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

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

Uses Common indications for topical steroids: Common indications for topical steroids: EczemaEczema Pityriasis roseaPityriasis rosea Lichen planusLichen planus Alopecia areataAlopecia areata Psoriasis (some forms)Psoriasis (some forms) vitiligovitiligo

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

Finger tip unit

2 FTU = nearly 1 gram 2 FTU = nearly 1 gram Enough for twice size of adult hand Enough for twice size of adult hand A hand and fingers (front and back) = 1FTUA hand and fingers (front and back) = 1FTU A foot (all over) + 2FTUA foot (all over) + 2FTU Front of chest and abdomen = 7FTUFront of chest and abdomen = 7FTU Back and buttocks = 7FTUBack and buttocks = 7FTU Face and neck = 2.5 FTUFace and neck = 2.5 FTU An entire arm and hand = 4 FTUAn entire arm and hand = 4 FTU An entire leg and foot = 8 FTUAn entire leg and foot = 8 FTU

Potencies (European) Weak Weak Moderate Moderate Potent Potent Very potent Very potent

Potencies (American) Class1 (superpotent) Class1 (superpotent) Class2 (potent) Class2 (potent) Class3 (potent) Class3 (potent) Class4 (midstrength) Class4 (midstrength) Class5 (midstrength) Class5 (midstrength) Class6 (mild) Class6 (mild) Class7 (least potent) Class7 (least potent)

Examples Weak Weak Hydrocrtisone % (Alfacort, Mycoheal with miconazole, Fucidin H with fucidic acid)Hydrocrtisone % (Alfacort, Mycoheal with miconazole, Fucidin H with fucidic acid) Moderate Moderate Clobetasone butyrate 0.05% (Eumovate)Clobetasone butyrate 0.05% (Eumovate) Hydrocrtisone with urea (Carmol HC)Hydrocrtisone with urea (Carmol HC)

Examples Potent Potent Mometasone dipropionate 0.025% or furoate 0.1% (Elica, Elica M with miconazole, Momenta with miconazol & gentamycin)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)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 Potent (cont.) Potent (cont.) Hydrocortisone 17 butyrate 0.1% (Locoid)Hydrocortisone 17 butyrate 0.1% (Locoid) Trimcinolone acetonide 0.1% (Panderm with gentamycin, nystatin & neomycin)Trimcinolone acetonide 0.1% (Panderm with gentamycin, nystatin & neomycin)

Examples Very potent Very potent Clobetasol propionate 0.05% (Dermovate, Gamavate)Clobetasol propionate 0.05% (Dermovate, Gamavate) Diflucortolone valerate (Nerisone)Diflucortolone valerate (Nerisone)

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

Side effects Local side effects Local side effects Telangiectasia, purpura, epidermal, dermal and subcutaneous atrophy, striae, psuedoscars……Telangiectasia, purpura, epidermal, dermal and subcutaneous atrophy, striae, psuedoscars…… FolliculitisFolliculitis Allergic reactionsAllergic reactions HypopigmentationHypopigmentation HypertrichosisHypertrichosis Delayed wound healingDelayed wound healing Alteration in skin elasticity & mechanical propertiesAlteration in skin elasticity & mechanical properties

Dermatitis due to topical steroid

Tinea incognito