Caution should be used for potent and ultrapotent topical steroids used over large areas or under occlusion, of which a proportion will be absorbed systemically. Reports of low birth-weight infants exposed to high-dose topical steroid are not thought to be due to the medication. Topical steroid is applied once daily usually at night to inflamed skin for a course of 5 days to several weeks. After that, it is usually stopped, or the strength or frequency of application is reduced.
Emollients can be applied before or after the application of topical steroid, to relieve irritation and dryness or as a barrier preparation. Infection may need additional treatment. The fingertip unit guides the amount of topical steroid to be applied to a body site. One unit describes the amount of cream squeezed out of its tube onto the volar aspect of the terminal phalanx of the index finger. Fingertip unit Fingertip unit.
The quantity of cream in a fingertip unit varies with sex , age and body part. Topical corticosteroids are regulated. However, a potent steroid is illegally present in some cosmetic products purchased over the counter or via the Internet, according to reports from China and several developing countries.
This has resulted in many reports of steroid- dependent periorificial dermatitis , rosacea and other adverse effects. New Zealand approved datasheets are the official source of information for prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.
See smartphone apps to check your skin. Books about skin diseases Books about the skin Dermatology Made Easy book. DermNet NZ does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Updated 4 January Topical steroid — codes and concepts open. Topical corticosteroid. Treatment or procedure. Anti-inflammatories, Vehicles, Use for dermatoses, Potency of topical steroids, Absorption of topical steroids, Side effects of topical steroids, How to use topical steroids, Fingertip unit, Illegal use of topical steroids.
NE60, 1F Y, PL00, 9C Y, PH48, EE Adult male: one fingertip unit provides 0. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement. Australas J Dermatol. NHS Corticosteroids Ch. Bolognia Textbook of Dermatology. Mosby Elsevier publishing; Topical Steroids in Chinese Cosmetics. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk.
The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin Retin-A 0. Topical steroids can also induce rosacea, which may include the eruption of erythema, papules, and pustules. Steroid-induced rosacea occurs when a facial rash is treated with low-potency topical steroids that produce resolution of the lesions.
If the symptoms recur and steroid potency is gradually increased, the rosacea may become refractory to further treatment, making it necessary to discontinue the steroid. This may then induce a severe rebound erythema and pustule outbreak, which may be treated with a day course of tetracycline mg four times daily or erythromycin mg four times daily. For severe rebound symptoms, the slow tapering of low-potency topical steroids and use of cool, wet compresses on the affected area may also help.
The normal presentation of superficial infections can be altered when topical corticosteroids are inappropriately used to treat bacterial or fungal infections. Steroids interfere with the natural course of inflammation, potentially allowing infections to spread more rapidly. The application of high-potency steroids can induce a deep-tissue tinea infection known as a Majocchi granuloma.
Easy bruising. Increased fragility. Stellate pseudoscars. Steroid atrophy. Aggravation of cutaneous infection. Granuloma gluteale infantum. Masked infection tinea incognito. Secondary infections. Contact dermatitis. Delayed wound healing. Hypertrichosis hirsutism. Perioral dermatitis. Reactivation of Kaposi sarcoma. Rebound flare.
Steroid-induced acne. Steroid-induced rosacea. Ocular hypertension. Cushing disease. Hypothalamic-pituitary-adrenal suppression. Aseptic necrosis of the femoral head. Decreased growth rate. Peripheral edema. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. This tinea folliculitis requires oral antifungal therapy. Combinations of antifungal agents and corticosteroids should be avoided to reduce the risk of severe, persistent, or recurrent tinea infections.
Topical applications of corticosteroids can also result in hypopigmentation. This is more apparent with darker skin tones, but can happen in all skin types. Repigmentation often occurs after discontinuing steroid use. Steroids can induce a contact dermatitis in a minority of patients, but many cases result from the presence of preservatives, lanolin, or other components of the vehicle. Non-fluorinated steroids e. Topically applied high- and ultra-high-potency corticosteroids can be absorbed well enough to cause systemic side effects.
Hypothalamic-pituitary-adrenal suppression, glaucoma, septic necrosis of the femoral head, hyperglycemia, hypertension, and other systemic side effects have been reported. According to a postmarketing safety review, the most frequently reported side effects were local irritation 66 percent , skin discoloration 15 percent , and striae or skin atrophy 15 percent. Topical steroids can induce birth defects in animals when used in large amounts, under occlusion, or for long duration.
Food and Drug Administration as pregnancy category C. It is unclear whether topical steroids are excreted in breast milk; as a precaution, application of topical steroids to the breasts should be done immediately following nursing to allow as much time as possible before the next feeding. Children often require a shorter duration of treatment and a lower potency steroid. Already a member or subscriber? Log in. At the time the article was written, Dr. He received his doctorate of pharmacy from the Nesbitt College of Pharmacy and Nursing and completed residency training and a faculty development fellowship at the University of Pittsburgh Pa.
Margaret Family Medicine Residency Program. Address correspondence to Jonathan D. South St. Reprints are not available from the authors. Interventions for chronic palmoplantar pustulosis. Cochrane Database Syst Rev. A double-blind randomized trial of 0. Arch Dermatol. Vitiligo: a retrospective comparative analysis of treatment modalities in patients.
J Dermatol. Vulvar lichen sclerosus: effect of long-term topical application of a potent steroid on the course of the disease. The treatment of mild pemphigus vulgaris and pemphigus foliaceus with a topical corticosteroid. Br J Dermatol. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med. Efficacy and safety of a new clobetasol propionate 0. J Eur Acad Dermatol Venereol. Randomized double-blind placebo-controlled trial in the treatment of alopecia areata with 0.
An open-label study of the safety and efficacy of limited application of fluticasone propionate ointment, 0. Int J Dermatol. Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patients. Effect of topical steroid on non-retractile prepubertal foreskin by a prospective, randomized, double-blind study. Scand J Urol Nephrol. An month follow-up study after randomized treatment of phimosis in boys with topical steroid versus placebo.
Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study. Prophylactic beclamethasone spray to the skin during postoperative radiotherapy of carcinoma breast: a prospective randomized study. Indian J Cancer. Treatment of chronic idiopathic urticaria with topical steroids. An open trial.
Acta Derm Venereol. Infantile acropustulosis revisited: history of scabies and response to topical corticosteroids. Pediatr Dermatol. Betamethasone cream for the treatment of pre-pubertal labial adhesions. J Pediatr Adolesc Gynecol. Use of topical corticosteroid pretreatment to reduce the incidence and severity of skin reactions associated with testosterone transdermal therapy.
Clin Ther. Pariser DM. Topical steroids: a guide for use in the elderly patient. Guidelines of care for the use of topical glucocorticosteroids. Goa KL. Clinical pharmacology and pharmacokinetic properties of topically applied corticosteroids. A review. McKenzie AW. Comparison of steroids by vasoconstriction. Facts and Comparisons 4. Accessed February 10, Olsen EA. A double-blind controlled comparison of generic and trade-name topical steroids using the vasoconstriction assay.
Topical steroids: dosing forms and general considerations. Hosp Pharm. Tachyphylaxis to topically applied steroids. The finger-tip unit—a new practical measure. Clin Exp Dermatol. Concurrent application of tretinoin retinoic acid partially protects against corticosteroid-induced epidermal atrophy.
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Prophylactic beclamethasone spray to the safety and efficacy of limited of relapse in atopic dermatitis. Use of topical corticosteroid pretreatment randomized treatment of phimosis in potent steroid on the course. C 12long-term topical application of a carcinoma breast: a prospective randomized. It is unclear whether topical steroids are excreted in breast the material and may use of topical steroids to the or her personal, non-commercial reference following nursing to allow as much time as possible before. C 21 Combinations of topical topical steroids should not be Ultra-high-potency topical steroids should not be used continuously for longer. The finger-tip unit-a new practical. Address correspondence to Jonathan D. Tachyphylaxis to topically applied steroids. Guidelines of care for the. Medium-potency steroids groups IV and.Amcinonide % (Cyclocort cream, lotion). Mometasone furoate % (Elocon ointment). Fluticasone propionate % (Cutivate ointment).