Topical steroids (2008)Topical steroids (2008)

Dr. Amal KokandiDr. Amal Kokandi

MB,BCh, MSc, MDMB,BCh, MSc, MD

Mode of actionMode of action

Anti-inflamatoryAnti-inflamatory ImmunosuppressionImmunosuppression VasoconstrictionVasoconstriction AntimtoticAntimtotic Glucocorticoid activityGlucocorticoid activity

• Cushing’s syndromeCushing’s syndrome Mineralocorticoid activityMineralocorticoid activity Antimetabolic effect Antimetabolic effect

• striae, dermal atrophy, and ecchymosis)striae, dermal atrophy, and ecchymosis)

UsesUses

Common indications for topical Common indications for topical steroids:steroids:• EczemaEczema• Pityriasis roseaPityriasis rosea• Lichen planusLichen planus• Alopecia areataAlopecia areata• Psoriasis (some forms)Psoriasis (some forms)• vitiligovitiligo

Special considerationsSpecial considerations

FaceFace Intertriginous areasIntertriginous areas ChildrenChildren Effect of occlusionEffect of occlusion infections and combination formulas infections and combination formulas

(with antibiotics and antifungals)(with antibiotics and antifungals)

Finger tip unitFinger tip unit

Finger tip unitFinger tip unit

2 FTU = nearly 1 gram2 FTU = nearly 1 gram Enough for twice size of adult handEnough for twice size of adult hand

• A hand and fingers (front and back) = 1FTUA hand and fingers (front and back) = 1FTU• A foot (all over) + 2FTUA foot (all over) + 2FTU• Front of chest and abdomen = 7FTUFront of chest and abdomen = 7FTU• Back and buttocks = 7FTUBack and buttocks = 7FTU• Face and neck = 2.5 FTUFace and neck = 2.5 FTU• An entire arm and hand = 4 FTUAn entire arm and hand = 4 FTU• An entire leg and foot = 8 FTUAn entire leg and foot = 8 FTU

Potencies (European)Potencies (European)

WeakWeak ModerateModerate PotentPotent Very potentVery potent

Potencies (American)Potencies (American)

Class1 (superpotent)Class1 (superpotent) Class2 (potent)Class2 (potent) Class3 (potent)Class3 (potent) Class4 (midstrength)Class4 (midstrength) Class5 (midstrength)Class5 (midstrength) Class6 (mild)Class6 (mild) Class7 (least potent)Class7 (least potent)

ExamplesExamples

WeakWeak• Hydrocrtisone 0.5-2.5% (Hydrocrtisone 0.5-2.5% (AlfacortAlfacort, ,

MycohealMycoheal with miconazole, with miconazole, Fucidin HFucidin H with fucidic acid)with fucidic acid)

ModerateModerate• Clobetasone butyrate 0.05% (Clobetasone butyrate 0.05% (EumovateEumovate))• Hydrocrtisone with urea (Hydrocrtisone with urea (Carmol HCCarmol HC))

ExamplesExamples

PotentPotent• Mometasone dipropionate 0.025% or Mometasone dipropionate 0.025% or

furoate 0.1% (furoate 0.1% (Elica, Elica MElica, Elica M with with miconazole, miconazole, MomentaMomenta with miconazol & with miconazol & gentamycingentamycin))

• Betamethasone esters as valerate 0.1% Betamethasone esters as valerate 0.1% or diproprionate 0.05% (or diproprionate 0.05% (Betnovate, Betnovate, Betaderm, Fucibact BBetaderm, Fucibact B with Fucidic acid, with Fucidic acid, BetazolBetazol with miconazole, with miconazole, DiprosalicDiprosalic with with salicylic acidsalicylic acid))

ExamplesExamples

Potent (cont.)Potent (cont.)• Hydrocortisone 17 butyrate 0.1% Hydrocortisone 17 butyrate 0.1%

((LocoidLocoid))

• Trimcinolone acetonide 0.1% (Trimcinolone acetonide 0.1% (PandermPanderm with gentamycin, nystatin & neomycinwith gentamycin, nystatin & neomycin))

ExamplesExamples

Very potentVery potent• Clobetasol propionate 0.05% Clobetasol propionate 0.05%

((DermovateDermovate, Gamavate, Gamavate))• Diflucortolone valerate (Diflucortolone valerate (NerisoneNerisone))

Side effectsSide effects

Perioral dermatitis and rosaceaPerioral dermatitis and rosacea Tachyphylaxis & steroid addictionTachyphylaxis & steroid addiction Infections (tinea incognito, herpes Infections (tinea incognito, herpes

simplex, pityriasis versicolor, simplex, pityriasis versicolor, scabies……)scabies……)

Adrenal suppressionAdrenal suppression Glucoma and cataractGlucoma and cataract Angina bullosa purpura (hard palate)Angina bullosa purpura (hard palate)

Side effectsSide effects

Local side effectsLocal side effects• Telangiectasia, purpura, epidermal, dermal and Telangiectasia, purpura, epidermal, dermal and

subcutaneous atrophy, striae, psuedoscars……subcutaneous atrophy, striae, psuedoscars……• FolliculitisFolliculitis• Allergic reactionsAllergic reactions• HypopigmentationHypopigmentation• HypertrichosisHypertrichosis• Delayed wound healingDelayed wound healing• Alteration in skin elasticity & mechanical Alteration in skin elasticity & mechanical

propertiesproperties

Dermatitis due to topical steroid

Tinea incognito