psoriasis, lichen planus, discoid lupus, chapped feet, lichen simplex chronicus, severe poison ivy exposure, alopecia areata, nummular eczema, and severe atopic dermatitis in adults.

For treating atopic dermatitis, newer (second generation) corticosteroids, such as fluticasone propionate and mometasone furoate, are more effective and safer than older ones. They are also generally safe and do not cause skin thinning when used intermittently to treat atopic dermatitis flare-ups. They are also safe when used twice a week for preventing flares (also known as weekend treatment).{{cite journal |vauthors=Harvey J, Lax SJ, Lowe A, Santer M, Lawton S, Langan SM, Roberts A, Stuart B, Williams HC, Thomas KS |date=October 2023 |title=The long-term safety of topical corticosteroids in atopic dermatitis: A systematic review |journal=Skin Health and Disease |volume=3 |issue=5 |pages=e268 |doi=10.1002/ski2.268 |pmc=10549798 |pmid=37799373}}{{cite journal |vauthors=Chu DK, Chu AW, Rayner DG, Guyatt GH, Yepes-Nuñez JJ, Gomez-Escobar L, Pérez-Herrera LC, Díaz Martinez JP, Brignardello-Petersen R, Sadeghirad B, Wong MM, Ceccacci R, Zhao IX, Basmaji J, MacDonald M, Chu X, Islam N, Gao Y, Izcovich A, Asiniwasis RN, Boguniewicz M, De Benedetto A, Capozza K, Chen L, Ellison K, Frazier WT, Greenhawt M, Huynh J, LeBovidge J, Lio PA, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Smith Begolka W, Wang J, Wheeler KE, Gardner DD, Schneider L |date=December 2023 |title=Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials |journal=The Journal of Allergy and Clinical Immunology |volume=152 |issue=6 |pages=1493–1519 |doi=10.1016/j.jaci.2023.08.030 |pmid=37678572 |s2cid=261610152|hdl=10576/50632 |hdl-access=free }}{{cite journal |vauthors=Axon E, Chalmers JR, Santer M, Ridd MJ, Lawton S, Langan SM, Grindlay DJ, Muller I, Roberts A, Ahmed A, Williams HC, Thomas KS |date=July 2021 |title=Safety of topical corticosteroids in atopic eczema: an umbrella review |journal=BMJ Open |volume=11 |issue=7 |pages=e046476 |doi=10.1136/bmjopen-2020-046476 |pmc=8264889 |pmid=34233978}} Applying once daily is enough as it is as effective as twice or more daily application.{{cite journal |vauthors=Lax SJ, Harvey J, Axon E, Howells L, Santer M, Ridd MJ, Lawton S, Langan S, Roberts A, Ahmed A, Muller I, Ming LC, Panda S, Chernyshov P, Carter B, Williams HC, Thomas KS, Chalmers JR |date=March 2022 |title=Strategies for using topical corticosteroids in children and adults with eczema |journal=The Cochrane Database of Systematic Reviews |volume=2022 |issue=3 |pages=CD013356 |doi=10.1002/14651858.CD013356.pub2 |pmc=8916090 |pmid=35275399 |collaboration=Cochrane Skin Group}}

To prevent tachyphylaxis, 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.Recommendations from New Zealand Dermatological Society Incorporated on [https://dermnetnz.org/doctors/dermatitis/corticosteroids.html corticosteroids] {{Webarchive|url=https://web.archive.org/web/20160708172139/http://www.dermnetnz.org/doctors/dermatitis/corticosteroids.html |date=2016-07-08 }} Long-term use of topical steroids can lead to secondary infection with fungus or bacteria (see tinea incognito), skin atrophy, telangiectasia (prominent blood vessels), skin bruising and fragility.{{cite book |author=Habif, Thomas P. |title=Clinical dermatology: a color guide to diagnosis and therapy |publisher=Mosby |location=St. Louis |year=1990 |pages=27–30 |isbn=0-8016-2465-7 |edition=2nd}}

The use of the finger tip unit may be helpful in guiding how much topical steroid is required to cover different areas of the body.

{{See also|Topical steroid addiction}}

• Hypothalamic–pituitary–adrenal axis (HPA) suppression{{cite journal|title=Adverse effects of topical corticosteroid use|first=DA|last=Fisher|pmc=1022645|pmid=7794369|volume=162|issue=2|year=1995|journal=West. J. Med.|pages=123–126}}
• Cushing's syndrome
• Diabetes mellitus{{cite journal |doi=10.2165/00002018-200932060-00008 |vauthors=van der Linden MW, Penning-van Beest FJ, Nijsten T, Herings RM |title=Topical corticosteroids and the risk of diabetes mellitus: a nested case-control study in the Netherlands |journal=Drug Saf |volume=32 |issue=6 |pages=527–537 |year=2009 |pmid=19459719 |s2cid=38326748 |url=https://dx.doi.org/10.2165/00002018-200932060-00008|url-access=subscription }}
• Osteoporosis
• Topical steroid addiction
• Allergic contact dermatitis (see steroid allergy)
• Steroid atrophy
• Perioral dermatitis: This is a rash that occurs around the mouth and the eye region that has been associated with topical steroids.
• Ocular effects: Topical steroid drops are frequently used after eye surgery but can also raise intraocular pressure (IOP) and increase the risk of glaucoma, cataract, retinopathy as well as systemic adverse effects.{{Cite journal

| last1 = Lebreton | first1 = O.

| last2 = Weber | first2 = M.

| doi = 10.1016/j.revmed.2011.01.003

| title = Complications ophtalmologiques des corticoïdes systémiques

| journal = La Revue de Médecine Interne

| volume = 32

| issue = 8

| pages = 506–512

| year = 2011

| pmid = 21330017

| pmc =

}}

• Tachyphylaxis: The acute development of tolerance to the action of a drug after repeated doses.{{cite book |author=Wolverton, Stephen E. |title=Comprehensive Dermatologic Drug Therapy |publisher=W.B. Saunders Company |location=Philadelphia|year=2001 |pages=562–563 |isbn=0-7216-7728-2 }} Significant tachyphylaxis can occur by day 4 of therapy. Recovery usually occurs after 3 to 4 days' rest. This has led to therapies such as 3 days on, 4 days off; or one week on therapy, and one week off therapy.
• Delivery-related adverse effects
• Other local adverse effects: These include facial hypertrichosis, folliculitis, miliaria, genital ulcers, and granuloma gluteale infantum. Long-term use has resulted in Norwegian scabies, Kaposi's sarcoma, and other unusual dermatosis.{{cite book |author=Wolverton, Stephen E. |title=Comprehensive Dermatologic Drug Therapy |publisher=W.B. Saunders Company |location=Philadelphia|year=2001 |pages=562–563 |isbn=0-7216-7728-2 }}

Using topical steroids as intended during pregnancy is safe and does not cause miscarriage, birth defects or any pregnancy-related problems.{{Cite journal|last1=Chi|first1=Ching-Chi|last2=Wang|first2=Shu-Hui|last3=Wojnarowska|first3=Fenella|last4=Kirtschig|first4=Gudula|last5=Davies|first5=Emily|last6=Bennett|first6=Cathy|date=2015-10-26|title=Safety of topical corticosteroids in pregnancy|url=https://www.cochrane.org/CD007346/SKIN_safety-topical-steroids-pregnancy|journal=Cochrane Database of Systematic Reviews|volume=2015|issue=10|pages=CD007346|language=en|doi=10.1002/14651858.CD007346.pub3|pmid=26497573|pmc=8558096|issn=1465-1858|access-date=2018-06-23|archive-date=2020-08-15|archive-url=https://web.archive.org/web/20200815200300/https://www.cochrane.org/CD007346/SKIN_safety-topical-steroids-pregnancy|url-status=live}}{{Cite journal |last=Andersson |first=Niklas Worm |last2=Skov |first2=Lone |last3=Andersen |first3=Jon Trærup |date=2021-07-01 |title=Evaluation of Topical Corticosteroid Use in Pregnancy and Risk of Newborns Being Small for Gestational Age and Having Low Birth Weight |url=https://jamanetwork.com/journals/jamadermatology/fullarticle/2779348 |journal=JAMA Dermatology |language=en |volume=157 |issue=7 |pages=788 |doi=10.1001/jamadermatol.2021.1090 |issn=2168-6068 |pmc=8100914 |pmid=33950165}}{{Citation |title=Topical Corticosteroids |date=April 2022 |work=Mother To Baby {{!}} Fact Sheets |url=https://www.ncbi.nlm.nih.gov/books/NBK582987/ |access-date=2024-07-29 |place=Brentwood (TN) |publisher=Organization of Teratology Information Specialists |pmid=35952259}}

{{see also|ATC code D07}}

The U.S. utilizes 7 classes, which are classified by their ability to constrict capillaries and cause skin blanching. Class I is the strongest, or superpotent. Class VII is the weakest and mildest.{{cite book |author=Habif, Thomas P. |title=Clinical dermatology: a color guide to diagnosis and therapy |publisher=Mosby |location=St. Louis |year=1990 |page=Inside front cover |isbn=0-8016-2465-7 |edition=2nd}}

Very potent: up to 600 times stronger than hydrocortisone

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

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

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

• 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)

• 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)

• Alclometasone dipropionate 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)

The weakest class of topical steroids. Has poor lipid permeability, and can not penetrate mucous membranes well.

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

Japan rates topical steroids from 1 to 5, with 1 being strongest.

Many countries, such as the United Kingdom, Germany, the Netherlands, New Zealand, recognize 4 classes.{{Cite web |url=http://dermnetnz.org/treatments/topical-steroids.html |title=Topical steroids (corticosteroid creams) |website=DermNet NZ |access-date=2008-12-05 |archive-date=2016-07-25 |archive-url=https://web.archive.org/web/20160725120934/http://dermnetnz.org/treatments/topical-steroids.html |url-status=live }} In the United Kingdom and New Zealand I is the strongest, while in Continental Europe, class IV is regarded as the strongest.

Very potent (up to 600 times as potent as hydrocortisone)

• Clobetasol propionate (Dermovate Cream/Ointment, Exel Cream)
• Betamethasone dipropionate (Diprosone OV Cream/Ointment, Diprovate Cream)

Potent (50–100 times as potent as hydrocortisone)

• Betamethasone valerate (Beta Cream/Ointment/Scalp Application, Betnovate Lotion/C Cream/C Ointment, Fucicort)
• Betamethasone dipropionate (Diprosone Cream/Ointment, Diprovate Cream, Daivobet 50/500 Ointment)
• Diflucortolone valerate (Nerisone C/Cream/Fatty Ointment/Ointment)
• Hydrocortisone 17-butyrate (Locoid C/Cream/Crelo Topical Emulsion/Lipocream/Ointment/Scalp Lotion)
• Mometasone furoate (Elocon Cream/Lotion/Ointment)
• Methylprednisolone aceponate (Advantan Cream/Ointment)
• Halometasone 0.05%

Moderate (2–25 times as potent as hydrocortisone)

• Clobetasone butyrate (Eumovate Cream)
• Triamcinolone acetonide (Aristocort Cream/Ointment, Viaderm KC Cream/Ointment, Kenacomb Ointment)

Mild

• Hydrocortisone 0.5–2.5% (DermAid Cream/Soft Cream, DP Lotion-HC 1%, Skincalm, Lemnis Fatty Cream HC, Pimafucort Cream/Ointment)

The highlighted steroids are often used in the screening of allergies to topical steroid and systemic steroids.{{cite book |author=Wolverton, Stephen E. |title=Comprehensive Dermatologic Drug Therapy |publisher=W.B. Saunders Company |location=Philadelphia |year=2001 |page=562 |isbn=0-7216-7728-2 }} When one is allergic to one group, one is allergic to all steroids in that group.

Hydrocortisone, hydrocortisone acetate, cortisone acetate, tixocortol pivalate, prednisolone, methylprednisolone, and prednisone

Triamcinolone acetonide, triamcinolone alcohol, amcinonide, budesonide, desonide, fluocinonide, fluocinolone acetonide, and halcinonide

Betamethasone, betamethasone sodium phosphate, dexamethasone, dexamethasone sodium phosphate, and fluocortolone

Hydrocortisone 17-butyrate, hydrocortisone-17-valerate, alclometasone dipropionate, betamethasone valerate, betamethasone dipropionate, prednicarbate, clobetasone-17-butyrate, Clobetasol-17 propionate, fluocortolone caproate, fluocortolone pivalate, fluprednidene acetate, and mometasone furoate

Corticosteroids were first made available for general use around 1950.{{cite journal|author=Rattner H |title=The status of corticosteroid therapy in dermatology |journal=Calif Med |volume=83 |issue=5|pages=331–335 |date=November 1955 |pmid=13260925 |pmc=1532588 }}

• Topical medication
• Glucocorticoid
• Corticosteroid
• Retrometabolic drug design

{{Reflist|2}}

{{Corticosteroids}}

{{Glucocorticoids}}

Category:Corticosteroids