Topical steroids 2008 Dr Amal Kokandi MB BCh

Topical steroids (2008) Dr. Amal Kokandi MB, BCh, MSc, MD

Mode of action n n Anti-inflamatory Immunosuppression Vasoconstriction Antimtotic Glucocorticoid activity • Cushing’s syndrome n n Mineralocorticoid activity Antimetabolic effect • striae, dermal atrophy, and ecchymosis)

Uses n Common indications for topical steroids: • Eczema • Pityriasis rosea • Lichen planus • Alopecia areata • Psoriasis (some forms) • vitiligo

Special considerations n n n Face Intertriginous areas Children Effect of occlusion infections and combination formulas (with antibiotics and antifungals)

Finger tip unit

Finger tip unit n n 2 FTU = nearly 1 gram Enough for twice size of adult hand • • A hand fingers (front and back) = 1 FTU A foot (all over) + 2 FTU Front of chest and abdomen = 7 FTU Back and buttocks = 7 FTU Face and neck = 2. 5 FTU An entire arm and hand = 4 FTU An entire leg and foot = 8 FTU

Potencies (European) n n Weak Moderate Potent Very potent

Potencies (American) n n n n Class 1 Class 2 Class 3 Class 4 Class 5 Class 6 Class 7 (superpotent) (potent) (midstrength) (mild) (least potent)

Examples n Weak • Hydrocrtisone 0. 5 -2. 5% (Alfacort, Mycoheal with miconazole, Fucidin H with fucidic acid) n Moderate • Clobetasone butyrate 0. 05% (Eumovate) • Hydrocrtisone with urea (Carmol HC)

Examples n Potent • Mometasone dipropionate 0. 025% or furoate 0. 1% (Elica, Elica M with miconazole, Momenta with miconazol & gentamycin) • Betamethasone esters as valerate 0. 1% or diproprionate 0. 05% (Betnovate, Betaderm, Fucibact B with Fucidic acid, Betazol with miconazole, Diprosalic with salicylic acid)

Examples n Potent (cont. ) • Hydrocortisone 17 butyrate 0. 1% (Locoid) • Trimcinolone acetonide 0. 1% (Panderm with gentamycin, nystatin & neomycin)

Examples n Very potent • Clobetasol propionate 0. 05% (Dermovate, Gamavate) • Diflucortolone valerate (Nerisone)

Side effects n n n Perioral dermatitis and rosacea Tachyphylaxis & steroid addiction Infections (tinea incognito, herpes simplex, pityriasis versicolor, scabies……) Adrenal suppression Glucoma and cataract Angina bullosa purpura (hard palate)

Side effects n Local side effects • Telangiectasia, purpura, epidermal, dermal and subcutaneous atrophy, striae, psuedoscars…… • Folliculitis • Allergic reactions • Hypopigmentation • Hypertrichosis • Delayed wound healing • Alteration in skin elasticity & mechanical properties

Dermatitis due to topical steroid

Tinea incognito