TOPICAL STEROIDS
- Glucocorticoids are used topically for a large variety of dermatological conditions. They benefit by virtue of their anti inflammatory, immunosuppressive, vasoconstrictor and antiproliferative (for scaling lesions) actions.
- The intensity of action depends on the extent of absorption to the deeper layers, thus lipophilicity of the compound determines potency to a great extent. Fluorinated compounds and lipid soluble esters, e.g. hydrocortisone butyrate are potent.
General guidelines for the use of topical steroids
Penetration of the steroid at different sites differs markedly -
- High Penetration region - axilla, groin, face, scalp and scrotum.
- Medium Penetration region - limbs and trunk.
- Low Penetration region - at palm, sole, elbow and knee.
Absorption into the skin also depends on the nature of lesion -
- High in atopic and exfoliative dermatitis,
- Low in hyperkeratinized and plaque forming lesions.
- Milder drugs should be used on acute lesions, stronger ones reserved for chronic lesions
Choice of vehicle-
- Lotions and creams (to some extent) are better for exudative lesions—they allow evaporation, have a cooling, drying and antipruritic effect.
- Sprays and gels used in hairy regions.
- Ointments form an occlusive film and are good for chronic,
scaly conditions
- Absorption is greater in infants and young children—milder agents should be used.
Use of potent preparations should be short term or intermittent to prevent adverse effects and tachyphylaxis.
Sudden
discontinuation should be avoided. Upon improvement a less potent preparation
may be substituted or the steroid may be alternated with an emollient till the
lesion resolves.
A combination of steroid with an antimicrobial may be used
for—impetigo, furunculosis, secondary infected dermatoses, napkin rash, otitis
externa, intertriginous eruptions.
Indications for topical steroids
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The available preparations may be roughly graded as:
Very potent preparations should be restricted to severe
inflammatory conditions, unresponsive eczema, psoriasis, etc., and that too
only for short periods till the lesion resolves. The mildest preparation that
will control the lesion should be used.
- Adrenal pituitary suppression can occur if large amounts are applied repeatedly.
- Infants and children are particularly susceptible.
- Rarely, Cushing’s syndrome has been reported.
- With proper use, the systemic risks are minimal.
Containing Chinoform or Quiniodochlor (3–4%): BECLATE-C, BETASONE-C, BETNOVATE-C, CORTOQUINOL, FLUCORT-C
Containing Gentamicin (0.1%): GENTICYN-HC TOPICAL, DERMOTYL-G, LOBATE-G
Containing Chloramphenicol (1%): CORTISONKEMICETINE
Containing Providone iodine (1%): ECZO-BETADINE
Containing Miconazole (2%): FLUCORT-MZ, TENOVATE-M
Containing Clotrimazole (1%): CLOBEN