Topical glucocorticoids

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Topical glucocorticoids are the topical forms of glucocorticoids. Topical glucocorticoids are used in the treatment of many skin conditions. They provide anti-inflammatory, antimitotic, and immune-system suppressing actions through various mechanisms. [1]

Contents

Hydrocortisone cream is a type of topical glucocorticoid that is commonly found on the market. Tube of hydrocortisone cream.jpg
Hydrocortisone cream is a type of topical glucocorticoid that is commonly found on the market.

Medical Uses

Topical glucocorticoids are indicated for the treatment of a variety of skin conditions: [2]

Formulations

Topical glucocorticoids are available in different formulations. If an inappropriate formulation is administered, the therapeutic effect of the treatment may be delayed and rendered insufficient. [2] The condition will even be worsened in some cases. For instance, usage of a topical glucocorticoid gel on fissured hand eczema intensifies the pain as well as stinging because of the alcohol present in the gel. If an ointment is applied on a moist skin injury, it might lead to follicle infection due to the occlusive features of the ointment. [2]

Ointments

Ointments are formed with water suspended in oil. Ointments are effective lubricants that can retain heat, lower the loss of water from the skin and provide better absorption of medication. Ointments are also semi-occlusive. Ointments are usually the most effective formulations for topical glucocorticoids because of their occlusive effect. However, acceptance and compliance of patients to the pharmacological treatment may be relatively low as they are oily, tacky, and usually cannot be applied to large or hairy areas. [2]

Creams

Creams are semi-solid emulsions consisting of oil suspended in water. They are of pleasant appearance and can be rinsed away by water. Regarding the same topical glucocorticoid, creams are generally more potent than lotions but less effective than ointments. [2] Creams are especially useful in acute inflammation with exudates due to their drying effects. Creams can also be applied to intertriginous areas that are inappropriate for the application of ointments. [2]

Lotions

Lotions refer to suspensions or solutions of drugs in water, alcohol, or other types of solvent. Therefore, the container should be shaked adequately to ensure the drug is mixed well with the solvent before each dosage to achieve the best therapeutic effect. Lotions are especially effective in hairy areas and also in situations where the medication has to be applied in large areas on the body. [3] Lotions exert a cooling and drying effect as they dry, making them to be effective in moist skin lesions and/or in itching.

Gels

Gels are emulsions with oil suspended in water containing alcohol in the base. Gels have a jelly-like property and dry in a thin and watery film. Gel formulations have therapeutic effects as good as ointments and appearance as cosmetically appealing as creams, resulting in a high patient acceptance. [4] Gels are absorbed readily and are appropriate for distributing topical glucocorticoids to hairy areas. Gels are especially effective for inflammation with exudates. [2]

Foams

Foams spread efficiently and are easier to be applied than other preparations, especially for skin inflammation and scalp conditions. Foams can be applied and spread readily, especially in hairy areas. The compliance for foam formulations is usually high. [5] However, due to the difficulty in designing appropriate vehicles, foam formulations are generally higher in price than other formulations.

Pharmacology

Mechanism of action

Topical glucocorticoids alter the functions of epidermal and dermal cells as well as that of the white blood cells involved in proliferative and inflammatory skin diseases. [6]

Topical glucocorticoids act as agonists for the cytoplasmic glucocorticoid receptor. After binding to the receptor, the complex is then transported into the nucleus. Within the nucleus, the complex binds to the glucocorticoid response elements in the promoter region of target genes. This results in the regulation of gene expression through altering the rate of transcription of certain mRNA. As mRNA acts as a template for protein synthesis, topical glucocorticoids can either enhance or suppress the synthesis of specific proteins. [7] This series of events lead to numerous effects. Transcription factors that are responsible for the synthesis of inflammation mediators including macrophages, eosinophils, lymphocytes, mast cells and dendritic cells are inhibited, [8] anti-inflammatory proteins such as lipocortin are released [6] and cell division of epidermal cells and dermal fibroblasts is inhibited. [9]

Pharmacokinetics

There are many factors determining the extent of absorption of topical glucocorticoids, including:

The differences in extent of percutaneous absorption in different parts of the body (percent of the total dose absorbed into the body through the skin) are as follows: [9]

Adverse Effects

Topical glucocorticoids are generally safer than systemic glucocorticoids. However, cutaneous and systemic adverse effects may happen, especially with the use of superpotent and potent topical glucocorticoids or excessive use of lower-potency agents.

Cutaneous

Appearance of purpura on the skin. Purpura.jpg
Appearance of purpura on the skin.

Withdrawal syndrome: Withdrawal of topical glucocorticoids after long-term use, particularly on the face or genitals, may bring about different kinds of signs and symptoms including redness of the skin, burning or stinging sensation, itching, pain, and hot flashes on the face. [12] These symptoms could persist for days to weeks after glucocorticoids withdrawal.

Allergic reaction: The vehicles (solvent containing the drug) or preservatives are usually the agents causing sensitivity, although allergy due to the contact with glucocorticoids merely is possible. [13] Contact allergy caused by topical glucocorticoid should be suspected in patients with chronic skin conditions that do not seem to improve but instead, is worsened by the treatment.

Other: Other cutaneous adverse effect of topical glucocorticoid consist of appearance of purpura (red discoloured spots) on the skin, changes in pigmentation, and abnormal hair growth. [14]

Systemic

A human eye with cataract. Cataract (28464844371).png
A human eye with cataract.

Some topical glucocorticoids can cause hypothalamic-pituitary axis (HPA) suppression. [15] Reasons that lead to suppression of the HPA include the use of high-potency glucocorticoids, long-term use, application to highly permeable areas, treatment of large areas, occlusion, changed skin barrier and young age. [15] Regular use of even mild glucocorticoids in young kids can lead to HPA suppression. [16]

Rarely, long-term application of high-potency topical glucocorticoids around the eyes may induce glaucoma or cataracts. [17] [18] [19]

The incorrect use of topical glucocorticoids can worsen or cover the typical clinical signs of the appearance of fungal skin infections. [20]

Cautions

Use in children

To reduce the risk of adverse events, high-potency glucocorticoid should not be applied on the face, intertriginous areas, areas with thin layers of skin (e.g. the perineum, armpit) in children. [21] [22] [23] Moreover, high-potency glucocorticoid should be applied to skin only once a day and should not be used for more than fourteen days. [24] Even low-potency topical glucocorticoids are able to cause adverse effects in children when used for prolonged periods of time.

Generally, a smaller dose of topical glucocorticoid is required by children for a given condition than adults, as children have relatively smaller body surface area compared to adults.

Use during pregnancy or lactation

Based on the evidence that are currently available, the use of low- to medium-potency topical glucocorticoid is not found to raise the risk of adverse effects for the mother and the baby, such as preterm delivery, birth defects, and low birth weight. [25] [26] However, since the correlation between long-term use of potent topical glucocorticoid in pregnant women and low birth weight cannot be neglected, pregnant women who require topical glucocorticoids should be administered with low- or medium-potency agents instead of potent or superpotent ones. If potent or superpotent topical glucocorticids are necessary in pregnant women, they should only be administered for a short period of time, the dose used should also be minimised, and growth of the baby should be closely monitored. [25] [26]

Classifications

USA Classification System

Topical glucocorticoid causes cutaneous vasoconstriction in proportion with their potency. [27] With reference to the United States classification system, topical glucocorticoid can be classified into seven groups, with group 1 being the most potent and group 7 the least potent. [28]

Super-high potency (Group 1)

High potency (Group 2)

Higher-mid potency (Group 3)

Medium potency (Group 4)

Lower-mid potency (Group 5)

Low potency (Group 6)

Least potent (Group 7)

Society

Topical Glucocorticoid Phobia

Topical glucocorticoid phobia is a concern or fear about using topical glucocorticoids, which is commonly found among patients with atopic dermatitis and their caregivers. [29] This phenomenon has been identified in more than 15 countries globally, including Canada, France, Japan, the United Kingdom, and the United States. [30] The most prevalent causes for topical glucocorticoid phobia were found to be the concern regarding skin thinning as well as that regarding systemic absorption that could possibly affect growth and development. [30] [29] This phenomenon may be associated with low adherence to topical glucocorticoid therapies. [31] [30]

The extent of corticosteroid fears is independent of corticosteroid acceptability, but correlates with patients' quality of life. Desensitization of parental corticosteroid fears should be integral part of eczema education and therapeutics in order to improve therapeutic efficacy and patients' quality of life.<J Dermatolog Treat . 2015;26:418-25.> <Acta Paediatr . 2006;95:1451-5> <Drugs Context. 2018;7:212547>

See also

Related Research Articles

Corticosteroid Class of steroid hormones

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involved in a wide range of physiological processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.

Hydrocortisone Glucocorticoid and Mineralocorticoid hormone Cortisol supplied as a medication

Hydrocortisone is the name for the hormone cortisol when supplied as a medication. Uses include conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis, rheumatoid arthritis, dermatitis, asthma, and COPD. It is the treatment of choice for adrenocortical insufficiency. It can be given by mouth, topically, or by injection. Stopping treatment after long-term use should be done slowly.

Pimecrolimus

Pimecrolimus is an immunomodulating agent of the calcineurin inhibitor class used in the treatment of atopic dermatitis (eczema). It is available as a topical cream, once marketed by Novartis under the trade name Elidel.

Clobetasol propionate Clobetasol Propionate Cream usp 0.05

Clobetasol propionate is a corticosteroid used to treat skin conditions such as eczema, contact dermatitis, seborrheic dermatitis, and psoriasis. It is applied to the skin as a cream, ointment, or shampoo. Use should be short term and only if other weaker corticosteroids are not effective. Use is not recommended in rosacea or perioral dermatitis.

Triamcinolone Steroid medication

Triamcinolone is a glucocorticoid used to treat certain skin diseases, allergies, and rheumatic disorders among others. It is also used to prevent worsening of asthma and COPD. It can be taken in various ways including by mouth, injection into a muscle, and inhalation.

Betamethasone Steroid medication

Betamethasone is a steroid medication. It is used for a number of diseases including rheumatic disorders such as rheumatoid arthritis and systemic lupus erythematosus, skin diseases such as dermatitis and psoriasis, allergic conditions such as asthma and angioedema, preterm labor to speed the development of the baby's lungs, Crohn's disease, cancers such as leukemia, and along with fludrocortisone for adrenocortical insufficiency, among others. It can be taken by mouth, injected into a muscle, or applied to the skin topically in cream, lotion, or liquid forms.

Desonide

Desonide (INN) is a low-potency topical corticosteroid anti-inflammatory that has been available since the 1970s. It is primarily used to treat atopic dermatitis (eczema), seborrheic dermatitis, contact dermatitis and psoriasis in both adults and children. It has a fairly good safety profile and is available as a cream, ointment, lotion, and as a foam under the tradename Verdeso Foam. Other trade names for creams, lotions, and ointments include Tridesilon, DesOwen, Desonate. It is a group VI corticosteroid under US classification, the second least potent group.

Betamethasone dipropionate

Betamethasone dipropionate is a glucocorticoid steroid with anti-inflammatory and immunosuppressive abilities. It is applied as a topical cream, ointment, lotion or gel (Diprolene) to treat itching and other minor skin conditions such as eczema. Minor side effects include dry skin and mild, temporary stinging when applied. Betamethasone dipropionate is a "super high potency" corticosteroid used to treat inflammatory skin conditions such as dermatitis, eczema and psoriasis. It is a synthetic analog of the adrenal corticosteroids. Although its exact mechanism of action is not known, it is effective when applied topically to cortico-responsive inflammatory dermatoses. It is available as a generic medication.

Betamethasone valerate Chemical compound

Betamethasone valerate is a synthetic glucocorticoid ester. It is the 17-valerate ester of betamethasone. Betamethasone valerate is often used to treat mild eczema with good efficacy and lower incidence of steroid induced adverse effects due to its lower potency compared to other glucocorticoids. Betamethasone-17-valerate is available in cream, ointment, lotion, and foam preparations for topical use.

Triamcinolone acetonide Medicinal chemical compound, steroid

Triamcinolone acetonide is a synthetic corticosteroid medication used topically to treat various skin conditions, to relieve the discomfort of mouth sores, and intra-articularly by proceduralists to treat various joint conditions. It is also injected intralesionally to treat inflammation in some parts of the body, particularly the skin. In nasal spray form, it is used to treat allergic rhinitis. It is a more potent derivative of triamcinolone, and is about eight times as potent as prednisone. It is used for the treatment of macular edema associated with uveitis.

Calcipotriol

Calcipotriol, also known as calcipotriene, is a synthetic derivative of calcitriol, a form of vitamin D. It is used in the treatment of psoriasis. It is safe for long-term application in psoriatic skin conditions.

Diflorasone diacetate Chemical compound and topical steroid

Diflorasone diacetate is a topical steroid that comes in the form of a cream. It is manufactured by E. Fougera & Co. and is used as an anti-inflammatory and anti-itching agent, like other topical corticosteroids. It is prescribed for psoriasis and atopic dermatitis, among other conditions. With respect to potency, it is regarded as a Class I corticosteroid [of classes I – VII] in the United States.

Amcinonide Chemical compound

Amcinonide is a topical glucocorticoid used to treat itching, redness and swelling associated with several dermatologic conditions such as atopic dermatitis and allergic contact dermatitis. Amcinonide can also be classified as a multi-functional small molecule corticosteroid, which has been approved by the FDA and is currently marketed as an ointment, lotion, or cream. It acts as both a transcription factor for responses to glucocorticoids and modulator for other transcription factors while also regulating phospholipase A2 activity.

Halometasone

Halometasone is a potent synthetic tri-halogenated corticosteroid for topical application possessing pronounced anti-inflammatory, antiexudative, antiepidermoplastic, antiallergic, and antipruritic properties. It has been approved in many European countries including Spain, Germany, Switzerland, Austria, Netherlands, Belgium, and Portugal and other regions such as China, Hong Kong, Turkey, Israel, South Africa and India.

In medicine, a finger tip unit (FTU) is defined as the amount of ointment, cream or other semi-solid dosage form expressed from a tube with a 5 mm diameter nozzle, applied from the distal skin-crease to the tip of the index finger of an adult. The "distal skin-crease" is the skin crease over the joint nearest the end of the finger. One FTU is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together, i.e. a "handprint". Two FTUs are approximately equivalent to 1 g of topical steroid.

Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema, and dermatitis. Topical steroids have anti-inflammatory properties, and are classified based on their skin vasoconstrictive abilities. There are numerous topical steroid products. All the preparations in each class have the same anti-inflammatory properties, but essentially differ in base and price.

Calcipotriol/betamethasone dipropionate

Calcipotriol/betamethasone dipropionate, sold under the brand name Taclonex among others, is a fixed-dose combination medication of the synthetic vitamin D3 analog calcipotriol (also known as calcipotriene) and the synthetic corticosteroid betamethasone dipropionate for the treatment of plaque psoriasis. It is used in the form of ointment, topical suspension, gel, aerosol, and foam.

Topical steroid withdrawal Medical condition

Topical steroid withdrawal, also known as red burning skin and steroid dermatitis, has been reported in people who apply topical steroids for 2 weeks or longer and then discontinue use. Symptoms affect the skin and include redness, a burning sensation, and itchiness, which may then be followed by peeling.

Domoprednate Chemical compound

Domoprednate is a synthetic glucocorticoid corticosteroid which was developed in the late 1970s and 1980s.

References

  1. ↑ "Corticosteroids—glucocorticoids, topical, skin", Meyler's Side Effects of Drugs, Elsevier, pp. 691–693, 2016, doi:10.1016/b978-0-444-53717-1.01683-8, ISBN   978-0-444-53716-4 , retrieved 2021-03-13
  2. 1 2 3 4 5 6 7 Ference, Jonathan D.; Last, Allen R. (2009-01-15). "Choosing Topical Corticosteroids". American Family Physician. 79 (2): 135–140. ISSN   0002-838X. PMID   19178066.
  3. ↑ Purnamawati, Schandra; Indrastuti, Niken; Danarti, Retno; Saefudin, Tatan (2017). "The Role of Moisturizers in Addressing Various Kinds of Dermatitis: A Review". Clinical Medicine & Research. 15 (3–4): 75–87. doi:10.3121/cmr.2017.1363. ISSN   1539-4182. PMC   5849435 . PMID   29229630.
  4. ↑ "Patient assessment of desonide hydrogel for the treatment of mild to moderate atopic dermatitis". Journal of the American Academy of Dermatology. 60 (3): AB69. 2009-03-01. doi:10.1016/j.jaad.2008.11.316. ISSN   0190-9622.
  5. ↑ "Review for "Healthcare utilization in Danish children with atopic dermatitis and parental topical corticosteroid phobia"". 2020-07-20. doi:10.1111/pai.13394/v1/review1.{{cite journal}}: Cite journal requires |journal= (help)
  6. 1 2 3 4 Uva, Luís; Miguel, Diana; Pinheiro, Catarina; Antunes, Joana; Cruz, Diogo; Ferreira, João; Filipe, Paulo (2012). "Mechanisms of Action of Topical Corticosteroids in Psoriasis". International Journal of Endocrinology. 2012: 561018. doi: 10.1155/2012/561018 . ISSN   1687-8337. PMC   3508578 . PMID   23213332.
  7. ↑ Revollo, Javier R.; Cidlowski, John A. (2009). "Mechanisms Generating Diversity in Glucocorticoid Receptor Signaling". Annals of the New York Academy of Sciences. 1179 (1): 167–178. Bibcode:2009NYASA1179..167R. doi:10.1111/j.1749-6632.2009.04986.x. ISSN   1749-6632. PMID   19906239. S2CID   28995545.
  8. ↑ Derendorf, H.; Nave, R.; Drollmann, A.; Cerasoli, F.; Wurst, W. (2006-11-01). "Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma". European Respiratory Journal. 28 (5): 1042–1050. doi: 10.1183/09031936.00074905 . ISSN   0903-1936. PMID   17074919. S2CID   8260397.
  9. 1 2 Paulo, Uva, Luís Miguel, Diana Pinheiro, Catarina Antunes, Joana Cruz, Diogo Ferreira, João Filipe (2012). Mechanisms of Action of Topical Corticosteroids in Psoriasis. Hindawi Publishing Corporation. OCLC   841551425.
  10. ↑ Coondoo, Arijit; Phiske, Meghana; Verma, Shyam; Lahiri, Koushik (2014). "Side-effects of topical steroids: A long overdue revisit". Indian Dermatology Online Journal. 5 (4): 416–425. doi:10.4103/2229-5178.142483. ISSN   2229-5178. PMC   4228634 . PMID   25396122.
  11. ↑ McCrory, P. (2008). "Phonophoresis and the Absorption of Dexamethasone in the Presence of an Occlusive Dressing". Yearbook of Sports Medicine. 2008: 31–32. doi:10.1016/s0162-0908(08)79275-4. ISSN   0162-0908.
  12. ↑ Hajar, Tamar; Leshem, Yael A.; Hanifin, Jon M.; Nedorost, Susan T.; Lio, Peter A.; Paller, Amy S.; Block, Julie; Simpson, Eric L. (2015). "A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses". Journal of the American Academy of Dermatology. 72 (3): 541–549.e2. doi:10.1016/j.jaad.2014.11.024. ISSN   0190-9622. PMID   25592622.
  13. ↑ Thiers, B.H. (2008-01-25). "Results of patch testing to a corticosteroid series: A retrospective review of 1188 patients during 6 years at Mayo Clinic". Yearbook of Dermatology and Dermatologic Surgery. 2008: 72–73. doi:10.1016/s0093-3619(08)70724-x. ISSN   0093-3619.
  14. ↑ Hengge, Ulrich R.; Ruzicka, Thomas; Schwartz, Robert A.; Cork, Michael J. (2006). "Adverse effects of topical glucocorticosteroids". Journal of the American Academy of Dermatology. 54 (1): 1–15. doi:10.1016/j.jaad.2005.01.010. PMID   16384751.
  15. 1 2 Dhar, Sandipan; Seth, Joly; Parikh, Deepak (2014). "Systemic Side-Effects of Topical Corticosteroids". Indian Journal of Dermatology. 59 (5): 460–464. doi:10.4103/0019-5154.139874. ISSN   0019-5154. PMC   4171913 . PMID   25284850.
  16. ↑ Wood-Heickman, Lauren; Davallow, Ladan; Conaway, Mark; Rogol, Alan (2018). "Evaluation of Hypothalamic-Pituitary-Adrenal Axis Suppression following Cutaneous Use of Topical Corticosteroids in Children: A Meta-Analysis". Hormone Research in Paediatrics. 89 (6): 389–396. doi: 10.1159/000489125 . ISSN   1663-2818. PMID   29898449. S2CID   49184547.
  17. ↑ Daniel, Benjamin S; Orchard, David (2015-05-05). "Ocular side-effects of topical corticosteroids: what a dermatologist needs to know: Ocular side-effects of TCS". Australasian Journal of Dermatology. 56 (3): 164–169. doi:10.1111/ajd.12292. PMID   25754554. S2CID   28572550.
  18. ↑ Haeck, Inge M.; Rouwen, Ton J.; Timmer-de Mik, Linda; de Bruin-Weller, Marjolein S.; Bruijnzeel-Koomen, Carla A. (2010-12-02). "Topical corticosteroids in atopic dermatitis and the risk of glaucoma and cataracts". Journal of the American Academy of Dermatology. 64 (2): 275–281. doi:10.1016/j.jaad.2010.01.035. ISSN   0190-9622. PMID   21122943.
  19. ↑ Tatham, Andrew (2008-04-28). "Atopic dermatitis, cutaneous steroids and cataracts in children: two case reports". Journal of Medical Case Reports. 2 (1): 124. doi:10.1186/1752-1947-2-124. ISSN   1752-1947. PMC   2383898 . PMID   18442376.
  20. ↑ Rathi, Sanjay K.; D'Souza, Paschal (2012). "Rational and Ethical Use of Topical Corticosteroids Based on Safety and Efficacy". Indian Journal of Dermatology. 57 (4): 251–259. doi:10.4103/0019-5154.97655. ISSN   0019-5154. PMC   3401837 . PMID   22837556.
  21. ↑ Balkrishnan, Rajesh; Camacho, Fabian T.; Pearce, Daniel J.; Kulkarni, Amit S.; Spencer, Lori; Fleischer, Alan B.; Feldman, Steven R. (2005). "Factors affecting prescription of ultra-high potency topical corticosteroids in skin disease: an analysis of US national practice data". Journal of Drugs in Dermatology: JDD. 4 (6): 699–706. ISSN   1545-9616. PMID   16302555.
  22. ↑ Ozon, A.; Cetinkaya, S.; Alikasifoglu, A.; Gonc, E.N.; Şen, Y.; Kandemir, N. (2007). "Inappropriate Use of Potent Topical Glucocorticoids in Infants". Journal of Pediatric Endocrinology and Metabolism. 20 (2): 219–225. doi:10.1515/JPEM.2007.20.2.219. ISSN   2191-0251. PMID   17396439. S2CID   22624420.
  23. ↑ Semiz, Serap; Balcı, Yasemin Işık; Ergin, Şeniz; Candemir, Maşallah; Polat, Aziz (2008-10-02). "Two Cases of Cushing's Syndrome Due to Overuse of Topical Steroid in the Diaper Area 1". Pediatric Dermatology. 25 (5): 544–547. doi:10.1111/j.1525-1470.2008.00735.x. PMID   18950396. S2CID   10010923.
  24. ↑ Schlessinger, Joel; Miller, Bruce; Gilbert, Richard D.; Plott, R. Todd (2006-12-01). "An Open-label Adrenal Suppression Study of 0.1% Fluocinonide Cream in Pediatric Patients With Atopic Dermatitis". Archives of Dermatology. 142 (12): 1568–1572. doi: 10.1001/archderm.142.12.1568 . ISSN   0003-987X. PMID   17178982.
  25. 1 2 Chi, C.-C.; Kirtschig, G.; Aberer, W.; Gabbud, J.-P.; Lipozenčić, J.; Kárpáti, S.; Haustein, U.-F.; Wojnarowska, F.; Zuberbier, T. (2017-02-24). "Updated evidence-based (S2e) European Dermatology Forum guideline on topical corticosteroids in pregnancy". Journal of the European Academy of Dermatology and Venereology. 31 (5): 761–773. doi: 10.1111/jdv.14101 . PMID   28233354. S2CID   3584364.
  26. 1 2 Chi, Ching-Chi; Wang, Shu-Hui; Wojnarowska, Fenella; Kirtschig, Gudula; Davies, Emily; Bennett, Cathy (2015-10-26). Cochrane Skin Group (ed.). "Safety of topical corticosteroids in pregnancy". Cochrane Database of Systematic Reviews (10): CD007346. doi:10.1002/14651858.CD007346.pub3. PMID   26497573.
  27. ↑ Borelli, C.; Gassmueller, J.; Fluhr, J.W.; Nietsch, K.H.; Schinzel, S.; Korting, H.C. (2008). "Activity of Different Desoximetasone Preparations Compared to Other Topical Corticosteroids in the Vasoconstriction Assay". Skin Pharmacology and Physiology. 21 (3): 181–187. doi:10.1159/000131082. ISSN   1660-5535. PMID   18523415. S2CID   916409.
  28. ↑ "UpToDate". www.uptodate.com. Retrieved 2021-03-15.
  29. 1 2 Charman, C. R.; Morris, A. D.; Williams, H. C. (2000). "Topical corticosteroid phobia in patients with atopic eczema". The British Journal of Dermatology. 142 (5): 931–936. doi:10.1046/j.1365-2133.2000.03473.x. ISSN   0007-0963. PMID   10809850. S2CID   31012940.
  30. 1 2 3 Li, Alvin W.; Yin, Emily S.; Antaya, Richard J. (2017-10-01). "Topical Corticosteroid Phobia in Atopic Dermatitis: A Systematic Review". JAMA Dermatology. 153 (10): 1036–1042. doi:10.1001/jamadermatol.2017.2437. ISSN   2168-6068. PMID   28724128. S2CID   25763417.
  31. ↑ Stalder, J.-F.; Aubert, H.; Anthoine, E.; Futamura, M.; Marcoux, D.; Morren, M.-A.; Trzeciak, M.; Szalai, Z.; Veres, K.; Deleuran, M.; Vestergaard, C. (2017-04-25). "Topical corticosteroid phobia in atopic dermatitis: International feasibility study of the TOPICOP score". Allergy. 72 (11): 1713–1719. doi:10.1111/all.13189. PMID   28439896. S2CID   6891105.
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