Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Dr.Bhavesh Pansuria
(BAMS)
Topical corticosteroids
Topical corticosteroids
MOA:
Anti-inflammation
Immunosuppressive
Antiproliferative
Use
erythema
scaling &
pruritus
High-potency steroids
(groups I to III)
Alopecia areata
Atopic dermatitis
(resistant)
Discoid lupus
Hyperkeratotic
eczema
Lichen planus
Lichen sclerosus
(skin)
Lichen simplex
chronicus
Nummular eczema
Poison ivy (severe)
PsoriasisSevere
Hand eczema
Medium-potency
steroids (groups IV
and
V)
Anal inflammation
Scabies (after
(severe)
Asteatotic eczema
Atopic dermatitis
Lichen sclerosus
(vulva)
Nummular eczema
scabicide)
Seborrheic
dermatitis
Severe dermatitis
Severe intertrigo
(short-term)
Stasis dermatitis
Low-potency steroids
(groups VI and VII)
Dermatitis
(diaper)
Dermatitis
(eyelids)
Dermatitis (face)
Intertrigo
Perianal
inflammation
Choosing a topical
steroid
Moderate:
Choice of vehicle
Ointments
Most effective
Ointment have oily/greasy base (ie:petroleum jelly)
Greasy texture persists on the skin surface
Translucent
Best lubrication, penetration
Best for dry or thick, hyperkeratotic lesions
Not recommended for hairy areas & areas where
skin touches skin or acute vesicular or weeping
rashes
Poor pt satisfaction / compliance b/o grease nature.
Creams
Lotions
Gels
Foams
Use:
Hairy areas
Expensive
Drying
Potency
Topical Steroids
Potency
I: (Most Potent)
Clobetasol propionate
0.05% (cream,
ointment,
solution)
Betamethasone
dipropionate
0.05% (optimized
vehicle; ointment)
Halobetasol propionate
0.05% (cream,
ointment)
Diflorasone diacetate
0.05% (optimized
vehicle;
ointment)
II: High
Betamethasone valerate
0.1% (cream)
Betamethasone
dipropionate
0.05% (ointment)
Mometasone furoate
0.1% (ointment)
Halcinonide
0.1% (cream)
0.1% (ointment)
Flucinonide
0.05% (cream)
Fluticasone propionate
0.005% (ointment)
Betamethasone
dipropionate
0.05% (cream)
IV: Medium
Triamcinolone acetonide
0.1% (ointment)
Hydrocortisone valerate
0.2% (ointment)
Mometasone furoate
0.1% (cream)
Fluocinolone acetonide
0.025% (ointment)
Methylprednisolone
aceponate
0.1% (cream)
V: Medium Low
Fluticasone propionate
0.05% (cream)
Betamethasone benzoate
0.025% (cream)
Betamethasone valerate
0.1% (cream)
Triamcinolone acetate
0.15% (lotion)
Hydrocortisone butyrate
0.1% (cream)
Hydrocortisone valerate
0.2% (cream)
VI: Low
Aclometasone
dipropionate
Fluocinolone acetonide
0.05% (cream,
ointment)
0.01% (cream,
solution)
0.05% (cream)
Desonide
Betamethasone valerate 0.1% (lotion)
Dexamethasone
0.1% (cream)
Methylprednisolone
1%
Regional Differences in
Penetration: Most to
Least
1. Mucous membrane
2. Scrotum
3. Eyelids
4. Face & scalp
5. Chest & back
6. Upper arms & legs
7. Lower arms & legs
8. Dorsa of hands & feet
9. Palmar & plantar skin
10. Nails
Sites
Low
Ultra-high
Application tips
Children/elderly:
avoid potent fluorinated compounds
Face:
only non-fluorinated
mild unless severe dematitis
Frequency of
Administration
QD or BID application
No improved result for more frequent
administration
Chronic application can induce
tachyphylaxis (tolerance)
Max 3wks for ultra-high-potency
steroids
Amount of application
Amount Required
Area
Treated
1
Applicatio
n (g)
Bid for 1
Week (g)
Bid for 1
Month (g)
Ano-genital, 2gm
face, hands,
head
28gm
120gm
1 arm,
posterior or
anterior
trunk
3gm
42gm
180gm
1 leg
4gm
56gm
240gm
Entire body
30gm
60gm
420gm
840gm
1.83.6 kg
Dosing-FTU Fingertip
unit
Dose of cream in a
fingertip unit varies with
age:
Finger-tip measurements
1 finger-tip length = 0.5gm
2 finger-tip lengths = 1gm
1 pump unit = 1gm
Topical steroids:
approximate single
application requirement
child0.5 g
Child
Face and
neck
0.5 g
One arm
2g
Trunk (front
and back)
1g
One leg
1g
Hands and
feet
Topical steroids:
approximate single
application requirement
adult1.5 g
Adult
Face and
neck
1.5 g
One arm
7g
Trunk (front
and back)
1g
One hand
3g
One leg
1g
One foot
Example
Skin Atropy
Vascular purpura
Telangiectasia
Hypopigmentation
Is commonly perilesional??
Striae
Allergic contact
Cutneous
candidiasis
Reversible
Miliaria
Perioral dermatitis
Steroid induced
Rosacea
Acneform eruption
Tachyphylaxis
Key Points
Allergy associations
Group C
Betamethasone, betamethasone sodium phosphate,
dexamethasone, dexamethasone sodium phosphate,
and fluocortolone
Group D
Hydrocortisone-17-butyrate, hydrocortisone-17valerate, aclometasone dipropionate,
betamethasone valerate, betamethasone
dipropionate, prednicarbate, clobetasone-17butyrate, clobetasol-17-propionate, fluocortolone
caproate, fluocortolone pivalate, and fluprednidene
acetate
Intralesional steroid
therapy
Indications
Keloids
Alopecia areata
Prurigo nodularis
LSC
Hypertrophic
lichen planus
Hemangiomas
Pemphigus vulgaris
Nodular scabies
Reiters disease
Granuloma cheilitis
DLE, mild LE
Nodulocystic acne
Localized
recalcitral psoriasis
Dose
Preparation
Triamcinolone 10mg
Kenacort
acetonide
IL,40mg every 10mg/ml
4 weeks
40mg/ml
Hydrocortison 25mg IL,
e (depot
every 4
preparation) weeks
Wycort
25mg/ml vial
Methyl
prednisolone
acetate
Depomedrol
10mg/ml,
40mg/ml
10mg IL,
every 4-8
weeks
Advantages over
topical and oral
steroid
The injection of a steroid into the skin
Side Effects
Key Points