Drug name:

Betamethasone valerate

Clobetasol propionate (Dermovate)

Hydrocortisone topical oral rectal

Hydroxycortisone acetate

Hydroxycortisone butyrate

Hydrocortisone probutate

Hydrocortisone valerate

Prototype-original:

Topical Hydrocortisone (1951) by Sulzberger and Witten

Drug category:

Topical Steroid

>Corticosteroid (long acting)

>Glucocorticoid

>Hormone

Area Treated 1 Application (g) Bid for 1 Week (g) Bid for 1 Month (g)

Ano-genital, 2gm 28gm 120gm

face, hands,
head

1 arm, posterior 3gm 42gm 180gm

or anterior trunk
1 leg 4gm 56gm 240gm

Entire body 30gm–60gm 420gm–840gm 1.8–3.6 kg

Dose/preparation:

MOA:

synthetic (man-made) corticosteroid that is used topically (on the skin). Betamethasone mimics the
action of cortisol (hydrocortisone), the naturally-occurring steroid produced in the body by the adrenal
glands. Corticosteroids have potent anti-inflammatory actions and also suppress the immune response.

Anti-inflammation - Corticosteroids exerts their Anti-inflammatry effects through the following

mechanism:-

-Vasoconstriction

-Stabilization of lysosomal membrane

-Inhibition of prostraglandins & leucotrienes synthesis by blocking phospholipase

-Decreased chemotaxis of pro inflammatory cells at the site of inflammation

Immunosuppressive - Corticosteroids exerts their Immunosuppressive effects through the following
mechanism:-

-Induction of lymphocytes and eosinophil apoptosis

-Depletion of langerhans cells in the epidermis & dermis

-Decreased IL-2 production by T-cells

Antiproliferative - Corticosteroids exerts their Antiproliferative effects through the following

mechanism:-

-Inhibition of mytosis of kerationcytes

-Inhibition of synthesis of dermal fibroblasts & subsequent collagen, elastin &

glycosaminoglycans
 -Corticosteroids bind to cytosolic receptors & affects transcription & translation

Inhibit phospholipase A2 which reduces skin levels of pro-inflam kinines:

-Arachidonic acid

(Omega-6, ’s inflammation)

-Prostaglandins

( ’s vascular dilation)

-Leukotrienes

(inflammatory response)

Special form ex. Fast relief capsule:

Ointments – most effective; oily greasy base (persists on the skin surface, best penetration, lubrication),
best for dry or thick, hyperkeratotic lesions, not recommended for airy areas or acute vesicular or
weeping rashes, poor compliance because of greasy nature

Creams – most often prescribe; water suspended in oil; white color, less greasy, vanish into skin; used
for most skin areas (groin, rectal, armpits), acute exudative inflammation bc of drying effect with
repeated use, less potent than ointment, often contain preservatives which cause irritation, stinging,
allergic reaction

Lotions - bases contain water, alcohol, other chemicals; clear or milky appearance; less greasy, less
occlusive; useful for scalp bc of no residue, can cause stinging and drying

Gels - mix of propylene glycol (Drying) and water; clear color, nongreasy, jelly-like consistency;

Foams – hairy areas, expensive, drying

Therapeutic uses/indications:
Atopic dermatitis, Seborrheic dermatitis, Lichen simplex chronicus, Pruritus ani, Later phase of allergic
contact dermatitis, Later phase of irritant dermatitis, Nummular eczematous dermatitis, Stasis
dermatitis, Psoriasis (especially of genitalia and face)

Hypercalcemia associated with cancer

Short-term management of inflammatory and allergic disorders, such as rheumatoid arthritis, collagen
diseases (eg, SLE), dermatologic diseases (eg, pemphigus), status asthmaticus, and autoimmune
disorders

Hematologic disorders: Thrombocytopenia purpura, erythroblastopenia

Ulcerative colitis, acute exacerbations of MS, and palliation in some leukemias and lymphomas

Trichinosis with neurologic or myocardial involvement

erythema

 scaling &

 pruritus

Side effects:

Sytemic:

-If more than 50g of clobetasol propionate, or 500g of hydrocortisone is used per week, sufficient
steroid may be absorbed through the skin to result in adrenal gland suppression and/or eventually
Cushing's syndrome.

-Adrenal Gland Suppression.

Topical steroids can suppress the production of natural steroids, which are essential for healthy living.
Stopping the steroids suddenly may then result in illness.

-Cushing's Syndrome If large amounts of steroid are absorbed through the skin, fluid retention, raised
blood pressure, diabetes etc. may result.

Local:

Local side effects Remarks/ Predospind factors

Skin Atropy Thin skin of eyelids, genitals, children

Vascular purpura Dependent areas, scury,collegen vascular disorder

Telangiectasia Senil skin, infants & children

Hypopigmentation Is commonly perilesional??

Striae Obesity, pregnancy, potent steroids

Allergic contact Due to vehical or steroid molecule

Cutneous candidiasis Diabetes, pt. on cytotoxic therapy & Malignancies

Poor wound healing Diabetes

Hypertrichosis Reversible

Folliculitis & other bacterial infection Pre existing cutaneous infection, diabetes, neuropathic patients, immuno defic
steroids in ointment form

Miliaria TCS under occlusion, TCS over occluded sites like flexures

Perioral dermatitis Fluorinated steroids & potent steroids over face, use of cosmetics

Steroid induced Rosacea Flurinated steroid & potent steroid over face

Acneform eruption Monomorphic papules mostly on back, no comedones & inflammatory lesions

Tachyphylaxis Sudden decrease in the response to a drug after its administration

Adverse effects:
The potential to suppress the pituitary-adrenal axis

Iatrogenic Cushing’s syndrome

growth retardation is of particular concern in the pediatric age group

atrophy, which may present as depressed, shiny, often wrinkled “cigarette paper”-appearing skin

with prominent telangiectases

a tendency to develop purpura and ecchymosis;

corticoid rosacea, with persistent erythema, telangiectatic vessels, pustules, and papules in central facial
distribution; perioral dermatitis, steroid acne, alterations of cutaneous infections, hypopigmentation,
and hypertrichosis; increased intraocular pressure; and allergic contact dermatitis. The latter may be
confirmed by patch testing with high concentrations of corticosteroids, ie, 1% in petrolatum, because
topical corticosteroids are not irritating. Screening for allergic contact dermatitis potential is performed
with tixocortol pivalate, budesonide, and hydrocortisone valerate or butyrate. Topical corticosteroids
are contraindicated in individuals who demonstrate hypersensitivity to them. Some sensitized subjects
develop a generalized flare when dosed with adrenocorticotropic hormone or oral prednisone.

>Acne

>cracking and stinging of the skin;

>dryness;

>excessive hair growth;

>inflamed hair follicles;

>itching; skin irritation.

½ life and important pharmacokinetics:

Absorption:

Thin to thick stratum corneum: mucous membranes -> scrotum-> eyelids-> face-> torso-> extremities->
palm,soles, elbows, knees

Inflamed skin: less barrier, better absorption

Distribution:

Things that consumes me:

Drug interaction:

Too much for me is:

Whats your net worth:

Which trigger/encounter of the drug: