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Healthcare Communications

Topical
Corticosteroids
for Skin Disorders

 

Steroids

Steroids have 3 six membered rings and one five membered ring joined in a characteristic way. Oestrogens, progectins, androgens, adrenal corticosteroids, cholesterol, vitamin D precursors, bile salts and bile acids are all steroids.

 

Corticosteroids

- Natural secretions of adrenal cortex
- Diverse effects on carbohydrate, protein, fat and mineral metabolism
- Potent anti-inflammatory effect

 

 

Steroid responsive dermatoses

1. Conditions responding well to topical corticosteroids
- Allergic contact dermatitis
- Primary irritant dermatitis
- Atopic eczema
- Lichen simplex
- Psoriasis (especially face & flexures)
- Seborrhoeic dermatitis
- Varicose eczema

 

Steroid responsive dermatoses (contd.)

2. Conditions responding to topical corticosteroids, but more slowly
- Acne cysts
- Alopecia areata
- Discoid lupus erythematosus
- Granuloma annulare
- Hypertrophic scars & keloids
- Lichen planus
- Lichen striatus
- Necrobiosis lipoidica
- Nodular prurigo
- Pretibial myxoedema
- Psoriasis (palms, soles, elbows, knees)
- Sarcoidosis

 


Potencies of Topical Corticosteroids

Very Potent
- Beclomethasone dipropionate 0.5%
- Clobetasol propionate 0.05%
- Diflucortolone valerate 0.3%
- Fluocinolone acetonide 0.2%

Potent
- Beclomethasone dipropionate 0.025%
- Betamethasone benzoate 0.025%
- Betamethasone dipropionate 0.05%
- Betamethasone valerate 0.1%
- Desonide 0.05%
- Desoxymethasone 0.25%
- Diflorasone diacetate 0.05%
- Diflucortolone valerate 0.1%
- Fluclorolone acetonide 0.025%
- Fluocinolone acetonide 0.025%
- Fluocinonide 0.05%
- Fluocortolone 0.5%
- Fluprednidene acetate 0.1%
- Fluandrenolone 0.05%
- Halcinonide 0.1%
- Hydrocortisone butyrate 0.1%
- Triamcinolone acetonide 0.1%

Potencies of Topical Corticosteroids
(contd.)

Moderately Potent
- Clobetasol butyrate 0.05%
- Flumethasone pivalate 0.02%
- Fluocinolone acetonide 0.01%
- Fluocortin butyl ester 0.75%
- Flucortolone 0.2%
- Flurandrenolone 0.0125%
- 0.025% - Hydrocortisone 1% with urea

Mild
- Dexamethasone 0.01%
- Hydrocortisone (alcohol or acetate) 0.1-1%
- Methylprednisolone 0.25%

Use of Topical Corticosteroids

- For commoner conditions lesser potencies may be adequate
- More potent agents for relatively
resistant dermatoses

 

Adverse Effects of Topical Corticosteroids

- Aggravating infection
- Cutaneous atrophy
- Systemic effects
- Rebound phenomenon

 

Precautions

- Infancy
- Most facial dermatoses
- Widespread inflammatory skin disease
- Hepatic failure
- Infected dermatoses, unless covered by the simultaneous use of an appropriate antimicrobial agent

 

Combination Therapy

- Combination with antimicrobial agent
may be employed for infected
eczema