Prescribed for inflammatory dermatological conditions.
Can lead to skin atrophy, telangiectasia and striae.
Prolonged use can lead to hypertrichosis.
Topical corticosteroids: order of increasing potency: hydrocortisone, betamethasone dipropionate, clobetasol 17-butyrate, and clobetasol dipropionate.
Divided into 7 classes based on potency to constrict blood vessels.
Class 1 agents are 600-1000 times stronger than over counter hydrocortisone,1%.
Fluorination increases the potency of these agents and potential for adverse side effects.
Prototypes of classes: 7-OTC hydrocortisone
6-desonide
5-hydrocortisone valerate
4-triamcinoloneacetonide/mometasone furoate
3-betamethasone valeratefluocinolone acetonide
2-fluocinonide/desoximetasone
1-clobetasol propionate
In general ultra high potency topical corticosteroids should not be used for longer than three weeks.
Low to high potency topical corticosteroids should not be used continuously for longer than three months to avoid adverse effects.
The amount of steroids absorb is a reflection of the skin thickness and , hyperkeratosis.
In areas of denuded skin more corticosteroids can be absorbed.
Application topical steroids generally should be done once or twice a day, and more frequent applications does not result in clinical improvement.
Application should be the amount that can be dispensed from a fingertip unit which equals approximately 0.5 g of material.
Side effects of topical corticocorticosteroids include: atrophy of the skin, easy bruisability, increased fragility, thinning of the skin, striae formation, and worsening of cutaneous infections.
Most common adverse effect in using topical corticosteroids is local burning or stinging, and generally improves after several applications.
Rarely systemic effects may occur with ultra potent corticosteroids applied over large surface areas and may include: Cushing’s disease, hypothalamus-pituitaryadrenal axis suppression, decreased growth rate, and aseptic necrosis of the femur head.