Topical steroid

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Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash and eczema. Topical steroids have anti-inflammatory properties and are classified based on their skin vasoconstrictive abilities. [1] 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.

Contents

Side effects may occur from long-term topical steroid use. [2]

Medical uses

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. [1]

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. [3] 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. [4]

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.

Adverse effects

Safety in pregnancy

A 2015 meta-analysis of observational studies of pregnancies found no association between mothers' use of topical steroids and type of delivery, APGAR score, birth defects, or prematurity. [10]

Classification systems

Seven-class System

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. [11]

Class I

Very potent: up to 600 times stronger than hydrocortisone

Class II

Class III

Class IV

Class V

Class VI

Class VII

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

Five-class System

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

Four-class System

Many countries, such as the United Kingdom, Germany, the Netherlands, New Zealand, recognize 4 classes. [12] In the United Kingdom and New Zealand I is the strongest, while in Continental Europe, class IV is regarded as the strongest.

Class IV (UK/NZ: class I)

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

Class III (UK/NZ: class II)

Potent (50–100 times as potent as hydrocortisone)

Class II (UK/NZ: class III)

Moderate (2–25 times as potent as hydrocortisone)

Class I (UK/NZ: class IV)

Mild

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


Allergy associations

The highlighted steroids are often used in the screening of allergies to topical steroid and systemic steroids. [13] When one is allergic to one group, one is allergic to all steroids in that group.

Group A

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

Group B

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

Group C

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

Group D

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

History

Corticosteroids were first made available for general use around 1950. [14]

See also

Related Research Articles

<span class="mw-page-title-main">Corticosteroid</span> 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.

A decongestant, or nasal decongestant, is a type of pharmaceutical drug that is used to relieve nasal congestion in the upper respiratory tract. The active ingredient in most decongestants is either pseudoephedrine or phenylephrine. Intranasal corticosteroids can also be used as decongestants and antihistamines can be used to alleviate runny nose, nasal itch, and sneezing.

ATC code D07Corticosteroids, dermatological preparations is a therapeutic subgroup of the Anatomical Therapeutic Chemical Classification System, a system of alphanumeric codes developed by the World Health Organization (WHO) for the classification of drugs and other medical products. Subgroup D07 is part of the anatomical group D Dermatologicals.

<span class="mw-page-title-main">Clobetasol propionate</span> 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.

<span class="mw-page-title-main">Triamcinolone</span> 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.

<span class="mw-page-title-main">Betamethasone</span> 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, typically in cream, lotion, or liquid forms.

<span class="mw-page-title-main">Desonide</span> Chemical compound

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.

<span class="mw-page-title-main">Betamethasone dipropionate</span> Glucocorticoid steroid (chemical compound)

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 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.

<span class="mw-page-title-main">Betamethasone valerate</span> 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.

<span class="mw-page-title-main">Triamcinolone acetonide</span> Medicinal chemical compound, steroid

Triamcinolone acetonide, sold under the brand name Kenalog among others, is a synthetic corticosteroid medication used topically to treat various skin conditions, to relieve the discomfort of mouth sores, and by injection into joints to treat various joint conditions. It is also injected into lesions 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 used for the treatment of macular edema associated with uveitis. It is a more potent derivative of triamcinolone, and is about eight times as potent as prednisone.

<span class="mw-page-title-main">Mometasone</span> Steroid medication

Mometasone, also known as mometasone y 3 s, is a steroid medication used to treat certain skin conditions, hay fever, and asthma. Specifically it is used to prevent rather than treat asthma attacks. It can be applied to the skin, inhaled, or used in the nose. Mometasone furoate, not mometasone, is used in medical products.

<span class="mw-page-title-main">Clobetasone</span> Chemical compound

Clobetasone (INN) is a corticosteroid used in dermatology, for treating such skin inflammation as seen in eczema, psoriasis and other forms of dermatitis, and ophthalmology. Topical clobetasone butyrate has shown minimal suppression of the hypothalamic–pituitary–adrenal axis.

<span class="mw-page-title-main">Diflorasone diacetate</span> 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.

<span class="mw-page-title-main">Amcinonide</span> 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.

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.

<span class="mw-page-title-main">Tinea incognita</span> Fungal skin infection caused by the presence of a topical immunosuppressive agent

Tinea incognita, also spelled tinea incognito, is a fungal infection of the skin that generally looks odd for a typical tinea infection. The border of the skin lesion is usually blurred and it appears to have florid growth.

<span class="mw-page-title-main">Domoprednate</span> Chemical compound

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

<span class="mw-page-title-main">Topical glucocorticoids</span>

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.

<span class="mw-page-title-main">Topical hydrocortisone</span> Pharmaceutical drug

Topical hydrocortisone is a drug under the class of corticosteroids, which is used for the treatment of skin inflammation, itchiness and allergies. Some examples include insect bites, dermatitis and rash.

References

  1. 1 2 Habif, Thomas P. (1990). Clinical dermatology: a color guide to diagnosis and therapy (2nd ed.). St. Louis: Mosby. p. 27. ISBN   0-8016-2465-7.
  2. ↑ Coondoo, A; Phiske, M; Verma, S; Lahiri, K (2014). "Side effects of topical steroids: A long overdue revisit". Indian Dermatol Online J. 5 (4): 416–425. doi: 10.4103/2229-5178.142483 . PMC   4228634 . PMID   25396122.
  3. ↑ Recommendations from New Zealand Dermatological Society Incorporated on corticosteroids Archived 2016-07-08 at the Wayback Machine
  4. ↑ Habif, Thomas P. (1990). Clinical dermatology: a color guide to diagnosis and therapy (2nd ed.). St. Louis: Mosby. pp. 27–30. ISBN   0-8016-2465-7.
  5. ↑ Fisher, DA (1995). "Adverse effects of topical corticosteroid use". West. J. Med. 162 (2): 123–126. PMC   1022645 . PMID   7794369.
  6. ↑ van der Linden MW, Penning-van Beest FJ, Nijsten T, Herings RM (2009). "Topical corticosteroids and the risk of diabetes mellitus: a nested case-control study in the Netherlands". Drug Saf. 32 (6): 527–537. doi:10.2165/00002018-200932060-00008. PMID   19459719. S2CID   38326748.
  7. ↑ Lebreton, O.; Weber, M. (2011). "Complications ophtalmologiques des corticoïdes systémiques". La Revue de Médecine Interne. 32 (8): 506–512. doi:10.1016/j.revmed.2011.01.003. PMID   21330017.
  8. ↑ Wolverton, Stephen E. (2001). Comprehensive Dermatologic Drug Therapy. Philadelphia: W.B. Saunders Company. pp. 562–563. ISBN   0-7216-7728-2.
  9. ↑ Wolverton, Stephen E. (2001). Comprehensive Dermatologic Drug Therapy. Philadelphia: W.B. Saunders Company. pp. 562–563. ISBN   0-7216-7728-2.
  10. ↑ Chi, Ching-Chi; Wang, Shu-Hui; Wojnarowska, Fenella; Kirtschig, Gudula; Davies, Emily; Bennett, Cathy (2015-10-26). "Safety of topical corticosteroids in pregnancy". Cochrane Database of Systematic Reviews. 2015 (10): CD007346. doi:10.1002/14651858.CD007346.pub3. ISSN   1465-1858. PMC   8558096 . PMID   26497573. Archived from the original on 2020-08-15. Retrieved 2018-06-23.
  11. ↑ Habif, Thomas P. (1990). Clinical dermatology: a color guide to diagnosis and therapy (2nd ed.). St. Louis: Mosby. p. Inside front cover. ISBN   0-8016-2465-7.
  12. ↑ "Topical steroids (corticosteroid creams)". DermNet NZ. Archived from the original on 2016-07-25. Retrieved 2008-12-05.
  13. ↑ Wolverton, Stephen E. (2001). Comprehensive Dermatologic Drug Therapy. Philadelphia: W.B. Saunders Company. p. 562. ISBN   0-7216-7728-2.
  14. ↑ Rattner H (November 1955). "The status of corticosteroid therapy in dermatology". Calif Med. 83 (5): 331–335. PMC   1532588 . PMID   13260925.
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