Topical Corticosteroids Flashcards
What are topical corticosteroids useful for?
They are effective treatments for skin conditions of: hyperproliferation, inflammation and immunologic involvement
They provide symptom relief for itching and burning
What are the classes of topical corticosteroids?
7 categories based on potency ranging from low to very high potency. It relates to the amount of vasoconstriction the formulation induces. Ultra high potency has the most vasoconstrictive properties
What are the mechanisms of action of topical corticosteroids?
Anti-inflammatory (decreases formation, release and activity of inflammatory mediators)
Vasoconstrictive (prevents cell migration and decreased access to affected area thereby reducing swelling)
Immunosuppression (inhibits action of cells involved in the immune response)
Antiproliferative (able to interfere with DNA synthesis and mitosis and obstruct fibroblast activity and the development of collagen
What is the goal of topical corticosteroids use?
The least potent effective topical corticosteroid should be used for the shortest duration to reduce the likelihood of adverse effects
Generally:
Low potency is used on thin skin areas such as the face and folds
Medium potency is used on medium thickness skin such as body scalp
High potency is used on thick skinned areas such as palms and soles
Response depends on the condition being treated and not just the thickness of the skin in the affected area
What are the topical corticosteroids that pharmacists can prescribe in Manitoba (and what is the class)
Hydrocortisone (schedule I or III; class VII) Hydrocortisone acetate (schedule I or III; class VII) Desonide (class VI) Clobetasone 17-butyrate (Schedule II; class IV) Triamcinolone actonide (class IV)
Same concentration of a steroid may have different potencies depending on the vehicle. How does formulation affect potency?
Optimized or augmented bases with propylene glycol enhance absorption creating “ultra-high potency”
Ointments: occlusive and provide lubrication, good for dry, scaly lesions (but they are greasy, which decreases patient compliance)
Creams: generally less potent than ointments, but still have good lubrication. They often contain preservatives and they are cosmetically appealing
Lotions and gels: good for hairy areas
What are adverse effects of topical corticosteroids?
Thin skin areas (resulting in increased permeability), have better response but are at increased risk of adverse effects
Dryness, itching, burning and local irritation may occur
Atrophic changes: steroid atrophy (thinning of the skin), telangiectasia (capillary dilation), striae (stretch marks), purpura (skin purpling), ulceration, easy bruising
Infections: may mask or aggravate microbial infection
Ocular changes: ocular hypertension, glaucoma, cataracts
Suppression of the hypothalamic-pituitary-adrenal (HPA) axis (decreases your stress response)
Pharmacologic effects: steroid rebound (can cause a flare), steroid addiction, tachyphylaxis (drug stops working and a higher concentration/potency is required)
Miscellaneous: steroid acne, perioral dermatitis, steroid rosacea, hyperpigmentation, hypopigmentation, photosensitzation
What should the frequency of application of topical corticosteroids be?
Apply once or twice daily (for most preparations)
More frequent application does not provide better results (applying 3-4 times daily is equally as effective as 1 to 2 times daily)
Less frequent application reduces the risk of side effects
Once under control, reduce frequency of application
Tapering (decreasing potency and/or decreased frequency) may be helpful to prevent rebound flares where potent or prolonged treatment is needed
How should hydrocortisone 0.5% and 1.0% cream be used?
7 to 14 day therapy
Not recommended in children under 2 years of age
How should clobetasone butyrate 0.5%
7 day therapy
Not recommended in children under 12 years of age
