Dermatology

Question 1

Mild steroid creams
Combination creams
Other

Answer 1

Form:
- Hydrocortisone cream 0.5-1%
(0.5% cream - dermaid, sigmacort)
- hydrocortisone acetate (0.5-1%)
( 1% oint - Cortic DS, Sigmacort)

Uses:
Face, Flexural dermatitis and psoriasis, nappy dermatitis

Hydrocortisone combinations:
- with clotrimazole
- with miconazole

Hydrocortisone 1% Clotrimszole 1% cream (candacort, canestan extra, canestan extra, hydrozole)
Hydrocortisone 0.5% miconazole 2% cream (Resolve Plus 0.5)
Hydrocortisone 1% miconazole 2% cream (Resolve Plus 1.0)

Inflamed fungal skin infections - seborhhoeic dermatitis, candida nappy dermatitis - thin layer twice daily

Eyelid area
- Pimecrolimus (Elidel) - antinflamm NOT a steroid - thin layer twice daily

Question 2

Moderate Steroid Creams

Answer 2

Form:
- Betamethasone valerate 0.02%, 0.05% (0.02% cream -Antroquoril)
- Clobetasone 0.05% (Eumovate, Kloxem)
- Desonide 0.05% (Desowen)
- Triamcinolone 0.02% (oint or cream Aristocort)

Use:
Mild-moderate atopic dermatitis, adjunctive treatment in extensive psoriasis

Question 3

Potent steroids

Answer 3

Form:
- Betamethasone dipropionate 0.05%
(0.05% cream - Diprosone or Eleuphrat)
(0.05% oint - Diprosone)
- Betamethasone valerate 0.1%
(0.1%cream or oint - Betnovate)
- Mometasone 0.1%
(Cream, ointment - Elocon, Novasone)
- Methylprednisolone 0.1%
(Advatan cream, lotion or fatty ointment)

Use:
Short term use in severe inflammatory dermatoses

Question 4

Very Potent

Answer 4

Form:
- Betamethasone diproprionate 0.05% in an Optimised Vehicle
(Diprosone OV)
- Clobetasol 0.05%
(Clobex shampoo)

Use:
- severe eczema and psoriasis
- eczema of hands and feet
- refractory lichen simplex and chronicus
- scalp psoriasis

Question 5

Steroid cream practice points

Answer 5

Potency
- ointment > cream
- increased with occlusion
- propylene glycol - absorption enhancing

Site
- hydrocortisone on face and flexures (avoid more potent steroids in this area - if unresponsive methylpred can be used for 2-3 days - max 7 days)
- palms, soles, lichenigues areas - use more potent steroids

Application
- topical steroids are usually used twice daily (except clobetasol (v.potent) mometasone (potent) and methylpred (potent))