Topical corticosteroids

Question 1

List the Super-potent TCS (according to WHO) - Class 1

Answer 1

• Betamethasone diproprionate ointment and gel 0.05%
• Clobetasole propionate ointment, cream… etc 0.05%

And others not commonly used in Aus

Question 2

List the high-potent TCS (according to WHO) - Class 2 and 3

Answer 2

**Class 2: **
* * Betamethasone diproprionate cream and lotion 0.05%

• Clobetasole propionate 0.025% cream
• Mometasone furoate ointment 0.1% (ELOCON)
• Triamcinolone acetonide ointment 0.5%

Class 3:
* Betamethasone valerate ointment 0.1% and foam 1.12%

Question 3

List the medium-potent TCS (according to WHO) - Class 4 and 5

Answer 3

Class 4:
* Betametasone valerate foam 0.12%
* Mometasone furoate cream and lotion 0.1%

Class 5:
* Betamethasone diproprionate lotion 0.05%

Question 4

What are the key adverse effects associated with topical corticosteroids?

Answer 4

Systemic (rare)
* Suppression of hypothalamic-pituitary-adrenal axis
* Iatrogenic Cushing’s syndrome
* Growth retardation in infants and children

Local
* Epidermal atrophy
- shiny, wrinkled, fragile skin with prominent hypopigmentation, prominent vasculature, stellate pseudoscars, striae or purpura
–> NB can be seen within 7 days of daily superpotent TCS under occlusion

• Peri-oroficial dermatitis
• Glaucoma
• Cataracts
• Allergic contact dermatitis
• Irritant contact dermatitis
• Tachyphylaxis
• Facial hypertrichosis
• Folliculitis
• Milliaria
• Genital ulceration
• Crusted scabies

Question 6

Risk factors for systemic absorption

Answer 6

Large surface area
Use of ultrapotent / high potency
Application under occlusion
Young age (infancy)
Location - face, neck, axillae, groin etc)