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Topical steroid

October 20, 2023

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.[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.

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

Medical uses Edit

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 Edit

See also: Topical steroid addiction

Safety in pregnancy Edit

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 Edit

See also: ATC code D07

Seven-class System Edit

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 Edit

Very potent: up to 600 times stronger than hydrocortisone

Class II Edit

Class III Edit

Class IV Edit

Class V Edit

Class VI Edit

Class VII Edit

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

Five-class System Edit

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

Four-class System Edit

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) Edit

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

Class III (UK/NZ: class II) Edit

Potent (50–100 times as potent as hydrocortisone)

Class II (UK/NZ: class III) Edit

Moderate (2–25 times as potent as hydrocortisone)

Class I (UK/NZ: class IV) Edit

Mild

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


Allergy associations Edit

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 Edit

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

Group B Edit

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

Group C Edit

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

Group D Edit

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 Edit

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

See also Edit

References Edit

  1. ^ a b 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): 416–25. doi:10.4103/2229-5178.142483. PMC 4228634. PMID 25396122.
  3. ^ Recommendations from New Zealand Dermatological Society Incorporated on corticosteroids 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): 123–6. 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): 527–37. 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, PA: W.B. Saunders Company. pp. 562–3. ISBN 0-7216-7728-2.
  9. ^ Wolverton, Stephen E. (2001). Comprehensive Dermatologic Drug Therapy. Philadelphia, PA: W.B. Saunders Company. p. 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. 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. from the original on 2016-07-25. Retrieved 2008-12-05.
  13. ^ Wolverton, Stephen E. (2001). Comprehensive Dermatologic Drug Therapy. Philadelphia, PA: 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): 331–5. PMC 1532588. PMID 13260925.

October 20, 2023
topical, steroid, topical, forms, corticosteroids, most, commonly, prescribed, topical, medications, treatment, rash, eczema, dermatitis, have, anti, inflammatory, properties, classified, based, their, skin, vasoconstrictive, abilities, there, numerous, topica. 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 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 Side effects may occur from long term topical steroid use 2 Contents 1 Medical uses 2 Adverse effects 3 Safety in pregnancy 4 Classification systems 4 1 Seven class System 4 1 1 Class I 4 1 2 Class II 4 1 3 Class III 4 1 4 Class IV 4 1 5 Class V 4 1 6 Class VI 4 1 7 Class VII 4 2 Five class System 4 3 Four class System 4 3 1 Class IV UK NZ class I 4 3 2 Class III UK NZ class II 4 3 3 Class II UK NZ class III 4 3 4 Class I UK NZ class IV 4 4 Allergy associations 4 4 1 Group A 4 4 2 Group B 4 4 3 Group C 4 4 4 Group D 5 History 6 See also 7 ReferencesMedical uses EditWeaker 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 EditSee also Topical steroid addiction Hypothalamic pituitary adrenal axis HPA suppression 5 Cushing s syndrome Diabetes mellitus 6 Osteoporosis Topical steroid addiction Allergic contact dermatitis see steroid allergy Steroid atrophy Perioral dermatitis This is a rash that occurs around the mouth and the eye region that has been associated with topical steroids Ocular effects Topical steroid drops are frequently used after eye surgery but can also raise intraocular pressure IOP and increase the risk of glaucoma cataract retinopathy as well as systemic adverse effects 7 Tachyphylaxis The acute development of tolerance to the action of a drug after repeated doses 8 Significant tachyphylaxis can occur by day 4 of therapy Recovery usually occurs after 3 to 4 days rest This has led to therapies such as 3 days on 4 days off or one week on therapy and one week off therapy Delivery related adverse effects Other local adverse effects These include facial hypertrichosis folliculitis miliaria genital ulcers and granuloma gluteale infantum Long term use has resulted in Norwegian scabies Kaposi s sarcoma and other unusual dermatosis 9 Safety in pregnancy EditA 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 EditSee also ATC code D07 Seven class System Edit 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 Edit Very potent up to 600 times stronger than hydrocortisone Clobetasol propionate 0 05 Dermovate Betamethasone dipropionate 0 25 Diprolene Halobetasol propionate 0 05 Ultravate Halox Diflorasone diacetate 0 05 Psorcon Class II Edit Fluocinonide 0 05 Lidex Halcinonide 0 05 Halog Amcinonide 0 05 Cyclocort Desoximetasone 0 25 Topicort Class III Edit Triamcinolone acetonide 0 5 Kenalog Aristocort cream Mometasone furoate 0 1 Elocon Elocom ointment Fluticasone propionate 0 005 Cutivate Betamethasone dipropionate 0 05 Diprosone Halometasone 0 05 Class IV Edit Fluocinolone acetonide 0 01 0 2 Synalar Synemol Fluonid Hydrocortisone valerate 0 2 Westcort Hydrocortisone butyrate 0 1 Locoid Flurandrenolide 0 05 Cordran Triamcinolone acetonide 0 1 Kenalog Aristocort A ointment Mometasone furoate 0 1 Elocon cream lotion Class V Edit Fluticasone propionate 0 05 Cutivate cream Desonide 0 05 Tridesilon DesOwen ointment Fluocinolone acetonide 0 025 Synalar Synemol cream Hydrocortisone valerate 0 2 Westcort cream Class VI Edit Alclometasone dipropionate 0 05 Aclovate cream ointment Triamcinolone acetonide 0 025 Aristocort A cream Kenalog lotion Fluocinolone acetonide 0 01 Capex shampoo Dermasmooth Desonide 0 05 DesOwen cream lotion Class VII Edit The weakest class of topical steroids Has poor lipid permeability and can not penetrate mucous membranes well Hydrocortisone 2 5 Hytone cream lotion ointment Hydrocortisone 1 Many over the counter brands Five class System Edit Japan rates topical steroids from 1 to 5 with 1 being strongest Four class System Edit 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 Edit Very potent up to 600 times as potent as hydrocortisone Clobetasol propionate Dermovate Cream Ointment Exel Cream Betamethasone dipropionate Diprosone OV Cream Ointment Diprovate Cream Class III UK NZ class II Edit Potent 50 100 times as potent as hydrocortisone Betamethasone valerate Beta Cream Ointment Scalp Application Betnovate Lotion C Cream C Ointment Fucicort Betamethasone dipropionate Diprosone Cream Ointment Diprovate Cream Daivobet 50 500 Ointment Diflucortolone valerate Nerisone C Cream Fatty Ointment Ointment Hydrocortisone 17 butyrate Locoid C Cream Crelo Topical Emulsion Lipocream Ointment Scalp Lotion Mometasone furoate Elocon Cream Lotion Ointment Methylprednisolone aceponate Advantan Cream Ointment Halometasone 0 05 Class II UK NZ class III Edit Moderate 2 25 times as potent as hydrocortisone Clobetasone butyrate Eumovate Cream Triamcinolone acetonide Aristocort Cream Ointment Viaderm KC Cream Ointment Kenacomb Ointment Class I UK NZ class IV Edit Mild Hydrocortisone 0 5 2 5 DermAid Cream Soft Cream DP Lotion HC 1 Skincalm Lemnis Fatty Cream HC Pimafucort Cream Ointment Allergy associations Edit 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 Edit Hydrocortisone hydrocortisone acetate cortisone acetate tixocortol pivalate prednisolone methylprednisolone and prednisone Group B Edit Triamcinolone acetonide triamcinolone alcohol amcinonide budesonide desonide fluocinonide fluocinolone acetonide and halcinonide Group C Edit Betamethasone betamethasone sodium phosphate dexamethasone dexamethasone sodium phosphate and fluocortolone Group D Edit 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 furoateHistory EditCorticosteroids were first made available for general use around 1950 14 See also EditTopical medication Glucocorticoid Corticosteroid Retrometabolic drug designReferences Edit a b 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 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 25 doi 10 4103 2229 5178 142483 PMC 4228634 PMID 25396122 Recommendations from New Zealand Dermatological Society Incorporated on corticosteroids Archived 2016 07 08 at the Wayback Machine 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 Fisher DA 1995 Adverse effects of topical corticosteroid use West J Med 162 2 123 6 PMC 1022645 PMID 7794369 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 37 doi 10 2165 00002018 200932060 00008 PMID 19459719 S2CID 38326748 Lebreton O Weber M 2011 Complications ophtalmologiques des corticoides systemiques La Revue de Medecine Interne 32 8 506 512 doi 10 1016 j revmed 2011 01 003 PMID 21330017 Wolverton Stephen E 2001 Comprehensive Dermatologic Drug Therapy Philadelphia PA W B Saunders Company pp 562 3 ISBN 0 7216 7728 2 Wolverton Stephen E 2001 Comprehensive Dermatologic Drug Therapy Philadelphia PA W B Saunders Company p 563 ISBN 0 7216 7728 2 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 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 Topical steroids corticosteroid creams DermNet NZ Archived from the original on 2016 07 25 Retrieved 2008 12 05 Wolverton Stephen E 2001 Comprehensive Dermatologic Drug Therapy Philadelphia PA W B Saunders Company p 562 ISBN 0 7216 7728 2 Rattner H November 1955 The status of corticosteroid therapy in dermatology Calif Med 83 5 331 5 PMC 1532588 PMID 13260925 Retrieved from https en wikipedia org w index php title Topical steroid amp oldid 1138645240, wikipedia, wiki, book, books, library,

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