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. 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.
Over the past decade, much awareness has been brought to the side effects and damage that long term topical steroid use can bring, particularly in cases where it used for the treatment of eczema.
Weaker topical steroids are utilized for thin-skinned and sensitive areas, especially areas under occlusion, such as the armpit, groin, buttock crease, 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.
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. 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.
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.
- Hypothalamic pituitary adrenal axis (HPA) suppression
- Cushing's syndrome
- Diabetes mellitus
- 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 intra-ocular pressure (IOP) and increase the risk of glaucoma, cataract, retinopathy as well as systemic adverse effects.
- Tachyphylaxis: The acute development of tolerance to the action of a drug after repeated doses. 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.
The USA system 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.
Very potent: up to 600 times stronger than hydrocortisone
The weakest class of topical steroids. Has poor lipid permeability, and can not penetrate mucous membranes well.
Most other countries, such as the United Kingdom, Germany, the Netherlands, New Zealand, recognize only 4 classes. In the United Kingdom and New Zealand I is the strongest, while in Continental Europe, class IV is regarded as the strongest.
Very potent (up to 600 times as potent as hydrocortisone)
Potent (50-100 times as potent as hydrocortisone)
Moderate (2-25 times as potent as hydrocortisone)
- Hydrocortisone 0.5-2.5% (DermAid Cream/Soft Cream, DP Lotion-HC 1%, Skincalm, Lemnis Fatty Cream HC, Pimafucort Cream/Ointment)
Japan rates topical steroids from 1 to 5, with 1 being strongest.
The highlighted steroids are often used in the screening of allergies to topical steroid and systemic steroids. When one is allergic to one group, one is allergic to all steroids in that group.
Hydrocortisone, hydrocortisone acetate, cortisone acetate, tixocortol pivalate, prednisolone, methylprednisolone, and prednisone
Triamcinolone acetonide, triamcinolone alcohol, amcinonide, budesonide, desonide, fluocinonide, fluocinolone acetonide, and halcinonide
Betamethasone, betamethasone sodium phosphate, dexamethasone, dexamethasone sodium phosphate, and fluocortolone
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
Corticosteroids were first made available for general use around 1950.
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